Neurodevelopment of monitored versus nonmonitored very low birth weight infants: the importance of family influences.

Very low birth weight (VLBW) infants are at increased risk for neurodevelopmental delays. Follow-up programs have been instituted as one form of secondary prevention, to identify delays early and refer affected children to intervention. To examine the relationship between follow-up care and later development, 82 neonates who weighed 1500 g or less at birth were followed to 36 months of age. Effectiveness of care was assessed by neurodevelopmental status of 45 patients who participated and 37 patients who failed to participate in annual post-neonatal intensive care unit (NICU) monitoring service. At the outset, the groups had similar medical and socioeconomic status characteristics. However, by the third year of life, the monitored patients had a 14-point General Cognitive Index (GCI) advantage over the nonmonitored group. Examination of family process variables, family organization styles, and mother-child behaviors revealed significant differences between the groups, and suggested that monitored patients were raised in more normal, supportive home environments. Correlation and stepwise regression analyses indicated that mother-child behaviors and quality of the home environment were most predictive of 3-year intellectual development, with neonatal and biological measures adding to the predictive classification of neurosensory delays. It is suggested that an infant's medical record, mother-child behaviors, and overall quality of home environment be measured prior to hospital discharge, followed by home-based intervention where indicated.