ORIGINAL ARTICLES

Effects of early intervention on cognitive function of low birth weight preterm infants J e a n n e B r o o k s - G u n n , PhD, F o n g - r u e y L i a w , PhD, a n d P a m e l a K a t o K l e b a n o v , PhD From the Center for the Study of Children and Families, Columbia University Teachers College, New York, New York, the Education Policy Research Division, Educational Testing Service, Princeton, New Jersey, and eight participating universities

The Infant Health and Development Program is a randomized clinical trial to test the efficacy of educational and family support services and pediatric follow-up, offered during the first 3 years of life, in reducing the incidence of developmental delay in low birth weight preterm infants at eight clinical sites (N = 985). It was hypothesized that larger intervention effects would be found for the domains in which low birth weight preterm infants are known to have problems, specifically visual-motor and spatial skills and receptive language skills. These analyses explore the effects of the Infant Health and Development Program on different domains of cognitive functioning. Cognitive domains are identified by means of factor analysis of the intelligence tests used at 12, 24, and 36 months (Bayley Scales of Infant Development (including the Mental and Motor scales) at 12 and 24 months; the Stanford-Binet, Peabody Picture Vocabulary Test, and Beery Test of Visual Motor Integration at 36 months). Our results reveal that, although intervention benefits accrue across cognitive domains at 24 and 36 months, gains are most pronounced for receptive language and visual-motor and spatial skills. (J PEDIATR1992;120:350-9) Educationally oriented intervention programs have been developed for both biologically and environmentally vulnerable young children. 17 A major goal of such programs

Supported through the Infant Health and Development Program by grants to the Department of Pediatrics, Stanford University, Stanford, Calif., and to the Frank Porter Graham Child Development Center, University of North Carolina at Chapel Hill, and through the eight participating universities by the Robert Wood Johnson foundation (for a list of these universities, see the acknowledgments at the end of the text). Additional support provided by the Pew Charitable Trusts; the Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration, U.S. Public Health Service, Department of Health and Human Services (grant No. MCJ-060515); the National Institute of Child Health and Human Development; and the March of Dimes Birth Defects Foundation. Submitted for publication June 10, 1991; accepted Sept. 20, 1991. Reprint requests: Jeanne Brooks-Gunn, PhD, Teachers College, Columbia University, New York, NY 10027. 9/20/33919

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is to reduce developmental delays and to increase the likelihood of the children's doing well in school. Positive results have been reported for most high-quality educational programs (especially those including center-based programming) for socioeconomically disadvantaged young children. 81~ Less is known about the impact of such programs ES IHDP LBW MLR PPVT-R VMI

Effect size Infant Health and Development Program Low birth weight Multiple linear regression Peabody Picture Vocabulary Test--Revised Visual Motor Integration Test

on biologically vulnerable children of low birth weight (see Shonkoff and Hauser-Cram 7 for a review of programs for children with disabilities). Most interventions for this group focused on tactile, sensory, and kinesthetic stimulation during the neonatal period, on teaching mothers about their biologically vulnerable neonates or offering parent support

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groups, or on providing support, education, or both through home-visiting programs during the first year or two of life. 1, 2, 5 Few center-based programs have directly targeted LBW children. A notable exception is the Infant Health and Development Program, a multisite, randomized clinical trial to test the efficacy of educational and family support services and of pediatric follow-up during the first 3 years of life in reducing the incidence of developmental delay in LBW preterm infants. Families in the intervention group were provided home visits during their children's first 3 years of life and full-time, center-based developmental care during their children's second and third years of life. This set of services had a significant impact on intellectual functioning, reducing by half the number of 3-year-old children with IQ scores in the mild to moderate range of mental retardation.ll Intelligence test scores provide only a global measure of child functioning. The lack of information as to which functional domains are influenced by early intervention is a particular concern for the assistance of biologically vulnerable children (such as those who were LBW or premature infants). Not only are major neurosensory disabling conditions associated with LBW and prematurity, but neurodevelopmental deficits also occur more frequently in LBW children.12-16 Such conditions have implications for school success, which is reflected in the relatively high prevalence of LBW children who have been held back a grade, have been placed in special classes, or have behavior problems. 15-19 The analyses reported here explore the effects of the IHDP on different domains of cognitive functioning in LBW preterm children. We expected that larger intervention effects would be found for the domains in which LBW preterm infants are known to have problems, specifically visual-motor and spatial skills and receptive language delays. 15,16, 20. 22We expected intervention effects at 24 and 36 months of age, but not at 12 months of age, because of previous findings from similar early intervention programs for environmentally and biologically vulnerable children 1, 4, 6, 9_3,24 and the nature of the cognitive domains assessed by intelligence tests given in the first year of life.25' 26 METHODS The methods of this study have been reported 2~ and are summarized here. Sample. Infants weighing --

Effects of early intervention on cognitive function of low birth weight preterm infants.

The Infant Health and Development Program is a randomized clinical trial to test the efficacy of educational and family support services and pediatric...
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