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Cistone N, Pickler RH, Fortney CA, Nist MD. Effect of Routine Nurse Caregiving on the Stress Responses and Behavior State in Preterm Infants: A Systematic Review. Adv Neonatal Care 2024; 24:442-452. [PMID: 38968382 PMCID: PMC11361837 DOI: 10.1097/anc.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Although routine nurse caregiving is vital for the overall health of preterm infants, variations in approaches may exert distinct effects on preterm infants' stress responses and behavior state. PURPOSE The purpose of this systematic review was to examine routine nurse caregiving in the neonatal intensive care unit and its effect on stress responses and behavior state in preterm infants. DATA SOURCES A systematic search was conducted using PubMed, Embase, and CINAHL for studies published between 2013 and 2023. STUDY SELECTION Included studies enrolled preterm infants born <37 weeks gestational age and investigated nurse caregiving practices and effects on stress responses and/or behavior state. DATA EXTRACTION Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data about study design, methods, findings, and limitations were extracted and summarized. Included studies were evaluated for bias using the National Health, Lung, and Blood Institute quality assessment tools. RESULTS All 13 studies included in the review received a fair quality rating. Nurse caregiving activities, including suctioning, diaper changes, bathing, and weighing, were associated with increases in heart and respiratory rates, blood pressure, energy expenditure, and motor responses, lower oxygen saturations, and fewer sleep states. IMPLICATIONS FOR PRACTICE AND RESEARCH Adapting nurse caregiving frequency and duration, aligning caregiving with infant state, and integrating developmental care strategies may reduce infant stress responses and support behavioral rest. Further research is needed to understand how caregiving activities affect stress responses and behavior state in preterm infants, aiding in identifying modifiable caregiving stressors to promote optimal development.
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Affiliation(s)
- Nicole Cistone
- The Ohio State University College of Nursing, Columbus, Ohio
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Silva NDF, Linhares MBM, Gaspardo CM. Stress and self-regulation behaviors in preterm neonates hospitalized at open-bay and single-family room Neonatal Intensive Care Unit. Infant Behav Dev 2024; 76:101951. [PMID: 38663037 DOI: 10.1016/j.infbeh.2024.101951] [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: 11/17/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 09/11/2024]
Abstract
The Neonatal Intensive Care Unit (NICU) could be a risk factor for the development of preterm neonates due to the stressful procedures they undergo. Stress-related behaviors must be managed through environmental strategies that support regulating the neonates' biobehavioural system to minimize the negative impact on their development. The study aimed to compare the NICU environment's stressful procedures and developmental care strategies and the stress and self-regulation behaviors of preterm neonates in groups differentiated by the NICU environmental design. The sample comprised 20 preterm neonates hospitalized in a NICU with an open-bay model (OB NICU) and 20 preterm neonates hospitalized in a single-family room model (SFR NICU). The stressful procedures were assessed by the Neonatal Infant Stressor Scale (NISS). The developmental care strategies and the preterm neonates' stress and self-regulation behaviors were assessed using a structured observational protocol. The between-group comparison was performed by the Mann-Whitney test, and the significance level was set at 5%. Both NICUs had similar stressful procedures and developmental care approaches. However, the preterm neonates hospitalized in the SFR NICU exhibited significantly fewer total stress behaviors, and specifically in the motor system, compared to those in the OB NICU. Additionally, the preterm neonates hospitalized in the SFR NICU exhibited significantly more total self-regulation behaviors, and specifically in the behavioral state system, compared to those in the OB NICU. The findings showed that the single-family room NICU model was consistent with the environmental protection of biobehavioural regulation in preterm neonates hospitalized in the NICU.
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Navalón P, Merchan-Naranjo J, Ghosn F, Almansa B, Chafer-Pericas C, González-Peñas J, Rodríguez-Toscano E, Zeballos S, Arriaga M, Castro Castro P, Blanco Bravo D, Vento M, Pina-Camacho L, García-Blanco A. Study of the pathophysiological mechanisms associated with the onset and course of neurodevelopmental disorders in preterm infants (the PeriSTRESS-PremTEA study): Rationale, objectives, design and sample description. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024; 17:19-27. [PMID: 33618030 DOI: 10.1016/j.rpsm.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/03/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are few studies exploring the pathophysiological pathways that may condition differentially the emergence/course of neurodevelopmental disorders (ND) in very preterm and extremely preterm newborns (VPTN/EPTN). Furthermore, there are no established biological markers predictive of ND in this population. The aim of this study is four-fold: in two cohorts of VPTN/EPTN (i) to characterize the emergence/course of ND up to corrected-age 6 years, (ii) to identify those factors (from prenatal stages up to age 6 years) that explain the interindividual differences related to emergence/course of ND, (iii) to identify in the first hours/days of life a urinary metabolomic biomarker profile predictive of ND, and (iv) to determine longitudinally variations in DNA methylation patterns predictive of ND. METHODS Observational, longitudinal, prospective, six-year follow-up, multicentre collaborative study. Two cohorts are being recruited: the PeriSTRESS-Valencia-cohort (n=26 VPTN, 18 EPTN, and 122 born-at-term controls), and the PremTEA-Madrid-cohort (n=49 EPTN and n=29 controls). RESULTS We describe the rationale, objectives and design of the PeriSTRESS-PremTEA project and show a description at birth of the recruited samples. CONCLUSIONS The PeriSTRESS-PremTEA project could help improve early identification of clinical, environmental and biological variables involved in the physiopathology of ND in VPTN/EPTN. It could also help to improve the early identification of non-invasive ND biomarkers in this population. This may allow early ND detection as well as early and personalised intervention for these children.
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Affiliation(s)
- Pablo Navalón
- Neonatal Research Group, La Fe Health Research Institute, Valencia, España; Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, España
| | - Jéssica Merchan-Naranjo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, España
| | - Farah Ghosn
- Neonatal Research Group, La Fe Health Research Institute, Valencia, España
| | - Belén Almansa
- Neonatal Research Group, La Fe Health Research Institute, Valencia, España
| | | | - Javier González-Peñas
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, España
| | - Elisa Rodríguez-Toscano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, España
| | - Susana Zeballos
- Department of Neonatology, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense, Madrid, España
| | - María Arriaga
- Department of Neonatology, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense, Madrid, España
| | - Pedro Castro Castro
- Section of Neuropaediatrics, Department of Paediatrics, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense, Madrid, España
| | - Dorotea Blanco Bravo
- Department of Neonatology, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense, Madrid, España
| | - Máximo Vento
- Neonatal Research Group, La Fe Health Research Institute, Valencia, España
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, España.
| | - Ana García-Blanco
- Neonatal Research Group, La Fe Health Research Institute, Valencia, España; Department of Personality, Assessment and Psychological Treatments, University of Valencia, España
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Cassiano RG, Gaspardo CM, Linhares MB. Neonatal stress and behavior problems in preschool children born preterm. Clin Child Psychol Psychiatry 2023; 28:500-511. [PMID: 35531999 DOI: 10.1177/13591045221098521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present longitudinal study was to examine the effect of preterm childbirth, acute neonatal stress, and child behavior at 18-36 months of age on later behavior outcomes in 4-5-year-old children. The sample comprised of 70 children who were born preterm. The neonatal characteristics of children were assessed during hospitalization by reviewing their medical records and utilizing the Neonatal Infant Stressor Scale. Behavior problems were evaluated by the maternal-report in the Child Behavior Checklist 1½-5 years. A multiple linear regression analysis was conducted. Also, the repeated measures analysis of variance and the McNemar test for paired samples were performed. Daily exposure of the infants to high neonatal acute stress during NICU hospitalization and more behavior problems at 18-36 months of age was associated with more total and externalizing behavior problems at 4-5 years of age. Lower gestational age at childbirth and more internalizing behavior problems at 18-36 months was associated with more internalizing problems at 4-5 years old. The present study showed the combination of predictors of neonatal conditions and behavioral problems at childhood, highlighting the relevance of the implementation of developmental care in the NICU and follow-up the preterm infants after discharge programs.
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Affiliation(s)
- Rafaela Gm Cassiano
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, 54539University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Claudia M Gaspardo
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, 54539University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Bm Linhares
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, 54539University of São Paulo, Ribeirão Preto, SP, Brazil
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Wang F, Zhang Q, Ni ZH, Lv HT. Effects of kangaroo care on pain relief in premature infants during painful procedures: A meta-analysis. J SPEC PEDIATR NURS 2022; 27:e12390. [PMID: 35859291 DOI: 10.1111/jspn.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to evaluate effects of kangaroo care on pain relief in premature infants during painful procedures. DESIGN A meta-analysis. METHODS Eight databases (Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine [CBM], China Science and Technology Journal Database [CSTJ], China National Knowledge Infrastructure [CNKI], and WanFang Data) were systematically reviewed from inception to November 2021 for randomized controlled and crossover trials. RESULTS Thirteen studies, including 2311 infants (kangaroo care: 1153, control: 1158) were analyzed. Kangaroo care had a moderate effect on pain relief during painful procedures in premature infants at a gestational age of 32-36 + 6 weeks but no effect at 28-31 + 6 weeks. Furthermore, 15 or 30 min of kangaroo care had a moderate effect and could markedly relieve pain at the instant of and 30/60 s after, had a small effect at 90 s after, and no effect at 120 s after the procedure. PRACTICE IMPLICATIONS Kangaroo care may be an effective nonpharmacologic alternative therapy to relieve procedural pain in premature infants born at a gestational age of 32-36 + 6 weeks.
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Affiliation(s)
- Fang Wang
- Neonatal Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Qing Zhang
- Neonatal Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Zhi Hong Ni
- Department of Nursing, Children's Hospital of Soochow University, Suzhou, China
| | - Hai Tao Lv
- Neonatal Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
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Canin N. Premature infancy: a 25-year scoping review of psychoanalytic journal articles. PSYCHOANALYTIC PSYCHOTHERAPY 2022. [DOI: 10.1080/02668734.2022.2078996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Nicole Canin
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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A Cross-sectional Survey of Enteral Feeding Tube Placement and Gastric Residual Aspiration Practices: Need for an Evidence-Based Clinical Practice Guideline. Adv Neonatal Care 2021; 21:418-424. [PMID: 33427751 DOI: 10.1097/anc.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm infants routinely require enteral feeding via nasogastric or orogastric tubes as an alternative to oral feeding to meet their nutritional needs. Anecdotal evidence suggests variations in practice related to correct tube placement and assessment of feed intolerance. PURPOSE To determine the current practices of enteral feeding tube placement confirmation and gastric residual (GR) aspiration of neonatal clinicians in Australia. METHODS A cross-sectional online survey comprising 24 questions was distributed to nursing and medical health professionals working in Australian neonatal care units through 2 e-mail listservs made available by professional organizations. FINDINGS The survey was completed by 129 clinicians. A single method was practiced by 50% of the clinicians in confirming tube placement, and most common practice was assessing the pH of GR aspirate. The majority of respondents (96%) reported that they relied on GR aspiration and clinical signs to determine feeding tolerance and subsequent decisions such as ceasing or decreasing feeds. However, the frequency of aspiration, the amount and color of aspirate considered to be normal/abnormal, and decisions on whether to replace gastric aspirate or whether aspiration should be performed during continuous tube feeding varied. IMPLICATION FOR PRACTICE This study demonstrated considerable variability in clinical practice for enteral feeding tube placement confirmation and GR aspiration despite most respondents reporting using a unit-based clinical practice guideline. Our study findings highlight the need for not only developing evidence-based practice guidelines for safe and consistent clinical practice but also ensuring that these guidelines are followed by all clinicians. IMPLICATION FOR RESEARCH Further research is needed to establish evidence-based methods both for enteral feeding tube placement confirmation and for the assessment of feeding intolerance during tube feeding. In addition, the reasons why evidence-based methods are not followed must be investigated.
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Individualized Family-Centered Developmental Care: A Model for High-Quality Care. J Perinat Neonatal Nurs 2021; 35:294-297. [PMID: 34726644 DOI: 10.1097/jpn.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ceylan SS, Keskin Z, Yavaş Z, Özdemir H, Tosun G, Güner E, İzci A. Developing the Scale of Parental Participation in Care: Neonatal Intensive Care Unit and Examining the Scale's Psychometric Properties. Intensive Crit Care Nurs 2021; 65:103037. [PMID: 33773901 DOI: 10.1016/j.iccn.2021.103037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to develop the Scale of Parental Participation in Care: Neonatal Intensive Care Unit and to examine the Scale's psychometric properties. METHODS The draft scale' items were created through relevant literature reviews, focus group interviews with nurses, and content validity evaluations by experts. Study data were collected in the neonatal intensive care unit of a public hospital in Turkey from June 2019 to February 2020. The study participants were comprised of 205 parents with an infant in the neonatal intensive care unit. The Scale's content validity and construct validity were evaluated to determine the validity of the scale. Cronbach's alpha coefficient, item-total score correlations, and intraclass correlation were calculated to evaluate the Scale's reliability. RESULTS Content validity index values of the draft form of the scale ranged from 0.93 to 1.00. The final scale consisted of 18 items. From the exploratory factor analysis, it was found that the scale structure comprised a single factor that accounted for 51.92% of the total variance. Concerning the reliability of the Scale, it was calculated that Cronbach's alpha level was 0.93; item total correlations ranged from 0.48 to 0.78; intraclass correlation level was 1.000. CONCLUSION It was found that the Parental Participation in Care Scale: Neonatal Intensive Care Unit was valid and reliable in this sample.
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Affiliation(s)
- Sibel Serap Ceylan
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey.
| | - Züleyha Keskin
- Neonatal Intensive Care Unit, Denizli State Hospital, Denizli, Turkey
| | - Zekiye Yavaş
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Hilal Özdemir
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Gülseren Tosun
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Elmas Güner
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Aysun İzci
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
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Abstract
BACKGROUND Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures. OBJECTIVES The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior. METHODS Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes. RESULTS Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior. DISCUSSION The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior.
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Affiliation(s)
- Marliese Dion Nist
- Marliese Dion Nist, PhD, RNC-NIC, is Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus. Abigail B. Shoben, PhD, is Associate Professor, Division of Biostatistics, The Ohio State University College of Public Health, Columbus
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Park J, Bang KS. Parenting experiences among fathers of prematurely-born children with cerebral palsy in South Korea. CHILD HEALTH NURSING RESEARCH 2021; 27:75-85. [PMID: 35004499 PMCID: PMC8650874 DOI: 10.4094/chnr.2021.27.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The symptoms and impairments caused by cerebral palsy usually require long-term treatment, resulting in a substantial burden on the family of affected children. This study explored the experiences of fathers with prematurely-born children with cerebral palsy, with a focus on how such experiences influenced their families. METHODS A qualitative case study method was used. Nine subjects were recruited from April 2018 to June 2019 at one hospital, and each was interviewed three times by a neonatal nurse. RESULTS Five core experiences of fathers were identified: regret for an insufficient initial response, confronting my child born as a premature baby, the position of being a dad who can't do anything, the process of treatment like a tunnel with no exit, and a father's getting meaning in life through children. These stories covered an individual's timeline and family interactions. CONCLUSION Our findings suggest that fathers of prematurely-born children tend to suppress their emotions; therefore, a novel intervention program to encourage fathers' emotional expression and to support healthier interactions with their families is needed. Moreover, our findings could contribute basic information for the construction of a community-based support system to aid families, including prematurely-born children and other persons with impairments.
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Affiliation(s)
- Jisun Park
- Head Nurse, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Sook Bang
- Professor, College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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The Effects of a Continuous Olfactory Stimulation Using Breast Milk (COSB) on Behavioral State and Physiological Responses in Korean Premature Infants. J Pediatr Nurs 2020; 53:e114-e120. [PMID: 32147276 DOI: 10.1016/j.pedn.2020.02.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE This study aimed to evaluate the effects of continuous olfactory stimulation with breast milk (COSB) on behavioral and physiologic states of Korean premature infants. DESIGN AND METHODS We examined the COSB effects on the behavioral states and physiological responses, including heart rate and oxygen saturation, in 30 premature infants using a non-equivalent control group pre- and post-test design. Sterile 2 cm × 2 cm gauzes wet with 2 cc breast milk were placed 10 cm away from the infants' nostrils 8 times per day for 3 consecutive days. We obtained five measurements each of the behavioral state, heart rate, and oxygen saturation of the premature infants in the neonatal intensive care unit (NICU). Statistical analysis was conducted using descriptive statistics and two-way repeated-measures ANOVA. RESULTS The experiment group presented significantly reduced heart rate variations (p = .039). There were significant differences in the heart rate at all time-points in the control group (p < .001) but not in the experimental group, indicating more stable (p > .089) heart rates in the latter group. There were positive COSB effects on the behavioral states of premature infants at some time points. CONCLUSIONS COSB can be a useful intervention program for high-risk infants for partial behavioral state stabilization and significant heart rate stabilization. PRACTICE IMPLICATIONS COSB might enable NICU nurses to provide a useful and safe developmental care plan for the premature infants hospitalized in the NICU to improve their physiologic and behavioral condition.
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Clinical validation of the Neonatal Infant Stressor Scale with preterm infant salivary cortisol. Pediatr Res 2020; 87:1237-1243. [PMID: 31847006 PMCID: PMC7255933 DOI: 10.1038/s41390-019-0713-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Preterm infants face unique stress states in early life. Early-life stress has been associated with changes in cortisol reactivity and behavioral abnormalities later in childhood in non-preterm populations. The Neonatal Infant Stressor Scale (NISS) has been used to estimate infant stress in the neonatal intensive care unit (NICU) but has not been biomarker validated. The relationship between NISS scores and salivary cortisol is unknown. The aim of this study is to test the association between NISS scores and salivary cortisol in the NICU Hospital Exposures and Long-Term Health (NICU-HEALTH) preterm birth cohort. METHODS Three hundred and eighty-six salivary cortisol specimens were collected from 125 NICU-HEALTH participants during the NICU hospitalization. NISS scores were calculated to represent the infant's experience in the 6 hours prior to specimen collection. Adjusted mixed-effect regression models were used to assess the association between each NISS score and salivary cortisol. RESULTS Acute and total NISS scores were significantly associated with salivary cortisol level (P = 0.002 and 0.05, respectively). The chronic NISS score was not associated with salivary cortisol levels. Caffeine treatment and postmenstrual age of the infant were important covariates in all models. CONCLUSION Acute and total NISS score are associated with salivary cortisol level in hospitalized moderately preterm infants.
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Cassiano RGM, Provenzi L, Linhares MBM, Gaspardo CM, Montirosso R. Does preterm birth affect child temperament? A meta-analytic study. Infant Behav Dev 2020; 58:101417. [PMID: 31927307 DOI: 10.1016/j.infbeh.2019.101417] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 11/26/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
The present meta-analytic study was conducted to examine differences in temperament between preterm and full-term children, considering behavior style and psychobiological approaches. Moreover, we explored the potential moderators of the associations between prematurity and temperament. A systematic literature search was performed on PubMed, Scopus, Web of Science, and CINAHL. Twenty-two studies were analyzed. Preterm children showed a higher Activity level as well as lower Attentional Focusing and Attention Span/Persistence, in comparison with their full-term counterparts. Extremely preterm children showed a higher Activity level than other preterm levels. These findings support the conclusion that preterm children present with a less regulated temperament relative to those born full term.
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Affiliation(s)
- Rafaela G M Cassiano
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Avenida Tenente Catão Roxo, 2260, Ribeirão Preto, SP, CEP: 14051-140, Brazil.
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Maria Beatriz Martins Linhares
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Avenida Tenente Catão Roxo, 2260, Ribeirão Preto, SP, CEP: 14051-140, Brazil
| | - Claudia M Gaspardo
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Avenida Tenente Catão Roxo, 2260, Ribeirão Preto, SP, CEP: 14051-140, Brazil
| | - Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842 Bosisio Parini, LC, Italy
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Effectiveness of Sucrose Used Routinely for Pain Relief and Neonatal Clinical Risk in Preterm Infants: A Nonrandomized Study. Clin J Pain 2019; 34:713-722. [PMID: 29300197 DOI: 10.1097/ajp.0000000000000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm infants (PI) requiring the neonatal intensive care unit are exposed to early repetitive pain/distress. Little is known about how pain relief strategies interact with infants' clinical health status, such as severity of illness with pain responses. This study aimed to examine main and interactive effects of routine sucrose intervention and neonatal clinical risk (NCR) on biobehavioral pain reactivity-recovery in PI during painful blood collection procedures. METHODS Very low birth weight PI (<1500 g; n=104) were assigned to low and high clinical risk groups, according to the Clinical Risk Index for Babies. Sucrose group (n=52) received sucrose solution (25%; 0.5 mL/kg) 2 minutes before the procedures and control group received standard care. Biobehavioral pain reactivity-recovery was assessed according to the Neonatal Facial Coding System, sleep-wake state scale, crying time, and heart rate at 5 phases (baseline, antisepsis, puncture (P), recovery-dressing, and recovery-resting [R]). Repeated measure ANOVA with mixed-design was performed considering pain assessment phases, intervention group, and NCR. RESULTS Independent of NCR, sucrose presented main effect in decreasing neonates' facial activity pain responses and crying time, during P and R. Independent of NCR level or routine sucrose intervention, all neonates displayed activated state in P and decreased biobehavioral responses in R phase. Although no sucrose or NCR effects were observed on physiological reactivity, all neonates exhibited physiological recovery 10 minutes after P, reaching the same heart rate patterns as the baseline. CONCLUSIONS Independent of NCR level, sucrose intervention for pain relief during acute painful procedures was effective to reduce pain intensity and increase biobehavioral regulation.
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Nist MD, Pickler RH, Steward DK, Harrison TM, Shoben AB. Inflammatory mediators of stress exposure and neurodevelopment in very preterm infants: Protocol for the stress neuro-immune study. J Adv Nurs 2019; 75:2236-2245. [PMID: 31115064 PMCID: PMC6746581 DOI: 10.1111/jan.14079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 12/27/2022]
Abstract
AIMS (a) Determine relationships among stress exposure, inflammation, and neurodevelopment in very preterm infants and determine the mediated effect of inflammation on the relationship between stress exposure and neurodevelopment; (b) describe cytokine trajectories following birth and determine the effect of stress exposure on these trajectories; and (c) examine relationships between stress exposure and chronic stress responses in very preterm infants. DESIGN Non-experimental, repeated measures. METHODS Very preterm infants born 28-31 weeks post menstrual age will be enrolled. Cumulative stress exposure over the first 14 days of life will be measured using the Neonatal Infant Stressor Scale. Blood will be collected weekly for the quantification of cytokines. Neurodevelopment will be assessed using the Neurobehavioral Assessment of the Preterm Infant and hair for quantification of hair cortisol will be collected at 35 weeks post menstrual age. Multiple linear regression and conditional process analysis will be used to analyse the relationships among stress exposure, inflammation and neurodevelopment. Linear mixed models will be used to determine inflammatory trajectories over time. IRB approval for the study was received May 2017, and funding from the National Institute of Nursing Research was awarded July 2017. DISCUSSION This study will determine the extent to which inflammation mediates the relationship between stress exposure and neurodevelopment. Interventions to attenuate inflammation in preterm infants may improve outcomes. IMPACT Determining the potentially modifiable mediators of stress exposure and neurodevelopment in preterm infants is critical to improving long-term outcomes.
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Affiliation(s)
- MD Nist
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - RH Pickler
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - DK Steward
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - TM Harrison
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - AB Shoben
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, Ohio
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Gaspardo CM, Cassiano RGM, Gracioli SMA, Furini GCB, Linhares MBM. Effects of Neonatal Pain and Temperament on Attention Problems in Toddlers Born Preterm. J Pediatr Psychol 2019; 43:342-351. [PMID: 29165703 DOI: 10.1093/jpepsy/jsx140] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the effects of individual characteristics of neonates and neonatal pain-related stress on attention problems and externalizing behavior problems of toddlers born preterm, analyzing the moderating effects of the dispositional traits of temperament. Methods The sample included 62 toddlers aged 18-36 months and their mothers. The mothers were interviewed using the Child Behavior Checklist 1.5-5 for toddlers' attention and externalizing behavior problems assessment, the Early Childhood Behavior Questionnaire for toddlers' temperament assessment, and the Adult Temperament Questionnaire for their temperament assessment. The Neonatal Infant Stressor Scale analyzed the number of pain-related stress events during neonatal intensive care unit (NICU) hospitalization recorded in the medical charts. Statistical descriptive, correlation, and multiple linear regression analyses were performed. Results High neonatal pain-related stress total index, associated with toddler's temperament with less Effortful Control, and mother's temperament with high Surgency explained 23% variability of the attention problems. Otherwise, the externalizing behavior problems were explained by temperament, but not by neonatal pain-related stress. Conclusions The findings support the impact of neonatal pain experiences, and current toddlers' and mothers' temperament characterized by poorer self-regulation on attention problems in toddlers born preterm. Developmental care in the NICU and follow-up programs after discharge are recommended to promote regulated temperament of the mother-child dyads, aiming to prevent attentional problems in toddlers born preterm.
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Affiliation(s)
- Claudia M Gaspardo
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo
| | - Rafaela G M Cassiano
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo
| | - Sofia M A Gracioli
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo.,Department of Psychology, Faculty of Philosophy, Sciences and Letters, University of São Paulo
| | - Guilherme C B Furini
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo
| | - Maria Beatriz M Linhares
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo
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18
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Cassiano RGM, Gaspardo CM, Linhares MBM. Temperament moderated by neonatal factors predicted behavioral problems in childhood: A prospective longitudinal study. Early Hum Dev 2019; 135:37-43. [PMID: 31234107 DOI: 10.1016/j.earlhumdev.2019.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The present study aimed to examine the predictor effects of neonatal, sociodemographic characteristics, and temperament assessed at 18-36 months of age on behavioral problems in 4- to 5-year-old children born preterm. METHODS The sample comprised 70 children born preterm. The amount and the intensity of stress procedures during a stay in the neonatal intensive care unit were evaluated using the Neonatal Infant Stressor Scale. Temperament was assessed using the Early Childhood Behavior Questionnaire, and behavioral problems were assessed using the Child Behavior Checklist 11/2-5. Multiple linear regression analysis was performed. RESULTS Total behavioral problems were predicted by a child temperament of more negative affectivity and less effortful control, moderated by gestational age. Internalizing behavioral problems was predicted by more negative affectivity and less effortful control moderated by male sex and associated with lower gestational age. Externalizing behavior problems was predicted by less effortful control. CONCLUSIONS The main findings of the present study showed that the high immaturity at the birth of preterm infants, associated with temperament traits of more negative affectivity and less effortful control, increase the risk for future behavioral problems.
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Affiliation(s)
- Rafaela G M Cassiano
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Avenida Tenente Catão Roxo, 2260, Ribeirão Preto, SP CEP: 14051-140, Brazil
| | - Claudia M Gaspardo
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Avenida Tenente Catão Roxo, 2260, Ribeirão Preto, SP CEP: 14051-140, Brazil
| | - Maria Beatriz Martins Linhares
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Avenida Tenente Catão Roxo, 2260, Ribeirão Preto, SP CEP: 14051-140, Brazil.
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Cavolo A, Dierckx de Casterlé B, Naulaers G, Gastmans C. Physicians' Attitudes on Resuscitation of Extremely Premature Infants: A Systematic Review. Pediatrics 2019; 143:peds.2018-3972. [PMID: 31076541 DOI: 10.1542/peds.2018-3972] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Whether to resuscitate extremely premature infants (EPIs) is a clinically and ethically difficult decision to make. Indications and practices vary greatly across different countries and institutions, which suggests that resuscitation decisions may be influenced more by the attitudes of the individual treating physicians. Hence, gaining in-depth insight into physicians' attitudes improves our understanding of decision-making regarding resuscitation of EPIs. OBJECTIVE To better understand physicians' attitudes toward resuscitation of EPIs and factors that influence their attitudes through a systematic review of the empirical literature. DATA SOURCES Medline, Embase, Web of Science, and Scopus. STUDY SELECTION We selected English-language articles in which researchers report on empirical studies of physicians' attitudes toward resuscitation of EPIs. DATA EXTRACTION The articles were repeatedly read, themes were identified, and data were tabulated, compared, and analyzed descriptively. RESULTS Thirty-four articles were included. In general, physicians were more willing to resuscitate, to accept parents' resuscitation requests, and to refuse parents' nonresuscitation requests as gestational age (GA) increased. However, attitudes vary greatly for infants at GA 23 to 24 weeks, known as the gray zone. Although GA is the primary factor that influences physicians' attitudes, a complex interplay of patient- and non-patient-related factors also influences their attitudes. LIMITATIONS Analysis of English-only articles may limit generalizability of the results. In addition, authors of only 1 study used a qualitative approach, which may have led to a biased reductionist approach to understanding physicians' attitudes. CONCLUSIONS Although correlations between GA and attitudes emerged, the results suggested a more complex interplay of factors influencing such attitudes.
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Affiliation(s)
- Alice Cavolo
- Interfaculty Centre for Biomedical Ethics and Law,
| | | | - Gunnar Naulaers
- Section of Pregnancy, Foetus and Newborn, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Silva IBD, Cunha PAGD, Linhares MBM, Martinez FE, Camelo Júnior JS. NEUROCOMPORTAMENTO DE BEBÊS NASCIDOS PRÉ-TERMO, PEQUENOS E ADEQUADOS PARA A IDADE GESTACIONAL. REVISTA PAULISTA DE PEDIATRIA 2018; 36:407-414. [PMID: 30379276 PMCID: PMC6322798 DOI: 10.1590/1984-0462/;2018;36;4;00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022]
Abstract
Objective: To compare the neurobehavioral development of preterm infants with
postconceptional age between 32 and 36 weeks and 6 days, according to the
adequacy of the weight for the gestational age at birth. Methods: A cross-sectional study was performed comparing two independent groups. The
55 preterm infants who were included in the sample were hospitalized in a
neonatal intermediate care unit and were evaluated using the Neurobehavioral
Assessment of the Preterm Infant (NAPI) at the postconceptional age between
32 and 36 weeks and 6 days and compared according to the adequacy of the
weight for the gestational age. In addition to the comparison between the
groups, infants who were born small for gestational age (SGA) and those ones
adequate for gestational age (AGA) were also compared, considering the type
of intrauterine growth. The following instruments were used: NAPI, anamnesis
script, Brazilian Economic Classification Criteria, and medical records. Results: Infants were born with mean gestational age of 32.0 weeks, with the
postconceptional age and postnatal age of 34.8 weeks and 19.5 days,
respectively. The sample consisted of 55% of female infants. The results did
not show any differences in NAPI domains between SGA and AGA groups, neither
in the subgroups of SGA babies with symmetric or asymmetric growth. Conclusions: There was no difference between SGA and AGA babies in relation to
neurobehavioral development evaluated before reaching term.
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Fumagalli M, Provenzi L, De Carli P, Dessimone F, Sirgiovanni I, Giorda R, Cinnante C, Squarcina L, Pozzoli U, Triulzi F, Brambilla P, Borgatti R, Mosca F, Montirosso R. From early stress to 12-month development in very preterm infants: Preliminary findings on epigenetic mechanisms and brain growth. PLoS One 2018; 13:e0190602. [PMID: 29304146 PMCID: PMC5755830 DOI: 10.1371/journal.pone.0190602] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
Very preterm (VPT) infants admitted to Neonatal Intensive Care Unit (NICU) are at risk for altered brain growth and less-than-optimal socio-emotional development. Recent research suggests that early NICU-related stress contributes to socio-emotional impairments in VPT infants at 3 months through epigenetic regulation (i.e., DNA methylation) of the serotonin transporter gene (SLC6A4). In the present longitudinal study we assessed: (a) the effects of NICU-related stress and SLC6A4 methylation variations from birth to discharge on brain development at term equivalent age (TEA); (b) the association between brain volume at TEA and socio-emotional development (i.e., Personal-Social scale of Griffith Mental Development Scales, GMDS) at 12 months corrected age (CA). Twenty-four infants had complete data at 12-month-age. SLC6A4 methylation was measured at a specific CpG previously associated with NICU-related stress and socio-emotional stress. Findings confirmed that higher NICU-related stress associated with greater increase of SLC6A4 methylation at NICU discharge. Moreover, higher SLC6A4 discharge methylation was associated with reduced anterior temporal lobe (ATL) volume at TEA, which in turn was significantly associated with less-than-optimal GMDS Personal-Social scale score at 12 months CA. The reduced ATL volume at TEA mediated the pathway linking stress-related increase in SLC6A4 methylation at NICU discharge and socio-emotional development at 12 months CA. These findings suggest that early adversity-related epigenetic changes might contribute to the long-lasting programming of socio-emotional development in VPT infants through epigenetic regulation and structural modifications of the developing brain.
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Affiliation(s)
- Monica Fumagalli
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Livio Provenzi
- 0–3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Pietro De Carli
- 0–3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Francesca Dessimone
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ida Sirgiovanni
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Roberto Giorda
- Molecular Biology Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Claudia Cinnante
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Uberto Pozzoli
- Bioinformatics Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
- Department of Psychiatry and Behavioral Neurosciences, University of Texas at Houston, Houston, TX, United States of America
| | - Renato Borgatti
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rosario Montirosso
- 0–3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
- * E-mail:
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22
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Rodriguez J, Jordan S, Mutic A, Thul T. The Neonatal Microbiome: Implications for Neonatal Intensive Care Unit Nurses. MCN Am J Matern Child Nurs 2017; 42:332-337. [PMID: 29049058 PMCID: PMC5679116 DOI: 10.1097/nmc.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nursing care of the neonate in the neonatal intensive care unit (NICU) is complex, due in large part to various physiological challenges. A newer and less well-known physiological consideration is the neonatal microbiome, the community of microorganisms, both helpful and harmful, that inhabit the human body. The neonatal microbiome is influenced by the maternal microbiome, mode of infant birth, and various aspects of NICU care such as feeding choice and use of antibiotics. The composition and diversity of the microbiome is thought to influence key health outcomes including development of necrotizing enterocolitis, late-onset sepsis, altered physical growth, and poor neurodevelopment. Nurses in the NICU play a key role in managing care that can positively influence the microbiome to promote more optimal health outcomes in this vulnerable population of newborns.
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Affiliation(s)
- Jeannie Rodriguez
- Jeannie Rodriguez is an Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. She can be reached via e-mail at Sheila Jordan is a Pre-Doctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Abby Mutic is a Certified Nurse Midwife, Doctoral Candidate, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Taylor Thul is a Doctoral Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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23
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Using Functional Connectivity Magnetic Resonance Imaging to Measure Brain Connectivity in Preterm Infants. Nurs Res 2017; 66:490-495. [PMID: 29095379 DOI: 10.1097/nnr.0000000000000241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of functional connectivity magnetic resonance imaging (fcMRI) in research involving preterm infants is relatively new, and its feasibility in this population is not fully established. However, fcMRI images reveal functional neural connections that may be useful in establishing the mechanisms of neuroprotective interventions in preterm infants. OBJECTIVE The aim of this study was to determine the feasibility of using fcMRI to measure differences in functional neural connections in nursing intervention studies. METHODS A pilot study was conducted as part of a longitudinal, randomized controlled trial (RCT) testing the effect of a feeding intervention on neurodevelopmental and clinical outcomes of preterm infants randomly assigned to one of two groups: a patterned feeding experience (PFE) group and a usual feeding care (UFC) group. The fcMRIs were done at term-equivalent age. Visual, motor, and default mode networks were analyzed. RESULTS Seven infants were studied (four were in the PFE group, and three were in the UFC group). Participants were selected sequentially from the parent RCT. Clear images were obtained from all participants. Differences were noted among PFE and UFC infants: Infants receiving PFE were hyperconnective in the default mode (caudate, anterior cingulate cortex, and precuneus) and motor networks (middle temporal and middle occipital areas) and hypoconnective in others areas of the default mode (hippocampal and lingual regions) and motor networks (precentral and superior frontal cortices) relative to UFC infants. No differences were noted in visual networks. DISCUSSION The feasibility of using fcMRI at term-equivalent age in preterm infants who participated in an RCT on the effect of a nursing intervention was shown. Differences in connectivity among infants by group were detected. Further research is needed to show the benefit of fcMRI in studies of preterm infants given the costs of the procedure as well as the uncertain relationship of this early outcome measure to long-term neurodevelopment.
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Eeles AL, Walsh JM, Olsen JE, Cuzzilla R, Thompson DK, Anderson PJ, Doyle LW, Cheong JLY, Spittle AJ. Continuum of neurobehaviour and its associations with brain MRI in infants born preterm. BMJ Paediatr Open 2017; 1:e000136. [PMID: 29637152 PMCID: PMC5862173 DOI: 10.1136/bmjpo-2017-000136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Infants born very preterm (VPT) and moderate-to-late preterm (MLPT) are at increased risk of long-term neurodevelopmental deficits, but how these deficits relate to early neurobehaviour in MLPT children is unclear. The aims of this study were to compare the neurobehavioural performance of infants born across three different gestational age groups: preterm <30 weeks' gestational age (PT<30); MLPT (32-36 weeks' gestational age) and term age (≥37 weeks' gestational age), and explore the relationships between MRI brain abnormalities and neurobehaviour at term-equivalent age. METHODS Neurobehaviour was assessed at term-equivalent age in 149 PT<30, 200 MLPT and 200 term-born infants using the Neonatal Intensive Care UnitNetwork Neurobehavioral Scale (NNNS), the Hammersmith Neonatal Neurological Examination (HNNE) and Prechtl's Qualitative Assessment of General Movements (GMA). A subset of 110 PT<30 and 198 MLPT infants had concurrent brain MRI. RESULTS Proportions with abnormal neurobehaviour on the NNNS and the HNNE, and abnormal GMA all increased with decreasing gestational age. Higher brain MRI abnormality scores in some regions were associated with suboptimal neurobehaviour on the NNNS and HNNE. The relationships between brain MRI abnormality scores and suboptimal neurobehaviour were similar in both PT<30 and MLPT infants. The relationship between brain MRI abnormality scores and abnormal GMA was stronger in PT<30 infants. CONCLUSIONS There was a continuum of neurobehaviour across gestational ages. The relationships between brain abnormality scores and suboptimal neurobehaviour provide evidence that neurobehavioural assessments offer insight into the integrity of the developing brain, and may be useful in earlier identification of the highest-risk infants.
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Affiliation(s)
- Abbey L Eeles
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jennifer M Walsh
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Paediatric Infant Perinatal Emergency Retrieval (PIPER), The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Joy E Olsen
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rocco Cuzzilla
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
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25
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LINHARES MBM, GASPARDO CM. Non-pharmacological management of neonatal pain: Research and clinical practice in the Neonatal Intensive Care Unit. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2017. [DOI: 10.1590/1982-02752017000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract According to the World Health Organization and the International Association for the Study of Pain, pain is a relevant worldwide problem in the healthcare field. The present study aimed to describe the definition of pediatric pain and the main characteristics, and to examine the findings regarding the impact of pain on the development of the child. The best clinical practices in Neonatal Intensive Care Units should include developmental care and specifically implement pain management, aiming to protect the health and development of the infants. The efficacious non-pharmacological management of neonatal pain includes breastfeeding, skin-to-skin, non-nutritive sucking, facilitated-tucking and swaddling. Sweet solutions also have pain relief effects. Psychologists could actively participate in the implementation of non-pharmacological interventions and in the whole process to sensitize and train the professional teams, to alert parents to protection against pain and to support policymakers in the implementation of pain guidelines in the hospital.
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26
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Cassiano RGM, Gaspardo CM, Faciroli RADD, Martinez FE, Linhares MBM. Temperament and behavior in toddlers born preterm with related clinical problems. Early Hum Dev 2017. [PMID: 28628773 DOI: 10.1016/j.earlhumdev.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare temperament and behavior profiles among groups of preterm toddlers differentiated by level of prematurity and the presence of bronchopulmonary dysplasia (BPD) or retinopathy of prematurity (ROP), controlling for neonatal clinical conditions and chronological age. METHOD The sample comprised 100 preterm toddlers segregated according to level of prematurity (75 very preterm and 25 moderate/late preterm) and presence of BPD (n=36) and ROP (n=63). Temperament was assessed by the Early Childhood Behavior Questionnaire and behavior by the Child Behavior Checklist. The MANOVA was performed with a post-hoc univariate test. RESULTS The level of prematurity and the presence of BPD and ROP did not affect temperament and behavioral problems in toddlers born preterm. However, the covariates age and length of stay in NICU (Neonatal Intensive Care Unit) affected temperament and behavioral problems, respectively. The older toddlers showed higher inhibitory control and lower activity levels than younger toddlers (range of 18-36months-old). Additionally, toddlers who stayed in the NICU longer showed more pervasive development and emotionally reactive problems than toddlers who stayed in NICU for less time. CONCLUSION The level of prematurity and the presence of bronchopulmonary dysplasia and retinopathy of prematurity did not affect temperament and behavioral problems in toddlers born preterm. However, a longer stay in the NICU increased the risk for behavioral problems, and age enhanced the regulation of temperament at toddlerhood.
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Affiliation(s)
- Rafaela Guilherme Monte Cassiano
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Claudia Maria Gaspardo
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Augusto de Deus Faciroli
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Eulógio Martinez
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Beatriz Martins Linhares
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Cong X, Wu J, Vittner D, Xu W, Hussain N, Galvin S, Fitzsimons M, McGrath JM, Henderson WA. The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU. Early Hum Dev 2017; 108:9-16. [PMID: 28343092 PMCID: PMC5444300 DOI: 10.1016/j.earlhumdev.2017.03.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU. METHODS A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7weeks gestational age) recruited at birth and followed for four weeks. Cumulative pain/stressors (NICU Infant Stressor Scale) were measured daily and neurodevelopmental outcomes (NICU Network Neurobehavioral Scale) were examined at 36-37weeks post-menstrual age. Data analyses were conducted on the distribution of pain/stressors experienced over time and the linkages among pain/stressors and neurobehavioral outcomes. RESULTS Preterm infants experienced a high degree of pain/stressors in the NICU, both in numbers of daily acute events (22.97±2.30 procedures) and cumulative times of chronic/stressful exposure (42.59±15.02h). Both acute and chronic pain/stress experienced during early life significantly contributed to the neurobehavioral outcomes, particularly in stress/abstinence (p<0.05) and habituation responses (p<0.01), meanwhile, direct breastfeeding and skin-to-skin holding were also significantly associated with habituation (p<0.01-0.05). CONCLUSION Understanding mechanisms by which early life experience alters neurodevelopment will assist clinicians in developing targeted neuroprotective strategies and individualized interventions to improve infant developmental outcomes.
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Affiliation(s)
- Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, United States; Institute for Systems Genomics, University of Connecticut, Farmington, CT, United States; School of Medicine Department of Pediatrics, University of Connecticut, Farmington, CT, United States.
| | - Jing Wu
- Department of Statistics, University of Connecticut, Storrs, CT, United States
| | - Dorothy Vittner
- School of Nursing, University of Connecticut, Storrs, CT, United States; Connecticut Department of Developmental Services, Hartford, CT, United States
| | - Wanli Xu
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Naveed Hussain
- School of Medicine Department of Pediatrics, University of Connecticut, Farmington, CT, United States; Connecticut Children's Medical Center, Hartford, CT, United States
| | - Shari Galvin
- Connecticut Children's Medical Center, Hartford, CT, United States
| | - Megan Fitzsimons
- Connecticut Children's Medical Center, Hartford, CT, United States
| | - Jacqueline M McGrath
- School of Nursing, University of Connecticut, Storrs, CT, United States; Connecticut Children's Medical Center, Hartford, CT, United States
| | - Wendy A Henderson
- Digestive Disorders Unit, Biobehavioral Branch, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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Impact of neonatal risk and temperament on behavioral problems in toddlers born preterm. Early Hum Dev 2016; 103:175-181. [PMID: 27701040 DOI: 10.1016/j.earlhumdev.2016.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 02/02/2023]
Abstract
Children born preterm are at risk for later developmental disorders. The present study examined the predictive effects of neonatal, sociodemographic, and temperament characteristics on behavioral outcomes at toddlerhood, in children born preterm. The sample included 100 toddlers born preterm and with very-low-birth-weight, and their mothers. Neonatal characteristics were evaluated using medical records. The mothers were interviewed using the Early Childhood Behavior Questionnaire for temperament assessment, and the Child Behavior Checklist for behavioral assessment. Multiple linear regression analyses were performed. Predictors of 39% of the variability of the total behavioral problems in toddlers born prematurely were: temperament with more Negative Affectivity and less Effortful Control, lower family socioeconomic status, and younger mothers at childbirth. Temperament with more Negative Affectivity and less Effortful Control and lower family socioeconomic status were predictors of 23% of the variability of internalizing behavioral problems. Additionally, 37% of the variability of externalizing behavioral problems was explained by temperament with more Negative Affectivity and less Effortful Control, and younger mothers at childbirth. The neonatal characteristics and stressful events in the neonatal intensive care unit did not predict behavioral problems at toddlerhood. However, temperament was a consistent predictor of behavioral problems in toddlers born preterm. Preventive follow-up programs could assess dispositional traits of temperament to provide early identification of preterm infants at high-risk for behavioral problems.
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LINHARES MBM. Estresse precoce no desenvolvimento: impactos na saúde e mecanismos de proteção. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2016. [DOI: 10.1590/1982-02752016000400003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este artigo tem por objetivo, primeiramente, apresentar uma abordagem do desenvolvimento na área de saúde da criança, focalizando modelos teórico-conceituais sobre o impacto do estresse precoce no desenvolvimento e na saúde. Em segundo lugar, busca apresentar pesquisas na área de Psicologia Pediátrica, que foram realizadas no âmbito de um hospital universitário público, com neonatos e crianças hospitalizadas, cujas condições clínicas ou de tratamento médico envolviam situações altamente estressoras. O artigo trata dos principais modelos teórico-conceituais sobre estresse precoce com impacto no desenvolvimento e na saúde, a saber: Sameroff; Evans e Wachs; Shonkoff; e Kazak. As pesquisas, por sua vez, abordam a exposição a estressores durante a hospitalização de neonatos e crianças, bem como suas mães, e intervenções preventivas para manejo de estresse e/ou dor. Ao final do artigo, é apresentado um modelo com diretrizes para promover a transferência de evidências científicas para a prática clínica, visando implementar mudanças no âmbito hospitalar.
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Lee H, Kim A, Maeng A, Kim G. Analysis of Studies on High-Risk Infants and Quality Assessment of Intervention Studies. CHILD HEALTH NURSING RESEARCH 2016. [DOI: 10.4094/chnr.2016.22.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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