Randomised trial of parental support for families with very preterm children: outcome at 5 years

Abstract

Aims: To test the effectiveness of a home based developmental education intervention in improving outcome at 5 years for very preterm infants. Methods: The Avon Premature Infant Project (APIP) is a randomised controlled trial in which the parents of 284 babies born ,33 weeks gestational age received a developmental education programme, a social support intervention, or standard care. A term reference population was also recruited. This study reports outcomes at 5 years (mean age 58 months 15 days) for 187 (66%) of these children without disability. Outcomes were assessed using the British Ability Scales II for cognitive development, the Movement ABC for motor impairment, and the Child Behavior Checklist for behavioural problems. Results: Preterm infants showed poorer cognitive performance than their term peers. Mean (SD) general conceptual ability (GCA) scores were: Portage 99.2 (15.7); parent adviser 100.3 (14.8); preterm control 101.1 (15.0); term reference 107.2 (13.4). There were no significant differences between preterm groups in GCA scores indicating no effect of either intervention. Similarly, there was no significant effect of intervention on behavioural or motor outcomes. Further analyses, in which outcome data were adjusted for social factors, did not reveal any differences between the three preterm groups or by subgroups classified by a range of perinatal variables. Conclusion: The small advantage shown at 2 years of age is no longer detectable at 5 years. These results question the effectiveness of early intervention in enhancing cognitive, behavioural, and motor function at 5 years.

Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review

“…This makes it difficult to distinguish whether there is an effect on motor outcome and, if not, whether the measures are sensitive enough to detect the effects of intervention. Specific motor assessments, such as the Alberta Infant Motor Scale, the TIMP, and the Movement Assessment Battery for Children were used only by individual studies, 26,28,38 and these data could not be pooled for meta-analysis. Lekskulchai and Cole 28 demonstrated a significant effect of intervention using the TIMP with short-term (4mo corrected age) follow-up.…”

Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis

“…In particular, this is shown by the IHDP [62][63][64][65] and the Avon Premature Infant Project (APIP) studies. 52,53 APIP followed infants in the Avon area of the United Kingdom to an age of 5 years, whereas the IHDP study is the only report of follow-up of interventions in the infant period up to the age of 18 years.…”

“…Few studies described the method of randomization in detail. Only three studies 38,[50][51][52][53][62][63][64][65] reported clearly adequate concealment, while in the remainder of the studies this was unclear. Owing to the inability to blind the initial intervention, a blinded assessment of outcome was considered important to minimize bias, and in 21 36,42 -44,46 -49, 52-56,59 -77 of 25 selected studies, blinding of the outcome assessment was specifically undertaken.…”

“…One study was reported twice 55,56 and five interventions were reported at different ages or for different outcomes for the same cohort. 38,[46][47][48][49][50][51][52][53][62][63][64][65][69][70][71][72] The Infant Health and Development Program (IHDP) was a large trial included in the category of 'other Developmental Interventions.' Twelve additional articles reporting randomized analyses from the IHDP are also summarized in an Appendix.…”

Rethinking preventive post‐discharge intervention programmes for very preterm infants and their parents

“…Immediately after completion of the intervention, Griffiths Mental Developmental Scale scores were slightly but significantly higher in both intervention groups, but at age five, no differences in cognitive, motor, and behavioural outcome were found between the three groups; 70% of the initial study population was seen in follow-up. 11 Some of the investigators of the Avon Premature Infant project went on and set up the Parent Baby Interaction Program 12 in 2002, which was carried out in seven NICUs in 232 infants <32 weeks gestational age. The Parent Baby Interaction Program provided structured parental support to facilitate attachment, interaction, and to sensitize parents to their baby's cues, and also educated parents in developmental care principles.…”