Liu F-C1,2, Chang J-H3, Hsu H-C4, Wu Y-T1, Jeng S-F1,5
1National Taiwan University, School and Graduate Institute of Physical Therapy, College of Medicine, Taipei, Taiwan, 2Shin Kong Wu Ho‑Su Memorial Hospital, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan, 3Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Department of Pediatrics, Taipei, Taiwan, 4University of Georgia, Department of Child and Family Development, Athens, GA, United States, 5National Taiwan University Hospital, Physical Therapy Center, Taipei, Taiwan

Background: The advancement of perinatal care has significantly improved the survival rate of preterm infants with very low birth weight (VLBW, birth weight 1500 g), however their risk of neurodevelopmental disorders remains high and their parent often encounter difficulty in interaction. Although early intervention may yield developmental benefit in preterm infants, the social pathway of effective intervention such as mother-infant interaction has rarely been investigated.

Purpose: The aim of this study was to investigate the effect of a family-centered intervention program (FCIP) on developmental outcomes and quality of mother-infant interaction in preterm infants with VLBW compared with a usual care program (UCP), and to examine if mother-infant interaction mediated the developmental effect.

Methods: This was a multi-centered, single-blind, randomized controlled study that enrolled preterm infants with VLBW from three medical centers in Taiwan. The FCIP group received parent-, child- and dyad-focused intervention during hospitalization and seven home- and clinic-based intervention sessions until 12 months of corrected age; whereas the UCP group received standard care during hospitalization and seven phone calls for general consultation after discharge. Infants were examined for cognitive, language, and motor development by the Bayley Scales of Infant and Toddler Development- 3rd edition at 6, 12 and 24 months, and were video recorded for quality of mother-infant interaction in a free-play procedure at 6 and 12 months with coding of maternal, infant and dyadic interactive behavior.

Results: The FCIP (N=120) and UCP groups (N=124) showed comparable developmental scores across ages. However, subgroup analysis revealed significantly higher language score in the FCIP group than in the UCP group among those firstborns (6 months: 100.1±7.7 vs. 97.5±9.2; 12 months: 95.1±7.9 vs. 93.0±8.0; 24 months: 102.5±12.6 vs. 99.1±15.3, p=0.03). The FCIP dyads showed significantly more high-quality maternal interactive behavior (6 months: 67.7%±20.4% vs. 60.0%±24.1%; 12 months: 73.7%±21.9% vs. 67.0%±19.7%, p=0.01) together with less inactive maternal interactive behavior (6 months: 16.0%±15.7% vs. 23.7%±20.5%; 12 months: 14.1%±16.7% vs. 18.8%±16.8%, p 0.01), less mother discordant pattern (6 months: 8.6%±12.3% vs. 15.4%±18.0%; 12 months: 6.5%±11.7% vs. 10.3%±12.6%, p 0.01) together with more child discordant pattern than the UCP group (6 months: 29.5%±19.4% vs. 22.2%±16.1%; 12 months: 29.5%±17.5% vs. 28.4%±15.7%, p=0.03). Mediator analyses revealed that the intervention effect on language outcome among those firstborns was markedly attenuated when the significant maternal or dyadic interactive measure was included in the model.

Conclusion(s): The FCIP benefited maternal and dyadic interactive behavior in interaction in preterm infants with VLBW in Taiwan throughout the first year of age. Furthermore, the FCIP favored the language development at 6 to 24 months in those firstborn preterm infants only for which intervention effect appeared to be mediated via improved quality of mother-infant interaction.

Implications: The population-specific developmental effect and the identified social pathway provided insightful information for the design and application of early intervention in preterm infants with VLBW in culturally similar societies.

Keywords: mother-infant interaction, family-centered intervention, preterm infants

Funding acknowledgements: All phases of this study was supported by a grant from the National Health Research Institute (NHRI-EX101-10106PI) in Taiwan.

Topic: Paediatrics

Ethics approval required: Yes
Institution: National Taiwan University Hospital
Ethics committee: Research Ethics Committee
Ethics number: NCT01807533

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

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