Intervention Effects on Developmental Outcomes and Emotion Regulation in Preterm Infants with Very Low Birth Weight

• Main Authors: Ying-Chin Wu, 吳盈瑾
• Other Authors: Suh-Fang Jeng
• Format: Others
• Language: en_US
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/56400453018969933316

博士 === 國立臺灣大學 === 物理治療學研究所 === 102 === Background and Purposes: Preterm infants with VLBW sustain a higher risk of delayed development, emotional difficulties, and behavioral problems than term counterparts. Several intervention studies for preterm infants in Western countries and China have yielded short-term motor benefits in early infancy and long-term cognitive benefits till preschool age. Given substantial variations in health care systems and family structures among societies, the effect of intervention programs needs to be investigated in relevant cultural contexts. Therefore, the purposes of this study were to longitudinally examine the intervention effect of the clinic-based intervention program (CBIP) and home-based intervention program (HBIP) in comparison with a usual care program (UCP) on preterm infants’ development, emotion regulation, and behavior, and to identify the possible mediators of effective interventions. Methods: In this randomized controlled trial, 178 VLBW preterm infants were enrolled and randomly allocated to the CBIP (n=57), HBIP (n=63), or usual care (n=58). The CBIP and HBIP contained identical services from hospitalization until 12 months of corrected age but the interventions after discharge were respectively delivered at clinic and at home. At 12 months of corrected age, dyadic interaction was observed during free play. At 12, 18, and 24 months of corrected age, infants’ emotion regulation was assessed using the toy-behind-barrier procedure. At 24 months of corrected age, infants’ developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development-3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Results: Compared with infants under usual care, the CBIP-group infants exhibited shorter durations of avoidance (difference [95% CI]=-0.84 [-1.57 to -0.10]) from 12 to 24 months, and showed higher cognitive composite scores (difference [95% CI]=4.4 [ 0.8 to 7.9]) and a lower rate of motor delay (odds ratio (OR) [95% CI]=0.29 [0.08 to 0.99]). The HBIP-group infants exhibited shorter durations of visual orientation to a toy (difference [95% CI]=-1.60 [-3.07 to -0.13]), and had lower sleep problem scores (difference [95% CI]=-1.4 [-2.5 to -0.3]) and a lower rate of internalizing problems at 24 months (OR [95% CI]=0.51 [0.28 to 0.93]) (all p<0.05). The CBIP’s effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP’s effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or reorientation was considered. Conclusions: Interventions enhanced the cognitive, motor, and behavioral outcomes and emotion regulation in VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early improved mother-infant interaction and infant emotional regulation, respectively. The findings provide insightful information regarding the social and developmental pathways of effective interventions for VLBW preterm infants. Furthermore, our data are helpful for planning effective interventions for preterm infants who are at risk of developmental and behavioral disorder in Taiwan.