Our laboratory has focused on the research of typical and atypical infant neuromotor development as the basis of clinical early intervention. The interested topics included the risk factors for neurodevelopmental delay in preterm infants, early detection and intervention on neurodevelopment in preterm infants, and the parent-child interaction in dyads with preterm infants, and the specific descriptions are as followed:
1. Risk factors for neurodevelopmental delay in preterm infants
We have longitudinally assessed the neurodevelopment in full-term and preterm infants with several sensitive measurements, including walking attainment age and multi-dimensional functional outcomes. The results indicated that the prevalence of neurodevelopmental delay during infancy was higher in preterm infants than in full-term infants. In addition to the severe brain insults, chronic lung disease and severe retinopathy of prematurity might also contribute to the adverse neurodevelopmental outcomes. These main findings have been published in top journals of child development and further brought about the highlighting on respiratory care for preterm infants in neonatal intensive care unit in Taiwan. In recent works, we perform a follow-up of respiratory health and neurodevelopment for preterm infants with bronchopulmonary dysplasia at preschool age to investigate the long-term prognosis of chronic lung disease.
2. Early detection of neurodevelopment delay in preterm infants
We have introduced several newly developed tests which were specifically used to assess the neuromotor outcomes of preterm infants aged from birth to 18 months in Western countries, i.e. the Neonatal Neurobehavioral Examination (NNE), the Alberta Infant Motor Scale (AIMS). The psychometric properties have been examined comprehensively, including the translation to Chinese version, reliability, validity and responsiveness to ensure the practicability and applicability of these instruments on Taiwanese preterm infants. A series of studies have driven the emphasis on cross-cultural and psychometric issues in domestic physical therapy and occupational therapy fields. Furthermore, in order to examine the neuromotor markers of delayed walking attainment, we have incorporated the 3-D kinematic motion analysis to objectively quantify the precursory lower extremity movement of walking (kicking at 2-4 months and stepping at 7-11 months). The results indicated that there was difference in structure and coordinated control of movement pattern between full-term and preterm infants. The distinction was related to delayed walking attainment, therefore can be used to early detect the preterm infants with risk of neurodevelopmental impairment. These main findings have been published in top journals of rehabilitation and we will keep going to investigate the effect of lower extremity exercise training on developmental outcomes in infants with high risk of neurodevelopmental delay in the future works.
3. Early intervention on neurodevelopment in preterm infants
Our research team cooperated with clinical specialists in pediatric department, physical therapy center, and rehabilitation department in National Taiwan University Hospital to develop the first clinical service of early intervention in neonatal intensive care unit in 1993. We further developed the first and the unique clinical training program of early intervention for high risk infants in 1998, providing in-service educational program for pediatric physical therapists. Up to date, many staffs from Taipei Veterans General Hospital, Chia-Yi Christian Hospital, Tao-Yuan General Hospital, Chung-Shan Rehabilitation Hospital, Taipei City Hospital Branch for Women and Children, Shin Kong Wu Ho-Su Memorial Hospital, Puli Christian Hospital, Cardinal Tien Hospital, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan Adventist Hospital, Mackay Memorial Hospital, Lotung Poh-Ai Hospital, and Buddhist Tzu Chi General Hospital have received the training program. In 2006, we designed two intervention programs: clinic-based intervention program (CBIP) and home-based intervention program (HBIP) for preterm infants with very low birth weight (birth body weight<1500 grams) during their first year of life. The purposes of this project were to investigate the cost effectiveness of CBIP and HBIP, compared with usual care program, and further to provide evidences for clinical administration of early intervention. The follow-up assessments at 2 and 3 years have been finished, and assessment at 4 years and school age are going to be conducted to examine the long-term effects. Furthermore, we revised our intervention program according to the findings of intervention effects to develop the new one: family center intervention program (FCIP). The purposes of FCIP project were to find the best mode of early intervention services for Taiwanese preterm infants and to find the critical factors in gene and environment that would show impact on intervention effects.
4. Parent-child interaction in dyads with preterm infants
Since 2005 we began an international collaborative project with Professor Hui-chin, Hsu of the Department of Human Development and Family Science, University of Georgia, USA. Professor Hsu is an expert in socio-emotional development and parent-child interaction in infancy and early childhood. Research shows that in addition to quality medical care, positive parenting contributes significantly to preterm infants’ development. Given that consultation resources on parenting skills for professionals are lacking, we aimed to generate information about parenting strategies that can promote preterm infants’ development. By observing nonverbal communicative behaviors (i.e. smile, gaze and touch) between parents and infants and documenting their links to cognitive, attentional, and socio-emotional outcomes, results of this collaborative research are expected to provide recommendations to Taiwanese parents with preterm infants.
5. Biomarkers of bronchopulmonary dysplasia in preterm infants
Our research team has investigated the potential biomarkers of bronchopulmonary dysplasia, a common disease of preterm infants, from 2009 with the grand from National Taiwan University Hospitals. This case-control study was conducted to examine the abnormal expression of microRNA in the peripheral blood. The candidate microRNAs are those function in regulating multiple gene expression and have relation with tissue development. We cooperated with the team in Genetic Epidemiology core laboratory in National Taiwan University Center of Genomic Medicine, incorporating the measurement technique for microRNA expression and statistical model for data exploration to examine the potential role of microRNA on pathogenic mechanism.
6. Family-Centered Intervention Program (FCIP)
Our research team conducted a five-year project, which was supported by National Health Research Institute, to examine the effectiveness of a family-centered intervention program (FCIP) for preterm infants with very low birth weight and their families in Taiwan using a multi-site randomized clinical trial and to evaluate the neurodevelopment, social-emotion, and genetic and environmental factors that may mediate or moderate the intervention effects on child developmental outcomes.