Early Intervention Including an Active Motor Component in Preterms with Varying Risks for Neuromotor Delay: A Systematic Review and Narrative Synthesis.

Abstract

Background/Objectives: Previous reviews demonstrated stronger benefits of early interventions on cognition compared to motor outcome in preterm-born infants. Potentially, motor development needs more targeted interventions, including at least an active motor component. However, there is no overview focusing on such interventions in preterm-born infants, despite the increased risk for neuromotor delays. Methods: PubMed, Embase and Web of Science were systematically searched for (quasi-)randomized controlled trials regarding early interventions in preterm-born infants, with varying risks for neuromotor delay, and trials comprising an active motor component started within the first year were included. Study data and participant characteristics were extracted. The risk of bias was assessed with the Risk of Bias 2 tool. Results: Twenty-five reports, including twenty-one unique (quasi-)RCTs, were included and categorized as either pure motor-based interventions (n = 6) or family-centered interventions (n = 19). Of the motor-based interventions, four improved motor outcomes immediately after the intervention, and one of these also did so at follow-up, compared to five and one for family-centered approaches, respectively. Only five family-centered studies assessed long-term effects beyond age five, finding no greater efficacy than standard care. Overall, large variations were present for intervention intensity, type and outcomes between the included studies. Conclusions: Although methodological heterogeneity compromised conclusions, limited effects on motor outcome, in particular long-term outcome, were identified. Including a stronger motor-focused component embedded within a family-centered approach could potentially increase the impact on motor outcome, which would be of particular interest for infants showing early signs of neuromotor delay.