AUTHOR=Bustamante Loyola Jorge , Pérez Retamal Marcela , Mendiburo-Seguel Andrés , Guedeney Antoine Claude , Salinas González Ricardo , Muñoz Lucia , Cox Melane Horacio , González Mas José Miguel , Simó Teufel Sandra , Morgues Nudman Mónica 

TITLE=The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.803932

DOI=10.3389/fped.2022.803932

ISSN=2296-2360

ABSTRACT=Background: sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year.
Objective: to compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants.
Design: multicenter randomized clinical trial.
Participants: 99 moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (n=49) and Control (n=50). Both groups attended medical check-ups at two, six and twelve months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised.
Results: At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03-14.2) for the control group and 22.4% (95% CI: 13.0-35.9) for the intervention group (OR = 0.22, p=.028 [95% CI = .06-0.84]). At 6 months, the prevalence was 10.0% (95% CI: 3.9-21.8) for the control group and 6.1% (95% CI: 2.1-16.5) for the intervention group (OR = 2.09, p=0.318 [95% CI = 0.49-8.88]). At 12 months, the prevalence was 22.0% (95% CI: 12.8-35.2) for the control group and 4.1% (95% CI: 1.1-13.7) for the intervention group (OR = 6.63, p=.018 [95% CI = 1.39-31.71]).
Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 (p=.022 [95% CI = 1.20-10.44]; Cohen’s d= 0.70). In the case of pooled adjusted OR, the model considered diagnosis (0= Withdrawal, 1= Normal) as the dependent variable, time of evaluation (1= 6 months, 2= 12 months) and group (0=Control, 1= Experimental) as factors. In this case, the pooled adjusted OR was 3.57 (p=.022 [95% CI = 1.20-10.65]; Cohen’s d= 0.70). 
Conclusion: Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes.
Trial Registration: ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03212547