A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants

doi:10.1067/S0022-3476(03)00455-4

The Journal of Pediatrics

Volume 143, Issue 5, November 2003, Pages 634-639

https://doi.org/10.1067/S0022-3476(03)00455-4 Get rights and content

Abstract

Objectives

To determine whether early psychosocial intervention with low birth weight term (LBW-T) infants improved cognition and behavior and to compare LBW-T with normal birth weight (NBW) infants.

Study design

A randomized controlled trial was carried out in Kingston, Jamaica, with 140 LBW-T infants (weight<2500 g). The intervention comprised weekly home visits by paraprofessionals for the first 8 weeks of life aimed at improving maternal-child interaction. LBW-T and 94 matched NBW (weight 2500 to 4000 g) infants were recruited from the main maternity hospital. Main outcome measures were problem solving (2 means-end tests: cover and support) and 4 behavior ratings at 7 months. Analyses used were the t test for intervention effects and multiple regression to compare LBW and NBW infants.

Results

LBW-T intervened infants had higher scores than LBW-T control infants on the cover test (P<.05) and were more cooperative (P<.01) and happy (P<.05). LBW-T control infants had poorer scores on both the cover (P<.001) and support tests (P<.01), vocalized less (P<.02), and were less cooperative (P<.001), happy (P<.02), and active (P<.02) than NBW infants. LBW-T intervened infants had lower scores than NBW infants only on the support test (P<.05).

Conclusions

Early low-cost intervention can improve cognition and behavior of LBW-T infants in developing countries.

Section snippets

Participants

All infants were recruited from the main public maternity hospital in Kingston, serving predominantly low-income women. We enrolled 140 LBW-T infants (birth weight<2500 g), recruiting 6 days a week all eligible infants who fulfilled the selection criteria during the period March to September 1999. Inclusion criteria were gestational age 36 to 37 weeks, determined by the Dubowitz examination,¹⁶ mother attended antenatal clinic more than once, mother's education below 3 secondary level

Participants

Only 5.4% of the mothers approached in the hospital did not agree to participate. The sample in the analysis included all infants successfully tested at 7 months: 66 LBW-T infants in the intervention group, 69 LBW-T control infants, and 87 NBW infants, making an overall loss of only 5.1%.

The infants' characteristics are shown in Table I. There were no significant differences between the LBW-T groups. Apart from size at birth, the NBW group had significantly greater gestational age than both

Discussion

We demonstrated in a randomized trial that a simple intervention program of 8 home visits benefited problem-solving in LBW-T infants. They also benefited in behavior and were more cooperative and happy during the test session than the control subjects. Although there was no true placebo, the control group also received weekly visits (to obtain morbidity data), albeit of shorter duration. Furthermore, after intervention, there were few significant differences in cognition and behavior between

Acknowledgements

We thank Carol Ewan-Whyte, Susan Chang-Lopez, Novie Younger, Helen Baker, and the Community Health Workers for assistance and Peter Willatts and Karen Rosie for training in the cognitive development assessment techniques.

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^☆: Supported by a grant from the Nestlé Foundation.

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A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants☆

Abstract

Objectives

Study design

Results

Conclusions

Section snippets

Participants

Participants

Discussion

Acknowledgements

J Pediatr

Infant Behav Dev

Lancet

Fourth report on the World Nutrition Situation

Levels and patterns of intrauterine growth retardation in developing countries

Eur J Clin Nutr

Influence of variation in birth weight within normal range and within sibships on IQ at age 7 years: cohort study

Br Med J

Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study

Br Med J

Birth weight and cognitive function in young adult life: historical cohort study

Br Med J

The cognitive outcome of full-term small for gestational age infants at late adolescence

Obstet Gynecol

Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort

JAMA

Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life

Pediatrics

Nine-year outcome of the Vermont intervention program for low birth weight infants

Pediatrics

Infant health and development program for low birth weight, premature infants: program elements, family participation, and child intelligence

Pediatrics

Child rearing in poor urban Jamaica

Child Care Health Dev