Effects of universally offered parenting interventions for parents with infants: a systematic review Massage therapy improves neurodevelopment outcome at two years corrected age for very low birth weight infants. Randomized outcome trial of nutrient-enriched formula and neurodevelopment outcome in preterm infants Positive Effect of Human Milk Feeding during NICU Hospitalization on 24 Month Neurodevelopment of Very Low Birth Weight Infants: An Italian Cohort Study Early home intervention with low-birth-weight infants and their parents. Pediatric Physical Therapy in Infancy: From Nightmare to Dream? A Two-Arm Randomized Trial Are support and parenting programmes of value for teenage parents? Who should provide them and what are the main goals? Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age Optimizing Medication Adherence in Older Patients: A Systematic Review. The effectiveness of music on pain among preterm infants in the neonatal intensive care unit: a systematic review Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers. Randomized trial of a parenting intervention for very preterm infants: outcome at 2 years. The effects of an early developmental mother-child intervention program on neurodevelopment outcome in very low birth weight infants: a pilot study. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18months in preterm infants Neurodevelopmental outcomes of preterm infants fed high-dose docosahexaenoic acid: a randomized controlled trial. Prediction of Respiratory Outcome in Extremely Low Gestational Age Infants Efficacy of baby-CIMT: study protocol for a randomised controlled trial on infants below age 12 months, with clinical signs of unilateral CP EFFECT OF BREASTMILK CONSUMPTION ON NEURODEVELOPMENTAL OUTCOMES AT 6 AND 12 MONTHS OF AGE IN VLBW INFANTS Impact of oral probiotics on neurodevelopmental outcomes in preterm infants Early Second Trimester Maternal Plasma Choline and Betaine Are Related to Measures of Early Cognitive Development in Term Infants Overestimating Neurodevelopment Using the Bayley-III After Early Complex Cardiac Surgery
Objectives From a developmental perspective , infancy is a critical stage of life . Early childhood interventions aim to support caretakers , but the effects of universal interventions for parents with infants are unknown . The objective is to determine the effects of universal parenting interventions offered to parents with infants 0–12 months on measures of child development and parent – child relationship . Design A systematic review using the Preferred Reporting Items for Systematic Review s and Meta- Analysis . We extracted publications from 10 data bases in June 2013 , January 2015 and June 2016 and supplemented with grey and h and search . Risk of bias was assessed , and effect sizes were calculated . Participants Inclusion criteria are : ( 1 ) r and omised controlled trials of structured , psychosocial interventions offered to a universal population of parents with infants 0–12 months old in western OECD countries , ( 2 ) interventions that include a minimum of 3 sessions with at least half of the sessions delivered postnatally and ( 3 ) programme outcomes reported for child development or parent – child relationship . Results 14 papers representing 7 studies are included . There were no statistically significant effects of the intervention for the majority of the primary outcomes across the studies . Conclusions The findings of this review are mixed . No clear conclusions can be drawn regarding the effects of universally offered parenting interventions on child development and parent – child relationship for this age group BACKGROUND Long term effects of massage therapy in very preterm newborns infants are still to be described . Few studies evaluated neurodevelopment just at six months , and included late preterm infants . OBJECTIVE To study the effect of massage therapy on neurodevelopment of very low birth weight infants at two years corrected age . STUDY DESIGN Newborns with birth weight between > or= 750 and < or= 1500 g and gestational age < or= 32 weeks were r and omly assigned to massage therapy by mothers plus skin-to-skin care ( Intervention Group ) or just skin-to-skin care ( Control Group ) during their hospital stay . Growth and neurodevelopment outcome were evaluated at 2 years corrected age . RESULTS We followed 73 newborns ( 35 in Intervention Group , and 38 in Control Group ) . Both groups were similar in neonatal data .  Growth at 2 years corrected age was similar in both groups . Intervention Group had borderline higher Psychomotor Development Index and significantly higher Mental Development Index scores than Control Group . CONCLUSIONS We suggest that massage therapy by mothers combined to skin-to-skin care during neonatal hospital stay improves neurodevelopment outcome at 2 years corrected age Background Preterm infants are at risk for adverse neurodevelopment . Furthermore , nutrition may play a key role in supporting neurodevelopment . The aim of this study was to evaluate whether a nutrient-enriched formula fed to preterm infants after hospital discharge could improve their neurodevelopment at 24 months ( term-corrected age ) . Methods We conducted an observer-blinded , single-center , r and omized controlled trial in infants admitted to the Fondazione IRCCS Cà Gr and a Ospedale Maggiore Policlinico , University of Milan , Italy between 2009 and 2011 . Inclusion criteria were gestational age < 32 weeks and /or birth weight < 1500 g , and being fed human milk for < 20 % of the total milk intake . Exclusion criteria were congenital malformations or conditions that could interfere with growth or body composition . Included infants were r and omized to  receive a st and ard full-term formula or a nutrient-enriched formula  up until 6 months of corrected age , using two computer-generated r and omization lists ; one appropriate for gestational age ( AGA ) and one for small for gestational age ( SGA ) infants . We assessed neurodevelopment at 24 months of corrected age using the Griffiths Mental Development Scale and related subscales ( locomotor , personal-social , hearing and speech , h and and eye coordination , and performance ) . Results Of the 207 r and omized infants , 181 completed the study . 52 AGA and 35 SGA infants were fed a nutrient-enriched formula , whereas 56 AGA and 38 SGA infants were fed a st and ard full-term formula . The general quotient at 24 months of corrected age was not significantly different between infants r and omized to receive a nutrient-enriched formula compared with a st and ard term formula up until 6 months of corrected age ( AGA infants : 93.8 ± 12.6 vs. 92.4 ± 10.4 , respectively ; SGA infants : 96.1 ± 9.9 vs. 98.2 ± 9 , respectively ) . The scores of related subscales were also similar among groups . Conclusions This study found that feeding preterm infants a nutrient-enriched formula after discharge does not affect neurodevelopment at 24 months of corrected age , in either AGA or SGA infants , free from major comorbidities . Trial registration Current Controlled Trials ( http://www.controlled-trials.com/IS RCT N30189842 ) London , UK The aim of this study was to determine the effect of human milk feeding during NICU hospitalization on neurodevelopment at 24 months of corrected age in very low birth weight infants . A cohort of 316 very low birth weight newborns ( weight ≤ 1500 g ) was prospect ively enrolled in a follow-up program on admission to the Neonatal Intensive Care Unit of S. Orsola Hospital , Bologna , Italy , from January 2005 to June 2011 . Neurodevelopment was evaluated at 24 months corrected age using the Griffiths Mental Development Scale . The effect of human milk nutrition on neurodevelopment was first investigated using a multiple linear regression model , to adjust for the effects of gestational age , small for gestational age , complications at birth and during hospitalization , growth restriction at discharge and socio-economic status . Path analysis was then used to refine the multiple regression model , taking into account the relationships among predictors and their temporal sequence . Human milk feeding during NICU hospitalization and higher socio-economic status were associated with better neurodevelopment at 24 months in both models . In the path analysis model intraventricular hemorrhage — periventricular leukomalacia and growth restriction at discharge proved to be directly and independently associated with poorer neurodevelopment . Gestational age and growth restriction at birth had indirect significant effects on neurodevelopment , which were mediated by complications that occurred at birth and during hospitalization , growth restriction at discharge and type of feeding . In conclusion , our findings suggest that mother ’s human milk feeding during hospitalization can be encouraged because it may improve neurodevelopment at 24 months corrected age We investigated the effects of a year-long home intervention with a sample of preterm infants r and omly assigned to 1 of 3 groups : a developmental intervention , a parent-infant intervention , and a no-treatment control group . A full-term no-treatment control was also used . Both intervention approaches focused on the parent-child unit , providing training for parents to improve observational skills , emotional support , and information about community re sources . However , whereas specific tasks to facilitate the child 's development were provided in the developmental intervention group , the quality of the parent-infant interaction was the target for treatment in the other group . All infants were assessed at 4 , 8 , 12 , and 16 months of age corrected for prematurity . The results suggest that although both intervention approaches were effective in modifying some aspects of the home environment and , to a lesser degree , in improving infants ' cognitive development , the parent-infant interaction approach seemed to have the greater impact . These findings confirm previous observations regarding the cognitive development of preterm and full-term infants during the first 18 months of life and demonstrate changes in behavior and behavior styles in both pre- and full-term infants as they become older Background Systematic review s have suggested that early intervention by means of specific motor training programs and general developmental programs in which parents learn how to promote infant development may be the most promising ways to promote infant motor and cognitive development of infants with or at high risk for developmental motor disorders . Objective The purpose of this study was to investigate the effects of a recently developed pediatric physical therapy intervention program ( “ Coping With and Caring for Infants With Special Needs ” [ COPCA ] ) on the development of infants at high risk for developmental disorders using a combined approach of a 2-arm r and omized trial and process evaluation . Setting The study was conducted at the University Medical Center Groningen in the Netherl and s. Participants and Intervention Forty-six infants at high risk for developmental disorders were r and omly assigned to receive  COPCA ( a family-centered program ) ( n=21 ) or traditional infant physical therapy ( TIP ) ( n=25 ) between 3 to 6 months corrected age ( CA ) . Developmental outcome was assessed by blinded assessors at 3 , 6 , and 18 months CA with a neurological examination , the Alberta Infant Motor Scales , the Pediatric Evaluation of Disability Inventory , and the Mental Developmental Index ( MDI ) of the Bayley Scales of Infant Development . Contents of the intervention were analyzed by a quantitative video analysis of therapy sessions . Quantified physical therapy actions were correlated to evaluate associations between intervention and developmental outcome components . Results The trial revealed that developmental outcome in both groups was largely identical . Process evaluation showed that typical COPCA actions—(1 ) family involvement and educational actions , ( 2 ) application of a wide variation in challenging the infant to produce motor behavior by himself or herself and allowing the infant to continue this activity , and ( 3 ) stimulation of motor behavior at the limit of the infant 's capabilities — had positive correlations with developmental outcome at 18 months CA . The use of h and ling techniques was negatively associated with the Pediatric Evaluation of Disability Inventory outcome at 18 months CA . Limitations Major limitations were the limited size of the groups studied and the differences between the groups in frequency and duration of physical therapy sessions . Conclusion Extending the r and omized trial with process evaluation was needed to obtain insight into associations between the components of intervention and developmental outcome . Specific therapist behaviors of parent coaching are associated with improved developmental outcome measures . Further studies are needed to examine whether these associations are caused by therapist behavior or whether therapist behavior is modified by children 's motor skills OBJECTIVE To review the evidence on what works in  teenage parent support programmes ; to determine the key elements of successful  teenage parent support and parenting programmes ; and to determine the gaps in the evidence . METHODS Data bases were search ed , using a specific search strategy , for systematic review s and r and omised controlled trials , to ascertain whether social support , parenting programmes , or both , are effective in improving maternal or infant outcomes . The findings were summarized . RESULTS Only one systematic review specifically addressed interventions among teenage parents and their children , although several r and omised trials have since been published . CONCLUSIONS Key questions remain for future support and parenting programmes . Social support and parenting interventions improve maternal-child interactions and child cognitive development , but do not reduce low-birth weight , stillbirth or neonatal death .  Social support and parenting programmes need to be combined with measures to increase the minimum income , reduce smoking in pregnancy and increase breast-feeding rates . Robust evaluations of packages of care in the UK are needed to inform national and local teenage pregnancy strategies IMPORTANCE Prevention of iron deficiency in infancy may promote neurodevelopment . Delayed cord clamping ( DCC ) can prevent iron deficiency during the first 6 months of life . However , no data are available on long-term effects on infant outcomes in relation to time for umbilical cord clamping . OBJECTIVE To investigate effects of DCC , as compared with early cord clamping ( ECC ) , on infant iron status and neurodevelopment at age 12 months in a European setting . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial of 382 full-term infants born after a low-risk pregnancy at a Swedish county hospital . Follow-up at 12 months included evaluation of iron status ( ferritin level , transferrin saturation , transferrin receptor level , reticulocyte hemoglobin level , and mean cell volume ) and parental assessment of neurodevelopment by the Ages and Stages Question naire , second edition ( ASQ ) . INTERVENTIONS Infants were r and omized to DCC ( ≥180 seconds after delivery ) or ECC ( ≤10 seconds after delivery ) . MAIN OUTCOMES AND MEASURES The main outcome was iron status at age 12 months ; the secondary outcome was ASQ score . RESULTS In total , 347 of 382 infants ( 90.8 % ) were assessed . The DCC and ECC groups did not differ in iron status ( mean ferritin level , 35.4 vs 33.6 ng/mL , respectively ; P = .40 ) or neurodevelopment ( mean ASQ total score , 229.6 vs 233.1 , respectively ; P = .42 ) at age 12 months . Predictors of ferritin levels were infant sex and ferritin in umbilical cord blood . Predictors of ASQ score were infant sex and breastfeeding within 1 hour after birth . For both outcomes , being a boy was associated with lower results . Interaction analysis showed that DCC was associated with an ASQ score 5 points higher among boys ( mean [ SD ] score , 229 [ 43 ] for DCC vs 224 [ 39 ] for ECC ) but 12 points lower among girls ( mean [ SD ] score , 230 [ 39 ] for DCC vs 242 [ 36 ] for ECC ) , out of a maximum of 300 points ( P = .04 for the interaction term ) . CONCLUSIONS AND RELEVANCE Delayed cord clamping did not affect iron status or neurodevelopment at age 12 months in a selected population of healthy term-born infants . However , it may not be possible to demonstrate minor effects on neurodevelopment with the size of the study population and the chosen method for assessment . The current data indicate that sex may influence the effects on infant development after DCC in different directions . The magnitude and biological reason for this finding remain to be investigated . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01245296 Background Sensory experience is the basis for learning in infancy . In older children , abnormal sensory reactivity is associated with behavioural and developmental disorders . We hypothesised that in preterm infants , abnormal sensory reactivity during infancy would be associated with perinatal characteristics and correlate with 2-year neurodevelopmental outcomes . Methods We conducted a prospect i ve observational study of infants with birth weight ≤1500 g using the Test of Sensory Function in Infants ( TSFI ) in the first year . Infants with gestational age ≤30 weeks were tested with the  Bayley Scales of Infant and Toddler Development III ( BSID III ) at 24 months . Results Of the 72 participants evaluated at 4–12 months corrected age ( median 8 months ) , 59 ( 82 % ) had a least one TSFI score concerning for abnormal sensory reactivity . Lower gestational age was associated with abnormal reactivity to deep pressure and vestibular stimulation ( p<0.001 ) . Poor ocular-motor control predicted worse cognitive and motor scores in early childhood ( OR 16.7 ; p=0.004 ) , but was tightly correlated to the presence of severe white matter injury . Poor adaptive motor function in response to tactile stimuli predicted worse BSID III motor ( p=0.01 ) and language scores ( p=0.04 ) at 2 years , even after adjusting for confounders . Conclusions Abnormal sensory reactivity is common in preterm infants ; is associated with immaturity at birth , severe white matter injury and lower primary caregiver education ; and predicts neurodevelopmental delays . Early identification of abnormal sensory reactivity of very preterm infants may promote parental support and education and may facilitate improved neurodevelopment OBJECTIVE : To review the literature on strategies to optimize medication adherence in community-dwelling older adults and to make recommendations for clinical practice . METHODS : A systematic literature search was conducted using the MEDLINE , CINAHL , PsycINFO , International Pharmaceutical Abstract s , and EMBASE data bases for r and omized controlled trials examining strategies to optimize medication adherence in patients aged 65 or older prescribed long-term medication regimens . Additional studies were found by examining the reference lists of systematic review s and selected papers . 34 papers reporting on 33 studies met the eligibility criteria and were included in this review . RESULTS : Improvement in adherence was mixed across the studies examining educational interventions , with only 12 of the 28 studies showing improvement in adherence ; most were delivered by pharmacists . Effect sizes for the statistically significant educational interventions ranged from Cohen 's d = 0.14 to 4.93 . Four of the 5 interventions using memory aids and cues , some in conjunction with newer technologies , improved adherence . Effect sizes for the statistically significant interventions using memory aids and cues ranged from Cohen 's d = 0.26 to 2.72 . CONCLUSION : The evidence from this review does not clearly support one single intervention to optimize medication adherence in older patients . Future studies should explore suggestive strategies , such as tailored interventions involving ongoing contact , and should endeavor to correct method ologic weaknesses found in the literature Review question / objective The objective of this review is to synthesize the best available evidence related to the effectiveness of music as pain relieving method among preterm infants during painful procedures in the neonatal intensive care unit . Review questions are : Among preterm infants in the neonatal intensive care unit , is music effective in reducing pain scores ? physiological pain indicators ? behavioural pain indicators ? hormonal pain indicators ? Background Patients and context Preterm infants ( i.e. babies born at or before 37 gestational weeks ) compose a patient group of the most vulnerable to pain . Infants treated in a neonatal intensive care unit ( NICU ) are exposed to a variety of painful procedures ( e.g. heel prick , iv cannula insertion , endotracheal suctioning ) and to environmental stress ( e.g. noise , light ) . Simons et al.1 , for example , described an average 14 + /‐ 4 painful procedures during the first 2 weeks of life within a period of 24 hours among 151 neonates . Many studies have shown that repeated and sustained pain can have direct and long‐term consequences on the neurological and behavior‐oriented development of the neonates during the rapid development phase of the central nervous system . Pain can cause detectable physiological , behavioral and hormonal changes2,3,4 and contribute to the altered development of the pain system during later childhood and adolescence3,4,50 . Instead , live music such as singing is excellent type of music when it is steady , constant , quiet , soothing and directed to the infants6 . Graven7 emphasizes that recorded sound should not replace human voice exposure in the NICU ; therefore , health care providers should provide ample opportunity for the infant to hear parent 's voices live , such as singing or humming , in interactions between the parent and the infant at the bedside . The AmericanAcademy of Pediatrics Committee on Environmental Health has recommended safe levels of sound8 , and these recommendations have been up date d by an expert team of practitioners . Recommendations specify that continuous sound should not exceed an hourly equivalent sound level of 50 A‐weighted decibels (dBA)7,8,9 , and music as an auditory stimulus not exceed 75 dB in NICU6,8,10 . If earphones or other devices are used , sound sources should be kept at reasonable distances from the infant 's ear , played for brief periods and at levels below 55 dB7 . Music listening can be initiated with or without the involvement of a music therapist . In this review , music can be implemented for premature infants by a music therapist or any health care providers and it will include both recorded and live music . Outcomes Regardless of the type of music , several studies have investigated the short term effects of music on preterm infants , including the improvement in physiological outcomes ( e.g. oxygen saturation , heart rate , respiratory rate , and blood pressure ) , as well as in behavioural state ( e.g. crying , facial expression , body movements ) and pain scores6,11,12,13 . For example , Chou et al. 6 showed that premature infants receiving recorded music , that was the combination of womb sounds and the mother singing , with endotracheal suctioning had significantly higher oxygen saturation than when they did not receive music . Butt & Kisilewsky12 compared recorded music involving both the vocal and instrumental version of Brahms lullaby versus no music , and found that infants older than 31 weeks demonstrated significant reduction in heart rate , behavioral state and pain . In the study of Arnon et al.11 the infants receiving live music , compared with infants receiving recorded music or no music , had significantly reduced heart rate and behavioral scores during the post‐intervention period . Live music comprised of a lullaby sang by the female voice with frame drum and an accompanying harp . The same music was played by a tape recorder . Live music showed significant benefits , whereas no statistically significant changes were found for the recorded music and control groups . Teckenberg‐Jansson et al.13 indicated that music therapy combined with kangaroo care  decreased the pulse , slowed down the respiration and increased the transcutaneous oxygen saturation in preterm infants . The musical instruments used were a lyre and a female human voice , which hummed or sang . There is evidence that music has also positive consequences on long‐term outcomes , including length of hospitalization , weight gain , and non‐nutritive sucking10,13,14,15 . For example , in the study of Caine16 the preterm infants received music stimulation which consisted of recorded vocal music ( including lullabies and children 's music ) and routine auditory stimulation . Exposure to the music stimulation had many positive effects on preterm infants , such as it increased daily average weight , formula and caloric intake , and significantly reduced total hospital stays and stress behaviors for the experimental group . In addition , according to Lubetzky et al.10 exposure to music by Mozart significantly lowered energy expenditure among healthy preterm infants . Hartling et al.17 have published a systematic review on the efficacy of music for medical indicators in term and preterm neonates . Nine r and omized trials ( 1989‐2006 ) were included . According to the results of this review music may have positive effects on physiological parameters and behavioral states , and may reduce pain and improve oral feeding rates among the premature infants . The effects of music were evaluated during medical procedures ( circumcision , heel prick ) and for other indicators . In addition , Cignacco et al.18 conducted a systematic literature review on the efficacy of non‐pharmacological interventions in the management of procedural pain in preterm and term neonates during the period from 1984 to 2004 . According to this review there was no clear evidence that the method of music could have a pain‐alleviating effect on neonates . In the Cochrane Library , one systematic review is also available up to year of 2011 concerning  non‐pharmacological  management of infants and young children ( preterm , neonate , older up to three years ) during procedural pain19 , but this review did not consider music as an intervention . To date , there is also one meta‐ analysis published by St and ley20 concerning the efficacy of music therapy  for premature infants during the period from 1950 to 1999 . It concluded that music was beneficial for many outcomes among the preterm infants in the NICU . However , the results of this review were limited by the poor method ological quality of the included studies , and unclear reporting on the phases of review . In our systematic review , studies published in 2000 and after will be considered for inclusion in the review . The number of the RCT 's concerning the effectiveness of music  among the preterm infants in NICU is especially increased during the last few years , and these studies have not included in the previous systematic review s and meta‐ analysis Background Exclusive breastfeeding for 6 months is assumed to ensure adequate micronutrients for term infants . Our objective was to investigate the effects of prolonged breastfeeding on B vitamin status and neurodevelopment in 80 infants with subnormal birth weights ( 2000 - 3000 g ) and examine if cobalamin supplementation may benefit motor function in infants who developed biochemical signs of impaired cobalamin function ( total homocysteine ( tHcy ) > 6.5 μmol/L ) at 6 months . Methods Levels of cobalamin , folate , riboflavin and pyridoxal 5´-phosphate , and the metabolic markers tHcy and methylmalonic acid ( MMA ) , were determined at 6 weeks , 4 and 6 months ( n = 80/68/66 ) . Neurodevelopment was assessed with the Alberta Infants Motor Scale ( AIMS ) and the parental question naire Ages and Stages ( ASQ ) at 6 months . At 6 months , 32 of 36 infants with tHcy > 6.5 μmol/L were enrolled in a double blind r and omized controlled trial to receive 400 μg hydroxycobalamin intramuscularly ( n = 16 ) or sham injection ( n = 16 ) . Biochemical status and neurodevelopment were evaluated after one month . Results Except for folate , infants who were exclusively breastfed for > 1 month had lower B vitamin levels at all assessment s and higher tHcy and MMA levels at 4 and 6 months . At 6 months , these infants had lower AIMS scores ( p = 0.03 ) and ASQ gross motor scores ( p = 0.01).Compared to the placebo group , cobalamin treatment result ed in a decrease in plasma tHcy ( p < 0.001 ) and MMA ( p = 0.001 ) levels and a larger increase in AIMS ( p = 0.02 ) and ASQ gross motor scores ( p = 0.03 ) . Conclusions The findings suggest that prolonged exclusive breastfeeding may not provide sufficient B vitamins for small infants , and that this may have a negative effect on early gross motor development . In infants with mild cobalamin deficiency at 6 months , cobalamin treatment significantly improvement cobalamin status and motor function , suggesting that the observed impairment in motor function associated with long-term exclusive breastfeeding , may be due to cobalamin deficiency . Clinical trial registration Clinical Trials.gov , number The purpose of this pilot study was to evaluate the effectiveness of a parent-focused intervention program ( COPE ) on infant cognitive development and maternal coping . A r and omized clinical trial was conducted with 42 mothers of low-birth-weight ( LBW ) premature infants hospitalized in a neonatal intensive care unit ( NICU ) , with follow-up at 3 months ' and 6 months ' corrected ages . COPE mothers received the four-phase educational-behavioral program that began 2 - 4 days postbirth and continued through 1 week following discharge from the NICU . Comparison mothers received audiotaped information during the same four time frames . Results indicated that COPE infants had significantly higher mental development scores at a 3 months ' corrected age ( M = 100.3 ) than did the comparison infants ( M = 93.9 ) , and this difference widened at 6 months ' corrected age , with COPE infants scoring 14 points higher . COPE mothers were significantly less stressed by the NICU sights and sounds and had significantly stronger beliefs about what behaviors and characteristics to expect from their premature infants . Findings from this study support the need for further testing of early NICU interventions with parents to determine their effectiveness on parental coping and infant developmental outcomes OBJECTIVES To determine the efficacy of a neonatal parenting intervention for improving development in very preterm infants . STUDY DESIGN A cluster-r and omized , controlled trial with a cross-over design and washout period was conducted in 6 neonatal centers . Two hundred thirty-three babies < 32 weeks ' gestation were recruited ( intervention = 112 ; control = 121 ) . Intervention families received weekly Parent Baby Interaction Programme ( PBIP ) sessions during neonatal intensive care unit admission and up to 6 weeks after discharge . Control families received st and ard care . All 195 infants remaining in the study at 24 months ' corrected age were assessed by psychologists blinded to group allocation . RESULTS There was no significant difference in Mental Development Index ( -0.9 points ; 95 % CI , -5.0 , 3.2 ) or Psychomotor Development Index ( 2.5 ; -3.3 , 8.4 ) scores between the intervention and control groups and no significant effect of intervention on Mental Development Index or Psychomotor Development Index scores for subgroups dichotomized by gestational age ( < 28 weeks/ > or = 28 weeks ) , parity ( 1st/other child ) or mother 's cohabiting status ( supported/unsupported ) . CONCLUSIONS There was no effect of PBIP on infant development at 2 years ' corrected age . Parenting interventions may be better delivered after discharge or targeted for preterm infants with high biological and social risk BACKGROUND Several studies report increased minor neurodevelopment dysfunctions in children born very low birth weight ( VLBW ) . Usefulness of preventive early intervention programs to improve neurodevelopment outcome of VLBW infants is still under investigation . AIMS To evaluate the effects of an early post-discharge developmental mother-child intervention program on neurodevelopment outcome at 36 months in VLBW infants . STUDY DESIGN Prospect i ve study . SUBJECTS 36 VLBW infants ( [ mean ( S.D. ) ] birthweight=864 g ( 204 g ) ; gestational age=27.9 weeks ( 2.4 weeks ) ) , consecutively born January-August 2001 , r and omized in intervention and control groups . OUTCOME MEASURES Neurodevelopment assessment at 36 months of chronological age with use of the Griffiths Mental Development Scale and related subscales . RESULTS At 36 months of chronological age , as compared to controls , children in intervention group exhibited higher scores in personal-social subscales ( [ mean (S.D.)]=101.4 ( 9.3 ) vs. 92.9 ( 12.1 ) , P=0.02 ) , eye-h and coordination ( 92.7 ( 4.5 ) vs. 87.1 ( 9.9 ) , P=0.041 ) , practical reasoning ( 98.6 ( 8.2 ) vs. 89.4 ( 10.1 ) , P=0.01 ) . Development Scale were 97.6 ( 5.5 ) and 92.4 ( 9.9 ) , respectively , in intervention and control groups ( P=0.074 ) . CONCLUSIONS Early post-discharge developmental mother-child intervention program may have a positive effect on later neurodevelopment outcome of VLBW children ABSTRACT Procedural pain in the neonatal intensive care unit triggers a cascade of physiological , behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm , who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development . The aim of this study was to examine relationships between cumulative procedural pain ( number of skin‐breaking procedures from birth to term , adjusted for early illness severity and overall intravenous morphine exposure ) , and later cognitive , motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age ( CCA ) , and further , to evaluate the extent to which parenting factors modulate these relationships over time . Participants were N = 211 infants ( n = 137 born preterm ⩽32 weeks gestational age [ GA ] and n = 74 full‐term controls ) followed prospect ively since birth . Infants with significant neonatal brain injury ( periventricular leucomalacia , grade 3 or 4 intraventricular hemorrhage ) and /or major sensori‐neural impairments , were excluded .  Poorer cognition and motor function were associated with higher number of skin‐breaking procedures , independent of early illness severity , overall intravenous morphine , and exposure to postnatal steroids . The number of skin‐breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation . In general , greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months , but not at 18 months CCA , however , specific protocol s for morphine administration were not evaluated . Lower parenting stress modulated effects of neonatal pain , only on cognitive outcome at 18 months CONTEXT Uncertainty exists about the benefit of dietary docosahexaenoic acid ( DHA ) on the  neurodevelopment of preterm infants . OBJECTIVE To determine the effect of meeting the estimated DHA requirement of preterm infants on neurodevelopment at 18 months ' corrected age . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind controlled trial enrolling infants born at less than 33 weeks ' gestation from April 2001 to October 2005 at 5 Australian tertiary hospitals , with follow-up to 18 months . INTERVENTION High-DHA ( approximately 1 % total fatty acids ) enteral feeds compared with st and ard DHA ( approximately 0.3 % total fatty acids ) from day 2 to 4 of life until term corrected age . MAIN OUTCOME MEASURES Bayley Mental Development Index ( MDI ) at 18 months ' corrected age . A priori subgroup analyses were conducted based on r and omization strata ( sex and birth weight < 1250 g vs > or = 1250 g ) . RESULTS Of the 657 infants enrolled , 93.5 % completed the 18-month follow-up . Bayley MDI scores did not differ between the high- and st and ard-DHA groups ( mean difference , 1.9 ; 95 % confidence interval [ CI ] , -1.0 to 4.7 ) . The MDI among girls fed the high-DHA diet was higher than girls fed st and ard DHA in unadjusted and adjusted analyses ( unadjusted mean difference , 4.7 ; 95 % CI , 0.5 - 8.8 ; adjusted mean difference , 4.5 ; 95 % CI , 0.5 - 8.5 ) . The MDI among boys did not differ between groups . For infants born weighing less than 1250 g , the MDI in the high-DHA group was higher than with st and ard DHA in the unadjusted comparison ( mean difference , 4.7 ; 95 % CI , 0.2 - 9.2 ) but did not reach statistical significance following adjustment for gestational age , sex , maternal education , and birth order ( mean difference , 3.8 ; 95 % CI , -0.5 to 8.0 ) . The MDI among infants born weighing at least 1250 g did not differ between groups . CONCLUSION A DHA dose of approximately 1 % total fatty acids in early life did not increase MDI scores of preterm infants overall born earlier than 33 weeks but did improve the MDI scores of girls . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12606000327583 Background : Bronchopulmonary dysplasia ( BPD ) is a commonly used outcome for r and omized neonatal trials . Objectives : The aim of the present study was to determine whether a diagnosis of BPD or respiratory morbidity ( RM1 or RM2 ) at 12 months corrected age better predicted subsequent RM in extremely low gestational age infants ( 23 - 28 weeks of gestation ) . Methods : Initial analysis was undertaken in a development cohort of 76 infants who underwent pulmonary function tests ( PFTs ) at 12 months corrected age . Parents completed infant respiratory diaries 2 weeks before the PFTs . Analysis was then undertaken in a validation cohort of 227 infants whose parents completed a 4-week respiratory diary when their infant was 12 months corrected age . BPD at 28 days ( BPD28d ) and 36 weeks post-menstrual age ( BPD36w ) , RM1 ( ≥3 days and /or nights of cough , wheeze , and /or medicine use ) and RM2 ( ≥4 days and /or nights of cough , wheeze , and /or respiratory medicine use ) each week for 2 weeks at 12 months corrected age were assessed with regard to prediction of respiratory outcomes at 24 months documented by respiratory health question naires . Results : BPD28d and BPD36w were not significantly associated with any respiratory outcome . Areas under the receiver operating characteristic curves were significantly better for either definition of RM than BPD28d or BPD36w for all outcomes . Conclusions : RM documented by parental completed diaries at 12 months corrected age better predicted respiratory outcome at 24 months corrected age than BPD regardless of diagnostic criteria Background Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy ( CP ) . Given the great plasticity of the young brain , possible interventions for infants at risk of unilateral CP deserve exploration . Constraint-induced movement therapy ( CIMT ) is known to be effective for older children with unilateral CP but is not systematic ally used for infants . The development of CIMT for infants ( baby-CIMT ) is described here , as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage . The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved h and faster than will infants receiving baby-massage in the first year of life . Method and design The study will be a r and omised , controlled , prospect i ve parallel-group trial . Invited infants will be to be r and omised to either the baby-CIMT or the baby-massage group if they : 1 ) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2 ) have been referred to Astrid Lindgren Children ’s Hospital due to asymmetric h and function . The inclusion criteria are age 3–8 months and established asymmetric h and use . Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause , for 12 weeks in total of treatment . The primary outcome measure will be the new H and Assessment for Infants ( HAI ) for evaluating manual ability . In addition , the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used . Clinical neuroimaging will be utilized to characterise the brain lesion type . To compare outcomes between treatment groups generalised linear models will be used . Discussion The model of early intensive intervention for h and function , baby-CIMT evaluated by the H and Assessment for Infants ( HAI ) will have the potential to significantly increase our underst and ing of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured . Trial registration PURPOSE To determine the influence of breastmilk consumption , as a dose response , in very low-birth-weight ( VLBW ) infants ( < 1,500 g ) on neurodevelopmental outcomes at 6 and 12 months corrected age , and to determine the influence of selected sociodemographic and infant variables on neurodevelopmental outcomes . SUBJECTSVLBW infants ( n = 148 ) who were fed mother 's milk or formula by parental choice . DESIGN Prospect i ve cohort with longitudinal follow-up at 6 and 12 months corrected age . METHODS Self-administered question naires given to mothers at study entry , before discharge , and at 3- , 6- , and 12-month follow-up visits . During hospitalization , mothers recorded the 24-hour volume of expressed milk once per week . At each follow-up visit , the volume of a  single feeding was assessed by pre- and postbreastfeeding test weights of infants measured on an electronic scale accurate to 1.0 g. The amount of breastfeeding was also assessed by feeding records and mother 's report . MAIN OUTCOME MEASURES The Bayley Scales of Infant Development ( 2nd Edition ) , the Mental Development Index ( MDI ) , and the Psychomotor Development Index ( PDI ) . PRINCIPAL RESULTS After controlling for specific sociodemographic and infant variables , this study of VLBW infants showed no statistically significant effect of predominantly breastfeeding compared with predominantly formula feeding on neurodevelopmental outcomes to 12 months corrected age . The most significant predictor of MDI scores at 6 and 12 months corrected age was birth weight , in which higher birth weights predicted higher MDI scores . CONCLUSIONS Despite the lack of statistically significant differences , the findings suggest a small but consistent advantage in developmental scores in infants who were fed their mother 's milk compared with those who were predominantly formula fed . Supporting parents to breastfeed preterm infants may maximize the potential advantages of early nutrition in the neurodevelopmental outcome of VLBW infants Abstract Objective : The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight ( VLBW ) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis ( NEC ) . Methods : A prospect i ve follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center r and omized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC . Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II . Sensory and neurological performance was evaluated by st and ard techniques . The primary outcome was neurodevelopmental impairment at 18–24 months ’ corrected age . Results : A total of 400 infants completed the trial protocol . Of the 370 infants eligible for follow-up , 249 infants ( 124 in the probiotics group and 125 in the control group ) were evaluated . There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups . Conclusion : Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor , neurosensory and cognitive outcomes at 18–24 months ’ corrected age Background The importance of maternal dietary choline for fetal neural development and later cognitive function has been well-documented in experimental studies . Although choline is an essential dietary nutrient for humans , evidence that low maternal choline in pregnancy impacts neurodevelopment in human infants is lacking . We determined potential associations between maternal plasma free choline and its metabolites betaine and dimethylglycine in pregnancy and infant neurodevelopment at 18 months of age . Methodology This was a prospect i ve study of healthy pregnant women and their full-term , single birth infants . Maternal blood was collected at 16 and 36 weeks of gestation and infant neurodevelopment was assessed at 18 months of age for 154 mother-infant pairs .  Maternal plasma choline , betaine , dimethylglycine , methionine , homocysteine , cysteine , total B12 , holotranscobalamin and folate were quantified . Infant neurodevelopment was evaluated using the Bayley Scales of Infant Development – III . Multivariate regression , adjusting for covariates that impact development , was used to determine the associations between maternal plasma choline , betaine and dimethylglycine and infant neurodevelopment . Results The maternal plasma free choline at 16 and 36 weeks gestation was median ( interquartile range ) 6.70 ( 5.78–8.03 ) and 9.40 ( 8.10–11.3 ) µmol/L , respectively . Estimated choline intakes were ( mean ±SD ) 383±98.6 mg/day , and lower than the recommended 450 mg/day . Betaine intakes were 142±70.2 mg/day . Significant positive associations were found between infant cognitive test scores and maternal plasma free choline ( B = 6.054 , SE = 2.283 , p = 0.009 ) and betaine ( B = 7.350 , SE = 1.933 , p = 0.0002 ) at 16 weeks of gestation . Maternal folate , total B12 , or holotranscobalamin were not related to infant development . Conclusion We show that choline status in the first half of pregnancy is associated with cognitive development among healthy term gestation infants . More work is needed on the potential limitation of choline or betaine in the diets of pregnant women BACKGROUND : The newest measure of neurodevelopmental outcomes , the Bayley Scales of Infant and Toddler Development , 3rd Edition ( Bayley-III ) , gives higher-than-expected scores for preterm infants ; results after cardiac surgery are unknown . OBJECTIVES : The goal of this study was to report Bayley-III scores after cardiac surgery and compare the results with those of the Bayley Scales of Infant Development , 2nd Edition ( BSID-II ) on a subset of the same children . METHODS : In this prospect i ve , inception cohort , neurodevelopmental outcome study after complex cardiac surgery in infants from 2004 to 2007 , the Bayley-III was given to 110 survivors ( 68 % boys ) at a mean age of 21 months ( SD : 4 months ) . Analysis of variance was used to compare intergroup differences . Results for both test editions on the same 25 children were compared by using paired- sample s statistics . RESULTS : Mean ( SD ) Bayley-III mean composite scores ( CSs ) for 110 children were as follows : cognitive , 95.9 ( 14.1 ) ; language , 90.8 ( 18.1 ) ; and motor , 93.7 ( 14.2 ) , differentiating selected cardiac surgery groups . The average difference in mean CSs was 7.4 points higher than BSID-II scores for a previous cohort from this site and 7.2 points higher than a systematic review report . Direct comparison of BSID-II and Bayley-III revealed an average difference in mean CSs of 6.1 points , similar to normative results . Mean cognitive CSs increased by 10.0 ( P < .001 ) , language by 1.4 ( P = .526 ) , and motor by 6.9 points ( P = .009 ) . CONCLUSIONS : Research ers should be careful attributing higher Bayley-III scores to changes in acute care . At-risk children who previously qualified for early developmental intervention may no longer do so . School-age longitudinal studies are needed to determine the accuracy of early developmental estimates using the Bayley-III
Conclusion : Positive clinical ly meaningful effects ( > 5 points ) are seen to an age of 36 months , but are no longer present at 5 years
Objective : To determine in a systematic review , whether interventions for infant development that involve parents , improve neurodevelopment at 12 months corrected age or older .