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Bansal S, Molloy EJ, Rogers E, Bidegain M, Pilon B, Hurley T, Lemmon ME. Families as partners in neonatal neuro-critical care programs. Pediatr Res 2024:10.1038/s41390-024-03257-6. [PMID: 38886506 DOI: 10.1038/s41390-024-03257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024]
Abstract
Parents of neonates with neurologic conditions face a specific breadth of emotional, logistical, and social challenges, including difficulties coping with prognostic uncertainty, the need to make complex medical decisions, and navigating new hopes and fears. These challenges place parents in a vulnerable position and at risk of developing mental health issues, which can interfere with bonding and caring for their neonate, as well as compromise their neonate's long-term neurodevelopment. To optimize neurologic and developmental outcomes, emerging neonatal neuro-critical care (NNCC) programs must concurrently attend to the unique needs of the developing newborn brain and of his/her parents. This can only be accomplished by embracing a family-centered care environment-one which prioritizes effective parent-clinician communication, longitudinal parent support, and parents as equitable partners in clinical care. NNCC programs offer a multifaceted approach to critical care for neonates at-risk for neurodevelopmental impairments, integrating expertise in neonatology and neurology. This review highlights evidence-based strategies to guide NNCC programs in developing a family-partnered approach to care, including primary staffing models; staff communication, implicit bias, and cultural competency trainings; comprehensive and tailored caregiver training; single-family rooms; flexible visitation policies; colocalized neonatal and maternal care; uniform mental health screenings; follow-up care referrals; and connections to peer support. IMPACT: Parents of neonates with neurologic conditions are at high-risk for experiencing mental health issues, which can adversely impact the parent-neonate relationship and long-term neurodevelopmental outcomes of their neonates. While guidelines to promote families as partners in the neonatal intensive care unit (NICU) have been developed, no protocols integrate the unique needs of parents in neonatal neurologic populations. A holistic approach that makes families true partners in the care of their neonate with a neurologic condition in the NICU has the potential to improve mental and physical well-being for both parents and neonates.
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Affiliation(s)
- Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Eleanor J Molloy
- Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St. James' Hospital, Dublin, Ireland
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TriCC), Children's Health Ireland & Coombe Hospital, Dublin, Ireland
| | - Elizabeth Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Tim Hurley
- Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St. James' Hospital, Dublin, Ireland
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Demirci GM, Kittler PM, Phan HTT, Gordon AD, Flory MJ, Parab SM, Tsai CL. Predicting mental and psychomotor delay in very pre-term infants using machine learning. Pediatr Res 2024; 95:668-678. [PMID: 37500755 PMCID: PMC10899098 DOI: 10.1038/s41390-023-02713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Very preterm infants are at elevated risk for neurodevelopmental delays. Earlier prediction of delays allows timelier intervention and improved outcomes. Machine learning (ML) was used to predict mental and psychomotor delay at 25 months. METHODS We applied RandomForest classifier to data from 1109 very preterm infants recruited over 20 years. ML selected key predictors from 52 perinatal and 16 longitudinal variables (1-22 mo assessments). SHapley Additive exPlanations provided model interpretability. RESULTS Balanced accuracy with perinatal variables was 62%/61% (mental/psychomotor). Top predictors of mental and psychomotor delay overlapped and included: birth year, days in hospital, antenatal MgSO4, days intubated, birth weight, abnormal cranial ultrasound, gestational age, mom's age and education, and intrauterine growth restriction. Highest balanced accuracy was achieved with 19-month follow-up scores and perinatal variables (72%/73%). CONCLUSIONS Combining perinatal and longitudinal data, ML modeling predicted 24 month mental/psychomotor delay in very preterm infants ½ year early, allowing intervention to start that much sooner. Modeling using only perinatal features fell short of clinical application. Birth year's importance reflected a linear decline in predicting delay as birth year became more recent. IMPACT Combining perinatal and longitudinal data, ML modeling was able to predict 24 month mental/psychomotor delay in very preterm infants ½ year early (25% of their lives) potentially advancing implementation of intervention services. Although cognitive/verbal and fine/gross motor delays require separate interventions, in very preterm infants there is substantial overlap in the risk factors that can be used to predict these delays. Birth year has an important effect on ML prediction of delay in very preterm infants, with those born more recently (1989-2009) being increasing less likely to be delayed, perhaps reflecting advances in medical practice.
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Affiliation(s)
- Gözde M Demirci
- Computer Science Department, The Graduate Center of the City University of NY, New York, NY, USA
| | - Phyllis M Kittler
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Ha T T Phan
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Anne D Gordon
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Michael J Flory
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - Santosh M Parab
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Chia-Ling Tsai
- Computer Science Department, Queens College of the City University of NY, Flushing, NY, USA.
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Ollerenshaw LV, McManus B, Rapport MJ, Perraillon M, Murphy NJ, Magnusson D. An analysis of interagency collaboration: Lessons learned from Colorado's early intervention program. Child Care Health Dev 2024; 50:e13210. [PMID: 38265142 DOI: 10.1111/cch.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/18/2023] [Accepted: 11/18/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION The purpose of this study was to describe interagency collaboration in Part C Early Intervention (EI) programs. METHODS Between 18 April and 9 May 2022, 48 EI service coordinators (SCs) from 14 programs in one state completed adapted versions of the Interagency Collaboration Activities Scale (IACAS) and Relational Coordination Survey (RCS). Assessing perceptions of shared structures (IACAS) and coordination quality (RCS), these combined measures summarized interagency collaboration with 11 organizations. Mean (SD) survey responses were estimated and ranked. RESULTS Sample SCs represent a breadth of professional disciples and vary substantially in their current and desired collaborations. The quantity of SCs collaborating with organizations ranged from 0% to 98%. Nearly all (98%) reported collaborating with the school districts, few (15%) reported collaborating with insurance, and none reported collaborating with Supplemental Nutrition Assistance Program or Special Supplemental Nutrition Program for Women, Infants, and Children. The majority of SCs expressed desire to increase their collaborations with most of the listed organizations. The perceived quality of collaborations varied substantially at both individual and organizational levels. When comparing SC perceptions of shared structures and coordination quality, SCs reported more favourable collaborations with school districts (IACAS rank: first and RCS rank: first) and less favourable collaborations with insurance (IACAS rank: ninth and RCS rank: seventh). Some organizations rankings varied across both scales, including pediatric primary care (IACAS rank: third and RCS rank: eighth) and hospitals (IACAS rank: sixth and RCS rank: second). Overall, SCs reported low perceived existence of shared structures while coordination quality varied by organization. Opportunities for collaborative growth were identified. DISCUSSION Despite its importance and required implementation in EI, perceptions of interagency collaboration varied substantially within and between EI programs. There is a suggested need to increase the quantity of SCs that collaborate and identified opportunities to increase the quality of collaborations that already exist.
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Affiliation(s)
- Lindsay V Ollerenshaw
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Beth McManus
- Department of Health Systems, Management, and Policy, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Mary Jane Rapport
- Doctor of Physical Therapy Program, College of Health and Society, Hawaii Pacific University, Honolulu, Hawaii, USA
| | - Marcelo Perraillon
- Department of Health Systems, Management, and Policy, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Natalie J Murphy
- Prevention Research Center for Family and Child Health, University of Colorado, Aurora, Colorado, USA
| | - Dawn Magnusson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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Harjpal P, Kovela RK, Qureshi MI. Promoting Survival and Primitive Reflexes to Prevent Brain Imbalance in Premature Infants: A Scoping Review of New Insights by Physiotherapists on Developmental Disorders. Cureus 2023; 15:e43757. [PMID: 37727176 PMCID: PMC10506688 DOI: 10.7759/cureus.43757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
Survival reflexes, originating from the brainstem, are involuntary motor responses that are present at birth and facilitate the survival of the neonate. The age of the baby is critical enough to give information about the maturation of these reflexes. In the case of preterm babies, the delayed maturity of these reflexes may pose a threat to the life of the newborn. One can perceive what the baby can feel, taste, smell, see, and hear through reflex maturation. The objective was to identify and understand the role of survival reflexes and primitive reflexes and their importance in premature children. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, The Cochrane Library, Scopus, and Web of Science were the electronic databases used from January 2017 until November 2022. We included the original articles, reviews, and randomized clinical trials that focused on the importance of survival reflexes. Later on, all the articles were systematically arranged as per the information they provided, and 101 titles were selected, of which 32 met the inclusion criteria. Various articles were written regarding the present literature about primitive reflexes, but none promoted them in the neonatal intensive care unit (NICU). This review is regarding the use of survival reflexes to improve the outcomes of neonates, specifically in the NICU. Simple interactions with the environment are made possible by primitive reflexes, which also serve as the foundation for early movement. This review presents a better understanding of the maturation of survival reflexes and primitive reflexes and provides further insight into how a physiotherapist can concentrate on the early identification and development of these reflexes to prevent further complications. Assessing the primitive reflex in the NICU will help in the early identification of developmental delay and further help us predict reflex maturation. Promoting them will provide positive outcomes in terms of neonatal development. A physiotherapist can play a vital role starting from the NICU to get the baby into an environment similar to the mother's womb and therapy to get the early maturation of the reflex.
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Affiliation(s)
- Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rakesh K Kovela
- Physiotherapy, Nitte Institute of Physiotherapy, Nitte (Deemed to be University), Mangalore, IND
| | - Moh'd Irshad Qureshi
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Caregiver Health Beliefs Associated with Use of Pediatric Therapy Services Among Children with Special Health Care Needs. Matern Child Health J 2022; 26:2254-2262. [DOI: 10.1007/s10995-022-03500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
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Frolek Clark G, Niblock J, Crane Vos T, Lieberman D, Hunter EG. Systematic Review of Occupational Therapy Interventions to Enhance Cognitive Development in Children 0–5 Years: Part 1, Identified Diagnoses. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2021. [DOI: 10.1080/19411243.2021.1959480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Deborah Lieberman
- Vice President Practice Improvement, American Occupational Therapy Association, Inc, USA
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Liu Y, Li ZF, Zhong YH, Zhao ZH, Deng WX, Chen LL, Liu BB, Du TJ, Zhang Y. Early combined rehabilitation intervention to improve the short-term prognosis of premature infants. BMC Pediatr 2021; 21:269. [PMID: 34107905 PMCID: PMC8188692 DOI: 10.1186/s12887-021-02727-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background To explore the clinical effect of early combined rehabilitation intervention on premature infants in the neonatal intensive care unit (NICU). Methods Premature infants with gestational ages less than 32 weeks or birth weights less than 1500 g were included in the present study.The participants were divided into the intervention group and control group. All infants received the current routine treatment based on the clinical guidelines, and the intervention group was additionally treated by visual and auditory stimulation, oral motor function, respiratory function and neurodevelopmental training. The following clinical outcomes were compared: durations of oxygen supplementation and indwelling gastric tube use; incidences of retinopathy of prematurity (ROP) and neonatal necrotizing enterocolitis (NEC); Sliverman scores; incidences of bronchopulmonary dysplasia (BPD) and intraventricular haemorrhage; days of hospitalization; and neurodevelopmental outcomes. Datas were analysed using the following statistical tests: the chi-square test, the independent samples or paired t test, repeated measures ANOVA, and the Wilcoxon rank sum test. Results Compared with those in the control group, premature infants in the intervention group had shorter durations of oxygen supplementation and indwelling gastric tube use, fewer hospitalization days and lower incidences of ROP, BPD, and NEC.The intervention group had lower Sliverman scores and higher Ballard neuromuscular scores than the control group. Conclusion Early combined rehabilitation intervention can improve the short-term clinical outcomes of premature infants.
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Affiliation(s)
- Yang Liu
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Zheng-Feng Li
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Yun-Huan Zhong
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Zhi-Hui Zhao
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Wen-Xin Deng
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Ling-Ling Chen
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Bei-Bei Liu
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Tao-Jun Du
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China
| | - Yong Zhang
- Department of Neonatology, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China. .,Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610031, Sichuan Province, China.
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Romo ML, McVeigh KH, Jordan P, Stingone JA, Chan PY, Askew GL. Birth characteristics of children who used early intervention and special education services in New York City. J Public Health (Oxf) 2020; 42:e401-e411. [PMID: 31884516 DOI: 10.1093/pubmed/fdz179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early intervention (EI) and special education (SE) are beneficial for children with developmental disabilities and/or delays and their families, yet there are disparities in service use. We sought to identify the birth characteristics that predict EI/SE service use patterns. METHODS We conducted a retrospective cohort study using linked administrative data from five sources for all children born in 1998 to New York City resident mothers. Multinomial regression was used to identify birth characteristics that predicted predominant patterns of service use. RESULTS Children with service use patterns characterized by late or limited/no EI use were more likely to be first-born children and have Black or Latina mothers. Children born with a gestational age ≤31 weeks were more likely to enter services early. Early term gestational age was associated with patterns of service use common to children with pervasive developmental delay, and maternal obesity was associated with the initiation of speech therapy at the time of entry into school. CONCLUSIONS Maternal racial disparities existed for patterns of EI/SE service use. Specific birth characteristics, such as parity and gestational age, may be useful to better identify children who are at risk for suboptimal EI use.
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Affiliation(s)
- Matthew L Romo
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Katharine H McVeigh
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - Phoebe Jordan
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Pui Ying Chan
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
| | - George L Askew
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA
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Klin A, Micheletti M, Klaiman C, Shultz S, Constantino JN, Jones W. Affording autism an early brain development re-definition. Dev Psychopathol 2020; 32:1175-1189. [PMID: 32938507 PMCID: PMC7880583 DOI: 10.1017/s0954579420000802] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The national priority to advance early detection and intervention for children with autism spectrum disorder (ASD) has not reduced the late age of ASD diagnosis in the US over several consecutive Centers for Disease Control and Prevention (CDC) surveillance cohorts, with traditionally under-served populations accessing diagnosis later still. In this review, we explore a potential perceptual barrier to this enterprise which views ASD in terms that are contradicted by current science, and which may have its origins in the current definition of the condition and in its historical associations. To address this perceptual barrier, we propose a re-definition of ASD in early brain development terms, with a view to revisit the world of opportunities afforded by current science to optimize children's outcomes despite the risks that they are born with. This view is presented here to counter outdated notions that potentially devastating disability is determined the moment a child is born, and that these burdens are inevitable, with opportunities for improvement being constrained to only alleviation of symptoms or limited improvements in adaptive skills. The impetus for this piece is the concern that such views of complex neurodevelopmental conditions, such as ASD, can become self-fulfilling science and policy, in ways that are diametrically opposed to what we currently know, and are learning every day, of how genetic risk becomes, or not, instantiated as lifetime disabilities.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Megan Micheletti
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Cheryl Klaiman
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - John N. Constantino
- Departments of Psychiatry and Pediatrics, Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St Louis,MO
| | - Warren Jones
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
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Lemmon ME, Chapman I, Malcolm W, Kelley K, Shaw RJ, Milazzo A, Cotten CM, Hintz SR. Beyond the First Wave: Consequences of COVID-19 on High-Risk Infants and Families. Am J Perinatol 2020; 37:1283-1288. [PMID: 32911555 PMCID: PMC7535978 DOI: 10.1055/s-0040-1715839] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/15/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic is affecting care for high-risk newborns in ways that will likely be sustained beyond the initial pandemic response. These novel challenges present an urgent imperative to understand how COVID-19 impacts parent, family, and infant outcomes. We highlight three areas that warrant targeted attention: (1) inpatient care: visitation policies, developmental care, and communication practices; (2) outpatient care: high-risk infant follow-up and early intervention programs; and (3) parent psychosocial distress: mental health, social support, and financial toxicity. Changes to care delivery in these areas provide an opportunity to identify and implement novel strategies to provide family-centered care during COVID-19 and beyond. KEY POINTS: · The COVID-19 pandemic is influencing care delivery for high-risk newborns and their families.. · Rapid changes to care delivery are likely to be sustained beyond the initial pandemic response.. · We have an urgent imperative to understand how COVID-19 impacts infant, parent, and family outcomes..
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Affiliation(s)
- Monica E. Lemmon
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Ira Chapman
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - William Malcolm
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Richard J. Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Angelo Milazzo
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - C. Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Susan R. Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Kingsley KL, Clark GF. Occupational Therapy Interventions for Children Ages Birth-5 Years. Am J Occup Ther 2020; 74:7405390010p1-7405390010p4. [PMID: 32804635 DOI: 10.5014/ajot.2020.745001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. This article presents a case example of a young child with autism spectrum disorder who receives occupational therapy evaluation and intervention in natural environments (home and child care center). Systematic review findings supporting enhancement of key life occupations through interventions to develop cognitive, motor, social-emotional, and self-care skills for young children were published in AOTA's Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years (Frolek Clark & Kingsley, 2020) and the March/April 2020 issue of the American Journal of Occupational Therapy (Gronski & Doherty, 2020; Kingsley et al., 2020; Tanner et al., 2020). Each article in the Evidence Connection series applies evidence from the published reviews on a topic to a related case. These articles are designed to promote application of the evidence to practice.
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Affiliation(s)
- Karrie L Kingsley
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Gloria Frolek Clark
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Clark GF, Kingsley KL. Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years. Am J Occup Ther 2020; 74:7403397010p1-7403397010p42. [PMID: 32365324 DOI: 10.5014/ajot.2020.743001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth-5 yr. OBJECTIVE Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social-emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. METHOD Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). RESULTS A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. CONCLUSION and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social-emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. WHAT THIS ARTICLE ADDS This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.
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Affiliation(s)
- Gloria Frolek Clark
- Gloria Frolek Clark, PhD, OTR/L, BCP, FAOTA, is an occupational therapist in private practice, Adel, Iowa;
| | - Karrie L Kingsley
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Factors Associated with Successful First High-Risk Infant Clinic Visit for Very Low Birth Weight Infants in California. J Pediatr 2019; 210:91-98.e1. [PMID: 30967249 DOI: 10.1016/j.jpeds.2019.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/11/2019] [Accepted: 03/08/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine rates of at least 1 high-risk infant follow-up (HRIF) visit by 12 months corrected age, and factors associated with successful first visit among very low birth weight (VLBW) infants in a statewide population-based setting. STUDY DESIGN We used the linked California Perinatal Quality of Care Collaborative and California Perinatal Quality of Care Collaborative-California Children's Services HRIF databases. Multivariable logistic regression examined independent associations of maternal, sociodemographic, neonatal clinical, and HRIF program factors with a successful first HRIF visit among VLBW infants born in 2010-2011. RESULTS Among 6512 VLBW children referred to HRIF, 4938 (76%) attended a first visit. Higher odds for first HRIF visit attendance was associated with older maternal age (OR, 1.48; 95% CI, 1.27-1.72; 30-39 vs 20-29 years), lower birth weight (OR, 2.11; 95% CI, 1.69-2.65; ≤750 g vs 1251-1499 g), private insurance (OR, 1.65; 95% CI, 1.19-2.31), a history of severe intracranial hemorrhage (OR, 1.61; 95% CI, 1.12-2.30), 2 parents as primary caregivers (OR, 1.18, 95% CI 1.03-1.36), and higher HRIF program volume (OR, 2.62; 95% CI, 1.88-3.66; second vs lowest quartile); and lower odds with maternal race African American or black (OR, 0.65; 95% CI, 0.54-0.78), and greater distance to HRIF program (OR, 0.69; 95% CI, 0.57-0.83). Rates varied substantially across HRIF programs, which remained after risk adjustment. CONCLUSIONS In a population-based California VLBW cohort, maternal, sociodemographic, and home- and program-level disparities were associated with HRIF non-attendance. These findings underscore the need to identify challenges in access and resource risk factors during hospitalization in the neonatal intensive care unit, provide enhanced education about the benefits of HRIF, and create comprehensive neonatal intensive care unit-to-home transition approaches.
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Klin A, Jones W. An agenda for 21st century neurodevelopmental medicine: lessons from autism. Rev Neurol 2018; 66:S3-S15. [PMID: 29516447 PMCID: PMC6606044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The future of neurodevelopmental medicine has the potential of situating child neurology at the forefront of a broad-based public health effort to optimize neurodevelopmental outcomes of children born with high-prevalence and diverse genetic, pre- and peri-natal, and environmental burdens compromising early brain development and leading to lifetime disabilities. Building on advancements in developmental social neuroscience and in implementation science, this shift is already occurring in the case of emblematic neurodevelopmental disorders such as autism. Capitalizing on early neuroplasticity and on quantification of trajectories of social-communicative development, new technologies are emerging for high-throughput and cost-effective diagnosis and for community-viable delivery of powerful treatments, in seamless integration across previously fragmented systems of healthcare delivery. These solutions could be deployed in the case of other groups of children at greater risk for autism and communication delays, such as those born extremely premature or with congenital heart disease. The galvanizing concept in this aspirational future is a public health focus on promoting optimal conditions for early brain development, not unlike current campaigns promoting pre-natal care, nutrition or vaccination.
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Affiliation(s)
- A Klin
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
| | - W Jones
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
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RAVARIAN A, VAMEGHI R, HEIDARZADEH M, NARIMAN S, SAGHEB S, NORI F, SAEEDERSHADI F, NOROZI M. Factors Influencing the Attendance of Preterm Infants to Neonatal Follow up And Early Intervention Services Following Discharge from Neonatal Intensive Care Unit during First Year of Life in Iran. IRANIAN JOURNAL OF CHILD NEUROLOGY 2018; 12:67-76. [PMID: 29379564 PMCID: PMC5760675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/14/2017] [Accepted: 07/18/2017] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors influencing the number of times neonatal intensive care unit admitted preterm infants attend Neonatal Follow up and Early Intervention services (NFEI) during first year of life. MATERIALS &METHODS A parent-report questionnaire was administered via phone after the first birthday of preterm infants admitted to the NICU at Arash Hospital, Tehran, for at least 24 h, and who received standard NICU-based therapeutic services, from Apr 2014 to Feb 2015. Data included mother's age, education, type of pregnancy, history of abortion or premature birth, self-reported post-partum depression, number of children, infant's gender, birth weight, gestational age, length of stay in the NICU, living area, twin or triplet birth, number of siblings, and the child rank. Number of attending times to services was recorded. Another question addressed the causes of not attending the NFEI services. RESULTS Ultimately, 119 eligible children participated, 51% were girls and whose mean birth weight was 1908±626.7 gr, and average length of NICU stay was 20.1±16.9 d. After multivariate analysis, shorter length of stay in the NICU, lower maternal education, number of children, self-declared lack of awareness about early intervention services, and self-reported lack of referral by a physician were the only factors that continued to be significantly correlated, and in fact, the truly influential ones associated with number of attending times. CONCLUSION This study has defined some predictors of poor follow up and early intervention service utilization in a high-risk group of infants suggested be addressing and tackling by policymakers.
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Affiliation(s)
- Aida RAVARIAN
- Arash Women ‘s Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Roshanak VAMEGHI
- 2.Pediatric Neuro-rehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad HEIDARZADEH
- 3.Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahin NARIMAN
- Arash Women ‘s Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Setareh SAGHEB
- 4.Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba NORI
- Arash Women ‘s Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Farhoud SAEEDERSHADI
- 5.Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi NOROZI
- Social determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Kirk CM, Uwamungu JC, Wilson K, Hedt-Gauthier BL, Tapela N, Niyigena P, Rusangwa C, Nyishime M, Nahimana E, Nkikabahizi F, Mutaganzwa C, Ngabireyimana E, Mutabazi F, Magge H. Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study. BMC Pediatr 2017; 17:191. [PMID: 29141590 PMCID: PMC5688768 DOI: 10.1186/s12887-017-0946-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/09/2017] [Indexed: 12/11/2022] Open
Abstract
Background As care for preterm and low birth weight (LBW) infants improves in resource-limited settings, more infants are surviving the neonatal period. Preterm and (LBW) infants are at high-risk of nutritional and medical comorbidities, yet little is known about their developmental outcomes in low-income countries. This study evaluated the health, nutritional, and developmental status of preterm/LBW children at ages 1–3 years in Rwanda. Methods Cross-sectional study of preterm/LBW infants discharged between October 2011 and October 2013 from a hospital neonatal unit in rural Rwanda. Gestational age and birth weight were gathered from hospital records to classify small for gestational age (SGA) at birth and prematurity. Children were located in the community for household assessments in November–December 2014. Caregivers reported demographics, health status, and child development using locally-adapted Ages and Stages Questionnaires (ASQ-3). Anthropometrics were measured. Bivariate associations with continuous ASQ-3 scores were conducted using Wilcoxon Rank Sum and Kruskal Wallis tests. Results Of 158 eligible preterm/LBW children discharged from the neonatal unit, 86 (54.4%) were alive and located for follow-up. Median birth weight was 1650 grams, median gestational age was 33 weeks, and 50.5% were SGA at birth. At the time of household interviews, median age was 22.5 months, 46.5% of children had feeding difficulties and 39.5% reported signs of anemia. 78.3% of children were stunted and 8.8% wasted. 67.4% had abnormal developmental screening. Feeding difficulties (p = 0.008), anemia symptoms (p = 0.040), microcephaly (p = 0.004), stunting (p = 0.034), SGA (p = 0.023), very LBW (p = 0.043), lower caregiver education (p = 0.001), and more children in the household (p = 0.016) were associated with lower ASQ-3 scores. Conclusions High levels of health, growth, and developmental abnormalities were seen in preterm/LBW children at age 1–3 years. As we achieve necessary gains in newborn survival in resource-limited settings, follow-up and early intervention services are critical for ensuring high-risk children reach their developmental potential. Electronic supplementary material The online version of this article doi: (10.1186/s12887-017-0946-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Kim Wilson
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Bethany L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Neo Tapela
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | - Francis Mutabazi
- Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda
| | - Hema Magge
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Nwabara O, Rogers C, Inder T, Pineda R. Early Therapy Services Following Neonatal Intensive Care Unit Discharge. Phys Occup Ther Pediatr 2017; 37:414-424. [PMID: 27967287 PMCID: PMC5630140 DOI: 10.1080/01942638.2016.1247937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To (1) characterize early therapy services for preterm infants in the first two years of life, and (2) define factors related to accessing early therapy services. METHODS Therapy utilization after discharge from the neonatal intensive care unit (NICU) was tracked in 57 infants born ≤30 weeks gestation from 2007 to 2010. Participants returned for developmental testing at two years. Factors related to early therapy utilization were explored. RESULTS Fifty-two (91%) infants received a referral for therapy at NICU discharge but only 44 (77%) received at least one type of therapy during the first two years of life. Infants who received early therapy services were more likely to have more days on ventilation (p =.005), have single mothers (p =.047), and exhibit abnormal neurobehavior at term equivalent age (p =.03). On average, infants first received occupational therapy at a mean age of 5.1 ± 4.6 months with a median of 2.6 (1.3-9.0), physical therapy at a mean age of 4.3 ± 4.1 months with a median of 3.7 (0.1-5.5), and speech-language pathology services at a mean age of 14.0 ± 6.1 months with a median of 15.0 (11.3-17.7) months corrected age. Of the 13 children who did not receive any therapy in the first two years after NICU discharge, seven (53%) had a developmental delay at an age of two years. CONCLUSIONS In spite of high referral rates for therapy services, there is a delay in therapy activation following NICU discharge, and some infants who warrant services do not obtain them.
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Affiliation(s)
- Odochi Nwabara
- a Program in Occupational Therapy , Washington University , St Louis , Missouri , USA
| | - Cynthia Rogers
- b Department of Psychiatry , Washington University , St. Louis , Missouri , USA
| | - Terrie Inder
- c Department of Pediatric Newborn Medicine , Brigham and Women's Hospital , Boston , Massachusetts , USA
| | - Roberta Pineda
- a Program in Occupational Therapy , Washington University , St Louis , Missouri , USA.,d Department of Pediatrics , Washington University , St. Louis , Missouri , USA
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Abstract
OBJECTIVE Early intervention (EI) programs under Part C of the Individuals with Disabilities Education Act serve a developmentally heterogeneous population of infants and toddlers with or at risk of developmental delays or disabilities. The aim of this study was to identify empirically distinct subgroups of children in EI so as to inform early prognosis and service planning. METHODS We applied mixture modeling to developmental assessment data from 1513 children who enrolled in a large, urban EI program between 2009 and 2013. The observed variables were children's EI-entry developmental quotients (DQs) in 5 domains (communication, cognitive, motor, adaptive, and personal-social) as assessed by the Battelle Developmental Inventory, Second Edition. RESULTS A 4-class model showed the best fit to the data, revealing subgroups with distinct developmental profiles. Children in the first subgroup showed a severe delay in communication with less severe delays in the other domains. Children in the second subgroup likewise showed a severe delay in communication, but with comparably severe delays in the cognitive and motor domains. Profiles for the third and fourth subgroups showed the same overall patterns as those for the first and second subgroups, respectively, but to a less severe degree. Developmental trajectories differed by subgroup. CONCLUSION Consideration of subgroups based on children's developmental assessment scores provides insight into underlying commonalities among children with different presenting diagnoses on entry into EI. The subgroups also have clinical relevance in terms of both practitioners' and parents' understanding of children's likely service needs and developmental trajectories.
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Neonatal Nurses NICU Quality Improvement: Embracing EBP Recommendations to Provide Parent Psychosocial Support. Adv Neonatal Care 2017; 17:33-44. [PMID: 27763909 DOI: 10.1097/anc.0000000000000352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The neonatal intensive care unit (NICU) can be a stressful environment for infants, their families, and the healthcare team. There is an immediate need for neonatal nurses to embrace and translate the new National Perinatal Association recommendations for psychosocial support of NICU parents into clinical practice to demonstrate best practices for infants, their families, and the whole team. PURPOSE To summarize the current evidence-based practice recommendations and to provide suggestions for team members to develop strategies to adopt and implement them through quality improvement (QI) projects. METHODS Literature reviews were conducted by the original 6 National Perinatal Association workgroup teams and covered all levels of available evidence (eg, qualitative, quantitative, and clinical research, guidelines, and clinical and parental expertise). Evidence was synthesized to formulate this set of recommendations published in December 2015. We describe their applicability to the vital role of neonatal nurses, while elucidating QI projects that track measurements of change to translate these recommendations into practice. RESULTS Neonatal nurses are in an ideal position to transform systems of support for NICU parents through the adoption of these recommendations at the bedside, and further to identify areas for QI to enhance implementation. IMPLICATIONS FOR PRACTICE Neonatal nurses are integral to problem solving and identifying QI strategies for translating these recommendations into NICU clinical practice to improve parent psychosocial support. IMPLICATIONS FOR RESEARCH This article disseminates evidence and encourages scientific investigation into various methods of supporting emotional health of NICU parents to create better health outcomes.
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Carniel CZ, Furtado MCDC, Vicente JB, Abreu RZD, Tarozzo RM, Cardia SETR, Massei MCI, Cerveira RCGF. Influência de fatores de risco sobre o desenvolvimento da linguagem e contribuições da estimulação precoce: revisão integrativa da literatura. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719115616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi identificar evidências na literatura a respeito da influência dos fatores de risco sobre o desenvolvimento da linguagem da criança e as contribuições da estimulação precoce. Trata-se de uma revisão integrativa, que utilizou as bases de dados Lilacs, PubMed e SciELO e os descritores: linguagem infantil, fatores de risco, prematuro, criança pós-termo, índice de Apgar, estimulação precoce. A partir dos achados, extraíram-se os seguintes dados: autores, ano de publicação, objetivo, desenho do estudo, participantes e critérios, variáveis estudadas, principais achados. Para a organização e análise foi utilizada a técnica de Análise de Conteúdo do tipo temática. Foram identificados 1.421 artigos, 29 atenderam os critérios de inclusão. Os estudos foram categorizados por resultados afins; A maioria dos artigos selecionados trata do efeito da prematuridade sobre o desenvolvimento da linguagem. Quatro estudos investigaram a associação entre fatores de risco e problemas no desenvolvimento da linguagem. Um dos estudos avaliou crianças em idade escolar e associou valores de Apgar com DEL. Foi unanime a recomendação acerca do acompanhamento e intervenção precoce. Conclui-se que os fatores de risco elencados influenciam negativamente no desenvolvimento da linguagem. Reforça-se a recomendação do atendimento precoce e qualificado dessas crianças, evitando e/ou minimizando alterações futuras.
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Racial and Ethnic Disparities in Unmet Need for Pediatric Therapy Services: The Role of Family-Centered Care. Acad Pediatr 2017; 17:27-33. [PMID: 27368126 DOI: 10.1016/j.acap.2016.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether individual elements of family-centered care (FCC) mediate racial/ethnic disparities in parent-reported unmet therapy need. METHODS We conducted a secondary data analysis using the 2009-2010 National Survey of Children With Special Health Care Needs. A total of 6478 black, Hispanic, and white children ages 0 to 5 years had complete data on parent-reported unmet need and FCC. Five measured indicators of FCC included whether the child's health care provider spent enough time with the child (time), listened carefully to the child's parents (listening), was sensitive to family culture and values (sensitivity), delivered information specific to the child's health (information), and helped parents feel like partners (partnership). We performed staged multivariate logistic regression to test the association between race/ethnicity and parent-reported unmet therapy need, and to explore whether this association was mediated by elements of FCC using the Baron-Kenny mediation framework. RESULTS Eighteen percent of children with special health care needs 0 to 5 years old with reported therapy need experienced unmet need. Black and Hispanic children were more likely than white children to have parent-reported unmet therapy need (adjusted odds ratio 1.59, 95% confidence interval 1.08-2.36). This disparity was no longer significant after adjustment for the FCC elements of time, sensitivity, or partnership. CONCLUSIONS The provision of FCC is likely an important factor in meeting the therapy needs of children with developmental delay and in reducing racial/ethnic disparities in parent-reported unmet therapy need. Interventions aimed at fostering parent-provider relationships through improved cultural sensitivity and engagement of parents as partners are necessary to ensure equitable utilization of these services.
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Hernandez-Mekonnen R, Duggan EK, Oliveros-Rosen L, Gerdes M, Wortham S, Ludmir J, Bennett IM. Health Literacy in Unauthorized Mexican Immigrant Mothers and Risk of Developmental Delay in their Children. J Immigr Minor Health 2016; 18:1228-1231. [DOI: 10.1007/s10903-015-0284-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Greene M, Patra K. Part C early intervention utilization in preterm infants: Opportunity for referral from a NICU follow-up clinic. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:287-295. [PMID: 26955914 DOI: 10.1016/j.ridd.2016.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Early Intervention (EI) services promote development for preterm infants. In the state of Illinois, Child and Family Connections (CFC) is the intake agency that determines qualification for EI services. In Illinois, all extremely low birth weight (ELBW) infants are eligible for and referred to CFC at discharge from the Neonatal Intensive Care Unit (NICU). This study investigated: (1) patterns of CFC and EI enrollment, and; (2) predictors of CFC enrollment, need for CFC referral, and high EI therapy use among preterm infants seen in a NICU follow-up clinic. METHODS 405 preterm infants, including 169 ELBW infants, were seen in a NICU follow-up clinic at 4-, 8- and 20-months corrected age. CFC/EI data were collected at each visit. Multiple regression analyses adjusted for the effect of medical, sociodemographic and neurodevelopmental risk factors on CFC/EI outcome. RESULTS Despite the high rate of EI utilization and routine care by primary pediatricians, up to 28% of ELBW infants required a CFC referral from a NICU follow-up clinic. Medical and neurodevelopmental risk factors were associated with CFC enrollment while medical, sociodemographic and neurodevelopmental risk factors were associated with need for CFC referral. CONCLUSION NICU follow-up clinics facilitate appropriate CFC/EI services for preterm infants.
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Affiliation(s)
- Michelle Greene
- Departments of Behavioral Sciences & Pediatrics, Rush University Medical Center, 1653W Congress Parkway, 1200 Kellogg Building, Chicago, IL 60612, USA.
| | - Kousiki Patra
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
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Lobo MA, Galloway JC. Assessment and stability of early learning abilities in preterm and full-term infants across the first two years of life. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1721-1730. [PMID: 23500166 PMCID: PMC3628416 DOI: 10.1016/j.ridd.2013.02.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 06/01/2023]
Abstract
Infants born preterm have increased risk for learning disabilities yet we lack assessments to successfully detect these disabilities in early life. We followed 23 full-term and 29 preterm infants from birth through 24 months to assess for differences in and stability of learning abilities across time. Measures included the Bayley-III cognitive subscale, the mobile paradigm assessment, and a means-end learning assessment. Preterm infants had poorer performance on measures of cognition and learning across the first two years of life. Learning performance at 3-4 months was consistent with learning performance at 12-24 months of age. At 3-4 months, the mobile paradigm had better sensitivity and predictive values for predicting 24-month cognitive delays on the Bayley-III than did the Bayley-III itself. At 12-18 months, the means-end learning assessment had better sensitivity than the Bayley-III for identifying 24-month cognitive delays on the Bayley-III. The results suggest that: (1) infants born preterm may demonstrate learning differences as early as the first few months of life, (2) learning differences identified in the first months of life are likely to persist throughout the second year of life, and (3) learning assessments that measure how infants and toddlers use their typical behaviors to problem-solve to control external events may be more effective than traditional standardized assessment tools for detecting early learning delays.
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Affiliation(s)
- Michele A Lobo
- University of Delaware, Physical Therapy Department, Newark, DE 19716, USA.
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Bibliography. Current world literature. Neonatology and perinatology. Curr Opin Pediatr 2013; 25:275-81. [PMID: 23481475 DOI: 10.1097/mop.0b013e32835f58ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE To determine factors associated with mothers' concern about infant development and intent to access therapy services following neonatal intensive care unit (NICU) discharge. METHODS Infant medical factors, magnetic resonance imaging results, neurobehavior at term, maternal factors, and maternal perceptions about developmental concern and intent to access therapy at NICU discharge were prospectively collected in 84 infants born premature (<30 weeks gestation). Regression was used to determine factors associated with developmental concern and intent to access therapy at NICU discharge. RESULTS Decreased developmental concern was reported by mothers with more children (P = .007). Infant stress signs (P = .038), higher maternal education (P = .047), reading books (P = .030), and maternal depression (P = .018) were associated with increased developmental concern. More maternal education was associated with more intent to access services (P = .040). CONCLUSION Maternal factors, rather than infant factors, had important associations with caregiver concern. In contrast, abnormal term neurobehavior and/or the presence of cerebral injury were not associated with caregiver concern about development.
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