title: Kangaroo Mother Care and the Bonding Hypothesis Cognitive performance and attachment patterns at four years of age in extremely low birth weight infants after early intervention Hospital-based case management for medically fragile infants: results of a randomized trial. Developmental intervention for low birth weight infants: improved early development outcome. Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools. Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). EFFECT OF EARLY NEURODEVELOPMENTAL THERAPY IN NORMAL AND AT-RISK SURVIVORS OF NEONATAL INTENSIVE CARE Sustained effects of high participation in an early intervention for low-birth-weight premature infants. Randomised trial of parental support for families with very preterm children: outcome at 5 years Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. Developmental care does not alter sleep and development of premature infants. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings Early experience alters brain function and structure. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. An intervention program for mothers of low-birthweight infants: preliminary results. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. Long-term family outcomes for children with very low birth weights. Minimizing adverse effects of low birthweight: four-year results of an early intervention program. Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects. Randomised trial of parental support for families with very preterm children. Avon Premature Infant Project. Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. The Infant Health and Development Program. A Randomized, Controlled Trial to Evaluate the Effects of the Newborn Individualized Developmental Care and Assessment Program in a Swedish Setting A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. No indications of increased quiet sleep in infants receiving care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Low Birth Weight and Home Intervention Strategies: Preterm Infants Nursery-based intervention with prematurely born babies and their mothers: are there effects? Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program. Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers. Kangaroo Care Compared to Incubators in Maintaining Body Warmth in Preterm Infants Effects of Brazelton demonstrations for mothers on the development of preterm infants. Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Effect of an early intervention programme on low birthweight infants with cerebral injuries. The effects of an early developmental mother-child intervention program on neurodevelopment outcome in very low birth weight infants: a pilot study. Earlier discharge with community-based intervention for low birth weight infants: a randomized trial. Impact of family structure and stability on academic outcome in preterm children at 10 years of age. Early intervention promotes intellectual development of premature infants: a preliminary report. Early Intervention of Premature Infants Cooperative Research Group. The behavioral and emotional well-being of school-age children with different birth weights. Early home intervention with low-birth-weight infants and their parents. Nine-year outcome of the Vermont intervention program for low birth weight infants. One-Year Outcome of Auditory-Tactile-Visual-Vestibular Intervention in the Neonatal Intensive Care Unit: Effects of Severe Prematurity and Central Nervous System Injury Randomized Controlled Trial of Kangaroo Care: Cardiorespiratory and Thermal Effects on Healthy Preterm Infants Beneficial Effects of Breast Milk in the Neonatal Intensive Care Unit on the Developmental Outcome of Extremely Low Birth Weight Infants at 18 Months of Age
abstract: Background . Based on the general bonding hypothesis , it is suggested that kangaroo mother care ( KMC ) creates a climate in the family whereby parents become prone to sensitive caregiving . The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant 's cues . Method . The r and omized controlled trial was conducted on a set of 488 infants weighing < 2001 g , with 246 in the KMC group and 242 in the traditional care ( TC ) group . The design allows precise observation of the timing and duration of mother – infant contact , and takes into account the infant 's health status at birth and the socioeconomic status of the parents . Bonding Assessment . Two series of outcomes are assessed as manifestations of a mother 's attachment behavior . The first is the mother 's feelings and perceptions of her premature birth experience , including her sense of competence , feelings of worry and stress , and perception of social support . The second outcome is derived from observations of the mother and child 's responsivity to each other during breastfeeding at 41 weeks of gestational age . Interventions . KMC has three components . The first is the kangaroo position . Once the premature infant has adapted to extrauterine life and is able to breastfeed , he is positioned on the mother 's chest , in a upright position , with direct skin-to-skin contact . The second component is kangaroo nutrition . Although breastfeeding is the prime source of nutrition , infants also may receive preterm formula whenever necessary and vitamin supplements . The third component is the clinical control ; infants are monitored on a regular basis , daily until they are gaining at least 20 g per day . Afterward , weekly clinic visits are scheduled until term , which constitutes the ambulatory minimal neonatal care . In the TC group , infants are kept in incubators until they are able to self-regulate their temperature and are thriving ( ie , have an appropriate weight gain ) . Infants are discharged according to current hospital practice , usually not before their weight is ∼1700 g. Afterward , as with the KMC group , weekly clinic visits are scheduled until term . Results . We observed a change in the mothers ' perception of her child , attributable to the skin-to-skin contact in the kangaroo-carrying position . This effect is related to a subjective “ bonding effect ” that may be understood readily by the empowering nature of the KMC intervention . Moreover , in stressful situations when the infant has to remain in the hospital longer , mothers practicing KMC feel more competent than do mothers in the TC group . This is what we call a resilience effect . In these stressful situations we also found a negative effect on the feelings of received support of mothers practicing KMC . We interpret this as an isolation effect . To thwart this deleterious effect , we would suggest adding social support as an integral component of KMC . The observations of the mothers ' sensitive behavior did not show a definite bonding effect , but rather a resilience effect . This is attributable to the KMC intervention ; mothers practicing KMC were more responsive to an at-risk infant whose development has been threatened by a longer hospital stay . Otherwise , we observed that the mothers ( in both the KMC group and the TC group ) had behavioral patterns that were adapted to the child 's at-risk health status and to the precarious condition of some premature infants requiring intensive care . We conclude that the infant 's health status may be a more prominent factor in explaining a mother 's more sensitive behavior , which overshadows the kangaroo-carrying effect . Conclusion . These results suggest that KMC should be promoted actively and that mothers should be encouraged to use it as soon as possible during the intensive care period up to the 40 weeks of gestational age . Thus , KMC should be viewed as a means of humanizing the process of giving birth in a context of prematurity . This finding confirms the conclusions of the 1996 Trieste workshop suggesting that KMC should be promoted both in hospitals and after early discharge Abstract This study aims at assessing the effects of an early occupational therapy intervention on the cognitive development and the development of attachment patterns in ELBW infants . The intervention , given weekly at home from six months to 12 months , aim ed at supporting parent-child interaction and enhancing motor control and coordination . The study population consisted of 100 ELBW infants matched in pairs in accordance to their pre-perinatal risk scores and allocated successively to intervention or non-intervention groups .  Cognitive development was assessed with the Bayley Scales at age two and with the WPPSI at age four . Attachment to primary caregiver was assessed with the Preschool Assessment of Attachment ( PAA ) . Cognitive performance was within age norms in both groups at both ages . Intervention did not show any effect on cognitive performance at the age of two years . At the age of four years , cognitive level was overall , and most notably for verbal performance , higher in the intervention group than in the control group . There was an over-representation of the so-called atypical attachment patterns ( those not fitting the normative A , B , or C categories ) in the control group . The results are discussed in terms of finding more global ways to support the development of at risk pre-term children A recent federal law has exp and ed the eligibility for multidisciplinary evaluation and assessment of infants suspected of developmental delay . At the same time , modern neonatal care has increased infant survival . These two developments have created a need for family education regarding the need for health and developmental intervention , as well as counseling to maintain family participation in these services . This study compares the education and counseling services of a hospital-based case management team with the traditional discharge and follow-up services of a neonatal intensive care unit ( NICU ) .  Subjects were the 10 % most medically severe infants discharged from a neonatal intensive care unit over a 16-month period . Preliminary data suggests a significantly greater number of families accessed community-based , coordinated , comprehensive health and developmental services when they received case management services . The data suggest that hospital professionals generally refer the most medically severe 3 % of this group for services under a traditional model . However , the additional 7 % referred under the transition model showed greater developmental benefits from the services during the first 6 months of life . These data support current federal initiatives for early intervention services which are family-centered , community-based and coordinated This prospect i ve longitudinal study was design ed to evaluate the effects of a multidisciplinary infant development program ( IDP )  on the mental and physical development of low birth weight infants ( less than 1,800 g ) . Infants in the neonatal intensive care were r and omly assigned to the IDP or to traditional care ( control group ) . IDP infants received developmental interventions in the hospital and at home through the first 2 years of life . Counseling and parenting education were provided to their parents during this same period . The control group received all the postnatal care and referrals customarily given in traditional care . Both IDP and control infants were enrolled in an independent follow-up program , which used the Bayley Scales of Infant Development in a blind evaluation design . The IDP group had a significantly lower incidence of developmental delay ( P less than .05 ) and scored significantly higher than the control group ( P less than .05 ) on mean mental and physical indices at 12 and 24 months of adjusted age CONTEXT Most studies of the long-term effects of early childhood educational interventions are of demonstration programs rather than large-scale public programs . Previous studies of one of the oldest federally funded preschool programs have reported positive effects on school performance , but effects on educational attainment and crime are unknown . OBJECTIVE To determine the long-term effectiveness of a federal center-based preschool and school-based intervention program for urban low-income children . DESIGN , SETTING , AND PARTICIPANTS Fifteen-year follow-up of a nonr and omized , matched-group cohort of 1539 low-income , mostly black children born in 1980 and enrolled in alternative early childhood programs in 25 sites in Chicago , Ill. INTERVENTIONS The  Chicago Child-Parent Center ( CPC ) Program ( n = 989 children ) provides comprehensive education , family , and health services and includes half-day preschool at ages 3 to 4 years , half- or full-day kindergarten , and school-age services in linked elementary schools at ages 6 to 9 years . The comparison group ( n = 550 ) consisted of children who participated in alternative early childhood programs ( full-day kindergarten ) : 374 in the preschool comparison group from 5 r and omly selected schools plus 2 others that provided full-day kindergarten and additional instructional re sources and 176 who attended full-day kindergartens in 6 CPCs without preschool participation . MAIN OUTCOME MEASURES Rates of high school completion and school dropout by age 20 years , juvenile arrests for violent and nonviolent offenses , and grade retention and special education placement by age 18 years . RESULTS Relative to the preschool comparison group and adjusted for several covariates , children who participated in the preschool intervention for 1 or 2 years had a higher rate of high school completion ( 49.7 % vs 38.5 % ; P = .01 ) ; more years of completed education ( 10.6 vs 10.2 ; P = .03 ) ; and lower rates of juvenile arrest ( 16.9 % vs 25.1 % ; P = .003 ) , violent arrests ( 9.0 % vs 15.3 % ; P = .002 ) , and school dropout ( 46.7 % vs 55.0 % ; P = .047 ) . Both preschool and school-age participation were significantly associated with lower rates of grade retention and special education services . The effects of preschool participation  on educational attainment were greater for boys than girls , especially in reducing school dropout rates ( P = .03 ) . Relative to less extensive participation , children with extended program participation from preschool through second or third grade also experienced lower rates of grade retention ( 21.9 % vs 32.3 % ; P = .001 ) and special education ( 13.5 % vs 20.7 % ; P = .004 ) . CONCLUSIONS Participation in an established early childhood intervention for low-income children was associated with better educational and social outcomes up to age 20 years . These findings are among the strongest evidence that established programs administered through public schools can promote children 's long-term success BACKGROUND AND OBJECTIVE Care based on the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) has been reported to exert a positive impact on the development of prematurely born infants . The aim of the present investigation was to determine the effect of such care on the 1-year development of infants born with a gestational age of less than 32 weeks . METHODS All surviving infants ( 11 in the NIDCAP group and 9 in the control group ) were assessed employing the Bayley Scales of Infant Development at 1 year of corrected age . RESULTS The Mental Developmental Index ( MDI ) of children who had received care according to NIDCAP was higher [ 88 ( 72 - 114 ) ] [ median ( range ) ] than the corresponding value for the control children [ 78 ( 50 - 82 ) ] ( p=0.01 ) . The odds ratio for being alive with an MDI>80 was 14 ( 95 % CI ; 1.4 - 141.5 ) in favour of the intervention group . However , the Psychomotor Developmental Indices ( PDI ) were not significantly different [ 85 ( 61 - 108 ) and 69 ( 50 - 114 ) , respectively ] ( p=0.23 ) . CONCLUSION Our findings indicate that care based on the NIDCAP might have a positive impact on the cognitive development of infants born very prematurely At a corrected age of 3 months , 80 low birth-weight infants were assigned to normal or at-risk groups on the basis of a neurodevelopmental assessment scale . Both groups were further divided into intervention and non-intervention sub-groups ( 20 infants in each ) . Intervention consisted of monthly hospital-based neurodevelopmental therapy in addition to a home exercise programme . Infants were re-assessed by a physiotherapist at 6 , 9 , and 12 months , and were tested at 12 months by an independent psychologist blinded for infant group . Mean birthweight and gestational age were similar for normal and at-risk groups . At-risk infants had higher mean neurodevelopmental scores throughout the study period and lower 1-year development quotients ( DQ ) than normals . In neither normal nor at-risk groups did neurodevelopmental therapy alter the pattern of development or the outcome Effects of high participation in the Infant Health and Development Program ( IHDP ) , an 8-site r and omized trial that targeted low-birth-weight ( LBW ) premature infants ( N=1,082 ) , were estimated . Children in the treatment group were offered high- quality center-based care in their 2nd and 3rd years of life ( full-day care , 50 weeks per year ) . High-dosage effects were estimated with a new methodology that found a matched comparison group within the follow-up group for those with high participation rates ; these estimates were compared with traditional intention-to-treat ( ITT ) estimates . At age 8 , effects on the Wechsler Intelligence Scale for Children Full and Verbal scales for children who attended > 400 days ranged from 7 to 10 points . For the heavier LBW infants ( 2,001 - 2,500 g ) , the effects were about 14 points for > 400 days ; for the lighter LBW infants ( < or = 2,000 g ) , the effects were about 8 points . These effects were all substantially higher than corresponding ITT effects . Similar but smaller effects were found for children who attended > 350 days Aims : To test the effectiveness of a home based developmental education intervention in improving outcome at 5 years for very preterm infants . Methods : The Avon Premature Infant Project ( APIP ) is a r and omised controlled trial in which the parents of 284 babies born <33 weeks gestational age received a developmental education programme , a social support intervention , or st and ard care .  A term reference population was also recruited . This study reports outcomes at 5 years ( mean age 58 months 15 days ) for 187 ( 66 % ) of these children without disability . Outcomes were assessed using the British Ability Scales II for cognitive development , the Movement ABC for motor impairment , and the Child Behavior Checklist for behavioural problems . Results : Preterm infants showed poorer cognitive performance than their term peers . Mean ( SD ) general conceptual ability ( GCA ) scores were : Portage 99.2 ( 15.7 ) ; parent adviser 100.3 ( 14.8 ) ; preterm control 101.1 ( 15.0 ) ; term reference 107.2 ( 13.4 ) . There were no significant differences between preterm groups in GCA scores indicating no effect of either intervention . Similarly , there was no significant effect of intervention on behavioural or motor outcomes . Further analyses , in which outcome data were adjusted for social factors , did not reveal any differences between the three preterm groups or by subgroups classified by a range of perinatal variables . Conclusion : The small advantage shown at 2 years of age is no longer detectable at 5 years . These results question the effectiveness of early intervention in enhancing cognitive , behavioural , and motor function at 5 years OBJECTIVE . To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist , we compared those in a multisite r and omized trial of such a program over the first 3 years of life ( INT ) to those with follow-up only ( FUO ) at 18 months of age . METHODS . This was a prospect i ve follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics . Originally 985 children were r and omized to the INT ( n = 377 ) or FUO ( n = 608 ) groups within 2 birth weight strata : heavier low birth weight ( HLBW ; 2001–2499 g ) and lighter low birth weight ( LLBW ; ≤2000 g ) . Primary outcome measures were the Peabody Picture Vocabulary Test ( PPVT-III ) , reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement , youth self-report on the Total Behavior Problem Index , and high-risk behaviors on the Youth Risk Behavior Surveillance System ( YRBSS ) . Secondary outcomes included Weschler full-scale IQ , caregiver report on the Total Behavior Problem Index , and caregiver and youth self-reported physical health using the Medical Outcome Study measure . Assessors were masked as to study status . RESULTS . We assessed 636 youths at 18 years ( 64.6 % of the 985 , 72 % of whom had not died or refused at prior assessment s ) . After adjusting for cohort attrition , differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math ( 5.1 points ) , YRBSS ( −0.7 points ) , and the PPVT-III ( 3.8 points ) in the HLBW youth . In the LLBW youth , the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group ( 4.2 ) . CONCLUSIONS . The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk . The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention To determine the safety , efficacy , and cost savings of early hospital discharge of very-low-birth-weight infants ( less than or equal to 1500 g ) , we r and omly assigned infants to one of two groups . Infants in the control group ( n = 40 ) were discharged according to routine nursery criteria , which included a weight of about 2200 g. Those in the early-discharge group ( n = 39 ) were discharged before they reached this weight if they met a st and ard set of conditions . For families of infants in the early-discharge group , instruction , counseling , home visits , and daily on-call availability of a hospital-based nurse specialist for 18 months were provided . Infants in the early-discharge group were discharged a mean of 11 days earlier , weighed 200 g less , and were two weeks younger at discharge than control infants . The mean hospital charge for the early-discharge group was 27 percent less than that for the control group ( $ 47,520 vs. $ 64,940 ; P less than 0.01 ) , and the mean physician 's charge was 22 percent less ( $ 5,933 vs. $ 7,649 ; P less than 0.01 ) . The mean cost of the home follow-up care in the early-discharge group was $ 576 , yielding a net saving of $ 18,560 for each infant . The two groups did not differ in the numbers of rehospitalizations and acute care visits , or in measures of physical and mental growth . We conclude that early discharge of very-low-birth-weight infants , with follow-up care in the home by a nurse specialist , is safe and cost effective OBJECTIVE The Neonatal Individualized Developmental Care Program ( NIDCAP ) for very low birth weight ( VLBW ) preterm infants has been suggested by Als et al to improve several medical outcome variables such as time on ventilator , time to nipple feed , the duration of hospital stay , better behavioral performance on Assessment of Preterm Infants ' Behavior ( APIB ) , and improved neurodevelopmental outcomes . We have tested the hypothesis of whether the infants who had received NIDCAP would show advanced sleep-wake pattern , behavioral , and neurodevelopmental outcome . METHODS Thirty-five VLBW infants were r and omly assigned to receive NIDCAP  or routine infant care . The goals for NIDCAP intervention were to enhance comfort and stability and to reduce stress and agitation for the preterm infants by : a ) altering the environment by decreasing excess light and noise in the neonatal intensive care unit ( NICU ) and by using covers over the incubators and cribs ; b ) use of positioning aids such as boundary supports , nests , and buntings to promote a balance of flexion and extension postures ; c ) modification of direct h and s-on caregiving to maximize preparation of infants for , tolerance of , and facilitation of recovery from interventions ; d ) promotion of self-regulatory behaviors such as holding on , grasping , and sucking ; e ) attention to the readiness for and the ability to take oral feedings ; and f ) involving parents in the care of their infants as much as possible . The infants ' sleep was recorded at 36 weeks postconceptional age ( PCA ) and at 3 months corrected age ( CA ) using the Motility Monitoring System ( MMS ) , an automated , nonintrusive procedure for determining sleep state from movement and respiration patterns . Behavioral and developmental outcome was assessed by the Neurobehavioral Assessment of the Preterm Infant ( NAPI ) at 36 weeks PCA , the APIB at 42 weeks PCA , and by the Bayley Scales of Infant Development ( BSID ) at 4 , 12 , and 24 months CA . RESULTS Sleep developmental measures at 3 months CA showed a clear developmental change compared with 36 weeks PCA . These include : increased amount of quiet sleep , reduced active sleep and indeterminate sleep , decreased arousal , and transitions during sleep . Longest sleep period at night showed a clear developmental effect ( increased ) when comparing nighttime sleep pattern of infants at 3 months with those at 36 weeks of age . Day-night rhythm of sleep-wake increased significantly from 36 weeks PCA to 3 months CA . However , neither of these sleep developmental changes showed any significant effects of NIDCAP intervention . Although all APIB measures showed better organized behavior in NIDCAP patients , neither NAPI nor Bayley showed any developmental advantages for the intervention group . The neurodevelopmental outcome measured by the Bayley at 4 , 12 , and 24 months CA showed 64 % of the NIDCAP intervention group at the lowest possible score compared with 33 % of the control group . These findings could not be explained by the occurrence of intraventricular hemorrhage or the socioeconomic status of the parents , which showed no significant group effect . CONCLUSION The results of this study , including measures of sleep maturation and neurodevelopmental outcome up to 2 years of age did not demonstrate that the NIDCAP intervention results in increased maturity or development . Buehler et al ( Pediatrics . 1995;96:923 - 932 ) have reported that premature infants ( N = 12 ; mean gestational age 32 weeks , mean birth weight 1700 g ) who received developmental care compared with a similar group of infants who received routine care showed better organized behavioral performance on an APIB assessment at 42 weeks PCA . None of the medical outcome measures were significantly different in this study . Although our APIB results are in agreement , the results of the NAPI , the Bayley and sleep measures do not show an increase in neurodevelopmental maturation . In the earlier report by Als et al ( Journal of the American Medical A r and omized controlled trial was carried out for 1 y in three tertiary and teaching hospitals , in Addis Ababa ( Ethiopia ) , Yogyakarta ( Indonesia ) and Merida ( Mexico ) , to study the effectiveness , feasibility , acceptability and cost of kangaroo mother care ( KMC ) when compared to conventional methods of care ( CMC ) . About 29 % of 649 low birthweight infants ( LBWI ; 1000‐1999 g ) died before eligibility . Of the survivors , 38 % were excluded for various reasons , 149 were r and omly assigned to KMC ( almost exclusive skin‐to‐skin care after stabilization ) , and 136 to CMC ( warm room or incubator care ) . There were three deaths in each group and no difference in the incidence of severe disease . Hypothermia was significantly less common in KMC infants in Merida ( 13.5 vs 31.5 episodes/100 infants/d ) and overall ( 10.8 vs 14.6 ) . Exclusive breastfeeding at discharge was more common in KMC infants in Merida ( 80 % vs 16 % ) and overall ( 88 % vs 70 % ) . KMC infants had a higher mean daily weight gain ( 21.3 g vs 17.7 g ) and were discharged earlier ( 13.4 vs 16.3 d after enrolment ) . KMC was considered feasible and presented advantages  over CMC  in terms of maintenance of equipment . Mothers expressed a clear preference for KMC and health workers found it safe and convenient . KMC was cheaper  than CMC in terms of salaries ( US$ 11 788 vs US$ 29 888 ) and other running costs ( US$ 7501 vs US$ 9876 ) . This study confirms that hospital KMC for stabilized LBWI 1000‐1999 g is at least as effective and safe as CMC , and shows that it is feasible in different setting s , acceptable to mothers of different cultures , and less expensive . Where exclusive breastfeeding is uncommon among LBWI , KMC may bring about an increase in its prevalence and duration , with consequent benefits for health and growth . For hospitals in low‐income countries KMC may represent an appropriate use of scarce re sources OBJECTIVE To investigate the effects of early experience on brain function and structure . METHODS A r and omized clinical trial tested the neurodevelopmental effectiveness of the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) .  Thirty preterm infants , 28 to 33 weeks ' gestational age ( GA ) at birth and free of known developmental risk factors , participated in the trial . NIDCAP was initiated within 72 hours of intensive care unit admission and continued to the age of 2 weeks , corrected for prematurity . Control ( 14 ) and experimental ( 16 ) infants were assessed at 2 weeks ' and 9 months ' corrected age on health status , growth , and neurobehavior , and at 2 weeks ' corrected age additionally on electroencephalogram spectral coherence , magnetic resonance diffusion tensor imaging , and measurements of transverse relaxation time . RESULTS The groups were medically and demographically comparable before as well as after the treatment . However , the experimental group showed significantly better neurobehavioral functioning , increased coherence between frontal and a broad spectrum of mainly occipital brain regions , and higher relative anisotropy in left internal capsule , with a trend for right internal capsule and frontal white matter . Transverse relaxation time showed no difference . Behavioral function was improved also at 9 months ' corrected age . The relationship among the 3 neurodevelopmental domains was significant . The results indicated consistently better function and more mature fiber structure for experimental infants compared with their controls . CONCLUSIONS This is the first in vivo evidence of enhanced brain function and structure due to the NIDCAP . The study demonstrates that quality of experience before term may influence brain development significantly CONTEXT Few studies document how parents adapt to the experience of a very low-birth-weight ( VLBW ; < 1500 g ) birth despite societal concerns about the ethics and justification of intensive care for these infants . OBJECTIVE To determine the degree and type of stress experienced over time by mothers whose infants vary in degree of prematurity and medical and developmental risk . DESIGN Longitudinal prospect i ve follow-up study of a cohort of mothers of high- and low-risk VLBW and term infants from birth to 3 years . SETTING All level III neonatal intensive care units from a large midwestern metropolitan region . PARTICIPANTS Mothers and infants prospect ively and consecutively enrolled in a longitudinal study between 1989 and 1991 . High-risk VLBW infants were diagnosed as having bronchopulmonary dysplasia , and comparison groups were low-risk VLBW infants without bronchopulmonary dysplasia and term infants ( > 36 weeks , > 2500 g ) . MAIN OUTCOME MEASURES St and ardized , normative self-report measures of maternal psychological distress , parenting stress , family impact , and life stressors . RESULTS Mothers of VLBW infants ( high risk , n = 122 ; low risk , n = 84 ) had more psychological distress than mothers of term infants ( n=123 ) at 1 month ( 13 % vs 1 % ; P = .003 ) . At 2 years , mothers of low-risk VLBW infants did not differ from term mothers , while mothers of high-risk infants continued to report psychological distress . By 3 years , mothers of high-risk VLBW children did not differ from mothers of term children in distress symptoms , while parenting stress remained greater . Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups . CONCLUSIONS The impact of VLBW birth varies with child medical risk status , age , and developmental outcome . Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period , with monitoring of mothers of high-risk VLBW infants Mothers of low-birthweight babies born at the Medical Center Hospital of Vermont during a 21-month period were r and omly assigned to experimental ( N = 34 ) and control ( N = 40 ) groups . Forty-one normal-birthweight controls were also recruited . Experimental mothers received an 11-session intervention program which emphasized maternal sensitivity and responsiveness to infant social signals . This paper analyzes the impact of the program , by 6 months , on maternal adaptation and psychopathology , and on infant cognitive development and temperament CONTEXT Despite more than 2 decades of outcomes research after very preterm birth , clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight ( ELBW ) infants . OBJECTIVE To determine the individual and combined prognostic effects of bronchopulmonary dysplasia ( BPD ) , ultrasonographic signs of brain injury , and severe retinopathy of prematurity ( ROP ) on 18-month outcomes of ELBW infants . DESIGN Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms ( TIPP ) . SETTING AND PARTICIPANTS A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada , the United States , Australia , New Zeal and , and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks . MAIN OUTCOME MEASURES Combined end point of death or survival to 18 months with 1 or more of cerebral palsy , cognitive delay , severe hearing loss , and bilateral blindness . RESULTS Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome . Odds ratios were 2.4 ( 95 % confidence interval [ CI ] , 1.8 - 3.2 ) for BPD , 3.7 ( 95 % CI , 2.6 - 5.3 ) for brain injury , and 3.1 ( 95 % CI , 1.9 - 5.0 ) for severe ROP . In children who were free of BPD , brain injury , and severe ROP the rate of poor long-term outcomes was 18 % ( 95 % CI , 14%-22 % ) . Corresponding rates with any 1 , any 2 , and all 3 neonatal morbidities were 42 % ( 95 % CI , 37%-47 % ) , 62 % ( 95 % CI , 53%-70 % ) , and 88 % ( 64%-99 % ) , respectively . CONCLUSION In ELBW infants who survive to a postmenstrual age of 36 weeks , a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment OBJECTIVE To examine long-term outcomes in families of children with very low birth weights ( < 1500 g ) in relation to the extent of low birth weight and neonatal medical risk . DESIGN Concurrent/cohort prospect i ve study . SETTING Regional follow-up program . PARTICIPANTS Families of 60 children of school age with birth weights less than 750 g , 55 with birth weights between 750 and 1499 g , and 49 normal birth weight full-term controls . MAIN OUTCOME MEASURES Parent ratings of psychological distress , family function , and child-related stress . RESULTS Families with children with birth weights less than 750 g experienced greater stress than did families of controls ( born at full term ) , and families who were sociodemographically advantaged experienced greater stress than did those who were disadvantaged . Higher neonatal medical risk also predicted a more negative impact on the family , but only in advantaged families . Regression analyses suggested that adverse family outcomes were mediated by ongoing problems in child functioning . CONCLUSIONS Families of children with birth weights less than 750 g experience more long-term adversity than families of full-term children . Family sequelae are also present for children with very low birth weight at high neonatal medical risk . Ongoing child health and behavior problems may be the major source of these sequelae , and sociodemographic status is an important consideration in identifying family adversity . Although many families appear unaffected , results support the need to monitor family outcomes and develop interventions for both the child and family The outcome of an early intervention program for low-birthweight ( LBW ) infants was examined in this study . The intervention consisted of 11 sessions , beginning during the final week of hospitalization and extending into the home over a 3-month period . The program aim ed to facilitate maternal adjustment to the care of a LBW infant , and , indirectly , to enhance the child 's development .  Neonates weighing less than 2,200 grams and under 37 weeks gestational age were r and omly assigned to experimental or control conditions . A full-term , normal birthweight ( NBW ) group served as a second control . 6-month analyses of dyads who completed all assessment s over a 4-year period ( N 's = 25 LBW experimental , 29 LBW control , and 28 NBW infant-mother dyads ) showed that the experimental group mothers reported significantly greater self-confidence and satisfaction with mothering , as well as more favorable perception of infant temperament than LBW control group mothers . A progressive divergence between the LBW experimental and LBW control children on cognitive scores culminated in significant group differences on the McCarthy GCI at ages 36 and 48 months , when the LBW experimental group caught up to the NBW group . Possible explanations for the observed delay in the emergence of intervention effects on cognitive development and the mediating role of favorable mother-infant transactional patterns are discussed in light of recent evidence from the literature OBJECTIVE To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants . DESIGN R and omized controlled trial . SETTING Newborn intensive care unit . PATIENTS Thirty-eight singleton preterm infants , free of known congenital abnormalities , weighing less than 1250 g , born before 30 weeks ' gestation , mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours , r and omly assigned to a control or an experimental group . INTERVENTION Caregiving by nurses specifically trained in individualized developmental care ; observation and documentation of the infants ' behavior within 12 hours of admission , and subsequently every 10th day ; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists ; and the availability of special caregiving accessories . MAIN OUTCOME MEASURES Medical outcome , including average daily weight gain ; number of days the infant required mechanical ventilation , oxygen , gavage tube feeding , and hospitalization ; severity of retinopathy of prematurity , bronchopulmonary dysplasia , pneumothorax , and intraventricular hemorrhage ; pediatric complications ; age at discharge ; and hospital charges . Neurodevelopmental outcome , including Assessment of Preterm Infants ' Behavior scale and quantified electroencephalography ( 2 weeks after due date ) ; and Bayley Scales of Infant Development and Kangaroo Box Paradigm ( 9 months after due date ) . RESULTS The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support ; earlier oral feeding ; reduced incidence of intraventricular hemorrhage , pneumothorax , and severe bronchopulmonary dysplasia ; improved daily weight gain ; shorter hospital stays ; younger ages at hospital discharge ; and reduced hospital charges compared with the infants in the control group . At 2 weeks after their due date s , these infants also showed improved autonomic regulation , motor system functioning , self-regulatory abilities , and visual evoked potential measures ; and at 9 months , they had improved Bayley Mental and Psychomotor Developmental Index scores , as well as Kangaroo Box Paradigm scores . CONCLUSION Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome AIM To test the effectiveness of a home based developmental education programme in very preterm children . METHODS A r and omised controlled trial was conducted of developmental or social support intervention , started at discharge for up to 2 years , in 309 consecutive survivors of 32 weeks gestation or less , born to mothers resident in greater Bristol between December 1990 and July 1993 . Home visits were made by research nurses trained in either Portage ( a developmental education programme ) or in nondirectional counselling ( parent adviser scheme ) . Interventions were also provided to appropriate primary care and community support for disability . Griffiths Mental Development Scales were used to assess outcome at 2 years . RESULTS Mean ( SEM ) Griffiths quotients ( GQ ) were : Portage 96.8 ( 1.6 ) ; parent adviser 95.9 ( 1.6 ) ; preterm control 92.9 ( 2.0 ) . Despite r and omisation , social variables significantly confounded these results . Using linear regression analysis , intervention was associated with improved scores : Portage : + 4.3 GQ points ( 95 % CI 1.6 to 7.0 ) ; parent adviser : + 3.4 GQ points ( 1.4 to 6.1 ) . The effect of Portage  was greatest in those children with birthweights < 1250 g ( + 5.3 GQ points ( 0.2 to 10.4 ) and in those with an abnormal neonatal cerebral ultrasound scan ( + 7.3 GQ points ( 1.6 to 13.0 ) . CONCLUSION Primary analysis showed no developmental benefit from long term family support after preterm birth . Secondary analysis controlling for the presence of adverse social markers showed similar small advantage for both intervention groups . In the smallest infants and those with brain injuries , a structured developmental programme may offer advantage over social support intervention The Infant Health and Development Program is an eight-site clinical trial design ed to evaluate the efficacy of a comprehensive early intervention in reducing the developmental and health problems of low-birth-weight ( less than or equal to 2500 g ) premature ( less than or equal to 37 weeks ) infants . Nine hundred eighty-five infants , stratified by site and weight ( less than or equal to 2000 g or 2001 to 2500 g ) , were r and omly assigned to receive an educational curriculum focused on child development , as well as family support and pediatric follow-up , or only pediatric follow-up . At corrected age 36 months , the intervention group had significantly higher mean IQ scores than the follow-up group ( mean difference in the heavier group was 13.2 and in the lighter group 6.6 ) , significantly fewer maternally reported behavior problems , and a small , but statistically significant , increase in maternally reported minor illnesses for the lighter-birth-weight group only , with no difference in serious health conditions Background and Objective . Family-centered developmentally supportive care of very low birth weight infants , provided by the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) has been reported to have positive medical and economic impacts . Our aim was to investigate its effect on need of ventilatory assistance , growth , and hospitalization in a Swedish setting . Methods . Preterm infants born between September 1994 and April 1997 with a gestational age < 32 weeks and with a need of ventilatory assistance at 24 hours were r and omly assigned to either NIDCAP ( n = 12 ) or conventional care ( n = 13 ) . The 2 groups were comparable ( median [ range ] ) with respect to birth weight ( 1083 [ 630–1411 ] vs 840[636–1939 g ] ) , head circumference ( 24.0 [ 22.3–26.5 ] vs 24.0 [ 21.1–30.0 cm ] ) , gestational age ( 27.6 [ 24.0–28.7 ] vs 26.1 [ 23.9–30.3 ] weeks ) , female/male ratio ( 3/9 vs 9/8 ) and Clinical Risk Index for Babies ( 4.0 [ 0–11 ] vs 6.0 [ 2–15 ] ) . The infants in the intervention group were cared for in a separate room by a group of specially trained nurses . Formal weekly observations of these infants starting within 3 days after birth and continuing until 36 weeks postconception were used to develop individualized care plans . These plans provided recommendations as to how care might be attuned to the current developmental stage of the infant and how the family might be supported and stimulated to participate in this care . The treatment of the 2 groups was in all other respects identical . Results . The duration of mechanical ventilation ( median [ range ] was 2.8 [ 0–36.7 ] days in the intervention group vs 4.8 [ .1–29.8 ] days ; not significant [ NS ] ) among the controls and continuous positive airway pressure was applied for 26.1 ( 6.9–52.0 ) vs 43.9 ( 5.0–65.1 ) days . Supplementary oxygen was withdrawn at 33.0 ( 29.3–35.7 ) vs 38.1 ( 33.1–44.9 ) weeks of postconceptional age ( PCA ) . The weight gain up to 35 weeks of PCA was 13.0 ( 6.7–21.0 ) vs 9.8 ( 6.8–16.6 ) g/day ( NS ) . The head growth up to 35 weeks of PCA was .73 ( .56–1.3 ) vs .63 ( .56-.77 ) cm/week ( NS ) . The age of the infant at discharge was 38.3 ( 36.1–57.7 ) vs 41.0 ( 36.9–48.4 ) weeks of PCA ( NS ) . Conclusions . NIDCAP does not seem to have detrimental effects on Swedish very low birth weight infants in comparison with conventional care . Indeed , NIDCAP might even be advantageous OBJECTIVE To assess the effectiveness and safety of Kangaroo Mother Care ( KMC ) for infants of low birth weight . METHODS An open , r and omized , controlled trial of a Colombian social security referral hospital was conducted . A total of 1084 consecutive infants who were born at < /=2000 g were followed , and 746 newborns were r and omized when eligible for minimal care , with 382 to KMC and 364 to " traditional " care .  Information on vital status was available for 693 infants ( 93 % ) at 12 months of corrected age . KMC consisted of skin-to-skin contact on the mother 's chest 24 hours/day , nearly exclusive breastfeeding , and early discharge , with close ambulatory monitoring . Control infants remained in incubators until the usual discharge criteria were met . Both groups were followed at term and at 3 , 6 , 9 , and 12 months of corrected age . The main outcomes measured were morbidity , mortality , growth , development , breastfeeding , hospital stay , and sequelae . RESULTS Baseline variables were evenly distributed , except for weight at recruitment ( KMC : 1678 g ; control participants : 1713 g ) . The risk for death was lower among infants who were given KMC , although the difference was not significant ( KMC : 11 [ 3.1 % ] of 339 ; control participants : 19 [ 5.5 % ] of 324 ; relative risk : 0.57 ; 95 % confidence interval : 0.17 - 1.18 ) . The growth index of head circumference was statistically significantly greater in the group given KMC , but the developmental indices of the 2 groups were similar . Infants who weighed < /=1500 g at birth and were given KMC spent less time in the hospital than those who were given st and ard care . The number of infections was similar in the 2 groups , but the severity was less among infants who received KMC . More of these infants were breastfed until 3 months of corrected age . CONCLUSION These results support earlier findings of the beneficial effects of KMC on mortality and growth . Use of this technique would humanize the practice of neonatology , promote breastfeeding , and shorten the neonatal hospital stay without compromising survival , growth , or development It has been proposed that the developmentally supportive care of very‐low‐birthweight ( VLBW ) infants provided by the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) can improve the infants ' opportunities for rest and sleep . The aim of the present study was to determine whether quiet sleep ( QS ) in VLBW infants is affected by NIDCAP care . Twentytwo infants with a gestational age of < 32 wk at birth r and omly received either NIDCAP ( n= 11 ) or conventional care ( n= 11 ) . These two groups were comparable ( mean ( SD ) ) with respect to birthweight ( 1021 ( 240 ) vs 913 ( 362 ) g , respectively ) and gestational age ( 27.1 ( 1.7 ) vs 26.4 ( 1.8 ) wk ) . The infants in the NIDCAP group were cared for in a separate room by a group of specially trained nurses and subjected to weekly NIDCAP observations until they reached a postconceptional age ( PCA ) of 36 wk . Quiet sleep ( QS ) was assessed from 24‐h amplitude‐integrated EEGs recorded at 32 and 36 wk of PCA . The percentage of time [ mean ( SD ) ] spent in QS at 32 wk of PCA was 33.5 ( 2.6 ) % for the NIDCAP group and 33.3 (6.9)% for the control infants ( ns ) . At 36 wk , the corresponding values were 24.5 (3.2)% and 25.7 (4.7)% , respectively ( ns ) . The number of QS periods/24 h decreased equally in both groups in association with maturation : from 24.6 ( 3.3 ) to 16.8 ( 1.8 ) and from 25.0 ( 5.8 ) to 17.5 ( 3.3 ) , at 32 wk , and 36 wk of PCA , respectively ( NS ) ABSTRACT . We investigated the effects of a 1 -year home intervention on premature infants with low ( < 1500 g ) and higher ( 1500–2000 g ) birth weights . Infants from each weight condition were block r and omly assigned to a control or to one of two treatment groups . One treatment group focused on the development of the infant ; the other treatment group focused on the parent-infant interaction . The low birth weight infants obtained significantly lower Bayley mental and motor scores , and were more passive and less intense than the higher birth weight infants . However , the low birth weight infants and their parents were more responsive to the home intervention than were the higher birth weight infants , as demonstrated by changes in the Bayley mental scores and the Home Observation for Measurement of the Environment ( HOME ) inventory . These findings exemplify the reciprocal relationship between the child 's characteristics and parental responding . The importance of selecting the most high-risk premature infants for early home intervention is outlined The effects of nursery-based intervention with healthy , prematurely born babies and their socially disadvantaged mothers were evaluated . Mother-infant dyads were r and omly assigned to one of three intervention groups : In group one , the babies received special stimulation design ed to make them more active contributors to the interactions with their mothers ; in group two , mothers received special training to help them become more responsive to cues from their babies ; in group three , infants received stimulation and mothers received training . In addition , a fourth group of preterm babies who received regular hospital care served as a comparison group to assess the short-term effects of the stimulation program . Outcome measures design ed to evaluate various aspects of mother-infant interaction and infant development failed to reflect any effects of the interventions , either at the time the babies were discharged from the hospital or one year later . We attribute the lack of positive findings to the fact that the mothers faced numerous crises in their social environments . We conclude , therefore , that nothing short of massive social change is likely to result in measurable effects OBJECTIVE To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program , an early childhood intervention that was provided to low-birth-weight ( LBW ) premature infants from neonatal discharge through age 3 years . DESIGN R and omized , controlled , multicenter trial , stratified by two LBW groups : lighter ( < or = 2000 g ) and heavier ( 2001 to 2500 g ) . SETTING Eight socioeconomically heterogeneous clinical sites . PARTICIPANTS Of 985 eligible infants weighing 2500 g or less and at 37 weeks ' or less gestational age , 377 infants were r and omly assigned to the intervention group and 608 to the follow-up only group . About two thirds of the infants in each group were in the lighter LBW stratum , and one third were in the heavier LBW stratum . INTERVENTION The intervention group received home visits ( from neonatal discharge through age 3 years ) as well as center-based schooling ( from 1 to 3 years of age ) . Children in both groups received pediatric surveillance . MAIN OUTCOME MEASURES Cognitive development , behavioral competence , and health status . RESULTS At age 5 years , the intervention group had full-scale IQ scores similar to children in the follow-up only group . However , in the heavier LBW stratum , children in the intervention group had higher full-scale IQ scores ( 3.7 points higher ; P = .03 ) and higher verbal IQ scores ( 4.2 points higher ; P = .02 ) . No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants . The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum . CONCLUSION The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants ' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants . The intervention did not affect health or behavior at age 5 years in either LBW stratum The purpose of this pilot study was to evaluate the effectiveness of a parent-focused intervention program ( COPE ) on infant cognitive development and maternal coping . A r and omized clinical trial was conducted with 42 mothers of low-birth-weight ( LBW ) premature infants hospitalized in a neonatal intensive care unit ( NICU ) , with follow-up at 3 months ' and 6 months ' corrected ages . COPE mothers received the four-phase educational-behavioral program that began 2 - 4 days postbirth and continued through 1 week following discharge from the NICU . Comparison mothers received audiotaped information during the same four time frames . Results indicated that COPE infants had significantly higher mental development scores at a 3 months ' corrected age ( M = 100.3 ) than did the comparison infants ( M = 93.9 ) , and this difference widened at 6 months ' corrected age , with COPE infants scoring 14 points higher . COPE mothers were significantly less stressed by the NICU sights and sounds and had significantly stronger beliefs about what behaviors and characteristics to expect from their premature infants . Findings from this study support the need for further testing of early NICU interventions with parents to determine their effectiveness on parental coping and infant developmental outcomes Many preterm infants cared for in incubators do not experience Kangaroo Care ( KC ) , skin-to-skin contact with their mothers , due to fear of body heat loss when being held outside the incubator . A r and omized clinical trial of 16 KC and 13 control infants using a pretest-test-posttest design of three consecutive interfeeding intervals of 2.5 to 3.0 h duration each was conducted over 1 day . Infant abdominal and toe temperatures were measured in and out of the incubator ; maternal breast temperature was measured during KC . Repeated measures ANOVA showed no change in abdominal temperature across all periods and between groups . Toe temperatures were significantly higher during KC than incubator periods , and maternal breast temperature met each infant ’s neutral thermal zone requirements within 5 min of onset of KC .  Preterm infants similar to those studied here will maintain body warmth with up to 3 h of KC Thirty healthy preterm infants were r and omly assigned either to a control group or to one of two experimental groups . The mothers of the first experimental group were present during an administration of the Brazelton Neonatal Behavioral Assessment Scale and were asked to complete the Mother 's Assessment of the Behavior of Her Infant Scale ( MABI ) at birth and weekly for four weeks after the discharge of their infants . The mothers of the second experimental group were not present during the administration of the Brazelton scale , but were asked to complete the MABI scale at birth and weekly for the first month after discharge . The mothers of the control infants did not observe administration of the Brazelton scale or complete the MABI scale , but were asked to complete a question naire on the developmental milestones of their infants . At 1 , 4 , and 12 months of age these infants were visited in their homes by teams of research ers blind to the hypothesis of the study and to the group assignment of the infants . The results at 1 month demonstrated that the experimental groups performed more optimally on the Brazelton scale interactive process items . These infants also received superior ratings on the video-taped feeding and face-to-face play sequences . At 4 months the experimental group infants showed better fine motor-adaptive abilities on the Denver Developmental Screening Test than did the control group . In addition , the face-to-face interaction ratings of the two experimental groups were significantly better that were those of the control group . The Bayley Scales of Infant Development were administered when the infants were 12 months corrected age . The infants of the experimental groups received significantly higher scores on the Mental Development Scale . This study suggests that teaching mothers the amazing skills of their newborns on the Brazelton and MABI scales may facilitate early interactions which , in turn , may contribute to early cognitive development AIM Care based on the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) has been reported to exert a positive impact on the development of prematurely born infants . The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk . METHODS All surviving infants in a r and omised controlled trial with infants born at a postmenstrual age less than 32 wk ( 11 in the NIDCAP group and 15 in the control group ) were examined at 66.3 ( 6.0 ) mo corrected for prematurity [ mean ( SD ) ] . In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised ( WPPSI-R ) for cognition , Movement Assessment Battery for Children ( Movement ABC ) for motor function , subtests of the NEPSY test battery for attention and distractibility , and the WHO definitions of impairment , disability and h and icap . Exact binary logistic regression was employed . RESULTS There were no significant differences between the intervention group in Full-Scale IQ 93.4 ( 14.2 ) [ mean ( SD ) ] versus the control group 89.6 ( 27.2 ) , Verbal IQ 93.6 ( 16.4 ) versus 93.7 ( 26.8 ) or Performance IQ 94.3 ( 14.7 ) versus 86.3 ( 24.8 ) . In the NIDCAP group 8/13 ( 62 % ) survived without disability and for the children with conventional care this ratio was 7/19 ( 37 % ) . The corresponding ratios for surviving without mental retardation were 10/13 ( 77 % ) and 11/19 ( 58 % ) , and for surviving without attention deficits 10/13 ( 77 % ) and 10/19 ( 53 % ) . Overall , the differences were not statistically significant , although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age , gender , growth retardation and educational level of the parents . CONCLUSION Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely . However , due to problems of recruitment less than half of the anticipated subjects were included in the study , which implies a low power and calls for caution in interpreting our findings . Larger trials in different cultural context s are warranted OBJECTIVE To determine the effect of an early intervention programme ( EIP ) on low birthweight infants with cerebral injuries . METHODS Subjects were 23 high-risk low birthweight infants ( periventricular leukomalacia 15 , intraventricular haemorrhage 5 , both 3 ) receiving care in the neonatal intensive care unit ( NICU ) at Nagasaki University Hospital . Subjects were r and omly assigned to the EIP  group ( n = 12 ) or the control group  ( n = 11 ) . Participants in the EIP group received a Neonatal Behavioral Assessment scale (NBAS)-based intervention combined with developmental support design ed to enhance the infants ' development and the quality of the parent-infant relationship . The control group received routine medical nursing care without the EIP . The EIP began prior to discharge from the NICU and lasted until 6 months of corrected age . All children were examined on the NBAS preintervention and again at 44 weeks postconceptional age . Maternal anxiety status ( STAI ) and maternal feelings of confidence in dealing with her baby ( LCC ) were measured pre and postintervention . Mental and motor development was assessed postintervention using the Bayley Scale of Infant Development . RESULTS Orientation and State Regulation of infant behavioural profiles , the STAI and LCC scores significantly improved in the EIP group ( mean difference ( 95 % CI ) : Orientation 0.7 ( 0.4 , 1.1 ) , State Regulation 0.9 ( 0.3 , 1.5 ) , STAI -5.5 ( - 9.1 , -1.9 , LCC 5.3 ( 4.2 , 6.5 ) ) , but not in the control group . Bayley mental developmental index ( MDI ) score in the EIP group was higher than in the control group , but there was no significant difference between the two groups ( mean difference ( 95 % CI ) : MDI 8.5 ( - 0.8 , 17.8 ) , PDI 6.7 ( - 1.9 , 15.4 ) ) . CONCLUSION The EIP has beneficial effects on neonatal neurobehavioural development and maternal mental health of low birthweight infants with cerebral injuries . This evidence suggests that short-term changes in maternal mental health and infant neurobehaviour promoted by an EIP may serve to initiate a positive interaction between parents and infants BACKGROUND Several studies report increased minor neurodevelopment dysfunctions in children born very low birth weight ( VLBW ) . Usefulness of preventive early intervention programs to improve neurodevelopment outcome of VLBW infants is still under investigation . AIMS To evaluate the effects of an early post-discharge developmental mother-child intervention program on neurodevelopment outcome at 36 months in VLBW infants . STUDY DESIGN Prospect i ve study . SUBJECTS 36 VLBW infants ( [ mean ( S.D. ) ] birthweight=864 g ( 204 g ) ; gestational age=27.9 weeks ( 2.4 weeks ) ) , consecutively born January-August 2001 , r and omized in intervention and control groups . OUTCOME MEASURES Neurodevelopment assessment at 36 months of chronological age with use of the Griffiths Mental Development Scale and related subscales . RESULTS At 36 months of chronological age , as compared to controls , children in intervention group exhibited higher scores in personal-social subscales ( [ mean (S.D.)]=101.4 ( 9.3 ) vs. 92.9 ( 12.1 ) , P=0.02 ) , eye-h and coordination ( 92.7 ( 4.5 ) vs. 87.1 ( 9.9 ) , P=0.041 ) , practical reasoning ( 98.6 ( 8.2 ) vs. 89.4 ( 10.1 ) , P=0.01 ) . Development Scale were 97.6 ( 5.5 ) and 92.4 ( 9.9 ) , respectively , in intervention and control groups ( P=0.074 ) . CONCLUSIONS Early post-discharge developmental mother-child intervention program may have a positive effect on later neurodevelopment outcome of VLBW children BACKGROUND Prolonged hospitalization of low birth weight infants increases the risk of medical and psychosocial complications . The feasibility of earlier discharge with community-based follow-up of infants of < or = 2000 g birth weight , without the use of home apnea monitors , was investigated . METHODS One hundred infants of < or = 2000 g birth weight were r and omized to either an intervention or control group . Intervention infants were discharged when readiness criteria were met . Based on assessed need , intervention group families received public health nursing and homemaker services for up to 8 weeks . Control infants were discharged to their homes at the discretion of the attending physician . All infants were assessed blindly at age 1 year with the Bayley and Home Observation for Measurement of the Environment ( HOME ) scales . RESULTS There were no group differences in baseline infants ' characteristics or in neonatal complications . Infants in the intervention group were discharged from the hospital at an earlier postconceptional age ( mean + /- SD 36.6 + /- 1.5 weeks vs 37.3 + /- 1.6 weeks ; P < .04 ) . Median length of hospital stay ( 23 days vs 31.5 days ) and mean weight at the time of discharge ( 2200 + /- 288 g vs 2275 + /- 301 g ) were lower , but not significantly , for infants in the intervention group . A secondary analysis by birth weight strata ( < or = 1500 g and 1501 through 2000 g ) revealed that the most significant reductions in hospital stay and weight at discharge were realized in infants of 1501 through 2000 g birth weight . The persistence of apneic episodes and need for electronic monitoring prevented earlier discharge of infants of < or = 1500 g birth weight . Postdischarge services to the intervention group included 185 public health nurse home visits ( 3.8 + /- 0.91 ) , 410 phone contacts ( 8.4 + /- 5 ) , and 2298 homemaker hours ( 46 + /- 78 ) of service . At 1 year , there were no deaths and no group differences in rehospitalization rates , use of ambulatory services , or Bayley scores . Intervention families had significantly higher 1-year HOME scores . Minimum cost of hospital care was $ 873 per day , while the total cost of community-based services averaged $ 626 per infant . CONCLUSIONS A significant reduction in average length of hospital stay was achieved for infants of 1501 through 2000 g birth weight . Earlier discharge of infants weighing < or = 1500 g at birth was hampered by persistent apneic episodes and feeding difficulties . A community-based program design ed to provide individualized support and education for families of low birth weight infants was cost-effective and had a positive influence on the home environment OBJECTIVE To compare school performance at age 10 years in a cohort of extremely preterm children and term control subjects and to examine the impact of family composition and stability on performance . STUDY DESIGN Prospect i ve , longitudinal follow-up from birth to 10 years of age of a regional cohort of children born at 24 to 31 weeks of gestational age and sociodemographically matched term control subjects .  Family composition , extent of parental care giving , and family moves were tracked sequentially . At 10 years , academic achievement and school performance were ascertained for 118 of 125 ( 94 % ) preterm survivors and 119 of 125 ( 95 % ) term children . RESULTS Term children were more likely to demonstrate optimal school outcome ( appropriate grade level without additional classroom assistance ) than were preterm children ( odds ratio 3.4 , 95 % CI 1.9 - 6.0 ) . Medical complications related to prematurity had little impact on school outcome . Among preterm children , optimal school outcome was significantly associated with increased parental education , child rearing by 2 parents ( regardless of marital status ) , and stability in family composition and geographic residence over 10 years . These environmental influences were less pronounced among term control subjects . CONCLUSION Although preterm children performed less well in school than term children , family factors were stronger predictors of school performance than were perinatal complications OBJECTIVE To evaluate the effect of early intervention on the intellectual development of the premature infants . METHODS Premature infants at gestational age of 28 - 36.9 weeks were r and omly divided into two groups : intervention and conventional care groups . Normal newborn infants during the same period were included in the control group ( routine care ) . Up to March 1996 , 156 cases were over the age 1.5 - 2 years ( corrected age ) , 52 in the intervention group , 51 in the conventional care group and 53 in the normal control group . Parents were taught to carry out the 0 - 2 year intervention program , which included motor , cognitive , speech development and social behavior . Every three months , height , weight and head circumference were measured . At the age of one and a half and two years , all infants in the three groups received infant development tests of Child Development Center of China ( CDCC ) scale . The examiner did not know which infant had received intervention . RESULTS There was no significant difference in biological factors among the two premature groups and in cultural and social factors among the three groups . Intelligence tests at the age of one and a half and two years showed that the average mental development index ( MDI ) in the intervention group was 13.8 and 14.6 higher than those in the conventional care group and the differences were significant . The psychomotor development index ( PDI ) was 5.2 and 4.7 higher but the differences were not significant . The MDI and PDI in the intervention group and normal control were quite close , but at two years , the MDI and PDI in the intervention group were 5.7 and 7.3 higher than those in the normal control and the differences were significant ( P < 0.05 ) . Compared with the normal control , the MDI in conventional care group at one and a half and two years of age were 11.5 and 8.9 lower . The difference was very significant . There were four cases of mental retardation , whose mental development index ( MDI ) was less then 70 in the conventional care group , but none in the intervention group . CONCLUSIONS Early intervention can promote intellectual development of the premature infants and may be beneficial to the prevention of mental retardation . Early and intensive intervention can produce better results . Bringing parent 's initiative into full play through deepening their underst and ing of the importance of early intervention is the key to success OBJECTIVE To describe the mental and emotional well-being of children born at different birth weights assessed at school age and to identify neonatal , intervening health , and sociodemographic and environmental factors associated with mental and emotional well-being . METHODS To address this issue , we used a prospect i ve cohort study involving two previously studied cohorts , which were recontacted at 8 to 10 years of age to provide a multisite sample of 247 children weighing 1000 g or less at birth , 364 weighing 1001 to 1500 g , 724 weighing 1501 to 2500 g , and 533 weighing more than 2500 g. Maternal reports were obtained on three st and ardized measures of mental and emotional well-being ( the R and General Well-being Scale , the Behavior Problem Index , and the Harter Scale of Child Competence ) and on intervening health , sociodemographic , and environmental variables . Neonatal variables were derived from records at birth . Statistical techniques included analysis of variance and ordinary least squares multiple regression . RESULTS Lower birth weight children did not differ on the General Well-being Scale but were more likely to have behavior problems and to be considered less competent . Other important correlates of mental and emotional well-being included childhood illness , maternal mental health , home environment score , and exposure to household cigarette smoking . CONCLUSION Although lower birth weight children have poorer mental and emotional well-being , a substantial portion of this adverse outcome reflects modifiable environmental factors We investigated the effects of a year-long home intervention with a sample of preterm infants r and omly assigned to 1 of 3 groups : a developmental intervention , a parent-infant intervention , and a no-treatment control group . A full-term no-treatment control was also used . Both intervention approaches focused on the parent-child unit , providing training for parents to improve observational skills , emotional support , and information about community re sources . However , whereas specific tasks to facilitate the child 's development were provided in the developmental intervention group , the quality of the parent-infant interaction was the target for treatment in the other group . All infants were assessed at 4 , 8 , 12 , and 16 months of age corrected for prematurity . The results suggest that although both intervention approaches were effective in modifying some aspects of the home environment and , to a lesser degree , in improving infants ' cognitive development , the parent-infant interaction approach seemed to have the greater impact . These findings confirm previous observations regarding the cognitive development of preterm and full-term infants during the first 18 months of life and demonstrate changes in behavior and behavior styles in both pre- and full-term infants as they become older Twenty-four low birth weight children who had received an experimental intervention ( LBWE ) during the neonatal period , 31 control children who had received no treatment ( LBWC ) , and 36 normal birth weight children were compared . The intervention involved seven hospital sessions and four home sessions in which a nurse helped mothers adapt to their LBW babies . At age 9 , LBWE children scored significantly higher than LBWC children on the Kaufman Mental Processing Composite , Sequential , Simultaneous , Achievement , Arithmetic , and Riddles scales , after statistical adjustments for socioeconomic status . The LBWE children had also advanced more rapidly in school than had LBWC children . Parent ( Child Behavior Checklist ) and teacher ( Teacher 's Report Form ) ratings of school functioning were more favorable for LBWE than LBWC children , with especially strong effects on Teacher 's Report Form scores for academic performance and the attention problems syndrome . At age 9 , LBWE children were not significantly inferior to normal birth weight children on any measure . These results bear out a progressive divergence between the LBWE and LBWC children that first became statistically significant in cognitive scores at age 3 . The findings suggest that the intervention prevented cognitive lags among LBW children and that this eventually had a favorable effect on academic achievement , behavior , and advancement in school . The progression from no significant differences between LBWE and LBWC children on early cognitive and achievement scores to significant and pervasive differences in later functioning argues for long-term follow-up periods to evaluate properly the power of behavioral interventions to compensate for biological risks Thirty-seven infants with severe central nervous system injury or extreme prematurity were r and omly assigned to a multisensory ( auditory-tactile-visual-vestibular ) intervention or control group . Intervention began in the hospital at 33 weeks ' postconceptional age and continued twice daily in the home until 2 months ' corrected age . Mother-infant interactions during feedings were videotaped , and the Bayley Scales of Infant Development were administered . Control mothers stimulated their infants more during feeding , but these significant differences dissipated by 4 months . The presence of periventricular leukomalacia was associated with significantly poorer mental development , regardless of group assignment . Experimental infants tended to exhibit better motor and mental performance and had 23 % fewer cerebral palsy diagnoses at 1 year , but these trends were not statistically significant . The type of brain injury was more important in determining 1-year developmental outcome than type of postnatal experience , suggesting that periventricular leukomalacia presents a major challenge for infant development . ( J Child Neurol 2001;16:493 - 498 ) Purpose : To determine the safety and effects on healthy preterm infants of three continuous hours of kangaroo care ( KC )  compared to st and ard NICU care  by measuring cardiorespiratory and thermal responses . Design : R and omized controlled trial — pretest-test-posttest control group design . Sample : Twenty-four healthy preterm infants ( 33–35 weeks gestation at birth ) nearing discharge . Eleven of the infants received KC ; 13 received st and ard NICU care .  Main Outcome Variables : Heart rate , respiratory rate , oxygen saturation , and abdominal skin temperature were manually recorded every minute . Apnea , bradycardia , periodic breathing , and regular breathing were captured continuously on a pneumocardiogram printout . Three consecutive interfeeding intervals ( three hours each ) on one day constituted the pretest , test , and posttest periods . Results : Mean cardiorespiratory and temperature outcomes remained within clinical ly acceptable ranges during KC . Apnea , bradycardia , and periodic breathing were absent during KC .  Regular breathing increased for infants receiving KC compared to infants receiving st and ard NICU care OBJECTIVE . Beneficial effects of breast milk on cognitive skills and behavior ratings have been demonstrated previously in term and very low birth weight infants . Extremely low birth weight infants are known to be at increased risk for developmental and behavior morbidities . The benefits of breast milk that is ingested in the NICU by extremely low birth weight infants on development and behavior have not been evaluated previously . METHODS . Nutrition data including enteral and parenteral feeds were collected prospect ively , and follow-up assessment s of 1035 extremely low birth weight infants at 18 months ’ corrected age were completed at 15 sites that were participants in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial between October 14 , 1999 , and June 25 , 2001 .  Total volume of  breast milk feeds  ( mL/kg per day ) during hospitalization was calculated . Neonatal characteristics and morbidities , interim history , and neurodevelopmental and growth outcomes at 18 to 22 months ’ corrected age were assessed . RESULTS . There were 775 ( 74.9 % ) infants in the breast milk and 260 ( 25.1 % ) infants in the no breast milk group . Infants in the breast milk group were similar to those in the no breast milk group in every neonatal characteristic and morbidity , including number of days of hospitalization . Mean age of first day of breast milk for the breast milk infants was 9.3 ± 9 days . Infants in the breast milk group began to ingest non – breast milk formula  later ( 22.8 vs 7.3 days ) compared with the non – breast milk group . Age at achieving full enteral feeds was similar between the breast milk and non – breast milk groups ( 29.0 ± 18 vs 27.4 ± 15 ) . Energy intakes of 107.5 kg/day and 105.9 kg/day during the hospitalization did not differ between the breast milk and non – breast milk groups , respectively . At discharge , 30.6 % of infants in the breast milk group still were receiving breast milk . Mothers in the breast milk group were significantly more likely to be white ( 42 % vs 27 % ) , be married ( 50 % vs 30 % ) , have a college degree ( 22 % vs 6 % ) , and have private health insurance ( 34 % vs 18 % ) compared with the no breast milk group . Mothers who were black , had a low household income ( ≤$20000 ) , or had higher parity were less likely to provide breast milk feeds . The analysis of outcomes between the any human milk and no human milk groups were adjusted for maternal age , maternal education , marital status , race/ethnicity , and the other st and ard covariates . Children in the breast milk group were more likely to have a Bayley Mental Development Index ≥85 , higher mean Bayley Psychomotor Development Index , and higher Bayley Behavior Rating Scale percentile scores for orientation/engagement , motor regulation , and total score . There were no differences in the rates of moderate to severe cerebral palsy or blindness or hearing impairment between the 2 study groups . There were no differences in the mean weight ( 10.4 kg vs 10.4 kg ) , length ( 80.5 cm vs 80.5 cm ) , or head circumference ( 46.8 cm vs 46.6 cm ) for the breast milk and no breast milk groups , respectively , at 18 months . Multivariate analyses , adjusting for confounders , confirmed a significant independent association of breast milk on all 4 primary outcomes : the mean Bayley ( Mental Development Index , Psychomotor Development Index , Behavior Rating Scale , and incidence of rehospitalization ) . For every 10-mL/kg per day increase in breast milk ingestion , the Mental Development Index increased by 0.53 points , the Psychomotor Development Index increased by 0.63 points , the Behavior Rating Scale percentile score increased by 0.82 points , and the likelihood of rehospitalization decreased by 6 % . In an effort to identify a threshold effect of breast milk on Bayley Mental Development Index and Psychomotor Development Index scores and Behavior Rating Scale percentile scores , the mean volume of breast milk per kilogram per day during the hospitalization was calculated , and infants in the breast milk group were divided into quintiles of breast milk ingestion adjusted for confounders . Overall , the differences across the feeding quintiles of Mental Development Index and Psychomotor Development Index were significant . There was a 14.0 % difference in Behavior Rating Scale scores between the lowest and highest quintiles . For the outcomes ( Mental Development Index , Psychomotor Development Index , Behavior Rating Scale , and Rehospitalization < 1 year ) , only the values for the > 80th percentile quintile of breast milk feeding were significantly different from the no breast milk values . In our adjusted regression analyses , every 10 mL/kg per day breast milk contributed 0.53 points to the Bayley Mental Development Index ; therefore , the impact of breast milk ingestion during the hospitalization for infants in the highest quintile ( 110 mL/kg per day ) on the Bayley Mental Development Index would be 10 × 0.53 , or 5.3 points . CONCLUSIONS . An increase of 5 points potentially would optimize outcomes and decrease costs by decreasing the number of very low birth weight children who require special education services . The societal implication s of a 5-point potential difference ( one third of an SD ) in IQ are substantial . The potential long-term benefit of receiving breast milk in the NICU for extremely low birth weight infants may be to optimize cognitive potential and reduce the need for early intervention and special education services
target: Conclusion : Positive clinical ly meaningful effects ( > 5 points ) are seen to an age of 36 months , but are no longer present at 5 years
background: Objective : To determine in a systematic review , whether interventions for infant development that involve parents , improve neurodevelopment at 12 months corrected age or older .