EARLY EDUCATIONAL INTERVENTION FOR VERY-LOW-BIRTH-WEIGHT INFANTS - RESULTS FROM THE INFANT-HEALTH-AND-DEVELOPMENT-PROGRAM

Objective: To examine the effect of early educational intervention after discharge from the hospital on the health and developmental status of very low birth weight (less-than-or-equal-to 1500 gm) infants. Design: Randomized, controlled trial, with post hoc analysis. Setting: Eight sites, heterogeneous for sociodemographic and health care use. Participants: Infants (N = 280) born weighing less-than-or-equal-to 1500 gm and selected for the Infant Health and Development Program. Eligibility was limited primarily by geographic distance from the day care center. One third were randomly assigned to the intervention (INT) group and two thirds to follow-up only. Interventions: All children received intensive pediatric and developmental surveillance. The INT group received home visits and center-based educational interventions until 36 months of age (corrected for gestational age when final assessments were completed). Outcomes: Cognitive development (Stanford-Binet Intelligence Scale), behavioral competence (Achebach Child Behavior Checklist), and health status (indexes summarizing reported morbidity, the Functional Status II (R) Scale, and General Health Ratings Index). Results: Cognitive development scores were 7.2 points higher (p = 0.002) in the INT group, after adjustment for baseline differences in site, sociodemographic characteristics, and neonatal morbidity, and were 9.4 points higher (p <0.0003) when the 29 children with significant cerebral palsy were removed. No differences in behavior, serious morbidity, functional status, or health rating were found overall. The infants in the INT group who weighed less-than-or-equal-to 1000 gm at birth had significantly lower behavior problem scores but no differences on other outcomes. All children in the INT group had slightly higher rates of less serious morbidity.