Family-Centered Intervention for Very Low Birth Wight Preterm Infants: Developmental Outcomes and Influences of Body Position of Activities and Adherence of Home Programs

Background and purposes: Preterm infants with very low birth weight (VLBW, birth weight <1,500g) are at high risk of developmental disorders. Several intervention programs grounded on family-centered care have been developed in Western countries that yielded short-to-medium term developmental benefits. However, the influences of environmental factors and parental adherence of home program on intervention effect remain unclear. Therefore, the purposes of this study were to evaluate the effectiveness of a family-centered intervention program (FCIP) consisting of clinic- and home-based intervention in comparison with a usual care program (UCP) on developmental outcomes for VLBW preterm infants in Taiwan, to examine whether the body position of activities influenced the developmental outcomes, and to evaluate the influence of parental adherence of home activities on the developmental outcomes during the first year of age. Methods: This randomized controlled trial included 269 VLBW preterm infants (129 in the FCIP and 140 in the UCP). The FCIP consisted of in-hospital intervention, and clinic- and home-based intervention; the UCP consisted of standard care in hospitalization and telephone consultation until 12 months of corrected age (CA). All infants were assessed the Bayley Scales of Infants and Toddler Development-Third Edition at 6 and 12 months CA and the Wakeful Position Questionnaire at 6 months CA. The FCIP-group parents additionally recorded the Home Activity Diary at term age, 1, 2, 4, 6, 9, and 12 months CA. Results: The FCIP showed no developmental benefit, except for a borderline effect on lowering the rate of ever motor delay during 6 to 12 months CA than the UCP (11% vs. 19.1%, p=0.1). The groups were comparable in the sleep and wakeful positions. However, analysis of influencing factors revealed that awaked prone position time >40 min during 0-6 months CA was significantly associated with a lower rate of ever motor delay compared with awaked prone position time <40 min (group: OR [95%CI]=0.6 [0.3, 1.3], p=0.2; position: OR [95%CI]=0.1 [0.0, 0.6], p=0.007). Furthermore, parental adherence of home activities with frequency of 6-7 days/week (2.6%), item administered >91% during 0-6 months CA (5.3%), and with frequency of 5-6 days/week during 7-12 months CA (3.3%) were significantly associated with lower rate of ever motor delay in comparison with the UCP during the first year of age (19.1%) (all p<0.05). Conclusions: The FCIP yielded a borderline effect of decreasing the rate of ever motor delay than the UCP in VLBW preterm infants during infancy. Early placement of preterm infants in prone position when awaked reduced the risk of ever motor delay. Frequency and comprehensiveness were important indices of parental adherence of home activities may influence the motor outcome in preterm infants under the FCIP. The results provide insightful information for the design and execution of family-centered intervention for preterm infants.