Effects of Family-Centered Intervention Program on Mother-Infant Interaction and Developmental Outcomes in Preterm Infants with Very Low Birth Weight

Background and Purposes: Preterm birth with very low birth weight (VLBW, birth weight <1500 g) is associated with high risk of motor, cognitive, language, and behavioral disorder. One prior study showed differential effects of clinic- and home-based intervention programs on developmental outcomes and mother-infant interaction in VLBW preterm infants. Therefore, this study was aimed to investigate the effect of a family-centered intervention program (FCIP) that combined these two intervention services on developmental outcomes and quality of mother-infant interaction in VLBW preterm infants with respect to a usual care program (UCP), and to examine whether mother-infant interaction mediated intervention effect on developmental outcomes. Method: This multi-site randomized controlled study included 269 VLBW preterm infants (129 in the FCIP group and 140 in the UCP group). The FCIP and UCP services lasted from hospitalization to 12 months of corrected age. All preterm infants and mothers were examined for child cognitive, language, and motor development by the Bayley Scales of Infant and Toddler Development- 3rd edition and for quality of interaction during a 6-min free play procedure at 6 and 12 months of corrected age. Results: The FCIP and UCP groups showed comparable developmental scores across ages. However, subgroup analysis revealed significantly higher language score in the FCIP group than in the UCP group among those firstborn (6 months: 100.1±7.7 vs. 97.5±9.2; 12 months: 95.1±7.9 vs. 93.0±8.0, p=0.03) but no group difference in the developmental scores among those not firstborn. The FCIP dyads demonstrated more high-quality (6 months: 67.7±20.4 vs. 60.0±24.1; 12 months: 73.7±21.9 vs. 67.0±19.7, p=0.01) and less inactive maternal interactive behavior (6 months: 16.0%±15.7% vs. 23.7%±20.5%; 12 months: 14.1%±16.7% vs. 18.8%±16.8%, p<0.01) together with more concordant pattern (6 months: 43.1%±22.1% vs. 41.3%±22.6%; 12 months: 49.8%±22.6% vs. 43.9%±20.1%, p=0.10) and child discordant pattern (6 months: 29.5%±19.4% vs. 22.2%±16.1%; 12 months: 29.5%±17.5% vs. 28.4%±15.7%, p=0.03) and less mother discordant pattern (6 months: 8.6%±12.3% vs. 15.4%±18.0%; 12 months: 6.5%±11.7% vs. 10.3%±12.6%, p<0.01), but comparable child interactive behavior than the UCP dyads. Mediator analysis revealed that adding high-quality maternal behavior, inactive maternal behavior, concordant dyadic pattern and mother discordant pattern had each markedly attenuated the intervention effect on language outcome among firstborn preterm infants. Conclusions: The FCIP benefited maternal interactive behavior and dyadic interactive pattern in VLBW preterm infants at 6 and 12 months of corrected age. However, the intervention improved the language development at 6 and 12 months of corrected age in firstborn preterm infants only. Furthermore, the language effect appeared to be mediated via enhanced mother-infant interaction among firstborn preterm infants.