PEDIATRICS Vol. 117 No. 3 March 2006, pp. 771-780 (doi:10.1542/10.1542/peds.2005-1316)
Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program
a Society, Human Development and Health
c Biostatistics, Harvard School of Public Health, Boston, Massachusetts
b National Center for Children and Families, Teachers College, and College of Physicians and Surgeons, Columbia University, New York, New York
d Psychiatry and Behavioral Sciences
e Pediatrics, University of Washington, Seattle, Washington
f Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
g Department of Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
h Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
i Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
j Children's Hospital Boston, Boston, Massachusetts
k Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
OBJECTIVE. To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist, we compared those in a multisite randomized trial of such a program over the first 3 years of life (INT) to those with follow-up only (FUO) at 18 months of age.
METHODS. This was a prospective follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics. Originally 985 children were randomized to the INT (n = 377) or FUO (n = 608) groups within 2 birth weight strata: heavier low birth weight (HLBW; 2001–2499 g) and lighter low birth weight (LLBW; 
2000 g). Primary outcome measures were the Peabody Picture Vocabulary Test (PPVT-III), reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement, youth self-report on the Total Behavior Problem Index, and high-risk behaviors on the Youth Risk Behavior Surveillance System (YRBSS). Secondary outcomes included Weschler full-scale IQ, caregiver report on the Total Behavior Problem Index, and caregiver and youth self-reported physical health using the Medical Outcome Study measure. Assessors were masked as to study status.
RESULTS. We assessed 636 youths at 18 years (64.6% of the 985, 72% of whom had not died or refused at prior assessments). After adjusting for cohort attrition, differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math (5.1 points), YRBSS (–0.7 points), and the PPVT-III (3.8 points) in the HLBW youth. In the LLBW youth, the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group (4.2).
CONCLUSIONS. The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk. The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention.
Key Words: early intervention • long-term results • low birth weight • randomized controlled trial
Abbreviations: IHDP—Infant Health and Development Program • LLBW—lighter low birth weight • HLBW—heavier low birth weight • INT—intervention • FUO—follow-up only • YRBSS—Youth Risk Behavior Surveillance System • BPI—Behavior Problem Index • WASI—Weschler Abbreviated Scale of Intelligence • PPVT-III—Peabody Picture Vocabulary Test-Version III • HSG—high school graduate • CI—confidence interval • LBW—low birth weight
Accepted Aug 12, 2005.
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