Multimodal Neurological Enhancement Intervention for Self-regulation in Premature Infants

BACKGROUND

The neonatal intensive care unit is often a noisy, overstimulating environment that disrupts infants' regulation of physiological and behavioral states and interrupts caregiver bonding; however, infants benefit from early intervention, including the use of multimodal neurological enhancement (MMNE) intervention to provide appropriate neurodevelopmental stimulation. No one has investigated whether it assists infants in self-regulation.

PURPOSE

The purpose of this retrospective longitudinal analysis was to examine the effect of a music therapy intervention, MMNE, on self-regulation of premature infants as measured by changes in heart rate (HR).

METHODS

A convenience sample of 60 premature infants received 486 MMNE sessions provided by a board-certified music therapist (MT-BC). Documentation, taken during routine clinical services, involved recording infant's HRs from the standard monitor for 3 minutes at baseline, during, and after a 20-minute MMNE intervention.

RESULTS

Infants' mean HRs were decreased during and post-MMNE sessions compared with baseline (P < .004 and P < .001, respectively). Furthermore, infants with a baseline HR above 170 had significant decreases both during and after the MMNE session (P < .001 for both time periods).

IMPLICATIONS FOR PRACTICE

Results of this study support the existing body of evidence showing the benefits of MMNE with premature infants. Based on our results, MMNE may help infants develop and demonstrate self-regulation as indicated by maintained HRs during and after the intervention as well as a lowered HR for infants who had high HRs prior to MMNE.

IMPLICATIONS FOR RESEARCH

Further research needs to be done regarding how infants process MMNE and its potential to aid sensory processing.

The Neonatal Behavioral Assessment Scale (NBAS) and Newborn Behavioral Observations (NBO) system for supporting caregivers and improving outcomes in caregivers and their infants

BACKGROUND

The first three years of a child's life are a key period of physical, physiological, cognitive and social development, and the caregiver-infant relationship in early infancy plays an important role in influencing these aspects of development. Specifically, caregiver attunement facilitates the move from coregulation to self-regulation; a parent's ability to understand their infant's behaviour as communication is a key part of this process. Early, brief interventions such as the Neonatal Behavioral Assessment Scale (NBAS) or Neonatal Behavioral Observation (NBO) system are potential methods of improving outcomes for both infant and caregiver.

OBJECTIVES

To assess the effects of the NBAS and NBO system for improving caregiver-infant interaction and related outcomes in caregivers and newborn babies. Secondary objectives were to determine whether the NBAS and NBO are more effective for particular groups of infants or parents, and to identify the factors associated with increased effectiveness (e.g. timing, duration, etc.).

SEARCH METHODS

In September 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and four trials registers. We also handsearched reference lists of included studies and relevant systematic reviews, and we contacted the Brazelton Institute and searched its websites to identify any ongoing and unpublished studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs that had used at least one standardised measure to assess the effects of the NBAS or NBO versus inactive control for improving outcomes for caregivers and their infants.

DATA COLLECTION AND ANALYSIS

Two reviewer authors independently assessed the records retrieved from the search. One reviewer extracted data, and a second checked them for accuracy. We presented the results for each outcome in each study as standardised mean differences (SMDs) or as risk ratios (RR) with 95% confidence intervals (CIs). When appropriate, we combined the results in a meta-analysis using standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the overall quality of the body of evidence for each outcome.

MAIN RESULTS

We identified and included 16 RCTs in this review: 13 assessing the NBAS and 3 the NBO for improving outcomes in 851 randomised participants, including parents and their premature or newborn (aged 4 to 12 weeks) infants. All studies took place in the USA, and we judged all of them to be at high risk of bias.Seven studies involving 304 participants contributed data to one meta-analysis of the impact of the NBAS or NBO for caregiver-infant interaction, and the results suggest a significant, medium-sized difference between intervention and control groups (SMD -0.53, 95% CI -0.90 to -0.17; very low-quality evidence), with moderate heterogeneity (I² = 51%). Subgroup analysis comparing the two types of programmes (i.e. NBAS and NBO) found a medium but non-significant effect for the NBAS (-0.49, 95% CI -0.99 to 0.00, 5 studies), with high levels of heterogeneity (I² = 61%), compared with a significant, large effect size for the NBO (-0.69, 95% CI -1.18 to -0.20, 2 studies), with no heterogeneity (I² = 0.0%). A test for subgroup differences between the two models, however, was not significant. One study found a significant impact on the secondary outcome of caregiver knowledge (SMD -1.30, 95% CI -2.16 to -0.44; very low-quality evidence). There was no evidence of an impact on maternal depression. We did not identify any adverse effects.

AUTHORS' CONCLUSIONS

There is currently only very low-quality evidence for the effectiveness of the NBAS and NBO in terms of improving parent-infant interaction for mostly low-risk, first-time caregivers and their infants. Further research is underway regarding the effectiveness of the NBO and is necessary to corroborate these results.

Video feedback compared to treatment as usual in families with parent-child interactions problems: a randomized controlled trial

BACKGROUND

For the first time to our knowledge, short- and long-term effects of a multi-site randomized-controlled trial (RCT) of video feedback of infant-parent interaction (VIPI) intervention in naturalistic settings are published. The intervention targets families with children younger than 2 years old and parent-child interactions problems. Outcome variables were 1) observed parent-child interactions and 2) parent-reported child social and emotional development. Between-group differences of the moderating effects of parental symptoms of depression, personality disorders traits, and demographic variables were investigated.

METHOD

The study had a parallel-group, consecutively randomized, single-blinded design; participants were recruited by health- and social workers. Seventy-five families received VIPI, and 57 families received treatment as usual (TAU). Videotapes of each parent-child interactions were obtained before treatment, right after treatment, and at a 6-month follow-up and coded according to Biringen's Emotional Availability Scales. Parental symptoms of depression and personality disorder traits were included as possible moderators.

RESULTS

Evidence of a short-term effect of VIPI treatment on parent-child interactions was established, especially among depressed parents and parents with problematic interactions-and, to some extent, among parents with dependent and paranoid personality disorder traits. A long-term positive effect of VIPI compared with TAU on child social/emotional development was also evident. In a secondary analysis, VIPI had a direct positive effect on the depressive symptoms of parents compared with TAU.

CONCLUSION

The findings of the study support the use of VIPI as an intervention in families with interaction difficulties.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN99793905.