The environment and the procedures at the Neonatal Intensive Care Unit (NICU) can be stressful for preterm infants. Thus, brain development might be decelerated, increasing the possibility for visual impairments. However, the clinical trial by Italian researchers has shown that early interventions by parents can have a positive effect on visual functions.
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Previous research suggests that multisensory stimulation, especially infant massages, can help with brain development and visual maturation in preterm infants. The randomized controlled trial by Fontana and colleagues examined the effectiveness of early intervention programs in stable, very preterm infants, to investigate this correlation. In the study, standard care was compared with additional early interventions. Care as usual followed national guideline requirements and included Kangaroo Mother Care, nesting as well as minimal handling and drug-free pain management. Parents of the intervention group received additional training, for example to help interpret the behaviour of the infant. Moreover, the infants of the intervention group received stimulation by their parents through massages and visual interactions. The massages were started three weeks after birth and were carried out twice per day, visual interactions started from 34+0 weeks of gestational age and were performed once a day.
All preterm infants born between April 2014 and January 2017 at one NICU in Milan, Italy, with a gestational age between 25+0 and 29+6 weeks were eligible for the study. In total, the study included 57 children, with 30 of them receiving standard care and 27 infants receiving early interventions. Importantly, only clinically stable infants, meaning that they did not for example receive mechanical ventilation or suffered from active sepsis, were included in the study.
The researchers used standardized clinical testing (e.g. ocular movements, ability to fix and follow a target) at term equivalent age to assess the visual development. The results showed that infants getting early interventions had better visual functions including for example spontaneous ocular mobility, eye movements, stripes discrimination and attention at distance. Additionally, Visual Evoked Potential (VEP) and Electroencephalogram (EEG) were performed before and after the massages and visual interactions. These showed that the interventions positively influenced brain development.
However, one limitation of this study was the small number of participants, thus statistical analysis did not result in significant power. In addition, due to the simultaneous implementation of massage and visual interactions, it was not possible to determine the benefits of each intervention separately. Future research should also assess long-term outcomes.
Paper available to view at: Frontiers in Pediatrics
Full list of authors: Camilla Fontana, Agnese De Carli, Daniela Ricci, Francesca Dessimone, Sofia Passera, Nicola Pesenti, Matteo Bonzini, Laura Bassi, Letizia Squarcina, Claudia Cinnante, Fabio Mosca and Monica Fumagalli
