河野 由美

OBJECTIVE: To evaluate neurodevelopmental outcomes of very preterm infants by gestational age (GA) using high follow-up rate data. STUDY DESIGN: This secondary analysis included infants born before 32 weeks' gestation in 2012-2014 from the Improvement of NICU practices and Team Approach Cluster randomized controlled Trial (INTACT). The primary outcome was survival without moderate or severe neurodevelopmental impairment (NDI). RESULTS: Among 2722 infants, NICU survival rate was 96.5%, ranging 72.1-99.6% at 22-31 weeks. At age three years, 2336 (89.5% of 2610 survivors) were completely assessed; 303 had moderate NDI and 183 had severe NDI. Of these, the proportions of infants surviving without NDI increased with GA; 45.2% at 22 weeks, 57.5% at 23 weeks, 88.1% at 31 weeks. CONCLUSION: Although survival without NDI varied by GA, more than half (55.0%, 83/151) of infants born at 22-23 weeks who survived to age three years were without neurodevelopmental sequelae.

BACKGROUND: Premature children are known to be at a high risk of developing behavioral problems. This study examined the effectiveness of parent-child interaction therapy (PCIT) in reducing behavioral problems in young children born premature. METHODS: The study included 18 child-parent pairs with children born at less than 35 weeks of gestation (range: 23-34 weeks, median: 31.0 weeks) and aged 27-52 months (median: 38.0 months). They were assigned to either the PCIT group (n = 7) or the non-PCIT group (n = 11) based on maternal desire for treatment. The study was designed to examine the effects of PCIT. Specifically, the Eyberg Child Behavior Inventory (ECBI) intensity score, ECBI problem score, and Parenting Stress Index Short Form (PSI-SF) scores were compared before treatment and after 6 months. RESULTS: In the PCIT group, the mean ECBI intensity score was 135.7 (SD = 13.5; T-score = 64) at baseline and 90.1 (SD = 15.5; T-score = 46) at post-assessment, the mean ECBI problem score was 9.8 (SD = 1.9; T-score = 54) at baseline and 4.4 (SD = 3.1; T-score = 44) at post-assessment, the mean PSI-SF total score was 60.1 (SD = 4.8; 95%tile) at baseline and 49.6 (SD = 5.6; 85%tile) at post-assessment, showing a significant improvement (ECBI intensity scores: p < 0.001, d = 2.03; ECBI problem scores: p < 0.001, d = 1.94; PSI-SF total scores: p = 0.004, d = 0.86). On the other hand, none of the scores showed significant change in the non-PCIT group. CONCLUSIONS: The PCIT can be considered as a potential treatment option for behavioral problems in young children born premature.