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Original Article The Influence of a Multisensory Intervention for Preterm Infants Provided by Parents, on Developmental Abilities and on Parental Stress Levels Journal of Child Neurology 2015, Vol. 30(7) 896-903 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0883073814549242 jcn.sagepub.com Lidia V. Gabis, MD1,2, Keren Hacham-Pilosof, OT, MSc1,2, Omer Bar Yosef, MD, PhD1,2, Gila Rabinovitz, OT, MSc2, Gili Leshem, MA1, Aya Shilon-Hadass, MD1,2, Yael Biran, MA1,2, Brian Reichman, MD1,2, Jacob Kuint, MD1,2, and Orit Bart, OT, PhD2 Abstract Evaluation of a multisensory intervention based on the developmental approach provided by parents, during neonatal intensive care unit hospitalization of their preterm infants. After guidance of parents and implementation of intervention program, children were followed up to 2 to 3 years using scales for evaluation of parental stress levels and child’s development. Our 2 to 3 years’ follow-up study included 41 infants (20 controls and 21 who received parental-guided intervention) as part of a group of 95 preterm infants who participated in a short-term study. The intervention group showed significantly higher scores in receptive language and fine-motor domains of the Bayley Scale of Infant and Toddler Development–3rd Edition. Boys showed superior improvements in language skills. No differences were found in the cognitive and adaptive domains. There were no differences in parental stress levels. A multisensory intervention program for preterm infants provided by trained and supervised parents may improve language and motor outcomes at 2 to 3 years. Keywords prematurity, parents, infants, development Received January 16, 2014. Received revised June 17, 2014. Accepted for publication August 02, 2014. Survival rates of preterm infants have risen over the past 2 decades as a result of improvements in obstetrics and neonatology.1,2 However, preterm infants are at increased risk of neurodevelopmental impairments3,4; that is, even near-term preterm infants tend to reach language milestones at a later age than comparable full-term infants.5 These deficiencies are often seen in light of biological factors, such as degree of prematurity, or central nervous system impairments due to disrupted brain development.6 The quality of early socioenvironmental factors, such as parent-infant interactions, influence child development.6-8 Parents of preterm infants often experience negative emotions because of a multitude of present and future concerns, including insecurity in interactions with their infants during hospitalization in the neonatal intensive care unit.9,10 Mothers of preterm infants were found to be less responsive to their infants than mothers of full-term infants. Poor maternal responsiveness was associated with deficits in early language acquisition.5 In the neonatal intensive care unit, preterm infants are repeatedly exposed to an overwhelming environment of noise, intense light, painful medical interventions, and lack of parental contact.11 These disturbances in the infant’s environment occur during a critical period for infant development of physiological immaturity and rapid brain development.12 It has been suggested that modification of infants’ physical and emotional environment in the neonatal intensive care unit may improve outcome, and various early intervention programs have been developed.11 1 Weinberg Child Development Center at Safra Children’s Hospital, Tel Hashomer, Ramat Gan, Israel 2 Tel Aviv University, Tel Aviv, Israel Corresponding Author: Lidia V. Gabis, MD, Weinberg Child Development Center, Sheba Tel-Hashomer, 5262000 Israel. Email: gabis@post.tau.ac.il Gabis et al In determining the effectiveness of these intervention programs, developmental differences between twins and singleton children, as well as gender, should also be considered.13-15 Implementation of a multisensory intervention program while the infants are hospitalized, performed by parents, may improve neurodevelopmental outcome, empower parents, and may conserve neonatal intensive care unit manpower resources. The objective of the current study was to assess the effects of the aforementioned early multisensory intervention and parents training applied in the neonatal intensive care unit, at short term and at 2 to 3 years postdischarge. We examined the same sample of preterm participants at 2 to 3 years of age in 5 different areas of development, that is, cognitive, language, motor, socialemotional, and adaptive behavior, using the Bayley developmental assessment battery. Because the intervention program emphasized these domains, we hypothesized that the intervention group will score higher on the Bayley subtests as toddlers, indicating a positive and long-term impact of the intervention program on several developmental areas. Additionally, we expected a differential long-term impact for the intervention program on prematurity level, gender, and twins/singletons. Methods Participants Ninety-five preterm infants hospitalized between the years of 2006 and 2008 in the neonatal intensive care unit of Chaim Sheba Medical Center were assigned to several integrated studies that were employed by the Weinberg Child Development Institute of Chaim Sheba Medical Center–Tel Hashomer. The control group included 48 infants born between July 2006 and May 2007. The intervention group included 47 infants born between July 2007 and June 2008. Inclusion criteria were infants born preterm at gestational age 32, very preterm 28 to 32, extremely preterm .95 indicating close fit (Bentler & Bonett, 1980), and the Root Mean Square Error of Approximation (RMSEA), with values  .08 indicating acceptable fit (see Marsh, Hau, & Wen, 2004). Missing data were handled using Full Information Maximum Likelihood estimation. An MLR estimator, which produces robust standard errors, was used to account for the non-normal distribution of emotional and behavioural problem scores. Statistical analyses Main effects of the GBG on emotional and behavioural problems were examined using a multilevel dual latent growth model, in which three levels were identified: (1) variation across time; (2) variation across individuals; and (3) variation across classes. The development of emotional problems and behavioural problems, respectively, were described with two growth parameters, an intercept (initial level, parameterized at baseline in kindergarten) and linear slope term (linear change between kindergarten and second grade). To test for intervention effects, the slopes of both trajectories were regressed on intervention status at the classroom level (between level, level 3), and intercepts were regressed on intervention status to control for possible group differences at baseline. The growth parameters were also regressed on sex and SES at the individual level (within level, level 2). The growth parameters of emotional problems were correlated with the growth parameters of behavioural problems to control for their co-occurrence. As the objective was to test for individual level variation in peer acceptance as a mediator in the link between the GBG and the development of emotional and behavioural problems, a dual latent growth model with two levels (1 ¼ time, 2 ¼ individual level) was fitted. Because assignment to intervention was done at the school by classroom level, standard errors were adjusted for the nesting of conditions within classrooms by using a sandwich estimator (Williams, 2000). The slopes of emotional as well as behavioural problems were regressed on second-grade peer acceptance, which was again regressed on its first-grade value (to control for previous levels of peer acceptance) and intervention status (Cheong, MacKinnon, & Khoo, 2003), Results Descriptive statistics The means and standard deviations of the study variables at each time point are in Table 1. Intervention children had significantly fewer emotional and behavioural problems than children in the control condition during the implementation of the GBG. Effect sizes for baseline (kindergarten) to second grade changes (comparing pre- to post-intervention changes in the intervention vs. the control group; see Beck, Hanson, Puffenberger, Benninger, & Benninger, 2010) in emotional and behavioural problems were, respectively, 1.07 and 0.56 (Cohen’s d; Cohen, 1988). Peer acceptance scores were higher in second grade in intervention children than in controls (effect size for change ¼ 0.33). Correlations between the study variables are shown in Table 2. Intervention effects on the development of emotional and behavioural problems A multilevel (three-level) growth model, in which both emotional and behavioural problems were analysed, was fitted. The growth parameters of emotional/behavioural problems were regressed on intervention status at the classroom level (CFI ¼ .96, RMSEA ¼ .05). The estimated path coefficients presented in Table 3 show that intervention status significantly and negatively predicted the slopes of both emotional and behavioural problems. 534 International Journal of Behavioral Development 39(6) Emotional problems Emotional problems Emotional problems Kindergarten Grade 1 Grade 2 Intercept Emotional problems Slope Emotional problems Receptive vocabulary sex Good Behavior Game Peer Acceptance Receptive vocabulary sex Grade 2 Receptive vocabulary sex Receptive vocabulary sex Slope Behavioral problems Intercept Behavioral problems Behaviora...
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