.0-3 Year-old High-risk Children Community Early Intervention To Guide Research

With the development of perinatal medicine, the survival rate of high-risk infants (HRI) who are born with a low birth weight, preterm, asphyxia and other biological risk factors has been obviously improved. However, there is an increased incidence of neurodevelopmental disorders of the survival infants. There are amount of researches about the early intervention (EI) for HRI, which is proved to improve the cognitive, motor and behavioural outcomes of the HRI. But few of these strategies have been translated to clinical practice and child health care in communities, especially in China. The objective of this study is to explore the current status of community EI services for HRI under three years old in Shanghai, to evaluate the effects of EI on neurodevelopment and visual system in preterm infants at six months old, and to establish a community-based, family-centered and three-tiered EI network with coordinated and multidisciplinary system for HRI. PartⅠStatus of community-based early interventions of high-risk infants under three years old in Shanghai【Objective】To investigate the current status of community EI services for HRI under three years old in Shanghai.【Methods】The survey was conducted through questionnaires, interviews and document consultations at twelve units in Luwan, Minhang and Songjiang Districts, which include five maternal and child health organizations, three early education institutions, two special education organizations and two Disabled Persons' Federations.【Results】1) Among the five maternal and child health organizations, all have HRI documents, but three have the problem of high drop-out rate; three establish HRI out-patient departments without offering systemic EI services; one offer systemic EI services, without follo wing-up and evaluation of the effectiveness of EI for HRI. All of them have the demands of training on EI skills and other related healthcare knowledge.2) Early education centers, special education organizations and Disabled Persons' Federations offer services to ordinary children and special children respectively, but they do not offer EI to HRI.【Conclusions】Community-based EI service for HRI under three years old haven't formed a systematic operation mode yet, and most HRI haven't obtained effective EI in communities, so it's needed to establish a community-based, family-centered and three-tiered EI network with coordinated and multidisciplinary system for the HRI to lower disability rate of HRI and improve population quality. PartⅡThe effects of early intervention on early cognitive development in preterm infants【Objective】To evaluate the effects of EI on neurodevelopment and visual system in preterm infant at six months old.【Methods】The interventional group infants 30 infants in the EI group were followed up regularly and received EI monthly while 22 were in the conventional care group. All of them were assessed using the Bayley Scales of Infant Development-Ⅱ(BSID-Ⅱ) and flash visual evoked potentials (FVEP) at six, nine, twelve months of corrected age respectively.【Results】1) At six months of corrected age, the mean score of mental development indexes (MDI) of BSID-Ⅱin the EI group and the conventional care group were 98±7 and 90±6 respectively, while the psychomotor development indexes (PDI) of BSID-Ⅱin the EI group and the conventional care group were 100±10 and 93±10 respectively. At nine months of corrected age, the mean score of MDI of BSID-Ⅱin the EI group and the conventional care group were 106±7 and 91±6 respectively, while the PDI of BSID-Ⅱin the EI group and the conventional care group were 103±6 and 90±7 respectively. At twelve months of corrected age, the mean score of MDI of BSID-Ⅱin the EI group and the conventional care group were 101±11 and 95±11 respectively, while the PDI of BSID-Ⅱin the EI group and the conventional care group were 92±16 and 79±12 respectively. The mean scores of MDI and PDI in the EI group were significantly higher than those of the conventional care group at all assessment points.2) The N1, P1, N2 wave was the major components presented in two groups. The mean latency of P1 of infants in the EI group and the conventional care group was significantly shorter than that of infants in the conventional care group (118.05±21.85 vesus125.70±13.88). But there was no significant differences in mean latency of the N1, N2 and the mean amplitude of N1P1 between the two groups.【Conclusions】Effective EI can improve neurodevelopment and visual system development of preterm infants. Further work is needed to evaluate the long-term effects of EI on the child development. PartⅢEstablishment and assessment an operational mode of community-based EI for high-risk infants【Objective】Aim to investigate effective systematic operational mode of community-based EI for HRI.【Methods】1) Pediatricians in Department of Child health,Children's Hospital of Fudan University (upper first-class hospital) and Luwan District Maternity and Child Health Hospital (second -class hospital) included preterm infants, assessed their growth and development, and adopted EI approaches to train their parents on every follow-up visit respectively.2) 90 preterm infants were followed up regularly and received EI monthly. We recorded and analyzed parents' compliance, the drop-out rate in follow-ups and the rate of participation in EI services.【Results】1) The drop-out rate of developmental follow-up was significantly higher in the upper first-class hospital (39.4%) than that in the second-class hospital (12.5%).2) Infants with better educated parents were more likely to attend follow-up and have higher compliance with EI parents training (followed-up:university -college versus losing follow-up:high school-middle school).3) Parents who were not aware of the EI importance, the distance between infants residency and the hospital, floating population were important factors of drop-out. Compliance with EI parents training and parents'education were positively correlated with follow-up attendance.The infant gender, gestational age did not e effect follow-up rates.【Conclusions】The operational mode of Luwan District Maternity and Child Health Hospital, which is a community-based, family-centered and three-tiered medical-care network coordinated system, was more effective. The mode had lower drop-out rate, close contact with preterm infants in the community. However, problems still exist in this mode, such as lower rate of EI participation and a lack of recognitions of the importance of EI.