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The Infant Health and Development Program

Cecelia M. McCarton, MD; Jeanne Brooks-Gunn, PhD; Ina F. Wallace, PhD; Charles R. Bauer, MD; Forrest C. Bennett, MD; Judy C. Bernbaum, MD; R. Sue Broyles, MD; Patrick H. Casey, MD; Marie C. McCormick, MD, ScD; David T. Scott, PhD; Jon Tyson, MD; James Tonasela, PhD; Curtis L. Meinen, PhD

JAMA. 1997;277(2):126-132.

Abstract
Objective.
—To reevaluate at age 8 years children who had participated during the first 3 years of life in a randomized clinical trial of special services for low-birthweight (LBW) premature infants.

Design.
—Follow-up of a randomized controlled trial of premature infants (<37 weeks' gestation), stratified by 2 LBW groups (lighter [<2000 g] and heavier [2001 2500 g]) and divided into intervention (n=377) and follow-up only (n=608) groups.

Setting.
—Eight sites serving diverse populations.

Participants.
—At age 8 years, 874 children were assessed: 336 in the intervention group and 538 in the follow-up only group.

Intervention.
—The 3-year intervention consisted of home visits (birth to 3 years), child development center services (ages 1 to 3 years), and parent group meetings (ages 1 to 3 years).

Primary Outcome Measures.
—Cognitive functioning (Weschler Intelligence Scale for Children-Ill; Peabody Picture Vocabulary Test-Revised); academic achievement (Woodcock-Johnson Tests of Achievement-Revised); and parental reports of school performance, behavior (Child Behavior Checklist), and health (Child General Health Survey).

Results.
—At age 8 years, in the entire cohort and in the lighter LBW stratum, the intervention and follow-up only groups were similar on all primary outcome measures. Differences favoring the intervention group were found within the heavier LBW group: full-scale IQ score (4.4 points higher, P=.007), verbal IQ score (4.2 points higher, P=.01 ), performance IQ score (3.9 points higher, P=.02), mathematics achievement score (4.8 points higher, P=.04), and receptive vocabulary score (6.7 points higher, P=.001 ). On a physical functioning subscale, the whole intervention group received less favorable ratings, while the lighter LBW intervention group had lower maternal ratings assessing social limitations caused by behavior.

Conclusion.
—Although at age 8 years there were modest intervention-related differences in the cognitive and academic skills of heavier LBW premature children, attenuation of the large favorable effects seen at 3 years was observed in both the heavier and lighter LBW groups. This indicates a need to develop additional intervention strategies for LBW premature children that can provide sustained benefits.

Author Affiliations
for the Infant Health and Development Program Research Group

From the Albert Einstein College of Medicine, Bronx, NY (Dr McCarton); Center for Children and Families, Teachers College, Columbia University, New York, NY (Dr Brooks-Gunn); Research Triangle Institute, Research Triangle Park, NC (Dr Wallace); Department of Pediatrics, University of Miami School of Medicine, Miami, Fia (Dr Bauer); Department of Pediatrics, University of Washington, Seattle (Drs Bennett and Scott); Children's Hospital of Philadelphia, University of Pennsylvania (Dr Bernbaum); Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Casey); Department of Maternal and Child Health, Children's Hospital, Boston, Mass (Dr McCormick); Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (Drs Tyson and Broyles); and Department of Biostatistics and Epidemiology, Johns Hopkins University, Baltimore, Md (Drs Tonascia and Meinen).

Footnotes
For a complete list of participants in the Infant Health and Development Program, see JAMA. 1990;263: 3035-3070, and JAMA. 1994;272:1257-1262.

Reprints: Cecelia McCarton, MD, Albert Einstein College of Medicine, Rose F. Kennedy Center, Room 820, 1410 Pelham Parkway South, Bronx, NY 10461.

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