In a secondary analysis of a randomized clinical trial, early developmental intervention (EDI) initiated in the NICU and continued through the first two years of life was associated with sustained improvements in executive function among very preterm children. The results highlight the long-term neurodevelopmental benefits of early intervention, with potential positive effects on later academic performance and socioemotional development, particularly in low- and middle-income settings. The study was published in JAMA Pediatrics by Mariana L. and colleagues.
Children born before 32 weeks of gestational age and weighing less than 1500 g have an increased probability of developing neuro-developmental issues during adulthood despite the absence of disability issues. Deficits in executive function pose significant concern as they play an important part in understanding capacity to learn, school-dependent behaviors, and general adaptability.
This study was part of the secondary outcomes from the randomized trial and was conducted based on school-aged outcomes at one facility in Porto Alegre, Brazil. It initially involved infants born at less than 32 weeks of gestational age and weighing less than 1500 g from January 2016 to February 2019. Neuropsychological examinations pertaining to child outcomes occurred from July 7, 2023, to August 16, 2024. Data analyses occurred from August to December 2024.
Key findings
A total of 80 children, equivalent to 96% of those eligible from the original randomized trial, were assessed at a mean age of 7 ± 1 years, of whom 43% (34 females) were females.
The baseline demographic and clinical characteristics were reported not to be different between the enhanced developmental intervention group and the usual care group.
The results in primary analysis indicated that children who received EDI intervention had higher scores than those in the usual care group in all four aspects of their executive functions, with a difference in score of 12-14 compared to 2-9.
The range of benefit across domains was moderate to large, with rank biserial correlation coefficients ranging from 0.44 to 0.77. Furthermore, all comparisons were highly statistically significant, with P < 0.001.
These differences were statistically significant while controlling for multiple testing effects via the Bonferroni correction (P < 0.0125).
Investigating EDI in relation to categorical performance in secondary analyses showed it to be associated with a markedly increased likelihood of “satisfying expected performance in designing fluency,” where the odds ratio was 11.3 (95% CI: 4.08 to 31.7; P <0.001).
There were no notable distinctions between groups for expected performance in the other three domains of executive function.
Early enhanced developmental intervention given in the NICU and continued over the first two years of life was linked with continued enhancement in executive functions among school-aged very preterm children. Such studies support the long-term neurodevelopmental value of early intervention techniques. These intervention techniques may even be useful in improving outcomes for children from low- and middle-income countries.
Reference:
Tarouco ML, Procianoy RS, O’Shea TM, Silveira RC. Parent-Led Early Intervention in Very Preterm Infants and Executive Function at School Age: Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatr. Published online January 20, 2026. doi:10.1001/jamapediatrics.2025.5866
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