Home visiting and outcomes of preterm infants: a systematic review.

Pediatrics. 2013 Sep;132(3):502-16. doi: 10.1542/peds.2013-0077. Epub 2013 Aug12.
Goyal NK, Teeters A, Ammerman RT.

BACKGROUND AND OBJECTIVES: Home visiting is 1 strategy to improve child health
and parenting. Since implementation of home visiting trials 2 decades ago, US
preterm births (<37 weeks) have risen by 20%. The objective of this study was to 
review evidence regarding home visiting and outcomes of preterm infants
METHODS: Searches of Medline, Cumulative Index to Nursing and Allied Health
Literature, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial
Register, PsycINFO, and Embase were conducted. Criteria for inclusion were (1)
cohort or controlled trial designs; (2) home-based, preventive services for
infants at medical or social risk; and (3) outcomes reported for infants born
preterm or low birth weight (<2500 g). Data from eligible reports were abstracted
by 2 reviewers. Random effects meta-analysis was used to synthesize data for
developmental and parent interaction measures.
RESULTS: Seventeen studies (15 controlled trials, 2 cohort studies) were
reviewed. Five outcome domains were identified: infant development, parent-infant
interaction, morbidity, abuse/neglect, and growth/nutrition. Six studies (n =
336) demonstrated a pooled standardized mean difference of 0.79 (95% confidence
interval 0.57 to 1.02) in Home Observation for Measurement of the Environment
Inventory scores at 1 year in the home-visited groups versus control. Evidence
for other outcomes was limited. Methodological limitations were common.
CONCLUSIONS: Reviewed studies suggest that home visiting for preterm infants
promotes improved parent-infant interaction. Further study of interventions
targeting preterm infants within existing programs may strengthen the impact and 
cost benefits of home visiting in at-risk populations.