Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants

Spittle, Alicia J; Orton, Jane; Anderson, Peter J.; Boyd, Roslyn N.; Doyle, Lex W.

doi:10.1002/14651858.cd005495.pub4

Cited by 550 publications

(547 citation statements)

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“…The median duration of each session was 9 minutes, close to the maximum intended duration. This dosage is similar to the intended dosage in another study of early PT by Cameron et al, 32 included in the review of Spittle et al 14 Not many studies of early PT have included reports on compliance. In the aforementioned study, infants of parents with good compliance had higher percentile ranks on the Alberta Infant Motor Scale at 4 months compared with those with moderate or poor compliance (median 75th versus 46th percentile; P = .05).…”

Section: Figurementioning

confidence: 91%

“…Involving parents as primary practitioners might help them to understand and respond more knowledgably to their infants' behavior, which can promote optimal development. 31 In the systematic review from 2015 by Spittle et al 14 that assessed early developmental intervention programs posthospital discharge, intervention studies performed both before and after discharge from the hospital were included. Types of interventions varied from teaching the parents about infant development and behavioral cues to performing stimulation programs.…”

Section: Figurementioning

confidence: 99%

“…13 A meta-analysis on effects of early interventions posthospital discharge concluded with a small significant difference in motor outcome at age 0 to 3 years favoring intervention groups. 14 Interventions initiated while the infants were in the hospital showed a slightly larger impact than those implemented after discharge, and a study with parents actively involved in the intervention found favorable change in motor performance in the treatment group compared with the control group. 15 More research is needed to elucidate the optimal age and type of intervention for improving outcomes associated with motor development.…”

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confidence: 99%

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Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Controlled Trial

et al. 2016

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OBJECTIVE: To investigate the short-term effect of parent-administered physical therapy in the preterm period on motor performance in medically stable infants. METHODS:This study was a pragmatic, multicenter, randomized controlled trial including 153 infants born at gestational age ≤32 weeks and randomized to an intervention (n = 74) or a control (n = 79) group. The intervention promoted postural control, head control, and midline orientation. Parents, supervised by a physical therapist, conducted the intervention 10 minutes twice a day for 3 weeks from 34 to 36 weeks' postmenstrual age (PMA). The control group received usual care. The Test of Infant Motor Performance Screening Items was used at baseline and the Test of Infant Motor Performance postintervention (week 37 PMA). Linear mixed models were used to assess change in motor performance between groups from 34 to 37 weeks' PMA by using z scores. Effect size was measured by using Cohen's d. RESULTS:The mean baseline z score was 0.06 (95% confidence interval, -0.48 to 0.60). After the intervention, there was a significant group difference, indicating a change in motor performance from week 34 to 37 PMA favoring the intervention group. The estimated difference in z scores was 0.42 (95% confidence interval, 0.13 to 0.72; P = .005), and the effect size was 0.40.CONCLUSIONS: Parent-administered physical therapy conducted before term-equivalent age improved motor performance at 37 weeks' PMA more than conventional care. All infants will be followed up until 2 years' corrected age to evaluate the long-term effects of this brief intervention. Mrs Ustad participated in planning the study, baseline and postintervention assessments, statistical analyses, and drafting of the manuscript; Dr Evensen was involved in supervision of statistical analyses and preparation of the manuscript; Drs Campbell and Girolami participated in planning the study, in preparation of the manuscript, and in proofreading; Dr Helbostad supervised the statistical analyses and preparation of the manuscript; Drs Kaaresen and Jørgensen participated in planning the study and in preparation of the manuscript; and Dr Øberg was responsible for design and planning the study and participated in postintervention assessments from video recordings, statistical analyses, and preparation of the manuscript. All authors approved the fi nal manuscript as submitted and agree to be accountable for all aspects of the work. WHAT'S KNOWN ON THIS SUBJECT: Studies on early intervention to improve motor function in preterm infants have failed to show large effects. Interventions involving parents seem to be more effective than when therapists conduct the intervention. WHAT THIS STUDY ADDS:Three weeks of parentadministered physical therapy implemented before term-equivalent age in very preterm infants improved short-term motor performance more than in the control group. The intervention was feasible and well tolerated by the infants.by guest on May 10, 2018 http://pediatrics.aappublications.org/ Downloaded from U...

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Section: Figurementioning

confidence: 91%

Section: Figurementioning

confidence: 99%

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confidence: 99%

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Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Controlled Trial

et al. 2016

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“…52 We do not have the necessary information on whether study participants were offered or received early intervention to evaluate its effect. A Cochrane review of 25 randomized controlled trials of early intervention programs reported that the cognitive benefit observed in infancy and at preschool age did not persist into school age.…”

Section: Figurementioning

confidence: 99%

“…A Cochrane review of 25 randomized controlled trials of early intervention programs reported that the cognitive benefit observed in infancy and at preschool age did not persist into school age. 53 However, most of these programs terminate within the first year after birth, and little work has been done on cognitive rehabilitation or training programs that are sustained beyond toddlerhood. Neurodevelopmental assessment at 2 or 3 years of age is often used as the endpoint for postdischarge follow-up of very preterm or VLBW infants.…”

Section: Figurementioning

confidence: 99%

Developmental Assessments in Preterm Children: A Meta-analysis

Wong

Santhakumaran²,

Cowan

et al. 2016

Pediatrics

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CONTEXT: Developmental outcomes of very preterm (gestational age ≤32 weeks) or very low birth weight (<1500 g) children are commonly reported before age 3 years although the predictive validity for later outcomes are uncertain. OBJECTIVE:To determine the validity of early developmental assessments in predicting schoolage cognitive deficits.DATA SOURCES: PubMed. STUDY SELECTION:English-language studies reporting at least 2 serial developmental/cognitive assessments on the same population, 1 between ages 1 and 3 years and 1 at ≥5 years. DATA EXTRACTION:For each study, we calculated the sensitivity, specificity, and positive and negative predictive values of early assessment for cognitive deficit (defined as test scores 1 SD below the population mean). Pooled meta-analytic sensitivity and specificity were estimated by using a hierarchical summary receiver operator characteristic curve. RESULTS:We included 24 studies (n = 3133 children). Early assessments were conducted at 18 to 40 months and generally involved the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; 11 different cognitive tests were used at school-age assessments at 5 to 18 years. Positive predictive values ranged from 20.0% to 88.9%, and negative predictive vales ranged from 47.8% to 95.5%. The pooled sensitivity (95% confidence interval) of early assessment for identifying school-age cognitive deficit was 55.0% (45.7%-63.9%) and specificity was 84.1% (77.5%-89.1%). Gestational age, birth weight, age at assessment, and time between assessments did not explain between-study heterogeneity. LIMITATIONS:The accuracy of aggregated data could not be verified. Many assessment tools have been superseded by newer editions. CONCLUSIONS:Early developmental assessment has poor sensitivity but good specificity and negative predictive value for school-age cognitive deficit.

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Association Between Intensive Handwashing Promotion and Child Development in Karachi, Pakistan

Bowen¹,

Agboatwalla²,

Luby³

et al. 2012

Arch Pediatr Adolesc Med

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To evaluate associations between handwashing promotion and child growth and development. Design: Cluster randomized controlled trial. Setting: Informal settlements in Karachi, Pakistan. Participants: A total of 461 children who were enrolled in a trial of household-level handwashing promotion in 2003 and were younger than 8 years at reassessment in 2009. Interventions: In 2003, neighborhoods were randomized to control (n = 9), handwashing promotion (n=9), or handwashing promotion and drinking water treatment (n=10); intervention households received free soap and weekly handwashing promotion for 9 months. Main Outcome Measures: Anthropometrics and developmental quotients measured with the Battelle Developmental Inventory II at 5 to 7 years of age. Results: Overall, 24.9% (95% CI, 20.0%-30.6%) and 22.1% (95% CI, 18.0%-26.8%) of children had z scores that were more than 2 SDs below the expected z scores for height and body mass index for age, respectively; anthropometrics did not differ significantly across study groups. Global developmental quotients averaged 104.4 (95% CI, 101.9-107.0) among intervention children and 98.3 (95% CI, 93.1-103.4) among control children (P = .04). Differences of similar magnitude were measured across adaptive, personal-social, communication, cognitive, and motor domains. Conclusions: Although growth was similar across groups, children randomized to the handwashing promotion during their first 30 months of age attained global developmental quotients 0.4 SDs greater than those of control children at 5 to 7 years of age. These gains are comparable to those of at-risk children enrolled in publicly funded preschools in the United States and suggest that handwashing promotion could improve child wellbeing and societal productivity.

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Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants

Cited by 550 publications

References 120 publications

Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Controlled Trial

Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Controlled Trial

Developmental Assessments in Preterm Children: A Meta-analysis

Association Between Intensive Handwashing Promotion and Child Development in Karachi, Pakistan

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