Parent-Guided Intervention Boosts Early Cognitive Development in Preterm Infants from Low-Income Families: JAMA

A parent-guided developmental intervention initiated in the neonatal intensive care unit (NICU) and continued at home enhanced early cognitive function in very preterm or very low birth weight infants in the randomized clinical trial involving 100 infants from families in a low- and middle-income country, the researchers reported.

Early interventions can enhance neurodevelopmental outcomes following preterm birth; however, few studies are focusing on preterm infants from families living in low- or middle-income countries. To fill this knowledge gap, Rita C. Silveira, Neonatal Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, and colleagues aimed to assess whether parent-guided early intervention enhances the neurodevelopmental outcomes of preterm infants in a low-or middle-income country.

For this purpose, the researchers performed a randomized clinical trial at a high-risk obstetric referral hospital in Brazil; outcomes were evaluated by examiners masked to the randomization group.

Eligible participants included infants born at the hospital, living within 40 km, and either born before 32 weeks of gestation or weighing less than 1500 g. Out of 138 enrolled infants, 19 died, and 19 withdrew, leaving 50 per group evaluated for the primary outcome. Data collection occurred from 2016 to 2022, with analysis from June 10 to July 31, 2022.

On postnatal day 7, infants were randomized to either usual care—which included lactation support, kangaroo care, and routine developmental therapies—or a parent-guided enhanced intervention. The enhanced intervention involved usual care plus infant massage and additional visual, auditory, and social stimulation, along with support for motor development, guided by developmental therapists.

The primary outcome was the adjusted Bayley Scales of Infant and Toddler Development–Third Edition score at 18 months of age.

The study revealed the following findings:

• Among the 100 infants in the analysis, the mean gestational age was 28.4 weeks, and 57% were male.
• The mean gestational age for the intervention group was 28.3 (2.3) weeks; for the usual care group, 28.5 weeks.
• Female infants accounted for 42% of infants in the intervention group and 44% of the usual care group; male infants, 58% and 56%, respectively.
• The enhanced developmental intervention group had higher cognitive scores at 18 months of corrected age (mean, 101.8 versus 97.3; mean difference, 4.5).

The findings showed that compared to usual care for very preterm infants, a continuous and multifaceted early intervention that starts in the NICU and continues after discharge significantly improves neurodevelopmental outcomes and enhances mother-child interactions, particularly for low-income families. The program is an effective strategy for promoting preterm development in LMICs.

"If validated by further research, our findings indicate that the intervention outlined here could enhance outcomes for preterm infants in other low- and middle-income countries," the researchers concluded.

Reference:

Silveira RC, Valentini NC, O’Shea TM, et al. Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(7):e2421896. doi:10.1001/jamanetworkopen.2024.21896