Karen Koldewijn

The effect of the Infant Behavioral Assessment and Intervention Program on mother-infant interaction after very preterm birth

BACKGROUND Prematurity and perinatal insults lead to increased developmental vulnerability. The home-based Infant Behavioral Assessment and Intervention Program (IBAIP) was designed to improve development of preterm infants. In a multicenter randomized controlled trial the effect of IBAIP on mother-infant interaction was studied as a secondary outcome. METHOD Mother-infant interaction was assessed during the Still-face procedure at 6 months corrected age. One hundred and twelve mother-infant dyads (57 intervention, 55 control) were studied. RESULTS Findings partially supported our hypothesis that the intervention would increase maternal sensitivity in interaction with their preterm infants. No effects were found on infant self-regulatory behavior or positive interaction behavior. CONCLUSION   The family-centered and strength-based approach of IBAIP appears to be a promising intervention method to promote sensitive mother-infant interaction at home after discharge from hospital. However, no positive effects were found on infant interaction behavior.

Maternal attachment representations after very preterm birth and the effect of early intervention

OBJECTIVE For very preterm infants the mother-infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is designed to assist parents to support and enhance their infants regulatory competence and development. The intervention consisted of 6-8 home visits during the first 8 months after birth. METHOD Seventy-eight mothers of very preterm infants (< 32 weeks and/or < 1500 g) were interviewed, who participated in a randomized controlled trial: 41 from the intervention group and 37 from the control group. Maternal attachment representations were assessed with the Working Model of the Child Interview (WMCI). The interviews resulted in a classification of the attachment representations into balanced or non-balanced. RESULTS 30% of the mothers had non-balanced attachment representations. Qualitative content analysis of the answers showed that negative feelings when first seeing their baby and negative or ambivalent feelings in the first weeks at home with their baby are related to non-balanced attachment representations. The WMCI revealed no differences between the intervention and control group. CONCLUSION Early support for mothers of very preterm born infants to develop a healthy mother-infant relationship is recommended especially for mothers who report negative first experiences.

Infant behavioral assessment and intervention program in very low birth weight infants improves independency in mobility at preschool age

OBJECTIVE To evaluate the effects of the Infant Behavioral Assessment and Intervention Program(©) (IBAIP) in very low birth weight infants on sensory processing and daily activities at preschool age. STUDY DESIGN Follow-up of children included in a randomized controlled trial. Eighty-six infants were enrolled in post-discharge IBAIP until 6 months corrected age, and 90 infants received standard care. At 3.5 years of age, the Sensory Profile-Dutch version (SP-NL) and Pediatric Evaluation of Disability Inventory-Dutch version (PEDI-NL) were administered. For comparison, parents of 41 term-born children also completed the SP-NL. RESULTS Seventy-six children (88%) in the IBAIP group and 75 children (83%) children in the control group were examined at 44 months corrected age. After adjustment for pre-randomization differences in perinatal characteristics, the IBAIP group outperformed the control group significantly on SP-NL domains of oral sensory processing and sensory processing related to endurance/tone and PEDI-NL domains of mobility. The control group only scored significantly lower than the term group on the SP-NL domain endurance/tone. The very low birth weight groups performed significantly below the PEDI-NLs norm. CONCLUSION In line with the positive developmental effects of the IBAIP until 24 months corrected age, independency in mobility in daily activities was improved at 3.5 years.

The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age.

BACKGROUND The Infant Behavioral Assessment and Intervention Program (IBAIP©) improved motor function at 24 months, and mental and behavioural development in high risk subgroups of very low birth weight (VLBW) infants. AIM To determine IBAIPs effects on executive functioning, behaviour and cognition at preschool age. STUDY DESIGN Follow-up of a randomised controlled trial (RCT). SUBJECTS At 44 months corrected age, all 176 VLBW infants were invited for follow-up. Forty-one term born children were assessed for comparison. OUTCOME MEASURES Visual Attention Task (VAT), Gift delay, Peabody Picture Vocabulary Test III-NL (PPVT), Visual motor integration tests and Miller assessment for preschoolers. Parents completed Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and Child Behavior Checklist (CBCL). RESULTS At preschool age, 76 (88%) children of the intervention group and 75 (83%) children of the control group participated. There were no significant differences between the intervention and the control group. However, positive interaction effects between intervention and infants with bronchopulmonary dysplasia, infants born at gestational age<28 weeks, and infants of low educated mothers were found on CBCL, CBCL and BRIEF-P, and PPVT respectively. Most interaction effects exceeded 1 standard deviation in favour of the intervention children. The 151 VLBW children performed significantly worse than the term born children on the VAT, BRIEF-P and CBCL. CONCLUSION IBAIP effects in VLBW children did not sustain until preschool age on executive functioning, behaviour and cognition. However, the most vulnerable children had a clinical relevant profit from IBAIP. VLBW children performed worse than the term born children. This study is a follow-up at preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW infants. The RCT was performed in Amsterdam, The Netherlands (IBAIP).

Sustained developmental effects of the infant behavioral assessment and intervention program in very low birth weight infants at 5.5 years corrected age

OBJECTIVE To evaluate the effect of the Infant Behavioral Assessment and Intervention Program (IBAIP) in very low birth weight (VLBW) infants on cognitive, neuromotor, and behavioral development at 5.5 years corrected age (CA). STUDY DESIGN In a randomized controlled trial, 86 VLBW infants received post discharge IBAIP intervention until 6 months CA, and 90 VLBW infants received standard care. At 5.5 years CA, cognitive and motor development, and visual-motor integration were assessed with the Wechsler Preschool and Primary Scale of Intelligence, third Dutch version, the Movement Assessment Battery for Children, second edition, and the Developmental Test of Visual Motor Integration. Neurologic conditions were assessed with the neurologic examination according to Touwen, and behavior with the Strengths and Difficulties Questionnaire. RESULTS At 5.5 years CA, 69 children in the intervention and 67 children in the control group participated (response rate 77.3%). Verbal and performance IQ-scores<85 occurred significantly less often in the intervention than in the control group (17.9% vs 33.3%, P=.041, and 7.5% vs 21.2%, P=.023, respectively). However, after adjustment for differences, only the OR for performance IQ was significant: 0.24, 95% CI: 0.06-0.95. Adjusted mean scores on Wechsler Preschool and Primary Scale of Intelligence, third version subtasks block design and vocabulary, the Movement Assessment Battery for Children, second edition component aiming and catching, and the Developmental Test of Visual Motor Integration were significantly better in the intervention group. No intervention effect was found on the Strengths and Difficulties Questionnaire. CONCLUSION The IBAIP leads, 5 years after the early neurobehavioral intervention, to improvements on performance IQ, ball skills, and visual-motor integration at 5.5 years CA.

Maternal psychological distress in the first two years after very preterm birth and early intervention

Preterm delivery may have a strong impact on mothers. In a multicentre randomised controlled trial, including very preterm infants (<32 weeks and/or <1500 g), the effect of the Infant Behavioral Assessment and Intervention Program (IBAIP) on maternal psychological distress at 6, 12 and 24 (corrected) months after preterm birth was assessed. The programme is designed to assist parents to support and enhance their infants’ regulatory competence and development. Eighty‐six infants and their parents were randomly assigned to the intervention group and 90 to the control group. Maternal psychological distress was assessed with the General Health Questionnaire. In general, the mothers reported high levels of psychological distress, especially during the first six months after discharge from hospital when 56% had clinical scores. No differences were found in maternal psychological distress between the intervention and control group. Early intervention to decrease maternal distress in mothers of preterm infants is warranted.

Rethinking preventive post-discharge intervention programmes for very preterm infants and their parents.

Post‐discharge preventive intervention programmes with involvement of the parent may support the resilience and developmental outcomes of infants born very preterm. Randomized controlled trials of home‐based family‐centred intervention programmes in very preterm infants that aimed to improve cognitive outcome, at least at age two, were selected and updated on the basis of a recent systematic review to compare their content and effect over time to form the basis of a narrative review. Six programmes were included in this narrative review. Four of the six programmes led to improved child cognitive and/or motor development. Two programmes, which focused primarily on responsive parenting and development, demonstrated improved cognitive outcome up till 5 years after completion of the programme. The programmes that also focused on maternal anxiety remediation led to improved maternal mental well‐being, along with improved child behaviour, in one study – even at 3 years after completion of the programme. The magnitude of the effects was modest. Family‐centred preventive intervention programmes that aim at improvement of child development should be continued after discharge home to improve the preterm childs resilience. Programmes may be most effective when they support the evolvement of a responsive parent–infant relationship over time, as well as the parents well‐being.

Early intervention leads to long‐term developmental improvements in very preterm infants, especially infants with bronchopulmonary dysplasia

Various early intervention programmes have been developed in response to the high rate of neurodevelopmental problems in very preterm infants. We investigated longitudinal effects of the Infant Behavioral Assessment and Intervention Program on cognitive and motor development of very preterm infants at the corrected ages of six months to five and a half years.

Comparing Two Motor Assessment Tools to Evaluate Neurobehavioral Intervention Effects in Infants With Very Low Birth Weight at 1 Year

Background Infants with very low birth weight (VLBW) are at increased risk for motor deficits, which may be reduced by early intervention programs. For detection of motor deficits and to monitor intervention, different assessment tools are available. It is important to choose tools that are sensitive to evaluate the efficacy of intervention on motor outcome. Objective The purpose of this study was to compare the Alberta Infant Motor Scale (AIMS) and the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development–Dutch Second Edition (BSID-II-NL) in their ability to evaluate effects of an early intervention, provided by pediatric physical therapists, on motor development in infants with VLBW at 12 months corrected age (CA). Design This was a secondary study in which data collected from a randomized controlled trial (RCT) were used. Methods At 12 months CA, 116 of 176 infants with VLBW participating in an RCT on the effect of the Infant Behavioral Assessment and Intervention Program were assessed with both the AIMS and the PDI. Intervention effects on the AIMS and PDI were compared. Results Corrected for baseline differences, significant intervention effects were found for AIMS and PDI scores. The highest effect size was for the AIMS subscale sit. A significant reduction of abnormal motor development in the intervention group was found only with the AIMS. Limitations No Dutch norms are available for the AIMS. Conclusions The responsiveness of the AIMS to detect intervention effects was better than that of the PDI. Therefore, caution is recommended in monitoring infants with VLBW only with the PDI, and the use of both the AIMS and the Bayley Scales of Infant Development is advised when evaluating intervention effects on motor development at 12 months CA.

Early intervention in preterm infants after discharge from hospital

ity of admissions were for a febrile illness (see Table 1). During the weekends, admitted patients were more likely to have unconsciousness or seizures and less likely to have a prolonged illness, malnutrition, or subcostal indrawing. There was no evidence for differences in the distributions of very early, early, and late prognostic scores between weekend and weekday admissions (Kruskall-Wallis tests: very early 2 1.08, P 0.30; early 2 0.51, P 0.47; late 2 2.53, P 0.11). When adjusted for prognostic score, age, bacteremia and Plasmodium falciparum parasitemia, admission during the weekend was associated with ORs for death of 2.05 (95% CI: 1.26–3.31) within 4 hours of admission, 1.54 (95% CI: 1.17–2.03) within 4 to 48 hours, and 1.09 (95% CI: 0.80–1.47) 48 hours after admission. There was a substantially higher risk of early inpatient death among weekend compared to weekday pediatric admissions. Because we adjusted for the presence or absence of the major clinical correlates of mortality, we cannot simply attribute the excess mortality on weekends to children being more severely ill on arrival on the ward. It could be argued that the prognostic scores were not sensitive enough to detect clinically important differences. Yet, the greatest mortality excess was in the first 4 hours, and the very early prognostic score had previously been shown to very accurately predict these deaths in this population.4 We recently reported that mortality among severely ill children with severe anemia is associated with delayed blood transfusion.5 Delays in identification and treatment of other common, severe complications such as hypoxemia, hypovolemia, metabolic acidosis, or hypoglycemia could be similarly associated with increased risk of early mortality. We think that these findings warrant a careful audit of the quality of care provided during the first few hours after admission. Since these data were collected, we have examined staffing levels and strengthened training in basic and advanced life support.