Original Article
Sustained Developmental Effects of the Infant Behavioral Assessment and Intervention Program in Very Low Birth Weight Infants at 5.5 Years Corrected Age

https://doi.org/10.1016/j.jpeds.2012.11.078Get rights and content

Objective

To evaluate the effect of the Infant Behavioral Assessment and Intervention Program (IBAIP) in very low birth weight (VLBW) infants on cognitive, neuromotor, and behavioral development at 5.5 years corrected age (CA).

Study design

In a randomized controlled trial, 86 VLBW infants received post discharge IBAIP intervention until 6 months CA, and 90 VLBW infants received standard care. At 5.5 years CA, cognitive and motor development, and visual-motor integration were assessed with the Wechsler Preschool and Primary Scale of Intelligence, third Dutch version, the Movement Assessment Battery for Children, second edition, and the Developmental Test of Visual Motor Integration. Neurologic conditions were assessed with the neurologic examination according to Touwen, and behavior with the Strengths and Difficulties Questionnaire.

Results

At 5.5 years CA, 69 children in the intervention and 67 children in the control group participated (response rate 77.3%). Verbal and performance IQ-scores <85 occurred significantly less often in the intervention than in the control group (17.9% vs 33.3%, P = .041, and 7.5% vs 21.2%, P = .023, respectively). However, after adjustment for differences, only the OR for performance IQ was significant: 0.24, 95% CI: 0.06-0.95. Adjusted mean scores on Wechsler Preschool and Primary Scale of Intelligence, third version subtasks block design and vocabulary, the Movement Assessment Battery for Children, second edition component aiming and catching, and the Developmental Test of Visual Motor Integration were significantly better in the intervention group. No intervention effect was found on the Strengths and Difficulties Questionnaire.

Conclusion

The IBAIP leads, 5 years after the early neurobehavioral intervention, to improvements on performance IQ, ball skills, and visual-motor integration at 5.5 years CA.

Section snippets

Methods

The study population consisted of VLBW children participating in a multicenter RCT on the effect of the IBAIP in Amsterdam, The Netherlands.7 In this RCT, 176 infants of gestational age (GA) <32 weeks and/or birth weight <1500 g were included. Exclusion criteria were severe congenital abnormalities of the infant, severe physical or mental illness/problems of the mother, non-Dutch-speaking families for whom an interpreter could not be arranged, and participation in other trials on postdischarge

Results

Of the 176 children participating in the RCT, 136 were available for follow-up at the CA of 5.5 years. The response rate was 80.2% (n = 69) in the intervention group and 74.4% (n = 67) in the control group. The mean (SD) CA at the assessment time point was 5.5 years (0.1). The sample size was calculated originally with 90% power to detect a difference of 0.5 SD in Bayley Scales of Infant Development, Second Edition scores at 6 and 24 months with an α level of 0.05. With our sample size at 5.5

Discussion

This study was performed to evaluate the effect of the IBAIP on cognitive, neuromotor, and behavioral outcomes in VLBW children at 5.5 years CA. We found that 5 years after completion of the intervention, the IBAIP improved the children's performance IQ, motor skills with respect to handling a ball, and visual-motor integration.

Because biologic risk factors, which are associated with worse development, occurred more often in the intervention group, all earlier and current results were based on

References (30)

  • E.S. Potharst et al.

    High incidence of multi-domain disabilities in very preterm children at five years of age

    J Pediatr

    (2011)
  • H. Als et al.

    The role of relationship-based developmentally supportive newborn intensice care in strengthening outcom of preterm infants

    Semin Perinatol

    (1997)
  • J.F. De Kieviet et al.

    Motor development in preterm and very low birth weight children from birth to adolescence

    JAMA

    (2009)
  • A.T. Bhutta et al.

    Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis

    JAMA

    (2002)
  • A.J. Spittle et al.

    Early Developmental Intervention Programs to improve cognitive and motor outcomes for preterm infants-an updated Cochrane review

    Abstract E-PAS

    (2012)
  • A.J. Spittle et al.

    Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants

    Cochrane Database Syst Rev

    (2007 Apr 18)
  • Hedlund R. The Infant Behavioral Assessment and Intervention Program. 1998. Washington Research Institute, Seatle....
  • K. Koldewijn et al.

    The Infant Behavioral Assessment and Intervention Program for very low birth weight infants at 6 months corrected age

    J Pediatr

    (2009)
  • D. Meijssen et al.

    The effect of the Infant Behavioral Assessment and Intervention Program on mother-infant interaction after very preterm birth

    J Child Psychol Psychiatry

    (2010)
  • K. Koldewijn et al.

    A neurobehavioral intervention and assessment program in very low birth weight infants: outcome at 24 months

    J Pediatr

    (2009)
  • G. Verkerk et al.

    Infant behavioral assessment and intervention program in very low birth weight infants improves independency in mobility at preschool age

    J Pediatr

    (2011)
  • A.L. Jobe et al.

    Bronchopulmonary dysplasia. NICHD/NHLBI/ORD Workshop Summary

    Am J Respir Crit Care Med

    (2001)
  • J. Hendrikson et al.

    WPPSI-III-NL. Wechsler preschool and primary scale of intellingences

    (2009)
  • S.E. Henderson et al.

    Movement Assessment Battery for Children. 2nd ed. (Movement ABC-2); Examiner's manual

    (2007)
  • K.E. Beery et al.

    The Beery-Buktenica developmental Test of Visual-Motor Integration, Beery VMI. Administration, Scoring, and Teaching Manual

    (2004)
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      Next to the socio-emotional component, this programme has a strong motor component as parents are taught for example about positioning and handling of the infant (e.g., positioning in prone position) (Hedlund, 1998). The first evaluations of this programme indicate that besides doing better on motor development, children who followed this programme also showed better performance IQ and self-regulation skills at age 5.5 years when compared to children who followed the standard care (Van Hus et al., 2013; Verkerk et al., 2011). Thus, targeting early motor development seems to have effects going beyond just the motor domain and lasting until at least age 5.5 years.

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    Supported by grants from the Innovatiefonds Zorgverzekeraars (576) and ZonMw (Zorg Onderzoek Nederland; 62200032). The sponsors had no involvement in study design, collection, analysis, or interpretation of the data; writing of the report; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.

    Registered with Controlled-Trials.com: ISRCTN65503576.

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