Liu FW1, Hsieh WS2, Chang JH3, Lin YJ4, Hsieh SL5,6,7, Lee CL8, Yao NJ1, Jeng SF1,9
1National Taiwan University, School and Graduate Institute of Physical Therapy, College of Medicine, Taipei, Taiwan, 2National Taiwan University Hospital, Department of Pediatrics, Taipei, Taiwan, 3Mackay Memorial Hospital, Department of Pediatrics, Taipei, Taiwan, 4National Cheng Kung University Hospital, Department of Pediatrics, Tainan, Taiwan, 5National Cheng Kung University, Department of Psychology, Tainan, Taiwan, 6National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan, 7National Cheng Kung University, Department and Institute of Public Health, Tainan, Taiwan, 8National Taiwan University, Graduate Institute of Linguistics, Taipei, Taiwan, 9National Taiwan University Hospital, Physical Therapy Center, Taipei, Taiwan

Background: Preterm infants with very low birth weight (VLBW, birth weight 1,500 g) are at increased risk of cognitive, motor and behavioral disorders than term infants. Accumulating data have demonstrated short-term motor benefit and medium-term cognitive benefit of family-centered care in preterm infants with VLBW, however, the neurophysiological pathways underlying effective intervention have rarely been explored. The electroencephalography/event-related potential (EEG/ERP) is a neurophysiological assessment increasingly applied in the executive function tasks to examine the neural basis of information processing in pediatric populations. Through electrical cap to collect the micro electrical current on the scalp, the ERP components can be processed and analyzed to represent different stages of information processing of brain.

Purpose: This study aimed to investigate the effects of a family-centered intervention program (FCIP) on motor and cognitive function in preterm infants with VLBW at four years of age in Taiwan compared to a usual care program (UCP), and to examine neurophysiological mechanisms of effective intervention.

Methods: This was a multi-centered, single-blinded, randomized controlled study in which preterm infants with VLBW were randomly assigned to the FCIP (N=129) and UCP group (N=140). The FCIP group infants received child-, parent- and dyad-focused intervention from hospitalization until 12 months of corrected age; whereas, the UCP group infants received standard care. Their motor function was assessed using the Movement Assessment Battery for Children, 2nd Edition; cognitive function was examined using the Wechsler Preschool and Primary Scale of Intelligence, Revised Edition, and executive function was assessed using the EEG/ERP in the inhibitory control task of Go/No-go.

Results: A total of 88 FCIP group children (68%) and 71 UCP group children (58%) returned for motor and cognitive assessment at four years of age. The FCIP and UCP groups were comparable in the motor score (7.4±2.4 vs. 7.3±2.1) and full scale IQ (96.1±13.6 vs. 93.7±15.3). As for the executive function, the FCIP group children manifested significantly higher correct rate (84%±12% vs. 76%±17%, p=0.03) together with longer latency of P3 on the Pz site in the inhibitory control task of Go/No-go than the UCP group children did (32.4±26.0 ms vs. 13.2±35.7 ms, p=0.01).

Conclusion(s): The FCIP yielded beneficial effect on cognitive function, specifically executive function with longer response time but greater accuracy in inhibitory control, in preterm children with VLBW at preschool age.

Implications: The EEG/ERP assessment provides useful information to help reveal the neurophysiological mechanisms underlying developmental benefit in preschool-aged preterm children with VLBW following family-centered care. While inhibitory control is the core ability of executive function that predicts subsequent adaptive function and academic performance, a continued follow-up of intervention effect on long-term outcomes in preterm children with VLBW at school age is warranted.

Keywords: Prematurity, Early intervention, Executive function

Funding acknowledgements: This study was supported by grants from the Ministry of Science and Technology (MOST 106-2314-B-002 -088) in Taiwan.

Topic: Paediatrics

Ethics approval required: Yes
Institution: National Taiwan University Hospital
Ethics committee: The Institutional Review Boards
Ethics number: 201412127RINC

All authors, affiliations and abstracts have been published as submitted.

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