title: Long-term benefits of home-based preventive care for preterm infants: a randomized trial.
abstract: BACKGROUND
  We have previously reported improved caregiver mental health and infant behavior at 2 years following a home-based preventive care program for very preterm infants and their caregivers. This study aimed to determine the longer-term effectiveness of the program by reviewing caregivers and children at preschool age.
  
  
  METHODS
  One hundred twenty very preterm infants (<30 weeks' gestation) were randomly allocated to intervention (n = 61) or control (n = 59) groups. The intervention included 9 home visits over the first year of life targeting infant development, parent mental health, and the parent-infant relationship. The control group received standard care. At 4 years' corrected age, child cognitive, behavioral, and motor functioning and caregiver mental health were assessed.
  
  
  RESULTS
  At age 4 years, 105 (89%) children were reviewed. There was little evidence of differences in cognitive or motor functioning between groups. The intervention group had lower scores for child internalizing behaviors than the control group (mean difference -5.3, 95% confidence interval [CI] -9.6 to -0.9, P = .02). Caregivers in the intervention group had fewer anxiety symptoms (mean difference -1.8, 95% CI -3.3 to -0.4, P = .01) and were less likely to exhibit "at-risk" anxiety (odds ratio 0.3, 95% CI 0.1 to 0.7, P = .01) than those in the control group.
  
  
  CONCLUSIONS
  This home-based preventive care program for very preterm infants has selective long-term benefits, including less caregiver anxiety and reduced preschooler internalizing behaviors.
authors.affiliation: Critical Care and Neurosciences, Murdoch Childrens Research Institute, Victoria, Australia. megan.spencer-smith@mcri.edu.au
authors.forename: Megan M
authors.initials: MM
authors.lastname: Spencer-Smith
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Spittle
authors.forename: Lex W
authors.initials: LW
authors.lastname: Doyle
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Lee
authors.forename: Lucy
authors.initials: L
authors.lastname: Lorefice
authors.forename: Anastasiya
authors.initials: A
authors.lastname: Suetin
authors.forename: Leona
authors.initials: L
authors.lastname: Pascoe
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Anderson
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control; D017028:Caregivers / Q000523:psychology; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000517:prevention & control*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000517:prevention & control; D003866:Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007389:Internal-External Control; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010287:Parent-Child Relations; D011594:Psychometrics; D011596:Psychomotor Disorders / Q000453:epidemiology / Q000517:prevention & control; D011795:Surveys and Questionnaires