Table 2 Study characteristics of published systematic and umbrella reviews exploring prevention, early detection, early intervention and rehabilitation amongst children 5 years of age and younger by target disability
First author (year) [ref] | Target disability | Evidence-based intervention | Intervention details | Country—n | Outcomes and impact | Studies in meta-analyses (n), Participants (n) | Overall confidence |
|---|---|---|---|---|---|---|---|
Motor impairment | |||||||
 Inamdar (2021) [24] | Developmental delay and at risk | Early intervention | Physiotherapy plus adjuncts | Egypt—2, South Korea—1, Turkey—1, USA—1 | Improvement in sitting with physical therapy plus adjuncts, over physical therapy alone ES = 1.91, (95% CI 0.28–3.54) | 5 studies, 146 participants | High |
 Li (2021) [25] | High risk of brain injury | Early intervention | Early rehabilitation (visual and auditory stimulation, hand- eye coordination training, massage, passive exercise, vestibular exercise training and active guidance activities) | China—13 | Early rehabilitation improved development compared to no treatment: OR 4.98 (95% CI 3.66–6.79), improved patient adaptability SMD = 0.63 (95% CI 0.50–0.80) and personal-social scores SMD = 0.79 (95% CI 0.65 to 0.93) | 13 studies, 1930 participants | High |
 Novak (2020) [26] | CP | Prevention and Early Intervention | Interventions for preventing and managing CP in 2019 | Finland—1, France—1, Japan—1, New Zealand—1, Netherlands—1, Multiple—2, USA—7, | Antenatal corticosteroids amongst women delivering preterm reduced the rate of CP compared to placebo: RR 0.60 (95%CI 0.34–1.03) Magnesium sulphate amongst preterm neonates reduced the rate of CP compared to placebo: RR 0.68 (95%CI 0.54–0.87) Environmental enrichment improved motor skills compared to standard care: SMD 0.39 (95%CI 0.05–0.72) | 14 studies, 7199 participants | High |
 Shepherd (2018) [27] | CP | Prevention | Therapeutic hypothermia, Prophylactic methylaxanthines (caffeine) | Australia—1, China—1, Germany—1, Multiple—2, New Zealand—1, UK—1, USA—1 | Therapeutic hypothermia effective in preventing CP when compared to standard care amongst term neonates with hypoxic-ischaemic neonatal encephalopathy: RR 0.66 (95%CI 0.54–0.82) Prophylactic caffeine effective in preventing CP when compared to standard care: RR 0.54 (95%CI 0.32–0.92) | 8 studies, 1525 participants | High |
 Spittle (2015) [28] | CP | Early intervention | Early developmental intervention post hospital discharge | Australia—2, Canada—1, China—1, Finland—2, Italy—1, Japan—1, Netherlands—1, Norway—3, South Africa—1, Taiwan—1, UK—2, USA—8 | Early developmental intervention programmes post hospital discharge improved cognitive outcomes in infancy, developmental quotient: SMD 0.32 (95% CI 0.16–0.47) and at preschool age, intelligence quotient; SMD 0.43 (95% CI 0.32–0.54) compared to standard medical follow-up of preterm infants at infancy | 24 studies, 3808 participants | High |
 Valentin-Gudiol (2013) [22] | Neuromotor delay | Early intervention | Treadmill intervention | Taiwan—1 USA—1 | Earlier onset of independent walking (ES) − 1.47 (95%CI − 2.97–0.03) | 2 studies, 58 participants | Moderate |
Cognitive Impairment | |||||||
 Fischer (2021) [29] | Preterm infant | Prevention | Neuroprotection using erythropoietin (rhEPO) | China—1, Germany—1, Switzerland—1 USA—3 | Prophylactic rhEPO for preterm neonates reduced the risk of neurocognitive impairment (defined as MDI < 70 (BSID II) or composite cognitive score < 85 (BSID-III) at 18–26 months’ corrected age from 20 to 14% (OR 0.61, 95%CI 0.39–0.96) | 6 studies, 1796 participants | Moderate |
Sensorineural impairment | |||||||
 Athe (2022) [30] | Congenital hearing impairment | Early detection | Screening and diagnostic accuracy | Bangladesh—3, India—10, Pakistan—1 | Odds of being identified with hearing loss OR:0.52 (95%CI 0.34–0.79) | 14 studies, 31,344 participants | Low |
 Edmond (2022) [23] | Hearing loss | Early detection | Universal newborn hearing screening (UNHS) and diagnostic accuracy | Australia—1, Netherlands—1, UK—1, USA—2, | Improved identification of permanent bilateral hearing loss (PBHL) before 9 months in infants with UNHS programmes compared to infants without UNHS (RR 3.28 (95% CI 1.84–5.85)) Earlier identification of children in the age of identification of PBHL in infants with UNHS compared to infants without UNHS, with mean difference 13.2 months earlier (95% CI − 26.3 to − 0.01) | 5 studies, 1,023,610 participants | High |
Behavioural | |||||||
 Fuller (2020b) [31] | ASD | Early intervention | Early start Denver model (ESDM) to improve developmental outcomes | Australia—1, Austria—1, China—2, Italy—1, USA—7 | Children who received ESDM showed improved outcomes compared to controls: Effect size = 0.36 (p = 0.02) (no CI given), driven by improvements in cognition and language | 12 studies, 640 participants | Moderate |
 Hampton (2016) [32] | ASD | Early intervention | Spoken word early intervention | Australia—2, Canada—1, UK—5, USA—18 | Early intervention improved spoken language outcomes ES = 0.26 (95%CI 0.11–0.42). Better effect on language outcomes for parent plus clinician delivered interventions (ES = 0.42) compared with parent-only (ES = 0.11) or clinician only (ES = 0.08) delivered interventions | 26 studies, 1738 participants | Moderate |
 Nahmias (2019) [33] | ASD | Early intervention | Community-based early intervention | Australia—7, Canada—1, Israel—2, Italy—2, Norway—1, Sweden—1, Taiwan—1, UK—6, USA—12, | Early intervention improved adaptive behaviour: 0.21 (95%CI 0.13–0.29) and communication outcomes: 0.32 (95% CI 0.24–0.40) | 33 studies, 1713 participants | Moderate |
 Nevill (2016) [34] | ASD | Early intervention | Parent-mediated intervention | Australia—3, Canada—1, Netherlands—1, Thailand—1, UK—3, USA—10, | Parent-mediated interventions improved communication-language 0.16 (95%CI 0.02–0.31) and socialisation 0.22 (95%CI 0.09–0.36) | 19 studies, 1025 participants | Low |
 Reichow (2018) [35] | ASD | Early Intervention | Early intensive behavioural intervention | UK—2, USA—3 | Improved adaptive behaviour: MD = 9.58 (95%CI 5.57–13.60), improved IQ: MD = 15.44, (95%CI 9.29–21.59), expressive language: SMD = 0.51 (95%CI 0.12–0.90), receptive language: SMD = 0.55 (95%CI 0.23–0.87) | 5 studies, 219 children | High |
 Sanchez-Garcia (2019) [36] | ASD | Early detection | 18 screening tools evaluated | Australia—1, Belgium—1, Japan—3, Norway—1 UK—1, Spain—1, Sweden—1, USA—5 | Pooled sensitivity was 0.72 (95% CI 0.61–0.81), and the specificity was 0.98 (95% CI 0.97–0.99) for diagnostic tests for early detection of ASD | 14 studies, 191,803 participants | Moderate |
 Shephard (2022) [37] | ADHD | Early Intervention | Neurocognitive and behavioural intervention | Belgium—1, Canada—2, China—1, Iran—1, Italy—2, New Zealand—3, UK—5, USA—16, Tunisia—1 | Intervention-related improvements in ADHD symptoms SMD = 0.43 (95%CI 0.22–0.64) and working memory SMD = 0.37 (95%CI 0.06–0.69) | 32 studies, 3848 participants | High |
 Tachibana (2017) [38] | ASD | Early intervention | Behavioural, social communication and multi-modal interventions | Australia—1, Canada—1, Japan—1, Norway—1, UK—2, USA—2 | Improved reciprocity of social interaction towards others’ SMD: 0.53 (95%CI 0.29–0.78) | 8 studies, 418 children | High |
 Wang (2022) [39] | ASD | Early intervention | Early start Denver model | Australia—1, China—5 USA—5 | Intervention improved autism symptoms ES: g = 0.27 (95%CI 0.02–0.53) and language ES: 0.28 (95%CI 0.002–0.56) | 11 studies, 624 participants | Moderate |