Prematurity Clinical Trial
Official title:
Family-Centered Neuropsychoeducational In-NICU Intervention for Preterm Infants With Severe Intrauterine Growth Retardation and for Their Families
The purpose of the study is to learn more about the development of small for gestational age (SGA) preterm infants and whether focusing on the infant's behavior has a positive effect on outcome. The study hypotheses state: 1) High risk severely SGA preterm infants will profit from detailed neuropsychological assessment, psychoeducational recommendations and practical guidance for caregiving, as well as formal educational and emotional support for the family and the professional care team. 2) Neuropsychological education and guidance for community-based early intervention providers caring for SGA preterm infants after their discharge is effective in promoting improved outcome.
The preterm infant who is not only born early but also did not grow well in the womb is at
double jeopardy for developmental disabilities. The literature indicates that the fetus who
has not gained weight properly nor is showing expected head growth in the womb [symmetrical
intrauterine growth retardation (IUGR) or small for gestational age (SGA) status] will not
only require significantly longer stays in the newborn intensive care unit (NICU) and grow
more poorly than the appropriately grown prematurely born infant, but will also show
significant disabilities later on in terms of fine and gross motor skills, cognitive
function activity, language abilities, abstract reasoning, concentration, attention, mood
and temperament. IUGR exerts an independent adverse effect on the developmental outcome of
preterm infants.
Given the importance of the last 4 months of gestation and the first 2 years post term for
brain growth and development, and given the relationship between cerebral development and
behavior which is a two-way street and a dynamic feedback system, the particular
vulnerability of SGA children to environmental factors indicates that there are grounds for
the hypothesis that appropriate support and intervention for severely SGA preterm infants
and their families might ameliorate dysfunction.
The general purpose of the proposed project is to develop and test a model of ameliorative
neuropsychoeducational intervention in the NICU in support of the developmental outcome of
severely SGA preterm infants and their families. The specific hypotheses to be tested are as
follows:
1. High risk severely SGA preterm infants cared for in the NICU with the support of a
neuropsychoeducational model of intervention will show:
1. At 2 weeks post term, more well-regulated autonomic, motor, state organizational
and attentional functioning
2. At 9 and 24 months post term:
- More well-regulated autonomic and visceral functioning with less colic and
improved eating patterns and weight gain
- More well-regulated motor system performance
- More well-regulated state organization, including sleep and awake
organization
- More well-regulated cognitive and attentional functioning in various domains,
including visual-motor integration, spatial planning, attentional planning,
expressive and receptive language function, abstract verbal reasoning, short
term memory and continuous performance regulation
- More well-regulated executive function capacities
- More well-regulated affective emotional functioning
2. Parents whose infants receive the support of a neuropsychoeducational model of care
will show:
1. At 2 weeks, 9 and 24 months post term, enhanced appreciation of their infant as an
individual
2. At 9 and 24 months post term, more sensitively attuned input in support of their
child's functioning, more competent parenting strategies, and a greater sense of
effectiveness in parenting the child.
The population will consist of severely small for gestational age preterm infants admitted
to the NICU and randomly assigned to a control and experimental group.
Effectiveness of the experimental treatment for the experimental group will be tested at
three systematic outcome points in various domains. The domains assessed include (1) medical
outcome; (2) neurobehavioral outcome; (3) neuroelectrophysiological outcome; and (4) family
outcome. The outcome points for infant and family are 2 weeks, 9 and 24 months after
expected due date.
The study is expected to demonstrate intervention effectiveness in improving IUGR preterm
infants' neurodevelopment. It is anticipated that the results will set the stage for a model
of caregiving and intervention that lives up to the mandate that every child is entitled to
an environment, care and education appropriate to his or her specific needs. The model can
then be used in other nurseries to provide improved outcome for preterm populations.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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