Abstract
BackgroundVery premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors. In particular, very preterm (VP) infants display anomalies in controlling attention and gathering task-relevant information. Early interventions that support attention control may be pivotal in providing a secure base for VP children’s later attainments. The Attention Control Training (ACT) is a cognitive training intervention that targets infants’ abilities to select visual information according to varying task demands but had not been tested in VP infants. We conducted a feasibility study to test the processes we intend to use in a trial delivering the ACT to VP infants.Methods and designWe tested recruitment and retention of VP infants and their families in a randomised trial, as well as acceptability and completion of baseline and outcome measures. To evaluate these aims, we used descriptive quantitative statistics and qualitative methods to analyse feedback from infants’ caregivers. We also investigated the quality of eye-tracking data collected and indicators of infants’ engagement in the training, using descriptive statistics.ResultsTwelve VP infants were recruited, and 10 (83%) completed the study. Participants’ parents had high education attainment. The rate of completion of baseline and outcome measures was optimal. VP infants demonstrated engagement in the training, completing on average 84 min of training over three visits, and displaying improved performance during this training. Eye-tracking data quality was moderate, but this did not interfere with infants’ engagement in the training.DiscussionThe results suggest the ACT can be delivered to VP infants. However, challenges remain in recruitment of numerous and diverse samples. We discuss strategies to overcome these challenges informed by results of this study.Trial registrationRegistered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov).
Highlights
IntroductionVery premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors
Very premature birth is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors
Moiseev and colleagues suggested that increased risks for delays in behaviour regulation, cognitive and intellectual abilities experienced by very preterm (VP) infants may be linked to disruption of pre- and frontal-cortex maturation caused by very premature birth [43]
Summary
Very premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors. Advances in obstetric care since the 1990s, the use of antenatal corticosteroids and surfactants, have contributed to the increasing survival and improved health of children born premature [9, 10] Even with these developments, premature children are still at increased risk for intellectual deficits [17, 49, 71] and poorer school attainment [2]. Moiseev and colleagues suggested that increased risks for delays in behaviour regulation, cognitive and intellectual abilities experienced by VP infants may be linked to disruption of pre- and frontal-cortex maturation caused by very premature birth [43]. Early appearing anomalies in attention control may initiate a cascade of effects, such as poorer EFs, leading to cognitive deficits [36, 37, 41, 54, 55]
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