Randomised trial of parental support for families with very preterm children
Department
of Child Health, St Michael's Hospital, Bristol
Correspondence to: Professor Neil Marlow Department of Child Health, Queens Medical Centre, Nottingham NG7 2UH Email: neil.marlow{at}nottingham.ac.uk
AIM
To test the
effectiveness of a home based developmental education programme in very
preterm children.
METHODSA randomised
controlled trial was conducted of developmental or social support
intervention, started at discharge for up to 2 years, in 309 consecutive survivors of 32 weeks gestation or less, born to mothers
resident in greater Bristol between December 1990 and July 1993. Home
visits were made by research nurses trained in either Portage (a
developmental education programme) or in non-directional counselling
(parent adviser scheme). Interventions were also provided to
appropriate primary care and community support for disability.
Griffiths Mental Development Scales were used to assess outcome at 2 years.
RESULTSMean (SEM)
Griffiths quotients (GQ) were: Portage 96.8 (1.6); parent adviser 95.9 (1.6); preterm control 92.9 (2.0). Despite randomisation, social
variables significantly confounded these results. Using linear
regression analysis, intervention was associated with improved scores:
Portage: + 4.3 GQ points (95% CI 1.6 to 7.0); parent adviser: +3.4 GQ
points (1.4 to 6.1). The effect of Portage was greatest in those
children with birthweights <1250 g (+5.3 GQ points (0.2 to 10.4) and
in those with an abnormal neonatal cerebral ultrasound scan (+7.3 GQ
points (1.6 to 13.0).
CONCLUSIONPrimary
analysis showed no developmental benefit from long term family support
after preterm birth. Secondary analysis controlling for the presence of
adverse social markers showed similar small advantage for both
intervention groups. In the smallest infants and those with brain
injuries, a structured developmental programme may offer advantage over
social support intervention.
© 1998 by Archives of Disease in Childhood
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