The infant behavioral assessment and intervention program in very low birth weight infants; Outcome on executive functioning, behaviour and cognition at preschool age
Introduction
Children born very preterm and/or with very low birth weight (VLBW) experience significantly more problems with self regulation, executive functions [1], [2], behaviour [3] and cognition [4] than term born peers. These problems become apparent during development and persist until adolescence [5]. During infancy, self-regulatory competence refers to the ability to interact successfully with the environment without experiencing distress. Self-regulation at infant age is regarded as the foundation for the development of executive functions [6], [7]. Executive functions, in turn, are a collection of self-regulatory processes responsible for guiding, directing and managing cognitive, emotional, and behavioural functions particularly during novel problem solving [8] and are crucial for the development of both cognitive and social capacities [6], [9]. These executive functions include inhibitory control and attention flexibility [10]. Deficits in executive functions might lead to academic underachievement [6], [9].
Early intervention programmes assist parents to support the resilience of their very preterm infants, aiming to prevent developmental difficulties at a later age. The Infant Behavioral Assessment and Intervention Program (IBAIP©) [11] aims to improve the infant's development by supporting the infant's self-regulation during interactions with the environment. Our group performed a multicentre randomised controlled trial (RCT) on the IBAIP in VLBW infants. The intervention implied that parents were guided by an IBAIP-trained paediatric physical therapist to observe their infant's attempts to approach and explore information and to regulate themselves during an interaction with the parent and/or a toy. The observations aimed to sensitise parents to their infant's strengths and needs to interact. Accordingly, parents were encouraged to offer co-regulation, to adjust the environment to their infant's needs, and to enjoy their infant's growing development and independency [11]. Infants in the intervention group received one IBAIP intervention shortly before discharge and 6 to 8 interventions were provided at home, up to the corrected age (CA) of 6 months [12]. The infants in the control group received standard care. A positive effect of the IBAIP was found on motor function, self regulation, behaviour and mental development at the end of the intervention [12]. At 24 months, IBAIP improved motor development, while for infants with bronchopulmonary dysplasia (BPD) and for infants with combined biological and social risk factors also improvements in mental and behavioural developments were found [13]. At 24 months no interaction was found between IBAIP and gestational age (GA) < 28 weeks, abnormal cranial ultrasound scanning (US) or low maternal education. To examine whether there was still an effect of the IBAIP just before the children start primary education we assessed them at 44 months CA and reported that IBAIP improved independency in mobility especially in children of the subgroups BPD, GA < 28 weeks and the group with an abnormal US [14].
The aim of this follow-up study was to determine whether the IBAIP has effects on executive functions, behaviour and cognition at preschool age. In addition, we wanted to determine whether subgroups of VLBW children benefitted specifically from IBAIP and whether VLBW children differed from term born children.
Section snippets
Participants and procedure
This study is a follow-up at preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW infants. The Medical Ethics Committee of The Academic Medical Centre in Amsterdam approved this follow-up study. Recruitment of infants with a gestational age (GA) < 32 weeks and/or birth weight < 1500 g took place between January 2004 and April 2006. Infants were randomised into the intervention group (IBAIP group) or control group with a computer-generated randomization scheme, stratified for GA (<
Results
At a mean (SD) corrected age of 44 (0.5) months 151 children (86% of the original cohort) participated; 76 children of the IBAIP group (88%) and 75 of the control group (83%). Participants did not differ significantly from the 25 non-participants with respect to perinatal characteristics, socio-demographic factors, mental developmental index and psychomotor developmental index at 24 months of the Bayley Scales of Infant Development-II [24]. However, children not participating were significantly
Discussion
In this study, we did not find an effect of the post-discharge IBAIP intervention in VLBW infants on executive functioning, behaviour and cognition at 44 months CA. However, specific subgroups still benefitted at 44 months CA from the intervention. These positive effects concern behaviour for infants with BPD, executive functioning and behaviour for infants with GA < 28 weeks, and word comprehension for infants born to low educated mothers.
The VLBW children had significantly worse outcomes than the
Conflict of interest statement
The authors declare that there is no potential conflict of interest that could inappropriately influence this work.
Acknowledgements
We thank all the participating parents and children, Richard van Seenus Nederland BV for their supplying the ALVEMA MAXIT chair, the Amsterdam's Public Health Service for help with collecting the matched term group, and M. J. Wolf for her assistance in the design of this study and support during data collection. This study was funded by the Zorg Onderzoek Nederland (ZonMw project 622300032) and Innovatiefonds Zorgverzekeraars (project 576).
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