Summary

Although the short-term impact of early interventions has been well demonstrated, the findings of evaluations of the long-term impact of early interventions for preterm infants have been ambiguous. Long-term prenatal and perinatal cohort studies conducted before the introduction of neonatal intensive care concluded that social factors and the quality of the home envi-

1Part C of the Individuals with Disabilities Education Act elevated the family component of early intervention to a new level. This legislation replaced the Individualized Education Program for children ages 3 to 21 years with the Individualized Family Service Plan for infants and toddlers with disabilities.

ronment can compensate for the disadvantages encountered perinatally and neonatally (Wolke, 1998). Recent evidence shows that intervention providing social and environmental enhancement through home visits and child development programs, is associated with catch up in cognitive and behavioral development in large preterm infants, especially those from socieconomically disadvantaged backgrounds (Brooks-Gunn et al., 1994; Olds and Kitzman, 1993; Ramey and Ramey, 1999). This suggests that these larger preterm infants may not have persistent central nervous system insults. In contrast, although early interventions may have an impact on the outcomes for smaller preterm infants, biological factors may be the best predictors of cognitive and behavioral outcomes at school age.

However, McCormick (1997) and others have argued that the lack of comparability across studies that use such a broad categorization of morbidity is but one methodological flaw recurring in the follow-up literature. Other methodological problems include the failure to characterize the study samples by the eligibility for the study and the number of losses in the cohort, the failure to provide sufficient information with which the representativeness of the sample can be assessed, and the failure to use appropriate controls (McCormick, 1997). In addition, the outcomes being assessed may be too limited. Finally, even for the outcomes selected, many studies fail to incorporate a specific underlying pathogenic or conceptual model to identify potential factors influencing the relationship between the initial state (i.e., prematurity or low birth weight) and the outcomes observed (McCormick, 1997).

Finding 11-4: Early childhood educational and other therapeutic research interventions have been demonstrated to improve outcomes for some infants born preterm; however, it is critical to determine the appropriate intensity, type of service, personnel, and curricula to achieve improvement in interventions.

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