Background
Methods
Search strategy and selection criteria
Data extraction
Data synthesis and statistical analysis
Quality of the evidence
Results
Study selection
Study characteristics
Author, Year | Country | Inclusion Criteria | Gestational Age at birth(w) (Mean (SD)) | Birth Weight(g) (Mean (SD)) | Number of participants (Intervention, Control) (n) | Intervention Method | Intervention Delivery | Intervention Intensity | Developmental results |
---|---|---|---|---|---|---|---|---|---|
Abou Turk, 2009 [45] | USA | BW: 401–1500 g | C: 26.5 (1.7)I: 25.7 (1.7) | C: 924 (216)I: 806 (236) | 34 (18,16) | Noise reduction | Nurse | Continuous | MDI: better in intervention PDI: ND |
Als, 1994 [46] | USA | GA: 24–30 wBW: < 1250 g | C: 26.5 (1.4)I: 27.1 (1.6) | NS | 38 (20,18) | NIDCAP | Nurse/Mother | Continuous | MDI: better in intervention PDI: better in intervention |
Als, 2004 [47] | USA | GA: (28w + 4 d) – (33w + 3 d) | C: 31.83 (1.47)I: 31.22 (1.39) | C: 1730 (350)I: 1648 (232) | 33 (18,15) | NIDCAP | Nurse/Mother | Continuous | MDI: better in intervention PDI: better in intervention |
Als, 2011 [48] | USA | Severe IUGRGA: 28–33 w | C: 31.69 (2.39)I: 32.06 (2.28) | C: 1122 (336)I: 1083 (343) | 30 (12,18) | NIDCAP | Nurse/Mother | Continuous | MDI: better in intervention PDI: ND |
Als,2012 [49] | USA | Severe IUGR GA: (26w + 4d) - (33w + 3d) | C: 30.40 (1.91)I: 30.76 (2.78) | C: 1048 (250)I: 997 (324) | 30 (13,17) | NIDCAP | Nurse/Mother | Continuous | MDI: better in intervention PDI: ND |
Ariagno, 1997 [50] | USA | GA: ≤ 30 w BW: ≤1250g | C: 26.1 (1.8) I: 26.4 (2.1) | C: 811.7 (210.8) I: 884.1 (182.0) | 35 (17,18) | NIDCAP | Nurse/Mother | Continuous | MDI: ND PDI: ND |
Brandon, 2017 [51] | USA | GA: ≤28 w | C: 26.3 (1.5) I: 26.3 (1.4) | C: 872.7 (232.7) I: 874.1 (219.7) | 121 (63,58) | Cycled light e | Nurse | Cycled light k | MDI: NDP DI: ND |
Brown, 1980 [52] | USA | GA: ≤ 37 BW: 1000–1750 a | C:31.1 (2.9)I: 31.8 (2.4) | C: 1506 (216)I: 1564 (217) | NS | Infant stimulation, Mother training | Nurse | -5 days/week- twice daily -30 min/session | MDI: ND PDI: ND |
USA | GA: < 31 BW: < 1300 g + AGA | C: 29.75 (28–31)I: 28.75 (26–30) | C: 1108 (680–1290)I: 1052 (817–1300) | 24 (12,12) | Reduce patterned stimuli f | Nurse | 4 weeks from 32 to 36 weeks PCA | MDI: ND PDI: better in good state organizer | |
Feeley, 2012 [55] | Canada | BW: < 1500 g | C: 27.9 (2.2) I: 28.0 (2.3) | C: 979.5 (221.6) I: 982.2 (284.1) | 122 (61,61) | Cues and Care trial | Mother | 1–2 sessions/ week l | Bayley III: Cognitive: ND Motor: ND Language: ND |
Guyer, 2012 [56] | Switzerland | GA: ≤32 0/7 | C: 29.5 (2.1)I: 30.6 (0.95) | C: 1284 (346) I: 1439 (299) | 37 (17,20) | Cycled lighting | Nurse | Cycled light m | MDI: NDPDI: ND |
Kramer, 1975 [57] | USA | GA: < 38 BW: < 1800 | C: 33 I: 33 | C: 1418 I: 1441 | 14 (8,6) | Touch, in the form of extra tactile stimulation | Nurse | - Daily for at least 2 weeks − 48 min/session | At transfer to crib MDI: better in interventionPDI: ND At 6 weeks and 3 months: MDI: NDPDI: ND |
Maguire Arch Dis Child Fetal Neonatal Ed, 2009 [58] | Netherlands | GA: < 32 | C: 29.1 (1.9)I: 29.5 (1.6) | C: 1238.5 (337.2)I: 1248.4 (338.1) | 192 (98,94) | Basic developmental care g | Healthcare professionals | Continuous | At 12 monthsMDI: ND PDI: better in intervention At 24 months MDI: ND PDI: ND |
Maguire PEDIATRICS, 2009 [59] | Netherlands | GA: < 32 | C: 29.3 (1.6)I: 29.6 (1.5) | C: 1247 (340)I: 1263 (311) | 168 (84,84) | NIDCAP | Nurse/Mother | Continuous | MDI: ND PDI: ND |
McAnulty, 2009 [60] | USA | GA: < 29 BW: < 1250 b | C: 26.20 (1.42) I: 30.3 (6.2) | C: 837 (135) I: 850 (157) | 107 (56,51) | NIDCAP | Nurse/Mother | Continuous | MDI: better in intervention PDI: better in intervention |
Parker, 1992 [61] | USA | GA: ≤ 36 | C: 33.4 (2.4) I: 30.3 (6.2) | C: 1687 (356) I: 1368 (410) | 41 (56,51) | h | infant-development specialist | -4 times (2–6 sessions)/ week | At 4 months MDI: better in intervention PDI: better in intervention At 8 months MDI: better in intervention PDI: ND |
Peters, 2009 [62] | Canada | GA: ≤ 32 BW: 500–1250 | C: 27.0 (2.3)I: 27.5 (1.4) | C: 927.1 (204.0) I: 988.2 (183.7) | 120 (60,60) | NIDCAP | Nurse/Mother | Continuous | MDI: ND PDI: ND |
Powell, 1974 [63] | USA | BW: 1000–2000 g c | NS | d | NS | Handling | Healthcare professionals/Mother | n | At 2 month MDI: NDPDI: ND At 4 months MDI: better in intervention PDI: better in intervention At 6 months MDI: ND PDI: ND |
Procianoy, 2010 [64] | Brazil | GA: ≤32 BW: 750–1500 | C: 29.7 (1.62)I: 30.0 (1.55) | C: 1151 (198)I: 1192 (189) | 104 (52,52) | Massage therapy | Mother observation | -Four times daily-15 min/session | MDI: better in intervention PDI: ND |
Szajnberg, 1987 [65] | USA | AGA GA: 28–32 w | C: 24.3 I: 25.7 | NS | 25 (12,13) | mother-infant observation i | Mother observation | -Only one session 30–40 min intervention at 34 weeks of age | MDI: ND PDI: ND |
Welch, 2015 [66] | USA | GA: 26–34 w | C: 30.7 (2.6) I: 30.8 (2.1) | C: 1474 (439) I: 1426 (3960 | 150 (78, 72) | FNI j | trained NICU nurses | o | Bayley III: cognitive: better in intervention if score above 85 language: better in intervention if score above 85 motor: ND |
Risk of Bias assessment
Meta-analysis findings
Analysis Type | Number of trials | SMD (95% CI) | P value | I square |
---|---|---|---|---|
MDI on 12 months of age (intervention versus control) | ||||
Primary analysis | 11 | 0.55 (0.23 to 0.87) | 0.001a | 71.61% |
Subgroup analysis by risk of bias | ||||
low risk studies | 4 | 0.62 (− 0.07 to 1.30) | 1 = 0.06b | 1 = 86.72% |
high risk studies | 7 | 0.56 (0.22 to 0.90) | 2 = 0.004a | 2 = 50.40% |
Subgroup analysis by intervention date (year) | ||||
≤ 2000 | 5 | 0.91 (0.63 to 1.19) | 1 = 0a | 1 = 0 |
> 2000 | 6 | 0.26 (− 0.10 to 0.63) | 2 = 0.161 | 2 = 65.2% |
Subgroup analysis with intervention type | ||||
NIDCAP | 7 | 0.83 (0.33 to 1.32) | 1 = 0.001a | 1 = 77.5% |
Environmental | 2 | −0.03 (− 0.47 to 0.40) | 2 = 0.884 | 2 = 0 |
Others | 2 | 0.29 (−0.26 to 0.84) | 3 = 0.303 | 3 = 58.5% |
Subgroup analysis with method of intervention delivery | ||||
Nurse | 2 | 0.58 (− 0.51 to 1.67) | 1 = 0.295 | 1 = 87% |
Nurse/ Mother | 7 | 0.74 (0.28 to 1.20) | 2 = 0.002a | 2 = 74.7% |
Environmental | 2 | - 0.03 (− 0.47 to 0.40) | 3 = 0.884 | 3 = 0 |
Subgroup analysis by Birth weight | ||||
≤ 1250 g | 3 | 0.68(− 0.06 to 1.42) | 1 = 0.071b | 1 = 78.9 |
> 1250 g | 3 | 0.74 (− 0.16 to 1.64) | 2 = 0.17 | 2 = 77.6 |
Subgroup analysis by Gestational age | ||||
≤ 28 w | 4 | 0.64 (0.06 to 1.22) | 1 = 0.031* | 1 = 71.5% |
> 28 w | 7 | 0.49 (0.09 to 0.89) | 2 = 0.016a | 2 = 71.5% |
Subgroup analysis by assessment time | ||||
9 m | 7 | 0.85 (0.45 to 1.25) | 1 = 0a | 1 = 60.1% |
12 m | 4 | 0.05 (− 0.15 to 0.26) | 2 = 0.607 | 2 = 0 |
PDI on12 months of age (intervention versus control) | ||||
Primary analysis | 11 | 0.33 (0.08 to 0.57) | 0.013* | I = 52.41% |
Subgroup analysis by risk of bias | ||||
low risk | 4 | 0.33 (0.07 to 0.58) | 1 = 0.039a | 1 = 19.41% |
high risk | 7 | 0.26 (− 0.09 to 0.61) | 2 = 0.192 | 2 = 52.96% |
Subgroup analysis by intervention date | ||||
≤ 2000 | 5 | 0.47 (0.07 to 0.87) | 1 = 0.021a | 1 = 48.3% |
> 2000 | 6 | 0.22(−0.10 to 0.55) | 2 = 0.178 | 2 = 56.1% |
Subgroup analysis by intervention type | ||||
NIDCAP | 7 | 0.52 (0.14 to 0.90) | 1 = 0.007a | 1 = 62.9% |
Environmental | 2 | −0.19 (−0.63 to 0.24) | 2 = 0.384 | 2 = 0 |
Others | 2 | 0.29 (− 0.01 to 0.58) | 3 = 0.055b | 3 = 0 |
Subgroup analysis by method of delivery | ||||
Nurse | 2 | 0.52 (0.01 to 1.04) | 1 = 0.047a | 1 = 50.4% |
Nurse/Mother | 7 | 0.41 (0.05 to 0.77) | 2 = 0.025a | 2 = 60.1% |
Environmental | 2 | −0.19(−0.63 to 0.24) | 3 = 0.384 | 3 = 0 |
Subgroup analysis by Birth weight | ||||
≤ 1250 g | 3 | 0.39(−0.24 to 1.02) | 1 = 0.228 | 1 = 72.6% |
> 1250 g | 3 | 0.38 (−0.47 to 1.23) | 2 = 0.383 | 2 = 76.2% |
Subgroup analysis by Gestational age | ||||
≤ 28 w | 4 | 0.36(−0.24 to 0.95) | 1 = 0.243 | 1 = 73.8% |
> 28 w | 7 | 0.28 (0.01 to 0.55) | 2 = 0.043a | 2 = 40.9% |
Subgroup analysis by assessment time | ||||
9 m | 7 | 0.53 (0.15 to 0.90) | 1 = 0.006a | 1 = 56.6% |
12 m | 4 | 0.13(−0.10 to 0.35) | 2 = 0.276 | 2 = 9.5% |
MDI on 24 months of age (Intervention versus control) | ||||
Primary analysis | 6 | 0.15(−0.05 to 0.35) | 0.15 | I = 18.09% |
Subgroup analysis by risk of bias | ||||
low risk | 4 | 0.14(−0.08 to 0.37) | 1 = 0.248 | 1 = 29.11% |
high risk | 2 | 0.21(− 0.29 to 0.70) | 2 = 0.431 | 2 = 0 |
Subgroup analysis by intervention date | ||||
≤ 2000 | 2 | 0.53 (0.12 to 0.93) | 1 = 0.011a | 1 = 0 |
> 2000 | 4 | 0.05 (−0.14 to 0.24) | 2 = 0.612 | 2 = 0 |
Subgroup analysis by intervention type | ||||
NIDCAP | 3 | 0.19(−0.09 to 0.48) | 1 = 0.187 | 1 = 20.1 |
Environmental | 1 | 0.01(−0.62 to 0.63) | 2 = 0.986 | 2 = −--- |
Others | 2 | 0.19(−0.40 to 0.78) | 3 = 0.531 | 3 = 76.6 |
Subgroup analysis by method of delivery | ||||
Nurse | 1 | −0.09(− 0.42 to 0.24) | 1 = 0.595 | 1 = −--- |
Nurse/ Mother | 4 | 0.27 (0.01 to 0.54) | 2 = 0.042a | 2 = 26.7% |
Environmental | 1 | 0.01 (−0.62 to 0.63) | 3 = 0.986 | 3 = −--- |
Subgroup analysis by Birth weight | ||||
≤ 1250 g | 3 | 0.33 (0.06 to 0.60) | 1 = 0.016a | 1 = 0 |
> 1250 g | 3 | 0(−0.23 to 0.23) | 2 = 0.997 | 2 = 1.6% |
Subgroup analysis by Gestational age | ||||
≤ 28 w | 3 | 0.28 (−0.03 to 0.59) | 1 = 0.072a | 1 = 0 |
> 28 w | 3 | 0.10 (−0.22 to 0.43) | 2 = 0.529 | 2 = 56% |
Subgroup analysis by assessment time | ||||
18 m | 2 | 0.24(−0.09 to 0.57) | 1 = 0.158 | 1 = 0 |
24 m | 4 | 0.15(−0.15 to 0.46) | 2 = 0.529 | 2 = 48.4% |
PDI on 24 months of age (Intervention versus Control) | ||||
Primary analysis | 6 | 0.15 (−0.02 to 0.32) | 0.089b | 0 |
Subgroup analysis by risk of bias | ||||
low risk | 4 | 0.20 (0.01 to 0.38) | 1 = 0.037a | 1 = 0 |
high risk | 2 | −0.19(−0.68 to 0.31) | 2 = 0.460 | 2 = 0 |
Subgroup analysis by intervention date | ||||
≤ 2000 | 2 | 0.19(−0.41 to 0.79) | 1 = 0.535 | 1 = 44% |
> 2000 | 4 | 0.12(−0.07 to 0.32) | 2 = 0.203 | 2 = 0 |
Subgroup analysis by intervention type | ||||
NIDCAP | 3 | 0.08(−0.16 to 0.32) | 1 = 0.516 | 1 = 0 |
Environmental | 1 | −0.17(− 0.79 to 0.46) | 2 = 0.602 | 2 = −--- |
Others | 2 | 0.30 (0.03 to 0.57) | 3 = 0.032a | 3 = 0 |
Subgroup analysis by method of delivery | ||||
Nurse | 1 | 0.23 (− 0.10 to 0.57) | 1 = 0.169 | 1 = −-- |
Nurse / Mother | 4 | 0.15(− 0.07 to 0.38) | 2 = 0.175 | 2 = 5.3% |
Environmental | 1 | - 0.17(−0.79 to 0.46) | 3 = 0.602 | 3 = −-- |
Subgroup analysis by birth weight | ||||
≤ 1250 g | 3 | 0.23(− 0.06 to 0.52) | 1 = 0.115 | 1 = 9.5% |
> 1250 g | 0 | – | 2 = −-- | 2 = −-- |
Subgroup analysis by Gestational age | ||||
≤ 28 w | 3 | 0.09(−0.22 to 0.40) | 1 = 0.571 | 1 = 0 |
> 28 w | 3 | 0.18(−0.04 to 0.41) | 2 = 0.110 | 2 = 10.6% |
Subgroup analysis by assessment time | ||||
18 m | 2 | 0.12(−0.27 to 0.51) | 1 = 0.553 | 1 = 22.4 |
24 m | 4 | 0.15(−0.05 to 0.36) | 2 = 0.110 | 2 = 3.3% |