Preterm birth is a global health problem associated with an increased risk of neurodevelopmental and physical growth impairment. Early interventions aim to improve cognitive, motor, length, or weight level in preterm infants, but there is wide variation in the frequency, duration, and follow-up of interventions, and the available evidence is fragmented and unsystematic.

This study aims to compare and rank the efficacy of different early interventions for cognitive, motor, length, or weight outcomes in preterm infants using systematic review and network meta-analysis.

PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were systematically searched using a combination of subject terms and free words from inception to July 20, 2024. The Cochrane risk-of-bias tool for Randomized controlled trials was used to assess the quality of included studies by two trained researchers. Network meta-analysis was performed using Stata 18.0. The effects of different early interventions were estimated according to the surface under the cumulative ranking curve (SUCRA). We use the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) system to perform the certainty of the evidence and strength of recommendations.

A total of 33 studies with 8 early intervention methods were included. Network meta-analysis showed that Newborn Individualized Developmental Care and Assessment Program and Mother Infant Transaction Program had more significant advantages to improve cognitive levels in preterm infants over standard nursing measures (MD = 0.81, 95% CrI: 0.22 to 1.41; MD = 0.67, 95% CrI: 0.05 to 1.30). Multisensory stimulation was higher than standard care in improving motor scores (MD = 0.95, 95% CrI: 0.16 to 1.75) and length growth (MD = 0.80, 95% CrI: 0.33 to 1.27; MD = 0.72, 95% CrI: 0.29 to 1.14), the difference was statistically significant. Moreover, Multisensory stimulation was helpful for promoting length growth in preterm infants than Newborn Individualized Developmental Care and Assessment Program (MD = 0.75, 95% CrI: 0.29 to 1.22). Based on the ranking probabilities, Multisensory stimulation was the most effective way in improving cognitive (SUCRA 74.8%), motor (SUCRA 79.3%), length (SUCRA 100.0%) and weight (SUCRA 74.7%). The certainty of evidence ranged from “high” to “very low” which was assessed by GRADE.

The results show that early interventions vary in their effects on the neurodevelopment and growth development of preterm infants. Multisensory stimulation has potential benefits in mitigating neurological and growth development vulnerability in preterm infants, notably cognitive, motor and growth levels, showing promise as an effective intervention. PROSPERO: CRD42024594964.