Hajar Sabour eghbali mostafa khan1, Ali Hosseini *2, Nazila Akbarfahimi3, Farin Soleimani4, Aida Ravarian5
1- Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences, Tehran, Iran & Occupational therapy Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Ira
2- Occupational therapy department, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. ,alihosse@gmail.com
3- Occupational therapy department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. & Social Determinants of Health Research Center Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
5- Pediatric Neurorehabilitation Research Center University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2- Occupational therapy department, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. ,
3- Occupational therapy department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. & Social Determinants of Health Research Center Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
5- Pediatric Neurorehabilitation Research Center University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Abstract: (26 Views)
Preterm infants continue to face an elevated risk of adverse neurodevelopmental outcomes after discharge from the neonatal intensive care unit (NICU), including impairments in motor skills, cognition, behavior, and self-regulation. Over the past two decades, numerous developmental support programs have been introduced to enhance long-term outcomes in this vulnerable population. However, substantial heterogeneity in underlying theoretical frameworks, intervention content, delivery methods, intensity, timing, and outcome assessment tools has led to inconsistencies across studies. This variability has limited comparability between trials and complicated the translation of research findings into clinical practice. Accordingly, the present scoping review aimed to systematically map, characterize, and categorize developmental supportive interventions implemented after NICU discharge for preterm infants.
Methods: A scoping review was conducted following the methodological framework proposed by Arksey and O’Malley and the recommendations of the Joanna Briggs Institute. A systematic search was performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and August 2024. Studies were eligible if they evaluated interventions targeting preterm infants and their caregivers when the intervention was initiated after discharge from the NICU, or when it began during hospitalization and continued into the post‑discharge period. Information on key aspects of the interventions-including their core components, underlying theoretical basis, implementation characteristics, and reported outcomes-was systematically extracted and summarized using descriptive analysis.
Results: Fifteen studies met the inclusion criteria. The identified interventions were classified into four major domains: motor interventions (n = 6), sensory interventions (n = 2), behavioral interventions (n = 4), and family-centered parent empowerment programs (n = 3). Motor-focused interventions mainly addressed improvements in motor development and, in some cases, cognitive functioning. Sensory-based approaches were designed to support sensory processing and regulation while also promoting more effective parent–infant interactions. Behavioral interventions emphasized strengthening infants’ self‑regulatory capacities and fostering co‑regulation through responsive caregiving practices. In contrast, family‑centered programs primarily sought to alleviate parental stress and enhance caregivers’ confidence and competence in providing care. Although favorable outcomes were reported in many studies, considerable heterogeneity was observed in theoretical foundations, intervention components, intervention duration and intensity, parental involvement, and outcome measures.
Conclusion: Discharge from the NICU should not be viewed as the endpoint of developmental support but rather as the start of a critical transition to home-based care. To maximize the effectiveness of post‑discharge interventions, therapists need to move beyond isolated or fragmented strategies and instead follow structured, stepwise guidance while adopting a coaching role that strengthens parental capacity and involvement. In addition, the development of comprehensive and context‑specific programs is crucial. Such programs may integrate pre‑discharge educational packages, tele‑rehabilitation services, and culturally adapted, parent‑centered protocols to ensure continuity and sustainability of developmental care within the home environment.
Methods: A scoping review was conducted following the methodological framework proposed by Arksey and O’Malley and the recommendations of the Joanna Briggs Institute. A systematic search was performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and August 2024. Studies were eligible if they evaluated interventions targeting preterm infants and their caregivers when the intervention was initiated after discharge from the NICU, or when it began during hospitalization and continued into the post‑discharge period. Information on key aspects of the interventions-including their core components, underlying theoretical basis, implementation characteristics, and reported outcomes-was systematically extracted and summarized using descriptive analysis.
Results: Fifteen studies met the inclusion criteria. The identified interventions were classified into four major domains: motor interventions (n = 6), sensory interventions (n = 2), behavioral interventions (n = 4), and family-centered parent empowerment programs (n = 3). Motor-focused interventions mainly addressed improvements in motor development and, in some cases, cognitive functioning. Sensory-based approaches were designed to support sensory processing and regulation while also promoting more effective parent–infant interactions. Behavioral interventions emphasized strengthening infants’ self‑regulatory capacities and fostering co‑regulation through responsive caregiving practices. In contrast, family‑centered programs primarily sought to alleviate parental stress and enhance caregivers’ confidence and competence in providing care. Although favorable outcomes were reported in many studies, considerable heterogeneity was observed in theoretical foundations, intervention components, intervention duration and intensity, parental involvement, and outcome measures.
Conclusion: Discharge from the NICU should not be viewed as the endpoint of developmental support but rather as the start of a critical transition to home-based care. To maximize the effectiveness of post‑discharge interventions, therapists need to move beyond isolated or fragmented strategies and instead follow structured, stepwise guidance while adopting a coaching role that strengthens parental capacity and involvement. In addition, the development of comprehensive and context‑specific programs is crucial. Such programs may integrate pre‑discharge educational packages, tele‑rehabilitation services, and culturally adapted, parent‑centered protocols to ensure continuity and sustainability of developmental care within the home environment.
Keywords: Preterm infant, Developmental care, Early intervention, Family-centered care, Parent empowerment, Scoping review.
Type of Study: Systematic Review |
Subject:
Occupational Therapy
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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 (CC-By-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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