title: A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: effects and mediators.
abstract: This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.
authors: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Ying-Chin
authors: YC
authors: Wu
authors: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Chi-Hon
authors: CH
authors: Leng
authors: Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
authors: Wu-Shiun
authors: WS
authors: Hsieh
authors: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Chyong-Hsin
authors: CH
authors: Hsu
authors: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Wei J
authors: WJ
authors: Chen
authors: Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors: Susan Shur-Fen
authors: SS
authors: Gau
authors: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Nan-Chang
authors: NC
authors: Chiu
authors: Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Ming-Chin
authors: MC
authors: Yang
authors: Taipei City Hospital, Branch for Women and Children, Taipei, Taiwan.
authors: Li-Jung Fang
authors: Department of Child and Family Development, University of Georgia, GA, USA.
authors: Hui-Chin
authors: HC
authors: Hsu
authors: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Yen-Ting
authors: YT
authors: Yu
authors: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Yen-Tzu
authors: YT
authors: Wu
authors: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
authors: Li-Chiou
authors: LC
authors: Chen
authors: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: Jeng@ntu.edu.tw.
authors: Suh-Fang
authors: SF
authors: Jeng
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D002657:Child Development; D003071:Cognition; D018479:Early Intervention, Educational / Q000379:methods*; D004644:Emotions; D005260:Female; D006699:Home Care Services; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000523:psychology*; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009034:Mother-Child Relations; D009048:Motor Skills; D016896:Treatment Outcome
keywords: Behavior; Development; Early intervention; Effectiveness; Emotional regulation; Mediator; Mother–infant interaction; Preterm infants