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Abstract
OBJECTIVE Our objective was to explore the case for adoption of flexibility as a core value in the design process for Neonatal Intensive Care Units (NICUs). METHODS Guidelines for NICU design and care of NICU patients and families were examined to identify opportunities for building flexibility into NICU design to optimize function and experience. RESULTS Benefits of building flexibility into NICU design included the ability for units to adapt quickly and economically to unpredictable events and demographic changes. Further, by centering family presence as a design necessity, NICUs may better protect families from experiencing additional harm due to separation and interruption of restorative activities. We were able to highlight several examples of current NICUs, which have successfully adopted flexible design and operational models to provide optimal levels of clinical and family-centered care. CONCLUSION By intentionally incorporating flexibility into the design of an NICU, infants, families, and healthcare providers can be provided with an environment that can adapt to shifting needs to optimally support unit function and clinical outcomes.
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Pineda R, Liszka L, Inder T. Early neurobehavior at 30 weeks postmenstrual age is related to outcome at term equivalent age. Early Hum Dev 2020; 146:105057. [PMID: 32470768 PMCID: PMC7377927 DOI: 10.1016/j.earlhumdev.2020.105057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/03/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
AIMS To determine 1) the relationship between infant medical factors and early neurobehavior, and 2) the relationship between early neurobehavior at 30 weeks postmenstrual age (PMA) and neurobehavior at term equivalent age. STUDY DESIGN In this prospective longitudinal study, 88 very preterm infants born ≤30 weeks estimated gestational age (EGA) had neurobehavioral assessments at 30 weeks PMA using the Premie-Neuro and at term equivalent age using the NICU Network Neurobehavioral Scale (NNNS) and Hammersmith Neonatal Neurological Evaluation (HNNE). RESULTS Lower Premie-Neuro scores at 30 weeks PMA were related to being more immature at birth (p = 0.01; β = 3.87); the presence of patent ductus arteriosus (PDA; p < 0.01; β = -16.50) and cerebral injury (p < 0.01; β = -20.46); and prolonged exposure to oxygen therapy (p < 0.01; β = -0.01), endotracheal intubation (p < 0.01; β = -0.23), and total parenteral nutrition (p < 0.01; β = -0.35). After controlling for EGA, PDA, and number of days of endotracheal intubation, lower Premie-Neuro scores at 30 weeks PMA were independently related to lower total HNNE scores at term (p < 0.01; β = 0.12) and worse outcome on the NNNS with poorer quality of movement (p < 0.01; β = 0.02) and more stress (p < 0.01; ß = -0.004), asymmetry (p = 0.01; β = -0.04), excitability (p < 0.01; β = -0.05) and suboptimal reflexes (p < 0.01; ß = -0.06). CONCLUSION Medical factors were associated with early neurobehavioral performance at 30 weeks PMA. Early neurobehavior at 30 weeks PMA was a good marker of adverse neurobehavior at NICU discharge.
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Affiliation(s)
- Roberta Pineda
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA, United States of America; Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, United States of America; Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States of America.
| | - Lara Liszka
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States of America; Seattle Children's Hospital, Seattle, WA, United States of America
| | - Terrie Inder
- Brigham and Women's Hospital, Department of Pediatric Newborn Medicine, Boston, MA, United States of America; Harvard University, Harvard Medical School, Boston, MA, United States of America
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53
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Yakobson D, Arnon S, Gold C, Elefant C, Litmanovitz I, Beck BD. Music Therapy for Preterm Infants and Their Parents: A Cluster-Randomized Controlled Trial Protocol. J Music Ther 2020; 57:219-242. [PMID: 32112555 DOI: 10.1093/jmt/thaa002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Music therapy (MT) interventions and skin-to-skin care (SSC) both aim to address the varied needs of preterm infants, including sensory regulation and stress reduction, inclusion of parents in their infant's care, support of parents' emotional state, and enhancing the parent-infant attachment process. Few studies have investigated the combination of both modalities through randomized controlled trials. Evidence of longer-term effects is missing. This article presents a study protocol that will investigate the effects of combined family-centered MT intervention and SSC on preterm-infants' autonomic nervous system (ANS) stability, parental anxiety levels, and parent-infant attachment quality. 12 clusters with a total of 72 preterm infants, with their parents, will be randomized to one of two conditions: MT combined with SSC or SSC alone. Each parent-infant dyad will participate in 3 sessions (2 in the hospital and a 3-month follow-up). The primary outcome of preterm infants' ANS stability will be measured by the high frequency power of their heart rate variability. Secondary outcomes will be physiological measures and behavioral states in infants and anxiety and attachment levels of parents. This trial will provide important, evidence-based knowledge on the use of the "First Sounds: Rhythm, Breath, and Lullaby" model of MT in neonatal care, through an intervention that is in line with the Newborn Individualized Developmental Care and Assessment Program model for supportive developmental care of preterm infants and their parents. Ethical approval (no. 0283-15) was granted from the local Institutional Review Board in April 2017. This trial is registered in ClinicalTrials.gov, NCT03023267.
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Affiliation(s)
- Dana Yakobson
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Shmuel Arnon
- Neonatal Department, Meir Medical Center, Kfar-Saba, IsraelTel-Aviv University, Tel-Aviv, Israel
| | - Christian Gold
- GAMUT, Uni Research Health, Uni Research, Bergen, Norway
| | - Cochavit Elefant
- School for Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Ita Litmanovitz
- Neonatal Department, Meir Medical Center, Kfar-Saba, IsraelTel-Aviv University, Tel-Aviv, Israel
| | - Bolette Daniels Beck
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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54
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Pados BF, Fuller K. Establishing a Foundation for Optimal Feeding Outcomes in the NICU. Nurs Womens Health 2020; 24:202-209. [PMID: 32387143 DOI: 10.1016/j.nwh.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/13/2020] [Accepted: 03/01/2020] [Indexed: 06/11/2023]
Abstract
Many infants in the NICU experience difficulties with oral feeding, which contribute to prolonged length of stay. Oral feeding is a complex task involving sensorimotor functioning of the face, mouth, and larynx, as well as coordination of sucking, swallowing, and breathing. The care provided in the NICU starting at birth sets the stage for future oral feeding. The purpose of this article is to describe strategies that will establish a positive foundation to support optimal oral feeding. Nurses can use these strategies to protect newborns from noxious stimuli and promote positive auditory, tactile, gustatory, and olfactory experiences to optimize neurodevelopment for the complex task of feeding.
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55
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A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant. Early Hum Dev 2020; 144:105000. [PMID: 32151905 PMCID: PMC7282956 DOI: 10.1016/j.earlhumdev.2020.105000] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
AIM To explore differences in maternal mental health and infant neurobehavioral outcome among infants who received and did not receive the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. STUDY DESIGN Eighty preterm infants (50 receiving standard-of-care and 30 receiving the SENSE program) born ≤32 weeks gestation were enrolled within the first week of life in a prospective quasi-experimental design, using a historical control group for comparison. Standard-of-care consisted of tactile (skin-to-skin, touch, holding) and olfactory (scent cloth, close maternal contact) interventions as determined to be appropriate by health care professionals and parents. The SENSE group received specific doses of tactile (skin-to-skin care, holding, massage, touch), auditory (human speech, music), olfactory (scent cloth, close maternal contact), kinesthetic/vestibular (movement, rocking/transfers), and visual (dim or cycled light) exposures, based on the infant's postmenstrual age and tailored to medical status and infant cues according to the SENSE program. The SENSE program includes the intentional delivery of positive, age-appropriate sensory exposures by parents (or a sensory support team, when parents are unavailable) each day of NICU hospitalization. Infant neurobehavioral outcome, as well as maternal mental health and confidence, were assessed prior to NICU discharge, using standardized measures. RESULTS Seventy-three infants were included in the final analysis. Mothers whose infants received the SENSE program demonstrated higher scores on the Maternal Confidence Questionnaire (p = 0.01). Infants who received the SENSE program demonstrated less asymmetry on the NICU Network Neurobehavioral Scale (p = 0.02; mean difference 0.9) and higher scores on the Hammersmith Neonatal Neurological Evaluation (p < 0.001; mean difference 4.8). DISCUSSION Preliminary evidence demonstrates improvements in maternal confidence and infant neurobehavioral performance following SENSE implementation.
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56
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Monson BB, Rock J, Cull M, Soloveychik V. Neonatal intensive care unit incubators reduce language and noise levels more than the womb. J Perinatol 2020; 40:600-606. [PMID: 32020037 DOI: 10.1038/s41372-020-0592-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/17/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the sound reducing characteristics of modern incubators in the neonatal intensive care unit (NICU) and to better characterize auditory and language exposures for NICU infants. STUDY DESIGN Sound frequency spectral analysis was conducted on language and noise audio acquired simultaneously inside and outside incubators located in the NICU. RESULTS Sound transmission into the incubators was nonuniform. Very low-frequency sounds (<100 Hz) were unattenuated or even slightly amplified inside the incubators. Maximal reduction was observed for low-to-mid frequencies (300-600 Hz) and high frequencies (>2000 Hz), which convey important language information. CONCLUSIONS Sound reductions observed across NICU incubator walls are more severe than those reported for sound transmission into the intrauterine environment, particularly for midrange frequencies that are important for language. Although incubator walls may serve as a protection against noxious noise levels, these findings reveal a potentially detrimental effect on language exposure for infants inside a NICU incubator.
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Affiliation(s)
- Brian B Monson
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA. .,Neuroscience Program, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Jenna Rock
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Molly Cull
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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57
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Monaghan J, Kim T, Dol J, Orovec A, Campbell-Yeo M. Parents’ learning needs and preferences in a neonatal intensive care unit: A desire for enhanced communication and eHealth technology. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jnn.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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58
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Pados BF, Davitt ES. Pathophysiology of Gastroesophageal Reflux Disease in Infants and Nonpharmacologic Strategies for Symptom Management. Nurs Womens Health 2020; 24:101-114. [PMID: 32101759 DOI: 10.1016/j.nwh.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/10/2019] [Accepted: 01/01/2020] [Indexed: 06/10/2023]
Abstract
Gastroesophageal reflux is common in young infants, particularly those born prematurely or with a history of medical complexity. The most recent clinical practice guidelines recommend the use of nonpharmacologic management strategies because of concerns about the safety of acid-reducing medications and a lack of evidence of their effectiveness. Our purpose in this article is to holistically review the pathophysiology of gastroesophageal reflux disease, identify symptom management targets, and describe nonpharmacologic strategies that nurses can implement and/or teach to parents to manage symptoms of gastroesophageal reflux. Strategies targeting stress, dysbiosis, food intolerances, feeding difficulties, and positioning are discussed. Nurses can work with families to identify factors contributing to gastroesophageal reflux disease and determine individualized strategies that can be used in lieu of, or in addition to, medication.
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59
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Loewy J, Jaschke AC. Mechanisms of Timing, Timbre, Repertoire, and Entrainment in Neuroplasticity: Mutual Interplay in Neonatal Development. Front Integr Neurosci 2020; 14:8. [PMID: 32210771 PMCID: PMC7069513 DOI: 10.3389/fnint.2020.00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Neonatal brain development relies on a combination of critical factors inclusive of genetic predisposition, attachment, and the conditions of the pre and postneonatal environment. The status of the infant’s developing brain in its most vulnerable state and the impact that physiological elements of music, silences and sounds may make in the earliest stages of brain development can enhance vitality. However, little attention has been focused on the integral aspects of the music itself. This article will support research that has hypothesized conditions of music therapeutic applications in an effort to further validate models of neurobehavioral care that have optimized conditions for growth, inclusive of recommendations leading toward the enhancement of self-regulatory behaviors.
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Affiliation(s)
- Joanne Loewy
- The Louis Armstrong Center for Music and Medicine, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY, United States
| | - Artur C Jaschke
- Department of Music Therapy, Beatrix Children's Hospital-University Medical Centre, ArtEZ University of the Arts, Groningen, Netherlands.,Department of Neonatology and Clinical Neuropsychology, Amsterdam, Netherlands
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60
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Fontana C, De Carli A, Ricci D, Dessimone F, Passera S, Pesenti N, Bonzini M, Bassi L, Squarcina L, Cinnante C, Mosca F, Fumagalli M. Effects of Early Intervention on Visual Function in Preterm Infants: A Randomized Controlled Trial. Front Pediatr 2020; 8:291. [PMID: 32582595 PMCID: PMC7287146 DOI: 10.3389/fped.2020.00291] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: To determine the effectiveness of an early intervention program in enhancing visual function in very preterm infants. Methods: We conducted a RCT. We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA), without severe morbidities, and their families. Infants were randomized to either receive Standard Care (SC) or Early Intervention (EI). SC, according to NICU protocols, included Kangaroo Mother Care and minimal handling. EI included, in addition to routine care, parental training according to the PremieStart program, and multisensory stimulation (infant massage and visual interaction) performed by parents. Visual function was assessed at term equivalent age (TEA) using a prevalidated battery evaluating ocular spontaneous motility, ability to fix and follow a target, reaction to color, stripes discrimination and visual attention at distance. Results: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to protocol. Fifty-seven infants (EI = 27, SC = 30) were assessed at TEA. The two groups were comparable for parental and infant characteristics. In total, 59% of infants in the EI group achieved the highest score in all the nine assessed items compared to 17% in the SC group (p = 0.001): all infants in both groups showed complete maturation in four items, but EI infants showed more mature findings in the other five items (ocular motility both spontaneous and with target, tracking arc, stripes discrimination and attention at distance). Conclusions: Our results suggest that EI has a positive effect on visual function maturation in preterm infants at TEA. Trial Registration: clinicalTrial.gov (NCT02983513).
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Affiliation(s)
- Camilla Fontana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Agnese De Carli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Daniela Ricci
- Pediatric Neurology, Department of Human and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy.,Department of Ophthalmology, National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired, IAPB, Rome, Italy
| | - Francesca Dessimone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Sofia Passera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Matteo Bonzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Occupational Health Unit, Milan, Italy
| | - Laura Bassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cinnante
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
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Filippa M, Lordier L, De Almeida JS, Monaci MG, Adam-Darque A, Grandjean D, Kuhn P, Hüppi PS. Early vocal contact and music in the NICU: new insights into preventive interventions. Pediatr Res 2020; 87:249-264. [PMID: 31266053 DOI: 10.1038/s41390-019-0490-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022]
Abstract
It is now clearly established that the environment and the sensory stimuli, particularly during the perinatal period, have an impact on infant's development. During the last trimester of gestation, activity-dependent plasticity shapes the fetal brain, and prematurity has been shown to alter the typical developmental trajectories. In this delicate period, preventive interventions aiming at modulating these developmental trajectories through activity-inducing interventions are currently underway to be tested. The purpose of this review paper is to describe the potentialities of early vocal contact and music on the preterm infant's brain development, and their potential beneficial effect on early development. Scientific evidence supports a behavioral orientation of the newborn to organized sounds, such as those of voice and music, and recent neuroimaging studies further confirm full cerebral processing of music as multisensory stimuli. However, the impact of long-term effects of music exposure and early vocal contact on preterm infants' long-term neurodevelopment needs be further investigated. To conclude, it is necessary to establish the neuroscientific bases of the early perception and the long-term effects of music and early vocal contact on the premature newborns' development. Scientific projects are currently on the way to fill this gap in knowledge.
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Affiliation(s)
- Manuela Filippa
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland. .,University of Valle d'Aosta, Aosta, Italy. .,Neuroscience of Emotion and Affective Dynamics, Swiss Center for Affective Sciences, and Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
| | - Lara Lordier
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
| | - Joana Sa De Almeida
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
| | | | - Alexandra Adam-Darque
- Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neuroscience, Division of Neurorehabilitation, University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics, Swiss Center for Affective Sciences, and Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Service de Médecine et réanimation du nouveau-né, Hôpital de Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Petra S Hüppi
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
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Detmer MR, Evans K, Shina E, Walker K, DeLoach D, Malowitz JR. Multimodal Neurologic Enhancement Improves Preterm Infants' Developmental Outcomes: A Longitudinal Pilot Study. Neonatal Netw 2020; 39:16-23. [PMID: 31919289 DOI: 10.1891/0730-0832.39.1.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to identify the long-term developmental effects of a NICU music therapy intervention, Multimodal Neurologic Enhancement, provided to preterm infants in the NICU. DESIGN Prospective randomized controlled study with one control group and one experimental group. SAMPLE Participants were medically stable preterm infants with a birth age of 31 and 6/7 weeks or less, admitted to a level-III NICU. A total of 84 participants were enrolled, and 48 completed the study. MAIN OUTCOME VARIABLE Post-discharge developmental scores on the Mullen Scales of Early Learning: AGS Edition. RESULTS The experimental group performed significantly better than the control group on the Visual Reception and Early Learning Composite scores.
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63
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Individualised developmental care for babies and parents in the NICU: Evidence-based best practice guideline recommendations. Early Hum Dev 2019; 139:104840. [PMID: 31445697 DOI: 10.1016/j.earlhumdev.2019.104840] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Advances in neonatal care have improved survival of premature and critically ill infants; and while rates of some long-term neurodevelopmental problems in survivors have improved, such as cerebral palsy, there are others such as learning and behavioural difficulties that have not. The goal of improving long term neurodevelopmental morbidity has led to an increased focus on improving developmental care not only in neonatal long term follow- up clinics but within the NICU itself to capture the period of earliest brain neuroplasticity. The application of a systematic approach to improve practice is considered the most effective strategy for implementing neuroprotective developmentally supportive care. The content of this paper incorporates evidence-based systematic reviews to guide clinicians in the application of developmentally supportive interventions.
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Tandberg BS, Flacking R, Markestad T, Grundt H, Moen A. Parent psychological wellbeing in a single-family room versus an open bay neonatal intensive care unit. PLoS One 2019; 14:e0224488. [PMID: 31689307 PMCID: PMC6830777 DOI: 10.1371/journal.pone.0224488] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/15/2019] [Indexed: 01/30/2023] Open
Abstract
Background Studies of parents’ psychological well-being in single-family rooms in neonatal intensive care units have shown conflicting results. Aims To compare emotional distress in the form of depression, anxiety, stress and attachment scores among parents of very preterm infants cared for in a single-family rooms unit vs an open bay unit. Study design Prospective survey design. Subject Parents (132) of 77 infants born at 28 0/7–32 0/7 weeks of gestation in the two units. Outcome measures Duration of parental presence was recorded. Scores for depression (The Edinburgh Postnatal Depression Scale), anxiety (The State–Trait–Anxiety Inventory, Short Form Y), stress (The Parent Stressor Scale: neonatal intensive care unit questionnaire and The Parenting Stress Index—short form) and attachment (Maternal Postnatal Attachment Scale) measured 14 days after delivery, at discharge, expected term date and four months post-term. Results Parents were present 21 hours/day in the single-family room unit vs 7 hours/day in the Open bay unit. Ninety-three percent of the fathers in the single-family rooms unit were present more than 12 hours per day during the first week. Mothers in the single-family rooms had a significantly lower depression score -1.9 (95% CI: -3.6, -0.1) points from birth to four months corrected age compared to mothers in the Open bay unit, and 14% vs 52% scored above a cut-off point considered being at high risk for depression (p<0.005). Both mothers and fathers in the single-family rooms reported significantly lower stress levels during hospitalization. There were no differences between the groups for anxiety, stress or attachment scores after discharge. Conclusion The lower depression scores by the mothers and lower parental stress scores during hospitalization for both parents supports that single-family rooms care contribute to parents’ psychological wellbeing.
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Affiliation(s)
- Bente Silnes Tandberg
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- * E-mail:
| | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Trond Markestad
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Hege Grundt
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Atle Moen
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
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65
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Pineda R, Roussin J, Heiny E, Smith J. Health Care Professionals' Perceptions about Sensory-Based Interventions in the NICU. Am J Perinatol 2019; 36:1229-1236. [PMID: 30577058 PMCID: PMC6635089 DOI: 10.1055/s-0038-1676536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The main objective of this article is to define perceptions of health care professionals regarding current use of sensory-based interventions in the neonatal intensive care unit (NICU). STUDY DESIGN A multidisciplinary group of NICU health care professionals (n = 108) defined the types of sensory-based interventions used in their NICU, the postmenstrual age (PMA) sensory-based interventions are administered, conditions under which sensory-based interventions are used, and personnel who administer sensory-based interventions. RESULTS The most commonly reported tactile intervention was infant holding (88% of respondents), the most common auditory intervention was recorded music/singing (69% of respondents), the most common kinesthetic intervention was occupational and physical therapy (85% of respondents), and the most common vestibular intervention was infant swings (86% of respondents). Tactile interventions were initiated most often at 24 to 26 weeks PMA (74% of respondents), auditory interventions at 30 to 32 weeks (60% of respondents), kinesthetic interventions at 30 to 32 weeks (76% of respondents), vestibular interventions at 33 to 34 weeks (86% of respondents), and visual interventions at 32 to 36 weeks (72% of respondents). Conditions under which sensory-based interventions were administered, and personnel who provided them, varied across settings. CONCLUSION Varied use of sensory-based interventions in the NICU were reported. While this study was limited by biased sampling and the identification of health care professionals' perceptions but not real-world practice, this information can be used to build a comprehensive approach to positive sensory exposures in the NICU.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica Roussin
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Elizabeth Heiny
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety and Practice Excellence, Saint Louis Children’s Hospital, St. Louis, Missouri
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Marinelli B, Pluchinotta F, Cozzolino V, Barlafante G, Strozzi MC, Marinelli E, Franchini S, Gazzolo D. Osteopathic Manipulation Treatment Improves Cerebro-splanchnic Oximetry in Late Preterm Infants. Molecules 2019; 24:molecules24183221. [PMID: 31487945 PMCID: PMC6767098 DOI: 10.3390/molecules24183221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background: To evaluate the effectiveness/side-effects of osteopathic manipulation treatment (OMT) performed on the 7th post-natal day, on cerebro-splanchnic oximetry, tissue activation and hemodynamic redistribution in late preterm (LP) infants by using near infrared spectroscopy (NIRS). Methods: Observational pretest-test study consisting in a cohort of 18 LPs who received OMT on the 7th post-natal day. NIRS monitoring was performed at three different time-points: 30 min before (T0), (30 min during (T1) and 30 min after OMT (T2). We evaluated the effects of OMT on the following NIRS parameters: cerebral (c), splanchnic (s) regional oximetry (rSO2), cerebro-splanchnic fractional tissue oxygen extraction (FTOE) and hemodynamic redistribution (CSOR). Results: crSO2 and cFTOE significantly (P < 0.001) improved at T0-T2; srSO2 significantly (P < 0.001) decreased and sFTOE increased at T0-T1. Furthermore, srSO2 and sFTOE significantly improved at T1-T2. Finally, CSOR significantly (P < 0.05) increased at T0-T2. Conclusions: The present data show that OMT enhances cerebro-splanchnic oximetry, tissue activation and hemodynamic redistribution in the absence of any adverse clinical or laboratory pattern. The results indicate the usefulness of further randomized studies in wider populations comparing the effectiveness of OMT with standard rehabilitation programs.
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Affiliation(s)
- Benedetta Marinelli
- Department, Italian Academy of Traditional Osteopathy (AIOT), 65100 Pescara, Italy
| | - Francesca Pluchinotta
- Laboratory Research, Department of Paediatric Cardiovascular Surgery, San Donato Milanese University Hospital, 20097 San Donato, Italy
| | - Vincenzo Cozzolino
- Department, Italian Academy of Traditional Osteopathy (AIOT), 65100 Pescara, Italy
| | - Gina Barlafante
- Department, Italian Academy of Traditional Osteopathy (AIOT), 65100 Pescara, Italy
| | - Maria Chiara Strozzi
- Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, 15121 Alessandria, Italy
| | - Eleonora Marinelli
- Department, Italian Academy of Traditional Osteopathy (AIOT), 65100 Pescara, Italy
| | - Simone Franchini
- Neonatal Intensive Care Unit G. D'Annunzio University of Chieti, 66100 Chieti, Italy
| | - Diego Gazzolo
- Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, 15121 Alessandria, Italy.
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Volpe JJ. Dysmaturation of Premature Brain: Importance, Cellular Mechanisms, and Potential Interventions. Pediatr Neurol 2019; 95:42-66. [PMID: 30975474 DOI: 10.1016/j.pediatrneurol.2019.02.016] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/12/2019] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
Prematurity, especially preterm birth (less than 32 weeks' gestation), is common and associated with high rates of both survival and neurodevelopmental disability, especially apparent in cognitive spheres. The neuropathological substrate of this disability is now recognized to be related to a variety of dysmaturational disturbances of the brain. These disturbances follow initial brain injury, particularly cerebral white matter injury, and involve many of the extraordinary array of developmental events active in cerebral white and gray matter structures during the premature period. This review delineates these developmental events and the dysmaturational disturbances that occur in premature infants. The cellular mechanisms involved in the genesis of the dysmaturation are emphasized, with particular focus on the preoligodendrocyte. A central role for the diffusely distributed activated microglia and reactive astrocytes in the dysmaturation is now apparent. As these dysmaturational cellular mechanisms appear to occur over a relatively long time window, interventions to prevent or ameliorate the dysmaturation, that is, neurorestorative interventions, seem possible. Such interventions include pharmacologic agents, especially erythropoietin, and particular attention has also been paid to such nutritional factors as quality and source of milk, breastfeeding, polyunsaturated fatty acids, iron, and zinc. Recent studies also suggest a potent role for interventions directed at various experiential factors in the neonatal period and infancy, i.e., provision of optimal auditory and visual exposures, minimization of pain and stress, and a variety of other means of environmental behavioral enrichment, in enhancing brain development.
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Affiliation(s)
- Joseph J Volpe
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, Massachusetts.
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68
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Pineda R, Raney M, Smith J. Supporting and enhancing NICU sensory experiences (SENSE): Defining developmentally-appropriate sensory exposures for high-risk infants. Early Hum Dev 2019; 133:29-35. [PMID: 31054467 DOI: 10.1016/j.earlhumdev.2019.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/29/2019] [Accepted: 04/24/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There is evidence to support the use of positive sensory exposures (music, touch, skin-to-skin) with preterm infants in the neonatal intensive care unit (NICU), but strategies to improve their consistent use are lacking. The Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed to promote consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for the preterm infant every day of NICU hospitalization. METHODS A systematic and rigorous process of development of the SENSE program included an integrative review of evidence on sensory exposures in the NICU, stakeholder feedback, expert opinion, and focus groups. RESULTS SENSE implementation materials consist of parent education materials, tailored doses of sensory exposures for each postmenstrual age, an infant assessment of tolerance, bedside logs and implementation considerations for integrating the SENSE program into the NICU. DISCUSSION Research is needed to evaluate the SENSE program as an implementation strategy and to assess its impact on parent and infant outcomes.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States of America; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Mary Raney
- St. Louis Children's Hospital, St Louis, MO, United States of America
| | - Joan Smith
- St. Louis Children's Hospital, St Louis, MO, United States of America
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69
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Abstract
Preterm babies are cared for in neonatal intensive care units (NICU), which are busy places with a lot of mechanical noise increasingly recognized to disrupt normal brain development. NICUs therefore invest in developmental care procedures, with music for example, but neurobiological evidence for these interventions is missing. We present results from a clinical trial to study the effects of a music intervention on preterm infants’ brain development. Based on resting-state fMRI, we provide evidence that music enhanced connectivity in a brain circuitry involving the salience network with regions implicated in sensory and higher-order cognitive functions, previously found to be altered in preterm infants. To our knowledge, this study is unique in observing an impact of music on brain development in preterm newborns. Neonatal intensive care units are willing to apply environmental enrichment via music for preterm newborns. However, no evidence of an effect of music on preterm brain development has been reported to date. Using resting-state fMRI, we characterized a circuitry of interest consisting of three network modules interconnected by the salience network that displays reduced network coupling in preterm compared with full-term newborns. Interestingly, preterm infants exposed to music in the neonatal intensive care units have significantly increased coupling between brain networks previously shown to be decreased in premature infants: the salience network with the superior frontal, auditory, and sensorimotor networks, and the salience network with the thalamus and precuneus networks. Therefore, music exposure leads to functional brain architectures that are more similar to those of full-term newborns, providing evidence for a beneficial effect of music on the preterm brain.
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70
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Affiliation(s)
- Katherine Sanchez
- Speech and Language Group Murdoch Children's Research Institute Parkville Vic. Australia
| | - Angela T. Morgan
- Speech and Language Group Murdoch Children's Research Institute Parkville Vic. Australia
- Department of Audiology and Speech Pathology The University of Melbourne Parkville Vic. Australia
- Royal Children's Hospital Parkville Vic. Australia
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Kentner AC, Cryan JF, Brummelte S. Resilience priming: Translational models for understanding resiliency and adaptation to early life adversity. Dev Psychobiol 2019; 61:350-375. [PMID: 30311210 PMCID: PMC6447439 DOI: 10.1002/dev.21775] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
Despite the increasing attention to early life adversity and its long-term consequences on health, behavior, and the etiology of neurodevelopmental disorders, our understanding of the adaptations and interventions that promote resiliency and rescue against such insults are underexplored. Specifically, investigations of the perinatal period often focus on negative events/outcomes. In contrast, positive experiences (i.e. enrichment/parental care//healthy nutrition) favorably influence development of the nervous and endocrine systems. Moreover, some stressors result in adaptations and demonstrations of later-life resiliency. This review explores the underlying mechanisms of neuroplasticity that follow some of these early life experiences and translates them into ideas for interventions in pediatric settings. The emerging role of the gut microbiome in mediating stress susceptibility is also discussed. Since many negative outcomes of early experiences are known, it is time to identify mechanisms and mediators that promote resiliency against them. These range from enrichment, quality parental care, dietary interventions and those that target the gut microbiota.
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Affiliation(s)
- Amanda C. Kentner
- School of Arts & Sciences, Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115,
| | - John F. Cryan
- Dept. Anatomy & Neuroscience & APC Microbiome Institute, University College Cork, College Rd., Cork, Ireland,
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI 48202,
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Chorna O, Filippa M, De Almeida JS, Lordier L, Monaci MG, Hüppi P, Grandjean D, Guzzetta A. Neuroprocessing Mechanisms of Music during Fetal and Neonatal Development: A Role in Neuroplasticity and Neurodevelopment. Neural Plast 2019; 2019:3972918. [PMID: 31015828 PMCID: PMC6446122 DOI: 10.1155/2019/3972918] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/06/2019] [Accepted: 02/24/2019] [Indexed: 01/17/2023] Open
Abstract
The primary aim of this viewpoint article is to examine recent literature on fetal and neonatal processing of music. In particular, we examine the behavioral, neurophysiological, and neuroimaging literature describing fetal and neonatal music perception and processing to the first days of term equivalent life. Secondly, in light of the recent systematic reviews published on this topic, we discuss the impact of music interventions on the potential neuroplasticity pathways through which the early exposure to music, live or recorded, may impact the fetal, preterm, and full-term infant brain. We conclude with recommendations for music stimuli selection and its role within the framework of early socioemotional development and environmental enrichment.
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Affiliation(s)
- O. Chorna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - M. Filippa
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Social Science Department, University of Valle d'Aosta, Aosta, Italy
| | - J. Sa De Almeida
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - L. Lordier
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - M. G. Monaci
- Social Science Department, University of Valle d'Aosta, Aosta, Italy
| | - P. Hüppi
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - D. Grandjean
- Swiss Center for Affective Sciences and Department of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - A. Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Neel ML, Yoder P, Matusz PJ, Murray MM, Miller A, Burkhardt S, Emery L, Hague K, Pennington C, Purnell J, Lightfoot M, Maitre NL. Randomized controlled trial protocol to improve multisensory neural processing, language and motor outcomes in preterm infants. BMC Pediatr 2019; 19:81. [PMID: 30890132 PMCID: PMC6423745 DOI: 10.1186/s12887-019-1455-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Premature infants are at risk for abnormal sensory development due to brain immaturity at birth and atypical early sensory experiences in the Neonatal Intensive Care Unit. This altered sensory development can have downstream effects on other more complex developmental processes. There are currently no interventions that address rehabilitation of sensory function in the neonatal period. METHODS This study is a randomized controlled trial of preterm infants enrolled at 32-36 weeks postmenstrual age to either standard care or standard care plus multisensory intervention in order to study the effect of multisensory intervention as compared to standard care alone. The study population will consist of 100 preterm infants in each group (total n = 200). Both groups will receive standard care, consisting of non-contingent recorded parent's voice and skin-to-skin by parent. The multisensory group will also receive contemporaneous holding and light pressure containment for tactile stimulation, playing of the mother's voice contingent on the infant's pacifier sucking for auditory stimulation, exposure to a parent-scented cloth for olfactory stimulation, and exposure to carefully regulated therapist breathing that is mindful and responsive to the child's condition for vestibular stimulation. The primary outcome is a brain-based measure of multisensory processing, measured using time locked-EEG. Secondary outcomes include sensory adaptation, tactile processing, speech sound differentiation, motor and language function, measured at one and two years corrected gestational age. DISCUSSION This is the first randomized controlled trial of a multisensory intervention using brain-based measurements in order to explain the causal effects of the multisensory intervention on neural processing changes to mediate neurodevelopmental outcomes in former preterm infants. In addition to contributing a critical link in our understanding of these processes, the protocolized multisensory intervention in this study is therapist administered, parent supported and leverages simple technology. Thus, this multisensory intervention has the potential to be widely implemented in various NICU settings, with the opportunity to potentially improve neurodevelopment of premature infants. TRIAL REGISTRATION NIH Clinical Trials ( clinicaltrials.gov ): NCT03232931 . Registered July 2017.
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Affiliation(s)
- Mary Lauren Neel
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Paul Yoder
- Department of Special Education, Vanderbilt University, Nashville, TN USA
| | - Pawel J. Matusz
- Information Systems Institute at the University of Applied Sciences Western Switzerland (HES-SO Valais), 3960 Sierre, Switzerland
- The LINE (Laboratory for Investigative Neurophysiology), Department of Radiology and Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Micah M. Murray
- The LINE (Laboratory for Investigative Neurophysiology), Department of Radiology and Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Electroencephalography Brain Mapping Core, Center for Biomedical Imaging (CIBM) of Lausanne and Geneva, Lausanne, Switzerland
- Department of Ophthalmology, Fondation Asile des Aveugles, Lausanne, Switzerland
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN USA
| | - Ashley Miller
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Stephanie Burkhardt
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Lelia Emery
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Kaleigh Hague
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Caitlin Pennington
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Jessica Purnell
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Megan Lightfoot
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Nathalie L. Maitre
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
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Lejeune F, Brand L, Palama A, Parra J, Marcus L, Barisnikov K, Debillon T, Gentaz E, Berne‐Audéoud F. Preterm infant showed better object handling skills in a neonatal intensive care unit during silence than with a recorded female voice. Acta Paediatr 2019; 108:460-467. [PMID: 30144160 DOI: 10.1111/apa.14552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/11/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
Abstract
AIM This study compared whether preterm infants showed better tactile abilities during silence or when they heard a prerecorded female voice at different intensities. METHODS We studied 74 preterm infants of 28-35 weeks' postconceptional age who were admitted to a French neonatal intensive care unit from 2014 to 2017. They were presented with wooden objects, one smooth and one angled, at various points during silence (n = 26) or while listening to a female voice at +5 (n = 24) or +15 decibels (n = 24) inside their incubator. We compared the conditions to see if there was any difference in how the infants handled the objects and also compared familiar and unfamiliar objects. RESULTS The preterm infants showed better handling skills and only displayed effective discrimination, during silence. We found that 27.1% of the infants exposed to female voices failed to get habituated to the object, compared to 7.7% in the silence condition (p < 0.05) and success during the voice conditions required more trials (6.1 vs. 5.3) than the silence condition (p = 0.05). The different voice intensities made no difference. CONCLUSION Being exposed to a female voice had a negative impact on preterm infants' tactile sensory learning, regardless of its intensity.
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Affiliation(s)
- Fleur Lejeune
- Child Clinical Neuropsychology Unit FPSE University of Geneva Geneva Switzerland
- Sensorimotor, Affective and Social Development Unit FPSE University of Geneva Geneva Switzerland
| | - Laure‐Anne Brand
- Intensive and Regular Neonatal Care Unit CHRU Grenoble Grenoble France
| | - Amaya Palama
- Sensorimotor, Affective and Social Development Unit FPSE University of Geneva Geneva Switzerland
| | - Johanna Parra
- Intensive and Regular Neonatal Care Unit CHR Chambery Chambery France
| | - Leïla Marcus
- Intensive and Regular Neonatal Care Unit CHRU Grenoble Grenoble France
| | - Koviljka Barisnikov
- Child Clinical Neuropsychology Unit FPSE University of Geneva Geneva Switzerland
| | - Thierry Debillon
- Intensive and Regular Neonatal Care Unit CHRU Grenoble Grenoble France
| | - Edouard Gentaz
- Sensorimotor, Affective and Social Development Unit FPSE University of Geneva Geneva Switzerland
- CNRS Grenoble France
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Affiliation(s)
- Manuela Filippa
- University of Geneva Geneva Switzerland
- University of Valle d'Aosta Aosta Italy
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76
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Cheong JLY, Thompson DK, Olsen JE, Spittle AJ. Late preterm births: New insights from neonatal neuroimaging and neurobehaviour. Semin Fetal Neonatal Med 2019; 24:60-65. [PMID: 30342897 DOI: 10.1016/j.siny.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
With increasing evidence of neurodevelopmental problems faced by late preterm children, there is a need to explore possible underlying brain structural changes. The use of brain magnetic resonance imaging has provided insights of smaller and less mature brains in infants born late preterm, associated with developmental delay at 2 years. Another useful tool in the newborn period is neurobehavioural assessment, which has also been shown to be suboptimal in late preterm infants compared with tern infants. Suboptimal neurobehaviour is also associated with poorer 2-year neurodevelopment in late preterm infants. More research into these tools will provide a better understanding of the underlying processes of developmental deficits of late preterm children. The value of their role in clinical care remains to be determined.
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Affiliation(s)
- Jeanie Ling Yoong Cheong
- Newborn Research, Royal Women's Hospital, Parkville, VIC, Australia; Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
| | - Deanne Kim Thompson
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Joy Elizabeth Olsen
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Neonatal Allied Health Team, Royal Women's Hospital, Parkville, VIC, Australia
| | - Alicia Jane Spittle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Physiotherapy, University of Melbourne, Grattan St, Parkville, VIC, Australia
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Early-life growth of preterm infants and its impact on neurodevelopment. Pediatr Res 2019; 85:283-292. [PMID: 30140070 DOI: 10.1038/s41390-018-0139-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/08/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time. METHODS We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts. RESULTS In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P < 0.001; neuromotor score β -1.9%, 95% CI -3.2; -0.6, P = 0.005), while SGA CUG+ subjects were comparable to adequately grown subjects. CONCLUSION Although the incidence of adverse growth patterns decreased between the cohorts, possibly indicating improvements in care over time, the impact of these growth patterns on neurodevelopmental outcomes was not significantly different. Achieving adequate early-life growth may be crucial for improving neurodevelopmental outcomes, especially for preterms born SGA.
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Alexander B, Kelly CE, Adamson C, Beare R, Zannino D, Chen J, Murray AL, Loh WY, Matthews LG, Warfield SK, Anderson PJ, Doyle LW, Seal ML, Spittle AJ, Cheong JL, Thompson DK. Changes in neonatal regional brain volume associated with preterm birth and perinatal factors. Neuroimage 2019; 185:654-663. [DOI: 10.1016/j.neuroimage.2018.07.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 01/07/2023] Open
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Targeted sensory enrichment interventions protect against behavioral and neuroendocrine consequences of early life stress. Psychoneuroendocrinology 2018; 98:74-85. [PMID: 30121011 DOI: 10.1016/j.psyneuen.2018.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/20/2018] [Accepted: 07/29/2018] [Indexed: 12/16/2022]
Abstract
Both basic and clinical research support the use of tactile stimulation to rescue several neurobiobehavioral consequences that follow early life stress. Here, using a translational rodent model of the neonatal intensive care unit (NICU), we tested the individual prophylactic potential of a variety of sensory interventions including tactile (brushing pups with a paint brush to mimic maternal licking), auditory (a simulated lactating rat dam heart beat), and olfactory (a series of aroma therapy scents) stimulation. The NICU model was developed to mimic not only the reduced parental contact that sick infants receive (by isolating rat pups from their litters), but also the nosocomial infections and medical manipulations associated with this experience (by utilizing a dual lipopolysaccharide injection schedule). Each of the neurobiobehavioral consequences observed were dissociable between isolation and inflammation, or required a combined presentation ('two hits') of the neonatal stressors. Sprague-Dawley rats exposed to these early life stressors presented with sex-specific disruptions in both separation-induced ultrasonic vocalization (USV) distress calls (males & females) and juvenile social play USVs (males only). All three sensory enhancement interventions were associated with the rescue of potentiated distress calls while olfactory stimulation was protective of social vocalizations. Female rats exposed to early life stress experienced precocious puberty and shifts in the hypothalamic GnRh axis; sensory enrichment counter-acted the advanced pubertal onset. Animals that underwent the NICU protocol also displayed maturational acceleration in terms of the loss of the rooting reflex in addition to hyperalgesia, a reduced preference for a novel conspecific, blunted basal plasma corticosterone and reduced hippocampal glucocorticoid receptor expression. These alterations closely simulated the clinical effects of early life adversity in terms of disruptions in the hypothalamic pituitary "stress" axis, social communication and engagement, tactile system processing, and accelerated maturation. Moreover, sensory enrichment attenuated many of these behavioral and neurophysiological alterations, and even slowed maturation. Overall, this supports the translatability of our novel rodent model and its potential utility in understanding how brain maturation and quality of early life experiences may interact to shape the integrity of stress and sensory system development. Future work must determine the appropriate modalities and parameters (e.g. patterning, timing) for effective sensory enrichment interventions.
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Human interaction in the NICU and its association with outcomes on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Early Hum Dev 2018; 127:6-14. [PMID: 30218893 DOI: 10.1016/j.earlhumdev.2018.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/11/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Extremely preterm infants represent one of the highest risk categories for impairments in social competence. Few studies have explored the impact of the neonatal intensive care unit (NICU) environment on social development. However, none have specifically analyzed the effects of the care structure the infant receives during hospitalization on later social competence indicators. OBJECTIVE To identify associations between the care structures received by extremely preterm infants in the NICU and scores on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) post-discharge. PARTICIPANTS 50 extremely preterm infants (mean gestational age: 25 weeks during hospitalization; mean chronological age during follow-up assessment: 2 years, 4 months). METHODS A secondary analysis of BITSEA data was performed exploring its relation to care structure data we extracted from electronic medical records (i.e., how much time infants were engaged in human interaction during their first thirty days of hospitalization and what types of interaction they were exposed to). RESULTS Extremely preterm infants spend a considerable amount of time alone during hospitalization (80%) with nursing care comprising the majority of human interaction. Infants who experienced greater human interaction scored significantly higher on the Social Competence (p = 0.01) and lower on the Dysregulation (p = 0.03) BITSEA subscales. CONCLUSION Human interaction and isolation in the NICU is associated with social competence and dysregulation outcomes in extremely preterm infants. Further research is needed to understand how various NICU care structures including centralized nursing teams, parental skin-to-skin care, and early therapy may synergistically play a positive role in developing social competence.
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81
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Gehrand AL, Hoeynck B, Jablonski M, Leonovicz C, Cullinan WE, Raff H. Programming of the Adult HPA Axis After Neonatal Separation and Environmental Stress in Male and Female Rats. Endocrinology 2018; 159:2777-2789. [PMID: 29878093 DOI: 10.1210/en.2018-00370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
Maternal separation, hypoxia, and hypothermia are common stressors in the premature neonate. Using our rat model of human prematurity, we evaluated sexual dimorphisms in the long-term effects of these neonatal stressors on behavior of the hypothalamic-pituitary-adrenal (HPA) axis in adult rats. Neonatal rats were exposed daily on postnatal days 2 to 6 to maternal separation with normoxia, with hypoxia allowing spontaneous hypothermia, with hypothermia per se, and with hypoxia while maintaining isothermia with external heat. The major findings were that (a) prior maternal-neonatal separation during the first week of postnatal life attenuated the plasma ACTH and corticosterone response to restraint stress in adult male but not female rats, (b) prior neonatal hypothermia augmented the plasma ACTH and corticosterone response to restraint stress in adult male rats, but not female rats, and (c) changes in hypothalamic, pituitary, and adrenal mRNA expression did not account for most of these HPA axis effects. Most of the programming effects on adult HPA axis was attributed to prior maternal-neonatal separation alone (with normoxia) because the addition of hypoxia with spontaneous hypothermia, hypothermia per se, and hypoxia while preventing hypothermia during maternal-neonatal separation had minimal effects on the HPA axis. These results may inform strategies to prevent sexually dimorphic sequelae of neonatal stress including those due to medical interventions.
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Affiliation(s)
- Ashley L Gehrand
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Brian Hoeynck
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Mack Jablonski
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - Cole Leonovicz
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
| | - William E Cullinan
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin
| | - Hershel Raff
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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82
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Frasch MG, Lobmaier SM, Stampalija T, Desplats P, Pallarés ME, Pastor V, Brocco MA, Wu HT, Schulkin J, Herry CL, Seely AJE, Metz GAS, Louzoun Y, Antonelli MC. Non-invasive biomarkers of fetal brain development reflecting prenatal stress: An integrative multi-scale multi-species perspective on data collection and analysis. Neurosci Biobehav Rev 2018; 117:165-183. [PMID: 29859198 DOI: 10.1016/j.neubiorev.2018.05.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023]
Abstract
Prenatal stress (PS) impacts early postnatal behavioural and cognitive development. This process of 'fetal programming' is mediated by the effects of the prenatal experience on the developing hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). We derive a multi-scale multi-species approach to devising preclinical and clinical studies to identify early non-invasively available pre- and postnatal biomarkers of PS. The multiple scales include brain epigenome, metabolome, microbiome and the ANS activity gauged via an array of advanced non-invasively obtainable properties of fetal heart rate fluctuations. The proposed framework has the potential to reveal mechanistic links between maternal stress during pregnancy and changes across these physiological scales. Such biomarkers may hence be useful as early and non-invasive predictors of neurodevelopmental trajectories influenced by the PS as well as follow-up indicators of success of therapeutic interventions to correct such altered neurodevelopmental trajectories. PS studies must be conducted on multiple scales derived from concerted observations in multiple animal models and human cohorts performed in an interactive and iterative manner and deploying machine learning for data synthesis, identification and validation of the best non-invasive detection and follow-up biomarkers, a prerequisite for designing effective therapeutic interventions.
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Affiliation(s)
- Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.
| | - Silvia M Lobmaier
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Mother and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Paula Desplats
- University of California, Departments of Neurosciences and Pathology, San Diego, USA
| | - María Eugenia Pallarés
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Verónica Pastor
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Marcela A Brocco
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín - Consejo Nacional de Investigaciones Científicas y Técnicas (UNSAM-CONICET), San Martín, Buenos Aires, Argentina
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, USA; Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | | | | | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Yoram Louzoun
- Bar-Ilan University, Department of Applied Mathematics, Israel
| | - Marta C Antonelli
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina
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83
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van Tilborg E, de Theije CGM, van Hal M, Wagenaar N, de Vries LS, Benders MJ, Rowitch DH, Nijboer CH. Origin and dynamics of oligodendrocytes in the developing brain: Implications for perinatal white matter injury. Glia 2017; 66:221-238. [PMID: 29134703 PMCID: PMC5765410 DOI: 10.1002/glia.23256] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 12/11/2022]
Abstract
Infants born prematurely are at high risk to develop white matter injury (WMI), due to exposure to hypoxic and/or inflammatory insults. Such perinatal insults negatively impact the maturation of oligodendrocytes (OLs), thereby causing deficits in myelination. To elucidate the precise pathophysiology underlying perinatal WMI, it is essential to fully understand the cellular mechanisms contributing to healthy/normal white matter development. OLs are responsible for myelination of axons. During brain development, OLs are generally derived from neuroepithelial zones, where neural stem cells committed to the OL lineage differentiate into OL precursor cells (OPCs). OPCs, in turn, develop into premyelinating OLs and finally mature into myelinating OLs. Recent studies revealed that OPCs develop in multiple waves and form potentially heterogeneous populations. Furthermore, it has been shown that myelination is a dynamic and plastic process with an excess of OPCs being generated and then abolished if not integrated into neural circuits. Myelination patterns between rodents and humans show high spatial and temporal similarity. Therefore, experimental studies on OL biology may provide novel insights into the pathophysiology of WMI in the preterm infant and offers new perspectives on potential treatments for these patients.
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Affiliation(s)
- Erik van Tilborg
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Caroline G M de Theije
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurik van Hal
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nienke Wagenaar
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David H Rowitch
- Department of Pediatrics, Eli and Edythe Broad Center for Stem Cell Research and Regeneration Medicine, University of California, San Francisco, San Francisco, California.,Department of Paediatrics, Wellcome Trust-MRC Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Cora H Nijboer
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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84
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Lee YN, Shin H. Analysis of Nurses’ Soothing Behaviors in Neonatal Intensive Care Unit: Focused on Babies with Bronchopulmonary Dysplasia. CHILD HEALTH NURSING RESEARCH 2017. [DOI: 10.4094/chnr.2017.23.4.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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85
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Raff H, Hoeynck B, Jablonski M, Leonovicz C, Phillips JM, Gehrand AL. Insulin sensitivity, leptin, adiponectin, resistin, and testosterone in adult male and female rats after maternal-neonatal separation and environmental stress. Am J Physiol Regul Integr Comp Physiol 2017; 314:R12-R21. [PMID: 28877872 DOI: 10.1152/ajpregu.00271.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Care of premature infants often requires parental and caregiver separation, particularly during hypoxic and hypothermic episodes. We have established a neonatal rat model of human prematurity involving maternal-neonatal separation and hypoxia with spontaneous hypothermia prevented by external heat. Adults previously exposed to these neonatal stressors show a sex difference in the insulin and glucose response to arginine stimulation suggesting a state of insulin resistance. The current study used this cohort of adult rats to evaluate insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR)], plasma adipokines (reflecting insulin resistance states), and testosterone. The major findings were that daily maternal-neonatal separation led to an increase in body weight and HOMA-IR in adult male and female rats and increased plasma leptin in adult male rats only; neither prior neonatal hypoxia (without or with body temperature control) nor neonatal hypothermia altered subsequent adult HOMA-IR or plasma adiponectin. Adult male-female differences in plasma leptin were lost with prior exposure to neonatal hypoxia or hypothermia; male-female differences in resistin were lost in the adults that were exposed to hypoxia and spontaneous hypothermia as neonates. Exposure of neonates to daily hypoxia without spontaneous hypothermia led to a decrease in plasma testosterone in adult male rats. We conclude that neonatal stressors result in subsequent adult sex-dependent increases in insulin resistance and adipokines and that our rat model of prematurity with hypoxia without hypothermia alters adult testosterone dynamics.
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Affiliation(s)
- Hershel Raff
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin.,Departments of Medicine, Surgery, and Physiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Brian Hoeynck
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Mack Jablonski
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Cole Leonovicz
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Jonathan M Phillips
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
| | - Ashley L Gehrand
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Aurora Research Institute , Milwaukee, Wisconsin
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86
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Philpott-Robinson K, Lane SJ, Korostenski L, Lane AE. The impact of the Neonatal Intensive Care Unit on sensory and developmental outcomes in infants born preterm: A scoping review. Br J Occup Ther 2017. [DOI: 10.1177/0308022617709761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Preterm infants admitted to the Neonatal Intensive Care Unit are at higher risk of poor neurodevelopmental and sensory outcomes. There is interest in establishing whether elements of the Neonatal Intensive Care Unit sensory environment may influence the sensory and overall development of these infants. Method The purpose of this scoping review was to provide a comprehensive overview of relevant research regarding the sensory elements of the Neonatal Intensive Care Unit, and their short- and long-term influence on preterm infants. This scoping review is underpinned by the six-stage framework by Arksey and O’Malley. Results There are few studies that have directly examined the influence of the Neonatal Intensive Care Unit environment upon the sensory and developmental outcomes of infants born preterm, in infancy. The findings of the studies included in this review suggest that the Neonatal Intensive Care Unit sensory environment may alter developmental trajectories of preterm infants. However, low-quality evidence exists in this field, with much of the literature being preliminary. Conclusion Further experimental studies are required that combine multiple methods of assessment to more rigorously understand the sensory characteristics of the Neonatal Intensive Care Unit, and their relationship with developmental outcomes across early childhood.
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Affiliation(s)
| | - Shelly J Lane
- Professor, School of Health Sciences, University of Newcastle, NSW, Australia
| | - Larissa Korostenski
- Neonatologist, Neonatal Intensive care, John Hunter Children's Hospital, NSW, Australia
| | - Alison E Lane
- Associate Professor, School of Health Sciences, University of Newcastle, NSW, Australia
- Priority Research Centre, GrowUpWell, University of Newcastle, NSW, Australia
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87
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Eidelman AI. Breastfeeding's Role in the Neurobiology of Parenting. Breastfeed Med 2017. [PMID: 28640645 DOI: 10.1089/bfm.2017.29046.aie] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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