EBNEO COMMENTARY: PARENT-GUIDED DEVELOPMENTAL INTERVENTION FOR INFANTS WITH VERY LOW BIRTH WEIGHT

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ACTA COMMENTARY:

Acta Paediatrica - 2025 - Jayakumar - EBNEO Commentary Parent%E2%80%90Guided Developmental Intervention for Infants With Very Low.pdf

Very preterm birth is associated with injury in the developing brain and subsequent impairments in cognitive, motor, behavioral and emotional skills.1,2 Early childhood provides a critical window for neurorestorative interventions, including developmental interventions, in the hospital and after discharge.3

Developmental interventions vary widely in their component elements, intensity, target domains, parental involvement, and cost. A majority of studies evaluating these interventions have been based in high-income countries.4 Given the heterogeneity of medical systems and access to follow-up care across the globe, results from prior studies may not be generalizable to low-to-middle-income (LMIC) countries. The randomized trial by Silveira et al, based in Brazil, addressed this critical gap and demonstrated that a parent-guided developmental intervention administered to high-risk preterm infants in a LMIC improved cognitive, language, and motor development through 18 months corrected age.

Silveira, et al. observed a stronger effect of enhanced developmental support on motor outcomes compared to cognitive outcomes. While it is plausible that early motor developmental skills are more amenable to improvement with the study intervention, this finding is in contrast to many prior studies which show greater improvements in cognitive domains with early developmental intervention programs.5. Notably, the effect on motor skills strengthened between 4 and 18 months, suggesting a sustained or even increasing intervention effect over time.

Strengths of this study include parental training beginning in the first week after birth and the assessment of numerous factors influencing neurodevelopment, including parents’ childhood experiences and socioeconomic status. Testing in the participants’ homes allowed for assessment of child neurodevelopment in a comfortable, familiar setting. The use of multiple scales measuring non-overlapping aspects of development allowed for a holistic evaluation of the child and their environment. The randomized design, use of blinded outcomes assessments, and robust sample size are additional strengths of the study.

This study could have been further strengthened by inclusion of validated measures of infant state control, parent-infant bonding, parental mental health and self-efficacy. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), used to assess the primary outcome, is known to overestimate development.6,7,8, 9 Notably, the intensity of follow-up care provided to the control group is markedly higher than in many other settings, including some high-income countries. Therefore, similar interventions in settings with less robust follow-up might yield even greater effects and will be important to study the scalability of this intervention. While the authors acknowledge the burdens of extended follow-up, longer-term assessments will be essential for demonstrating persistence of intervention effects.

Dr. Silveira’s trial represents an essential contribution to the literature describing the important impact of neurodevelopmental interventions on outcomes of high-risk infants and demonstrates the success of a parent-guided intervention in a LMIC. While LMICs are a varied group, the study offers a low-cost intervention that could be applied to numerous resource-limited settings, with potentially greater impact depending on the intensity of their follow-up services. This trial sets a benchmark for future studies of developmental interventions and provides a template for evidence-based developmental care of high-risk infants around the world.