Effects of Early Intervention for Preterm Children at School Age
Condition: Premature Birth
MeSH terms: Premature Birth
Study type: Observational

Summary: 
      Despite the remarkable achievements in neonatal survival of preterm infants with very low
      birth weight (VLBW, birth weight < 1,500 g) over the past three decades, improvements have
      produced little change in their prevalence of severe developmental disability and the rate of
      low severity dysfunctions (e.g., learning disabilities, low IQ, attention-deficit
      hyperactivity disorder, specific neuropsychological deficits, poor perceptual-motor skills
      and internalizing behavioral problems) remains high as 50% to 70%. Few intervention programs
      developed for preterm infants in Western societies were shown to have short- to long-term
      benefits in certain cognitive functions, however, rare studies have investigated intervention
      effect at school age and explored plausible neurological pathway for effective intervention.
      This three-year study was therefore aimed to extend our previous research to longitudinally
      examine the effectiveness of three intervention programs (clinic-based intervention program
      [CBIP], home-based intervention program [HBIP] and usual care program [UCP]) for VLBW preterm
      children in Taiwan at seven years of age.(The intervention had been delivered from birth to
      one year of corrected age in the previous study. The intervention will not be given in this
      study.)The CBIP and HBIP contained similar child- and parent-focused services as well as
      interaction activities but were respectively delivered at the clinic for the CBIP and at home
      for the HBIP. A total of 178 VLBW preterm infants had been randomly assigned to the CBIP,
      HBIP or UCP. Sixty-two gender and maternal education level matched term children with normal
      birth weight had also been included to serve as the reference group for comparison of
      developmental outcomes. Effectiveness examined included child and parent outcomes. The
      long-term effect of the early intervention for preterm children would provide important
      information to help medical professionals and public policy makers to develop an effective
      intervention for Taiwanese preterm children who are at risk of developmental disorders.
    

Detailed description: 
      Specific Aims:

      This study was to extend our previous research to longitudinally examine the effectiveness of
      three intervention programs (CBIP, HBIP and UCP) for VLBW preterm children in Taiwan at seven
      years of age. Gender and maternal education level matched term children were also included to
      serve as the reference group for comparison of developmental outcomes. The intervention had
      been delivered from birth to one year of corrected age in the previous study. Effectiveness
      examined including children's and parental outcomes. Primary outcome referred to measures of
      child neurobehavioral functions. Neurobehavioral assessment included cognitive, motor and
      behavioral measurement. Secondary outcomes referred to child growth and health,
      neurophysiological functions, and the quality of parenting measures. Neurophysiological
      assessment referred to electroencephalogram/event-related potential examinations that were
      used to investigate the neurological pathways underlying the effective intervention.

      Subjects and Methods:

      Participants:

      One hundred and seventy-eight VLBW preterm children and 62 term children who had participated
      in our previous study were enrolled in this study. VLBW preterm children were born or
      admitted at the National Taiwan University Hospital, the Mackay Memorial Hospital and Taipei
      City Hospital, Branch for Women and Children in Taipei, Taiwan, during the time period of
      2006 to 2008.

      Methods:

      While age seven is an important time period that children enter elementary school and begin
      to participate in school activities, more comprehensive outcome measurements are required.
      The World Health Organization emphasizes that health conditions should be considered from the
      body, individuals and societal perspectives as depicted in the International Classification
      of Functioning, Disability and Health model. Accordingly, the outcome measures in this study
      consisted of the primary (i.e., child neurobehavioral functions) and secondary outcomes
      (i.e., child growth and health, neurophysiological functions, and quality of parenting).
      Child neurobehavioral assessment included measurements of cognitive, motor, and behavior
      function. The domains of cognitive functions examined including the intelligence (IQ test),
      the efficiency of attention control (sustained attention test), and the cognitive flexibility
      and planning (executive function test). The motor function included motor skill acquisition
      and coordination. Children's behavior was measured using the parental report of child
      behavior and teacher's observation for child's adaptive behavior in the school context.
      Children's educational resources (special education or resource class) or other
      education-related support received from any institution would also be recorded in this study.
      Child neurophysiological functions were measured by the electroencephalogram
      (EEG)/event-related potential (ERP) technique.

      All families were contacted via phone call and mail to be enrolled in this study. Children
      and their parents would have been examined for the following outcomes when the children
      approached at seven years of age. All measures except for the neurophysiological measures
      were conducted at Infant Motor Development Laboratory, School of Physical Therapy, National
      Taiwan University. Several examiners with the background knowledge of physical therapy or
      psychology received training with the testing instruments and procedures. Before commencing
      the study assessments, the interrater reliability (agreement with an experienced investigator
      > 0.80) would have been required for the assessors. All the examiners were kept blind to
      children's group assignment. To decrease the fatigue in children due to the prolonged
      examination, participants were asked to return twice for assessment.The first assessment
      would have taken 180 minutes which consisted of the IQ test, sustained attention test, and
      executive function test that the whole session.The second assessment was the
      neurophysiological measurement with the EEG/ERP tasks which would have taken 90 minutes.
    

Intervention name(s): Home-based intervention program; Clinic-based intervention program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention had been done in the previous intervention study. The intervention included in-hospital and after-discharge service. After-discharge intervention performed at 0, 1, 2, 4, 6, 9, 12 months of age at the home.; The intervention had been done in the previous intervention study. The intervention included in-hospital and after-discharge service. After-discharge intervention performed at 0, 1, 2, 4, 6, 9, 12 months of age at the clinic.
Other intervention name(s): HBIP; CBIP
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Term and VLBW preterm children were born at the National Taiwan University Hospital and the
        Mackay Memorial Hospital (MMH) and who received the intervention service in our previous
        intervention study will be invited to participate in this study.
      
Keywords: Early intervention; Mother-child interaction; Neurodevelopment; Parenting; Prematurity; School age