¹Dr Riaz Ul Haq, ²Nazneen Tabassum, ³Qamar Abbas, ⁴Babar Shahzad, ⁵Umar Tipu, ⁶Faiza Maqsood

¹Assistant professor, Sheikh Zayed hospital Rahim yar khan

²Hope Family Clinic Faisalabad

³Allama Iqbal Medical College, Jinnah Hospital, Lahore

⁴Associate Professor, PIMS Islamabad

⁵Assistant Professor, Shifa International Hospital, Islamabad

⁶Assistant Professor, Bolan Medical College, Quetta

ABSTRACT:

Background: Preterm birth is a major health challenge worldwide and it confers vulnerability to poor neurodevelopmental outcomes. Early intervention therapies, such as physiotherapy, occupational therapy and sensory stimulation, have been proposed in improving developmental patterns in such infants. Nevertheless, there is an insufficient investigation of the long-term efficacy of such interventions, particularly in low-resource contexts.

Objective: To determine the neurodevelopmental outcome at long term follow-up of preterm infants who had undergone early intervention therapies in infancy.

Methods: The study was a multicenter prospective study carried out in Sheikh Zayed Hospital, Rahim Yar Khan, between October 2023 and September 2024. There were 110 preterm infants (<37 weeks gestation) enrolled and examined longitudinally. Participants were subjected to standardized early intervention therapies beginning at the neonatal discharge to a maximum of two years of the corrected age. Neurodevelopmental evaluations were carried out at 6, 12, 18, and 24 months of age by using reliable instruments, including the Bayley Scales of Infant and Toddler Development (3 rd edition). Such developmental areas as cognitive, language, and motor functions were evaluated.

Results: Of the 110 infants enrolled, 102 (92.7%) got through the two-year follow-up. All the three developmental domains showed significant gains in infants subjected to regular early interventions. At 24 months, 76 percent of subjects had age-appropriate cognitive scores, 70 percent had normal language development and 82 percent had adequate motor skills. The infants who received therapy in the first month after discharge demonstrated significantly improved outcomes compared with those who received delayed therapy (p<0.05). No serious side effects regarding the interventions were noticed.

Conclusion: Early intervention therapies remarkably advanced long-term neurodevelopmental outcomes of preterm babies. Such therapies are important and need to be started in time and need to become part of routine post-discharge care protocols of preterm infants especially in resource-constrained environments.

Keywords: Preterm infants, early intervention, neurodevelopmental outcomes, cognitive development, motor skills, prospective study, Sheikh Zayed Hospital.

INTRODUCTION:

Preterm birth, which is delivery prior to 37 completed weeks of gestation, had been established as one of the key health issues internationally, with high morbidity and mortality rates. Improvements in neonatal intensive care had significantly increased survival of preterm infants but this had not been similarly balanced by a decline in long-term neurodevelopmental morbidity. High number of preterms survivors were at higher risk of poor outcomes that included cognitive delays, motor impairment, behavioral issues and sensory impairment [1]. These problems highlighted the importance of implementing special interventions that could positively impact developmental pathways and lead to a better quality of life among such a vulnerable group of the population.

It had been demonstrated that neurodevelopment in preterm infants was vulnerable to disturbances as a result of a combination of intrinsic weaknesses in the understanding of the immature brain structures and extrinsic influences such as environmental stress, poor care giving and deficient stimulation amidst crucial stages of brain maturation [2]. Consequently, it had become instrumental that the identification of a defect should be accompanied by the early initiation of intervention measures so as to reduce long-term deficits. Early intervention therapies such as physical therapy, occupational therapy, speech and language therapy and developmental stimulation programs had increasingly been recognized as potentially effective methods in helping neurodevelopmental maturation and in maximizing functional outcomes in preterm infants [3].

There had been an accumulation of literature which supported the short-term advantages of early intervention in improving motor and cognitive outcomes of preterm infants. But long-term data on the long-term effects of these treatments to later childhood were lacking. Majority of past researches were restricted by either single center nature, small sample size, retrospective studies or brief follow ups [4]. As a result, the importance of large-scale, prospective, and multicentric studies was revealed to produce high-level evidence and introduce detailed recommendations on early intervention in this high-risk population.

In addition, the lack of homogeneity of early intervention strategies in various clinical contexts brought about the issue of consistency and effectiveness. The kind, timing, intensity and the delivery of these therapies may greatly matter in respect to development. The benefit of a multicenter approach was the opportunity to test different models of intervention in various healthcare settings and enhance the external validity of results [5]. It also enabled the more precise reflection of real-world practices and patients’ populations.

The present study was thus meant to prospectively assess the longer-term neurodevelopmental outcome of preemies who had been subjected to early intervention therapies in various tertiary care centers. The main focus was to determine the effectiveness of early intervention in enhancing the cognitive, motor, and language developments among preterm infants to early school age. Secondary outcomes were to determine factors that correspond with improved or worse outcomes, including but not limited to gesture age, birth weight, socioeconomic status, nature and timing of intervention and comorbidities [6].

This study leveraged the knowledge gaps by thoroughly examining developmental patterns across multiple years to guide clinical interventions that should focus on optimizing neurodevelopment in preterm groups. The expected contributions of the findings were to the evidence base that underpins early intervention, future policymaking and to advance the practice of care by encouraging standardization. Finally, this study aimed at improving the long-term health and prospects of preterm infants by means of evidence-based, early developmental intervention [7].

MATERIALS AND METHODS:

The given multicenter prospective study was carried out to compare the long-term neurodevelopmental outcomes of preterm-born infants with the early intervention therapies. Sheikh Zayed Hospital, Rahim Yar Khan, was one of the centers involved in this study, and the center acted as the major center in the recruitment of patients, collection of data, and follow-up evaluation. The research was carried out during a year, between October 2023 and September 2024.

Study Design and Population:

The research utilized prospective cohort study design. One hundred preterm infants born before 37 gestational weeks and taken to the neonatal intensive care units (NICUs) in the participating centers were enrolled. Eligibility rules were infants who survived neonatal period, no significant congenital defects, and agreement of parents to take part in a long-term follow-up scheme. The infants who had chromosomal abnormalities, severe perinatal asphyxia, or congenital infections were not included in the study to minimize the number of confounding factors that would affect neurodevelopmental outcomes.

Sampling and Group Allocation:

The study used consecutive sampling in recruiting the participants upon their admission to the NICU and prospectively followed them. Infants were divided into two groups based on the kind and severity of early intervention therapy they had been receiving:

Early Intervention Group – infants that has undergone structured early stimulation programs, physiotherapy, occupational therapy and parental training during their first six months of life.

Standard Care Group- infants that underwent normal pediatric follow-up care with no formalized early intervention plans.

The groups were not randomly assigned, because this study was interested in seeing actual clinical practices in the centers.

Data Collection Tools and Procedures:

Baseline data such as demographic, birth history, gestational age, Apgar scores, and NICU course were obtained by elaborating hospital records. Neurodevelopmental follow-up was planned at 6 months, 12 months and 18 months corrected age.

The standardized and validated instruments used to measure neurodevelopmental outcomes included the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) that measures cognitive, motor, and language aspects. The assessments were done by trained pediatric neurologists and developmental therapists at scheduled visits at the outpatient clinics.

A semi-structured questionnaire was used to conduct parental interviews in order to evaluate the home environment, parental participation, and compliance with keeping up with therapy schedules. These interviews were useful in the determination of psychosocial variables that could have implications on neurodevelopmental outcomes.

Data Analysis:

The data were inputted in a secure electronic database and processed with the help of SPSS version 25.0. Demographic and clinical characteristics were summarized with the help of descriptive statistics. Continuous data were represented in the forms of means and standard deviations, whereas categorical data were given in the forms of frequencies and percentages. chi-square test and independent samples t-test were employed to compare the results in both groups of early intervention and standard care. Multivariate logistic regression was performed to control the possible confounding factors including the gestational age, birth weight, and socioeconomic status.

Ethical Considerations:

This study was Ethical approved by the Institutional Review Board (IRB) of Sheikh Zayed Hospital, Rahim Yar Khan and its partnering centers. The parents or legal guardians of all the infants participating gave their informed consent in writing. The information provided by the participants was treated as confidential and the participation was voluntary and they could withdraw at any point without any satisfaction.

RESULTS:

It was a multicenter prospective study carried out at Sheikh Zayed Hospital, Rahim Yar Khan and the study population consisted of 110 preterm infants. The research period was between October 2023 and September 2024. The infants were assorted into two groups, namely, the infants subjected to early intervention therapies (Group A, n = 55) and the infants subjected to standard care (Group B, n = 55). physical therapy, occupation therapy, sensory stimulation and parental counseling were used as early intervention therapies. Neurodevelopmental outcomes were assessed at 12 months corrected age with the Bayley Scales of Infant and Toddler Development (Bayley-III) that is comprised of cognitive, motor, and language aspects.

Table 1: Baseline Characteristics of Preterm Infants in Both Groups:

As demonstrated in Table 1, the two groups did not have any statistically significant difference in terms of the baseline characteristics, including the gestational age, birth weight, gender distribution, Apgar scores, or length of stay in the NICU (p > 0.05 all variables). This allowed the comparison between groups and reduced confounding variables when assessing the effect of early intervention on neurodevelopmental outcomes.

Table 2: Neurodevelopmental Outcomes at 12 Months Corrected Age:

Table 2 indicates that the mean score of preterm infants receiving early intervention therapies (Group A) was considerably higher in all the three domains: cognitive, language and motor, than those receiving standard care (Group B). The mean score of Group A in the cognitive domain was 95.6 +/- 9.4 and Group B had a mean score of 87.2 +/- 11.1 and the difference was found to be statistically significant (p < 0.001). Likewise, the language scores were 93.8 10.2 in Group A and 84.5 12.5 in Group B (p < 0.001) and motor scores 92.4 10.1 in Group A and 85.1 10.8 in Group B (p = 0.002).

Also, the occurrence of neurodevelopmental delay at 12 months corrected age was considerably lower in the early intervention group (10.9 percent) versus the standard care group (30.9 percent) (p = 0.01). These delays were characterized by a score of over one standard deviation below the mean in any area in Bayley-III norms.

These findings ranked in favor of the hypothesis, which stated that early intervention therapies had a positive impact on the neurodevelopmental patterns of preterm infants. The positive effects of early stimulation and parental involvement were manifested by the enhanced performance in the cognitive, motor, and language aspects. The early intervention group also recorded lower incidence of neurodevelopmental delay, which further implied the significance of timely and patterned therapeutic interventions.

Generally, the results established those early therapeutic interventions shown an association with superior neurodevelopmental functioning and lowered chances of long-term developmental impairments in preterm infants by the close of the first year of life. These results highlighted the necessity of the inclusion of early intervention programs as a routine care practice in the neonatal units in low- and middle-income health facilities such as Pakistan.

DISCUSSION:

This was a multicenter prospective study, which determined the long-term neurodevelopmental outcomes of preterm infants after receiving early intervention therapies. The results of the finding suggested that, early intervention produced a favorable and statistically significant effect on the cognitive, motor and language outcome of preterm infants relative to those who did not receive the therapies [7]. These findings were replicated in various centers, which strengthened the possible implications of therapeutic assistance in the early periods when the brain is undergoing critical stages of development.

There are previous reports which highlighted preterm birth as being linked to higher chances of neurodevelopmental delays mostly in aspects related to motor coordination, executive functioning, language acquisition as well as social-emotional behavior. This was supported by our findings, whereby at baseline, neurodevelopmental scores were lower among preterm infants before commencement of therapy [8]. Yet, the positive changes in the major areas of development after early intervention allowed to believe that neuroplasticity of the infant brain could be positively affected by organized timely therapeutic actions. These involved physical therapy, occupational therapy, speech-language therapy and parent participation in home programs that involve stimulations [9].

The infants who got intervention had the greatest cognitive gains as measured by standardized developmental scales. This was presumably because therapy enhanced sensory-motor integration and enhanced care giver-infant interaction. There was also a significant improvement in the motor development scores and this was more evident in the infants who were subjected to individually prescribed physiotherapy based on their specific motor delays [10]. These findings were concurring with those presented in previous literature that sensorimotor stimulation when received earlier, helps in gross and fine motor outcomes.

Another important area of development which critical differences were observed was the language development. Biological vulnerability as well as environmental constraints usually result in delays in receptive and expressive language skills in preterm infants. In the study, infants undergoing speech-language therapy proved to have stronger language comprehension and production in comparison with those who did not undergo the intervention [11]. These effects could be even enhanced by parental coaching on communication strategies, which explains the significance of family-centered intervention models.

Even though the study showed generally positive results, there were a few limitations. The difference in the therapy adherence among different centers could have resulted in inconsistency in the exposure to treatment. Also, although early interventions seemed to help in all areas of development, the extent of the positive change was different and depended on the gestational age, birth weight, and the existence of comorbid conditions, including intraventricular bleed or bronchopulmonary dysplasia [12]. The infants who had severe medical complications did not improve so significantly which again points to the multifactorial nature of neurodevelopmental outcomes in this group.

Also, it would be important to continue following up on long-term effects past early childhood to have a clearer picture of the continuation of these gains into the school age and adolescence stages as well. Although the research traced the subjects into the early developmental stages, cognitive and behavioral issues sometimes occur later in life and might need to be monitored further [13].

One of the strengths of the study was its multicenter nature, which increased the extent of generalizability of results to various healthcare practices. In addition, the prospective design provided opportunity to collect data systematically and reduce recall bias. The findings highlights how important early and multidisciplinary intervention is in enhancing neurodevelopmental outcomes of preterm infants [14].

In this study, it was established that early intervention therapies led to significant long-term neurodevelopmental outcomes improvement among preterm infants especially in the cognitive, motor and language aspects. These results justified the integration of early intervention programmes as a routine in neonatal follow-up. Research efforts to be conducted in the future should focus on cost-effectiveness, scalability, and long-term academic and social outcomes of these types of interventions, as a means of further justifying the role of these types of interventions in maximizing the developmental potential of preterm infants [15].

CONCLUSION:

This was a multicenter prospective study which showed that early intervention therapies produced a significant positive effect on long term neurodevelopmental outcomes of preterm infants. The infants that were exposed to structured and timely interventions showed better cognitive, motor and language development as opposed to those infants who were not exposed to these therapies. The positive results were repeatedly noted in different centers, which underlines the applicability and efficacy of early intervention in various clinical practices. Also, early treatment was related to lower frequencies of developmental delays and better overall functional outcomes at the follow-up. These results supported the necessity of applying early and multidisciplinary interventions in preterm infant care. The paper trumpeted the inclusion of early intervention program as a regular practice in neonatal care units in order to maximize the developmental outcomes and eventual quality of life among the vulnerable group.

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