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Msall ME, Lagatta JM, Bora S. Optimizing trajectories of social adaptive competencies after extreme prematurity during the first 1000 days. Semin Fetal Neonatal Med 2024; 29:101531. [PMID: 38632009 PMCID: PMC11156543 DOI: 10.1016/j.siny.2024.101531] [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] [Indexed: 04/19/2024]
Abstract
Over 75% of surviving extremely preterm infants do not have major neurodevelopmental disabilities; however, more than half face difficulties with communication, coordination, attention, learning, social, and executive function abilities. These "minor" challenges can have a negative impact on educational and social outcomes, resulting in physical, behavioral, and social health problems in adulthood. We will review assessment tools for social-emotional and adaptive functional skills in early childhood as these determine family and early childhood supports. We highlight bronchopulmonary dysplasia as an example of the critical intersections of parental wellbeing, medical and developmental adaptive trajectories in infancy and early childhood, and partnerships between child neurologists and community medical and developmental professionals. We examine studies of engaging parents to promote developmental trajectories, with a focus on supporting parent-child interactions that underlie communication, social-adaptive behaviors, and learning in the first 1000 days of life. Recommendations for neurodevelopmental surveillance and screening of extremely preterm infants can also be applied to infants with other risk factors for altered neurodevelopment.
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Affiliation(s)
- Michael E Msall
- Department of Pediatrics, Section of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Developmental Disabilities, University of Chicago Medicine, Chicago, IL, USA.
| | - Joanne M Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Samudragupta Bora
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Pineda R, Kellner P, Guth R, Gronemeyer A, Smith J. NICU sensory experiences associated with positive outcomes: an integrative review of evidence from 2015-2020. J Perinatol 2023; 43:837-848. [PMID: 37029165 PMCID: PMC10325947 DOI: 10.1038/s41372-023-01655-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
To inform changes to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, studies investigating sensory-based interventions in the NICU with preterm infants born ≤32 weeks were identified. Studies published between October 2015 to December 2020, and with outcomes related to infant development or parent well-being, were included in this integrative review. The systematic search used databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar. Fifty-seven articles (15 tactile, 9 auditory, 5 visual, 1 gustatory/olfactory, 5 kinesthetic, and 22 multimodal) were identified. The majority of the sensory interventions that were identified within the articles were reported in a previous integrative review (1995-2015) and already included in the SENSE program. New evidence has led to refinements of the SENSE program, notably the addition of position changes across postmenstrual age (PMA) and visual tracking starting at 34 weeks PMA.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Guth
- Center for Clinical Excellence, BJC HealthCare, St. Louis, MO, USA
| | | | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
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Kapito EM, Chirwa EM, Chodzaza E, Norr KF, Patil C, Maluwa AO, White-Traut R. The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison. BMC Pediatr 2023; 23:187. [PMID: 37085764 PMCID: PMC10120231 DOI: 10.1186/s12887-023-04015-z] [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: 09/10/2022] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Early behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant's Environment). In US studies, H-HOPE increased mother-preterm infant responsivity at 6-weeks corrected age (CA). Kangaroo Mother Care (KMC) improves infant survival and is the standard of care for preterm infants in Malawi. This is the first study to examine whether H-HOPE is feasible and promotes mother-preterm infant responsivity in Malawi, and the first to examine the impact of H-HOPE when KMC is the standard of care. METHOD This pilot was conducted in a KMC unit using a prospective cohort comparison design. Because the unit is an open room without privacy, random assignment would have led to contamination of the control cohort. H-HOPE includes participatory guidance for mothers and Massage + , a 15 min multisensory session provided by mothers twice daily. H-HOPE began when infants were clinically stable and at least 32 weeks postmenstrual age. Mothers participated if they were physically stable and willing to return for follow-up. Mother-preterm infant dyads were video-recorded during a play session at 6-weeks CA. Responsivity was measured using the Dyadic Mutuality Code (DMC). RESULTS The final sample included 60 H-HOPE + KMC and 59 KMC only mother-preterm infant dyads. Controlling for significant maternal and infant characteristics, the H-HOPE + KMC dyads were over 11 times more likely to have higher responsivity than those in the KMC only dyads (AOR = 11.51, CI = 4.56, 29.04). The only other factor related to higher responsivity was vaginal vs. Caesarian delivery (AOR = 5.44, CI = .096, 30.96). CONCLUSION This study demonstrated that H-HOPE can be provided in Malawi. Mother-infant dyads receiving both H-HOPE and KMC had higher responsivity at 6-weeks CA than those receiving KMC only. H-HOPE was taught by nurses in this study, however the nursing shortage in Malawi makes H-HOPE delivery by nurses challenging. Training patient attendants in the KMC unit is a cost-effective alternative. H-HOPE as the standard of care offers benefits to preterm infants and mothers that KMC alone does not provide.
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Affiliation(s)
- Esnath M Kapito
- School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
| | - Ellen M Chirwa
- School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Elizabeth Chodzaza
- School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Kathleen F Norr
- Children's Hospital of Wisconsin, Children's Research Institute, 9000 Winsconsin Avenue, Milwaukee, Winsconsin, 53226, USA
- College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Crystal Patil
- College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Alfred O Maluwa
- Malawi University of Science and Technology, P. O Box 5196, Limbe, Malawi
| | - Rosemary White-Traut
- Children's Hospital of Wisconsin, Children's Research Institute, 9000 Winsconsin Avenue, Milwaukee, Winsconsin, 53226, USA
- College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
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Factors Affecting Oral Feeding Ability in Indonesian Preterm Infants. Pediatr Rep 2022; 14:233-243. [PMID: 35645368 PMCID: PMC9149927 DOI: 10.3390/pediatric14020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/10/2022] Open
Abstract
Most preterm infants exhibit atypical and immature feeding skills. Even though preterm infants have fulfilled the oral feeding readiness criteria, they still do not have optimal oral feeding ability. This study aimed to determine various factors affecting oral feeding ability in Indonesian preterm infants who have fulfilled oral feeding readiness criteria but still have not been able to feed orally. A cross-sectional study included 120 preterm infants admitted to five tertiary hospitals in Jakarta, Indonesia. Participants were preterm infants born at 28-34 weeks gestational age who had fulfilled the oral feeding readiness as the inclusion criteria: (1) stable cardiorespiratory status, (2) have achieved full enteral feeding via orogastric tube (OGT) 120 mL/kg/day without vomiting or bloating, and (3) strong and rhythmic non-nutritive sucking (NNS) through objective measurement. Infants' oral feeding ability and various factors that were assumed to affect oral feeding ability, including physiological flexion postural tone, physiological stability, rooting reflex, self-regulation, behavioral state, and level of morbidity were evaluated. Chi-square and multivariate analysis with Poisson regression were performed. Results indicated that postural tone, rooting reflex, physiological stability, self-regulation, behavioral state, and level of morbidity were significantly related to oral feeding ability in preterm infants. The most influencing factors were self-regulation with a prevalence ratio (PR) of 1.96 (1.16-3.34; CI 95%) and p = 0.012, followed by postural tone, high morbidity, and behavioral state (PR 1.91; 1.59; 1.56; CI 95%, respectively). In conclusion, despite meeting the oral feeding readiness criteria, most preterm infants were still not able to feed orally. There are other factors affecting oral feeding ability in Indonesian preterm infants.
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McKenzie K, Lynch E, Msall ME. Scaffolding Parenting and Health Development for Preterm Flourishing Across the Life Course. Pediatrics 2022; 149:186921. [PMID: 35503323 PMCID: PMC9847416 DOI: 10.1542/peds.2021-053509k] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in obstetrics and neonatal medicine have resulted in improved survival rates for preterm infants. Remarkably, >75% extremely (<28 weeks) preterm infants who leave the NICU do not experience major neurodevelopmental disabilities, although >50% experience more minor challenges in communication, perception, cognition, attention, regulatory, and executive function that can adversely impact educational and social function resulting in physical, behavioral, and social health issues in adulthood. Even late premature (32-36 weeks) infants have more neurodevelopmental challenges than term infants. Although early intervention and educational programs can mitigate risks of prematurity for children's developmental trajectories, restrictive eligibility requirement and limitations on frequency and intensity mean that many premature infants must "fail first" to trigger services. Social challenges, including lack of family resources, unsafe neighborhoods, structural racism, and parental substance use, may compound biological vulnerabilities, yet existing services are ill-equipped to respond. An intervention system for premature infants designed according to Life Course Health Development principles would instead focus on health optimization from the start; support emerging developmental capabilities such as self-regulation and formation of reciprocal secure early relationships; be tailored to each child's unique neurodevelopmental profile and social circumstances; and be vertically, horizontally, and longitudinally integrated across levels (individual, family, community), domains (health, education), and time. Recognizing the increased demands placed on parents, it would include parental mental health supports and provision of trauma-informed care. This developmental scaffolding would incorporate parenting, health, and developmental interventions, with the aim of improved health trajectories across the whole of the life course.
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Affiliation(s)
- Kamryn McKenzie
- University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, Illinois
| | - Emma Lynch
- University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, Illinois
| | - Michael E. Msall
- Address correspondence to Address correspondence to: Michael E. Msall, MD, Section of Developmental and Behavioral Pediatrics, University of Chicago Kennedy Research Center and Comer Children's Hospital, 936 East 61 St Street, Room 207, Chicago, IL 60637. E-mail:
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White-Traut R, Gillette P, Simpson P, Zhang L, Nazarloo HP, Carter CS. Early Postpartum Maternal and Newborn Responses to Auditory, Tactile, Visual, Vestibular, and Olfactory Stimuli. J Obstet Gynecol Neonatal Nurs 2022; 51:402-417. [PMID: 35469779 DOI: 10.1016/j.jogn.2022.03.003] [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] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare maternal psychological well-being, newborn behavior, and maternal and newborn salivary oxytocin (OT) and cortisol before and after two maternally administered multisensory behavioral interventions or an attention control group. DESIGN Randomized prospective clinical trial. SETTING U.S. Midwest community hospital. PARTICIPANTS Newborns and their mothers (n = 102 dyads) participated. Mothers gave birth vaginally at term gestation and had no physical or mental health diagnoses. Newborns with low Apgar scores, receipt of oxygen, suspected infection, or congenital anomalies were excluded. METHODS Dyads were randomly assigned to the auditory, tactile, visual, and vestibular (ATVV) intervention, the ATVV with odor from a baby lotion (ATVVO), or the attention control (AC) Group. Maternal psychological well-being, newborn behavior, and endocrine responses (salivary cortisol and OT) were measured before and after the intervention. RESULTS Newborns in the ATVV and ATVVO groups exhibited increases in potent engagement behaviors (p < .0001 and p = .001, respectively). Newborns in the AC group exhibited a decrease in potent engagement (p = .013) and an increase in potent disengagement (p = .029). Mothers in the ATVVO group exhibited an increase in OT (p = .01) and the largest change in OT (p = .02) compared to mothers in the ATVV and AC groups. We noted no change in maternal psychological well-being or newborn endocrine responses. CONCLUSION Inclusion of an odor via lotion with a behavioral intervention (ATVV) influenced maternal OT more than the behavioral intervention alone. Newborns were behaviorally responsive to the interventions; however, endocrine measures were not associated with intervention changes.
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White-Traut R, Griffith T, Zheng C, Lagatta J, Rigby-McCotter C, Walsh C, Gralton K. Descriptive Longitudinal Pilot Study: Behaviors Surrounding Feeding of Preterm Infants Who Received Extended Tube Feedings. HSOA JOURNAL NEONATOLOGY & CLINICAL PEDIATRICS 2022; 9:092. [PMID: 36590457 PMCID: PMC9799997 DOI: 10.24966/ncp-878x/100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose Seventy percent of preterm infants experience challenges with oral feeding and commonly require tube feedings. Yet it is not well understood how these behaviors change over time while infants are receiving tube feedings only and through the transition to oral feedings. The purpose of this pilot study was to describe the change in behaviors surrounding feeding and with respect to advancing Post Menstrual Age (PMA) for preterm infants who received extended tube feedings during hospitalization in the Neonatal Intensive Care Unit (NICU). Methods and measures A prospective pilot study was conducted in a NICU. We recruited thirty-five infants who were born between 28 to 32 weeks gestational age and expected to have at least two weeks of tube feedings. Infant health status and feeding progression were obtained from the medical record. Behaviors surrounding feeding included infant state, social interactive behaviors, orally directed behaviors, and hunger/satiation cues were evaluated via weekly recorded videos. Results During the pre-feeding segment, we noted an increase over time for awake, facial gaze, gaze aversion, tongue protrusion, fussing, mouthing, vocalization, and interest in the pacifier. During the intra-feeding segment, we found an increase over time for fussing, and a decrease for eye widening, eye searching, and vocalization. Conclusion To our knowledge, this was the first pilot study to comprehensively describe the changes in behaviors surrounding feeding over time and with respect to advancing PMA for preterm infants who received extended tube feedings during the NICU hospitalization. Infants demonstrated distinct behaviors surrounding feeding as young as 28 weeks post menstrual age. These behaviors may vary among infants and change significantly with advancing post-menstrual age. Assessment of subtle behaviors surrounding feeding is important to ensure oral feeding readiness.
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Affiliation(s)
- Rosemary White-Traut
- Nursing Research, Children’s Wisconsin, Milwaukee, Wisconsin, USA,Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA,Corresponding author: Rosemary White-Traut, Nursing Research, Children’s Wisconsin, Milwaukee, Wisconsin, USA, Tel: +414 3370261;
| | - Thao Griffith
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - Cheng Zheng
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Joanne Lagatta
- Divison of Neonatology, Department of Pediactrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Claire Walsh
- Nursing Research, Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Karen Gralton
- Nursing Research, Children’s Wisconsin, Milwaukee, Wisconsin, USA
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White-Traut R, Brandon D, Kavanaugh K, Gralton K, Pan W, Myers ER, Andrews B, Msall M, Norr KF. Protocol for implementation of an evidence based parentally administered intervention for preterm infants. BMC Pediatr 2021; 21:142. [PMID: 33761902 PMCID: PMC7988259 DOI: 10.1186/s12887-021-02596-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/07/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents' interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants' behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. METHODS The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers' individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining. DISCUSSION This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT04555590 , Registered on 8/19/2020.
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Affiliation(s)
- Rosemary White-Traut
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA.
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
| | - Debra Brandon
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Karen Kavanaugh
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Karen Gralton
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
| | - Wei Pan
- School of Nursing and Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Evan R Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Bree Andrews
- College of Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Michael Msall
- College of Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Kathleen F Norr
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Impact of an integrated mother-preterm infant intervention on birth hospitalization charges. J Perinatol 2020; 40:858-866. [PMID: 31913324 PMCID: PMC7253350 DOI: 10.1038/s41372-019-0567-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 11/25/2019] [Accepted: 12/18/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine whether the H-HOPE (Hospital to Home: Optimizing the Preterm Infant's Environment) intervention reduced birth hospitalization charges yielding net savings after adjusting for intervention costs. STUDY DESIGN One hundred and twenty-one mother-preterm infant dyads randomized to H-HOPE or a control group had birth hospitalization data. Neonatal intensive care unit costs were based on billing charges. Linear regression, propensity scoring and regression analyses were used to describe charge differences. RESULTS Mean H-HOPE charges were $10,185 lower than controls (p = 0.012). Propensity score matching showed the largest savings of $14,656 (p = 0.003) for H-HOPE infants, and quantile regression showed a savings of $13,222 at the 75th percentile (p = 0.015) for H-HOPE infants. Cost savings increased as hospital charges increased. The mean intervention cost was $680 per infant. CONCLUSIONS Lower birth hospitalization charges and the net cost savings of H-HOPE infants support implementation of H-HOPE as the standard of care for preterm infants.
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Neel ML, Yoder P, Matusz PJ, Murray MM, Miller A, Burkhardt S, Emery L, Hague K, Pennington C, Purnell J, Lightfoot M, Maitre NL. Randomized controlled trial protocol to improve multisensory neural processing, language and motor outcomes in preterm infants. BMC Pediatr 2019; 19:81. [PMID: 30890132 PMCID: PMC6423745 DOI: 10.1186/s12887-019-1455-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Premature infants are at risk for abnormal sensory development due to brain immaturity at birth and atypical early sensory experiences in the Neonatal Intensive Care Unit. This altered sensory development can have downstream effects on other more complex developmental processes. There are currently no interventions that address rehabilitation of sensory function in the neonatal period. METHODS This study is a randomized controlled trial of preterm infants enrolled at 32-36 weeks postmenstrual age to either standard care or standard care plus multisensory intervention in order to study the effect of multisensory intervention as compared to standard care alone. The study population will consist of 100 preterm infants in each group (total n = 200). Both groups will receive standard care, consisting of non-contingent recorded parent's voice and skin-to-skin by parent. The multisensory group will also receive contemporaneous holding and light pressure containment for tactile stimulation, playing of the mother's voice contingent on the infant's pacifier sucking for auditory stimulation, exposure to a parent-scented cloth for olfactory stimulation, and exposure to carefully regulated therapist breathing that is mindful and responsive to the child's condition for vestibular stimulation. The primary outcome is a brain-based measure of multisensory processing, measured using time locked-EEG. Secondary outcomes include sensory adaptation, tactile processing, speech sound differentiation, motor and language function, measured at one and two years corrected gestational age. DISCUSSION This is the first randomized controlled trial of a multisensory intervention using brain-based measurements in order to explain the causal effects of the multisensory intervention on neural processing changes to mediate neurodevelopmental outcomes in former preterm infants. In addition to contributing a critical link in our understanding of these processes, the protocolized multisensory intervention in this study is therapist administered, parent supported and leverages simple technology. Thus, this multisensory intervention has the potential to be widely implemented in various NICU settings, with the opportunity to potentially improve neurodevelopment of premature infants. TRIAL REGISTRATION NIH Clinical Trials ( clinicaltrials.gov ): NCT03232931 . Registered July 2017.
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Affiliation(s)
- Mary Lauren Neel
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Paul Yoder
- Department of Special Education, Vanderbilt University, Nashville, TN USA
| | - Pawel J. Matusz
- Information Systems Institute at the University of Applied Sciences Western Switzerland (HES-SO Valais), 3960 Sierre, Switzerland
- The LINE (Laboratory for Investigative Neurophysiology), Department of Radiology and Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Micah M. Murray
- The LINE (Laboratory for Investigative Neurophysiology), Department of Radiology and Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Electroencephalography Brain Mapping Core, Center for Biomedical Imaging (CIBM) of Lausanne and Geneva, Lausanne, Switzerland
- Department of Ophthalmology, Fondation Asile des Aveugles, Lausanne, Switzerland
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN USA
| | - Ashley Miller
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Stephanie Burkhardt
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Lelia Emery
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Kaleigh Hague
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Caitlin Pennington
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Jessica Purnell
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Megan Lightfoot
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Nathalie L. Maitre
- Nationwide Children’s Hospital Division of Neonatology & Center for Perinatal Research, The Ohio State University, 5th floor; 575 Children’s Crossroads, Columbus, OH 43215 USA
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Abstract
BACKGROUND The term "oral feeding success" (OFS) is frequently used in clinical practice and research. However, OFS is inconsistently defined, which impacts the ability to adequately evaluate OFS, identify risk factors, and implement interventions in clinical practice and research. PURPOSE To develop the defining attributes, antecedents, and consequences for the concept of OFS in preterm infants during their initial hospitalization. METHODS PubMed, CINAHL, and PsycINFO databases were searched for English articles containing the key words "oral feeding success" and "preterm infants." The Walker and Avant method for concept analysis was employed. RESULTS Sixteen articles revealed the defining attributes, antecedents, and consequences. Defining attributes included (1) physiologic stability; (2) full oral feeding; and (3) combined criteria of feeding proficiency (≥30% of the prescribed volume during the first 5 minutes), feeding efficiency (≥1.5 mL/min over the entire feeding), and intake quantity (≥80% of the prescribed volume). IMPLICATIONS FOR PRACTICE The 3 defining attributes may be used in clinical practice to consistently evaluate OFS. The antecedents of OFS provide clinicians with a frame of reference to assess oral feeding readiness, identify risk factors, and implement effective interventions. The consequences of OFS allow clinicians to anticipate challenges when OFS is not achieved and create a care plan to support the infants. IMPLICATIONS FOR RESEARCH The empirical referents of OFS provide consistent and clear operational definitions of OFS for use in research. The antecedents and consequences may guide researchers to select specific measures or covariates to evaluate valid measures of OFS.
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Voos MC, Maria Clara Drummond SDM, Hasue RH. Hip Mobilization at Preterm Age May Accelerate Developmental Dysplasia Recovery. Case Rep Med 2018; 2018:8625721. [PMID: 30510581 PMCID: PMC6231373 DOI: 10.1155/2018/8625721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/13/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Few studies have described mobilization approaches in developmental dysplasia of the hip (DDH). The present study describes the hip mobilization of a preterm infant (born at 33 6/7 weeks of gestational age) diagnosed with DDH. DESIGN AND METHODS During the 43-day hospital stay, the infant was seen twice a week (ten sessions, 20 minutes each). All sessions included hip approximation maneuvers, with the hip positioned in abduction, lateral rotation and flexion, and lower limbs passive mobilization, which were taught to the mother. Early intervention with auditory, tactile, visual, and vestibular stimulations was also performed. The infant was assessed with hip ultrasound before and after treatment. RESULTS At 34 2/7 weeks of gestational age, she was classified as Graf IIa (left: alpha: 55°, beta: 68°; right: alpha: 59°, beta: 64°). At 40 5/7 weeks, she was classified as Graf I for left (alpha: 67°; beta: 42°) and right (alpha: 66°; beta: 42°) hips. PRACTICAL IMPLICATIONS The intervention seemed to accelerate the acquisition of stability of dysplasic hips in a preterm infant. The outcome supports further investigation of hip approximation maneuvers as part of early stimulation in preterm infants with DDH during hospital stay.
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Affiliation(s)
- Mariana Callil Voos
- Department of Physical Therapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, Brazil
| | - Soares de Moura Maria Clara Drummond
- Department of Physical Therapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, Brazil
| | - Renata Hydee Hasue
- Department of Physical Therapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, Brazil
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Griffith TT, Bell AF, White-Traut R, Medoff-Cooper B, Rankin K. Relationship Between Duration of Tube Feeding and Success of Oral Feeding in Preterm Infants. J Obstet Gynecol Neonatal Nurs 2018; 47:620-631. [DOI: 10.1016/j.jogn.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 02/01/2023] Open
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Systematic Review: What Is the Evidence for the Side-Lying Position for Feeding Preterm Infants? Adv Neonatal Care 2018; 18:285-294. [PMID: 30020161 DOI: 10.1097/anc.0000000000000529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Side-lying position is an increasingly common feeding strategy used by parents, nurses, and feeding therapists to support oral feeding in preterm infants. Better understanding of the research evidence on the effect of the side-lying position will help clinicians make informed decisions and guide future research in this important area. PURPOSE To identify and summarize the available evidence on the effect of side-lying position on oral feeding outcomes in preterm infants. METHODS/SEARCH STRATEGY PubMed, CINAHL, Web of Science and PsycINFO were searched for ("preterm" OR "premature") AND "feed*" AND "position*". The full text of 47 articles was reviewed to identify eligible studies that use a quasi-experimental or experimental design to examine the intervention effectiveness; 4 studies met criteria. FINDINGS/RESULTS Four studies compared the effect of the side-lying position with either the semi-upright, cradle-hold, or semi-reclined positions on various feeding outcomes. The findings were conflicting: 2 studies found the side-lying position to be beneficial for supporting physiologic stability during feeding compared with the semi-upright position whereas 2 studies did not find significant differences in any of their outcomes between the side-lying position and other feeding positions. However, this finding should be interpreted cautiously because of various methodological weaknesses and limited generalizability. IMPLICATIONS FOR PRACTICE This review does not provide strong or consistent evidence that the side-lying position improves preterm infants' oral feeding outcomes. IMPLICATIONS FOR RESEARCH A large randomized controlled trial with a diverse group of preterm infants is needed to determine the effects of the side-lying position and identify infants who would receive the most benefit.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
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Do orally-directed behaviors mediate the relationship between behavioral state and nutritive sucking in preterm infants? Early Hum Dev 2017; 109:26-31. [PMID: 28431255 PMCID: PMC5479324 DOI: 10.1016/j.earlhumdev.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
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Arianas EA, Rankin KM, Norr KF, White-Traut RC. Maternal weight status and responsiveness to preterm infant behavioral cues during feeding. BMC Pregnancy Childbirth 2017; 17:113. [PMID: 28399825 PMCID: PMC5387281 DOI: 10.1186/s12884-017-1298-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/29/2017] [Indexed: 11/15/2022] Open
Abstract
Background Parental obesity is highly predictive of child obesity, and preterm infants are at greater risk of obesity, but little is known about obese and non-obese mothers’ responsiveness to preterm infant cues during feeding. The relationship between maternal weight status and response to preterm infant behavioral cues during feeding at 6-weeks corrected age was examined. Methods This secondary analysis used data from a randomized clinical trial. Maternal weight was coded during a play session. Mother-infant interaction during feeding was coded using the Nursing Child Assessment Satellite Training Feeding Scale (NCAST). We used multivariate linear regressions to examine NCAST scores and multivariate logistic regressions for the two individual items, satiation cues and termination of feeding. Results Of the 139 mothers, 56 (40.3%) were obese, two underweight women were excluded. Obese mothers did not differ from overweight/normal weight mothers for overall NCAST scores, but they had higher scores on response to infant’s distress subscale (mean = 10.2 vs. 9.6, p = 0.01). The proportion of infants who exhibited satiation cues did not differ by maternal weight. Obese mothers were more likely than overweight/normal weight mothers to terminate the feeding when the infant showed satiation cues (82.1% vs. 66.3%, p = 0.04, adjusted OR = 2.31, 95% CI = 0.97, 5.48). Conclusions Limitations include lack of BMI measures and small sample size. Additional research is needed about maternal weight status and whether it influences responsiveness to preterm infant satiation cues. Results highlight the need for educating all mothers of preterm infants regarding preterm infant cues. Trial registration NCT02041923. Feeding and Transition to Home for Preterms at Social Risk (H-HOPE). Registered 15 January 2014.
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Affiliation(s)
- Evanthia A Arianas
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, (MC 802) 845 South Damen Avenue, Chicago, IL, 60612-7350, USA.
| | - Kristin M Rankin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL, USA
| | - Kathleen F Norr
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, (MC 802) 845 South Damen Avenue, Chicago, IL, 60612-7350, USA
| | - Rosemary C White-Traut
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, (MC 802) 845 South Damen Avenue, Chicago, IL, 60612-7350, USA.,Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J Perinatol 2017; 37:323-332. [PMID: 27763631 PMCID: PMC5389912 DOI: 10.1038/jp.2016.179] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes. STUDY DESIGN The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists. RESULTS Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature. CONCLUSIONS Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.
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Affiliation(s)
- R Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - R Guth
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO, USA
| | - A Herring
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO, USA
| | - L Reynolds
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - S Oberle
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - J Smith
- St Louis Children's Hospital, St Louis, MO, USA
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The Relationship Between Behavioral States and Oral Feeding Efficiency in Preterm Infants. Adv Neonatal Care 2017; 17:E12-E19. [PMID: 27649302 DOI: 10.1097/anc.0000000000000318] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between behavioral states (alert, sleep, drowsy, and crying) and oral feeding efficiency in preterm infants is not well understood. PURPOSE To determine the relationship between behavioral states and feeding efficiency in preterm infants. METHODS This correlational study was conducted as a secondary analysis from a randomized controlled trial. Medically stable preterm infants born between 29 and 34 weeks' gestational age participated. Baseline data from the randomized controlled trial (week 0), 1 minute prior to feeding, were used. Behavioral states were coded by 2 blinded coders. Oral feeding efficiency (mL/min) was calculated as the amount of intake over the first 10 minutes of feeding. RESULTS Data from 147 infants were included. The proportion of time spent in alert states (β = .76, F = 11.29, P ≤ .05), sleep states (β = -1.08, F = 25.26, P ≤ .05), and crying (β = 1.50, F = 12.51, P ≤ .05) uniquely predicted oral feeding efficiency. IMPLICATIONS FOR PRACTICE Comprehensive assessment of behavioral states and infant characteristics for oral feeding readiness is crucial. Alert states are optimal for oral feeding. Forced oral feeding when infants are sleeping should be avoided. Infants in crying or drowsy states prior to feeding should be closely evaluated. Sleeping or drowsy infants may benefit from interventions (eg, oral sensory stimulation, nonnutritive sucking, or multisensory intervention) to support transition to alert states prior to feeding. IMPLICATIONS FOR RESEARCH Future research should evaluate behavioral states prior to and during feeding and their relationship to oral feeding efficiency.
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Crowe L, Chang A, Wallace K. Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. Cochrane Database Syst Rev 2016; 2016:CD005586. [PMID: 27552522 PMCID: PMC6464358 DOI: 10.1002/14651858.cd005586.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the most challenging milestones for preterm infants is the acquisition of safe and efficient feeding skills. The majority of healthy full term infants are born with skills to coordinate their suck, swallow and respiration. However, this is not the case for preterm infants who develop these skills gradually as they transition from tube feeding to suck feeds. For preterm infants the ability to engage in oral feeding behaviour is dependent on many factors. The complexity of factors influencing feeding readiness has led some researchers to investigate the use of an individualised assessment of an infant's abilities. A limited number of instruments that aim to indicate an individual infant's readiness to commence either breast or bottle feeding have been developed. OBJECTIVES To determine the effects of using a feeding readiness instrument when compared to no instrument or another instrument on the outcomes of time to establish full oral feeding and duration of hospitalisations. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 22 February 2016), EMBASE (1980 to 22 February 2016), and CINAHL (1982 to 22 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised trials comparing a formal instrument to assess a preterm infant's readiness to commence suck feeds with either no instrument (usual practice) or another feeding readiness instrument. DATA COLLECTION AND ANALYSIS The standard methods of Cochrane Neonatal were used. Two authors independently screened potential studies for inclusion. No studies were found that met our inclusion criteria. MAIN RESULTS No studies met the inclusion criteria. AUTHORS' CONCLUSIONS There is currently no evidence to inform clinical practice, with no studies meeting the inclusion criteria for this review. Research is needed in this area to establish an evidence base for the clinical utility of implementing the use of an instrument to assess feeding readiness in the preterm infant population.
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Affiliation(s)
- Linda Crowe
- Mater Health ServicesNursing Research CentreBrisbaneAustralia
| | - Anne Chang
- Queensland University of TechnologySchool of NursingBrisbaneQueenslandAustralia
| | - Karen Wallace
- Mater Health ServicesMater Mothers HospitalLevel 1 Augbiny PlaceRaymond TerraceBrisbaneQueenslandAustralia
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Vonderheid SC, Rankin K, Norr K, Vasa R, Hill S, White-Traut R. Health Care Use Outcomes of an Integrated Hospital-to-Home Mother-Preterm Infant Intervention. J Obstet Gynecol Neonatal Nurs 2016; 45:625-38. [PMID: 27505467 DOI: 10.1016/j.jogn.2016.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To compare health care use from initial hospital discharge through 6 weeks corrected age in two groups of mother-preterm infant dyads: those who received an intervention, Hospital to Home: Optimizing Premature Infant's Environment (H-HOPE), and an attention control group. DESIGN Prospective randomized controlled trial. SETTING Two community hospital NICUs. PARTICIPANTS Mothers (n = 147) with social-environmental risk factors and their stable preterm infants. METHODS Mother-infant dyads were randomly assigned to the H-HOPE or control group. When infants reached 6 weeks corrected age, information about health care visits since their hospital discharges was collected through an interview. RESULTS Only half of all infants received all recommended well-child visits. Infants in H-HOPE were half as likely to have acute care episodes (illness visit to the clinic or emergency department or hospital readmission) as control infants (odds ratio [OR] = 0.46, 95% confidence interval [CI] [0.22, 0.95]). Infants of mothers with high trait anxiety were nearly 3 times more likely to have an acute care episode (OR = 2.78, 95% CI [1.05, 7.26]), and mothers who had low education levels (OR = .22, 95% CI [0.08, 0.60]) were less likely to have acute care episodes. There was a trend toward fewer acute care visits for infants whose mothers preferred an English interview (OR = .47, 95% CI [0.21, 1.06]). CONCLUSION Findings emphasize the importance of reinforcing well-child visits for vulnerable preterm infants. H-HOPE, an integrated mother-infant intervention, reduces acute care episodes (visits to the clinic or emergency department or hospital readmissions) for preterm infants.
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Tully KP, Holditch-Davis D, White-Traut RC, David R, O'Shea TM, Geraldo V. A Test of Kangaroo Care on Preterm Infant Breastfeeding. J Obstet Gynecol Neonatal Nurs 2016; 45:45-61. [PMID: 26815798 PMCID: PMC4730116 DOI: 10.1016/j.jogn.2015.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal-infant characteristics and the mother's choice to use KC were related to breastfeeding measures. DESIGN Secondary analysis of a multisite, stratified, randomized three-arm trial. The treatment groups used KC, auditory-tactile-visual-vestibular (ATVV) intervention, or received preterm infant care information. SETTING Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011. PARTICIPANTS Racially diverse mothers (N = 231) and their preterm infants born weighing less than 1,750 g. METHODS Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1,000 g, and could be safely held outside the incubator by parents. Participants were instructed by study nurses; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity. RESULTS Feeding at the breast during hospitalization, the duration of postdischarge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women. CONCLUSION As implemented in this study, assignment to the KC group did not appear to influence the measured breastfeeding outcomes.
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Abstract
BACKGROUND Premature infants are at risk for difficulties in feeding, social interaction, and growth. Many premature infants exhibit a lower capacity for self-regulation, resulting in less behavioral alertness and hypersensitivity to stimulation. Feeding is critically important because it is a primary factor for infant growth and a major concern for both parents and clinicians. PURPOSE The aim of this randomized controlled trial was to evaluate sucking organization in premature infants following a preterm infant multisensory intervention, the Auditory, Tactile, Visual, and Vestibular (ATVV) intervention. METHODS A convenience sample of 183 healthy premature infants born 29-34 weeks postmenstrual age (PMA) enrolled. Sucking organization was measured at baseline, then weekly, during the infant's hospital stay. RESULTS A quadratic trend was observed for number of sucks, sucks per burst, and maturity index with the intervention group increasing significantly faster by day 7 (model estimates for group × day: β= 13.69, P < .01; β = 1.16, P < .01; and β= 0.12, P < .05, respectively). Sucking pressure increased linearly over time, with significant between-group differences at day 14 (β= 45.66, P < .01). IMPLICATIONS FOR PRACTICE The ATVV infants exhibited improved sucking organization during hospitalization, suggesting that the ATVV intervention improves maturation of oral feeding. IMPLICATIONS FOR RESEARCH Further research that includes 2 or more tests, delivered the same day and/or over consecutive days, will provide researchers and clinicians a more sensitive indicator of maturational changes in feeding behaviors.
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White-Traut R. Nurse management of the NICU environment is critical to optimal infant development. J Obstet Gynecol Neonatal Nurs 2015; 44:169-70. [PMID: 25728355 DOI: 10.1111/1552-6909.12561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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