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Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020383. [PMID: 36832512 PMCID: PMC9955546 DOI: 10.3390/children10020383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
Births involving shoulder dystocia or tight nuchal cords can deteriorate rapidly. The fetus may have had a reassuring tracing just before birth yet may be born without any heartbeat (asystole). Since the publication of our first article on cardiac asystole with two cases, five similar cases have been published. We suggest that these infants shift blood to the placenta due to the tight squeeze of the birth canal during the second stage which compresses the cord. The squeeze transfers blood to the placenta via the firm-walled arteries but prevents blood returning to the infant via the soft-walled umbilical vein. These infants may then be born severely hypovolemic resulting in asystole secondary to the loss of blood. Immediate cord clamping (ICC) prevents the newborn's access to this blood after birth. Even if the infant is resuscitated, loss of this large amount of blood volume may initiate an inflammatory response that can enhance neuropathologic processes including seizures, hypoxic-ischemic encephalopathy (HIE), and death. We present the role of the autonomic nervous system in the development of asystole and suggest an alternative algorithm to address the need to provide these infants intact cord resuscitation. Leaving the cord intact (allowing for return of the umbilical cord circulation) for several minutes after birth may allow most of the sequestered blood to return to the infant. Umbilical cord milking may return enough of the blood volume to restart the heart but there are likely reparative functions that are carried out by the placenta during the continued neonatal-placental circulation allowed by an intact cord.
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Héon M, Aita M, Lavallée A, De Clifford-Faugère G, Laporte G, Boisvert A, Feeley N. Comprehensive mapping of NICU developmental care nursing interventions and related sensitive outcome indicators: a scoping review protocol. BMJ Open 2022; 12:e046807. [PMID: 35105609 PMCID: PMC8808373 DOI: 10.1136/bmjopen-2020-046807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Neurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions have emerged as a philosophy of care aimed at protecting and enhancing preterm infant's development and promoting parental outcomes. In the past two decades, many authors have suggested DC models, core measures, practice guidelines and standards of care but outlined different groupings of interventions rather than specific interventions that can be used in NICU clinical practice. Moreover, as these DC interventions are mostly implemented by neonatal nurses, it would be strategic and valuable to identify specific outcome indicators to make visible the contribution of NICU nurses to DC. OBJECTIVES The overarching objective of this review is to identify the nature, range, and extent of the literature regarding DC nursing interventions for preterm infants in the NICU. The secondary twofold objectives are to highlight interventions that fall into identified categories of DC interventions and suggest nursing-sensitive outcome indicators related to DC interventions in the NICU. INCLUSION CRITERIA Papers reporting on or discussing a DC nursing intervention during NICU hospitalisation will be included. METHODS AND ANALYSIS The Joanna Briggs Institute's methodology for scoping reviews will be followed. CINAHL, MEDLINE, Embase, PubMed, Web of Science, Scopus, ProQuest and PsycInfo databases from 2009 to the present will be searched. Any type of paper, published in English or French, will be considered. Study selection and data extraction will be conducted by pairs of two review authors independently. A qualitative content analysis will be conducted. ETHICS AND DISSEMINATION No Institutional Review Board ethical approbation is needed. Results of this review will be presented in scientific meetings and published in refereed papers.
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Affiliation(s)
- Marjolaine Héon
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Quebec Network on Nursing Intervention Research/Réseau de Recherche en Interventions en Sciences Infirmières du Québec (RRISIQ), Montreal, Quebec, Canada
| | - Marilyn Aita
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Quebec Network on Nursing Intervention Research/Réseau de Recherche en Interventions en Sciences Infirmières du Québec (RRISIQ), Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Gwenaëlle De Clifford-Faugère
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Geneviève Laporte
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Boisvert
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- NICU, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Nancy Feeley
- Quebec Network on Nursing Intervention Research/Réseau de Recherche en Interventions en Sciences Infirmières du Québec (RRISIQ), Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
- Centre for Nursing Research and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Peterson JK, Casida J. Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease. AACN Adv Crit Care 2021; 32:204-208. [PMID: 34161962 DOI: 10.4037/aacnacc2021425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jennifer K Peterson
- Jennifer K. Peterson is Assistant Professor, Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD 21205
| | - Jesus Casida
- Jesus Casida is Associate Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Neu M, Klawetter S, Greenfield JC, Roybal K, Scott JL, Hwang SS. Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care. Adv Neonatal Care 2020; 20:68-79. [PMID: 31567314 PMCID: PMC10029125 DOI: 10.1097/anc.0000000000000671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. PURPOSE The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago. METHODS In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis. RESULTS Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving. IMPLICATIONS FOR PRACTICE Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance. IMPLICATIONS FOR RESEARCH Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.
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Affiliation(s)
- Madalynn Neu
- College of Nursing, University of Colorado, and Children's Hospital Colorado, Aurora (Dr Neu); Portland State University, Oregon (Dr Klawetter); University of Denver, Colorado (Dr Greenfield and Ms Roybal); Department of Pediatrics/Neonatology, University of Colorado, Aurora (Ms Scott and Dr Hwang); and Children's Hospital Colorado, Aurora (Dr Hwang)
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Cheong JLY, Burnett AC, Treyvaud K, Spittle AJ. Early environment and long-term outcomes of preterm infants. J Neural Transm (Vienna) 2019; 127:1-8. [PMID: 31863172 DOI: 10.1007/s00702-019-02121-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
Prematurity is associated with an increased risk of long-term health and neurodevelopmental problems. Key perinatal and neonatal factors that affect these outcomes have long been studied. However, more recently, there has been an appreciation of the importance of environmental factors in long-term outcomes of preterm babies, particularly in light of the rapid maturation of the brain during these babies' early days of life. Breastmilk and breastfeeding is the gold standard for infant feeding, including preterm babies. The benefits are well established in regard to protection from serious complications like necrotising enterocolitis. Although theoretically plausible, the benefits for neurodevelopment are less clear. Noise, pain and the environment of the neonatal intensive care can also affect infant neurodevelopment. It is established that noise and pain have deleterious effects. However, the benefits of single-room vs open-bay neonatal units remain under debate. Developmental care practices, of which there are many, are increasingly embraced worldwide. There are benefits both for the parents and the baby, however, the evidence is difficult to pool due to the heterogeneity of studies and study populations. Finally, it is important to remember the importance of the role of parents in shaping long-term neurodevelopment of the high-risk preterm newborn. Increasingly, positive parenting and parents' mental health are shown to have long lasting advantages for preterm infants. A deeper understanding of early environmental factors is key to developing future interventions to optimise outcomes of preterm newborns.
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Affiliation(s)
- Jeanie L Y Cheong
- Level 7, Newborn Research, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Alice C Burnett
- Level 4, Victorian Infant Brain Studies, Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Karli Treyvaud
- Department of Psychology and Counselling, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Alicia J Spittle
- Level 7, Department of Physiotherapy, University of Melbourne, 161 Barry Street, Parkville, VIC, 3052, Australia
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Vohr BR. The importance of parent presence and involvement in the single-family room and open-bay NICU. Acta Paediatr 2019; 108:986-988. [PMID: 30957269 DOI: 10.1111/apa.14783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Betty R. Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island The Alpert Medical School of Brown University Providence RI USA
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7
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Song D, Jegatheesan P, Nafday S, Ahmad KA, Nedrelow J, Wearden M, Nemerofsky S, Pooley S, Thompson D, Vail D, Cornejo T, Cohen Z, Govindaswami B. Patterned frequency-modulated oral stimulation in preterm infants: A multicenter randomized controlled trial. PLoS One 2019; 14:e0212675. [PMID: 30817764 PMCID: PMC6394921 DOI: 10.1371/journal.pone.0212675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/30/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the effect of patterned, frequency-modulated oro-somatosensory stimulation on time to full oral feeds in preterm infants born 26–30 weeks gestation. Study design This is a multicenter randomized controlled trial. The experimental group (n = 109) received patterned, frequency-modulated oral stimulation via the NTrainer system through a pulsatile pacifier and the control group (n = 101) received a non-pulsatile pacifier. Intent-to-treat analysis (n = 210) was performed to compare the experimental and control groups and the outcomes were analyzed using generalized estimating equations. Time-to-event analyses for time to reach full oral feeds and length of hospital stay were conducted using Cox proportional hazards models. Results The experimental group had reduction in time to full oral feeds compared to the control group (-4.1 days, HR 1.37 (1.03, 1.82) p = 0.03). In the 29–30 weeks subgroup, infants in the experimental group had a significant reduction in time to discharge (-10 days, HR 1.87 (1.23, 2.84) p < 0.01). This difference was not observed in the 26–28 weeks subgroup. There was no difference in growth, mortality or morbidities between the two groups. Conclusions Patterned, frequency-modulated oro-somatosensory stimulation improves feeding development in premature infants and reduces their length of hospitalization. Trial registration ClinicalTrials.gov NCT01158391
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Affiliation(s)
- Dongli Song
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
- * E-mail:
| | - Priya Jegatheesan
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Suhas Nafday
- Pediatrics—Neonatology, Children's Hospital at Montefiore-Weiler Division, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kaashif A. Ahmad
- Pediatrix Medical Group, North Central Baptist Hospital, San Antonio, TX, United States of America
- Pediatrics–Neonatology, Baylor College of Medicine, San Antonio, TX, United States of America
| | - Jonathan Nedrelow
- Pediatrics–Neonatology, Cook Children's Medical Center, Fort Worth, TX, United States of America
| | - Mary Wearden
- Pediatrix Medical Group, North Central Baptist Hospital, San Antonio, TX, United States of America
| | - Sheri Nemerofsky
- Pediatrics–Neonatology, Children's Hospital at Montefiore-Wakefield Division, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Sunshine Pooley
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Diane Thompson
- aVenture Consulting, LLC, Leawood, KS, United States of America
| | - Daniel Vail
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Tania Cornejo
- Neonatology, Montefiore Medical Center-Weiler, Bronx, New York, United States of America
| | - Zahava Cohen
- Neonatology, Montefiore Medical Center-Wakefield, Bronx, New York, United States of America
| | - Balaji Govindaswami
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
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Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle. J Perinat Neonatal Nurs 2019; 33:331-339. [PMID: 31651627 DOI: 10.1097/jpn.0000000000000435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.
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Peterson JK. Supporting Optimal Neurodevelopmental Outcomes in Infants and Children With Congenital Heart Disease. Crit Care Nurse 2018; 38:68-74. [PMID: 29858197 PMCID: PMC6563801 DOI: 10.4037/ccn2018514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Improved survival has led to increased recognition of developmental delays in infants and children with congenital heart disease. Risk factors for developmental delays in congenital heart disease survivors may not be modifiable; therefore, it is important that lifesaving, high-technology critical care interventions be combined with nursing interventions that are also developmentally supportive. Implementing developmental care in a pediatric cardiac intensive care unit requires change implementation strategies and widespread support from all levels of health care professionals. This manuscript reviews developmentally supportive interventions such as massage, developmentally supportive positioning, kangaroo care, cue-based feeding, effective pain/anxiety management, and procedural preparation and identifies strategies to implement developmentally supportive interventions in the care of infants and children with congenital heart disease. Improving developmental support for these infants and children at high risk for developmental delay may improve their outcomes and help promote family-centered care.
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Affiliation(s)
- Jennifer K Peterson
- Jennifer K. Peterson is a PhD candidate at University of California, Irvine, Sue & Bill Gross School of Nursing, as well as the Children's Heart Institute Clinical Program Director at Miller Children's and Women's Hospital in Long Beach, California.
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Luu TM, Xie LF, Peckre P, Cote S, Karsenti T, Walker CD, Gosselin J. Web-Based Intervention to Teach Developmentally Supportive Care to Parents of Preterm Infants: Feasibility and Acceptability Study. JMIR Res Protoc 2017; 6:e236. [PMID: 29191797 PMCID: PMC5730819 DOI: 10.2196/resprot.8289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. Objective This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. Methods A total of 107 infants born at <30 weeks and admitted to Sainte-Justine Hospital neonatal intensive care unit and their parents were enrolled in a nonrandomized controlled before-and-after interventional study (intervention n=55, comparison n=52). Acceptability of the program was assessed with a user satisfaction questionnaire. When the infants were at 4 months’ corrected age, all parents completed questionnaires on infant temperament, parenting stress, sense of competence, and parenting satisfaction. At 12 months’ corrected age, neurodevelopmental testing was performed on infants using the Alberta Infant Motor Scale and the Bayley Scales of Infant and Toddler Development, Third Edition. Comparisons between the 2 groups were done using independent t tests, Wilcoxon rank-sum tests, and Fisher exact tests. Results The majority of parents (43/45) were satisfied with the intervention program and all would recommend MAQ to others. MAQ met their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviors in the intervention group, although proportions scoring in the coercive range did not differ. Conclusions Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and investigate how Web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.
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Affiliation(s)
- Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Perrine Peckre
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Sylvana Cote
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Thierry Karsenti
- Faculty of Teaching and Education Sciences, University of Montreal, Montreal, QC, Canada
| | - Claire-Dominique Walker
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Julie Gosselin
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
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Abstract
Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child's behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child's survival but also optimising development through individualised developmental care in the cardiac ICU.
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Peterson JK, Evangelista LS. Developmentally Supportive Care in Congenital Heart Disease: A Concept Analysis. J Pediatr Nurs 2017; 36:241-247. [PMID: 28579078 PMCID: PMC6567997 DOI: 10.1016/j.pedn.2017.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
THEORETICAL PRINCIPLES Improved survival of infants and children with congenital heart disease experience has led to recognition that up to half of congenital heart disease survivors also experience developmental delay. Developmentally supportive care is a care model shown in Neonatal Intensive Care Units to be associated with improved outcomes, but developmentally supportive practices with premature infants may not be equally effective in the cardiac population that includes all ages. PHENOMENA ADDRESSED The purpose of this paper is to present a concept analysis using the Walker and Avant method in order to identify and define characteristics of developmentally supportive care as it may be applied to the population of neonates, infants, and children with congenital heart disease. A theoretical definition of developmentally supportive care is presented. RESEARCH LINKAGES This concept analysis will provide nurses and allied health professionals with a theoretical basis to implement high quality, family-centered care that meets individual developmental needs in a population at high risk for developmental sequelae. Nursing implications for developmentally supportive care as it applies to infants and children with heart disease are discussed.
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Affiliation(s)
- Jennifer K Peterson
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States.
| | - Lorraine S Evangelista
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States.
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De Bernardo G, Svelto M, Giordano M, Sordino D, Riccitelli M. Supporting parents in taking care of their infants admitted to a neonatal intensive care unit: a prospective cohort pilot study. Ital J Pediatr 2017; 43:36. [PMID: 28412958 PMCID: PMC5392981 DOI: 10.1186/s13052-017-0352-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-Centred Care (FCC) is recognized as an important component of all paediatric care, including neonatal care, although practical clinical guidelines to support this care model are still needed in Italy. The characteristics and services for families in Italian NICUs show a lack of organization and participation. METHODS The first aim was to compare satisfaction and stress levels in two groups of parents: an FCC group and a non-FCC group (NFCC). The second aim was to evaluate body weight gain in the newborns enrolled. This non-randomized, prospective cohort pilot study was conducted in a single level III NICU at a hospital in Naples, Italy. A cohort of newborns in the NICU, with their parents were enrolled between March 2014 and April 2015 and they were divided into two groups: the FCC group (enrolled between October 2014 and April 2015) remained in the NICU for 8 h a day with FCC model; the NFCC group (enrolled between March 2014 and September 2014) was granted access to the NICU for only 1 hour per day. At discharge, both parent groups completed the Parental Stressor Scale (PSS)-NICU and a questionnaire to assess their satisfaction. In addition, we compared scores from the mothers and fathers within and between groups and the body weights of the newborns in the two groups at 60 days. RESULTS Parents participating in the FCC group were more satisfied and less stressed than those in the NFCC group. Infants in the FCC group also showed increased body weight after 60 days of hospital stay. CONCLUSIONS Despite our small population, we confirm that routine adoption of a procedure designed to apply a FCC model can contribute to improving satisfaction and distress among preterm infants' parents. Future multi-centre, randomized, controlled trials are needed to confirm these findings.
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Affiliation(s)
- Giuseppe De Bernardo
- Department and Institution: Department of Emergency, NICU-A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Maria Svelto
- Department and Institution: Department of Emergency, NICU-A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Maurizio Giordano
- Department and Institution: Department of Emergency, NICU-A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Desiree Sordino
- Department and Institution: Department of Emergency, NICU-A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Marina Riccitelli
- Department and Institution: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Montirosso R, Tronick E, Borgatti R. Promoting Neuroprotective Care in Neonatal Intensive Care Units and Preterm Infant Development: Insights From the Neonatal Adequate Care for Quality of Life Study. CHILD DEVELOPMENT PERSPECTIVES 2016. [DOI: 10.1111/cdep.12208] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Kommers D, Oei G, Chen W, Feijs L, Bambang Oetomo S. Suboptimal bonding impairs hormonal, epigenetic and neuronal development in preterm infants, but these impairments can be reversed. Acta Paediatr 2016; 105:738-51. [PMID: 26519107 DOI: 10.1111/apa.13254] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/24/2015] [Accepted: 10/26/2015] [Indexed: 01/21/2023]
Abstract
UNLABELLED This review aimed to raise awareness of the consequences of suboptimal bonding caused by prematurity. In addition to hypoxia-ischaemia, infection and malnutrition, suboptimal bonding is one of the many unnatural stimuli that preterm infants are exposed to, compromising their physiological development. However, the physiological consequences of suboptimal bonding are less frequently addressed in the literature than those of other threatening unnatural stimuli. CONCLUSION This review found that suboptimal bonding significantly impaired hormonal, epigenetic and neuronal development, but these impairments could be reversed by bonding interventions. This suggests that neonatal intensive care units should focus more on interventions that optimise bonding.
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Affiliation(s)
- D Kommers
- Department of Neonatology; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - G Oei
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Gynaecology; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
| | - W Chen
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - L Feijs
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - S Bambang Oetomo
- Department of Neonatology; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
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Gabis LV, Hacham-Pilosof K, Yosef OB, Rabinovitz G, Leshem G, Shilon-Hadass A, Biran Y, Reichman B, Kuint J, Bart O. The influence of a multisensory intervention for preterm infants provided by parents, on developmental abilities and on parental stress levels. J Child Neurol 2015; 30:896-903. [PMID: 25246304 DOI: 10.1177/0883073814549242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 08/02/2014] [Indexed: 11/17/2022]
Abstract
Evaluation of a multisensory intervention based on the developmental approach provided by parents, during neonatal intensive care unit hospitalization of their preterm infants. After guidance of parents and implementation of intervention program, children were followed up to 2 to 3 years using scales for evaluation of parental stress levels and child's development. Our 2 to 3 years' follow-up study included 41 infants (20 controls and 21 who received parental-guided intervention) as part of a group of 95 preterm infants who participated in a short-term study. The intervention group showed significantly higher scores in receptive language and fine-motor domains of the Bayley Scale of Infant and Toddler Development-3rd Edition. Boys showed superior improvements in language skills. No differences were found in the cognitive and adaptive domains. There were no differences in parental stress levels. A multisensory intervention program for preterm infants provided by trained and supervised parents may improve language and motor outcomes at 2 to 3 years.
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Affiliation(s)
- Lidia V Gabis
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | - Keren Hacham-Pilosof
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | - Omer Bar Yosef
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | | | - Gili Leshem
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel
| | - Aya Shilon-Hadass
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | - Yael Biran
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | - Brian Reichman
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | - Jacob Kuint
- Weinberg Child Development Center at Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel Tel Aviv University, Tel Aviv, Israel
| | - Orit Bart
- Tel Aviv University, Tel Aviv, Israel
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Bonan KCSDC, Pimentel Filho JDC, Tristão RM, Jesus JALD, Campos Junior D. Sleep deprivation, pain and prematurity: a review study. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:147-54. [DOI: 10.1590/0004-282x20140214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022]
Abstract
The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants.
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18
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Davanzo R, Strajn T, Kennedy J, Crocetta A, De Cunto A. From tube to breast: the bridging role of semi-demand breastfeeding. J Hum Lact 2014; 30:405-9. [PMID: 25172892 DOI: 10.1177/0890334414548697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Determination of the optimal timing of breastfeeding initiation for preterm infants is still a challenge for health professionals. Often unjustified delays and restrictions of breastfeeding occur due to non-evidence-based current opinions about preterm infants' feeding capacity. Semi-demand feeding has been proposed for preterm infants during the transition from scheduled to full demand feeding, to promote the establishment of self-regulated oral feeding. Although semi-demand feeding has been shown to be safe and effective in reducing time to reaching oral feeding, the implementation of this feeding pattern for preterm infants in the neonatal intensive care unit (NICU) is still limited. We developed a protocol for the application of semi-demand feeding in preterm infants based on the existing knowledge of preterm infant neurodevelopment and NICU organization and staff experience. The protocol's aim is to attain successful transition from tube feeding to breastfeeding. In this article, we describe the protocol used in the neonatal unit of the Maternal and Child Health Institute of Trieste, a third level care center in northeastern Italy.
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Affiliation(s)
- Riccardo Davanzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Strajn
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Jacqueline Kennedy
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Anna Crocetta
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Angela De Cunto
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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19
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Rand K, Lahav A. Impact of the NICU environment on language deprivation in preterm infants. Acta Paediatr 2014; 103:243-8. [PMID: 24164604 DOI: 10.1111/apa.12481] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 12/28/2022]
Abstract
UNLABELLED It is unclear whether the atypical language development commonly seen in preterm infants is a consequence of language deficiency experienced during their prolonged NICU stay. This review provides a novel viewpoint, which highlights the potential impact of the NICU design on the developmental origin of language disabilities in preterm infants. CONCLUSION Further research is needed to identify evidence-based design solutions for providing preterm infants with a healthier linguistic hospital environment that aids growth and development.
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Affiliation(s)
- Katherine Rand
- Department of Newborn Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Amir Lahav
- Department of Newborn Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Pediatrics; MassGeneral Hospital for Children; Boston MA USA
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20
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Kynø NM, Ravn IH, Lindemann R, Smeby NA, Torgersen AM, Gundersen T. Parents of preterm-born children; sources of stress and worry and experiences with an early intervention programme - a qualitative study. BMC Nurs 2013; 12:28. [PMID: 24313957 PMCID: PMC3879424 DOI: 10.1186/1472-6955-12-28] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 12/04/2013] [Indexed: 11/24/2022] Open
Abstract
Background Preterm-born children are at increased risk of adverse developmental outcomes, and their parents may experience increased stress levels. The Mother–Infant Transaction Program (MITP) is an early intervention that aims to enhance the parent–infant relationship and child development. The present study investigated differences in parents’ experience of stress and concerns about caring for their preterm-born child according to whether they participated in the programme. Parental satisfaction with the intervention was also explored. Methods As part of a follow-up study at 36 months, a randomized controlled trial of the MITP—14 parents of 11 children from the intervention group, and 17 parents of 14 children from the control group were interviewed by the use of semi-structured focus group interviews. The interviews were analysed thematically. Results The intervention parents reported that the knowledge, advice, guidance and emotional support given during the intervention made them feel less stressed and more confident, competent and secure caring for their preterm born child than they would otherwise have been. The control parents described feeling less involved and emotionally supported, and seemed more anxious about their child’s development than the intervention parents. All parents were vigilant and alert to their child’s needs and monitored developmental milestones carefully. Conclusion This qualitative exploration of the influences of the MITP revealed a positive impact of the intervention and seems to be an important educational and supportive initiative. Thus, reducing parental stress and enhancing confidence in the parental role.
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Affiliation(s)
- Nina M Kynø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P O Box 4956, Nydalen, NO-0424 Oslo, Norway.
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21
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Kardaş Özdemir F, Güdücü Tüfekci F. The effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants: the effect of mother's scent and flexion position. J Clin Nurs 2013; 23:3036-44. [DOI: 10.1111/jocn.12407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Fatma Güdücü Tüfekci
- Pediatric Nursing Department; Health Science Faculty; Atatürk University; Erzurum Turkey
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22
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Filippa M, Devouche E, Arioni C, Imberty M, Gratier M. Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatr 2013; 102:1017-20. [PMID: 23848529 DOI: 10.1111/apa.12356] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/24/2013] [Accepted: 07/10/2013] [Indexed: 11/29/2022]
Abstract
AIM To study the effects of live maternal speaking and singing on physiological parameters of preterm infants in the NICU and to test the hypothesis that vocal stimulation can have differential effects on preterm infants at a behavioural level. METHODS Eighteen mothers spoke and sang to their medically stable preterm infants in their incubators over 6 days, between 1 and 2 pm. Heart rate (HR), oxygen saturation (OxSat), number of critical events (hypoxemia, bradycardia and apnoea) and change in behavioural state were measured. RESULTS Comparisons of periods with and without maternal vocal stimulation revealed significantly greater oxygen saturation level and heart rate and significantly fewer negative critical events (p < 0.0001) when the mother was speaking and singing. Unexpected findings were the comparable effects of maternal talk and singing on infant physiological parameters and the differential ones on infant behavioural state. CONCLUSION A renewed connection to the mother's voice can be an important and significant experience for preterm infants. Exposure to maternal speech and singing shows significant early beneficial effects on physiological state, such as oxygen saturation levels, number of critical events and prevalence of calm alert state. These findings have implications for NICU interventions, encouraging maternal interaction with their medically stable preterm infants.
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Affiliation(s)
- Manuela Filippa
- Université Paris Ouest Nanterre La Défense; Nanterre Cedex; France
| | | | | | - Michel Imberty
- Université Paris Ouest Nanterre La Défense; Nanterre Cedex; France
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23
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Understanding neurodevelopmental outcomes of prematurity: education priorities for NICU parents. Adv Neonatal Care 2013; 13 Suppl 5:S21-6. [PMID: 24042181 DOI: 10.1097/anc.0000000000000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
NICU nurses have an important role to play in many aspects of parent education. This article stresses the need for an increased focus on teaching parents about the central role that self-regulation will play in their infant's neurobehavioral development not only during the early infancy period but throughout all of childhood and adolescence. Suggestions are made about how to conceptualize the relation between cognition and emotions in humans and how to help parents understand that continued vigilance concerning potential problems in attention and self-regulation will be necessary.
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24
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Ancora G, Lago P, Garetti E, Pirelli A, Merazzi D, Mastrocola M, Pierantoni L, Faldella G. Efficacy and safety of continuous infusion of fentanyl for pain control in preterm newborns on mechanical ventilation. J Pediatr 2013; 163:645-51.e1. [PMID: 23582138 DOI: 10.1016/j.jpeds.2013.02.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 01/24/2013] [Accepted: 02/18/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the analgesic superiority and the safety equivalence of continuous fentanyl infusions versus fentanyl boluses in preterm infants on mechanical ventilation. STUDY DESIGN In this multicenter, double-blind, randomized controlled trial, mechanically ventilated newborns (≤ 32(+6) weeks gestational age) were randomized to fentanyl (continuous infusion of fentanyl plus open-label boluses of fentanyl) or placebo (continuous infusion of placebo plus open-label boluses of fentanyl). The primary endpoint was analgesic efficacy, as evaluated by the Echelle Douleur Inconfort Nouveau-Né (EDIN) and Premature Infant Pain Profile scales. Safety variables were evaluated as well. RESULTS Sixty-four infants were allocated to the fentanyl group, and 67 were allocated to the placebo group. The need for open-label boluses of fentanyl was similar in the 2 groups (P = .949). EDIN scores were comparable in the 2 groups; 65 of 961 (6.8%) EDIN scores were >6 in the fentanyl group and 91 of 857 (10.6%) in the placebo group (P = .003). The median Premature Infant Pain Profile score was clinically and statistically higher in the placebo group compared with the fentanyl group on days 1, 2, and 3 of treatment (P < .05). Mechanical ventilation at age 1 week was required in 27 of 64 infants in the fentanyl group (42.2%), compared with 17 of 67 infants in the placebo group (25.4%) (P = .042). The first cycle of mechanical ventilation was longer and the first meconium passage occurred later in the fentanyl group (P = .019 and .027, respectively). CONCLUSION In very preterm infants on mechanical ventilation, continuous fentanyl infusion plus open-label boluses of fentanyl does not reduce prolonged pain, but does reduce acute pain and increase side effects compared with open-label boluses of fentanyl alone.
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Affiliation(s)
- Gina Ancora
- Neonatology and Neonatal Intensive Care Unit, Department of Women's, Child's and Adolescent's Health, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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26
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Ohlsson A, Jacobs SE. NIDCAP: a systematic review and meta-analyses of randomized controlled trials. Pediatrics 2013; 131:e881-93. [PMID: 23420913 DOI: 10.1542/peds.2012-2121] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The "synactive" theory of neurobehavioral development forms the basis of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Our objective was to assess the effectiveness of NIDCAP in improving outcomes in preterm infants. METHODS Medline, CINAHL, Embase, PsychInfo, The Cochrane Library, Pediatric Academic Societies' Abstracts and Web of Science were searched in July 2010 and February 2012. The studies selected were randomized controlled trials testing the effectiveness of NIDCAP on medical and neurodevelopmental outcomes. The authors abstracted baseline characteristics of infants and outcomes. The risk of bias was assessed by using Cochrane criteria. RevMan 5.1 was used to synthesize data by the use of relative risk and risk difference for dichotomous outcomes and mean or standardized mean difference for continuous outcomes. RESULTS Eleven primary and 7 secondary studies enrolling 627 neonates were included, with 2 of high quality. The composite primary outcomes of death or major sensorineural disability at 18 months corrected age or later in childhood (3 trials, 302 children; relative risk 0.89 [95% confidence interval 0.61 to 1.29]) and survival free of disability at 18 months corrected age or later in childhood (2 trials, 192 infants; relative risk 0.97 [95% confidence interval 0.69 to 1.35]), were not significantly different between the NIDCAP and control groups. With the sensitivity analysis that excluded the 2 statistically heterogeneous outlying studies, there were no significant differences between groups for short-term medical outcomes. CONCLUSIONS This systematic review including 627 preterm infants did not find any evidence that NIDCAP improves long-term neurodevelopmental or short-term medical outcomes.
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Affiliation(s)
- Arne Ohlsson
- Department of Paediatrics, University of Toronto, Ontario, Canada.
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Pineda RG, Tjoeng H, Vavasseur C, Kidokoro H, Neil J, Inder T. Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit. J Pediatr 2013; 162:470-476.e1. [PMID: 23036482 PMCID: PMC3582758 DOI: 10.1016/j.jpeds.2012.08.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/29/2012] [Accepted: 08/09/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate differences in neurobehavior between preterm infants at term and full-term infants, changes in neurobehavior between 34 weeks postmenstrual age (PMA) and term equivalent in the preterm infant, and the relationship of neurobehavior to perinatal exposures. STUDY DESIGN In this prospective cohort study, 75 infants were tested at 34 weeks PMA and again at term using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Infants underwent magnetic resonance imaging at term equivalent. Regression was used to investigate differences in the scale's domains of function across time and in relation to perinatal exposures. RESULTS At term equivalent, preterm infants exhibited altered behavior compared with full-term infants, with poorer orientation (P < .001), lower tolerance of handling (P < .001), lower self-regulation (P < .001), poorer reflexes (P < .001), more stress (P < .001), hypertonicity (P < .001), hypotonia (P < .001), and more excitability (P = .007). Preterm infants from 34 weeks PMA to term equivalent, demonstrated changes in motor functions with declining quality of movement (P = .006), increasing hypertonia (P < .001), decreasing hypotonia (P = .001), and changes in behavior with increasing arousal (P < .001), increasing excitability (P < .001), and decreasing lethargy (P < .001). Cerebral injury was associated with more excitability (P = .002). However, no associations were detected between any of the perinatal exposures and developmental change from 34 weeks PMA to term equivalent. CONCLUSION Preterm infants have altered neurobehavior in a broad number of domains at term equivalent. Cerebral injury alters neurobehavior but does not appear to impair early neurobehavioral changes. Important neurobehavioral changes occur before term, and this provides an opportunity for interventions in the neonatal intensive care unit.
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Affiliation(s)
- Roberta G. Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri, USA
| | - Han Tjoeng
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Claudine Vavasseur
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey Neil
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA,Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA,Department of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Terrie Inder
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA,Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA,Department of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
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Lebel V, Aita M. Analyse du concept « soins du développement » selon la méthode basée sur les principes. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.113.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Weindling AM. Outcome of ELGANS after a protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr 2012; 101:1198-9. [PMID: 23062218 DOI: 10.1111/apa.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Michael Weindling
- School of Reproductive and Developmental Medicine, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK.
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30
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Campbell-Yeo ML, Johnston CC, Joseph KS, Feeley N, Chambers CT, Barrington KJ. Cobedding and recovery time after heel lance in preterm twins: results of a randomized trial. Pediatrics 2012; 130:500-6. [PMID: 22926182 DOI: 10.1542/peds.2012-0010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cobedding of preterm twin infants provides tactile, olfactory, and auditory stimulation and may affect pain reactivity. We carried out a randomized trial to assess the effect of cobedding on pain reactivity and recovery in preterm twin neonates. METHODS Stable preterm twins (n = 67 sets) between 28 and 36 weeks of gestational age were randomly assigned to a cobedding group (cared for in the same incubator or crib) or a standard care group (cared for in separate incubators or cribs). Pain response (determined by the Premature Infant Pain Profile [PIPP]) and time to return to physiologic baseline parameters were compared between groups with adjustment for the nonindependence of twin infants. RESULTS Maternal and infant characteristics were not significantly different between twin infants in the cobedding and standard care groups except for 5-minute Apgar <7 and postnatal age and corrected gestational age on the day of the heel lance. Mean PIPP scores were not different between groups at 30, 60, or 120 seconds. At 90 seconds, mean PIPP scores were higher in the cobedding group (6.0 vs 5.0, P = .04). Recovery time was shorter in the cobedding group compared with the standard care group, (mean = 75.6 seconds versus 142.1 seconds, P = .001). No significant adverse events were associated with cobedding. Adjustment for nonindependence between twins and differences in baseline characteristics did not change the results. CONCLUSIONS Cobedding enhanced the physiologic recovery of preterm twins undergoing heel lance, but did not lead to lower pain scores.
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Affiliation(s)
- Marsha L Campbell-Yeo
- Women’s and Newborn Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Montirosso R, Del Prete A, Bellù R, Tronick E, Borgatti R. Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics 2012; 129:e1129-37. [PMID: 22492762 PMCID: PMC4074610 DOI: 10.1542/peds.2011-0813] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the relation between the neurobehavior of very preterm infants and the level of NICU quality of developmental care. METHODS The neurobehavior of 178 very preterm infants (gestational age ≤29 weeks and/or birth weight ≤1500 g) from 25 NICUs participating in a large multicenter, longitudinal study (Neonatal Adequate Care for Quality of Life, NEO-ACQUA) was examined with a standardized neurobehavioral assessment, the NICU Network Neurobehavioral Scale (NNNS). A questionnaire, the NEO-ACQUA Quality of Care Checklist was used to evaluate the level of developmental care in each of the NICUs. A factor analyses applied to NEO-ACQUA Quality of Care Checklist produced 2 main factors: (1) the infant-centered care (ICC) index, which measures parents' involvement in the care of their infant and other developmentally oriented care interventions, and (2) the infant pain management (IPM) index, which measures the NICU approach to and the procedures used for reducing infant pain. The relations between NNNS neurobehavioral scores and the 2 indexes were evaluated. RESULTS Infants from NICUs with high scores on the ICC evidenced higher attention and regulation, less excitability and hypotonicity, and lower stress/abstinence NNNS scores than infants from low-care units. Infants from NICUs with high scores on the IPM evidenced higher attention and arousal, lower lethargy and nonoptimal reflexes NNNS scores than preterm infants from low-scoring NICUs. CONCLUSIONS Very preterm infant neurobehavior was associated with higher levels of developmental care both in ICC and in IPM, suggesting that these practices support better neurobehavioral stability.
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Affiliation(s)
- Rosario Montirosso
- Centre for the Study of Social Emotional Development of the at Risk Infant, Scientific Institute E. Medea, Bosisio Parini, Lecco, Italy.
| | | | | | - Ed Tronick
- Child Development Unit, Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts; and,Department of Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Ricki F. Goldstein
- Department of Pediatrics, and High-Risk Infant Follow-up Program, Division of Neonatal-Perinatal Medicine, Duke University Medical Center, Durham, North Carolina
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Øberg GK, Campbell SK, Girolami GL, Ustad T, Jørgensen L, Kaaresen PI. Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences. BMC Pediatr 2012; 12:15. [PMID: 22336194 PMCID: PMC3305610 DOI: 10.1186/1471-2431-12-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy. METHODS/DESIGN A pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age. DISCUSSION The paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT01089296.
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Affiliation(s)
- Gunn Kristin Øberg
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, 9037 Tromsø, Norway
- Clinic of Rehabilitation, Physical Therapy Section, University Hospital of Northern Norway HF, 9038 Tromsø, Norway
| | | | | | - Tordis Ustad
- Clinic of Clinical Services, University Hospital Trondheim, St.Olavs Hospital HF, 7006 Trondheim, Norway
| | - Lone Jørgensen
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, 9037 Tromsø, Norway
| | - Per Ivar Kaaresen
- Faculty of Health Sciences, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- BUK, University Hospital of Northern Norway HF, 9038 Tromsø, Norway
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Abstract
Developmental care for premature infants was introduced by Dr. Heidi Als more than 20 years ago, and has become an accepted standard of care. Research into developmental care has shown some benefits in neonatal outcomes, but there is no standard definition of developmental care, and its practice can vary widely across different neonatal units. Dr. Bernadette Melnyk developed a program entitled "Creating Opportunities for Parent Empowerment" (COPE) to help parents of premature infants learn about the common appearance and behaviors of these infants, and about developmentally appropriate parenting skills. COPE has helped to reduce parental anxiety and stress and to improve outcomes for premature infants.
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Kandasamy Y, Smith R, Wright IMR, Hartley L. Pain relief for premature infants during ophthalmology assessment. J AAPOS 2011; 15:276-80. [PMID: 21641250 DOI: 10.1016/j.jaapos.2011.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 03/04/2011] [Accepted: 03/08/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND The ophthalmological examination of premature infants, which is essential for the detection of retinopathy of prematurity (ROP), can be painful and distressing for the infant. Various researchers have investigated the benefits of topical anesthesia, oral sucrose, and non pharmacological intervention for pain relief. The purpose of this study is to review the current state of knowledge on the effectiveness of these approaches. METHODS A literature search was performed with MEDLINE (January 1980 to January 2011) and the Cochrane Central Register of Controlled Trials, Issue 1 of 4 (January 2011), to determine the currently available evidence on methods of pain relief for premature infants undergoing ROP examination. RESULTS Most studies supported the use of topical proparacaine, which marginally decreased pain without any side effects. Oral sucrose did not significantly reduce pain scores during ROP examinations, and withholding feeding before the examination was not beneficial. Infants given pacifiers had lower pain scores than those without pacifiers, and infants who were nested experienced less distress during and after the procedure. Conflicting data existed on the benefits of different examination techniques, but the insertion of a lid speculum appeared to be the most uncomfortable aspect of the screening examination. CONCLUSIONS Topical anesthetics marginally reduce pain during eye examination in premature infants. Contrary to standard practice, it appears that patients are more comfortable if they are fed before the examination, and there is no benefit of oral sucrose. Nonpharmacological interventions, including sucking on a pacifier and nesting, may also be beneficial.
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Understanding neurodevelopmental outcomes of prematurity: education priorities for NICU parents. Adv Neonatal Care 2010; 10:188-93; quiz 194-5. [PMID: 20697216 DOI: 10.1097/anc.0b013e3181e9414b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
NICU nurses have an important role to play in many aspects of parent education. This article stresses the need for an increased focus on teaching parents about the central role that self-regulation will play in their infant's neurobehavioral development not only during the early infancy period but throughout all of childhood and adolescence. Suggestions are made about how to conceptualize the relation between cognition and emotions in humans and how to help parents understand that continued vigilance concerning potential problems in attention and self-regulation will be necessary.
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Mreihil K, McDonagh AF, Nakstad B, Hansen TWR. Early isomerization of bilirubin in phototherapy of neonatal jaundice. Pediatr Res 2010; 67:656-9. [PMID: 20308939 DOI: 10.1203/pdr.0b013e3181dcedc0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neonatal jaundice is usually treated with phototherapy that converts bilirubin to more polar stereoisomers. These should theoretically be less able to cross the blood-brain barrier. The rates of photoisomer formation and concentrations accumulating in the circulation may have a bearing on the risk of kernicterus. The purpose of this study was to determine the rate of appearance of the major 4Z, 15E photoisomer of bilirubin during the early stages of phototherapy. Twenty jaundiced neonates were treated with phototherapy, and blood samples were drawn before and at approximately 15, 30, 60, and 120 min (10 infants) or at approximately 15, 60, 120, and 240 min (10 infants) after beginning phototherapy. Blood samples were analyzed for total serum bilirubin (TSB) and the 4Z, 15E photoisomer of bilirubin. Significant (p<0.0001) formation of the 4Z, 15E photoisomer was detectable within 15 min. The change in TSB from time 0 was insignificant at 120 min but reached significance at 240 min (p<0.001). The 4Z, 15E bilirubin constituted up to 20-25% of TSB at 2 h and may not have peaked by 4 h. Further studies are needed to determine whether this early shift in balance between bilirubin isomers with different polarities may impact the risk of bilirubin encephalopathy even before TSB starts to fall.
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Affiliation(s)
- Khalaf Mreihil
- Neonatal Intensive Care Unit, Children's and Youth Clinic, Akershus University Hospital, N-1478 Nordbyhagen, Norway
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38
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Staff perception one year after implementation of the the newborn individualized developmental care and assessment program (NIDCAP). J Pediatr Nurs 2010; 25:89-97. [PMID: 20185059 DOI: 10.1016/j.pedn.2009.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) was piloted at one NICU. Staff perception of impact and the feasibility of applying the program was explored in a survey and a focus group interview. NIDCAP was perceived to impact positively on infant well-being and parents' way of caring. Although the influence of NIDCAP on staff working conditions and job perfomance was overall positive, their perceptions varied. Presence of the NIDCAP observer and empowerment of parents was challenging to some nurses, especially in terms of decision making in care. Conflicts of interest occurred between staff member need of light and infant need of light reduction.
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Abstract
The mother's voice, along with other developmentally appropriate sensory events (ie, touch, light, smells), stimulates maturation of the sensory systems and helps shape normal fetal development. While vast changes in the neonatal intensive care unit have occurred over the last 2 decades, little research has addressed the loss of exposure to maternal voice for the preterm infant. To address this gap, we compared studies that directly investigated effects of exposure to maternal voice on preterm infants. Studies reviewed were conducted between 1972 and 2007. All presented recordings of maternal voice at sound levels above current recommendations, and few of the findings reached statistical significance. Some potentially positive developmental effects were indicated. Future study of the effects of exposure to maternal voice on preterm infants using recommended sound levels is needed.
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Improving the outcome of infants born at <30 weeks' gestation--a randomized controlled trial of preventative care at home. BMC Pediatr 2009; 9:73. [PMID: 19954550 PMCID: PMC2797495 DOI: 10.1186/1471-2431-9-73] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/03/2009] [Indexed: 11/13/2022] Open
Abstract
Background Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems. Methods/Design We have designed a randomized controlled trial to assess the effectiveness of a preventative care program delivered at home over the first 12 months of life for infants born very preterm (<30 weeks of gestational age) and their families, compared with standard medical follow-up. The aim of the program, delivered over nine sessions by a team comprising a physiotherapist and psychologist, is to improve infant development (cognitive, motor and language), behavioral regulation, caregiver-child interactions and caregiver mental health at 24 months' corrected age. The infants will be stratified by severity of brain white matter injury (assessed by magnetic resonance imaging) at term equivalent age, and then randomized. At 12 months' corrected age interim outcome measures will include motor development assessed using the Alberta Infant Motor Scale and the Neurological Sensory Motor Developmental Assessment. Caregivers will also complete a questionnaire at this time to obtain information on behavior, parenting, caregiver mental health, and social support. The primary outcomes are at 24 months' corrected age and include cognitive, motor and language development assessed with the Bayley Scales of Infant and Toddler Development (Bayley-III). Secondary outcomes at 24 months include caregiver-child interaction measured using an observational task, and infant behavior, parenting, caregiver mental health and social support measured via standardized parental questionnaires. Discussion This paper presents the background, study design and protocol for a randomized controlled trial in very preterm infants utilizing a preventative care program in the first year after discharge home designed to improve cognitive, motor and behavioral outcomes of very preterm children and caregiver mental health at two-years' corrected age. Clinical Trial Registration Number ACTRN12605000492651
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42
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Graven SN, Browne JV. Sensory Development in the Fetus, Neonate, and Infant: Introduction and Overview. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.nainr.2008.10.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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The universe of developmental care: a new conceptual model for application in the neonatal intensive care unit. Adv Neonatal Care 2008; 8:141-7. [PMID: 18535418 DOI: 10.1097/01.anc.0000324337.01970.76] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Developmental care for high-risk infants is practiced in most neonatal units around the world. Despite its wide acceptance, inconsistency in its definition and application has resulted in criticism regarding its scientific merit. The universe of developmental care model proposed in this article is the first major reformulation of neonatal developmental care theory since Als' synactive theory. Neither the developing brain nor the environment exists in isolation, and therefore are dependent on each other for all caregiving activities. Central to this model is the concept of a shared surface, manifested most obviously by the skin that forms the critical link between the body/organism and environment and becomes the focal point for human interactions. The components of the model and its theoretical underpinnings, its practical application and direction for future clinical practice, education, and research are presented.
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44
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Ludwig S, Steichen J, Khoury J, Krieg P. Quality Improvement Analysis of Developmental Care in Infants Less Than 1500 Grams at Birth. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.nainr.2008.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- K J S Anand
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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46
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Kaaresen PI, Rønning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB. A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev 2008; 84:201-9. [PMID: 17698301 DOI: 10.1016/j.earlhumdev.2007.07.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 07/05/2007] [Accepted: 07/09/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preterm infants are at increased risk of cognitive, motor and behavioral problems. Different intervention programs have been designed in an attempt to improve outcome, but the results are conflicting. OBJECTIVE To examine the effects of an early intervention program on cognitive, motor and behavioral problems and parenting stress among low birth weight children at 2 years corrected age. METHODS A randomized controlled trial was conducted including infants with a birth weight <2000 g treated at the University Hospital of North Norway, to examine the effects of a modified version of the Mother-Infant Transaction Program on cognitive, motor and behavioral outcomes and parenting stress. The children were assessed with the Bayley Scales of Infant Development and the Child Behavior Checklist/2-3 (CBCL) and the Parenting Stress Index were administered to the parents at 2 years corrected age. RESULTS Sixty-nine children in the intervention group and 67 in the control group were assessed at 2 years. There were no differences between the groups in cognitive or motor outcomes. The intervention group scored consistently lower on all CBCL syndrome scales, but no difference was significant. The mothers in the intervention group reported significantly lower parental stress in both child and parent domain, whereas the fathers reported lower stress in child domain compared to the control group. CONCLUSION This early intervention program does not improve cognitive, motor or behavioral outcomes at 2 years. There was a significant reduction in parenting stress reported by both mothers and fathers in the intervention group.
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Affiliation(s)
- Per Ivar Kaaresen
- Pediatric Department, University Hospital of North Norway, N-9038 Tromsø, Norway.
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008. [PMID: 18041117 PMCID: PMC7080031 DOI: 10.1007/s00103-007-0337-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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48
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Affiliation(s)
- Kay Marie Tomashek
- US Public Health Service, Epidemiology Activity, Dengue Branch, Division of Vector-Borne Infectious Disease, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, Puerto Rico.
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1265-303. [PMID: 18041117 PMCID: PMC7080031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
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50
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Carlson B, Walsh S, Wergin T, Schwarzkopf K, Ecklund S. Challenges in design and transition to a private room model in the neonatal intensive care unit. Adv Neonatal Care 2006; 6:271-80. [PMID: 17045947 DOI: 10.1016/j.adnc.2006.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As the need for neonatal intensive care units (NICU) continues to increase, a growing body of evidence on the developmentally appropriate healing environment for neonates suggests that changes are needed in NICU design. The private room NICU model is emerging as an alternative to large multi-bed wards; however, some have suggested that such a radical design change may be difficult to implement. This article presents the experience of one unit in the design and transition from a traditional setting to the private room model. Using change theory, this model was developed with staff input throughout the entire design and implementation process, resulting in a successful transition, as suggested by preliminary data on patient outcomes, family experiences, and nursing staff satisfaction.
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Affiliation(s)
- Beth Carlson
- Saint Elizabeth Regional Medical Center, Lincoln, Nebraska 68510, USA
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