A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: Effects and mediators

• Published in: Research in developmental disabilities 2014-10, Vol.35 (10), p.2384-2393
• Main Authors: Wu, Ying-Chin, Leng, Chi-Hon, Hsieh, Wu-Shiun, Hsu, Chyong-Hsin, Chen, Wei J., Gau, Susan Shur-Fen, Chiu, Nan-Chang, Yang, Ming-Chin, Li-Jung Fang, Hsu, Hui-Chin, Yu, Yen-Ting, Wu, Yen-Tzu, Chen, Li-Chiou, Jeng, Suh-Fang
• Format: Article
• Language: English
• Subjects: Ambulatory Care - methods; Behavior; Biological and medical sciences; Child Development; Cognition; Development; Early intervention; Early Intervention (Education) - methods; Effectiveness; Emotional regulation; Emotions; Female; Home Care Services; Humans; Infant; Infant Behavior - psychology; Infant Care - methods; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Institution therapy. Inpatient treatment; Male; Mediator; Medical sciences; Mother-Child Relations; Mother–infant interaction; Motor Skills; Preterm infants; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Treatment Outcome; Treatments
• ISSN: 0891-4222; 1873-3379
• DOI: 10.1016/j.ridd.2014.06.009

•Interventions enhanced the cognition, motor, and behavior in preterm infants.•Early improved dyadic interaction may mediate the effects on infants’ cognition.•Early improved emotional regulation may mediate the effects on infants’ behavior.•Findings are insightful for the design of intervention programs in preterm infants. This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5–5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8–7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08–0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=−1.4, −2.5 to −0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28–0.93) (all p