Published in Infectious Diseases in Children July 2010
Preventive care program benefits preterm infants, caregivers
A specially designed intervention program involving
input from a psychologist and physiotherapist not only improved developmental
outcomes at 2 years for preterm infants but diminished depression and anxiety
in caregivers as well, according to researchers in Melbourne, Australia.
“Very preterm infants at high risk of abnormal
development should commence intervention programs as soon as possible, to take
advantage of the increased plasticity of the developing brain,” the
researchers wrote. They also noted that addressing the mental well-being of
these infants’ parents and guardians is essential because they are at an
increased risk for emotional distress. The researchers said, however, that few
studies have been conducted in this area.
To evaluate the efficacy of an in-home preventive care
program on the physical and cognitive development of preterm infants, the
researchers performed a randomized controlled trial using an intervention plan
devised by the Victorian Infant Brain Studies (VIBeS) team.
“The intervention aimed to educate the primary
caregivers about infant self-regulation and techniques for improving postural
stability, coordination, and strength and to support the parents’ mental
health and parent-infant relationship throughout the first year,” the
researchers wrote. The program was composed of nine 1.5- to 2-hour sessions
that took place in families’ homes.
Primary outcomes for the children included cognitive
language, motor development at corrected age of 2 years, as denoted by Bayley
Scales of Infant and Toddler Development III scores. Behavioral and emotional
regulation at corrected age of 2 years was also gauged using the Infant-Toddler
Social and Emotional Assessment. For this examination, parents reported on
their children’s behavior via questionnaire.
Caregiver outcomes — such as the presence of
anxiety or depression — were measured using the Hospital Anxiety and
Depression Scale. Parents and guardians answered 14 questions designed to
assess the mental health of the respondent.
The researchers reported that 96% of the 120 children
analyzed went on to complete the Bayley Scales of Infant and Toddler
Development III and 83% underwent testing with the Infant-Toddler Social and
Emotional Assessment. Eighty-six percent of caregivers answered the questions
contained in the Hospital Anxiety and Depression Scale.
Results indicated that few differences existed between
the control and intervention groups in the areas of cognitive, language or
motor composite scores, although intervention was linked to a 0.26 SD
improvement in cognitive scores. The researchers also did not observe any
disparities between the groups when comparing motor, cognitive or language
delays.
Children in the intervention group, however, did have
better scores for externalizing and dysregulation behaviors as well as higher
competence scores. Additionally, data showed that these children were less
likely to be at risk for having externalizing, internalizing or dysregulation
behaviors when compared with those in the control group (21% vs. 50%; OR=0.26;
95% CI, 0.10-0.70).
Caregivers of children in the intervention group also benefited from the
program and generally reported lower levels of anxiety and depression and were
less likely to be at risk for either condition.
Spittle AJ. Pediatrics. 2010;126:e171-e178.
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