| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 107 === Background and purpose: Preterm infants with very low birth weight (VLBW, birth weight < 1,500 g) are at risk of developmental disabilities. Although meta-analyses revealed short-term developmental effect of early intervention for preterm infants, the long-term neurobehavioral and neurophysiological changes and their relationship has rarely been examined. The purposes of this study were therefore to examine the long-term effectiveness of a family-centered intervention program (FCIP) on neurobehavioral and neurophysiological function in VLBW preterm infants in Taiwan at 4 years of age compared with a usual care program (UCP), and to assess if early neurophysiological changes mediated the effects on the 4-year outcomes.
Methods: This study prospectively examined the neurobehavioral and neurophysiological function in 251 VLBW preterm infants at 4 years of age who were randomly allocated for FCIP (N=122) and UCP (N=129) from hospitalization to 12 months of corrected age (CA). Infants were assessed neurophysiological function using the electroencephalography (EEG) in sleep and EEG/event-related potentials (ERP) in an auditory oddball task at 1 and 4 months CA, followed by neurobehavioral (cognition: Wechsler Preschool and Primary Scale of Intelligence-Revised; motor function: Movement Assessment Battery for Children-2nd Edition; behavior: Child Behavioral Check List for Ages 1.5-5) and neurophysiological assessment (EEG/ERPs in resting, auditory oddball task and inhibitory control tasks) at 4 years of age. Results: A total of 102 FCIP group children and 102 UCP group children returned for assessment at 4 years of age. The FCIP and UCP groups were comparable in the motor score (7.4±2.4 vs. 7.4±2.1), full scale IQ score (96.8±14.4 vs. 94.3±16.7) and total behavior score (53.9±11.4 vs. 55.0±10.5). As for the executive function, the FCIP group children manifested significantly higher correct rate (83% vs. 77%, p=0.03) and shorter N2 latency at the Fcz channel (357.94 ms vs. 389.75 ms, p=0.04) and shorter P3 peak latency at the Pz channel (499.16 ms vs. 553.47 ms, p=0.02) in the go trials during the shape Go/Nogo task; the FCIP group children had significantly shorter P3 peak latency at the Fz, Fcz, Cz and Pz channels in the nogo and go trials (489.95~586.75 ms vs. 587.04~676.33 ms, all P<0.05), larger P3 mean amplitudes at the Cz channel in the nogo trials (16.92 μV vs. 5.92 μV, p=0.04) and larger P3 mean amplitudes at the Pz channel in the go trials (9.76 μV vs. -1.18 μV, p=0.04) during the color Go/Nogo task than the UCP group children. There was no difference between groups in the resting EEG coherence, and peak amplitude and latency variables in the auditory oddball task at 4 years of age, however. Neither was the early neurophysiological variables related to later neurodevelopmental outcome. Conclusions: The FCIP yielded beneficial effect on cognitive function, specifically inhibitory control in executive function, in VLBW preterm children at preschool age than the UCP.
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