Critical Care and Neurosciences, Murdoch Childrens Research Institute, Victoria, Australia.
Pediatrics. 2012 Dec;130(6):1094-101. doi: 10.1542/peds.2012-0426. Epub 2012 Nov 5.
We have previously reported improved caregiver mental health and infant behavior at 2 years following a home-based preventive care program for very preterm infants and their caregivers. This study aimed to determine the longer-term effectiveness of the program by reviewing caregivers and children at preschool age.
One hundred twenty very preterm infants (<30 weeks' gestation) were randomly allocated to intervention (n = 61) or control (n = 59) groups. The intervention included 9 home visits over the first year of life targeting infant development, parent mental health, and the parent-infant relationship. The control group received standard care. At 4 years' corrected age, child cognitive, behavioral, and motor functioning and caregiver mental health were assessed.
At age 4 years, 105 (89%) children were reviewed. There was little evidence of differences in cognitive or motor functioning between groups. The intervention group had lower scores for child internalizing behaviors than the control group (mean difference -5.3, 95% confidence interval [CI] -9.6 to -0.9, P = .02). Caregivers in the intervention group had fewer anxiety symptoms (mean difference -1.8, 95% CI -3.3 to -0.4, P = .01) and were less likely to exhibit "at-risk" anxiety (odds ratio 0.3, 95% CI 0.1 to 0.7, P = .01) than those in the control group.
This home-based preventive care program for very preterm infants has selective long-term benefits, including less caregiver anxiety and reduced preschooler internalizing behaviors.
我们之前报道过，为极早产儿及其照顾者提供家庭为基础的预防保健计划可改善照顾者的心理健康和婴儿的行为，且这种改善可持续到 2 年。本研究旨在通过对学龄前儿童和照顾者进行评估，来确定该计划的长期效果。
120 名极早产儿（<30 周）被随机分配到干预组（n=61）或对照组（n=59）。干预组在婴儿生命的第一年中接受 9 次家访，以关注婴儿的发育、父母的心理健康和父母-婴儿关系。对照组接受标准护理。在 4 年的矫正年龄时，评估儿童的认知、行为和运动功能以及照顾者的心理健康。
在 4 岁时，有 105 名（89%）儿童接受了评估。两组之间在认知或运动功能方面几乎没有差异的证据。干预组儿童的内化行为评分低于对照组（平均差异-5.3，95%置信区间[CI]为-9.6 至-0.9，P=0.02）。干预组的照顾者焦虑症状较少（平均差异-1.8，95%CI 为-3.3 至-0.4，P=0.01），表现出“风险”焦虑的可能性较小（比值比 0.3，95%CI 为 0.1 至 0.7，P=0.01）。
这种针对极早产儿的家庭为基础的预防保健计划具有选择性的长期益处，包括减少照顾者的焦虑和减少学龄前儿童的内化行为。
