Neurodevelopment and Growth of a Cohort of Very Low Birth Weight Preterm Infants Compared to Full-Term Infants in Brazil.

OBJECTIVE: The objective of this study was to investigate the neurodevelopment and growth of very low birth weight (BW) preterm infants, at 8 and 18 months corrected age (CA), compared with full term in Brazil. METHODS: Prospective cohort study including 83 preterm infants with BW ≤ 1,500 g and gestational age ≤ 32 weeks, and 52 full-term control infants. Preterm infants free from significant sensory and motor disability, and from congenital anomalies were included. Alberta infant motor scale (AIMS) and Brunet-Lèzini scale (BLS) were used to evaluate the neurodevelopment at 8 and 18 months. Anthropometric measurements were collected to evaluate the growth in both age groups. RESULTS: At 8 months CA, preterm infants scored significantly lower in total AIMS score (p = 0.001). At 18 months, they scored significantly lower on the stand subscale from AIMS (p = 0.040) and exhibited poor psychomotor development in the BLS (p = 0.006). The nutritional status showed significant differences between the groups, in both age groups (p < 0.001). There were positive correlations between nutritional status and AIMS (r = 0.420; p < 0.001) and BLS (r = 0.456; p < 0.001) at 8 months, and between head circumference and BLS (r = 0.235; p < 0.05) at 8 months and AIMS (r = 0.258; p < 0.05) at 18 months. CONCLUSION: Very low BW preterm infants at 8 and 18 months CA showed significant differences in the neurodevelopment and growth pattern when compared with their full-term peers.

Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight: A Randomized Clinical Trial.

Importance: Early interventions improve neurodevelopmental outcomes after preterm birth, but few studies of early intervention have focused on preterm infants whose families reside in low- or middle-income countries (LMICs). Objective: To evaluate whether parent-guided early intervention improves the neurodevelopmental outcomes of preterm infants in an LMIC. Design, Setting, and Participants: This randomized clinical trial was performed at a high-risk obstetric referral hospital in Brazil, with outcome evaluations by examiners masked to randomization group. Eligibility criteria were (1) birth at the study hospital, (2) residence within 40 km of the birth hospital, and (3) gestational age of less than 32 weeks or birth weight of less than 1500 g. Of 138 enrolled infants, 19 died after randomization and 19 withdrew from the study; all other enrollees (50 per randomization group) were evaluated for the primary outcome. Data were collected from January 1, 2016, to May 31, 2022, and analyzed from June 10 to July 31, 2022. Interventions: On postnatal day 7, infants were randomized to usual care, consisting of support for lactation, kangaroo care, and routine developmental therapies, or to a parent-guided enhanced developmental intervention, consisting of usual care plus infant massage and enhanced visual stimulation, auditory stimulation, social interactions, and support for motor development, instructed by developmental therapists. Main Outcomes and Measures: The primary outcome was the Bayley Scales of Infant and Toddler Development-Third Edition score at 18 months of age adjusted for prematurity. Results: Among the 100 infants included in the analysis, mean (SD) gestational age was 28.4 (2.2) weeks, and 57 (57%) were male. The mean (SD) gestational age for the intervention group was 28.3 (2.3) weeks; for the usual care group, 28.5 (2.2) weeks. Female infants accounted for 21 infants (42%) of the intervention group and 22 (44%) of the usual care group; male infants, 29 (58%) and 28 (56%), respectively. The enhanced developmental intervention group had higher cognitive scores at 18 months of corrected age (mean [SD], 101.8 [11.9] vs 97.3 [13.5]; mean difference, 4.5 [95% CI, 0.1-8.9]). Conclusions and Relevance: In this randomized clinical trial of a parent-guided developmental intervention for early cognitive function of very preterm or very low birth weight infants implemented in an LMIC, the intervention improved very preterm infants' neurodevelopmental outcomes at 18 months of adjusted age. Parent-guided early intervention can improve neurodevelopmental outcome of very preterm infants born in LMICs. Trial Registration: ClinicalTrials.gov Identifier: NCT02835612.