Parent-Based Interventions for Premature

Infants Cognitive Outcomes: A Systematic Review

Chelsea Len, Alinoel Navia, Samantha Notte, Mary Salama
Seton Hall University

Results

Background
According to the CDC, premature birth is the birth of
an infant weighing less than 2500g (5 lbs, 5 oz) and
before 37 weeks of pregnancy. It is the leading cause
of long-term neurological disabilities in children;
450,000 babies were born premature in 2012.
Previous research has shown that mothers of preterm
infants provide a less responsive and stimulating
home environment when compared to full-term
infants. Feldman et al. (2002) suggest that this has
detrimental effects on the infants cognitive
development.
An important concern for premature infants is their
cognitive development. Traditionally, clinicians provide
treatment in this domain. Comparatively, parent-based
intervention is proposed to be more efficient because
the parent has more opportunities to increase
responsiveness and engagement in various
environments across the lifespan.
The purpose of this systematic review is to examine
different parent-based interventions and premature
infants cognitive outcomes. The research question
is:
What types of interventions support the use of
parent-focused early intervention strategies to
improve cognitive development of premature
infants?

Literature Search
Studies consisting of eleven randomized,
controlled trials and one randomized, controlled
trial were selected from the following databases:
Google Scholar
EbscoHost
Science Direct
PubMed (NCBI)
Proquest
CINAHL
Search terms and key words: parent-based early
intervention, cognitive outcomes, premature
infants, early intervention.
Articles published before 1990 were excluded.

Intervention

Intervention Descriptions

KC

Age at
Measure
Assessment
6 months
BSID-MDI

Treatment Control
Cohens d Effect Size
Infants (n) Infants (n)
73
73
.47
Medium

MTIP

2 years

BSID-MDI

69

67

.20

Small

PBIP

BSID-MDI

112

121

.09

Small

Portage

Griffiths

111

99

.17

Small

IHDP

BSID

377

608

.59

Medium

BSID-MDI

72

74

.36

Small

SB-3

377

608

.59

Medium

WPPSI-R

72

37

.35

Small

BAS-II

63

63

.12

Small

MITP

3 years

IHDP
MITP

5 years

Portage
MITP

7 years

KABC

24

32

.94

Large

IHDP
MITP
IHDP

8 years
9 years
18 years

WISC-III
KABC
WASI

336
24
254

538
31
382

N/A
.97
.03

N/A
Large
Small

Measure abbreviations: BAS-II, British Ability Scales-II, BSID-MDI, Bayley Scale of Infant
Development Mental Development Index; Griffiths, Griffiths Mental Development Scale;
KABC, Kaufman Assessment Battery for Children; SB-3, Stanford-Binet Intelligence Scale3rd Edition; WASI, Wechsler Abbreviated Scale of Intelligence; WISC- III, Wechsler
Intelligence Scale for Children-III; WPPSI-R, Wechsler Preschool and Primary Scale of
Intelligence

Patient Characteristics
Premature babies were recruited at
birth.
Birth weight was less than 2500g and
ages ranged from 25 weeks gestational
age up to 18 years.
No major congenital abnormalities.
Studies included medically low and highrisk premature infants to assess rate of
effects of parent-based interventions
across severities.

Dosage
Total treatment hours were provided at
an average of 9.57 hours with a
standard deviation of 4.19 hours.
Duration of treatment was provided
across an average of 57.16 weeks with
a standard deviation of 59.21.
Sessions ranged from 1 to 7 days per
week for 30-60 minutes and
discontinued based on individualized
protocol.

Intervention
Infant Health
Development
.
Program
(IHDP)
Kangaroo Care (KC)

Mother Infant
Transaction
Program (MITP)
Parent Baby
Interaction Program
(PBIP)
Portage
Intervention

Description
Comprehensive program incorporating a
triad of home visits, childhood development
and parent meetings.
Infants are removed from the incubator
wearing only a diaper (and sometimes a
cap), then they are placed on the mothers
bare chest for at least one hour for 14
consecutive days.
Educating parents in using techniques
such as modeling, verbal instruction and
practical experience to elicit frequent and
meaningful interactions with the infant
beginning one-week pre-discharge.
Parent education on developmental care
principles and training on attachment,
interaction and sensitivity to the babys
cues. Activity sessions targeted four main
areas: discursive (infant development),
tactile (handling), verbal and observational
(behavioral states
and cues).
Team-based,
family-focused
approach
where professionals use precision teaching
on development to promote and facilitate
learning. Home teaching is structured
through child-led play.

Clinical Recommendations
Findings suggest that parent-based MITP treatment
is effective compared to clinician-based treatment
until age 9.
Limitations:
Using birth weight instead of gestation
age led to inclusion of more mature
infants; findings cannot be generalized.
SES effects on the fidelity of treatment.
Inclusion of center-based programs
when the child reached school-age.
Parent and nurse specialist blinding.
Parent-based interventions are recommended
because although many studies had a small to
medium effect size, parents reported less stress
and higher comfort levels when responding to their
premature infant. This plays a role in the infants
cognitive development (Feldman et al., 2002).
Future directions: Future research is needed in the
area of MITP to determine if positive long-term
effects persist past age 9.