Feeding and Transition to Home for Preterms at Social Risk

Premature infants are at high risk of suboptimal health and development. This randomized
clinical trial evaluated the impact of a developmentally based intervention, H-HOPE
(Hospital-home transition: optimizing prematures' environment), for infants born between
29-34 weeks gestational age (GA) with at least two social-environmental risk factors. H-HOPE
is innovative because it integrates two components used successfully in prior research but
never before combined. Infant remediation using a developmentally appropriate multisensory
intervention addresses the specific behavioral organization needs of premature infants.
Maternal redefinition and re-education by a nurse-community advocate team uses participatory
guidance to address the needs of mothers of premature infants. The synergistic effect of
these simultaneous improvements for infant and mother should lead to: 1) more mature infant
behavioral organization and hospital progression; 2) improved maternal recognition of infant
behavioral cues, greater confidence in infant care, more positive perception of the infant,
and lower anxiety; 3) more positive mother-infant interaction and greater mother-infant
contingency; 4) improved infant development and growth; and 5) lower infant health care
utilization and costs. H-HOPE provides intervention from 32 weeks GA to one month corrected
age, a time of transition to oral feeding, from the hospital to home, and from hospital to
outpatient providers, when mothers of premature infants express need for support. We will
randomly assign 252 infants to the H-HOPE or the Attention Control group. Power analysis
shows that with an 80% retention rate, we will have adequate power to identify expected
intervention effects. Variables are measured during hospital stay, at intake, immediately
prior to discharge, and at six weeks corrected age. Analyses employ Hierarchical Linear
Modeling clustered within clinical sites, with infant sex, biologic and social-environmental
risk factors as covariates. If successful, H-HOPE will provide a national model for improving
early infant health and development and reducing health costs. For example, reducing hospital
stays by just three days for the almost 500,000 infants born prematurely could save over two
billion dollars annually.

Inclusion Criteria:

29-34 weeks gestation at birth

no other major health problems

mothers have at least 2 socio-environmental risk factors such as African American or Latina

Less then high school education

history of mental illness

less than 150% poverty level

2 children less than 24 months old

4 or more children living in the home

living in a disadvantaged neighborhood

Exclusion Criteria:

Infant has congenital anomaly

Necrotizing enterocolitis

Brain injury

chronic lung disease

prenatal drug exposure

mother is an illicit drug user

mother is not the legal guardian