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 .
Earlier discharge with community-based intervention for low birth weight infants: a randomized trial.
BACKGROUND Prolonged hospitalization of low birth weight infants increases the risk of medical and psychosocial complications . The feasibility of earlier discharge with community-based follow-up of infants of < or = 2000 g birth weight , without the use of home apnea monitors , was investigated . METHODS One hundred infants of < or = 2000 g birth weight were r and omized to either an intervention or control group . Intervention infants were discharged when readiness criteria were met . Based on assessed need , intervention group families received public health nursing and homemaker services for up to 8 weeks . Control infants were discharged to their homes at the discretion of the attending physician . All infants were assessed blindly at age 1 year with the Bayley and Home Observation for Measurement of the Environment ( HOME ) scales . RESULTS There were no group differences in baseline infants ' characteristics or in neonatal complications . Infants in the intervention group were discharged from the hospital at an earlier postconceptional age ( mean + /- SD 36.6 + /- 1.5 weeks vs 37.3 + /- 1.6 weeks ; P < .04 ) . Median length of hospital stay ( 23 days vs 31.5 days ) and mean weight at the time of discharge ( 2200 + /- 288 g vs 2275 + /- 301 g ) were lower , but not significantly , for infants in the intervention group . A secondary analysis by birth weight strata ( < or = 1500 g and 1501 through 2000 g ) revealed that the most significant reductions in hospital stay and weight at discharge were realized in infants of 1501 through 2000 g birth weight . The persistence of apneic episodes and need for electronic monitoring prevented earlier discharge of infants of < or = 1500 g birth weight . Postdischarge services to the intervention group included 185 public health nurse home visits ( 3.8 + /- 0.91 ) , 410 phone contacts ( 8.4 + /- 5 ) , and 2298 homemaker hours ( 46 + /- 78 ) of service . At 1 year , there were no deaths and no group differences in rehospitalization rates , use of ambulatory services , or Bayley scores . Intervention families had significantly higher 1-year HOME scores . Minimum cost of hospital care was $ 873 per day , while the total cost of community-based services averaged $ 626 per infant . CONCLUSIONS A significant reduction in average length of hospital stay was achieved for infants of 1501 through 2000 g birth weight . Earlier discharge of infants weighing < or = 1500 g at birth was hampered by persistent apneic episodes and feeding difficulties . A community-based program design ed to provide individualized support and education for families of low birth weight infants was cost-effective and had a positive influence on the home environment
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 .