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Filippa M, Kuhn P. Early parental vocal contact in neonatal units: rationale and clinical guidelines for implementation. Front Neurol 2024; 15:1441576. [PMID: 39410994 PMCID: PMC11473331 DOI: 10.3389/fneur.2024.1441576] [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: 05/31/2024] [Accepted: 08/19/2024] [Indexed: 10/19/2024] Open
Abstract
This paper aims to present clear and evidence-based proposals for the integration of Early Parental Vocal Contact into the clinical practices of neonatal units. In the first part, we present a comprehensive rationale exploring the ontogenesis of voice perception in both term and preterm newborns that establishes a foundational understanding. This knowledge serves as a crucial starting point for developing evidence-based auditory and multisensory interventions aimed at fostering the developmental trajectory of preterm infants. Drawing insights from neuroscience and brain development, our proposals underscore the significance of tailoring auditory environments within neonatal settings. Special attention is given to the unique needs of preterm infants, factoring in their gestational age and maturation levels. In the second part clinical guidelines for implementation are provided and healthcare professionals are supported to assist parents in modulating their vocal interactions, aligning them with the infant's responses. Furthermore, we provide practical suggestions for engaging in discussions with parents about the content, duration, and frequency of vocal interventions. Finally, we delve into the potential roles of caregivers, parents, and health professionals within this enriched parental vocal interactional environment. Our perspective is firmly grounded in an infant and family-centered developmental care philosophy, aiming to enhance the overall well-being and the neurodevelopment of preterm infants in neonatal units.
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Affiliation(s)
- Manuela Filippa
- Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Department of Neonatal Medicine, Hautepierre Hospital University Hospital, University of Strasbourg, Strasbourg, France
- Centre National de la Recherche Scientifique and University of Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
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2
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van der Straaten M, van den Hoogen A, Tataranno ML, van Berkel CJM, Schmit L, Jeekel H, Hennink A, Benders M, Dudink J. Impact of daily music on comfort scores in preterm infants: a randomized controlled trial. Pediatr Res 2024:10.1038/s41390-024-03586-6. [PMID: 39313555 DOI: 10.1038/s41390-024-03586-6] [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: 05/10/2024] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Premature birth heightens neurodevelopmental risks, theorized to partly stem from altered sensory inputs and disrupted sleep patterns. Modifying the acoustic milieu through music intervention (MI) offers promise to improve neonatal comfort, reduce sleep disturbances, and stabilize physiological parameters. This study explores the impact of non-pharmacological MI on these health indicators within the Neonatal Intensive Care Unit (NICU). METHODS A single-blinded RCT was conducted. Premature infants (34 > GA > 29 wks) were randomly assigned to either receive 8 min of daily MI or placebo for up to 15 days. Validated behavioral comfort scores were visually obtained by a blinded observer before and after intervention. Additionally, physiological signs (HR, RR, SatO2) were recorded. Differences between the groups were analyzed using χ² tests and t-tests. RESULTS In total 56 preterm infants were included. After intervention, comfort levels increased significantly in the MI compared to placebo group (p = 0.000). Neonates receiving MI transitioned from wakefulness to a state of sleep significantly more compared to placebo (p = 0.002). Physiological parameters remained stable. CONCLUSIONS This study adds to existing literature demonstrating that a music intervention in a NICU setting can enhance comfort and sleep of premature infants without adversely affecting physiological parameters. IMPACT The study demonstrates that music interventions (MI) in a Neonatal Intensive Care Unit (NICU) setting can significantly increase comfort levels and positively impact the sleep of premature infants without negatively impacting their physiological parameters. This research increases evidence for non-pharmacological interventions, specifically music, as beneficial for the well-being of premature infants in NICU settings. It replicates and expands upon previous methodological designs, providing more robust evidence of MI's positive effects on this vulnerable population. The positive outcomes of music intervention could influence hospital policies by integrating non-pharmacological practices into standard neonatal care protocols to enhance developmental support for premature infants.
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Affiliation(s)
- Merel van der Straaten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| | - Maria-Luisa Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catelijn J M van Berkel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Schmit
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Annelies Hennink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Sibrecht G, Wróblewska-Seniuk K, Bruschettini M. Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev 2024; 5:CD010333. [PMID: 38813836 PMCID: PMC11137833 DOI: 10.1002/14651858.cd010333.pub4] [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] [Indexed: 05/31/2024]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are subjected to different types of stress, including sounds of high intensity. The sound levels in NICUs often exceed the maximum acceptable level recommended by the American Academy of Pediatrics, which is 45 decibels (dB). Hearing impairment is diagnosed in 2% to 10% of preterm infants compared to only 0.1% of the general paediatric population. Bringing sound levels under 45 dB can be achieved by lowering the sound levels in an entire unit; by treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled; or by reducing sound levels at the individual level using earmuffs or earplugs. By lowering sound levels, the resulting stress can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. This review is an update of one originally published in 2015 and first updated in 2020. OBJECTIVES To determine the benefits and harms of sound reduction on the growth and long-term neurodevelopmental outcomes of neonates. SEARCH METHODS We used standard, extensive Cochrane search methods. On 21 and 22 August 2023, a Cochrane Information Specialist searched CENTRAL, PubMed, Embase, two other databases, two trials registers, and grey literature via Google Scholar and conference abstracts from Pediatric Academic Societies. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (less than 32 weeks' postmenstrual age (PMA) or less than 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or stepdown unit. We specified three types of intervention: 1) intervention at the unit level (i.e. the entire neonatal department), 2) at the section or room level, or 3) at the individual level (e.g. hearing protection). DATA COLLECTION AND ANALYSIS We used the standardised review methods of Cochrane Neonatal to assess the risk of bias in the studies. We used the risk ratio (RR) and risk difference (RD), with their 95% confidence intervals (CIs), for dichotomous data. We used the mean difference (MD) for continuous data. Our primary outcome was major neurodevelopmental disability. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included one RCT, which enroled 34 newborn infants randomised to the use of silicone earplugs versus no earplugs for hearing protection. It was a single-centre study conducted at the University of Texas Medical School in Houston, Texas, USA. Earplugs were positioned at the time of randomisation and worn continuously until the infants were 35 weeks' postmenstrual age (PMA) or discharged (whichever came first). Newborns in the control group received standard care. The evidence is very uncertain about the effects of silicone earplugs on the following outcomes. • Cerebral palsy (RR 3.00, 95% CI 0.15 to 61.74)and Mental Developmental Index (MDI) (Bayley II) at 18 to 22 months' corrected age (MD 14.00, 95% CI 3.13 to 24.87); no other indicators of major neurodevelopmental disability were reported. • Normal auditory functioning at discharge (RR 1.65, 95% CI 0.93 to 2.94) • All-cause mortality during hospital stay (RR 2.07, 95% CI 0.64 to 6.70; RD 0.20, 95% CI -0.09 to 0.50) • Weight (kg) at 18 to 22 months' corrected age (MD 0.31, 95% CI -1.53 to 2.16) • Height (cm) at 18 to 22 months' corrected age (MD 2.70, 95% CI -3.13 to 8.53) • Days of assisted ventilation (MD -1.44, 95% CI -23.29 to 20.41) • Days of initial hospitalisation (MD 1.36, 95% CI -31.03 to 33.75) For all outcomes, we judged the certainty of evidence as very low. We identified one ongoing RCT that will compare the effects of reduced noise levels and cycled light on visual and neural development in preterm infants. AUTHORS' CONCLUSIONS No studies evaluated interventions to reduce sound levels below 45 dB across the whole neonatal unit or in a room within it. We found only one study that evaluated the benefits of sound reduction in the neonatal intensive care unit for hearing protection in preterm infants. The study compared the use of silicone earplugs versus no earplugs in newborns of very low birth weight (less than 1500 g). Considering the very small sample size, imprecise results, and high risk of attrition bias, the evidence based on this research is very uncertain and no conclusions can be drawn. As there is a lack of evidence to inform healthcare or policy decisions, large, well designed, well conducted, and fully reported RCTs that analyse different aspects of noise reduction in NICUs are needed. They should report both short- and long-term outcomes.
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Affiliation(s)
- Greta Sibrecht
- II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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4
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Franco F, Chifa M, Politimou N. Home Musical Activities Boost Premature Infants' Language Development. CHILDREN (BASEL, SWITZERLAND) 2024; 11:542. [PMID: 38790537 PMCID: PMC11120229 DOI: 10.3390/children11050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 05/26/2024]
Abstract
Infants born prematurely are considered at risk for language development delay and impairments. Using online parental reports, the present study investigated the influence of early musical experience in the home environment (Music@Home Infant Questionnaire) on language development (MacArthur-Bates Communicative Development Inventory) while controlling for general enrichment at home (Stim-Q Cognitive Home Environment Questionnaire) and perinatal post-traumatic stress disorder (Perinatal PTSD Questionnaire). Caregivers of 117 infants between 8 and 18 months of age (corrected age) without reported developmental difficulties completed an online survey. Results revealed that the musical home environment significantly predicted outcomes in reported infants' receptive vocabulary and gestural communication, independently from infants' corrected age and general enrichment of home activities. These findings constitute the first evidence that an enriched musical experience can enhance the development of early communication skills in a population at risk for language delays, namely infants born prematurely, opening the path for future intervention research in home and/or early childcare settings. Given that the majority of participants in this study were highly educated and from socioeconomically stable backgrounds, considerations regarding the generalizability of these results are discussed.
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Affiliation(s)
- Fabia Franco
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK;
| | - Maria Chifa
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK;
| | - Nina Politimou
- Department of Psychology and Human Development, IOE Faculty of Education and Society, University College London, London WC1H 0AA, UK
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Altimier L, Barton SA, Bender J, Browne J, Harris D, Jaeger CB, Johnson BH, Kenner C, Kolberg KJS, Loder A, Martin GL, Mohammed S, Oelrich T, Wilson Orr L, Philbin MK, McCuskey Shepley M, Shultz J, Smith JA, Thompson TS, White RD. Recommended standards for newborn ICU design. J Perinatol 2023; 43:2-16. [PMID: 38086961 DOI: 10.1038/s41372-023-01784-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Leslie Altimier
- SSM Health-Cardinal Glennon Children's Hospital, 1465 S Grand Blvd, St. Louis, MO, 63104, USA
| | - Sue Ann Barton
- ZGF Architects LLP, 1223 SW Washington Street, Portland, OR, 97205, USA
| | - Jesse Bender
- Mission Health System, 509 Biltmore Avenue, Asheville, NC, 28801, USA
| | - Joy Browne
- University of Colorado School of Medicine, Department of Pediatrics at the Children's Hospital, 1056 E19th Avenue, Denver, CO, 80218, USA
| | - Debra Harris
- Family & Consumer Sciences, Interior Design, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97346, Waco, TX, 76798, USA
| | - Carol B Jaeger
- The Ohio State University College of Nursing, Columbus, OH, 43210, USA
| | - Beverley H Johnson
- Institute for Patient- and Family-Centered Care, 6917 Arlington Road, Suite 309, Bethesda, MD, 20814, USA
| | - Carole Kenner
- The College of New Jersey School of Nursing, Health, & Exercise Science, 206 Trenton Hall 2000 Pennington Road, Ewing, NJ, 08628, USA
| | - Kathleen J S Kolberg
- Center for Health Sciences Advising, 219 Jordan Hall of Science, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Angela Loder
- International WELL Building Institute, 220 Fifth Avenue, 8th Floor, New York, NY, 10001, USA
| | - Gilbert L Martin
- Citrus Valley Medical Center 1135 S. Sunset, Suite 406, West Covina, CA, 91719, USA
| | - Sabah Mohammed
- Healthcare Designer, Planning + Strategies, Perkins & Will, 1315 Peachtree St NE, Atlanta, GA, 30309, USA
| | - Teri Oelrich
- Consulting Partner/Healthcare NBBJ, 310 SW 4th, Portland, OR, 97204, USA
| | - Lynne Wilson Orr
- Parkin Architects Limited 1 Valleybrook Drive, Toronto, ON, M3B 2S7, Canada
| | | | - Mardelle McCuskey Shepley
- College of Engineering, NC A&T State University, 1601 East Market Street, Greensboro, NC, 27411, USA
| | - Jonas Shultz
- Health Quality Council of Alberta, Adjunct Lecturer, Cumming School of Medicine, University of Calgary, 210, 811 - 14 Street NW, Calgary, AB, T2N 2A4, Canada
| | - Judith A Smith
- Principal, Smith Hager Bajo, Inc., 10947 E Cannon Dr, Scottsdale, AZ, 85259, USA
| | - Tammy S Thompson
- College of Engineering, NC A&T State University, 1601 East Market Street, Greensboro, NC, 27411, USA
| | - Robert D White
- Regional Newborn Program, Beacon Children's Hospital, 615 N. Michigan Street, South Bend, IN, 46601, USA.
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Filippa M, Benis D, Adam-Darque A, Grandjean D, Hüppi PS. Preterm infants show an atypical processing of the mother's voice. Brain Cogn 2023; 173:106104. [PMID: 37949001 DOI: 10.1016/j.bandc.2023.106104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
To understand the consequences of prematurity on language perception, it is fundamental to determine how atypical early sensory experience affects brain development. At term equivalent age, ten preterm and ten full-term newborns underwent high-density EEG during mother or stranger speech presentation, in the forward or backward order. A general group effect terms > preterms is evident in the theta frequency band, in the left temporal area, with preterms showing significant activation for strangers' and terms for the mother's voice. A significant group contrast in the low and high theta in the right temporal regions indicates higher activations for the stranger's voice in preterms. Finally, only full terms presented a late gamma band increase for the maternal voice, indicating a more mature brain response. EEG time-frequency analysis demonstrate that preterm infants are selectively responsive to stranger voices in both temporal hemispheres, and that they lack selective brain responses to their mother's forward voice.
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Affiliation(s)
- Manuela Filippa
- Division of Development and Growth, Child and Adolescent Department, Rue Willy-Donzé 1205 Genève, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Boulevard Carl-Vogt 101 Genève, Geneva, Switzerland.
| | - Damien Benis
- Division of Development and Growth, Child and Adolescent Department, Rue Willy-Donzé 1205 Genève, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Boulevard Carl-Vogt 101 Genève, Geneva, Switzerland
| | - Alexandra Adam-Darque
- Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neuroscience, Division of Neurorehabilitation, University Hospital of Geneva and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Didier Grandjean
- Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Boulevard Carl-Vogt 101 Genève, Geneva, Switzerland
| | - Petra S Hüppi
- Division of Development and Growth, Child and Adolescent Department, Rue Willy-Donzé 1205 Genève, University of Geneva, Geneva, Switzerland
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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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8
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Chifa M, Hadar T, Politimou N, Reynolds G, Franco F. The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience. CHILDREN-BASEL 2021; 8:children8080644. [PMID: 34438535 PMCID: PMC8391440 DOI: 10.3390/children8080644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022]
Abstract
Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.
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Affiliation(s)
- Maria Chifa
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
| | - Tamar Hadar
- Division of Expressive Therapies, Graduate School of Arts & Social Sciences, Lesley University, Cambridge, MA 02138, USA;
| | - Nina Politimou
- Institute of Education, University College London, London WC1H 0AA, UK;
| | - Gemma Reynolds
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
| | - Fabia Franco
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
- Correspondence:
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9
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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052046. [PMID: 34155135 DOI: 10.1542/peds.2021-052046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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10
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Menke BM, Hass J, Diener C, Pöschl J. Family-centered music therapy-Empowering premature infants and their primary caregivers through music: Results of a pilot study. PLoS One 2021; 16:e0250071. [PMID: 33989286 PMCID: PMC8121291 DOI: 10.1371/journal.pone.0250071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Neonatal Intensive Care Units (NICUs) premature infants are exposed to various acoustic, environmental and emotional stressors which have a negative impact on their development and the mental health of their parents. Family-centred music therapy bears the potential to positively influence these stressors. The few existing studies indicate that interactive live-improvised music therapy interventions both reduce parental stress factors and support preterm infants' development. METHODS The present randomized controlled longitudinal study (RCT) with very low and extremely low birth weight infants (born <30+0 weeks of gestation) and their parents analyzed the influence of music therapy on both the physiological development of premature infants and parental stress factors. In addition, possible interrelations between infant development and parental stress were explored. 65 parent-infant-pairs were enrolled in the study. The treatment group received music therapy twice a week from the 21st day of life till discharge from hospital. The control group received treatment as usual. RESULTS Compared to the control group, infants in the treatment group showed a 11.1 days shortening of caffeine therapy, 12.1 days shortening of nasogastric/ orogastric tube feed and 15.5 days shortening of hospitalization, on average. While these differences were not statistically significant, a factor-analytical compound measure of all three therapy durations was. From pre-to-post-intervention, parents showed a significant reduction in stress factors. However, there were no differences between control and treatment group. A regression analysis showed links between parental stress factors and physiological development of the infants. CONCLUSION This pilot study suggests that a live-improvised interactive music therapy intervention for extremely and very preterm infants and their parents may have a beneficial effect on the therapy duration needed for premature infants before discharge from hospital is possible. The study identified components of the original physiological variables of the infants as appropriate endpoints and suggested a slight change in study design to capture possible effects of music therapy on infants' development as well. Further studies should assess both short-term and long-term effects on premature infants as well as on maternal and paternal health outcomes, to determine whether a family-centered music therapy, actually experienced as an added value to developmental care, should be part of routine care at the NICU.
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Affiliation(s)
- Barbara M. Menke
- Department of Neonatology, University Children’s Hospital, Heidelberg, Germany
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
| | - Joachim Hass
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Carsten Diener
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
| | - Johannes Pöschl
- Department of Neonatology, University Children’s Hospital, Heidelberg, Germany
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11
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Filippa M, Della Casa E, D’amico R, Picciolini O, Lunardi C, Sansavini A, Ferrari F. Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083915. [PMID: 33917889 PMCID: PMC8068283 DOI: 10.3390/ijerph18083915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021.
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Affiliation(s)
- Manuela Filippa
- Department of Psychology and Educational Sciences, University of Geneva, 24, rue General Dufour, 1211 Geneva, Switzerland
- Department of Social Sciences, University of Valle d’Aosta, Str. Cappuccini, 2, 11100 Aosta, Italy
- Correspondence:
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
| | - Roberto D’amico
- Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy;
| | - Odoardo Picciolini
- Pediatric Physical Medicine & Rehabilitation Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy;
| | - Clara Lunardi
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy;
| | - Alessandra Sansavini
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy;
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
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12
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Yates R, Treyvaud K, Doyle LW, Ure A, Cheong JLY, Lee KJ, Inder TE, Spencer-Smith M, Anderson PJ. Rates and Stability of Mental Health Disorders in Children Born Very Preterm at 7 and 13 Years. Pediatrics 2020; 145:peds.2019-2699. [PMID: 32276969 DOI: 10.1542/peds.2019-2699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children born very preterm (VPT) are at an increased risk of developing mental health (MH) disorders. Our aim for this study was to assess rates of MH disorders in children born VPT and term at 13 years of age and stability of MH disorders between ages 7 and 13 years by using a diagnostic measure. METHODS Participants were from the Victorian Infant Brain Study longitudinal cohort and included 125 children born VPT (<30 weeks' gestational age and/or <1250 g) and 49 children born term (≥37 weeks' gestational age) and their families. Participants were followed-up at both 7 and 13 years, and the Development and Well-Being Assessment was administered to assess for MH disorders. RESULTS Compared with term peers, 13-year-olds born VPT were more likely to meet criteria for any MH disorder (odds ratio 5.9; 95% confidence interval 1.71-20.03). Anxiety was the most common disorder in both groups (VPT = 14%; term = 4%), whereas attention-deficit/hyperactivity disorder carried the greatest differential elevated risk (odds ratio 5.6; 95% confidence interval 0.71-43.80). Overall rates of MH disorders remained stable between 7 and 13 years, although at an individual level, many participants shifted in or out of diagnostic categories over time. CONCLUSIONS Children born VPT show higher rates of MH disorders than their term peers, with changing trajectories over time. Findings highlight the importance of early identification and ongoing assessment to support those with MH disorders in this population.
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Affiliation(s)
- Rosemary Yates
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Karli Treyvaud
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Psychology and Counselling, La Trobe University, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Departments of Obstetrics and Gynaecology and.,Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Ure
- Department of Paediatrics and Education Research, Monash University, Clayton, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Mental Health, The Royal Children's Hospital, Parkville, Victoria, Australia.,Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Departments of Obstetrics and Gynaecology and
| | - Katherine J Lee
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Terrie E Inder
- Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Megan Spencer-Smith
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and .,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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13
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Almadhoob A, Ohlsson A. Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev 2020; 1:CD010333. [PMID: 31986231 PMCID: PMC6989790 DOI: 10.1002/14651858.cd010333.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are subjected to stress, including sound of high intensity. The sound environment in the NICU is louder than most home or office environments and contains disturbing noises of short duration and at irregular intervals. There are competing auditory signals that frequently challenge preterm infants, staff and parents. The sound levels in NICUs often exceed the maximum acceptable level of 45 decibels (dB), recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general paediatric population. Noise may cause apnoea, hypoxaemia, alternation in oxygen saturation, and increased oxygen consumption secondary to elevated heart and respiratory rates and may, therefore, decrease the amount of calories available for growth. Elevated levels of speech are needed to overcome the noisy environment in the NICU, thereby increasing the negative impacts on staff, newborns, and their families. High noise levels are associated with an increased rate of errors and accidents, leading to decreased performance among staff. The aim of interventions included in this review is to reduce sound levels to 45 dB or less. This can be achieved by lowering the sound levels in an entire unit, treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled, or reducing the sound levels that reaches the individual infant by using earmuffs or earplugs. By lowering the sound levels that reach the neonate, the resulting stress on the cardiovascular, respiratory, neurological, and endocrine systems can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. OBJECTIVES Primary objective To determine the effects of sound reduction on growth and long-term neurodevelopmental outcomes of neonates. Secondary objectives 1. To evaluate the effects of sound reduction on short-term medical outcomes (bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity). 2. To evaluate the effects of sound reduction on sleep patterns at three months of age. 3. To evaluate the effects of sound reduction on staff performance. 4. To evaluate the effects of sound reduction in the neonatal intensive care unit (NICU) on parents' satisfaction with the care. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, abstracts from scientific meetings, clinical trials registries (clinicaltrials.gov; controlled-trials.com; and who.int/ictrp), Pediatric Academic Societies Annual meetings 2000 to 2014 (Abstracts2ViewTM), reference lists of identified trials, and reviews to November 2014. SELECTION CRITERIA Preterm infants (< 32 weeks' postmenstrual age (PMA) or < 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or a stepdown unit. DATA COLLECTION AND ANALYSIS We performed data collection and analyses according to the Cochrane Neonatal Review Group. MAIN RESULTS One small, high quality study assessing the effects of silicone earplugs versus no earplugs qualified for inclusion. The original inclusion criteria in our protocol stipulated an age of < 48 hours at the time of initiating sound reduction. We made a deviation from our protocol and included this study in which some infants would have been > 48 hours old. There was no significant difference in weight at 34 weeks postmenstrual age (PMA): mean difference (MD) 111 g (95% confidence interval (CI) -151 to 374 g) (n = 23). There was no significant difference in weight at 18 to 22 months corrected age between the groups: MD 0.31 kg, 95% CI -1.53 to 2.16 kg (n = 14). There was a significant difference in Mental Developmental Index (Bayley II) favouring the silicone earplugs group at 18 to 22 months corrected age: MD 14.00, 95% CI 3.13 to 24.87 (n = 12), but not for Psychomotor Development Index (Bayley II) at 18 to 22 months corrected age: MD -2.16, 95% CI -18.44 to 14.12 (n =12). AUTHORS' CONCLUSIONS To date, only 34 infants have been enrolled in a randomised controlled trial (RCT) testing the effectiveness of reducing sound levels that reach the infants' ears in the NICU. Based on the small sample size of this single trial, we cannot make any recommendations for clinical practice. Larger, well designed, conducted and reported trials are needed.
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Affiliation(s)
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and EvaluationTorontoCanada
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14
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Filippa M, Lordier L, De Almeida JS, Monaci MG, Adam-Darque A, Grandjean D, Kuhn P, Hüppi PS. Early vocal contact and music in the NICU: new insights into preventive interventions. Pediatr Res 2020; 87:249-264. [PMID: 31266053 DOI: 10.1038/s41390-019-0490-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022]
Abstract
It is now clearly established that the environment and the sensory stimuli, particularly during the perinatal period, have an impact on infant's development. During the last trimester of gestation, activity-dependent plasticity shapes the fetal brain, and prematurity has been shown to alter the typical developmental trajectories. In this delicate period, preventive interventions aiming at modulating these developmental trajectories through activity-inducing interventions are currently underway to be tested. The purpose of this review paper is to describe the potentialities of early vocal contact and music on the preterm infant's brain development, and their potential beneficial effect on early development. Scientific evidence supports a behavioral orientation of the newborn to organized sounds, such as those of voice and music, and recent neuroimaging studies further confirm full cerebral processing of music as multisensory stimuli. However, the impact of long-term effects of music exposure and early vocal contact on preterm infants' long-term neurodevelopment needs be further investigated. To conclude, it is necessary to establish the neuroscientific bases of the early perception and the long-term effects of music and early vocal contact on the premature newborns' development. Scientific projects are currently on the way to fill this gap in knowledge.
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Affiliation(s)
- Manuela Filippa
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland. .,University of Valle d'Aosta, Aosta, Italy. .,Neuroscience of Emotion and Affective Dynamics, Swiss Center for Affective Sciences, and Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
| | - Lara Lordier
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
| | - Joana Sa De Almeida
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
| | | | - Alexandra Adam-Darque
- Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neuroscience, Division of Neurorehabilitation, University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics, Swiss Center for Affective Sciences, and Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Service de Médecine et réanimation du nouveau-né, Hôpital de Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Petra S Hüppi
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
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15
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Filippa M, Poisbeau P, Mairesse J, Monaci MG, Baud O, Hüppi P, Grandjean D, Kuhn P. Pain, Parental Involvement, and Oxytocin in the Neonatal Intensive Care Unit. Front Psychol 2019; 10:715. [PMID: 31001173 PMCID: PMC6454868 DOI: 10.3389/fpsyg.2019.00715] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/14/2019] [Indexed: 12/16/2022] Open
Abstract
Preterm infants (PTI) typically experience many painful and stressful procedures or events during their first weeks of life in a neonatal intensive care unit, and these can profoundly impact subsequent brain development and function. Several protective interventions during this sensitive period stimulate the oxytocin system, reduce pain and stress, and improve brain development. This review provides an overview of the environmental risk factors experienced by PTI during hospitalization, with a focus on the effects of pain, and early maternal separation. We also describe the long-term adverse effects of the simultaneous experiences of pain and maternal separation, and the potential beneficial effects of maternal vocalizations, parental contact, and several related processes, which appear to be mediated by the oxytocin system.
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Affiliation(s)
- Manuela Filippa
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology and Educational Sciences, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Department of Social Sciences, University of Valle d'Aosta, Aosta, Italy
| | - Pierrick Poisbeau
- Centre National de la Recherche Scientifique, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France
| | - Jérôme Mairesse
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland
| | | | - Olivier Baud
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland.,Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Petra Hüppi
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology and Educational Sciences, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Centre National de la Recherche Scientifique, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France.,Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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16
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Teitler JO, Plaza R, Hegyi T, Kruse L, Reichman NE. Elective Deliveries and Neonatal Outcomes in Full-Term Pregnancies. Am J Epidemiol 2019; 188:674-683. [PMID: 30698621 DOI: 10.1093/aje/kwz014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
Cesarean and induced delivery rates have risen substantially in recent decades and currently account for over one-third and one-fourth of US births, respectively. Initiatives to encourage delaying deliveries until a gestational age of 39 weeks appear to have slowed the increases but have not led to declines. The rates are at historic highs and the consequences of these interventions when not medically necessary have not been systematically explored at the population level. In this study, we used population-level data on births in New Jersey (1997-2011) to document trends in elective deliveries (induced vaginal delivery, cesarean delivery with no labor trial, and cesarean delivery after induction) and estimate logistic and linear regression models of associations between delivery method and neonatal morbidities and cost-related outcomes in low-risk pregnancies. We found that elective deliveries more than doubled during the observation period and were associated with neonatal morbidities and cost-related outcomes even at gestational ages of 39 and 40 weeks. Findings suggest that delaying beyond 39 weeks and avoiding delivery interventions when not medically necessary would improve infant health and reduce health-care costs.
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Affiliation(s)
| | - Rayven Plaza
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Lakota Kruse
- New Jersey Department of Health, Trenton, New Jersey
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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17
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Raboshchuk G, Nadeu C, Vidiella Pinto S, Ros Fornells O, Muñoz Mahamud B, Riverola de Veciana A. Pre-processing techniques for improved detection of vocalization sounds in a neonatal intensive care unit. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Raboshchuk G, Nadeu C, Jančovič P, Lilja AP, Köküer M, Muñoz Mahamud B, Riverola De Veciana A. A Knowledge-Based Approach to Automatic Detection of Equipment Alarm Sounds in a Neonatal Intensive Care Unit Environment. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2017; 6:4400110. [PMID: 29404227 PMCID: PMC5788405 DOI: 10.1109/jtehm.2017.2781224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/01/2017] [Accepted: 11/27/2017] [Indexed: 11/08/2022]
Abstract
A large number of alarm sounds triggered by biomedical equipment occur frequently in the noisy environment of a neonatal intensive care unit (NICU) and play a key role in providing healthcare. In this paper, our work on the development of an automatic system for detection of acoustic alarms in that difficult environment is presented. Such automatic detection system is needed for the investigation of how a preterm infant reacts to auditory stimuli of the NICU environment and for an improved real-time patient monitoring. The approach presented in this paper consists of using the available knowledge about each alarm class in the design of the detection system. The information about the frequency structure is used in the feature extraction stage, and the time structure knowledge is incorporated at the post-processing stage. Several alternative methods are compared for feature extraction, modeling, and post-processing. The detection performance is evaluated with real data recorded in the NICU of the hospital, and by using both frame-level and period-level metrics. The experimental results show that the inclusion of both spectral and temporal information allows to improve the baseline detection performance by more than 60%.
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Affiliation(s)
- Ganna Raboshchuk
- TALP Research CenterDepartment of Signal Theory and CommunicationsUniversitat Politècnica de Catalunya08034BarcelonaSpain
| | - Climent Nadeu
- TALP Research CenterDepartment of Signal Theory and CommunicationsUniversitat Politècnica de Catalunya08034BarcelonaSpain
| | - Peter Jančovič
- Department of Electronic, Electrical and Systems EngineeringUniversity of BirminghamBirminghamB15 2TTU.K.
| | - Alex Peiró Lilja
- TALP Research CenterDepartment of Signal Theory and CommunicationsUniversitat Politècnica de Catalunya08034BarcelonaSpain
| | - Münevver Köküer
- Department of Electronic, Electrical and Systems EngineeringUniversity of BirminghamBirminghamB15 2TTU.K.
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The Importance of Specific Workplace Environment Characteristics for Maximum Health and Performance: Healthcare Workers' Perspective. J Occup Environ Med 2017; 60:e245-e252. [PMID: 29227360 DOI: 10.1097/jom.0000000000001248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the importance of specific workplace environment characteristics for maximum health and performance, assigned by healthcare employees, and how they relate to the nature of their work. METHODS A cross-sectional mixed-method study was conducted with content analysis and robust regression models to examine the relationship between workplace environment characteristics and perceived importance in promoting health and performance. RESULTS Our findings suggest that perceptions of key environment characteristics that safeguard health and performance in healthcare workplaces may vary by employee sex, setting, and nature of healthcare work involved. Theme and model descriptions of the influence of these factors on participant perceptions are provided. CONCLUSIONS Employee feedback on workplace characteristics that impact health and performance could be instrumental in determining the priorities of workplace design.
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20
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Sadatsafavi H, Niknejad B, Shepley M, Sadatsafavi M. Probabilistic Return-on-Investment Analysis of Single-Family Versus Open-Bay Rooms in Neonatal Intensive Care Units-Synthesis and Evaluation of Early Evidence on Nosocomial Infections, Length of Stay, and Direct Cost of Care. J Intensive Care Med 2017; 34:115-125. [PMID: 28118769 DOI: 10.1177/0885066616689774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: There is increasing evidence that the physical environment of neonatal intensive care units (NICUs), including single-family rooms (SFRs) versus open-bay rooms (OPBYs), has tangible effects on vulnerable patients. The objective of this study was to illustrate the financial implications of SFR versus OPBY units by synthesizing and evaluating the evidence regarding the benefits and costs of each unit from a hospital perspective. METHODS: We assumed a hypothetical NICU with 40 beds in OPBY rooms, to be replaced with a new NICU with 32 SFRs and 8 OPBYs. We synthesized evidence regarding the comparative benefit of each option on 3 outcomes-nosocomial infections, length of stay, and direct costs. We calculated incremental benefit-cost ratio separately considering each outcome over an analysis period of 5 years. A ratio of more than 1 indicates that the investment is worthwhile. Input parameters were assigned probability distributions representing the degree of uncertainty around their true values. Monte Carlo simulation with 5000 iterations was used to quantify the distribution of benefits and costs. RESULTS: The mean value of the incremental benefit-cost ratio was 0.730 (95% credible interval: 0.724-0.735) when nosocomial infections were considered, 1.298 (1.282-1.315) when reduced length of stay was considered, and 1.794 (1.783-1.804) when direct costs of care were compared. The probability of a benefit-cost ratio of lower than 1 was about 91%, 31%, and 2% in each case, respectively. CONCLUSION: Cost savings associated with SFR units would justify additional construction and operation costs compared to OPBY units only when evidence on inclusive outcomes such as length of stay or direct costs of care is considered. A specific outcome such as infection rate potentially fails to capture all benefits of SFRs. As more evidence becomes available on full benefits and hazards of SFRs versus OPBYs, future studies should investigate the broader return-on-investment outcomes.
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Affiliation(s)
- Hessam Sadatsafavi
- 1 Cornell Institute for Healthy Futures, Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Bahar Niknejad
- 2 Department of Geriatrics, Weill Cornell Medical College, New York, NY, USA
| | - Mardelle Shepley
- 1 Cornell Institute for Healthy Futures, Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Mohsen Sadatsafavi
- 3 Faculty of Pharmaceutical Sciences, Faculty of Medicine, and Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
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21
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Les chambres familiales en néonatologie : effets sur le nouveau-né prématuré, ses parents et l’équipe soignante. Revue systématique de la littérature. Arch Pediatr 2016; 23:921-6. [DOI: 10.1016/j.arcped.2016.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/22/2016] [Accepted: 04/09/2016] [Indexed: 11/23/2022]
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23
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Shoemark H, Hanson-Abromeit D, Stewart L. Constructing optimal experience for the hospitalized newborn through neuro-based music therapy. Front Hum Neurosci 2015; 9:487. [PMID: 26388762 PMCID: PMC4558927 DOI: 10.3389/fnhum.2015.00487] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/21/2015] [Indexed: 11/13/2022] Open
Abstract
Music-based intervention for hospitalized newborn infants has traditionally been based in a biomedical model, with physiological stability as the prime objective. More recent applications are grounded in other theories, including attachment, trauma and neurological models in which infant, parent and the dyadic interaction may be viewed as a dynamic system bound by the common context of the neonatal intensive care unit (NICU). The immature state of the preterm infant’s auditory processing system requires a careful and individualized approach for the introduction of purposeful auditory experience intended to support development. The infant’s experience of an unpredictable auditory environment is further compromised by a potential lack of meaningful auditory stimulation. Parents often feel disconnected from their own capacities to nurture their infant with potentially life-long implications for the infant’s neurobehavioral and psychological well-being. This perspectives paper will outline some neurological considerations for auditory processing in the premature infant to frame a premise for music-based interventions. A hypothetical clinical case will illustrate the application of music by a music therapist with an infant and family in NICU.
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Affiliation(s)
- Helen Shoemark
- Music Therapy, Temple University Philadelphia, PA, USA ; Sensory Experience in Early Development, Murdoch Childrens Research Institute Melbourne, VIC, Australia
| | | | - Lauren Stewart
- Department of Psychology, Goldsmiths, University of London New Cross London, UK ; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University and The Royal Academy of Music Aarhus/Aalborg Aarhus, Denmark
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Pickler RH, Wetzel PA, Meinzen-Derr J, Tubbs-Cooley HL, Moore M. Patterned feeding experience for preterm infants: study protocol for a randomized controlled trial. Trials 2015; 16:255. [PMID: 26041365 PMCID: PMC4460964 DOI: 10.1186/s13063-015-0781-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/27/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neurobehavioral disabilities occur in 5-15% of preterm infants with an estimated 50-70% of very low birth weight preterm infants experiencing later dysfunction, including cognitive, behavioral, and social delays that often persist into adulthood. Factors implicated in poor neurobehavioral and developmental outcomes are hospitalization in the neonatal intensive care unit (NICU) and inconsistent caregiving patterns. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies can stop lesions from progressing, particularly when these strategies are used during the most sensitive periods of neural plasticity occurring months before term age. The purpose of this randomized trial is to test the effect of a patterned feeding experience on preterm infants' neurobehavioral organization and development, cognitive function, and clinical outcomes. METHODS This trial uses an experimental, longitudinal, 2-group design with 120 preterm infants. Infants are enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience from the first gavage feeding through discharge or to a control group receiving usual feeding care experience. The intervention involves a continuity of tactile experiences associated with feeding to train and build neuronal networks supportive of normal infant feeding experience. Primary outcomes are neurobehavioral organization as measured by Neurobehavioral Assessment of the Preterm Infant at 3 time points: the transition to oral feedings, NICU discharge, and 2 months corrected age. Secondary aims are cognitive function measured using the Bayley Scales of Infant and Toddler Development, Third Edition at 6 months corrected age, neurobehavioral development (sucking organization, feeding performance, and heart rate variability), and clinical outcomes (length of NICU stay and time to full oral feeding). The potential effects of demographic and biobehavioral factors (perinatal events and conditions of maternal or fetal/newborn origin and immunologic and genetic biomarkers) on the outcome variables will also be considered. DISCUSSION Theoretically, the intervention provided at a critical time in neurologic system development and associated with a recurring event (feeding) should enhance neural connections that may be important for later development, particularly language and other cognitive and neurobehavioral organization skills. TRIAL REGISTRATION NCT01577615 11 April 2012.
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Affiliation(s)
- Rita H Pickler
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Paul A Wetzel
- Virginia Commonwealth University, 401 West Main Street, PO Box 843067, Richmond, VA, USA.
| | - Jareen Meinzen-Derr
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Heather L Tubbs-Cooley
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Margo Moore
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
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Almadhoob A, Ohlsson A. Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev 2015; 1:CD010333. [PMID: 25633155 DOI: 10.1002/14651858.cd010333.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are subjected to stress, including sound of high intensity. The sound environment in the NICU is louder than most home or office environments and contains disturbing noises of short duration and at irregular intervals. There are competing auditory signals that frequently challenge preterm infants, staff and parents. The sound levels in NICUs often exceed the maximum acceptable level of 45 decibels (dB), recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general paediatric population. Noise may cause apnoea, hypoxaemia, alternation in oxygen saturation, and increased oxygen consumption secondary to elevated heart and respiratory rates and may, therefore, decrease the amount of calories available for growth. Elevated levels of speech are needed to overcome the noisy environment in the NICU, thereby increasing the negative impacts on staff, newborns, and their families. High noise levels are associated with an increased rate of errors and accidents, leading to decreased performance among staff. The aim of interventions included in this review is to reduce sound levels to 45 dB or less. This can be achieved by lowering the sound levels in an entire unit, treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled, or reducing the sound levels that reaches the individual infant by using earmuffs or earplugs. By lowering the sound levels that reach the neonate, the resulting stress on the cardiovascular, respiratory, neurological, and endocrine systems can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. OBJECTIVES Primary objectiveTo determine the effects of sound reduction on growth and long-term neurodevelopmental outcomes of neonates. Secondary objectives1. To evaluate the effects of sound reduction on short-term medical outcomes (bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity).2. To evaluate the effects of sound reduction on sleep patterns at three months of age.3. To evaluate the effects of sound reduction on staff performance.4. To evaluate the effects of sound reduction in the neonatal intensive care unit (NICU) on parents' satisfaction with the care. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, abstracts from scientific meetings, clinical trials registries (clinicaltrials.gov; controlled-trials.com; and who.int/ictrp), Pediatric Academic Societies Annual meetings 2000 to 2014 (Abstracts2View(TM)), reference lists of identified trials, and reviews to November 2014. SELECTION CRITERIA Preterm infants (< 32 weeks' postmenstrual age (PMA) or < 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or a stepdown unit. DATA COLLECTION AND ANALYSIS We performed data collection and analyses according to the Cochrane Neonatal Review Group. MAIN RESULTS One small, high quality study assessing the effects of silicone earplugs versus no earplugs qualified for inclusion. The original inclusion criteria in our protocol stipulated an age of < 48 hours at the time of initiating sound reduction. We made a deviation from our protocol and included this study in which some infants would have been > 48 hours old. There was no significant difference in weight at 34 weeks postmenstrual age (PMA): mean difference (MD) 111 g (95% confidence interval (CI) -151 to 374 g) (n = 23). There was no significant difference in weight at 18 to 22 months corrected age between the groups: MD 0.31 kg, 95% CI -1.53 to 2.16 kg (n = 14). There was a significant difference in Mental Developmental Index (Bayley II) favouring the silicone earplugs group at 18 to 22 months corrected age: MD 14.00, 95% CI 3.13 to 24.87 (n = 12), but not for Psychomotor Development Index (Bayley II) at 18 to 22 months corrected age: MD -2.16, 95% CI -18.44 to 14.12 (n =12). AUTHORS' CONCLUSIONS To date, only 34 infants have been enrolled in a randomised controlled trial (RCT) testing the effectiveness of reducing sound levels that reach the infants' ears in the NICU. Based on the small sample size of this single trial, we cannot make any recommendations for clinical practice. Larger, well designed, conducted and reported trials are needed.
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Stevens DC, Thompson PA, Helseth CC, Hsu B, Khan MA, Munson DP. A comparison of the direct cost of care in an open-bay and single-family room NICU. J Perinatol 2014; 34:830-5. [PMID: 25254332 DOI: 10.1038/jp.2014.178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This research examined the proposition that the direct costs of care were no different in an open-bay (OPBY) as compared with a single-family room (SFR) neonatal intensive care (NICU) environment. STUDY DESIGN This was a sequential cohort study. RESULT General linear models were implemented using clinical and cost data for all neonates admitted to the two cohorts studied. Costs were adjusted to year 2007 U.S. dollars. Models were constructed for the unadjusted regression and subsequently by adding demographic variables, treatment variables, length of respiratory support and length of stay. With the exception of the last, none were found to achieve significance. The full model had R(2)=0.799 with P=0.0095 and predicted direct costs of care less in the SFR NICU. CONCLUSION For the time, location and administrative practices in place, this study demonstrates that care can be provided in the SFR NICU at no additional cost as compared with OPBY NICU.
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Affiliation(s)
- D C Stevens
- 1] Boekelheide Neonatal Intensive Care Unit, Sanford Children's Hospital, Sioux Falls, SD, USA [2] Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
| | - P A Thompson
- 1] Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA [2] Sanford Research, Sanford Health System, Sioux Falls, SD, USA
| | - C C Helseth
- 1] Boekelheide Neonatal Intensive Care Unit, Sanford Children's Hospital, Sioux Falls, SD, USA [2] Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
| | - B Hsu
- 1] Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA [2] Sanford Children's Hospital, Sioux Falls, SD, USA
| | - M Akram Khan
- 1] Boekelheide Neonatal Intensive Care Unit, Sanford Children's Hospital, Sioux Falls, SD, USA [2] Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
| | - D P Munson
- 1] Boekelheide Neonatal Intensive Care Unit, Sanford Children's Hospital, Sioux Falls, SD, USA [2] Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
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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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Pickier RH, McGrath JM, Reyna BA, McCain N, Lewis M, Cone S, Wetzel P, Best A. A model of neurodevelopmental risk and protection for preterm infants. Adv Neonatal Care 2013; 13 Suppl 5:S11-20. [PMID: 24042179 PMCID: PMC10884979 DOI: 10.1097/anc.0000000000000022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.
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Affiliation(s)
- Rita H Pickier
- Department of Family and Community Health Nursing, School of Nursing (Drs Pickler and McGrath), VCU Health System (Mss Reyna, Lewis, and Cone), Department of Adult Health and Nursing Systems, School of Nursing (Dr McCain), Department of Biostatics, School of Medicine (Dr Best), Department of Biomedical Engineering, School of Engineering (Dr Wetzel), and Virginia Commonwealth University (Drs Pickler, McGrath, McCain, Wetzel, and Best), Richmond, Virginia
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Kushnerenko EV, Van den Bergh BRH, Winkler I. Separating acoustic deviance from novelty during the first year of life: a review of event-related potential evidence. Front Psychol 2013; 4:595. [PMID: 24046757 PMCID: PMC3763200 DOI: 10.3389/fpsyg.2013.00595] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/16/2013] [Indexed: 01/15/2023] Open
Abstract
Orienting to salient events in the environment is a first step in the development of attention in young infants. Electrophysiological studies have indicated that in newborns and young infants, sounds with widely distributed spectral energy, such as noise and various environmental sounds, as well as sounds widely deviating from their context elicit an event-related potential (ERP) similar to the adult P3a response. We discuss how the maturation of event-related potentials parallels the process of the development of passive auditory attention during the first year of life. Behavioral studies have indicated that the neonatal orientation to high-energy stimuli gradually changes to attending to genuine novelty and other significant events by approximately 9 months of age. In accordance with these changes, in newborns, the ERP response to large acoustic deviance is dramatically larger than that to small and moderate deviations. This ERP difference, however, rapidly decreases within first months of life and the differentiation of the ERP response to genuine novelty from that to spectrally rich but repeatedly presented sounds commences during the same period. The relative decrease of the response amplitudes elicited by high-energy stimuli may reflect development of an inhibitory brain network suppressing the processing of uninformative stimuli. Based on data obtained from healthy full-term and pre-term infants as well as from infants at risk for various developmental problems, we suggest that the electrophysiological indices of the processing of acoustic and contextual deviance may be indicative of the functioning of auditory attention, a crucial prerequisite of learning and language development.
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Affiliation(s)
- Elena V Kushnerenko
- School of Psychology, Institute for Research in Child Development, University of East London London, UK
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Arthurs OJ, Edwards A, Austin T, Graves MJ, Lomas DJ. The challenges of neonatal magnetic resonance imaging. Pediatr Radiol 2012; 42:1183-94. [PMID: 22886375 DOI: 10.1007/s00247-012-2430-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/27/2012] [Accepted: 05/06/2012] [Indexed: 12/29/2022]
Abstract
Improved neonatal survival rates and antenatal diagnostic imaging is generating a growing demand for postnatal MRI examinations. Neonatal brain MRI is now becoming standard clinical care in many settings, but with the exception of some research centres, the technique has not been optimised for imaging neonates and small children. Here, we review some of the challenges involved in neonatal MRI, including recent advances in overall MR practicality and nursing practice, to address some of the ways in which the MR experience could be made more neonate-friendly.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Stevens DC, Helseth CC, Thompson PA, Pottala JV, Khan MA, Munson DP. A Comprehensive Comparison of Open-Bay and Single-Family-Room Neonatal Intensive Care Units at Sanford Children's Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2012; 5:23-39. [DOI: 10.1177/193758671200500403] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This paper summarizes the results of a comprehensive comparison of open-bay (OPBY) and single-family-room (SFR) neonatal intensive care unit (NICU) designs. Background: The NICU expanded from 7000 ft2 in two large rooms to 27,000 ft2 with 45 individual family spaces. Results: Sound measurements indicated a significant reduction in the unoccupied SFR to less than half of the levels in the OPBY NICU. However, respiratory support equipment generated levels well above those of the ambient environment. Illumination was significantly reduced in the SFR. Ambient illumination in nursing work areas was less than recommended. In other comparisons with the OPBY NICU the SFR NICU was shown to have: a shorter interval until full enteric feedings were established; improved parent satisfaction; improved staff perceptions of the environment and care; a decrease in nurses State-Trait Anxiety scores; an increased need for total numbers of staff and nursing staff per shift; increased walking per shift by nurses and nurse practitioners; and improved sleep time in a very small sample of patients. Analysis of the cost of construction showed comparable cost per ft2; however, the cost per bed in the SFR NICU was much greater because of the increased area of this facility. Highly notable findings of this investigation included the same incidence of adverse outcomes of care and a reduction in the adjusted direct cost of care in the SFR NICU. Conclusion: These data overwhelmingly support the SFR NICU in preference to the traditional OPBY facility. They substantiate that the SFR NICU should be the new standard for NICU care.
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32
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Liu WF. Comparing sound measurements in the single-family room with open-unit design neonatal intensive care unit: the impact of equipment noise. J Perinatol 2012; 32:368-73. [PMID: 21852773 DOI: 10.1038/jp.2011.103] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine if measured sound levels in the occupied level 3 single-family room (SFR) neonatal intensive care unit (NICU) will be significantly and perceptibly different from the occupied level 3 open-unit (OU) NICU. STUDY DESIGN Case-control. Comparison of sound measurements obtained with varying types of respiratory support in SFR unit with measurements obtained from OU level 3 bedside NICU. RESULT SFR sound measurements were quieter and less loud compared with the open unit, except when high-frequency ventilation (HFV) was used. CONCLUSION The SFR level 3 NICU is a quieter, less loud environment compared with the open unit level 3 Bedside NICU when the patient is supported on room air, high flow nasal cannula, bubble continuous positive airway pressure and conventional ventilation. High HFV will result in similar measurements to the open unit level 3 bedside NICU.
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Affiliation(s)
- W F Liu
- Pediatrix Medical Group of Florida, The Children's Hospital of Southwest Florida, Fort Myers, FL, USA.
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Abstract
Sleep is a very important element for the development of a premature newborn, because it helps in creating good clinical condition, good weight gain, mastering full oral feeding and improving parent-infant relationship as well. Moreover, the development of a correct sleeping-awaking pattern is a key factor for the development of the brain. To protect sleep is important to modify the environment, for example, reducing noise levels, creating period of semi darkness and protecting infant face from direct light. To obtain this, individualized care, based on infant behavioural cues, becomes fundamental, requiring a change in daily assistance that should become more relationship-oriented. It is also fundamental to foster the presence of parents because it helps the baby to feel more protected and allows him to relax.
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Kuhn P, Zores C, Astruc D, Dufour A, Casper C. [Sensory system development and the physical environment of infants born very preterm]. Arch Pediatr 2011; 18 Suppl 2:S92-102. [PMID: 21763981 DOI: 10.1016/s0929-693x(11)71097-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The sensory systems develop in several sequences, with a process specific to each system and with a transnatal continuum. This development is based partly on interactions between the fetus and the newborn and their physical and human environments. These interactions are key drivers of the child development. The adaptation of the newborn's environment is crucial for his survival, his well-being and his development, especially if he is born prematurely. The physical environment of the hospital where immature infants are immersed differs greatly from the uterine environment from which they were extracted prematurely. There are discrepancies between their sensory expectations originating in the antenatal period and the atypical stimuli that newborns encounter in their postnatal nosocomial environment. These assertions are valid for all sensory modalities. Many studies have proven that very preterm infants are highly sensitive to this environment which can affect their physiological and behavioural well being. Moreover, it can alter their perception of important human sensory signals, particularly the ones coming from their mother. The long term impacts of this environment are more difficult to identify due to the multi-sensory nature of these stimuli and the multifactorial origin of the neurological disorders that these children may develop. However, the adaptation of their physical environment is one of the corner stones of specific developmental care programs, like the NIDCAP program that has been shown to be successful to improve their short and medium term outcomes. The architectural design, technical equipment and used health-care products, and the strategies and organizations of care are the main determinants of the physical environment of these children. Recommendations for the hospital environment, integrating a newborn's developmental perspective, have been made available. They should be applied more widely and should be completed. Technological equipment advances are also expected to allow better compliance to them. All these evolutions are completely in accordance with the concept of humane neonatal care.
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Affiliation(s)
- P Kuhn
- Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, CHU Strasbourg, 28 Avenue Molière 67098 Strasbourg cedex, France.
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Philbin MK, Ross ES. The SOFFI Reference Guide: text, algorithms, and appendices: a manualized method for quality bottle-feedings. J Perinat Neonatal Nurs 2011; 25:360-80. [PMID: 22071621 PMCID: PMC3909685 DOI: 10.1097/jpn.0b013e31823529da] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Support of Oral Feeding for Fragile Infants (SOFFI) method of bottle-feeding rests on quality evidence along with implementation details drawn from clinical experience. To be clear, the SOFFI Method is not focused on the amount of food taken in but on the conduct of the feeding and the development of competent infant feeding behavior that, consequently, assures the intake of food necessary for growth. The unique contribution of the SOFFI method is the systematic organization of scientific findings into clinically valid and reliable, easily followed algorithms, and a manualized Reference Guide for the assessments, decisions, and actions of a quality feeding.A quality feeding is recognized by a stable, self-regulated infant and a caregiver who sensitively (responsively) adjusts to the infant's physiology and behavior to realize an individualized feeding experience in which the infant remains comfortable and competent using his nascent abilities to ingest a comfortable amount of milk/formula. The SOFFI Reference Guide and Algorithms begin with prefeeding adjustments of the environment and follow step by step through a feeding with observations of specific infant behavior, decisions based on that behavior, and specific actions to safeguard emerging abilities and the quality of the experience. An important aspect the SOFFI Reference Guide and Algorithms is the clarity about pausing and stopping the feeding on the basis of the infant's physiology and behavior rather than on the basis of the amount ingested. The specificity of each observation, decision, and action enables nurses at all levels of experience to provide quality, highly individualized, holistic feedings. Throughout the course of feeding in the NICU, the nurse conveys to parents the integrated details (observations, decisions, and actions) particular to their infant, thus passing on the means for parents to become competent in quality feeding, to enjoy feeding time into the future, and to gain in confidence as they watch their infants grow.
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Olischar M, Shoemark H, Holton T, Weninger M, Hunt RW. The influence of music on aEEG activity in neurologically healthy newborns ≥32 weeks' gestational age. Acta Paediatr 2011; 100:670-5. [PMID: 21261705 DOI: 10.1111/j.1651-2227.2011.02171.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Music is increasingly being used in neonatal intensive care units to aid neurodevelopmental care. The aim of this pilot study was to examine the possible effects of music on quiet sleep (QS) in neurologically healthy newborns. METHODS Twenty newborns ≥32 weeks' gestational age admitted to the neonatal intensive care unit at The Royal Children's Hospital in Melbourne for specialist consultation were randomly assigned to experimental or control groups. Ten subjects were exposed to music (Music for Dreaming, (Sound Impressions, Pty. Ltd.) using a CD player (50-55 decibel A). Amplitude-integrated EEG was recorded on the BrainZ Monitor (BRM2, Version 8.0, Natus). Background pattern, presence and quality of sleep-wake cycles (SWC) were assessed before and after exposure to music. RESULTS All 20 subjects showed continuous background patterns with developing SWC. Whereas no subject in the control group showed differences in their QS and eight patients in the intervention group showed lower minimum amplitudes of their QS after music exposure. Also, the length of QS and interval between QS epochs became progressively longer in all ten subjects of the intervention group. CONCLUSION We report a trend to more mature SWC in subjects who were exposed to music when compared to controls suggesting that there might be a small effect of music on quiet sleep in newborns.
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Affiliation(s)
- Monika Olischar
- University Childrens Hospital, Neonatology, Vienna, Austria.
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Domanico R, Davis DK, Coleman F, Davis BO. Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. J Perinatol 2011; 31:281-8. [PMID: 21072040 PMCID: PMC3070087 DOI: 10.1038/jp.2010.120] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/04/2010] [Accepted: 08/09/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To test the efficacy of single family room (SFR) neonatal intensive care unit (NICU) designs, questions regarding patient medical progress and relative patient safety were explored. Addressing these questions would be of value to hospital staff, administrators and designers alike. STUDY DESIGN This prospective study documented, by means of Institution Review Board-approved protocols, the progress of patients in two contrasting NICU designs. Noise levels, illumination and air quality measurements were included to define the two NICU physical environments. RESULT Infants in the SFR unit had fewer apneic events, reduced nosocomial sepsis and mortality, as well as earlier transitions to enteral nutrition. More mothers sustained stage III lactation, and more infants were discharged breastfeeding in the SFR. CONCLUSION This study showed the SFR to be more conducive to family-centered care, and to enhance infant medical progress and breastfeeding success over that of an open ward.
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Affiliation(s)
- R Domanico
- Joan C. Edwards School of Medicine, Marshall University, Neonatal Intensive Care Unit, Cabell Huntington Hospital, Huntington, WV, USA
| | | | - F Coleman
- Neonatal Intensive Care Unit, Cabell Huntington Hospital, Huntington, WV, USA
| | - B O Davis
- Department of Biology and Physics, College of Science and Mathematics, Kennesaw State University, Kennesaw, GA, USA
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Stevens DC, Helseth CC, Khan MA, Munson DP, Reid EJ. A Comparison of Parent Satisfaction in an Open-Bay and Single-Family Room Neonatal Intensive Care Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2011; 4:110-23. [DOI: 10.1177/193758671100400309] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). Methods: This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. Results: Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. Conclusions: Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.
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Peixoto PV, Balbino FS, Chimirri V, Pinheiro EM, Kakehashi TY. Ruído no interior das incubadoras em unidade de terapia intensiva neonatal. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000300009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Identificar níveis de pressão sonora (NPS) no interior das incubadoras e as fontes geradoras de ruído nesse microambiente de Unidade de Terapia Intensiva Neonatal de um hospital universitário. MÉTODOS: Pesquisa quantitativa, descritiva, conduzida nas incubadoras de Unidade de Terapia Intensiva Neonatal de um hospital universitário do Município de São Paulo. Os registros de NPS foram obtidos por meio de dosímetro, totalizando 261 horas, 48 horas de registros das fontes produtoras de ruídos. RESULTADOS: Constataram-se elevados NPS no interior das incubadoras. Maiores Leq médios foram 79,7 dBA na sala A e 74,3 dBA na B. As principais fontes de ruído foram: barulho da água do ventilador, permanência das portinholas abertas da incubadora, durante os cuidados prestados, alarmes dos equipamentos e conversa entre profissionais próxima à incubadora. CONCLUSÕES: Os resultados evidenciaram que os NPS no interior das incubadoras estão distantes do recomendado pelos órgãos regulamentadores. Com base nesses resultados, foram desenvolvidos um protocolo e programa educativo.
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Chiappedi M, Balottin U, Baschenis IM, Piazza F, Bernardi ED, Bejor M. Scientifically based nurture and nature: Alternative but non exclusive hypotheses on attention development. Med Hypotheses 2010; 75:445-7. [DOI: 10.1016/j.mehy.2010.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 04/07/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
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Abstract
The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.
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The impact of a noise reduction quality improvement project upon sound levels in the open-unit-design neonatal intensive care unit. J Perinatol 2010; 30:489-96. [PMID: 20010612 DOI: 10.1038/jp.2009.188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To decrease measured sound levels in the neonatal intensive care unit through implementation of human factor and minor design modification strategies. STUDY DESIGN Prospective time series. Two open-unit-design neonatal centers. RESULT Implementation of a coordinated program of noise reduction strategies did not result in any measurable improvement in levels of loudness or quiet. CONCLUSION Two centers, using primarily human behavior noise reduction strategies, were unable to demonstrate measurable improvements in sound levels within the occupied open-unit-design neonatal intensive care unit.
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Abstract
The newborn shows several signs of consciousness, such as being awake and aware of him/herself and mother. The infant processes olfactory and painful inputs in the cortex, where consciousness is believed to be localized. Furthermore, the newborn expresses primary emotions such as joy, disgust, and surprise and remember rhymes and vowels to which he or she has been exposed during fetal life. Thus, the newborn infant fulfills the criteria of displaying a basic level of consciousness, being aware of its body and him/her-self and somewhat about the external world. Preterm infants may be conscious to a limited degree from about 25 weeks, when the thalamocortical connections are established.
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Affiliation(s)
- Hugo Lagercrantz
- Neonatal Research Unit, Karolinska Institute, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
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Matook SA, Sullivan MC, Salisbury A, Miller RJ, Lester BM. Variations of NICU sound by location and time of day. Neonatal Netw 2010; 29:87-95. [PMID: 20211830 DOI: 10.1891/0730-0832.29.2.87] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/AIMS The primary aim of this study was to identify time periods of sound levels >45 decibels (dB) in a large Level III NICU. The second aim was to determine whether there were differences in decibel levels across the five bays of the NICU, the four quadrants within each bay, and two 12-hour shifts. DESIGN A repeated measures design was used. Bay, quadrant, and shift were randomly selected for sampling. Staff and visitors were blinded to the location of the sound meter, which was placed in one of five identical wooden boxes and was preset to record for 12 hours. SAMPLE Sound levels were recorded every 60 seconds over 40 12-hour periods, 20 during the day shift and 20 during the night shift. Total hours measured were 480. Data were collected every other day during a three-month period. Covariates of staffing, infant census, infant acuity, and medical equipment were collected. MAIN OUTCOME VARIABLE The main outcome variable was sound levels in decibels, with units of measurement of energy equivalent sound level (Leq), peak instantaneous sound pressure level, and maximum sound pressure level during each interval for a total of 480 hours. RESULTS All sound levels were >45 dB, with average readings ranging from 49.5 to 89.5 dB. The middle bay had the highest levels, with an Leq of 85.74 dB. Quadrants at the back of a bay were louder than quadrants at the front of a bay. The day shift had higher decibel levels than the night shift. Covariates did not differ across bays or shifts.
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Affiliation(s)
- Sherry A Matook
- NICU , Women & Infants Hospital, Providence, Rhode Island, USA
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Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design. J Perinatol 2010; 30:352-8. [PMID: 19798047 DOI: 10.1038/jp.2009.137] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare perceived workplace quality in an open-bay neonatal intensive care unit (NICU) and a single-family room (SFR) NICU. STUDY DESIGN Prospective non-randomized, non-controlled cohort study. RESULT Staff workplace quality perceptions assessed included the following: the quality of being a Sanford Health System employee (NS-not significant), the quality of the NICU physical work environment, the quality of NICU patient care, the job quality in the NICU, the quality of health and safety in the NICU (NS), the quality of safety and security in the NICU, the quality of interaction with other members of the NICU health-care team (NS; in subanalysis nurse scores significantly declined), the quality of interaction with NICU technology and the off-job quality of life (NS). Scores for each category and the total scores were statistically greater in the SFR, except as noted (NS). CONCLUSION Staff perceptions of workplace quality were significantly greater in the SFR than the open-bay NICU.
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White-Traut RC, Nelson MN, Silvestri JM, Patel M, Lee H, Cimo S, McReynolds E. Maturation of the Cardiac Response to Sound in High-Risk Preterm Infants. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.nainr.2009.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Goines L. The importance of quiet in the home: Teaching noise awareness to parents before the infant is discharged from the NICU. Neonatal Netw 2008; 27:171-6. [PMID: 18557264 DOI: 10.1891/0730-0832.27.3.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research over several decades describes various adverse health effects of noise on the hospitalized neonate. Noise is a direct cause of long-lasting auditory problems and a significant cause of cardiovascular and respiratory problems and neurologic impairment. Many hospitals have turned the NICU into a quiet environment that promotes the neonate's health and well-being. But auditory pathways continue to develop during the neonatal period, reaching maturation at 12 months and beyond. Some of this development thus occurs after the neonate is discharged from the hospital. It is a responsibility of NICU professionals to teach families about the health benefits of noise modulation and planned quiet in the home environment. This teaching may make a world of difference to the continued healthy growth, development, and well-being of the infant.
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Kellam B, Bhatia J. Sound spectral analysis in the intensive care nursery: measuring high-frequency sound. J Pediatr Nurs 2008; 23:317-23. [PMID: 18638675 DOI: 10.1016/j.pedn.2007.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 09/29/2007] [Indexed: 11/27/2022]
Abstract
Uterine structures protect the fetus from high-frequency sounds (i.e., >500 Hz). Preterm infants are not protected from sound >500 Hz. It is necessary to assess sound frequencies to protect preterm infants from high-frequency sound. However, no noise measurement study has been reported using sound spectral analysis (SSA). This article reports the results of an SSA in two Level III neonatal intensive care units (NICUs). The results of the SSA indicated that significant high-frequency sound existed within the infant's immediate care environment. Results of SSA assessments may lend evidentiary support to clinical managers seeking to redesign traditional NICUs.
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Affiliation(s)
- Barbara Kellam
- East Carolina University College of Nursing, Greenville, NC; Medical College of Georgia, Augusta, GA, USA.
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