title: School-age effects of the newborn individualized developmental care and assessment program for preterm infants with intrauterine growth restriction: preliminary findings.
abstract: BACKGROUND
  The experience in the newborn intensive care nursery results in premature infants' neurobehavioral and neurophysiological dysfunction and poorer brain structure. Preterms with severe intrauterine growth restriction are doubly jeopardized given their compromised brains. The Newborn Individualized Developmental Care and Assessment Program improved outcome at early school-age for preterms with appropriate intrauterine growth. It also showed effectiveness to nine months for preterms with intrauterine growth restriction. The current study tested effectiveness into school-age for preterms with intrauterine growth restriction regarding executive function (EF), electrophysiology (EEG) and neurostructure (MRI).
  
  
  METHODS
  Twenty-three 9-year-old former growth-restricted preterms, randomized at birth to standard care (14 controls) or to the Newborn Individualized Developmental Care and Assessment Program (9 experimentals) were assessed with standardized measures of cognition, achievement, executive function, electroencephalography, and magnetic resonance imaging. The participating children were comparable to those lost to follow-up, and the controls to the experimentals, in terms of newborn background health and demographics. All outcome measures were corrected for mother's intelligence. Analysis techniques included two-group analysis of variance and stepwise discriminate analysis for the outcome measures, Wilks' lambda and jackknifed classification to ascertain two-group classification success per and across domains; canonical correlation analysis to explore relationships among neuropsychological, electrophysiological and neurostructural domains at school-age, and from the newborn period to school-age.
  
  
  RESULTS
  Controls and experimentals were comparable in age at testing, anthropometric and health parameters, and in cognitive and achievement scores. Experimentals scored better in executive function, spectral coherence, and cerebellar volumes. Furthermore, executive function, spectral coherence and brain structural measures discriminated controls from experimentals. Executive function correlated with coherence and brain structure measures, and with newborn-period neurobehavioral assessment.
  
  
  CONCLUSIONS
  The intervention in the intensive care nursery improved executive function as well as spectral coherence between occipital and frontal as well as parietal regions. The experimentals' cerebella were significantly larger than the controls'. These results, while preliminary, point to the possibility of long-term brain improvement even of intrauterine growth compromised preterms if individualized intervention begins with admission to the NICU and extends throughout transition home. Larger sample replications are required in order to confirm these results.
  
  
  BACKGROUND
  The study is registered as a clinical trial. The trial registration number is NCT00914108.
authors: Department of Psychiatry, Neurobehavioral Infant and Child Studies, Enders Pediatric Research Laboratories, EN-107, Children's Hospital Boston, Harvard Medical School, 320 Longwood Avenue, 02115, Boston, MA, USA. gloria.mcanulty@childrens.harvard.edu
authors: Gloria
authors: G
authors: McAnulty
authors: Frank H
authors: FH
authors: Duffy
authors: Sandra
authors: S
authors: Kosta
authors: Neil I
authors: NI
authors: Weisenfeld
authors: Simon K
authors: SK
authors: Warfield
authors: Samantha C
authors: SC
authors: Butler
authors: Moona
authors: M
authors: Alidoost
authors: Jane Holmes
authors: JH
authors: Bernstein
authors: Richard
authors: R
authors: Robertson
authors: David
authors: D
authors: Zurakowski
authors: Heidelise
authors: H
authors: Als
mesh_terms: D000124:Achievement; D000704:Analysis of Variance; D001921:Brain / Q000254:growth & development / Q000502:physiology*; D002648:Child; D002652:Child Behavior; D002657:Child Development / Q000502:physiology*; D003071:Cognition; D016002:Discriminant Analysis; D004569:Electroencephalography; D056344:Executive Function; D005260:Female; D005317:Fetal Growth Retardation / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D011581:Psychological Tests; D016896:Treatment Outcome