Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2005 May 17;90(9):909–915. doi: 10.1136/adc.2004.057620

Randomised trial of parental support for families with very preterm children: outcome at 5 years

S Johnson 1, W Ring 1, P Anderson 1, N Marlow 1
PMCID: PMC1720549  PMID: 15899921

Abstract

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 randomised controlled trial in which the parents of 284 babies born <33 weeks gestational age received a developmental education programme, a social support intervention, or standard 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.

Full Text

The Full Text of this article is available as a PDF (96.1 KB).

Figure 1.

Figure 1

Open in a new tab

 Patient flow and long term follow up at 5 years.

Figure 2.

Figure 2

Open in a new tab

 Mean differences (95% CI) in GCA scores for the Portage, parent adviser, and preterm control groups from the term reference group.

Figure 3.

Figure 3

Open in a new tab

 Effect size (95% CI) of social variables and interventions on BAS-II GCA scores at 5 years.

Figure 4.

Figure 4

Open in a new tab

 Mean differences (95% CI) in GCA scores from preterm controls for the Portage (P) and parent adviser (PA) groups categorised by perinatal variables.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achenbach T. M., Howell C. T., Aoki M. F., Rauh V. A. Nine-year outcome of the Vermont intervention program for low birth weight infants. Pediatrics. 1993 Jan;91(1):45–55. [PubMed] [Google Scholar]
  2. Aucott Susan, Donohue Pamela K., Atkins Eileen, Allen Marilee C. Neurodevelopmental care in the NICU. Ment Retard Dev Disabil Res Rev. 2002;8(4):298–308. doi: 10.1002/mrdd.10040. [DOI] [PubMed] [Google Scholar]
  3. Bao X., Sun S., Wei S. Early intervention promotes intellectual development of premature infants: a preliminary report. Early Intervention of Premature Infants Cooperative Research Group. Chin Med J (Engl) 1999 Jun;112(6):520–523. [PubMed] [Google Scholar]
  4. Bhutta Adnan T., Cleves Mario A., Casey Patrick H., Cradock Mary M., Anand K. J. S. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002 Aug 14;288(6):728–737. doi: 10.1001/jama.288.6.728. [DOI] [PubMed] [Google Scholar]
  5. Botting N., Powls A., Cooke R. W., Marlow N. Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birthweight children at 12 years. J Child Psychol Psychiatry. 1997 Nov;38(8):931–941. doi: 10.1111/j.1469-7610.1997.tb01612.x. [DOI] [PubMed] [Google Scholar]
  6. Botting N., Powls A., Cooke R. W., Marlow N. Cognitive and educational outcome of very-low-birthweight children in early adolescence. Dev Med Child Neurol. 1998 Oct;40(10):652–660. doi: 10.1111/j.1469-8749.1998.tb12324.x. [DOI] [PubMed] [Google Scholar]
  7. Briscoe J., Gathercole S. E., Marlow N. Everyday memory and cognitive ability in children born very prematurely. J Child Psychol Psychiatry. 2001 Sep;42(6):749–754. doi: 10.1111/1469-7610.00771. [DOI] [PubMed] [Google Scholar]
  8. Briscoe J., Gathercole S. E., Marlow N. Short-term memory and language outcomes after extreme prematurity at birth. J Speech Lang Hear Res. 1998 Jun;41(3):654–666. doi: 10.1044/jslhr.4103.654. [DOI] [PubMed] [Google Scholar]
  9. Brooks-Gunn J., Liaw F. R., Klebanov P. K. Effects of early intervention on cognitive function of low birth weight preterm infants. J Pediatr. 1992 Mar;120(3):350–359. doi: 10.1016/s0022-3476(05)80896-0. [DOI] [PubMed] [Google Scholar]
  10. Brooks-Gunn J., McCarton C. M., Casey P. H., McCormick M. C., Bauer C. R., Bernbaum J. C., Tyson J., Swanson M., Bennett F. C., Scott D. T. Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program. JAMA. 1994 Oct 26;272(16):1257–1262. [PubMed] [Google Scholar]
  11. Censullo M. Developmental delay in healthy premature infants at age two years: implications for early intervention. J Dev Behav Pediatr. 1994 Apr;15(2):99–104. [PubMed] [Google Scholar]
  12. Cooke R. W. I., Foulder-Hughes L. Growth impairment in the very preterm and cognitive and motor performance at 7 years. Arch Dis Child. 2003 Jun;88(6):482–487. doi: 10.1136/adc.88.6.482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Davis H., Rushton R. Counselling and supporting parents of children with developmental delay: a research evaluation. J Ment Defic Res. 1991 Apr;35(Pt 2):89–112. doi: 10.1111/j.1365-2788.1991.tb01039.x. [DOI] [PubMed] [Google Scholar]
  14. Hack M., Fanaroff A. A. Outcomes of children of extremely low birthweight and gestational age in the 1990's. Early Hum Dev. 1999 Jan;53(3):193–218. doi: 10.1016/s0378-3782(98)00052-8. [DOI] [PubMed] [Google Scholar]
  15. Hille E. T., den Ouden A. L., Saigal S., Wolke D., Lambert M., Whitaker A., Pinto-Martin J. A., Hoult L., Meyer R., Feldman J. F. Behavioural problems in children who weigh 1000 g or less at birth in four countries. Lancet. 2001 May 26;357(9269):1641–1643. doi: 10.1016/S0140-6736(00)04818-2. [DOI] [PubMed] [Google Scholar]
  16. Johnson A., Bowler U., Yudkin P., Hockley C., Wariyar U., Gardner F., Mutch L. Health and school performance of teenagers born before 29 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2003 May;88(3):F190–F198. doi: 10.1136/fn.88.3.F190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Luoma L., Herrgård E., Martikainen A., Ahonen T. Speech and language development of children born at < or = 32 weeks' gestation: a 5-year prospective follow-up study. Dev Med Child Neurol. 1998 Jun;40(6):380–387. [PubMed] [Google Scholar]
  18. Marlow N. Neurocognitive outcome after very preterm birth. Arch Dis Child Fetal Neonatal Ed. 2004 May;89(3):F224–F228. doi: 10.1136/adc.2002.019752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Marlow N., Roberts B. L., Cooke R. W. Motor skills in extremely low birthweight children at the age of 6 years. Arch Dis Child. 1989 Jun;64(6):839–847. doi: 10.1136/adc.64.6.839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McCarton C. M., Brooks-Gunn J., Wallace I. F., Bauer C. R., Bennett F. C., Bernbaum J. C., Broyles R. S., Casey P. H., McCormick M. C., Scott D. T. Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program. JAMA. 1997 Jan 8;277(2):126–132. [PubMed] [Google Scholar]
  21. McCarton C. M., Wallace I. F., Bennett F. C. Preventive interventions with low birth weight premature infants: an evaluation of their success. Semin Perinatol. 1995 Aug;19(4):330–340. doi: 10.1016/s0146-0005(05)80049-7. [DOI] [PubMed] [Google Scholar]
  22. McCarton C. Behavioral outcomes in low birth weight infants. Pediatrics. 1998 Nov;102(5 Suppl E):1293–1297. [PubMed] [Google Scholar]
  23. McCormick M. C., McCarton C., Brooks-Gunn J., Belt P., Gross R. T. The Infant Health and Development Program: interim summary. J Dev Behav Pediatr. 1998 Oct;19(5):359–370. doi: 10.1097/00004703-199810000-00009. [DOI] [PubMed] [Google Scholar]
  24. McCormick M. C., McCarton C., Tonascia J., Brooks-Gunn J. Early educational intervention for very low birth weight infants: results from the Infant Health and Development Program. J Pediatr. 1993 Oct;123(4):527–533. doi: 10.1016/s0022-3476(05)80945-x. [DOI] [PubMed] [Google Scholar]
  25. McCormick M. C., McCarton C., Tonascia J., Brooks-Gunn J. Early educational intervention for very low birth weight infants: results from the Infant Health and Development Program. J Pediatr. 1993 Oct;123(4):527–533. doi: 10.1016/s0022-3476(05)80945-x. [DOI] [PubMed] [Google Scholar]
  26. Melnyk B. M., Alpert-Gillis L., Feinstein N. F., Fairbanks E., Schultz-Czarniak J., Hust D., Sherman L., LeMoine C., Moldenhauer Z., Small L. 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. Res Nurs Health. 2001 Oct;24(5):373–389. doi: 10.1002/nur.1038. [DOI] [PubMed] [Google Scholar]
  27. Resnick M. B., Armstrong S., Carter R. L. Developmental intervention program for high-risk premature infants: effects on development and parent-infant interactions. J Dev Behav Pediatr. 1988 Apr;9(2):73–78. [PubMed] [Google Scholar]
  28. Sajaniemi N., Mäkelä J., Salokorpi T., von Wendt L., Hämäläinen T., Hakamies-Blomqvist L. Cognitive performance and attachment patterns at four years of age in extremely low birth weight infants after early intervention. Eur Child Adolesc Psychiatry. 2001 Jun;10(2):122–129. doi: 10.1007/s007870170035. [DOI] [PubMed] [Google Scholar]
  29. Werner E. E. Overcoming the odds. J Dev Behav Pediatr. 1994 Apr;15(2):131–136. [PubMed] [Google Scholar]
  30. Wolke D., Meyer R. Cognitive status, language attainment, and prereading skills of 6-year-old very preterm children and their peers: the Bavarian Longitudinal Study. Dev Med Child Neurol. 1999 Feb;41(2):94–109. doi: 10.1017/s0012162299000201. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES