Randomised trial of parental support for families with very preterm children. Avon Premature Infant Project

A. P. Project, A. P. Project

Abstract

Aim: To test the effectiveness of a home based developmental education programme in very preterm children.

Methods: A randomised controlled trial was conducted of developmental or social support intervention, started at discharge for up to 2 years, in 309 consecutive survivors of 32 weeks gestation or less, born to mothers resident in greater Bristol between December 1990 and July 1993. Home visits were made by research nurses trained in either Portage (a developmental education programme) or in nondirectional counselling (parent adviser scheme). Interventions were also provided to appropriate primary care and community support for disability. Griffiths Mental Development Scales were used to assess outcome at 2 years.

Results: Mean (SEM) Griffiths quotients (GQ) were: Portage 96.8 (1.6); parent adviser 95.9 (1.6); preterm control 92.9 (2.0). Despite randomisation, social variables significantly confounded these results. Using linear regression analysis, intervention was associated with improved scores: Portage: +4.3 GQ points (95% CI 1.6 to 7.0); parent adviser: +3.4 GQ points (1.4 to 6.1). The effect of Portage was greatest in those children with birthweights < 1250 g (+5.3 GQ points (0.2 to 10.4) and in those with an abnormal neonatal cerebral ultrasound scan (+7.3 GQ points (1.6 to 13.0).

Conclusion: Primary analysis showed no developmental benefit from long term family support after preterm birth. Secondary analysis controlling for the presence of adverse social markers showed similar small advantage for both intervention groups. In the smallest infants and those with brain injuries, a structured developmental programme may offer advantage over social support intervention.

References

    1. Child Dev. 1986 Feb;57(1):20-33
    1. J Child Psychol Psychiatry. 1997 Nov;38(8):931-41
    1. Pediatrics. 1987 Nov;80(5):650-8
    1. Early Hum Dev. 1988 Mar;16(2-3):225-33
    1. Child Care Health Dev. 1988 Mar-Apr;14(2):81-91
    1. Pediatrics. 1989 Nov;84(5):797-801
    1. Dev Med Child Neurol. 1990 Jan;32(1):30-45
    1. Lancet. 1990 Jun 23;335(8704):1477-81
    1. BMJ. 1991 Apr 27;302(6783):978-9
    1. Dev Med Child Neurol. 1991 Apr;33(4):283-4
    1. J Ment Defic Res. 1991 Apr;35 ( Pt 2):89-112
    1. J Child Psychol Psychiatry. 1991 Jul;32(5):723-41
    1. Pediatrics. 1993 Jan;91(1):45-55
    1. Arch Dis Child. 1993 Mar;68(3 Spec No):286-90
    1. Arch Dis Child. 1993 Jul;69(1 Spec No):9-13
    1. J Pediatr. 1993 Oct;123(4):527-33
    1. Arch Dis Child Fetal Neonatal Ed. 1995 Sep;73(2):F62-6
    1. JAMA. 1996 Aug 28;276(8):637-9
    1. Child Dev. 1986 Apr;57(2):308-15

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