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

Published:August 02, 2017DOI:



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


      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.


      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).


      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.


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        • Barnett S.
        Benefit-Cost Analysis of the Perry Preschool Program and Its Policy Implications.
        Educ Eval Policy Anal. 1985; 7: 333-342
        • Campbell F.A.
        • Ramey C.T.
        Effects of early intervention on intellectual and academic achievement: a follow-up study of children from low-income families.
        Child Dev. 1994; 65: 684-698
        • Eldevik S.
        • Hastings R.P.
        • Hughes J.C.
        • et al.
        Meta-analysis of Early Intensive Behavioral Intervention for children with autism.
        J Clin Child Adolesc Psychol. 2009; 38: 439-450
        • Feldman M.A.
        Early intervention: the essential readings.
        Blackwell Pub., Malden, MA, USA2004
        • Reichow B.
        • Wolery M.
        Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model.
        J Autism Dev Disord. 2009; 39: 23-41
        • Shonkoff J.P.
        • Hauser-Cram P.
        Early intervention for disabled infants and their families: a quantitative analysis.
        Pediatrics. 1987; 80: 650-658
        • McCormick M.C.
        • Litt J.S.
        • Smith V.C.
        • et al.
        Prematurity: an overview and public health implications.
        Annu Rev Public Health. 2012; 32: 367-379
        • Gray J.E.
        • McCormick M.C.
        • Richardson D.K.
        • et al.
        Normal birth weight intensive care unit survivors: outcome assessment.
        Pediatrics. 1996; 97: 832-838
      1. Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. The Infant Health and Development Program.
        JAMA. 1990; 263: 3035-3042
      2. Randomised trial of parental support for families with very preterm children. Avon Premature Infant Project.
        Arch Dis Child Fetal Neonatal Ed. 1998; 79: F4-F11
        • Spittle A.J.
        • Orton J.
        • Doyle L.W.
        • et al.
        Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants.
        Cochrane Database Syst Rev. 2007; : CD005495
        • Spittle A.
        • Orton J.
        • Anderson P.J.
        • et al.
        Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants.
        Cochrane Database Syst Rev. 2015; : CD005495
        • Austin P.C.
        • Stuart E.A.
        Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.
        Stat Med. 2015; 34: 3661-3679
        • Bailey Jr., D.B.
        • Hebbeler K.
        • Scarborough A.
        • et al.
        First experiences with early intervention: a national perspective.
        Pediatrics. 2004; 113: 887-896
        • Scarborough A.H.K.
        • Spiker D.
        Eligibility Characteristics of Infants and Toddlers Entering Early Intervention Services in the United States.
        Journal of Policy and Practice in Intellectual Abilities. 2006; 3: 57-64
        • Batton D.G.
        Clinical report–Antenatal counseling regarding resuscitation at an extremely low gestational age.
        Pediatrics. 2009; 124: 422-427
        • Barfield W.D.
        • Clements K.M.
        • Lee K.G.
        • et al.
        Using linked data to assess patterns of early intervention (EI) referral among very low birth weight infants.
        Matern Child Health J. 2008; 12: 24-33
        • Kim C.
        • Disare K.
        • Pfeiffer M.
        • et al.
        Effects of individual and neighborhood characteristics on the timeliness of provider designation for early intervention services in New York City.
        J Dev Behav Pediatr. 2009; 30: 38-49
        • Spiker D.H.K.
        • Wagner M.
        • Cameto R.
        • et al.
        A framework for describing variation in state early intervention systems.
        Top Early Child Spec Educ. 2000; 20: 195-207
        • Wang C.J.
        • Elliott M.N.
        • Rogowski J.
        • et al.
        Factors influencing the enrollment of eligible extremely-low-birth-weight children in the part C early intervention program.
        Acad Pediatr. 2009; 9: 283-287
        • Faries D.
        • Kadziola Z.
        Analysis of Longitudinal Observational Data Using Marginal Structural Models.
        in: Faries D. Leon A. Haro J. Analysis of Observational Health Care Data Using SAS. SAS Institute, Inc., Cary, NC2010
        • Naimi A.I.
        • Moodie E.E.
        • Auger N.
        • et al.
        Constructing inverse probability weights for continuous exposures: a comparison of methods.
        Epidemiology. 2014; 25: 292-299
        • Johnson S.
        • Hennessy E.
        • Smith R.
        • et al.
        Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study.
        Arch Dis Child Fetal Neonatal Ed. 2009; 94: F283-F289
        • Hutchinson E.A.
        • De Luca C.R.
        • Doyle L.W.
        • et al.
        School-age outcomes of extremely preterm or extremely low birth weight children.
        Pediatrics. 2013; 131: e1053-e1061
        • Sterne J.A.
        • White I.R.
        • Carlin J.B.
        • et al.
        Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls.
        BMJ. 2009; 338: b2393
        • Peters S.A.
        • Bots M.L.
        • den Ruijter H.M.
        • et al.
        Multiple imputation of missing repeated outcome measurements did not add to linear mixed-effects models.
        J Clin Epidemiol. 2012; 65: 686-695
        • McManus B.
        • McCormick M.C.
        • Acevedo-Garcia D.
        • et al.
        The effect of state early intervention eligibility policy on participation among a cohort of young CSHCN.
        Pediatrics. 2009; 124: S368-S374
        • Verhulst F.C.
        • Koot H.M.
        • Van der Ende J.
        Differential predictive value of parents' and teachers' reports of children's problem behaviors: a longitudinal study.
        Journal of abnormal child psychology. 1994; 22: 531-546