By Anne Harding
NEW YORK (Reuters Health) - Home visits by nurses or other trained health professionals can improve the development of preterm infants, parenting and the home environment, according to a new review of recent research.
"Overall the trend did seem to support that it is effective," Dr. Neera Goyal, an assistant professor of pediatrics at the Children's Hospital Cincinnati Medical Center and the study's lead author, told Reuters Health.
The Patient Protection and Affordable Care Act, also known as Obamacare, has set aside funding for home visiting programs for at-risk families to improve outcomes for mothers and their babies born prematurely, Goyal and her team note in the journal Pediatrics.
There are 400 such programs currently providing care to at least 500,000 U.S. families, largely funded by state and local governments, they note.
About 12 percent of U.S. babies are born early - before completing at least 37 weeks' gestation - and that puts them at higher risk of physical and mental development problems, especially during their first year of life.
The last major review of evidence on the effectiveness of home visits was 20 years ago, according to Goyal's team, and the rate of premature births has risen 20 percent since then.
To assess the latest evidence on home visits for preterm infants and their families, Goyal and her colleagues identified 17 studies including a total of 2,983 babies.
The researchers looked at five overall categories: infant development, parent-child interaction, morbidity (illness), abuse and neglect and growth and nutrition.
Providers, who ranged from nurses to development specialists or graduate students, typically visited the home once or twice a week, and families were visited for durations ranging from eight weeks to three years.
Goyal's team found that nine of the studies, including 516 infants in all, showed a positive effect of home visits on infant development.
Six studies, which included 336 babies, gauged the effect of the visits on parent-child interactions, and also showed a significant benefit for home visits.
In the other three categories, however, the study did not find any significant effects of home visits.
"Federal dollars are being invested to home visiting that basically will provide some stability and allow for long range planning for home visiting services," Goyal said.
"This provides an opportunity to think about how we can tailor this intervention now to subgroups and really improve the impact and the efficacy of this intervention overall for our high risk communities."
More research is particularly needed to understand how home visits can benefit low-income families, Goyal said, given that low socioeconomic status is linked to a higher risk of preterm birth.
Better understanding is also needed, she added, to determine how best to help moderate- and late-preterm infants (born between 32 and 34 weeks' gestation and from 34 to 36 weeks' gestation, respectively).
Research in recent years has shown that these babies, who account for 70 percent of all preterm births, are also at risk of developmental problems. "This is really a significant group to focus on," Goyal said.
SOURCE: http://bit.ly/17NmKnw Pediatrics, online August 12, 2013.