Improving Developmental Motor Outcomes Through Intensive Early Intervention at 3-months Corrected Age in Preterm Infants: A Pilot Feasibility Study

Abstract

Background Preterm birth, particularly in moderate to late preterm (MLP) (32+0 to 36+6 weeks gestation), is associated with an increased risk of long-term neurodevelopmental difficulties compared to term infants. These impairments are often under- recognised and consequently low-risk MLP infants, typically receive no developmental follow-up on discharge home or referral to early intervention (EI) services. Although ‘early’ EI is more effective to enhance neuroplasticity in the maturing infant brain, access for MLP is often restricted. Group-delivered EI may offer a solution and may improve accessibility and resource efficiency for service providers. When provided as early as 12-weeks corrected age and at a high intensity, group-based EI has the potential to improve developmental outcomes. Currently there is limited research investigating the feasibility and acceptability of utilising a group-delivery model EI for very young infants born MLP. Objective This study explored the feasibility and acceptability of a 12-week, high-intensity, group-based, early implemented EI programme (NEOgrads Playgroup) for healthy, low-risk MLP infants and their caregivers in Auckland. Methods This non-randomised pilot feasibility study, NEOgrads Playgroup, involved nine MLP infants recruited at 11 weeks corrected age, all with normal general movements and deemed ‘low risk’ of abnormal neurological sequalae. The intervention was delivered weekly via a group class (community/clinic-based setting), over a 12-week period by a neurodevelopmental therapist. In addition to the developmentally supportive play and educational group classes, caregivers implemented a personalised home exercise programme over the duration of the study. Feasibility was assessed via caregiver’s programme compliance (group and home programme), group-based intervention protocol fidelity audit, and caregiver’s acceptability of the programme following intervention completion. Initial efficacy was explored pre and post intervention using the Peabody Developmental Motor Scale – Second edition (PDMS-2) to assess changes in gross motor developmental trajectories.

Results The median group programme caregiver compliance rate was 90% (80-91.6%), with mean home exercise programme compliance reported at 4.9/7 (SD =1.18) sessions per week. Protocol fidelity was met for the group programme delivery for core NEOgrads Playgroup principles. The caregiver-rated satisfaction survey showed a strong belief in programme benefits to their infant, themselves and whānau, with a strong support of programme endorsement to other caregivers. Three subthemes emerged with the programme improving: caregiver-infant relationship, caregiver self-efficacy, and infant’s self-efficacy. Initial efficacy findings indicated six infants demonstrated meaningful improvements in gross motor development from pre to post intervention, as measured by the Peabody Developmental Motor Scale (PDMS-2). These changes exceeded the standard error of measurement (SEM = 5.88), suggesting trajectories above normal developmental progression. Whilst two infants showed a reduction in their PDMS-2 scores (a change of 8 points), and one infant demonstrated stable developmental progression (a change of 2 points). Conclusion This initial pilot feasibility study demonstrated that the NEOgrads Playgroup, a group-based early intervention programme, is both feasible and acceptable for caregivers of low-risk MLP infants. While initial efficacy testing suggested positive trends in gross motor development following the intervention, larger population-based studies with longer-term follow-up are needed to assess the sustained impact of the NEOgrads Playgroup on MLP developmental outcomes.