Three-Year Outcome of the Early Intervention Program for Very Low Birthweight Infants

新生児期に実施した極低出生体重児に対する早期介入early intervention program(EIP)の修正3歳時の発達効果を検討した。対象は, 1990-96年に当院未熟児室にて加療し, 抽出条件を満たし, 修正3歳時まで追跡調査した極低出生体重児47例(介入群29例, 対照群18例)であった。測定は, 修正3歳時のMcCarthy知能発達検査(McCarthy Scale)の各指数を2群間で比較した。結果は, McCarthy Scaleの各指数ともベースライン状態を調整した重回帰分析で2群間に有意な差はなかった。また, ベースライン状態で調整した一般知能指数の分布の比較結果にも, 2群間に有意差はなかった。EIPによってみられた新生児期および修正1歳時の両者の発達の差は, 3歳時点ではなくなるように考えられた。介入による長期的な発達効果を期待するためには, 継続的な介入プログラムを実施することが必要であると思われた。To reevaluate at 3 years corrected age children who had participated in an early intervention program(EIP)designed to promote the neonatal behavioral organization and developmentl progress in infants born prematurely. The study subjects consisted of 47 very low birthweight infants(≧ 1500 gms). During 1993-1996, the experimental group(n=29)received the EIP for 44 weeks starting from 38 weeks of postmenstrual age. The control group(historical control, n=18)received the standard medical-nursing care without EIP during 1990-1992. Developmental outcome was assessed in both groups using the McCarthy Scale. Multivariate analyses were performed to adjust baseline variables that might be associated with the developmental outcome: sex, appropriate or light for dates infant, birthweight, gestational age, Apgar score at 1 minute and duration of intubation. In the McCarthy Scale, none of the outcome measures were significantly different between the two groups. Furthermore, there were no significant differences between two groups in the distribution of the adjusted IQ scores. EIP provided during the first 1 month of life exerted no effects on VLBW infants' cognitive development at 3 years corrected age. These results indicated a need to develop additional intervention strategies for very low birthweight infants that can provide sustained benefits