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Séassau A, Munos P, Gire C, Tosello B, Carchon I. Neonatal Care Unit Interventions on Preterm Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:999. [PMID: 37371231 DOI: 10.3390/children10060999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Prematurity is becoming a real public health issue as more and more children are being born prematurely, alongside a higher prevalence of neurodevelopmental disorders. Early intervention programs in Neonatal Intensive Care Units (NICUs) correspond to these uni- or multi-sensorial solicitations aiming to prevent and detect complications in order to support the development of preterm infants. This article aims to distinguish sensory intervention programs according to the gradient of the type of solicitations, uni- or multi-modal, and according to the function of the person who performs these interventions. Uni-sensorial interventions are essentially based on proprioceptive, gustatory, or odorant solicitations. They allow, in particular, a reduction of apneas that support the vegetative states of the preterm infant. On the other hand, the benefits of multi-sensory interventions seem to have a longer-term impact. Most of them allow the support of the transition from passive to active feeding, an increase in weight, and the improvement of sleep-wake cycles. These solicitations are often practiced by caregivers, but the intervention of parents appears optimal since they are the main co-regulators of their preterm child's needs. Thus, it is necessary to co-construct and train the parents in this neonatal care.
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Affiliation(s)
- Alexia Séassau
- Centre Hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | | | - Catherine Gire
- Department of Neonatology, Hôpital Nord de Marseille, 13015 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, Hôpital Nord de Marseille, 13015 Marseille, France
| | - Isabelle Carchon
- CHART Human and Artificial Cognition Laboratory at Ephe, École Pratique des Hautes Études-PSL Paris-Sciences-Lettres, 93322 Aubervilliers, France
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2
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Pighini MJ, Guhn M, Zumbo BD. Over-reaching with causality language in neurodevelopmental infant research: A methodological literature review. Early Hum Dev 2023; 182:105781. [PMID: 37257252 DOI: 10.1016/j.earlhumdev.2023.105781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND A methodological review of 78 empirical articles focusing on the neurodevelopmental outcomes of at-risk infants was conducted. AIMS To examine ways language and terminology are used to describe methods, present results, and/or state conclusions in studies published during 1994-2005, a decade reflecting major advances in neurodevelopmental research and in medical intervention. More specifically, to investigate to what extent the design of the study and the language in the results section aligned in regard to causality. METHODS A process of search and selection of studies published in pediatric journals was conducted through Google Scholar. Criteria of inclusion and exclusion, following PRISMA, were used. Selected studies reported neurodevelopmental outcomes of infants and young children considered at-risk, and were further categorized accordingly to their study designs. Language use in regard to whether the presentation and interpretation of results may convey causal relationships between birth risk factors and neurodevelopmental outcomes was examined following two analytical steps. RESULTS Forty out of 78 studies, (51.28 %) used causality-implying language (e.g., effect, predict, influence) notwithstanding that the study design was non-causal. CONCLUSIONS Anticipating the next generation of neurodevelopmental-outcomes research, a framework that aims to raise awareness of the importance of language use and the impact of causality-related terms often used in longitudinal studies is proposed. The objective is to avoid ambiguities and misunderstandings around causal or non-causal connections between birth risk factors and developmental outcomes across diverse audiences, including early intervention practitioners working directly with infants and their families.
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Affiliation(s)
- Maria J Pighini
- Faculty of Education, The University of British Columbia, Canada.
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, The University of British Columbia, Canada
| | - Bruno D Zumbo
- Faculty of Education, The University of British Columbia, Canada
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3
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Rodovanski GP, Réus BAB, Neves Dos Santos A. The effects of multisensory stimulation on the length of hospital stay and weight gain in hospitalized preterm infants: A systematic review with meta-analysis. Braz J Phys Ther 2023; 27:100468. [PMID: 36689887 PMCID: PMC9876839 DOI: 10.1016/j.bjpt.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/14/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multisensory interventions, such as auditory-tactile-visual-vestibular intervention (ATVV), tactile-kinesthesic stimulation (TKS), and the kangaroo mother care (KMC), have been commonly applied in hospitalized preterm infants. OBJECTIVE To investigate the effectiveness of the ATVV, the TKS, and the KMC combined to standard care compared to standard care in the length of hospital stay and weight gain of hospitalized preterm infants. METHODS PubMed, Scopus, Web of Science, Embase, SciELO Citation Index, CINAHL, Cochrane, and LILACS databases were searched from the inception to May 06, 2022 without language restrictions. We included randomized controlled trials. Two independent reviewers selected studies and extracted information about participants, interventions, outcomes, and the risk of bias. The body of evidence was synthesized through GRADE. Data were pooled using a random-effects model. RESULTS Sixty-three randomized clinical trials included a range of 20-488 preterm infants (gestational age=25 to <37 weeks). Evidence was low to very low due to risk of bias, inconsistency, and imprecision. Most studies presented some concerns about methodological quality. The ATVV and the KMC increased weight gain. The TKS reduced the number of days at the hospital and increased the daily weight gain and the total weight gain. CONCLUSIONS Adding ATVV, TKS, or KMC to standard care was more effective than standard care alone to improve weight gain. Only the TKS combined with standard care was more effective than standard care alone to reduce the length of hospital stay.
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Firmino C, Rodrigues M, Franco S, Ferreira J, Simões AR, Castro C, Fernandes JB. Nursing Interventions That Promote Sleep in Preterm Newborns in the Neonatal Intensive Care Units: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10953. [PMID: 36078666 PMCID: PMC9518210 DOI: 10.3390/ijerph191710953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Sleep is a crucial factor for the psychological and physiological well-being of any human being. In Neonatal Intensive Care Units, preterm newborns' sleep may be at risk due to medical and nursing care, environmental stimuli and manipulation. This review aims to identify the nurses' interventions that promote sleep in preterm newborns in the Neonatal Intensive Care Units. An integrative review was conducted following Whittemore and Knafl's methodology and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ScienceDirect, with a timeframe from 2010 to 2021. A total of 359 articles were initially identified. After selection and analysis, five studies were included in the sample. Interventions by nursing staff that promote sleep in preterm newborns in the Neonatal Intensive Care Units fall within three categories: environmental management, relaxation techniques and therapeutic positioning. Nurses play a vital role in implementing interventions that promote preterm newborns' sleep. They can positively affect preterm newborns' sleep by controlling environmental stimuli and applying relaxation techniques and therapeutic positioning to their care practices.
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Affiliation(s)
- Catarina Firmino
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Marlene Rodrigues
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Sofia Franco
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Judicília Ferreira
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Ana Rita Simões
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Cidália Castro
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal
| | - Júlio Belo Fernandes
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), 2829-511 Almada, Portugal
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5
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Moon HJ, Cho KS, An MY, Son DW. Effects of Supportive Positioning Training Video Program for Preterm Infants on the Knowledge and Performance of Nurses in the Neonatal Intensive Care Unit. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:25-34. [DOI: 10.1016/j.anr.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/28/2022] Open
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Rheeder A, Lubbe W, van der Walt CSJ, Pretorius R. Compliance With Best Practice Guidelines for Neurodevelopmental Supportive Care in South Africa: A Situational Analysis. J Perinat Neonatal Nurs 2021; 35:E83-E96. [PMID: 29194079 DOI: 10.1097/jpn.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurodevelopmental supportive care provides preterm infants with evidence-based care to ensure the best possible neurological outcomes. The study aimed to determine the compliance of current nursing care practices with best practice guidelines by means of a situational analysis. The situational analysis was done in 2 cycles in the neonatal intensive care units (n = 25) of a private healthcare provider in South Africa. Structured observations were done in cycle 1 using the Implementation of Neurodevelopmental Supportive Care checklist. Cycle 2 comprised focus group discussions to verify findings from cycle 1. Seventeen conclusion statements were formulated, which were thematically combined to be presented as 9 categories: neonatal intensive care unit design, individualized care, family-centered care, infant positioning, handling techniques, environmental manipulation, pain management, knowledge of infant behavior, and feeding. The conclusion statements identified improvement opportunities in current practice and offer suggestions, which can be used to guide an implementation strategy for best practice guidelines of neurodevelopmental supportive care in the neonatal intensive care units of the private healthcare group in future. Addressing improvement opportunities in all the categories will ensure that all aspects of the guideline requirements are met, resulting in a comprehensive strategy improving practice and patient outcomes.
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Affiliation(s)
- Aletta Rheeder
- INSINQ-Research to Advance Quality in Nursing and Midwifery, North-West University, Potchefstroom, South Africa (Ms Rheeder and Drs Lubbe and van der Walt); and Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa (Dr Pretorius)
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7
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From Neural Command to Robotic Use: The Role of Symmetry/Asymmetry in Postural and Locomotor Activities. Symmetry (Basel) 2021. [DOI: 10.3390/sym13101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article deepens a reflection on why and how symmetry/asymmetry affects the motor and postural behavior from the neural source, uterine development, child maturation, and how the notion of symmetry/asymmetry has been applied to walking robot design and control. The concepts of morphology and tensegrity are also presented to illustrate how the biological structures have been used in both sciences and arts. The development of the brain and the neuro-fascia-musculoskeletal system seems to be quite symmetric from the beginning of life through to complete maturity. The neural sources of movements (i.e., central pattern generators) are able to produce both symmetric or asymmetric responses to accommodate to environmental constraints and task requirements. Despite the fact that the human development is mainly symmetric, asymmetries already regulate neurological and physiological development. Laterality and sports training could affect natural musculoskeletal symmetry. The plasticity and flexibility of the nervous system allows the abilities to adapt and compensate for environmental constraints and musculoskeletal asymmetries in order to optimize the postural and movement control. For designing humanoid walking robots, symmetry approaches have been mainly used to reduce the complexity of the online calculation. Applications in neurological retraining and rehabilitation should also be considered.
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Bos M, Dokkum NH, Ravensbergen A, Kraft KE, Bos AF, Jaschke AC. Pilot study finds that performing live music therapy in intensive care units may be beneficial for infants' neurodevelopment. Acta Paediatr 2021; 110:2350-2351. [PMID: 33811376 PMCID: PMC8360105 DOI: 10.1111/apa.15867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mai Bos
- Division of Neonatology Department of Pediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Nienke H. Dokkum
- Division of Neonatology Department of Pediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Anne‐Greet Ravensbergen
- Division of Neonatology Department of Pediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Music Therapy ArtEZ University of the Arts Enschede The Netherlands
| | - Karianne E. Kraft
- Division of Neonatology Department of Pediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Arend F. Bos
- Division of Neonatology Department of Pediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Artur C. Jaschke
- Division of Neonatology Department of Pediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Music Therapy ArtEZ University of the Arts Enschede The Netherlands
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Groppetti D, Meazzi S, Filipe JFS, Colombani C, Panseri S, Zanzani SA, Palestrini C, Cannas S, Giordano A, Pecile A. Maternal and neonatal canine cortisol measurement in multiple matrices during the perinatal period: A pilot study. PLoS One 2021; 16:e0254842. [PMID: 34293013 PMCID: PMC8297866 DOI: 10.1371/journal.pone.0254842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
Stress exposure during perinatal period may lead to maternal cortisol increase that negatively affects the offspring development. In recent years, the interest on non-invasive sampling methods to measure cortisol as a marker of stress is increasing in both humans and animals. Indeed, discomfort due to blood collection may compromise the diagnostic outcome, mainly in uncooperative patients. So far, some alternative matrices but not milk have been explored in adult dogs, while no data are available on the neonate and paediatric live pups. This study aimed to measure cortisol concentration in different biological substrates in both dams (blood, saliva, hair and milk) and pups (saliva and hair) at established times from proestrus up to two months after parturition. For this purpose, five female German shepherd bitches and their 22 pups were enrolled. Cortisol concentration was assessed using the enzyme immunoassay kit (Salivary Cortisol ELISA kit, Salimetrics) after matrices appropriate preparation if required. Cortisol was measurable in all the substrates, except some milk samples below the detection limit. Maternal cortisol concentrations differed among the matrices (P <0.0001) with the highest values recorded in plasma (median 0.596 μg/dL) compared to saliva (median 0.159 μg/dL), hair (median 0.083 μg/dL) and milk (median 0.045 μg/dL). Cortisol in dams did not vary within the same matrix over time. In pups, salivary (median 0.295 μg/dL) cortisol was always higher than hair (median 0.049 μg/dL; P <0.0001). At birth (P = 0.01) and two months later (P = 0.05), neonatal salivary cortisol was higher compared to other samplings. The present study demonstrates the suitability of these innovative substrates for cortisol measurement, suggesting them as potential diagnostic support in canine neonatology and welfare.
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Affiliation(s)
- Debora Groppetti
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Sara Meazzi
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Joel F. S. Filipe
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Carla Colombani
- Department of Agricultural and Environmental Sciences—Production, Landscape, Agroenergy, Università degli Studi di Milano, Milan, Italy
| | - Sara Panseri
- Department of Veterinary Science for Health, Animal Production and Food Safety, Università degli Studi di Milano, Milan, Italy
| | - Sergio A. Zanzani
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Clara Palestrini
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Simona Cannas
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Alessia Giordano
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
- * E-mail:
| | - Alessandro Pecile
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
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Hazelhoff EM, Dudink J, Meijer JH, Kervezee L. Beginning to See the Light: Lessons Learned From the Development of the Circadian System for Optimizing Light Conditions in the Neonatal Intensive Care Unit. Front Neurosci 2021; 15:634034. [PMID: 33815040 PMCID: PMC8013699 DOI: 10.3389/fnins.2021.634034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
The circadian timing system optimizes health by temporally coordinating behavior and physiology. During mammalian gestation, fetal circadian rhythms are synchronized by the daily fluctuations in maternal body temperature, hormones and nutrients. Circadian disruption during pregnancy is associated with negative effects on developmental outcomes in the offspring, highlighting the importance of regular and robust 24-h rhythms over gestation. In the case of preterm birth (before 37 weeks of gestation), maternal cues no longer synchronize the neonate's circadian system, which may adversely affect the neonate. There is increasing evidence that introducing robust light-dark cycles in the Neonatal Intensive Care Unit has beneficial effects on clinical outcomes in preterm infants, such as weight gain and hospitalization time, compared to infants exposed to constant light or constant near-darkness. However, the biological basis for these effects and the relationship with the functional and anatomical development of the circadian system is not fully understood. In this review, we provide a concise overview of the effects of light-dark cycles on clinical outcomes of preterm neonates in the NICU and its alignment with the development of the circadian system.
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Affiliation(s)
- Esther M. Hazelhoff
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children’s Hospital and Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johanna H. Meijer
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Laura Kervezee
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
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Abstract
Approximately half of all pediatric tracheostomies are performed in infants younger than 1 year. Most tracheostomies in patients in the NICU are performed in cases of chronic respiratory failure requiring prolonged mechanical ventilation or upper airway obstruction. With improvements in ventilation and management of long-term intubation, indications for tracheostomy and perioperative management in this population continue to evolve. Evidence-based protocols to guide routine postoperative care, prevent and manage tracheostomy emergencies including accidental decannulation and tube obstruction, and attempt elective decannulation are sparse. Clinician awareness of safe tracheostomy practices and larger, prospective studies in infants are needed to improve clinical care of this vulnerable population.
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Affiliation(s)
- Julia Chang
- Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
| | - Douglas R Sidell
- Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
- Stanford Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford, CA
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KAYNAK S. YENİDOĞAN YOĞUNBAKIM ÜNİTESİNDE GELİŞİMSEL BAKIM. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.700450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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13
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[Characteristics of motor behaviour in premature infants during the first months of postnatal life. A literature review]. Rehabilitacion (Madr) 2020; 54:31-40. [PMID: 32007181 DOI: 10.1016/j.rh.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 06/02/2019] [Accepted: 09/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the characteristics of motor behaviour in premature infants during the first months of postnatal life, according to the available evidence. MATERIALS AND METHODS A systematic literature review was carried out; this method forms part of secondary studies under investigation and describes a phenomenon in detail based on primary sources of information. RESULTS The literature search in the databases consulted yielded 7,228 articles; of these, 15 more were identified through "snowball" search strategies. At the start of the screening process, 63 eligible records were chosen based on their title and summary, and 14 were excluded because they were duplicates. A total of 49 articles were selected for a full text revision and, of these, 37 were excluded because they did not meet all the inclusion criteria. Finally, 12 articles were selected to prepare the qualitative synthesis of the present research work. CONCLUSIONS In comparison with neonates born at term, premature infants demonstrate a particular motor repertoire, due to the immaturity of their systems; their motor behaviour follows a line of development mainly characterised by deficits in muscle tone, postural control, muscle balance, and antigravity muscle activation.
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McNair C, Campbell-Yeo M, Johnston C, Taddio A. Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update. Clin Perinatol 2019; 46:709-730. [PMID: 31653304 DOI: 10.1016/j.clp.2019.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available that may be used for these painful procedures, including swaddling/containment, pacifier/non-nutritive sucking, rocking/holding, breastfeeding and breastmilk, skin-to-skin care, sweet tasting solutions, music therapy, sensorial saturation, and parental presence. Adoption these interventions into routine clinical practice is feasible and should be a standard of care in quality health care for infants. This review summarizes the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions.
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Affiliation(s)
- Carol McNair
- Nursing and Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, IWK Health Centre, School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celeste Johnston
- Ingram School of Nursing, McGill University, Montreal, Canada; IWK Health Centre, 5850/5980 University Avenue, Halifax B3K 6R8, Canada
| | - Anna Taddio
- Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, 144 College Street, Toronto, Ontario M5S 3M2, Canada.
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15
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Body Posture Asymmetry in Prematurely Born Children at Six Years of Age. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9302520. [PMID: 29181408 PMCID: PMC5664194 DOI: 10.1155/2017/9302520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022]
Abstract
Aims The purpose of the study was to assess body posture asymmetries in the standing and sitting position in prematurely born children at six years of age. Study Design and Subjects We measured trunk symmetry in coronal plane. The study was carried out in a group of 101 children, aged 6-7 years, mean age of 6.63, including 50 preterm children born at gestational age <32 weeks (preterm group) and 51 full-term children (control group). Outcome Measures Trunk symmetry in coronal plane was measured using photogrammetric technique with Mora 4G CQ Elektronik. The subjects were examined in standing and sitting position. Statistical analyses were carried out using Shapiro-Wilk W-test, Student's t-test, Mann–Whitney U test, and Pearson's chi-squared test. Statistical significance was assumed at p < 0.05. Results No significant differences were found between the groups in the asymmetries identified in the relevant anthropometric points, relative to the position assumed during the examination or to the subjects' sex. Conclusions There are no significant differences in body posture in the coronal plane, between preterm children and full-term children. Premature birth does not have adverse effects related to body posture asymmetry in preterm children at the age of six.
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Bröring T, Oostrom KJ, Lafeber HN, Jansma EP, Oosterlaan J. Sensory modulation in preterm children: Theoretical perspective and systematic review. PLoS One 2017; 12:e0170828. [PMID: 28182680 PMCID: PMC5300179 DOI: 10.1371/journal.pone.0170828] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/11/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neurodevelopmental sequelae in preterm born children are generally considered to result from cerebral white matter damage and noxious effects of environmental factors in the neonatal intensive care unit (NICU). Cerebral white matter damage is associated with sensory processing problems in terms of registration, integration and modulation. However, research into sensory processing problems and, in particular, sensory modulation problems, is scarce in preterm children. AIM This review aims to integrate available evidence on sensory modulation problems in preterm infants and children (<37 weeks of gestation) and their association with neurocognitive and behavioral problems. METHOD Relevant studies were extracted from PubMed, EMBASE.com and PsycINFO following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria included assessment of sensory modulation in preterm born children (<37 weeks of gestation) or with prematurity as a risk factor. RESULTS Eighteen studies were included. Results of this review support the presence of sensory modulation problems in preterm children. Although prematurity may distort various aspects of sensory modulation, the nature and severity of sensory modulation problems differ widely between studies. CONCLUSIONS Sensory modulation problems may play a key role in understanding neurocognitive and behavioral sequelae in preterm children. Some support is found for a dose-response relationship between both white matter brain injury and length of NICU stay and sensory modulation problems.
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Affiliation(s)
- Tinka Bröring
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kim J. Oostrom
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Harrie N. Lafeber
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Elise P. Jansma
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research and Medical Library, VU University Medical Center, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
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Abstract
Knowledge of the effects of nursing-induced stress on short-term outcomes in preterm infants is limited. Effects of 2 standard nursing procedures-weighing and bathing-on autonomic and motor stability of preterm infants were studied during their hospitalization. Outcomes were evaluated during and after the procedures. Eleven preterm infants were observed between 32 and 35 weeks' postmenstrual age (PMA) (postnatal days range: 4-63). Neonatal responses were assessed according to the Synactive Theory of Development and nursing was performed taking into account Newborn Individualized Developmental Care and Assessment Program (NIDCAP) principles. Effects of the studied nursing procedures on infants' stability during and after their execution were evaluated by nonparametric statistics. During monitored procedures, stress responses in autonomic and motor systems were observed at all PMAs. However, after 32 weeks' PMA, preterm infants also showed an autonomic and motor stability recovery 5 minutes after procedure completion. Contrary to our hypothesis, preterm infants showed to be stressed by weighing and bathing procedures up to 35 weeks' PMA. However, if facilitated and supported after nursing conclusion by interventions such as swaddling and nesting, according to NIDCAP principles, they recovered autonomic and motor stability by 5 minutes after ending procedures.
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18
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Crozier SC, Goodson JZ, Mackay ML, Synnes AR, Grunau RE, Miller SP, Zwicker JG. Sensory Processing Patterns in Children Born Very Preterm. Am J Occup Ther 2016; 70:7001220050p1-7. [PMID: 26709425 DOI: 10.5014/ajot.2016.018747] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We describe the prevalence and type of sensory processing differences in children born very preterm and determine associations with neonatal risk factors. METHOD We assessed sensory processing patterns using the Short Sensory Profile in a retrospective cohort of 160 children age 4 yr born very preterm (≤ 32 wk gestational age). Data analyses included descriptive statistics to describe the prevalence of sensory processing patterns and logistic regression to examine associations with neonatal risk factors. RESULTS Almost half of our cohort (46%) exhibited atypical sensory processing patterns. Lower Apgar scores (p = .03) and longer length of stay in the neonatal intensive care unit (NICU; p = .02) independently predicted atypical sensory processing patterns. CONCLUSION Children born very preterm are at increased risk for sensory processing differences, which are associated with perinatal risk factors and length of stay in the NICU. Routine evaluation for sensory processing differences of children born preterm is recommended.
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Affiliation(s)
- Stephanie C Crozier
- Stephanie C. Crozier, MOT, is Graduate, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer Z Goodson
- Jennifer Z. Goodson, MOT, is Graduate, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Margot L Mackay
- Margot L. Mackay, BSc OT, is Occupational Therapist, Neonatal Follow-Up Program, British Columbia Children's and Women's Hospitals, Vancouver, Canada
| | - Anne R Synnes
- Anne R. Synnes, MDCM, MHSc, is Neonatalogist, British Columbia Children's and Women's Hospitals; Clinical Investigator, Child and Family Research Institute; and Clinical Professor, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ruth E Grunau
- Ruth E. Grunau, PhD, is Professor, Department of Pediatrics, University of British Columbia, and Senior Scientist, Child and Family Research Institute, Vancouver, Canada
| | - Steven P Miller
- Steven P. Miller, MDCM, is Affiliate Scientist, Child and Family Research Institute, and Affiliate Professor, Department of Pediatrics, University of British Columbia, Vancouver, Canada; and Professor, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jill G Zwicker
- Jill G. Zwicker, PhD, OT(C), is Assistant Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia; Scientist Level 1, Child and Family Research Institute; Associate Member, Department of Pediatrics, University of British Columbia; and Clinician Scientist, Sunny Hill Health Centre for Children, Vancouver, Canada;
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A Meta-Analysis of Preterm Infant Massage: An Ancient Practice With Contemporary Applications. MCN Am J Matern Child Nurs 2016; 40:344-58. [PMID: 26302088 DOI: 10.1097/nmc.0000000000000177] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of massage on the short- and long-term outcomes of preterm infants. METHODS A search was conducted using the PRISMA framework. Validity of included studies was assessed using criteria defined by the Cochrane Collaboration that was carried out independently by two reviewers with a third reviewer to resolve differences. RESULTS Thirty-four studies met the inclusion criteria, 3 were quasi-experimental, 1 was a pilot study, and the remaining 30 were randomized controlled trials (RCTs). The outcomes that could be used in the meta-analysis and found in more than three studies noted that massage improved daily weight gain by 0.53 g (95% CI = 0.28-0.78), p < 0.0001, and resulted in a significant improvement in mental scores by 7.89 points (95% CI = 0.96-14.82), p < 0.03. There were no significant effects on length of hospital stay, caloric intake, or weight at discharge. Other outcomes were not analyzed either because the units of measurement varied or because means and standard deviations were not provided by the authors. These included vagal activity and heart rate variability (5 studies), neurobehavioral states (7 studies), pain responses (2 studies), maternal outcomes (2 studies), breastfeeding (2 studies), and physiologic parameters: bone formation (2 studies), immunologic markers (1 study), brain maturity (1 study), and temperature (1 study). The quality of the studies was variable with methods of randomization and blinding of assessment unclear in 18 of the 34 studies. CONCLUSIONS Massage therapy could be a comforting measure for infants in the NICU to improve weight gain and enhance mental development. However, the high heterogeneity, the weak quality in some studies, and the lack of a scientific association between massage and developmental outcomes preclude making definite recommendations and highlight the need for further RCTs to contribute to the existing body of knowledge.
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Dunsirn S, Smyser C, Liao S, Inder T, Pineda R. Defining the nature and implications of head turn preference in the preterm infant. Early Hum Dev 2016; 96:53-60. [PMID: 27064959 PMCID: PMC4867076 DOI: 10.1016/j.earlhumdev.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 11/16/2022]
Abstract
AIM To determine the relationship of head turn preference in the preterm infant to: 1) perinatal medical factors, 2) neonatal neurobehavior, and/or 3) infant neurodevelopmental outcomes. METHODS Seventy preterm infants born ≤30weeks gestation were enrolled at birth. Detailed information regarding neonatal intensive care unit (NICU) medical course was compiled for each infant. Neurobehavioral testing was performed during NICU hospitalization. Head turn preference was quantified at term equivalent age using a newly developed scale. Infants returned at age two years for standardized developmental testing. RESULTS All infants demonstrated a head turning preference, with most preferring the right side (n=51, 77%). Fifty-five infants (79%) had moderate to severe head turn preference. Head turn preference was associated with 1) medical severity (hours of inotrope use, p=0.02; oxygen requirement at 36weeks postmenstrual age, p=0.03), 2) worse neurobehavioral performance (decreased self-regulation, p=0.007; more sub-optimal reflexes p=0.006), and 3) worse developmental outcome at age two years (poorer fine motor, p=0.02). INTERPRETATION Medical factors in the NICU appear to be associated with the development of a head turn preference. Increased severity of head turn preference may be a marker for poor developmental outcome. Early identification may inform therapeutic interventions designed to minimize symptoms and optimize neurodevelopmental outcome.
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Affiliation(s)
- Sonya Dunsirn
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States,Corresponding author at: OTD, OTR/L Washington University School of Medicine Program in Occupational Therapy, 4444 Forest Park Parkway, St Louis, MO 63116, United States
| | - Christopher Smyser
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States,Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States,Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Steve Liao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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Cardin AD, Rens L, Stewart S, Danner-Bowman K, McCarley R, Kopsas R. Neuroprotective Core Measures 1–7: A Developmental Care Journey: Transformations in NICU Design and Caregiving Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Abstract
PURPOSE The benefits of kangaroo care (KC) are well supported by previously published studies, yet KC is offered inconsistently and faces obstacles in the neonatal intensive care unit (NICU). The March of Dimes designed Close to Me to facilitate and increase KC in NICUs. The program incorporates KC education for nurses and parents, as well as awareness and comfort components. The purpose of this study was to assess whether Close to Me increased favorable attitudes toward KC among nurses and parents, and changed nurse and parent behaviors to implement KC earlier, more often and for longer duration. SUBJECTS AND DESIGN This study took place in 5 NICUs with 48 nurse participants and 101 parent participants. It used a pre-/postprogram implementation design for nurses and a nonequivalent comparison versus intervention group design for parents. METHODS Nurses and parents were surveyed on knowledge, attitudes, perceived behavioral control, and behavior. Comparisons were made pre- and postprogram implementation for nurses and between intervention and comparison groups for parents. Nurse focus groups were conducted pre- and postimplementation and analyzed using a constant comparative analysis method. Parents recorded care behaviors and satisfaction in journals, which were analyzed similarly. MAIN OUTCOME MEASURES/PRINCIPAL RESULTS After the Close to Me intervention, nurses reported more positive attitudes toward KC (P = .04), increased transfer of ventilated babies from incubators to parents (P = .01), and more parents requesting KC. Parents who received Close to Me had greater knowledge about KC (P = .03) compared with those who did not. With the Close to Me intervention, all babies born at less than 28 weeks' gestation had KC by the age of 12 days, whereas without the intervention, some did not have KC until the age of 31 days (P < .05). CONCLUSIONS March of Dimes Close to Me improved knowledge and behavior regarding KC in NICUs. By offering KC education to parents, providing KC awareness and comfort components, and providing information and encouragement on the benefits and feasibility of KC to nurses, hospitals can potentially promote earlier and more frequent use of KC, particularly with infants born less than 28 weeks' gestation.
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23
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Rosenstock A, van Manen M. Adolescent parenting in the neonatal intensive care unit. J Adolesc Health 2014; 55:723-9. [PMID: 25287982 DOI: 10.1016/j.jadohealth.2014.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/16/2014] [Accepted: 08/01/2014] [Indexed: 11/26/2022]
Abstract
This review presents data from studies that report on adolescent parents as part of larger neonatal intensive care unit (NICU) parent populations, as well as studies where adolescent parents are given central consideration. A systematic search for English publications from 1990 onward relevant to adolescent parenting in the NICU was conducted. Most studies reporting on adolescent parents focus on parental stress or parenting practices in the NICU. A few studies examine parent-staff communication, parental needs, and parent intervention programs. One study presents a qualitative examination of teenage mothers' experiences in the NICU. Areas for further research include experiences of younger adolescent parents, adolescent fathers, and same-sex partners; issues unique to adolescent parents; and support programs for adolescent parents in the NICU.
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Affiliation(s)
- Amanda Rosenstock
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Michael van Manen
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada; Neonatal-Perinatal Medicine, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.
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24
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Pereira FL, Nogueira de Góes FDS, Fonseca LMM, Scochi CGS, Castral TC, Leite AM. [Handling of preterm infants in a neonatal intensive care unit]. Rev Esc Enferm USP 2014; 47:1272-8. [PMID: 24626374 DOI: 10.1590/s0080-623420130000600003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 07/31/2013] [Indexed: 11/21/2022] Open
Abstract
While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.
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Affiliation(s)
- Fabíola Lima Pereira
- Unidade de Cuidado Intensivo Neonatal, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil, Ribeirão PretoSP, Mestre. Enfermeira da Unidade de Cuidado Intensivo Neonatal , Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brasil
| | - Fernanda dos Santos Nogueira de Góes
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Brasil, Ribeirão PretoSP, Enfermeira. Doutora. Professora Associada, Escola de Enfermagem de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brasil
| | - Luciana Mara Monti Fonseca
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Brasil, Ribeirão PretoSP, Enfermeira. Doutora. Professora Associada, Escola de Enfermagem de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brasil
| | - Carmen Gracinda Silvan Scochi
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Brasil, Ribeirão PretoSP, Enfermeira. Doutora. Professora Titular, Escola de Enfermagem de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brasil
| | - Thaíla Corrêa Castral
- Faculdade de Enfermagem, Universidade Federal de Goiás, Brasil, GoiâniaGO, Enfermeira. Doutora. Professora Adjunta, Faculdade de Enfermagem , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Adriana Moraes Leite
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Brasil, Ribeirão PretoSP, Enfermeira. Doutora. Professora Associada, Escola de Enfermagem de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brasil
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25
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Very preterm birth: maternal experiences of the neonatal intensive care environment. J Perinatol 2014; 34:555-61. [PMID: 24651730 PMCID: PMC4154363 DOI: 10.1038/jp.2014.43] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/17/2014] [Accepted: 02/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Examine sources, predictors and child outcomes associated with neonatal intensive care unit (NICU)-related stress for mothers of infants born very preterm (VPT). STUDY DESIGN Participants were 133 mothers of VPT infants admitted to a regional level-III NICU. At term equivalent, mothers completed the Parental Stressor Scale: NICU and were interviewed about their psychological well-being and family circumstances. Infant clinical data were also collected. At corrected age 4 years, 49 children were assessed for cognition, language and socio-emotional development. RESULT Mothers reported moderate to low stress, with parental role alteration considered most stressful and parent-staff communications least stressful. Predictors of overall stress included maternal educational underachievement, stressful life events, postnatal depression and infant unsettled-irregular behavior. NICU-related stress was associated with child anxiety and poorer language development. CONCLUSION Parental well-being is an important focus of care in the neonatal setting. Strategies are needed to optimize early engagement and reduce stress levels to assist improved child outcomes.
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26
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So S, Rogers A, Patterson C, Drew W, Maxwell J, Darch J, Hoyle C, Patterson S, Pollock-BarZiv S. Parental experiences of a developmentally focused care program for infants and children during prolonged hospitalization. J Child Health Care 2014; 18:156-67. [PMID: 23723301 DOI: 10.1177/1367493513485476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigates parental experiences and perceptions of the care received during their child's prolonged hospitalization. It relates this care to the Beanstalk Program (BP), a develop-mentally focused care program provided to these families within an acute care hospital setting. A total of 20 parents (of children hospitalized between 1-15 months) completed the Measures of Processes of Care (MPOC-20) with additional questions regarding the BP. Scores rate the extent of the health-care provider's behaviour as perceived by the family, ranging from 'to a great extent' (7) to 'never' (1). Parents rated Respectful and Supportive Care (6.33) as highest, while Providing General Information (5.65) was rated lowest. Eleven parents participated in a follow-up, qualitative, semi-structured interview. Interview data generated key themes: (a) parents strive for positive and normal experiences for their child within the hospital environment; (b) parents value the focus on child development in the midst of their child's complex medical care; and (c) appropriate developmentally focused education helps parents shift from feeling overwhelmed with a medically ill child to instilling feelings of confidence and empowerment to care for their child and transition home. These results emphasize the importance of enhancing child development for hospitalized infants and young children through programs such as the BP.
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Affiliation(s)
| | | | | | - Wendy Drew
- Hospital for Sick Children, Toronto, Canada
| | | | - Jane Darch
- Hospital for Sick Children, Toronto, Canada
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Picciolini O, Porro M, Meazza A, Giannì ML, Rivoli C, Lucco G, Barretta F, Bonzini M, Mosca F. Early exposure to maternal voice: effects on preterm infants development. Early Hum Dev 2014; 90:287-92. [PMID: 24661448 DOI: 10.1016/j.earlhumdev.2014.03.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preterm infants complete their development in Neonatal Intensive Care Unit being exposed to environmental stimuli that lead to the early maturation of the sensory systems. It is known that the fetus perceives sounds and reacts to them with movements since the 26th-28th week of gestational age. Maternal voice represents a source of sensory stimulation for the fetus. AIMS To investigate the effect of the exposure to maternal voice, administered by bone conduction, on preterm infants autonomic and neurobehavioral development. STUDY DESIGN Longitudinal, explorative, case control study. SUBJECTS 71 preterm infants with birth weight <1500g, born adequate for gestational age OUTCOME MEASURES vital and neurobehavioral parameters at term, neurofunctional assessment at 3 and 6months of corrected age. RESULTS Infants in the treatment group had lower heart rate values and a higher proportion of stable skin color at each study point as compared to the control group. The scores in the visual attention performance and in the quality of the general movements at term were better in the treatment group than in the control one. Neurofunctional assessment score at 3months of corrected age was higher in the treatment group whereas no difference between the two groups was detected at 6months of corrected age. CONCLUSIONS Early exposure to maternal voice exerts a beneficial effect on preterm infants autonomic and neurobehavioral development.
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Affiliation(s)
- Odoardo Picciolini
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Matteo Porro
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
| | - Anna Meazza
- Audio-psycho phonology Italian Association, Italy
| | - Maria Lorella Giannì
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Chiara Rivoli
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Giovanna Lucco
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Francesco Barretta
- Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Matteo Bonzini
- Epidemiology and Preventive Medicine Research Centre, University of Insubria, Varese
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
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Dearn T, Shoemark H. The Effect of Maternal Presence on Premature Infant Response to Recorded Music. J Obstet Gynecol Neonatal Nurs 2014; 43:341-50. [DOI: 10.1111/1552-6909.12303] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Neonatal nurses' and therapists' perceptions of positioning for preterm infants in the neonatal intensive care unit. Neonatal Netw 2014; 32:110-6. [PMID: 23477978 DOI: 10.1891/0730-0832.32.2.110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Determine perceptions about positioning for preterm infants in the neonatal intensive care unit (NI CU). DESIGN Twenty-item survey. SAMPLE Neonatal nurses (n = 68) and speech, physical, and occupational therapists (n = 8). MAIN OUTCOME VARIABLE Perceptions about positioning were obtained, and differences in perceptions between nurses and therapists were explored. RESULTS Ninety-nine percent of respondents agreed that positioning is important for the well-being of the infant. Sixty-two percent of nurses and 86 percent of therapists identified the Dandle ROO as the ideal method of neonatal positioning. Forty-four percent of nurses and 57 percent of therapists reported that the Dandle ROO is the easiest positioning method to use in the NICU. Some perceptions differed: Therapists were more likely to report that the SleepSack does not hold the infant in good alignment. Nurses were more likely to report that the infant does not sleep well in traditional positioning.
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Madlinger-Lewis L, Reynolds L, Zarem C, Crapnell T, Inder T, Pineda R. The effects of alternative positioning on preterm infants in the neonatal intensive care unit: a randomized clinical trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:490-497. [PMID: 24374602 PMCID: PMC3938096 DOI: 10.1016/j.ridd.2013.11.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 05/31/2023]
Abstract
There is a paucity of studies that have investigated the developmental benefits of positioning in the neonatal intensive care unit. The purpose of this study was to investigate the effects of a new, alternative positioning device compared to traditional positioning methods used with preterm infants. In this randomized, blinded clinical trial, one hundred preterm infants (born ≤ 32 weeks gestation) from a level III neonatal intensive care unit in the United States were enrolled at birth. Participants were randomized to be positioned in the alternative positioning device or to traditional positioning methods for their length of stay in the neonatal intensive care unit. Infants were assessed using the NICU Network Neurobehavioral Scale between 35-40 weeks postmenstrual age. Clinical and feeding outcomes were also captured. Linear and logistic regressions were used to investigate differences in neurobehavioral outcome, feeding performance, and medical outcomes. Infants in the alternative positioning arm of the study demonstrated less asymmetry of reflex and motor responses on the NICU Network Neurobehavioral Scale (p=0.04; adjusted mean difference=0.90, 95% CI 0.05-1.75) than those positioned using traditional positioning methods. No other significant differences were observed. Reduction in asymmetry among preterm infants is an important benefit of alternative positioning, as symmetrical movement and responses are crucial for early development. However, it will be important to follow this sample of preterm infants to determine the effects of early positioning on neurodevelopmental outcome in childhood.
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Affiliation(s)
- Laura Madlinger-Lewis
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States
| | - Lauren Reynolds
- Washington University School of Medicine, Department of Psychiatry, 660 South Euclid, Saint Louis, MO 63110, United States
| | - Cori Zarem
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States
| | - Tara Crapnell
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States
| | - Terrie Inder
- Washington University School of Medicine, Department of Pediatrics, 1 Children's Place, Saint Louis, MO 63110, United States; Washington University School of Medicine, Department of Neurology, 1 Children's Place, Saint Louis, MO 63110, United States; Washington University School of Medicine, Department of Radiology, 1 Children's Place, Saint Louis, MO 63110, United States
| | - Roberta Pineda
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States; Washington University School of Medicine, Department of Pediatrics, 1 Children's Place, Saint Louis, MO 63110, United States.
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Light Reduction Capabilities of Homemade and Commercial Incubator Covers in NICU. ISRN NURSING 2013; 2013:502393. [PMID: 24286012 PMCID: PMC3830803 DOI: 10.1155/2013/502393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/10/2013] [Indexed: 11/27/2022]
Abstract
Reduction of high-risk neonates' exposure to aversive light stimulation is an important component of developmentally supportive care. In neonatal intensive care unit (NICU), usually light is reduced by reducing the room's light level or by using incubator covers. Many types of incubator covers are in use, including homemade and commercial covers. A comparative study was used to determine the light reducing capabilities of 19 homemade incubator covers, 2 commercial covers, and 1 receiving blanket. The covers were tested by covering and uncovering an incubator and an oxygen hood in the NICU during daytime and nighttime lightings. The light reducing capabilities value was determined for each cover using an Extech light dosimeter when the cover was placed over and removed from an oxyhood, and an incubator. The study showed that the light reducing capability of the commercial covers was 91.2%, the homemade covers capability was 72.1%, and the receiving blankets capability was 55.1%. A significant difference between the commercial and homemade covers was found (F = 452.50, P < 0.00). Commercial incubator covers are the most effective covers to achieve light reduction; homemade covers can be effective if made large enough so that they completely cover all sides of the incubator.
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McNair C, Campbell Yeo M, Johnston C, Taddio A. Nonpharmacological management of pain during common needle puncture procedures in infants: current research evidence and practical considerations. Clin Perinatol 2013; 40:493-508. [PMID: 23972753 DOI: 10.1016/j.clp.2013.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
All infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available for these painful procedures, including swaddling, holding, skin-to-skin care, pacifier, sweet-tasting solutions, and breast-feeding. Adoption of nonpharmacologic pain-relieving interventions into routine clinical practice is feasible and should be a standard of care in the delivery of quality health care for infants. This review summarizes current knowledge about the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions for future research.
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Affiliation(s)
- Carol McNair
- Nursing, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
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Reynolds LC, Duncan MM, Smith GC, Mathur A, Neil J, Inder T, Pineda RG. Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior. J Perinatol 2013; 33:636-41. [PMID: 23412640 PMCID: PMC3700586 DOI: 10.1038/jp.2013.4] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/06/2012] [Accepted: 01/04/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the effects of parental presence and infant holding in the neonatal intensive care unit (NICU) on neurobehavior at term equivalent. STUDY DESIGN Prospective cohort enrolled 81 infants born 30 weeks gestation. Nurses tracked parent visitation, holding and skin-to-skin care throughout the NICU hospitalization. At term, the NICU Network Neurobehavioral Scale was administered. Associations between visitation, holding and early neurobehavior were determined using linear and logistic regression. RESULT The mean hours per week of parent visitation was 21.33±20.88 (median=13.90; interquartile range 10.10 to 23.60). Infants were held an average of 2.29±1.47 days per week (median=2.00; interquartile range 1.20 to 3.10). Over the hospital stay, visitation hours decreased (P=0.01), while holding frequencies increased (P<0.001). More visitation was associated with better quality of movement (P=0.02), less arousal (P=0.01), less excitability (P=0.03), more lethargy (P=0.01) and more hypotonia (P<0.01). More holding was associated with improved quality of movement (P<0.01), less stress (P<0.01), less arousal (P=0.04) and less excitability (P<0.01). CONCLUSION Infants of caregivers who were visited and held more often in the NICU had differences in early neurobehavior by term equivalent, which supports the need for and importance of early parenting in the NICU.
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Affiliation(s)
- Lauren C. Reynolds
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Mallory M. Duncan
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Gillian C. Smith
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jeffrey Neil
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Terrie Inder
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Roberta G. Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
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Sleep-wake cycling in a neonate admitted to the NICU: a video-EEG case study during hypothermia treatment. J Perinat Neonatal Nurs 2013; 27:263-73. [PMID: 23899806 DOI: 10.1097/jpn.0b013e31829dc2d3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This retrospective case study describes the sleep-wake cycles of an infant in the neonatal intensive care unit. We analyzed video-electroencephalographic recording of the term infant monitored during treatment with therapeutic hypothermia for hypoxic-ischemic encephalopathy. The continuous video-electroencephalographic recording over a 4-day period also allowed us to describe the following dimensions of daily care in relation to the infant's sleep-wake states: (1) handling by professional and parent caregivers and (2) stress, pain, and analgesia. Physical contact constituted 17% to 36% of each 24-hour period. The infant's care was fragmented, with a mean of 3 to 4 physical contacts per hour. As a result, the structure of infant sleep was altered by the increased amount of awake and quiet sleep. The number of painful procedures ranged from 5 to 24 per day. Nurses were the main care providers. Parents had more contact after the infant was rewarmed. This case study suggests that neonatal intensive care unit infants are exposed to frequent handling and stress as well as altered sleep. The cumulative negative impact of frequent handling and sleep fragmentation may go unnoticed by caregivers focused on episodes of care. Continuous video-electroencephalographic monitoring is a useful tool for longitudinal evaluation of infant sleep and responses to caregiving in the neonatal intensive care unit.
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Bhat BV, Adhisivam B. Neurosensory stimulation among preterm infants. Indian J Pediatr 2013; 80:444-5. [PMID: 23696153 DOI: 10.1007/s12098-013-1077-9] [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] [Received: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
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Shaker CS. Cue-based Co-regulated Feeding in the Neonatal Intensive Care Unit: Supporting Parents in Learning to Feed Their Preterm Infant. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2012.12.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Matsota P, Christodoulopoulou T, Smyrnioti ME, Pandazi A, Kanellopoulos I, Koursoumi E, Karamanis P, Kostopanagiotou G. Music's use for anesthesia and analgesia. J Altern Complement Med 2012; 19:298-307. [PMID: 22989077 DOI: 10.1089/acm.2010.0235] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review article provides an overview of published data regarding the involvement of music in anesthesia practice. Music is an important topic for research in different fields of anesthesiology. The use of music preoperatively is aimed at reducing anxiety, stress, and fear. However, the effect of music on perception of pain intraoperatively is controversial, according to studies of both adults and children undergoing various surgical procedures under general and/or regional anesthesia. In postoperative pain management, postanesthesia care, and neonatal intensive care, music can be a complementary method for reducing pain, anxiety, and stress. Music is a mild anxiolytic, but it is relatively ineffective when a pain stimulus is severe. However, music is inexpensive, easily administered, and free of adverse effects, and as such, can serve as complementary method for treating perioperative stress and for acute and chronic pain management, even though music's effectiveness depends on each individual patient's disposition and severity of pain stimulus.
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Affiliation(s)
- Paraskevi Matsota
- 2 nd Department of Anesthesiology, University of Athens School of Medicine, Attikon University Hospital, Chaidari, Athens, Greece.
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Integrative literature review defining evidence-based neurodevelopmental supportive care of the preterm infant. J Perinat Neonatal Nurs 2012; 26:251-9. [PMID: 22843007 DOI: 10.1097/jpn.0b013e3182650b7e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurodevelopmental supportive care (NDSC) is a well-researched topic and extensive evidence is available on its benefits in terms of the outcome for preterm infants. The programs, strategies, and individual elements of NDSC have been evaluated; however, knowledge and implementation of the developmental care approach is fragmented and the evidence base for elements of NDSC that make up the holistic model is not explicitly documented. The aim of this study was to identify and critically appraise the methodologic quality of relevant research studies and synthesize the current best available evidence of NDSC. A comprehensive investigation of NDSC including studies using research methods other than clinical trials may provide a combination of results from several primary studies, therefore an integrative literature review was utilized as the method of choice. Sixteen research articles were found to be of good methodologic quality and level and strength of evidence after critical appraisal. They described or defined the elements of NDSC explicitly. Extraction of data from these articles contributed to the formulation of 25 conclusion statements. Each of these statements could be grouped under 9 categories that resulted from a process of synthesis, and each of these categories could be substantiated from its literature support, clinical impact, and supporting evidence, including the specific literature references and volume and level of evidence associated with that element of NDSC, providing the evidence base for defining NDSC.
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Montirosso R, Del Prete A, Bellù R, Tronick E, Borgatti R. Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics 2012; 129:e1129-37. [PMID: 22492762 PMCID: PMC4074610 DOI: 10.1542/peds.2011-0813] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the relation between the neurobehavior of very preterm infants and the level of NICU quality of developmental care. METHODS The neurobehavior of 178 very preterm infants (gestational age ≤29 weeks and/or birth weight ≤1500 g) from 25 NICUs participating in a large multicenter, longitudinal study (Neonatal Adequate Care for Quality of Life, NEO-ACQUA) was examined with a standardized neurobehavioral assessment, the NICU Network Neurobehavioral Scale (NNNS). A questionnaire, the NEO-ACQUA Quality of Care Checklist was used to evaluate the level of developmental care in each of the NICUs. A factor analyses applied to NEO-ACQUA Quality of Care Checklist produced 2 main factors: (1) the infant-centered care (ICC) index, which measures parents' involvement in the care of their infant and other developmentally oriented care interventions, and (2) the infant pain management (IPM) index, which measures the NICU approach to and the procedures used for reducing infant pain. The relations between NNNS neurobehavioral scores and the 2 indexes were evaluated. RESULTS Infants from NICUs with high scores on the ICC evidenced higher attention and regulation, less excitability and hypotonicity, and lower stress/abstinence NNNS scores than infants from low-care units. Infants from NICUs with high scores on the IPM evidenced higher attention and arousal, lower lethargy and nonoptimal reflexes NNNS scores than preterm infants from low-scoring NICUs. CONCLUSIONS Very preterm infant neurobehavior was associated with higher levels of developmental care both in ICC and in IPM, suggesting that these practices support better neurobehavioral stability.
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Affiliation(s)
- Rosario Montirosso
- Centre for the Study of Social Emotional Development of the at Risk Infant, Scientific Institute E. Medea, Bosisio Parini, Lecco, Italy.
| | | | | | - Ed Tronick
- Child Development Unit, Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts; and,Department of Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Procedural pain management for neonates using nonpharmacological strategies: Part 1: sensorial interventions. Adv Neonatal Care 2011; 11:235-41. [PMID: 22123343 DOI: 10.1097/anc.0b013e318225a2c2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neonates who are born preterm and are admitted to neonatal intensive care units endure frequent procedures that may be painful. Nonpharmacological interventions that have been studied to relieve their pain may be categorized in 2 main groups according to their nature: interventions that focus on creating a favorable environment and offering pleasant sensorial stimuli and interventions that are centered on maternal care. These interventions may be considered within the philosophy of developmental care, since they are aimed at adjusting the environment to the needs of the neonate and involve family-centered care. In this article, the first of a 2-part series, we will synthesize the evidence from experimental studies of interventions that focus on the environment and on tactile and gustatory stimulation. The mechanisms suggested by researchers as possible explanations for the efficacy of these interventions are pointed, and the implications for procedural pain management in neonatal care are drawn.
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Parental support in neonatal intensive care units: a cross-cultural comparison between New Zealand and Japan. J Pediatr Nurs 2011; 26:206-15. [PMID: 21601144 DOI: 10.1016/j.pedn.2009.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 09/28/2009] [Accepted: 10/19/2009] [Indexed: 11/23/2022]
Abstract
This is a cross-cultural comparative study involving both quantitative and qualitative data analyses. This study examines sources of parental stress in the two neonatal intensive care units (NICUs) located in New Zealand and Japan and explores how cultural norms of NICU care environments influence parental stress-related experiences and nursing support. The three main sources of data collection were the following: a NICU staff interview, parental interview, and parental questionnaire survey, the PSS: NICU. Thirty-one pairs of parents in each NICU (N = 121) participated in this study. The differences between the two NICUs in terms of the NICU care environment and sources of parental stress within the NICU contexts were identified, highlighting NICU characteristics associated with the sources of stress in the two NICUs. Recognition of the norms of NICU care environments that may hinder parent-staff communication is an important element of NICU nursing practice.
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Johnston CC, Fernandes AM, Campbell-Yeo M. Pain in neonates is different. Pain 2010; 152:S65-S73. [PMID: 20971562 DOI: 10.1016/j.pain.2010.10.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 12/16/2022]
Abstract
Pain processing and management in neonates, especially preterm neonates, differs from older populations. In this review, a brief background on pain processing in neonatal life, pain exposure in Neonatal Intensive Care Units (NICU), the consequences of untreated pain, and the difficulties in treating procedural pain pharmacologically will be presented. A more detailed review of non-pharmacological interventions for procedural pain in neonates will include sensory stimulation approaches, oral sweet solutions, and maternal interventions. Some possible mechanisms for the effectiveness of non-pharmacological interventions are offered. Finally, avenues of research into similar interventions as adjuvant therapies or drug-sparing effects in older populations are suggested.
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Affiliation(s)
- Celeste C Johnston
- McGill University School of Nursing, Montreal, Canada Coimbra School of Nursing, Coimbra, Portugal IWK Health Centre, Halifax, Canada
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Lefkowitz DS, Baxt C, Evans JR. Prevalence and Correlates of Posttraumatic Stress and Postpartum Depression in Parents of Infants in the Neonatal Intensive Care Unit (NICU). J Clin Psychol Med Settings 2010; 17:230-7. [DOI: 10.1007/s10880-010-9202-7] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Coppola G, Cassibba R. Mothers' social behaviours in the NICU during newborns' hospitalisation: an observational approach. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830903298731] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pickler R, Brown L, McGrath J, Lyon D, Rattican D, Cheng CY, Howland L, Jallo N. Integrated review of cytokines in maternal, cord, and newborn blood: part II-- associations with early infection and increased risk of neurologic damage in preterm infants. Biol Res Nurs 2009; 11:377-86. [PMID: 20028689 DOI: 10.1177/1099800409344619] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A growing body of literature supports the relationship of maternal inflammation with preterm birth and adverse neonatal outcomes, including infection and central nervous system (CNS) dysfunction. Mediators of inflammation, most notably proinflammatory cytokines, have been implicated as having an association with and perhaps playing a causal role in the pathogenesis, leading to adverse neonatal outcomes. Even though the association of cytokines with early adverse neonatal outcomes has been actively pursued as a line of research, there has been little integration of diverse findings across studies. Therefore, the purpose of this systematic review was to appraise and classify empirical evidence from human studies for the association of cytokine levels in blood (serum, plasma, or cells; maternal, cord, or neonatal) with two adverse early outcomes in preterm infants: early infection and increased risk of neurologic damage. The review revealed that the proinflammatory cytokines most frequently linked with sepsis are in the interleukin (IL) 1 family as well as tumor necrosis factor alpha (TNF-alpha) and IL-6. The proinflammatory cytokines most frequently linked to neurologic insult in the reviewed studies were IL-1beta, IL-6, and IL-8. In all cases where IL-1beta was studied, the levels were increased when there was neurologic insult. A better understanding of the relationship of these inflammatory substances with these adverse conditions is needed for the future development of maternal and neonatal biobehavioral nursing research.
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Affiliation(s)
- Rita Pickler
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Abstract
AIM To review developmental care over time in the UK. METHODS Longitudinal study comprising two prospective observational studies of unit organization and developmental care activity collected in 2005 and 2008 in all UK neonatal units. Indices related to developmental care and an aggregated score are reported corresponding to year and level of care. RESULTS In 2008, over 90% units had open visiting for parents and modified lighting and 80% modified noise, showing no change since 2005. Incubator cover usage increased from 75% to 95%. Rates of parental tube feeding dropped from 76% to 64% and kangaroo care increased from 50% to 80%. Proportions of units with developmental care personnel and staff trained in developmental care have almost doubled to 64% and 57%. Aggregated scores, reflecting eight basic indices of developmental care, were unchanged: the 2005 mean was 5.7 (SD = 1.5) and 6.2 (SD = 1.5) in 2008. Scores were significantly higher in larger units and in those with developmental care personnel or developmentally trained staff. CONCLUSION Despite a significant increase in developmental care skills and infrastructure, variable approaches persist, with limited improvements over time. These findings reflect a UK culture that is ambivalent towards developmental care, and enable comparison with other countries where developmental care is more fully supported.
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Affiliation(s)
- K E StC Hamilton
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
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Scher MS, Ludington-Hoe S, Kaffashi F, Johnson MW, Holditch-Davis D, Loparo KA. Neurophysiologic assessment of brain maturation after an 8-week trial of skin-to-skin contact on preterm infants. Clin Neurophysiol 2009; 120:1812-8. [PMID: 19766056 DOI: 10.1016/j.clinph.2009.08.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 07/30/2009] [Accepted: 08/04/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Skin-to-skin contact (SSC) promotes physiological stability and interaction between parents and infants. Analyses of EEG-sleep studies can compare functional brain maturation between SSC and non-SSC cohorts. METHODS Sixteen EEG-sleep studies were performed on eight preterm infants who received 8 weeks of SSC, and compared with two non-SSC cohorts at term (N=126), a preterm group corrected to term age and a full-term group. Seven linear and two complexity measures were compared (Mann-Whitney U test comparisons p<.05). RESULTS Fewer REMs, more quiet sleep, increased respiratory regularity, longer cycles, and less spectral beta were noted for SSC preterm infants compared with both control cohorts. Fewer REMs, greater arousals and more quiet sleep were noted for SSC infants compared with the non-SSC preterms at term. Three right hemispheric regions had greater complexity in the SSC group. Discriminant analysis showed that the SSC cohort was closer to the non-SSC full-term cohort. CONCLUSIONS Skin-to-skin contact accelerates brain maturation in healthy preterm infants compared with two groups without SSC. SIGNIFICANCE Combined use of linear and complexity analysis strategies offer complementary information regarding altered neuronal functions after developmental care interventions. Such analyses may be helpful to assess other neuroprotection strategies.
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Affiliation(s)
- Mark S Scher
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA.
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Abstract
Improved technology and management approaches that have reduced bronchopulmonary dysplasia (BPD) have decreased mortality and morbidity in extremely low birth weight (ELBW) infants. Early extubation to nasal continuous positive airway pressure (NCPAP) decreases the complications associated with long-term oral/nasal endotracheal intubation, including BPD, ventilator-associated pneumonia, volutrauma, subglottic stenosis, oral palatal grooves, and nasal septum erosion. Research and anecdotal evidence have shown that iatrogenic injuries to the nose also occur with extended time on NCPAP. Research observing associations between the patient interface and nasal injury has shown duration of therapy to be the most significant risk factor. Immature skin and developing nasal structures place ELBW infants at increased risk for injury. The challenge for NICU caregivers is maintaining the ELBW infant on NCPAP for extended periods without nasal injury. Appropriate protocols, practice guidelines, and staff education can decrease these injuries.
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Allen MC, Aucott S, Cristofalo EA, Alexander GR, Donohue PK. Extrauterine neuromaturation of low risk preterm infants. Pediatr Res 2009; 65:542-7. [PMID: 19127205 DOI: 10.1203/pdr.0b013e3181998b86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of the study was to follow neuromaturation in preterm infants. From serial exams in 90 low risk very low birthweight infants, each infant's Maturity Scores (the sum of tone, reflex, and response items) were plotted against postmenstrual age (PMA) when examined. Each infant's estimated line of best fit provides two descriptors of that infant's neuromaturation: slope (Individual Maturity Slope) and y-value (Predicted Maturity Score at 32-wk PMA). We found that Maturity Scores increased with PMA; 96% had correlation coefficients >0.8. Mean Actual and Predicted Maturity Scores at 32-wk PMA were 60 and 58, respectively, in 65 infants. When stratified by gestational age, Mean Actual Maturity Score at 30-wk PMA were 50 whether infants were 1 or several weeks old when examined. Therefore, low risk preterm infants demonstrated individual variability in rate of neuromaturation. Tone, reflexes, and responses nonetheless emerged in a predictable pattern, whether neuromaturation was intrauterine or extrauterine. This unique tool that measures preterm neuromaturation requires expertise but no technology. It has an exciting potential for providing insight into how emerging central nervous system function and structure influence each other, as well as how the central nervous system recovers from injury.
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Affiliation(s)
- Marilee C Allen
- Department of Pediatrics, Johns Hopkins School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland 21287-3200, USA.
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