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Yao N.-J.1, Lee C.-J.2, Chen C.-N.3,4, Jeng S.-F.1
1National Taiwan University, College of Medicine, School and Graduate Institute of Physical Therapy, Taipei, Taiwan, 2Far Eastern Memorial Hospital, Department of Pediatrics, New Taipei, Taiwan, 3National Taiwan University Hospital Hsin-Chu Branch, Department of Pediatrics, Hsin-Chu, Taiwan, 4National Taiwan University, Institute of Occupational Medicine and Industrial Hygiene, Taipei, Taiwan
Background: Preterm infants sustain a higher risk of developmental and behavioral disorders compared to their term counterparts throughout childhood. Meta-analyses of intervention programs for preterm infants have demonstrated short- to medium-term benefit on cognitive outcome; however, the behavioral effect has rarely been systematically investigated.
Purpose: To examine the effect of early intervention on behavioral outcome in preterm infants compared with standard care at infancy and toddler age ( 3 years of age), pre-school age (3-5 years of age), and school age and teenage (6-18 years of age) using a meta-analysis.
Methods: Only randomized controlled trials (RCTs) or quasi-randomized controlled trials that examined the effect of comprehensive early intervention on behavioral outcome in preterm infants (born before 37 weeks of gestational age) were considered for this review. MEDLINE, Pubmed, Scopus, CINAHL, EMBASE, PsycINFO, Ovid and Cochrane Database (from 1990 to 2016) were used to extract relevant papers written in English. Two reviewers worked independently to extract papers, enter data and rate the quality using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted using Review Manager 5.3 software.
Results: This study has abstracted 30 articles that 14 were performed meta-analysis and 16 were included for discussion only because of incomplete information or using different outcome assessment tools. At infancy and toddler age, preterm infants receiving early intervention presented with lower internalizing behavioral problem score than those receiving standard care (mean difference: -1.91, 95% CI:-3.16, -0.67, p=0.003) but showed no difference in the total behavioral problem score and externalizing behavioral problem score. At pre-school age, early intervention significantly decreased the total behavioral problem score in preterm children (mean difference: -0.17, 95% CI: -0.28, -0.06, p=0.004) but yielded no effect in the internalizing behavioral problem score and externalizing behavioral problem score. Only two intervention studies longitudinally examined the behavioral outcome in preterm adolescents that revealed no obvious effect.
Conclusion(s): Early intervention has favored the behavioral outcome in preterm infants than standard developmental care until five years of age, with the effect waning to no significant at adolescence.
Implications: Comprehensive early intervention is beneficial for short- to medium term behavioral outcome in preterm infants. More longitudinal follow-up studies of early intervention for preterm infants are warranted.
Funding acknowledgements: This study was supported by the National Health Research Institute (NHRI-EX105-10106PI) and Ministry of Science and Technology (105-2314-B-002-017-) in Taiwan.
Topic: Paediatrics
Ethics approval: No ethics approval was required.
All authors, affiliations and abstracts have been published as submitted.
