TABLE 4

Review of Key Impacts of Interventions Delivered in the Neonatal Period

Key InterventionsSummary Effects With Implications for Developmental Outcomes (Direct Developmental Effects)
Delayed cord clamping, 4 SRs, HIC, and LMICFewer complications of prematurity: reduced risk of intraventricular hemorrhage in preterm (RR 0.59, 95% CI 0.41 to 0.85; N = 539 in 10 studies) and early-preterm neonates (RR 0.62, 95% CI 0.43 to 0.91; N = 390 in 9 studies) and reduced risk of necrotizing enterocolitis (RR 0.62, 95% CI 0.43 to 0.90; N = 241 in 5 studies)
Improved iron status: in premature infants, increased hematocrit at 24 h (MD 3.28, 95% CI 1.34 to 5.22; N = 199 in 3 studies); in extremely low birth weight infants, increased hemoglobin on NICU admission (MD 3.42 g/dL, 95% CI 3.11 to 3.74; N = 137 in 10 studies); and in term infants, reduced iron deficiency at 3–6 mo (early versus delayed RR 2.65, 95% CI 1.04 to 6.73; N = 1152 in 5 studies)
Reduced risk of infection: decreased odds of late-onset sepsis in extremely low birth weight infants (OR 0.39, 95% CI 0.18 to 0.81; 10 studies)
Mixed effects on development at 4 mo in term infants: improved problem-solving ASQ score (MD 1.80, 95% CI 0.22 to 3.38; N = 365 in 1 study) and reduced personal-social ASQ score (MD −2.30, 95% CI −4.09 to −0.51; N = 365 in 1 study)
Nonsignificant effects: total ASQ score at 4 mo (MD −1.40, 95% CI −7.31 to 4.51; N = 365 in 1 study) and BSID mental development score <70 at 24 mo (OR 0.52, 95% CI 0.14 to 1.98; 2 studies)
Therapeutic hypothermia for hypoxic ischemic encephalopathy, 1 SR, HIC, and LMICReduced cognitive developmental and motor disability: reduced risk of major developmental disability (RR 0.77, 95% CI 0.63 to 0.94; N = 1344 in 8 studies), cerebral palsy (RR 0.66, 95% CI 0.54 to 0.82; N = 881 in 7 studies), neuromotor delay (RR 0.75, 95% CI 0.59 to 0.94; N = 657 in 6 studies), and developmental delay (RR 0.74, 95% CI 0.58 to 0.94; N = 667 in 6 studies)
Nonsignificant effects: neuromotor development score (MD 0.77, 95% CI −4.39 to 5.94; N = 271 in 3 studies) and mental development score (MD 2.47, 95% CI −2.77 to 7.71; N = 271 in 3 studies)
KMC, skin-to-skin contact, and other thermal care methods in preterm infants, 4 SR, HIC, and LMICImproved feeding practices: more exclusive breastfeeding at 1–3 mo (RR 1.20, 95% CI 1.01 to 1.43; N = 600 in 5 studies) and 3–6 mo (RR 1.97, 95% CI 1.37 to 2.83; N = 149 in 3 studies)
Reduced risk of infection: reduced risk of sepsis (RR 0.56, 95% CI 0.40 to 0.78; N = 1343 in 7 studies)
Improved mother-infant attachment score (MD 6.24, 95% CI 5.57 to 6.91; N = 100 in 1 study)
Nonsignificant effects: psychomotor development at 12 mo (MD 1.05, 95% CI −0.75 to 2.85; N = 579 in 1 study)
Topical emollient therapy, 2 SR, HIC, and LMICReduced infection risk in preterm infants: reduced risk of hospital-acquired infection in LMIC (RR 0.50, 95% CI 0.36 to 0.71; N = 697 in 3 studies)
Increased early growth: increased rate of length gain (MD 1.22 mm per wk, 95% CI 1.01 to 1.44; N = 320 in 5 studies), head circumference (MD 0.45 mm per wk, 95% CI 0.19 to 0.70; N = 320 in 5 studies), weight gain (MD 2.55 g/kg/d, 95% CI 1.76 to 3.34; N = 379 in 6 studies), and weight gain at 28 d in LMIC (SMD 1.57, 95% CI 0.79 to 2.36; N = 192 in 2 studies)
  • ASQ, Ages and Stages Questionnaire; BSID, Bayley Scales of Infant Development; CI, confidence interval; HIC, high-income country; MD, mean difference; OR, odds ratio; RR, risk ratio; SMD, standard mean difference; SR, systematic review.