Faculty of Nursing, Université de Montréal, P.O. Box 6128, Succursale centre-ville, Montréal, QC, H3C 3J7, Canada.
CHU Sainte-Justine Research Centre, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
BMC Pediatr. 2021 Apr 29;21(1):210. doi: 10.1186/s12887-021-02559-6.
As preterm infants' neurodevelopment is shaped by NICU-related factors during their hospitalization, it is essential to evaluate which interventions are more beneficial for their neurodevelopment at this specific time. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of interventions initiated during NICU hospitalization on preterm infants' early neurodevelopment during their hospitalization and up to two weeks corrected age (CA).
This systematic review referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO (CRD42017047072). We searched CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Systematic Reviews, CENTRAL, and Web of Science from 2002 to February 2020 and included randomized controlled/clinical trials conducted with preterm infants born between 24 and 36 weeks of gestation. All types of interventions instigated during NICU hospitalization were included. Two independent reviewers performed the study selection, data extraction, assessment of risks of bias and quality of evidence.
Findings of 12 studies involving 901 preterm infants were synthesized. We combined three studies in a meta-analysis showing that compared to standard care, the NIDCAP intervention is effective in improving preterm infants' neurobehavioral and neurological development at two weeks CA. We also combined two other studies in a meta-analysis indicating that parental participation did not significantly improve preterm infants' neurobehavioral development during NICU hospitalization. For all other interventions (i.e., developmental care, sensory stimulation, music and physical therapy), the synthesis of results shows that compared to standard care or other types of comparators, the effectiveness was either controversial or partially effective.
The overall quality of evidence was rated low to very low. Future studies are needed to identify interventions that are the most effective in promoting preterm infants' early neurodevelopment during NICU hospitalization or close to term age. Interventions should be appropriately designed to allow comparison with previous studies and a combination of different instruments could provide a more global assessment of preterm infants' neurodevelopment and thus allow for comparisons across studies.
Prospero CRD42017047072 .
由于早产儿的神经发育受新生儿重症监护病房（NICU）相关因素的影响，因此评估在特定时间内哪些干预措施对其神经发育更有益至关重要。本系统评价和荟萃分析的目的是评估 NICU 住院期间开始的干预措施对早产儿住院期间及其至两周校正年龄（CA）时早期神经发育的有效性。
本系统评价参照系统评价和荟萃分析的首选报告项目[PRISMA]指南，并在 PROSPERO（CRD42017047072）中进行了注册。我们从 2002 年至 2020 年 2 月在 CINAHL、MEDLINE、PubMed、EMBASE（OVID）、Cochrane 系统评价、CENTRAL 和 Web of Science 中进行了检索，并纳入了在 24 至 36 周胎龄之间出生的早产儿进行的随机对照/临床试验。纳入了 NICU 住院期间开始的所有类型的干预措施。两名独立的评审员进行了研究选择、数据提取、偏倚风险评估和证据质量评估。
纳入的 12 项研究涉及 901 名早产儿，对其进行了综合分析。我们将三项研究合并进行荟萃分析，结果表明，与标准护理相比，神经发育矫正治疗（NIDCAP）干预措施在两周 CA 时可有效改善早产儿的神经行为和神经发育。我们还将另外两项研究合并进行荟萃分析，结果表明，父母参与并不能显著改善早产儿在 NICU 住院期间的神经行为发育。对于所有其他干预措施（即发育护理、感觉刺激、音乐和物理治疗），结果综合表明，与标准护理或其他类型的对照组相比，其效果要么存在争议，要么部分有效。
总体证据质量被评为低至极低。需要进一步研究以确定在 NICU 住院期间或接近足月年龄时最能促进早产儿早期神经发育的干预措施。干预措施的设计应适当，以便与先前的研究进行比较，并且不同仪器的组合可以提供早产儿神经发育的更全面评估，从而允许在研究之间进行比较。
PROSPERO CRD42017047072。
