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Ribeiro AL, Costa MFP, Silva PYF, Lima RO, Bezerra RB, Bezerra IFD, Torres VB, Alvarez CDDL, Azevedo IG, Pereira SA. Effects of the use of a cocoon on the autonomic, motor, and regulatory systems in preterm newborns: Randomized clinical trial. Arch Pediatr 2024; 31:250-255. [PMID: 38538471 DOI: 10.1016/j.arcped.2024.01.005] [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: 07/11/2023] [Revised: 11/04/2023] [Accepted: 01/05/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The wrapping of the newborn in an orthopedic tubular mesh, simulating a cocoon, can allow the infant to regain the feeling of security and stability experienced in the uterus given that the movement of one of the parts of the body exerts tactile and pressure variation in others. OBJECTIVE We aimed to evaluate the influence of an orthopedic tubular mesh, simulating a cocoon, in therapeutic positioning, on the variables of the autonomous, motor, and regulatory systems of preterm newborns. METHODS A controlled and randomized clinical trial was conducted with preterm newborns positioned in dorsal decubitus and divided into two groups: (a) cocoon - newborns covered with an orthopedic tubular mesh, and (b) control - newborns positioned according to the sector's routine and without the use of an orthopedic mesh. During the follow-up, each newborn was placed in the position for 30 min and was recorded for a total of 2 min, once at the beginning and again at the end of the observation period. Variables related to the autonomous system (heart rate, respiratory rate, and peripheral oxygen saturation), motor system (general movements), and regulatory system (Neonatal Infant Pain Scale) were evaluated before and after the intervention. The videos were evaluated by a researcher blind to the purpose of the study, and the resulting data were analyzed using SPSS. RESULTS Of the 40 preterm newborns evaluated (32.5 ± 1.83 weeks), 21 were female, and 20 were allocated to the cocoon group. The variables related to the autonomous, motor, and regulatory systems remained unchanged following the positioning in the cocoon, as compared to the typical positioning employed in the neonatal unit. CONCLUSION The simulation of a cocoon, utilizing an orthopedic tubular mesh, when applied to preterm newborns admitted to a neonatal intensive care unit can contribute to maintaining low levels of stress, without altering variables of the autonomous, motor, and regulatory systems.
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Affiliation(s)
- Anni Lima Ribeiro
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Mayara Fabiana Pereira Costa
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Pedro Ykaro Fialho Silva
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Rayane Oliveira Lima
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Ruth Batista Bezerra
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | | | - Vanessa Braga Torres
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | | | - Ingrid Guerra Azevedo
- Academic Vicerectory, Catholic University of Temuco, Rudecindo Ortega 03694, Edificio EDI 2 Piso, Manuel Montt 56, Temuco, La Araucanía, Chile
| | - Silvana Alves Pereira
- Department of Physical Therapy, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil.
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Oh J, Ordoñez ELT, Velasquez E, Mejía M, Grazioso MDP, Rohloff P, Smith BA. Early full-day leg movement kinematics and swaddling patterns in infants in rural Guatemala: A pilot study. PLoS One 2024; 19:e0298652. [PMID: 38422106 PMCID: PMC10903813 DOI: 10.1371/journal.pone.0298652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Tools to accurately assess infants' neurodevelopmental status very early in their lives are limited. Wearable sensors may provide a novel approach for very early assessment of infant neurodevelopmental status. This may be especially relevant in rural and low-resource global settings. METHODS We conducted a longitudinal observational study and used wearable sensors to repeatedly measure the kinematic leg movement characteristics of 41 infants in rural Guatemala three times across full days between birth and 6 months of age. In addition, we collected sociodemographic data, growth data, and caregiver estimates of swaddling behaviors. We used visual analysis and multivariable linear mixed models to evaluate the associations between two leg movement kinematic variables (awake movement rate, peak acceleration per movement) and infant age, swaddling behaviors, growth, and other covariates. RESULTS Multivariable mixed models of sensor data showed age-dependent increases in leg movement rates (2.16 [95% CI 0.80,3.52] movements/awake hour/day of life) and movement acceleration (5.04e-3 m/s2 [95% CI 3.79e-3, 6.27e-3]/day of life). Swaddling time as well as growth status, poverty status and multiple other clinical and sociodemographic variables had no impact on either movement variable. CONCLUSIONS Collecting wearable sensor data on young infants in a rural low-resource setting is feasible and can be used to monitor age-dependent changes in movement kinematics. Future work will evaluate associations between these kinematic variables from sensors and formal developmental measures, such as the Bayley Scales of Infant and Toddler Development.
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Affiliation(s)
- Jinseok Oh
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | | | | | | | | | - Peter Rohloff
- Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Beth A. Smith
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
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Tang X, Sha S, Shen N, Zhu Z, Qin Y, Shen J, Bei F. Multisensory stimulation bundles on sleep and neurobehavioral development in the first year after birth in very preterm infants: a randomized crossover controlled study protocol. Trials 2023; 24:732. [PMID: 37964365 PMCID: PMC10647058 DOI: 10.1186/s13063-023-07753-8] [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] [Received: 05/09/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Disrupted sleep is believed to contribute to short- and long-term neurodevelopmental problems in very preterm infants (VPIs). This study presents a protocol for an evaluator-blinded, randomized crossover trial. It aims to assess the sleep efficiency of hospitalized VPIs by providing multisensory stimulation bundles. Furthermore, it aims to observe the intervention impacts on sleep during hospitalization of the VPIs and their sleep and neurodevelopmental outcomes during the first year of post-discharge follow-up. METHODS The study will be conducted in the neonatology department of a tertiary pediatric teaching hospital. All the eligible VPIs will undergo two types of care in random order: "standard care" (2 weeks) and "standard care plus multisensory stimulation bundles," each lasting 2 weeks. A generated list of random numbers will be used for case sequence allocation. Sleep outcomes will be evaluated using the Actiwatch-2 Actigraph. Moreover, the amplitude-integrated electroencephalography and the Griffiths Mental Development Scales will be used to measure the neurodevelopmental outcomes during hospitalization and in the first year of follow-up of the VPIs. DISCUSSION The intervention protocol of this study differs from that of other traditional interventions by producing precise and consistent supportive stimulations, similar to maternal tactile, auditory, posture, and visual effects for hospitalized VPIs. This protocol could be an effective measure to facilitate sleep and early neurodevelopment of VPIs. The expected outcomes will help confirm the implementation and generalization of the multisensory stimulation bundles' care protocol in neonatology departments. We expect that the study will positively impact hospitalized VPIs, especially in their sleep and early neurodevelopmental outcomes. It will also provide a new perspective regarding parent and infant interaction strategies, particularly for newborn intensive care units that limit visits because of the global spread of COVID-19. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR 2200059099. Registered on 25 April 2022, https://www.chictr.org.cn/showproj.html?proj=166980 ; the Hospital Research Ethics Committee (approval number: SCMCIRB-K2021086-1, Version 01), approved on 21 January 2022.
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Affiliation(s)
- Xiaoli Tang
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
- Department of Nursing Department, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Sha Sha
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Nanping Shen
- Department of Nursing Department, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Zhiyu Zhu
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Yanmin Qin
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Junyi Shen
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Fei Bei
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China.
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Yang L, Fu H, Zhang L. A systematic review of improved positions and supporting devices for premature infants in the NICU. Heliyon 2023; 9:e14388. [PMID: 36967878 PMCID: PMC10031313 DOI: 10.1016/j.heliyon.2023.e14388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Background In the neonatal intensive care unit, nurses often place premature infants in the supine, prone, and lateral positions. However, these positions do not always meet all the physiological needs of premature infants. Thus, many improved positions and various position-supporting devices have been studied to provide infants with a development-friendly and comfortable environment. Aim We aimed to help nurses recognize and understand the various improved positions and devices, and to provide nurses with more options in addressing the needs of preterm infants. Study design We searched PubMed, Web of Science, and EMBASE from 2012 to 2022 for studies on position management of preterm infants, and screened the search results according to inclusion and exclusion criteria. Then we extracted data and evaluated the quality of the included studies. Finally, we conducted a qualitative summary of the results. Results Twenty-one articles were included in this review. Fourteen were studies about improved positions, including hammock position, facilitated tucking position, ROP position, reverse kangaroo mother care position (R-KMC), and supported diagonal flexion position (SDF). Seven were studies on positioning devices, four on cranial deformity prevention, and three on reformative swaddling. They have a positive impact on sleep and flexion maintenance, in addition, they can prevent head deformity and reduce the pain of premature infants. Conclusion The position management of premature infants is diversified. Instead of sticking to a single position placement, nurses should adjust the position according to the unique physiological conditions of infants to reduce sequelae and promote their recovery and growth during long-term hospitalization. There should be more studies on position management with large sample sizes in the future.
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Faez N, Hmami F, Kojmane W, Atmani S. Developmentally supportive care in neonatology: Correlational study of the knowledge and declared practices of professionals. Ann Med Surg (Lond) 2022; 84:104928. [PMID: 36582915 PMCID: PMC9793219 DOI: 10.1016/j.amsu.2022.104928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/29/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
•Developmental Care contributes to improving the quality of neonatal life.•Professionals must develop multidisciplinary approaches to clinical practice.•This research identified a low level of knowledge and practice in Developmental Care.•Significant correlations were detected between clinical practice and knowledge.•The implementation of Developmental Care seems to be a priority.
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Affiliation(s)
- Naima Faez
- Faculty of Science and Technology, Sidi Mohamed Ben Abdelah University, Fez, Morocco,Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Sidi Mohamed Ben Abdelah University, Fez, Morocco,Corresponding author. Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Faculty of Science and Technology / Sidi Mohamed Ben Abdelah University, Fez, 30000, Morocco.
| | - Fouzia Hmami
- Neonatology and Intensive Care Unit. Hassan II University Hospital, Mother and Child Department, General Pediatrics, Fez, Morocco,Human Pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy / sidi Mohamed Ben Abdelah University, Fez, Morocco
| | - Widade Kojmane
- Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Sidi Mohamed Ben Abdelah University, Fez, Morocco,Neonatology and Intensive Care Unit. Hassan II University Hospital, Mother and Child Department, General Pediatrics, Fez, Morocco
| | - Samir Atmani
- Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Sidi Mohamed Ben Abdelah University, Fez, Morocco,Medico-surgical Unit of Pediatric Cardiology. Pediatric Cardiac Catheterization. Hassan II University Hospital, Mother and Child Department, General Pediatrics and Pediatric Cardiology, Fez, Morocco
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Hawkins B, Ventresco C, Cummings M, McCaffrey K, Willwerth AJ, Blume ED, VanderPluym C. Design and pilot testing of therapeutic clothing for hospitalized children. J SPEC PEDIATR NURS 2022; 27:e12363. [PMID: 34878721 DOI: 10.1111/jspn.12363] [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: 05/13/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this paper is to describe the design and pilot program of a parent designed clothing option for hospitalized infants and children and to better understand the importance and effects of hospital clothing on families. Little research has been done on how clothing a hospitalized child impacts the child's quality of life and their parent's perception of care. Research has been limited to clothing in adults and its relation to infection. DESIGN AND METHODS A pediatric outfit (the Georgie) for hospitalized infants and children was designed based on insight from bedside nursing, physicians, parents, and supply chain personnel. The garment was pilot tested on select patients from intensive care units of a large children's hospital. A pre- and post-use questionnaire was disseminated with questions focused on aspects of the child's care, comfort in changing child's clothes/diapers, number of times the Georgie was used and comfort level of using the Georgie. Survey responses were summarized using descriptive statistics. RESULTS Parents overall response to the Georgie was positive with great value placed on having their child dressed. All parents (n = 5) responded that too many lines were an obstacle to having their child dressed. Compared to the hospital Johnny, the Georgie (80%, n = 4) was the most preferred when placement and securement of monitoring lines was taken into consideration with one parent preferring a blanket and diaper only. Nurses felt the benefit outweighed the added effort in dressing the patient. The majority of the nurses had a positive initial reaction to the Georgie (80%, n = 4) and felt the lines or external devices were "very secure/secure" (80%, n = 4) when the patient was wearing the Georgie. PRACTICE IMPLICATIONS Implementing a new family centered care initiative of dressing critically ill patients in the Georgie may improve patient and family's quality of life while hospitalized. A larger scale study is indicated to assess the importance of dressing hospitalized pediatric patients for their families, to clarify the effect on nursing care, to optimize ability to stabilize lines, and to understand logistical issues.
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Affiliation(s)
- Beth Hawkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Courtney Ventresco
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meghan Cummings
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberly McCaffrey
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Delcour M, Russier M, Castets F, Turle-Lorenzo N, Canu MH, Cayetanot F, Barbe MF, Coq JO. Early movement restriction leads to maladaptive plasticity in the sensorimotor cortex and to movement disorders. Sci Rep 2018; 8:16328. [PMID: 30397222 PMCID: PMC6218548 DOI: 10.1038/s41598-018-34312-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023] Open
Abstract
Motor control and body representations in the central nervous system are built, i.e., patterned, during development by sensorimotor experience and somatosensory feedback/reafference. Yet, early emergence of locomotor disorders remains a matter of debate, especially in the absence of brain damage. For instance, children with developmental coordination disorders (DCD) display deficits in planning, executing and controlling movements, concomitant with deficits in executive functions. Thus, are early sensorimotor atypicalities at the origin of long-lasting abnormal development of brain anatomy and functions? We hypothesize that degraded locomotor outcomes in adulthood originate as a consequence of early atypical sensorimotor experiences that induce developmental disorganization of sensorimotor circuitry. We showed recently that postnatal sensorimotor restriction (SMR), through hind limb immobilization from birth to one month, led to enduring digitigrade locomotion with ankle-knee overextension, degraded musculoskeletal tissues (e.g., gastrocnemius atrophy), and clear signs of spinal hyperreflexia in adult rats, suggestive of spasticity; each individual disorder likely interplaying in self-perpetuating cycles. In the present study, we investigated the impact of postnatal SMR on the anatomical and functional organization of hind limb representations in the sensorimotor cortex and processes representative of maladaptive neuroplasticity. We found that 28 days of daily SMR degraded the topographical organization of somatosensory hind limb maps, reduced both somatosensory and motor map areas devoted to the hind limb representation and altered neuronal response properties in the sensorimotor cortex several weeks after the cessation of SMR. We found no neuroanatomical histopathology in hind limb sensorimotor cortex, yet increased glutamatergic neurotransmission that matched clear signs of spasticity and hyperexcitability in the adult lumbar spinal network. Thus, even in the absence of a brain insult, movement disorders and brain dysfunction can emerge as a consequence of reduced and atypical patterns of motor outputs and somatosensory feedback that induce maladaptive neuroplasticity. Our results may contribute to understanding the inception and mechanisms underlying neurodevelopmental disorders, such as DCD.
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Affiliation(s)
- Maxime Delcour
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, 13331, Marseille, France
- Equipe de Recherche en Réadaptation Sensorimotrice, Faculté de Médecine, Département de Physiologie, Université de Montréal, C.P. 6128, Montréal, H3C 3J7, Canada
| | - Michaël Russier
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, 13331, Marseille, France
- Inserm UMR 1072, Unité de Neurobiologie des Canaux Ioniques et de la Synapse, Faculté de Médecine Secteur Nord, 13344, Marseille Cedex 15, France
| | - Francis Castets
- Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille UMR 7286, CNRS, Aix-Marseille Université, 13344, Marseille, France
| | | | - Marie-Hélène Canu
- Université de Lille, EA 7369 « Activité Physique, Muscle et Santé » - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
| | - Florence Cayetanot
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, 13385, Marseille, France
- UMR_S1158 Inserm-Sorbonne Université, Neurophysiologie Respiratoire Expérimentale et Clinique, Faculté de Médecine, 75636, Paris Cedex, France
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Jacques-Olivier Coq
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, 13331, Marseille, France.
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, 13385, Marseille, France.
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