Wu Ying-Chin, Hsieh Wu-Shiun, Hsu Chyong-Hsin, Chang Jui-Hsing, Chou Hung-Chieh, Hsu Hui-Chin, Chiu Nan-Chang, Lee Wang-Tso, Chen Wei-J, Ho Yu-Wen, Jeng Suh-Fang
School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Res Dev Disabil. 2016 Jan;48:1-12. doi: 10.1016/j.ridd.2015.10.016. Epub 2015 Oct 31.
Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36-38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers' responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI]=-1.60 [-3.07 to -0.13], p=0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI]=-0.84 [-1.57 to -0.10], p=0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants' emotion regulation in response to stress at toddler age.
早产儿有出现情绪障碍和行为问题的风险。本研究旨在调查基于门诊的干预项目（CBIP）和基于家庭的干预项目（HBIP）与常规护理项目（UCP）相比，对极低出生体重（VLBW，出生体重<1500g）早产儿应激时情绪调节的影响。共有178名VLBW早产儿先前被随机分配接受三种干预措施之一（CBIP组57名，HBIP组63名，UCP组58名）。CBIP和HBIP包含相同的以儿童、父母和亲子关系为重点的干预措施，在住院期间提供给婴儿，并分别在矫正年龄36 - 38周和40周、1个月、2个月、4个月、6个月、9个月、12个月时在门诊和家中实施。在矫正年龄12个月、18个月和24个月时，对所有婴儿进行前瞻性观察，以了解其对玩具屏障程序诱发的实验性应激的行为反应性和调节情况。在12个月时还评估了他们的认知和语言能力以及母亲的反应性作为潜在协变量。与UCP组婴儿相比，在矫正年龄12至24个月期间，HBIP组婴儿对玩具的视觉定向持续时间较短（调整差异[95%CI]= -1.60[-3.07至-0.13]，p = 0.03），CBIP组婴儿的回避持续时间较短（调整差异[95%CI]= -0.84[-1.57至-0.10]，p = 0.03）。然而，CBIP和HBIP与UCP在应激反应性方面没有差异。这些结果表明，纳入以儿童、父母和亲子关系为重点服务的综合干预措施可增强VLBW早产儿在幼儿期对应激的情绪调节能力。
