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Open Access Research article

School-age effects of the newborn individualized developmental care and assessment program for preterm infants with intrauterine growth restriction: preliminary findings

Gloria McAnulty1*, Frank H Duffy2, Sandra Kosta1, Neil I Weisenfeld3, Simon K Warfield3, Samantha C Butler1, Moona Alidoost1, Jane Holmes Bernstein1, Richard Robertson4, David Zurakowski5 and Heidelise Als1

Author affiliations

1 Department of Psychiatry, Neurobehavioral Infant and Child Studies, Enders Pediatric Research Laboratories, EN-107, Children’s Hospital Boston, Harvard Medical School, 320 Longwood Avenue, 02115, Boston, MA, USA

2 Department of Neurology, Developmental Neurophysiology Laboratory, Enders Pediatric Research Laboratories, EN-109-110, Children’s Hospital Boston, Harvard Medical School, 320 Longwood Avenue, 02115, Boston, MA, USA

3 Department of Radiology, Computational Radiology Laboratory, Main 2, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, 02115, Boston, MA, USA

4 Department of Radiology, Main South 1, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, 02115, Boston, MA, USA

5 Department of Anesthesiology, Perioperative & Pain Medicine, Pavilion 121, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, 02115, Boston, MA, USA

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Citation and License

BMC Pediatrics 2013, 13:25  doi:10.1186/1471-2431-13-25

Published: 19 February 2013

Abstract

Background

The experience in the newborn intensive care nursery results in premature infants’ neurobehavioral and neurophysiological dysfunction and poorer brain structure. Preterms with severe intrauterine growth restriction are doubly jeopardized given their compromised brains. The Newborn Individualized Developmental Care and Assessment Program improved outcome at early school-age for preterms with appropriate intrauterine growth. It also showed effectiveness to nine months for preterms with intrauterine growth restriction. The current study tested effectiveness into school-age for preterms with intrauterine growth restriction regarding executive function (EF), electrophysiology (EEG) and neurostructure (MRI).

Methods

Twenty-three 9-year-old former growth-restricted preterms, randomized at birth to standard care (14 controls) or to the Newborn Individualized Developmental Care and Assessment Program (9 experimentals) were assessed with standardized measures of cognition, achievement, executive function, electroencephalography, and magnetic resonance imaging. The participating children were comparable to those lost to follow-up, and the controls to the experimentals, in terms of newborn background health and demographics. All outcome measures were corrected for mother’s intelligence. Analysis techniques included two-group analysis of variance and stepwise discriminate analysis for the outcome measures, Wilks’ lambda and jackknifed classification to ascertain two-group classification success per and across domains; canonical correlation analysis to explore relationships among neuropsychological, electrophysiological and neurostructural domains at school-age, and from the newborn period to school-age.

Results

Controls and experimentals were comparable in age at testing, anthropometric and health parameters, and in cognitive and achievement scores. Experimentals scored better in executive function, spectral coherence, and cerebellar volumes. Furthermore, executive function, spectral coherence and brain structural measures discriminated controls from experimentals. Executive function correlated with coherence and brain structure measures, and with newborn-period neurobehavioral assessment.

Conclusion

The intervention in the intensive care nursery improved executive function as well as spectral coherence between occipital and frontal as well as parietal regions. The experimentals’ cerebella were significantly larger than the controls’. These results, while preliminary, point to the possibility of long-term brain improvement even of intrauterine growth compromised preterms if individualized intervention begins with admission to the NICU and extends throughout transition home. Larger sample replications are required in order to confirm these results.

Clinical trial registration

The study is registered as a clinical trial. The trial registration number is NCT00914108.

Keywords:
Newborn individualized developmental care and assessment program (NIDCAP); Intrauterine growth restriction (IUGR); Preterm; School-age; Executive function; Memory; Spectral coherence; MRI tissue segmentation; Cerebellum; Rey-Osterrieth Complex Figure Test