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Does a comprehensive family-centred early intervention service affect stress reactivity and emotion regulation in very low birth weight preterm infants at toddler age?


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We would like to promote one of the recent EBNEO reviews, this time about a family-centre early intervention and later outcome in VLBW infants.

Read the full review on the EBNEO web site.



Infants born preterm are at higher risk of adverse developmental outcomes compared with term born infants, including attentional difficulties (1), reduced cognitive performance and behavioural impairments at school age (2), and motor impairment from infancy to adolescence (3). Early intervention programs positively affect cognitive and motor outcomes in infancy, with persisting cognitive benefits at pre-school age (4). However, Wu and colleagues highlight that studies investigating the efficacy of early intervention programs for emotion regulation in preterm infants at toddler age are lacking, and Taiwanese services for VLBW preterm infants are largely limited to in-hospital child centred design (5).

This multicentre RCT suggests that a comprehensive clinic or home based child, parent and dyad focused early intervention program improved emotion regulation for VLBW preterm infants in Taiwan. However, the authors found no stress reactivity benefits, or enhanced regulatory strategies for either intervention group which only partly supports this conclusion. Furthermore, cognitive and language performance at 12 months CA did not differ between groups, although statistical significance is not presented in this paper.

The authors identify several pertinent limitations of their study. Of particular interest is the demographic characteristics of VLBW families, with 73% having high maternal education level, and moderate to high socio-economic status (SES). Social and environmental factors play an important role in the developmental outcome of preterm infants (6, 7), therefore this factor may affect the representativeness of the study population. The laboratory setting for outcome assessment, and the length of follow up should be considered in future study design.

Participant follow up is another important consideration, with low follow up rates introducing potential bias and possibly affecting the statistical power of this study. Furthermore, at each time point a proportion of infants were not assessed due to seating difficulty. For VLBW infants, this was reported 42 times, with an additional 8 term born toddlers at 24 months unable to be seated. The birth and demographic characteristics of these infants were comparable with assessed infants, however it is possible that non-participants may have had underlying behavioural or motor difficulties. Exclusion of these infants from assessment further limits the representativeness of the VLBW population in this study.

This RCT contributes to the field by exploring the important area of emotion regulation and behaviour after a comprehensive child, parent and dyad focused early intervention program in Taiwan. Future research should include high risk preterm populations to identify the efficacy of intervention programs for those infants who are likely to benefit most (4). The financial feasibility of the home and clinic based interventions detailed by Wu and colleagues would be a valuable area of further study to guide future design of early intervention programs. As both clinic and home based settings were found to be beneficial for reducing stress evoked primitive behaviour when compared to usual care, the parental mental health, wellbeing and engagement in each program could also be a valuable method of evaluating each setting.


Anderson PJ, De Luca CR, Hutchinson E, Spencer-Smith MM, Roberts G, Doyle LW. Attention problems in a representative sample of extremely preterm/extremely low birth weight children. Developmental Neuropsychology. 2011;36(1):57-73.

Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand K. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. Jama. 2002;288(6):728-37.

de Kieviet JF, Piek JP, Aarnoudse-Moens CS, Oosterlaan J. Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis. JAMA: Journal of the American Medical Association. 2009;302(20):2235-42 8p.

Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. The Cochrane Library. 2015.

Wu Y-C, Hsieh W-S, Hsu C-H, Chang J-H, Chou H-C, Hsu H-C, et al. Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial. Research in developmental disabilities. 2016;48:1-12.

Treyvaud K, Anderson VA, Howard K, Bear M, Hunt RW, Doyle LW, et al. Parenting behavior is associated with the early neurobehavioral development of very preterm children. Pediatrics. 2009;123(2):555-61.

Miceli PJ, Goeke-Morey MC, Whitman TL, Kolberg KS, Miller-Loncar C, White RD. Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants. Journal of pediatric psychology. 2000;25(5):353-8.


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