Infants, Intervention for Premature

The Context of Premature Birth

Among the more than 4 million new births each year in the United States, 11% are born too early and 7% are born too small. Prematurity is a major cause of developmental delay. Four decades of research confirm that preterm infants, defined as less than 37 weeks gestational age (GA) and comprising 11% of all yearly births in the United States, are at higher risk than [Page 583]full-term infants for death in the early postpartum period, chronic medical conditions, and developmental delays in physical growth and intellectual and socioemotional functioning that can persist into the school-age years and beyond. These problems are more pronounced among very premature (< 32 weeks GA) and extremely premature (< 28 weeks GA) infants, the latter of whom have been found to be at extreme risk for developmental delay by 30 months of age (Wood, Marlow, Costeloe, Chir, Gibson, & Wilkinson, 2000).

The very preterm infant has average hospital stays of 45–50 days, and 33% to 50% experience one or more rehospitalizations during the first 3 years. Rates of premature birth in industrialized counties are unlikely to decrease. Indeed, the premature birth rate in the United States has increased 17% between 1981 and 1995, in response to technological advances in neonatal care that promote the viability of small infants. Pressing needs thus remain for cost-effective, replicable, theoretically based interventions targeting preterm infants and their families (Ventura, Martin, Curtin, & Matthews, 1995).

Interventions targeting preterm infants and their parents (almost always mothers) have included infant stimulation, attempts to facilitate mother-infant bonding, provision of parental supports, and psychoeducational programs to foster parental skills in reading and responding to infant social cues.

Etiology and Risk Factors of Early Birth

The etiology of developmental delays in children born preterm can be traced in part to the degree of perinatal illness occasioned by preterm birth, which is a more important predictor of development among preterms than degree of prematurity per se. However, preterm infants are also at risk for inefficiencies in state and behavioral organization that arise simply from being born too soon. These irregularities render preterms less communicative and “readable” than full-term infants, setting the stage for deficits in both cognitive and socioemotional domains. Compared to full-term infants, preterms have been characterized as less responsive and more gaze avoidant of their mothers. In turn, mothers of preterms have been rated as less engaged, less responsive, and overstimulating. Preterm infant-parent interactive difficulties may be compounded by the fact that parents of preterms are themselves in a premature developmental stage.

Parents may grieve for the loss of the expected full-term, healthy baby and may experience depression, anxiety, helplessness, and self-blame; psychologically distressed parents are in turn at risk for parenting difficulties (Teti, O'Connell, & Reiner, 1997).

Infant Stimulation Programs

The use of systematic infant stimulation in intervention is based on the premise that early stimulation compensates for what the infant would have experienced in utero had the pregnancy gone full term (e.g., vestibular stimulation), or for deprivations of specific extrauterine stimulation (e.g., gentle touch) normally available to full-term infants and perceived as critical for intimate parent-child relations. Programmatic tactile stimulation, performed by trained neonatal intensive care unit (NICU) personnel, has been found to stimulate infant growth rates and weight gain, activity level, health status, and cognitive/motor development. Field (2001) in particular has revived interest in touch as an intervention modality for neonates at risk. Her 10-day program of tactile/kinesthetic stimulation, involving three 15-minute sessions of tactile/kinesthetic stimulation per day, has had positive effects on weight gain among preterms, with treatment infants gaining 47% more weight per day (8 more grams per day) than did controls, with longer-term effects reported for infant cognitive and motor development.

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