A randomised clinical trial on the impact of early intervention on parental child-rearing attitudes and cognitive, motor and behavioral outcomes in preterm infants.

Abstract

BACKGROUND: Preterm infants are at increased risk of cognitive problems/delay and behavioual problems in the long term. Studies have shown that their mothers are more overprotective, and find it hard to implement a nurturant child rearing practice compared to parents of term infants. To improve the parent-infant interaction and thereby influence infant development in a beneficial different early intervention (EI) strategies have been studied but the results are conflicting OBJECTIVE: To study the effect of an EI program in low birth weight (LBW) children on parental child-rearing attitudes, and cognitive, motor and behaviorual outcomes in pre-school age (2-5 years). METHODS: LBW babies (BW <2000g) were randomized to an intervention (IG) or a control group (CG). In addition a term group (TG) was recruited to provide reference data. The EI program was a modified version of the Mother Infant Transaction Program (MITP). The intervention was implemented by eight specially trained neonatal nurses and consisted of seven daily sessions during the week prior to discharge, followed by four home visits. The unit’s standard discharge procedure was followed in the CG and TG. RESULTS: A total of 146 LBW infants were randomized, and 134 and 131 were assessed at 3 and 5 y, respectively. BW in the IG (n=72) was 1396 (SD 429) g, 1381(436)g in CG (n=74) and 3619 (490) in the TG . Mean GA was 30.2 (3.1) w in IG, 29.9 ( 3.5) w in CG and 39.3 (1.3) in TG. The groups were well balanced in baseline characteristics. At 1 and 2 year, mothers in the intervention group reported significantly more nurturant child- rearing attitudes compared to the control group. Children in the intervention group had 4.5 higher IQ scores at 3 years and this difference increased to 6.4 points at 5 years. Furthermore, children in the intervention group had significantly less behaviour problems reported by parents at 5 years compared with the control group. CONCLUSION: This EI program leads to improved IQ scores and less behaviour problems in the pre-school age in preterm infants. In addition, mothers reveal more nurturant child-rearing attitudes at 1 and 2 years. There were no effect on motor outcome.