Publication

Abstract : Background Preterm infants are at increased risk of long‐term cognitive, motor, and behavioral impairments due to disrupted brain development. Although various early developmental interventions have been implemented to improve neurodevelopmental outcomes, evidence on their effectiveness remains inconsistent due to variations in intervention types, timing, duration, delivery methods, and caregiver involvement. Furthermore, recent evidence evaluating healthcare provider–led and caregiver‐led interventions has not been comprehensively synthesized. This systematic review addresses this gap by evaluating the effectiveness of early developmental interventions on neurodevelopmental outcomes in preterm infants. Objective This study was conducted to evaluate the effectiveness of early developmental interventions, including healthcare provider–led and caregiver‐mediated interventions, on the cognitive, motor, and behavioral outcomes of preterm infants compared with standard care. This systematic review was registered with PROSPERO (CRD42025646308) on February 14, 2025. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, CINAHL, and EBSCO to identify studies evaluating the effects of early developmental interventions on the neurodevelopmental outcomes of preterm infants. The search included studies published between June 2015 and May 2025. A combination of keywords and Medical Subject Headings (MeSH) terms related to preterm infants, early developmental interventions, and neurodevelopmental outcomes was used. Randomized controlled trials and cohort studies that met the predefined eligibility criteria were included. The Revised Cochrane Risk‐of‐Bias Tool for Randomized Trials (RoB 2) and the Newcastle‐Ottawa Quality Assessment Scale for cohort studies were used to assess the risk of bias. Owing to the heterogeneity of interventions, outcome measures, and follow‐up periods, a narrative synthesis of the findings was undertaken. Results Nine studies were included, comprising eight randomized controlled trials and one cohort study. Motor development was assessed in four studies; only one study (25%) reported significant improvements following a home‐based postdischarge intervention, whereas the remaining three studies found no significant between‐group differences despite within‐group gains. Cognitive outcomes were evaluated in six studies; none demonstrated significant long‐term cognitive improvements compared with standard care, although some reported trends toward age‐appropriate development or short‐term gains. Behavioral outcomes were assessed in two studies; one reported improved early personal–social and communication skills following parent‐supported physiotherapy, whereas the other found no direct intervention effect and identified maternal parenting stress as a significant predictor of adverse behavioral outcomes. Overall, interventions that actively engaged parents and incorporated psychosocial support demonstrated the most promising effects on motor and behavioral development, whereas evidence for cognitive benefits remained limited. Discussion The available evidence suggests that early developmental interventions may support selected neurodevelopmental outcomes in preterm infants, particularly motor and behavioral development when interventions actively involve parents. However, evidence for cognitive benefits remains inconsistent, and substantial heterogeneity in intervention approaches, outcome measures, and follow‐up periods limits definitive conclusions. Further high‐quality, adequately powered randomized controlled trials with standardized interventions and long‐term follow‐up are needed to establish the effectiveness of these interventions.