A critical analysis of the infant health and development program

Abstract

The largest study designed to ameliorate adverse effects of premature low birth weight (LBW) and to prevent mental retardation is the Infant Health and Development Program (IHDP). This was a randomized, multisite intervention: home visits for 3 years, parents meetings, and intensive preschool education for 2 years. IHDP reported results alleging the program significantly influenced intelligence and prevented mental retardation. We conducted an independent analysis of the original computerized database (at 3 years). Five-year follow-up data were obtained from the journal publication and from data on file with the National Auxiliary Publication Service. Our intent was to determine the magnitude, durability, and clinical significance of purported intervention effects and how these are mediated. Methods used were primarily multivariate correlational analyses and examination of the logic underlying the conclusions. Results suggest alternative interpretations of claims regarding IHDP. Effects are explained by confounding variables, questionable analytical procedures, distorted interpretations, and data inconsistencies. Effect sizes and specificity of effect reported by IHDP do not survive scrutiny either in the original database or at 5 years. Given the vastly complex nature of premature LBW, IHDP was poorly conceived, failing to produce meaningful and enduring effects on IQ. Policy conclusions for interventions with LBW infants stemming from IHDP are misleading.