Early Intervention Services Improve School-age Functional Outcome Among Neonatal Intensive Care Unit Graduates

Abstract

Objective: To evaluate the effect of community-based early intervention (EI) services the on functional outcomes of high-risk infants at school age.

Methods: This was a retrospective cohort study using data from the US Department of Education's National Early Intervention Longitudinal Study. Participants were enrolled in 1997 to 1998 with follow-up through 5 years and had a neonatal intensive care unit (NICU) admission, birth weight >400 g, and gestational age >23 weeks. Kindergarten outcomes were teacher assessments of academic and physical skills compared with classmates. Because treatment assignment is determined according to level of clinical need, we used repeated measures, marginal structural models with inverse probability of treatment weighting to account for confounding by indication.

Results: Of 405 participants, 47% had academic ratings average/above average and 71% had physical skills ratings average/above average. Odds of average/above average academic skills were lower for those with delayed EI enrollment (adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI], 0.43-0.99) and trending, although not significantly, higher for those with greater service duration (aOR, 1.47; 95% CI, 0.98-2.22) and breadth (odds ratio, 1.74; 95% CI, 0.95-3.20). Odds of average/above average physical skills were lower for those with delayed EI enrollment (aOR, 0.61; 95% CI, 0.40-0.93) and higher for those with greater intensity (aOR, 1.06; 95% CI, 1.00-1.13) and breadth (aOR, 1.86; 95% CI, 1.03-3.35), approaching significance for those with greater service duration (aOR, 1.41; 95% CI, 0.96-2.09).

Conclusions: Longer, more intense services were associated with higher kindergarten skills ratings in children at risk for disabilities. Our novel findings support the effectiveness of large-scale EI programs and reinforce the importance of referral after NICU discharge.

Keywords: early intervention; preterm infant; school outcomes.