EARLY INTERVENTION IN LOW-BIRTH-WEIGHT PREMATURE-INFANTS - RESULTS THROUGH AGE 5 YEARS FROM THE INFANT HEALTH AND DEVELOPMENT PROGRAM
EARLY INTERVENTION IN LOW-BIRTH-WEIGHT PREMATURE-INFANTS - RESULTS THROUGH AGE 5 YEARS FROM THE INFANT HEALTH AND DEVELOPMENT PROGRAM
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DOI：
10.1001/jama.272.16.1257
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发表时间：
1994-10-26
影响因子：
120.7
通讯作者：
MEINERT, CL
中科院分区：
文献类型：
--
作者：
BROOKSGUNN, J;MCCARTON, CM;MEINERT, CL
客观。-为了评估婴儿健康与发展计划对5岁时健康和发展的持续影响，该计划是一项早期儿童干预措施，从新生儿出院到3岁提供给低出生体重（LBW）早产儿。随机、对照、多中心试验，按两个LBW组分层：较轻（小于或等于2000 g）和较重（2001至2500 g）。八个社会经济异质临床站点。在985名符合条件的体重2500 g或以下、胎龄37周或以下的婴儿中，377名婴儿被随机分配到干预组，608名婴儿被随机分配到仅随访组。每组中约有三分之二的婴儿属于LBW较轻的阶层，三分之一属于LBW较重的阶层。干预组接受家访（从新生儿出院到3岁）以及基于中心的学校教育（1至3岁）。两组儿童均接受儿科监测。主要结果测量。认知发展、行为能力和健康状况。在5岁时，干预组的全面智商得分与仅随访组的儿童相似。然而，在较重的LBW层中，干预组的儿童具有较高的全量表智商得分（高出3.7分; P= 0.03）和较高的语言智商得分（高出4.2分; P= 0.02）。在5岁时，在较轻的LBW婴儿中，干预组和仅随访组在认知测量方面没有显著差异。干预组和随访组的行为和健康措施相似，无论LBW层。在出生后头3年提供的幼儿干预对体重较重的LBW早产儿的智商和5岁时的言语表现有影响，而对体重较轻的LBW早产儿则没有观察到这种影响。干预并没有影响健康或行为在5岁的任何LBW阶层。
Objective.-To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years.Design.-Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (less than or equal to 2000 g) and heavier (2001 to 2500 g).Setting.-Eight socioeconomically heterogeneous clinical sites.Participants.-Of 985 eligible infants weighing 2500 g or less and at 37 weeks' or less gestational age, 377 infants were randomly assigned to the intervention group and 608 to the follow-up only group. About two thirds of the infants in each group were in the lighter LBW stratum, and one third were in the heavier LBW stratum.Intervention.-The intervention group received home visits (from neonatal discharge through age 3 years) as well as center-based schooling (from 1 to 3 years of age). Children in both groups received pediatric surveillance.Main Outcome Measures.-Cognitive development, behavioral competence, and health status.Results.-At age 5 years, the intervention group had full-scale IQ scores similar to children in the follow-up only group. However, in the heavier LBW stratum, children in the intervention group had higher full-scale IQ scores (3.7 points higher; P=.03) and higher verbal IQ scores (4.2 points higher; P=.02). No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants. The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum.Conclusion.-The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants. The intervention did not affect health or behavior at age 5 years in either LBW stratum.