PEDIATRICS Vol. 117 No. 3 March 2006, pp. 940-941 (doi:10.1542/peds.2005-2701)
COMMENTARY |
Progress in Improving the Development of Low Birth Weight Newborns
Department of Pediatrics, University of Colorado, Denver, Colorado
In 1982, with major funding from the Robert Wood Johnson Foundation, a team of investigators initiated an 8-site randomized, controlled trial of an educational intervention for preterm and low birth weight newborns known as the Infant Health and Development Program. Although interventions had been tested for this population in earlier studies,1 this trial was unique in its boldness of program and research design.
The investigators adapted a promising program for the intervention that consisted of home visiting and educationally enriched day care for children who were aged 0 to 3 years, which previously had been tested with young children and their families living in poverty.2 Fortunately, the investigators stratified the randomization by birth weight (
2000 vs 2001–2500 g). In earlier phases of follow-up, the investigators found large intervention effects on cognition and behavior at the end of the program, with those benefits concentrated in children who were born in the higher birth weight stratum.3 By age 5 and 8, those effects began to attenuate, especially for those in the lower birth weight subsample.4,5
In this month's issue of Pediatrics, McCormick et al6 report the results of a follow-up of the children at age 18. Among children in the higher low-birth weight group, those in the intervention group had better language development and math achievement and fewer risky behaviors compared with control-group counterparts. There were no discernible long-term benefits for children in the lower low-birth weight stratum. Also, there were no effects for either birth weight group on grade retention and placement in special education, which are outcomes that might help offset the high cost of the intervention. Although effects for the higher-weight children are modest, it is remarkable that, 18 years after birth, the program signal could be detected at all.
Knowing now that it is possible to alter the long-term trajectories of newborns in the 2000- to 2500-g range, we are in a position to ask new questions:
- Is it possible to alter the long-term developmental trajectories of very low birth weight newborns by adjusting their NICU care in ways that are consistent with their individual neurophysiologic capacities, thereby promoting behavioral and neurologic regulation?7
- Is it possible to increase and sustain program effects at lower cost by building on promising interventions that work with parents before and after discharge with interventions that emphasize the promotion of neurobehavioral regulation?1
This current trial is of immense significance in telling us that something important can be achieved for vulnerable infants born in the 2000- to 2500-g range. Now we need to find ways of helping those with lower weights and doing so at lower cost.
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FOOTNOTES |
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Accepted Nov 1, 2005.
Address correspondence to David Olds, PhD, Department of Pediatrics, 1825 Marion St, Denver, CO 80218. E-mail: olds.david{at}tchden.org
The author has indicated he has no financial relationships relevant to this article to disclose.
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REFERENCES |
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3. Infant Health and Development Program. Enhancing the outcomes of low-birth-weight, premature infants: a multisite, randomized trial.
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4. Brooks-Gunn J, McCarton CM, Casey PH, et al. Early intervention in low-birth-weight premature infants: results through age 5 years from the Infant Health and Development Program.
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5. McCarton CM, Brooks-Gunn J, Wallace IF, et al. Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program.
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6. McCormick MC, Brooks-Gunn J, Buka SL, et al. Early intervention in low birth weight premature infants: results at 18 years of age for the Infant Health and Development Program.
Pediatrics. 2006;117
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7. Als H, Duffy FH, McAnulty GB, et al. Early experience alters brain function and structure. Pediatrics. 2005;113 :846 –857
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
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