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Andy L, Fan H, Valerie S, Jing W. Systematic review of environmental noise in neonatal intensive care units. Acta Paediatr 2024. [PMID: 39363441 DOI: 10.1111/apa.17445] [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: 07/21/2024] [Revised: 08/26/2024] [Accepted: 09/24/2024] [Indexed: 10/05/2024]
Abstract
AIM To systematically review the literature on noise exposure within the neonatal intensive care unit/special care nursery settings, specifically to describe: noise characteristics, sources of noise and ways of measuring noise. METHODS Systematic searches were conducted through databases Medline, Embase and PubMed. Studies were included if they met the inclusion criteria (1) reported noise characteristics; (2) reported noise exposure measurements; (3) in the neonatal intensive care unit/ special care nursery settings. Methods and key findings were extracted from included studies. Quality analysis was done using a modified version of the Newcastle-Ottawa Scale. RESULTS We identified 1651 studies, screened 871, reviewed 112 and included 47. All reported NICU average equivalent sound levels were consistently louder than recommended guidelines (45 dB). The most consistent association with higher sound pressure levels were noise sources grouped under people congregation. Half of the studies did not use measuring devices adhering to international sound level meter (SLM) standards. CONCLUSION All NICUs exceeded recommended accumulative sound levels. People were the most consistent source of noise. Sound pressure levels need to be consistently measured with devices adhering to international SLM standards in future studies.
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Affiliation(s)
- Liang Andy
- Faculty of Medicine, Dentistry and Health Sciences, Austin Hospital, Heidelberg, Victoria, Australia
| | - He Fan
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Sung Valerie
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Wang Jing
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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2
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Retsa C, Turpin H, Geiser E, Ansermet F, Müller-Nix C, Murray MM. Longstanding Auditory Sensory and Semantic Differences in Preterm Born Children. Brain Topogr 2024; 37:536-551. [PMID: 38010487 PMCID: PMC11199270 DOI: 10.1007/s10548-023-01022-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
More than 10% of births are preterm, and the long-term consequences on sensory and semantic processing of non-linguistic information remain poorly understood. 17 very preterm-born children (born at < 33 weeks gestational age) and 15 full-term controls were tested at 10 years old with an auditory object recognition task, while 64-channel auditory evoked potentials (AEPs) were recorded. Sounds consisted of living (animal and human vocalizations) and manmade objects (e.g. household objects, instruments, and tools). Despite similar recognition behavior, AEPs strikingly differed between full-term and preterm children. Starting at 50ms post-stimulus onset, AEPs from preterm children differed topographically from their full-term counterparts. Over the 108-224ms post-stimulus period, full-term children showed stronger AEPs in response to living objects, whereas preterm born children showed the reverse pattern; i.e. stronger AEPs in response to manmade objects. Differential brain activity between semantic categories could reliably classify children according to their preterm status. Moreover, this opposing pattern of differential responses to semantic categories of sounds was also observed in source estimations within a network of occipital, temporal and frontal regions. This study highlights how early life experience in terms of preterm birth shapes sensory and object processing later on in life.
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Affiliation(s)
- Chrysa Retsa
- The Radiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland.
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland.
| | - Hélène Turpin
- The Radiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Eveline Geiser
- The Radiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François Ansermet
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
- Department of Child and Adolescent Psychiatry, University Hospital, Geneva, Switzerland
| | - Carole Müller-Nix
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Micah M Murray
- The Radiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
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Di Fiore JM, Liu G, Loparo KA, Bearer CF. The effect of early postnatal auditory stimulation on outcomes in preterm infants. Pediatr Res 2024:10.1038/s41390-024-03329-7. [PMID: 38909158 DOI: 10.1038/s41390-024-03329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 06/24/2024]
Abstract
Preterm infants are deprived of in utero sensory stimulation during the third trimester, an important period of central nervous system development. As a result, maturational trajectories are often reduced in infants born preterm. One such system affected is the brain including the auditory and respiratory control pathways. During normal pregnancy the intrauterine environment attenuates external auditory stimuli while exposing the fetus to filtered maternal voice, intra-abdominal sounds, and external stimuli. In contrast, during the third trimester of development, preterm infants are exposed to a vastly different soundscape including non-attenuated auditory sounds and a lack of womb related stimuli, both of which may affect postnatal brain maturation. Therefore, fostering a nurturing postnatal auditory environment during hospitalization may have a significant impact on related outcomes of preterm infants. Studies using a range of postnatal auditory stimulations have suggested that exposure to sounds or lack thereof can have a significant impact on outcomes. However, studies are inconsistent with sound levels, duration of exposure to auditory stimuli, and the gestational age at which infants are exposed. IMPACT: Auditory stimulation can provide a low cost and low risk intervention to stabilize respiration, improve neuronal maturation and reduce long-term sequelae in preterm infants. The potential benefits of auditory stimulation are dependent on the type of sound, the duration of exposure and age at time of exposure. Future studies should focus on the optimal type and duration of sound exposure and postnatal developmental window to improve outcomes.
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Affiliation(s)
- Juliann M Di Fiore
- Dept of Pediatrics, Case Western Reserve University, Cleveland, OH, 44016, USA
- Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, OH, 44016, USA
| | - Gloria Liu
- Dept of Pediatrics, Case Western Reserve University, Cleveland, OH, 44016, USA
| | - Kenneth A Loparo
- ISSACS: Institute for Smart, Secure and Connected Systems, Case Western Reserve University, Cleveland, OH, USA
| | - Cynthia F Bearer
- Dept of Pediatrics, Case Western Reserve University, Cleveland, OH, 44016, USA.
- Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, OH, 44016, USA.
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Pineda R, Misikoff M, Ghahramani S, Smith J, Mathur A. Description and evidence on the supporting and enhancing neonatal intensive care unit sensory experiences (SENSE) program. Acta Paediatr 2024. [PMID: 38809111 DOI: 10.1111/apa.17293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
AIM To describe the supporting and enhancing neonatal intensive care unit (NICU) sensory experiences (SENSE) program, associated research and opportunities for further study. METHODS A review of current materials on SENSE program implementation, publications related to SENSE development, and research on program implementation and patient outcomes was conducted to describe the SENSE program and its associated research. RESULTS The SENSE program combines structured, evidence-based, multisensory interventions with parent engagement in order to optimise outcomes in the complex NICU environment. Through a stepwise and scientific process, the SENSE program was developed to include specific doses and targeted timing (based on the infant's postmenstrual age, PMA) of evidence-based interventions such as massage, auditory exposure, rocking, holding and skin-to-skin care for parents to provide their infants each day of NICU hospitalisation. It is adapted in context of concurrent medical interventions, infant behavioural responses, as well as NICU culture. The program is feasible to implement, acceptable to staff, and related to infants receiving more developmentally appropriate sensory exposures. Adaptations related to NICU culture and parent involvement have been reported. Research has identified relationships of the SENSE program to improved parent confidence, neurobehaviour and feeding at term age as well as improved communication 1 year of age. CONCLUSION The literature related to the SENSE program is promising, but more research on efficacy and implementation is needed.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California, USA
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
- Program in Occupational Therapy, Washington University, St. Louis, Missouri, USA
| | - Maya Misikoff
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Sahar Ghahramani
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Amit Mathur
- Department of Pediatrics, St. Louis University, St. Louis, Missouri, USA
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Erdei C, Sunwoo J, Corriveau GC, Forde M, El-Dib M, Inder T. Effect of music-based interventions on physiologic stability of hospitalized preterm infants. A pilot study. J Perinatol 2024; 44:665-670. [PMID: 38418527 DOI: 10.1038/s41372-024-01907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Hospitalized preterm infants experience reduced meaningful auditory exposures during a critical period of brain development. Music-based interventions (MBI) may be beneficial, though it remains unclear which stimuli optimally enhance infant stabilization. We investigated the relationship between three conceptually-different MBIs and short-term responses in hospitalized preterm infants. STUDY DESIGN This is a case-crossover pilot study including 21 preterm infants between 30 and 35 weeks postmenstrual age. Participants listened to three MBIs and 'no music'; each condition was provided three times in random order. We monitored physiologic and behavioral parameters around each exposure and analyzed results using linear mixed models. RESULTS Respiratory rates decreased after each MBI compared with 'no music' (p = 0.02). The most notable decrease occurred following exposure to a low, repetitive musical pattern resembling a lullaby (p = 0.01). We noted no significant changes for the remaining parameters. CONCLUSION Specific MBI characteristics may preferentially enhance physiologic stabilization in hospitalized preterm infants.
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Affiliation(s)
- Carmina Erdei
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
- Harvard Medical School, Pediatrics, 25 Shattuck St, Boston, MA, USA.
| | - John Sunwoo
- Harvard Medical School, Pediatrics, 25 Shattuck St, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th St, Charlestown, MA, USA
| | - Gabriel Cote Corriveau
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
| | - Madison Forde
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
| | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
- Harvard Medical School, Pediatrics, 25 Shattuck St, Boston, MA, USA
| | - Terrie Inder
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
- Harvard Medical School, Pediatrics, 25 Shattuck St, Boston, MA, USA
- Division of Neonatology, Children's Hospital of Orange County and University of California Irvine, 1001, Health Sciences Rd, Irvine, CA, USA
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Erdei C, Schlesinger K, Pizzi MR, Inder TE. Music Therapy in the Neonatal Intensive Care Unit: A Center's Experience with Program Development, Implementation, and Preliminary Outcomes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:533. [PMID: 38790528 PMCID: PMC11120361 DOI: 10.3390/children11050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The role of music in the NICU continues to evolve, with recent studies documenting the positive impact of music therapy for hospitalized infants and families. With many potential benefits and no substantial adverse effects reported to date in medically stable infants, we aimed to create a clinical guideline to integrate this therapy into the NICU operations. METHODS we launched and implemented a pilot music therapy clinical program within a subunit of a level-III NICU, building upon available evidence. RESULTS In this report, we describe our experience with initial program development and early outcomes in terms of population served, frequency of music therapy, and therapeutic modalities employed to implement service delivery. CONCLUSION we highlight the importance of establishing practices that are aligned with currently available data and recommendations, in order to facilitate delivery of a safe, evidence-based, meaningful therapeutic experience with monitoring of preliminary effects of the therapy on all those involved in the experience.
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Affiliation(s)
- Carmina Erdei
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
- Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Kim Schlesinger
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
| | - Meredith R. Pizzi
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
| | - Terrie E. Inder
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
- Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Pediatrics, Division of Neonatology, Children’s Hospital of Orange County, 1201 W La Veta Ave, Orange, CA 92868, USA
- Pediatrics, University of California Irvine, 1001 Health Sciences Rd, Irvine, CA 92697, USA
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Kellner P, Kwon J, Smith J, Pineda R. Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge. Am J Perinatol 2024; 41:561-568. [PMID: 34996118 PMCID: PMC11062498 DOI: 10.1055/a-1733-2690] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood. STUDY DESIGN This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic. RESULTS At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment. CONCLUSION Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU. KEY POINTS · There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..
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Affiliation(s)
- Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jenny Kwon
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
- Center for the Changing Family, University of Southern California, Los Angeles, California
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Filippa M, Benis D, Adam-Darque A, Grandjean D, Hüppi PS. Preterm infants show an atypical processing of the mother's voice. Brain Cogn 2023; 173:106104. [PMID: 37949001 DOI: 10.1016/j.bandc.2023.106104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
To understand the consequences of prematurity on language perception, it is fundamental to determine how atypical early sensory experience affects brain development. At term equivalent age, ten preterm and ten full-term newborns underwent high-density EEG during mother or stranger speech presentation, in the forward or backward order. A general group effect terms > preterms is evident in the theta frequency band, in the left temporal area, with preterms showing significant activation for strangers' and terms for the mother's voice. A significant group contrast in the low and high theta in the right temporal regions indicates higher activations for the stranger's voice in preterms. Finally, only full terms presented a late gamma band increase for the maternal voice, indicating a more mature brain response. EEG time-frequency analysis demonstrate that preterm infants are selectively responsive to stranger voices in both temporal hemispheres, and that they lack selective brain responses to their mother's forward voice.
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Affiliation(s)
- Manuela Filippa
- Division of Development and Growth, Child and Adolescent Department, Rue Willy-Donzé 1205 Genève, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Boulevard Carl-Vogt 101 Genève, Geneva, Switzerland.
| | - Damien Benis
- Division of Development and Growth, Child and Adolescent Department, Rue Willy-Donzé 1205 Genève, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Boulevard Carl-Vogt 101 Genève, Geneva, Switzerland
| | - Alexandra Adam-Darque
- Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neuroscience, Division of Neurorehabilitation, University Hospital of Geneva and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Didier Grandjean
- Swiss Center for Affective Sciences, Department of Psychology and Educational Sciences, University of Geneva, Boulevard Carl-Vogt 101 Genève, Geneva, Switzerland
| | - Petra S Hüppi
- Division of Development and Growth, Child and Adolescent Department, Rue Willy-Donzé 1205 Genève, University of Geneva, Geneva, Switzerland
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Monson BB, Ambrose SE, Gaede C, Rollo D. Language Exposure for Preterm Infants is Reduced Relative to Fetuses. J Pediatr 2023; 262:113344. [PMID: 36736889 PMCID: PMC10390654 DOI: 10.1016/j.jpeds.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess changes and deficits in language and auditory exposures consequent to preterm birth and neonatal intensive care unit stay compared with exposures in utero among typically developing fetuses. STUDY DESIGN We analyzed over 23 000 hours of auditory exposure data in a cohort study of 27 typically-developing fetuses and 24 preterm infants. Extrauterine exposures for fetuses were captured by having pregnant women wear 24-hour audio recording devices. For preterm infants, recording devices were placed in the infant's crib. Multilevel linear regressions were conducted to test for group differences and effects of infant sex, maternal education, and mother' occupation. A linear mixed-effects model was used to test for an effect of speaker gender. RESULTS Fetuses were exposed to an estimated 2.6 ± 1.8 hours/day of nearby, predominantly female language, nearly 5 times greater than 32 ± 12 minutes/day estimated for preterm infants (P < .001). Preterm infants had greater daily exposure to electronic sounds (5.1 ± 2.5 vs 1.3 ± 0.6 hours; P < .001) and noise (4.4 ± 2.1 vs 2.9 ± 2.8 hours; P < .05), with 4.7 ± 3.9 hours/day of silence. Language and extrauterine sound exposure for fetuses showed a marked day/night cyclical pattern, with low exposure during nighttime hours, but preterm infants' exposures showed significantly less change across the 24-hour cycle (P < .001). Maternal occupation requiring frequent communication predicted greater language exposure (P < .05). CONCLUSIONS Our findings provide the first comparison of preterm infant auditory exposures to typically-developing fetuses. Some preterm infants may incur deficits of over 150 hours of language exposure over the preterm period. Given known effects of prenatal/preterm language exposure on neurobehavioral outcomes, this magnitude of deficit is alarming.
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Affiliation(s)
- Brian B. Monson
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine
- Neuroscience Program, University of Illinois Urbana-Champaign
- Carle Foundation Hospital, Urbana, Illinois
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10
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Romeo R, Pezanowski R, Merrill K, Hargrave S, Hansen A. Parent and staff perspectives on the benefits and barriers to communication with infants in the neonatal intensive care unit. J Child Health Care 2023; 27:410-423. [PMID: 35232268 PMCID: PMC9433464 DOI: 10.1177/13674935221076216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to high quantity and quality of language in the neonatal period is critical to neurocognitive development; however, Neonatal Intensive Care Unit (NICU) environments may contribute to language deprivation. Using qualitative thematic content analysis, this study aimed to characterize the knowledge and attitudes of NICU staff and patient families toward the importance of early language experience, the current NICU language environment, and the benefits and barriers of communication in the NICU. Results revealed that all respondents recognized the importance of communication for optimal cognitive development, though few understood why. Staff and family members alike recognized the role of nurses as coaches and role models in promoting communication at the bedside. Nurses generally felt that family members communicate less with their babies than family members themselves perceived, and that cell phone use has fewer communicative advantages than parents perceive. Respondents reported that patient illness, lack of time, and intimidating equipment all raise barriers to communication. These findings yield important considerations for developing educational interventions to improve NICU language environments, including a synergistic, dual focus on both staff and families. Communication in the NICU is a low cost, feasible, and accessible target with aims of ensuring optimal neurocognitive development for at-risk children.
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Affiliation(s)
- Rachel Romeo
- Boston Children’s Hospital, Boston MA USA
- Harvard Medical School, Boston MA USA
- Massachusetts Institute of Technology, Cambridge MA USA
| | | | | | | | - Anne Hansen
- Boston Children’s Hospital, Boston MA USA
- Harvard Medical School, Boston MA USA
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11
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de Azevedo Bringel JM, Abreu I, Muniz MCMC, de Almeida PC, Silva MRG. Health Professionals' Chronotype Association with Salivary Cortisol and Occupational Stress in Neonatal Intensive Care Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095683. [PMID: 37174200 PMCID: PMC10178597 DOI: 10.3390/ijerph20095683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/18/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Burnout syndrome has been reported among health workers, particularly those working in critical areas, and is considered a significant public health problem. This study aimed to investigate the relationship between chronotype and work-related stress, as measured by salivary cortisol levels and burnout, among health professionals working in neonatal intensive care units. A cross-sectional study was conducted across four public hospitals in Fortaleza, Ceará, Brazil. Two hundred and fifty-six health professionals were administered the brazilian version of the Burnout Characterization Scale, the morningness-eveningness questionnaire, for chronotype, a sociodemographic questionnaire that included lifestyle habits and a salivary cortisol test. The results indicated that morning chronotype workers were significantly associated with the following: advanced age (p < 0.001), female gender (p = 0.032), married status (p = 0.014), and having children (p = 0.030) compared to those with evening and intermediate chronotypes. However, no significant association was found between signs of burnout syndrome and chronotype (p = 0.316). Participants whose work shift did not match their chronotype had significantly higher initial salivary cortisol levels (p = 0.013). The findings suggest that adapting working hours to an individual's biological rhythm can help mitigate potential negative effects on physical and mental health. Thus, it is recommended that professionals' working hours be adjusted accordingly.
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Affiliation(s)
| | - Isabel Abreu
- Faculty of Science and Technology, University Fernando Pessoa, 4249-004 Porto, Portugal
- FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
| | | | - Paulo César de Almeida
- Postgraduate Program in Clinical Health Care Nursing, Universidade Estadual do Ceará, Fortaleza 60714-903, Brazil
| | - Maria-Raquel G Silva
- FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, 4200-150 Porto, Portugal
- CIAS-Research Centre for Anthropology and Health-Human Biology, Health and Society, University of Coimbra, 3000-456 Coimbra, Portugal
- CHRC-Comprehensive Health Research Centre-Nova Medical School, Nova University of Lisbon, 1150-090 Lisbon, Portugal
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Latif M, Duarte Ribeiro AP, Blatz MA, Burkett K, Dragon MA, Craver T, Cogan S, Ricciardi S, Weber A. Encouraging Our NICU to "Read-a-Latte": Leveraging a Read-a-Thon to Launch a Quality Improvement Initiative. Adv Neonatal Care 2023; 23:120-131. [PMID: 36322927 PMCID: PMC10065879 DOI: 10.1097/anc.0000000000001038] [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: 03/31/2023]
Abstract
BACKGROUND Preterm infants have known impairments in language development relative to infants born at full term, and the language-poor environment of the neonatal intensive care unit (NICU) is a contributing factor. Adapting outpatient literacy programs for the NICU is a potential evidence-based intervention to encourage adult speech exposure to infants through reading sessions during NICU hospitalization. PURPOSE To evaluate implementation of a 10-day NICU Read-a-Thon and potential barriers and facilitators of a year-round program aimed at increasing reading sessions for NICU patients. METHODS We established an implementation team to execute a Read-a-Thon and evaluated its impact utilizing quantitative and qualitative approaches. Quantitative methodology was used to report number of donated books and infant reading sessions. Qualitative methodology inclusive of interviews, surveys, and source document reviews was used to evaluate the Read-a-Thon. RESULTS We received approximately 1300 donated books and logged 663 reading sessions over the 10-day Read-a-Thon. Qualitative evaluation of the Read-a-Thon identified 6 main themes: motivation, emotional response to the program, benefits and outcomes, barriers, facilitators, and future of literacy promotion in our NICU. Our evaluation informed specific aims for improvement (eg, maintaining book accessibility) for a quality improvement initiative to sustain a year-round reading program. IMPLICATIONS FOR PRACTICE AND RESEARCH Neonatal units can leverage Read-a-Thons as small tests of change to evaluate barriers, facilitators, and change processes needed to implement reading programs. Process maps of book inventory and conducting a 5 W's, 2 H's (who, what, when, where, why, how, how much) assessment can aid in program planning.
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Affiliation(s)
- Marina Latif
- Case Western Reserve University School of Medicine, Cleveland, Ohio (Ms Latif); Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs Duarte Ribeiro, Blatz, and Weber and Mss Burkett, Dragon, Craver, Cogan, and Ricciardi); and University of Cincinnati College of Nursing, Cincinnati, Ohio (Dr Weber)
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13
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Erdei C, Klass P, Inder TE. Reading Aloud with Infants in the Neonatal Intensive Care Unit: A Unit-Based Program to Enhance Language Enrichment and Support Early Foundational Relationships. Am J Perinatol 2023; 40:255-259. [PMID: 34100273 DOI: 10.1055/s-0041-1731043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Early meaningful auditory experiences in the neonatal intensive care unit (NICU) enhance language outcomes and promote cognitive and social-emotional development. METHODS This is a descriptive report sharing our level III NICU experience of building a reading-aloud enrichment program with the goals of enhancing infant neurodevelopment and strengthening early parent-infant relationships. RESULTS We propose a roadmap for program development, outline challenges and possible ways to mitigate them, and highlight opportunities for further research in this area. KEY POINTS · Early auditory experiences enhance language, cognitive, and social-emotional development.. · High-risk infants experience an atypical neurosensory environment while receiving care in the NICU.. · Reading aloud in the NICU enhances language enrichment and supports early foundational relationships.. · We describe our center's experience with building a reading-aloud enrichment program in the NICU..
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Affiliation(s)
- Carmina Erdei
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Perri Klass
- Department of Pediatrics, New York University School of Medicine, New York, New York.,Arthur L. Carter Journalism Institute, New York University, New York, New York
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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14
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Eeles AL, Olsen JE, Cameron KL, McKinnon CT, Rawnsley KL, Cruz M, Pussell K, Dubois K, Hunt RW, Cheong JLY, Spittle AJ. Impact of current Australian paid parental leave on families of preterm and sick infants. J Paediatr Child Health 2022; 58:2068-2075. [PMID: 36054633 PMCID: PMC9805188 DOI: 10.1111/jpc.16170] [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: 03/10/2022] [Revised: 06/10/2022] [Accepted: 07/10/2022] [Indexed: 01/09/2023]
Abstract
AIM Parents of preterm or sick infants are at increased risk of mental health problems. The financial stress associated with an infant's prolonged hospital stay can have an additional negative effect on families' wellbeing and child development. This study explores parent use of Australian paid parental leave (PPL) and the financial impact of having an infant requiring neonatal care. METHODS Retrospective, cross-sectional, online survey study conducted from November 2020 to February 2021. Participants were parents of babies born from 1 January 2013, admitted to a neonatal intensive care unit or special care nursery in Australia. The survey explored use of Australian Government and private sector PPL, and financial stress. Parent-reported anxiety and depression were measured using the EuroQol Group 5D-5L Anxiety and Stress Subscale. RESULTS Two hundred and thirty-one parents responded of which 93% had a preterm infant. Seventy-three percent of infants were hospitalised for more than 1 month, and 34% were readmitted to hospital within the first year following discharge home. Eighty-three percent of parents reported moderate, severe or extreme levels of anxiety or depression. Seventy-six percent reported that having a child in hospital had a moderate-very large financial impact on their family. Parents identified main costs to be travel, food, inability to work and direct medical costs. CONCLUSIONS Having an infant born preterm or sick has significant emotional and financial implications for families. The current Australian Government PPL scheme does not adequately support parents of preterm or sick infants, and a change is urgently needed to improve outcomes for this vulnerable population.
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Affiliation(s)
- Abbey L Eeles
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Newborn ResearchThe Royal Women's HospitalMelbourneVictoriaAustralia,Department of PhysiotherapyUniversity of MelbourneMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Joy E Olsen
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Newborn ResearchThe Royal Women's HospitalMelbourneVictoriaAustralia
| | - Kate L Cameron
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PhysiotherapyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Clare T McKinnon
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Kate L Rawnsley
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PhysiotherapyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Melinda Cruz
- Miracle Babies FoundationSydneyNew South WalesAustralia
| | - Kylie Pussell
- Miracle Babies FoundationSydneyNew South WalesAustralia
| | - Kara Dubois
- Miracle Babies FoundationSydneyNew South WalesAustralia
| | - Rod W Hunt
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Jeanie LY Cheong
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Newborn ResearchThe Royal Women's HospitalMelbourneVictoriaAustralia,Neonatal ServicesThe Royal Women's HospitalMelbourneVictoriaAustralia
| | - Alicia J Spittle
- Clinical Sciences ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Newborn ResearchThe Royal Women's HospitalMelbourneVictoriaAustralia,Department of PhysiotherapyUniversity of MelbourneMelbourneVictoriaAustralia
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15
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Buil A, Sankey C, Caeymaex L, Gratier M, Apter G, Vitte L, Devouche E. Skin-to-skin SDF positioning: The key to intersubjective intimacy between mother and very preterm newborn-A pilot matched-pair case-control study. Front Psychol 2022; 13:790313. [PMID: 36304846 PMCID: PMC9593100 DOI: 10.3389/fpsyg.2022.790313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits, for both the baby and the parent. However, very few studies have investigated SSC' benefits for communication, in particular in the very-preterm newborn immediately after birth. Aims To investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother-very-preterm newborn communication and to examine the coordination of the timing of communicative behaviors, just a few days after birth. Subjects and study design Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA, mean age at birth: 30 weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control positioning (n = 17) or the SDF Intervention positioning (n = 17). Mother and newborn were filmed during the first 5 min of their first SSC. Outcome measures Infants' states of consciousness according to the Assessment of Preterm Infants' Behavior scale (APIB). Onset and duration of newborns' and mothers' vocalizations and their temporal proximity within a 1-s time-window. Results In comparison with the Vertical group, very preterm newborns in the SDF Intervention Group spent less time in a drowsy state and more in deep sleep. At 3.5 days of life, newborns' vocal production in SSC did not differ significantly between the two groups. Mothers offered a denser vocal envelope in the SDF group than in the Vertical group and their vocalizations were on average significantly longer. Moreover, in a one-second time-frame, temporal proximity of mother-very preterm newborn behaviors was greater in the SDF Intervention Group. Conclusion Although conducted on a limited number of dyads, our study shows that SDF positioning fosters mother-very preterm newborn intimate encounter during the very first skin to skin contact after delivery. Our pioneer data sheds light on the way a mother and her very preterm vocally meet, and constitutes a pilot step in the exploration of innate intersubjectivity in the context of very preterm birth.
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Affiliation(s)
- Aude Buil
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Paris, France
- NICU Service de réanimation néonatale, Hospital Center Intercommunal De Créteil, Créteil, France
| | - Carol Sankey
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Paris, France
| | - Laurence Caeymaex
- NICU Service de réanimation néonatale, Hospital Center Intercommunal De Créteil, Créteil, France
- Université Paris Nanterre, Nanterre, France
| | - Maya Gratier
- Faculté de santé - Université Paris Est Créteil, Créteil, France
| | - Gisèle Apter
- Service de pédopsychiatrie universitaire, Hospital Group Du Havre, Le Havre, France
| | - Lisa Vitte
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Paris, France
- Service de pédopsychiatrie universitaire, Hospital Group Du Havre, Le Havre, France
| | - Emmanuel Devouche
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Paris, France
- Service de pédopsychiatrie universitaire, Hospital Group Du Havre, Le Havre, France
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16
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Pineda R, Liszka L, Tran P, Kwon J, Inder T. Neurobehavior in very preterm infants with low medical risk and full-term infants. J Perinatol 2022; 42:1400-1408. [PMID: 35717460 PMCID: PMC9529919 DOI: 10.1038/s41372-022-01432-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/20/2022] [Accepted: 06/09/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe differences in neurobehavior among very preterm infants with low medical risk at term equivalent age and full-term infants. STUDY DESIGN One-hundred eighty-six (136 infants born ≤32 weeks gestation with low medical risk at term equivalent age and 50 full-term infants within 4 days of birth) had standardized neurobehavioral assessments. Low medical risk was defined by ventilation <10 days and absence of significant brain injury, necrotizing enterocolitis, patent ductus arteriosus, and retinopathy of prematurity. RESULTS Very preterm infants with low medical risk at term equivalent age demonstrated more sub-optimal reflexes (p < 0.001; ß = 1.53) and more stress (p < 0.001; ß = 0.08) on the NICU Network Neurobehavioral Scale compared to their full-term counterparts. Very preterm infants with low medical risk also performed worse on the Hammersmith Neonatal Neurological Examination (p = 0.005; ß = -3.4). CONCLUSION Very preterm infants at term equivalent age continue to demonstrate less optimal neurobehavior compared to full-term infants.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
- Center for the Changing Family, University of Southern California, Los Angeles, CA, USA.
| | - Lara Liszka
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Physical and Occupational Therapy, Duke University Health System, Durham, NC, USA
| | - Pido Tran
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Jenny Kwon
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Unintended Consequences of the Neonatal Intensive Care Unit Environment: Integrative Review of Single-Family Room Unit Design. Adv Neonatal Care 2022; 23:151-159. [PMID: 35939818 DOI: 10.1097/anc.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent trends in neonatal intensive care unit design have been directed toward reducing negative stimuli and creating a more developmentally appropriate environment for infants who require intensive care. These efforts have included reconfiguring units to provide private rooms for infants. PURPOSE The purpose of this integrative review was to synthesize and critically analyze negative outcomes for patients, families, and staff who have been identified in the literature related to single-family room (SFR) care in the neonatal intensive care unit. METHODS/SEARCH STRATEGY The electronic databases of CINAHL, ProQuest Nursing & Allied Health, and PubMed databases were utilized. Inclusion criteria were research studies in English, conducted from 2011 to 2021, in which the focus of the study was related to unit design (SFRs). Based on the inclusion criteria, our search yielded 202 articles, with an additional 2 articles found through reference list searches. After screening, 44 articles met our full inclusion/exclusion criteria. These studies were examined for outcomes related to SFR unit design. FINDINGS/RESULTS Our findings revealed both positive and negative outcomes related to SFR unit design when compared with traditional open bay units. These outcomes were grouped into 4 domains: Environmental Outcomes, Infant Outcomes, Parent Outcomes, and Staff Outcomes. IMPLICATIONS FOR PRACTICE AND RESEARCH Although SFR neonatal intensive care unit design improves some outcomes for infants, families, and staff, some unexpected outcomes have been identified. Although these do not negate the positive outcomes, they should be recognized so that steps can be taken to address potential issues and prevent undesired outcomes.
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18
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Simon KR, Merz EC, He X, Noble KG. Environmental noise, brain structure, and language development in children. BRAIN AND LANGUAGE 2022; 229:105112. [PMID: 35398600 PMCID: PMC9126644 DOI: 10.1016/j.bandl.2022.105112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 06/03/2023]
Abstract
While excessive noise exposure in childhood has been associated with reduced language ability, few studies have examined potential underlying neurobiological mechanisms that may account for noise-related differences in language skills. In this study, we tested the hypotheses that higher everyday noise exposure would be associated with 1) poorer language skills and 2) differences in language-related cortical structure. A socioeconomically diverse sample of children aged 5-9 (N = 94) completed standardized language assessments. High-resolution T1-weighted magnetic resonance imaging (MRI) scans were acquired, and surface area and cortical thickness of the left inferior frontal gyrus (IFG) and left superior temporal gyrus (STG) were extracted. Language Environmental Analysis (LENA) was used to measure levels of exposure to excessive environmental noise over the course of a typical day (n = 43 with complete LENA, MRI, and behavioral data). Results indicated that children exposed to excessive levels of noise exhibited reduced cortical thickness in the left IFG. These findings add to a growing literature that explores the extent to which home environmental factors, such as environmental noise, are associated with neurobiological development related to language development in children.
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Affiliation(s)
- Katrina R Simon
- Department of Human Development, Teachers College, Columbia University, New York, NY, USA
| | - Emily C Merz
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Xiaofu He
- Department of Psychiatry, The Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Kimberly G Noble
- Department of Human Development, Teachers College, Columbia University, New York, NY, USA; Teachers College, Columbia University, Department of Biobehavioral Sciences, USA.
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19
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Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, Janvier A. Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology. J Pediatr 2022; 243:85-90.e2. [PMID: 34843711 DOI: 10.1016/j.jpeds.2021.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. STUDY DESIGN During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. RESULTS Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. CONCLUSIONS Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.
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Affiliation(s)
- Sonia Dahan
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Espace Éthique Méditerranéen, Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Marseille, France
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Melissa Savaria
- Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Préma-Québec, Quebec, Quebec, Canada; Bureau de l'Éthique Clinique, University of Montreal, Montreal, Quebec, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montreal, Quebec, Canada.
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20
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Vohr BR, McGowan EC, Brumbaugh JE, Hintz SR. Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth. J Pediatr 2022; 241:12-21. [PMID: 34673090 DOI: 10.1016/j.jpeds.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI.
| | - Elisabeth C McGowan
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI
| | - Jane E Brumbaugh
- Children's Center of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
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21
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Lisle J, Buma K, Smith J, Richter M, Satpute P, Pineda R. Maternal Perceptions About Sensory Interventions in the Neonatal Intensive Care Unit: An Exploratory Qualitative Study. Front Pediatr 2022; 10:884329. [PMID: 35783324 PMCID: PMC9240393 DOI: 10.3389/fped.2022.884329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/10/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mothers play an important role in providing positive sensory experiences to their infants during NICU hospitalization. However, little is known regarding maternal perceptions about sensory-based interventions in the NICU. Further, understanding maternal perceptions was an important part of the process during development of the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. METHODS Twenty mothers of very preterm infants were interviewed after NICU discharge and asked open-ended questions about sensory-based interventions they performed in the NICU and probed about their perceptions related to the development of a sensory-based guideline and the use of volunteers to provide sensory-based interventions when unable to be present in the NICU. Interviews were transcribed and uploaded into NVivoV.12 for content analysis. RESULTS Mothers reported that kangaroo care was a common sensory intervention they performed in the NICU. Of the 18 mothers who commented on the development of a sensory-based guideline, 17 (94%) said they would be accepting of one. Among 19 mothers, 18 (95%) supported volunteers conducting sensory-based interventions in their absence. Identified themes included: 1) Perceptions about development of a sensory-based guideline, 2) Perceptions of interactions with healthcare providers, 3) Maternal participation in sensory interventions, 4) Maternal experience, and 5) Emotions from mothers. CONCLUSION Maternal perceptions regarding the development of a sensory-based guideline were favorable, and the SENSE program has since been finalized after incorporating important insights learned from stakeholders in this study. Mothers' perceptions were tied to their NICU experiences, which elicited strong emotions. These findings highlight important considerations when developing family-centered interventions.
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Affiliation(s)
- Julia Lisle
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Kylie Buma
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Joan Smith
- Department of Quality, Safety and Practice Excellence St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marinthea Richter
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Prutha Satpute
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States.,Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.,Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, United States.,Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, United States
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22
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Capriolo C, Viscardi RM, Broderick KA, Nassebeh S, Kochan M, Solanki NS, Leung JC. Assessment of Neonatal Intensive Care Unit Sound Exposure Using a Smartphone Application. Am J Perinatol 2022; 39:189-194. [PMID: 32702769 DOI: 10.1055/s-0040-1714679] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to determine the impact of neonatal intensive care unit (NICU) design and environmental factors on neonatal sound exposures. We hypothesized that monitoring with a smartphone application would identify modifiable environmental factors in different NICU design formats. STUDY DESIGN Minimum, maximum, and peak decibel (dB) recordings were obtained using the Decibel X phone app, and the presence of noise sources was recorded in each patient space at three NICUs over a 6-month period (December 2017 to May 2018). Data were analyzed by Student's t-test and ANOVA with Bonferroni correction. Data were collected at the University of Maryland Medical Center single family room (SFR) level IV and St. Agnes Healthcare hybrid pod/single family room level III NICU, Baltimore, MD and at Prince George's Hospital Center open-pod design Level III NICU, Cheverly, MD. RESULTS All recordings in the three NICUs exceeded the American Academy of Pediatrics (AAP) recommended <45 dB level. The maximum and peak dB were highest in the open pod format level III NICU. Conversations/music alone and combined with other factors contributed to increased sound exposure. Sound exposure varied by day/night shift, with higher day exposures at the level III hybrid and open pod NICUs and higher night exposures at the level IV SFR NICU. CONCLUSION Although sound exposure varied by NICU design, all recordings exceeded the AAP recommendation due, in part, to potentially modifiable environmental factors. A smartphone application may be useful for auditing NICU sound exposure in quality improvements efforts to minimize environmental sound exposure. KEY POINTS · Smartphone application was used to assess NICU sound exposure.. · All cases of sound exposure exceed recommendations.. · A smartphone application was used to identify modifiable factors..
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Affiliation(s)
- Christine Capriolo
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Sepideh Nassebeh
- Department of Pediatrics, St. Agnes Hospital, Baltimore, Maryland
| | - Michael Kochan
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nina S Solanki
- Department of Pediatrics, Jersey Shore University Medical Center Neptune City, Neptune City, New Jersey
| | - Jocelyn C Leung
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Pineda R, Smith J, Roussin J, Wallendorf M, Kellner P, Colditz G. Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU. J Perinatol 2021; 41:2449-2462. [PMID: 34012055 PMCID: PMC8516670 DOI: 10.1038/s41372-021-01078-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate the effect of a manualized multisensory program, applied across NICU hospitalization, on infant and parent outcomes. STUDY DESIGN Seventy parent-infant dyads (born ≤32 weeks gestation) in a Level IV NICU were randomized at birth to the multisensory program or standard-of-care. Parents in the multisensory group administered prespecified amounts of age-appropriate, evidence-based sensory interventions to their infants each day during NICU hospitalization according to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. RESULTS Infants who received the SENSE program had more lethargy on the NICU Network Neurobehavioral Scale (NNNS) (p = 0.05), even after controlling for medical and social risk (p = 0.043), and had higher Communication scores on the Ages and Stages Questionnaire (p = 0.04) at 1-year corrected age, but this relationship failed to reach significance after controlling for medical and social risk (p = 0.12). CONCLUSION The SENSE program shows promise for improving outcomes, but more research with larger sample sizes is needed.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jessica Roussin
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | | | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Graham Colditz
- Department of Surgery, Washington University, St. Louis, MO, USA
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A Survey of Neonatal Nurses Perspectives on Voice Use and Auditory Needs with Premature Infants in the NICU. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168471. [PMID: 34444220 PMCID: PMC8393431 DOI: 10.3390/ijerph18168471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exposure to the voice and language during the critical period of auditory development associated with the third trimester is thought to be an essential building block for language. Differences in the auditory experience associated with early life in the NICU may increase the risk of language delays for premature infants. NICU nurses are fundamental in the care of premature infants; how they use their voices may be important in understanding auditory experiences in the NICU. This study examined voice use behaviors of NICU nurses in the United States and their current knowledge of early auditory development. METHOD An opt-in, online questionnaire. RESULTS Nurses reported using their voice more as the age of infants approached term gestation and speaking to infants was the most common type of voice use. Both infant and nurse factors influenced reported voice use decisions in the NICU. Nurses did not believe the NICU auditory environment to be sufficient to meet early auditory needs of premature infants but did believe that premature infants are exposed to adequate voice sounds. CONCLUSIONS A gap in knowledge regarding the importance of early exposure to voice sounds may be a barrier to nurses using their voices to support early auditory development.
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Knudsen K, McGill G, Ann Waitzman K, Powell J, Carlson M, Shaffer G, Morris M. Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement. Neonatal Netw 2021; 40:212-223. [PMID: 34330871 DOI: 10.1891/11-t-680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
The number of babies born extremely low birth weight surviving to be discharged home after experiencing the NICU continues to improve. Unfortunately, early sensory development for these babies occurs in an environment vastly different from the intended in-utero environment and places them at high risk of long-term neurodevelopmental and neurocognitive challenges. Our goal in the NICU must transition from simply discharge home to supporting the neurosensory development necessary for a thriving lifetime. To accomplish a goal of thriving families and thriving babies, it is clear the NICU interprofessional team must share an understanding of neurosensory development, the neuroprotective strategies safeguarding development, the neuropromotive strategies supporting intended maturational development, and the essential nature of family integration in these processes. We share the educational endeavors of 11 center collaboratives in establishing the foundational knowledge necessary to support preterm babies and their families.
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Jain VG, Kessler C, Lacina L, Szumlas GA, Crosh C, Hutton JS, Needlman R, Dewitt TG. Encouraging Parental Reading for High-Risk Neonatal Intensive Care Unit Infants. J Pediatr 2021; 232:95-102. [PMID: 33453203 DOI: 10.1016/j.jpeds.2021.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/25/2020] [Accepted: 01/07/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess whether a citywide structured book-sharing program (NICU Bookworms) designed to promote reading to infants while admitted in the neonatal intensive care unit (NICU) would increase parental reading behaviors (≥3-4 days/week) in the NICU and after discharge home, including high-risk parents who do not themselves enjoy reading. STUDY DESIGN The NICU Bookworms program comprised staff training, parent education, and building a literacy-rich environment. In this quasi-experimental intervention study, parents of medically high-risk NICU graduates <6 months of age were administered a questionnaire at their first NICU follow-up clinic visit. The survey incorporated questions from the StimQ-I READ subscale to assess home reading environment and shared reading practices. RESULTS A total of 317 infants were enrolled, 187 in an unexposed comparison group and 130 in the intervention group. Parents exposed to Bookworms were significantly more likely to read ≥3-4 days per week while in the NICU (34.5% vs 51.5%; P = .002; aOR, 2.2; 95% CI, 1.2-4.0), but reading at home did not differ (67.9% vs 73.1%; P = .28; aOR, 0.99; 95% CI, 0.5-1.8). However, among parents who did not themselves enjoy reading, frequency was significantly higher both in the NICU (18.4% vs 46.1%; P = .009; aOR, 5.0; 95% CI, 1.2-21.5) and at home (36.9% vs 70%; P = .003; aOR, 3.7; 95% CI, 1.1-12.9). A qualitative thematic analysis found that Bookworms decreased parental stress, enhanced bonding, and supported positive parent-infant interactions. CONCLUSIONS A book-sharing intervention in the NICU increased parent-reported reading aloud during hospitalization and among parents disinclined to read for pleasure, both in the NICU and following discharge. This change may have been mediated by enhancement of parent-infant interactions.
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Affiliation(s)
- Viral G Jain
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL.
| | - Christy Kessler
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Linda Lacina
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Greg A Szumlas
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Clare Crosh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John S Hutton
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Reading & Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert Needlman
- Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH
| | - Thomas G Dewitt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Reading & Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Enhancing the NICU language environment with a neonatal Cuddler program. J Perinatol 2021; 41:2063-2071. [PMID: 33772111 PMCID: PMC7995673 DOI: 10.1038/s41372-021-01037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 03/01/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare effects of a language intervention on Cuddler and parent adult word counts (AWC), and to compare Cuddler versus parent and nurse-care times. DESIGN Prospective pilot cohort intervention study. Twelve Cuddler-low-visit (≤2/week) infant pairs and 17 high-visit (≥3/week) parent-infant pairs were enrolled. Each had a 16-hour baseline recording (R1) followed by a language curriculum with linguistic feedback and an outcome recording (R2) 1 week later. Bivariate group analyses and longitudinal negative binomial regressions were run. RESULTS After the intervention, there were non-significant increases in AWC/h for Cuddlers and high-visit parents. Cuddler AWCs were similar to high-visit parents and significantly higher than nurse-care times on both recordings. Within the low-visit group, hourly AWCs were higher when Cuddlers were present versus absent (R1 = 1779 versus 552, R2 = 2530 versus 534, p < 0.0001). CONCLUSIONS NICU language environments are different for low-visit and high-visit infants and Cuddlers can increase infant language exposure in the NICU.
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Akiyama A, Tsai JD, W Y Tam E, Kamino D, Hahn C, Go CY, Chau V, Whyte H, Wilson D, McNair C, Papaioannou V, Hugh SC, Papsin BC, Nishijima S, Yamazaki T, Miller SP, Ochi A. The Effect of Music and White Noise on Electroencephalographic (EEG) Functional Connectivity in Neonates in the Neonatal Intensive Care Unit. J Child Neurol 2021; 36:38-47. [PMID: 32838628 DOI: 10.1177/0883073820947894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study is to investigate whether listening to music and white noise affects functional connectivity on scalp electroencephalography (EEG) in neonates in the neonatal intensive care unit.Nine neonates of ≥34 weeks' gestational age, who were already undergoing clinical continuous EEG monitoring in the neonatal intensive care unit, listened to lullaby-like music and white noise for 1 hour each separated by a 2-hour interval of no intervention. EEG segments during periods of music, white noise, and no intervention were band-pass filtered as delta (0.5-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz). Synchronization likelihood was used as a measure of connectivity between any 2 electrodes.In theta, lower alpha, and upper alpha frequency bands, the synchronization likelihood values yielded statistical significance with sound (music, white noise and no intervention) and with edge (between any 2 electrodes) factors. In theta, lower alpha, and upper alpha frequency bands, statistical significance was obtained between music and white noise (t = 3.12, 3.32, and 3.68, respectively; P < .017), and between white noise and no intervention (t = 4.51, 3.09, and 2.95, respectively, P < .017). However, there was no difference between music and no intervention.Although limited by a small sample size and the 1-time only auditory intervention, these preliminary results demonstrate the feasibility of EEG connectivity analyses even at bedside in neonates on continuous EEG monitoring in the neonatal intensive care unit. They also point to the possibility of detecting significant changes in functional connectivity related to the theta and alpha bands using auditory interventions.
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Affiliation(s)
- Akiyoshi Akiyama
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Bioscience and Bioinformatics, 12924Kyushu Institute of Technology, Fukuoka, Japan
| | - Jeng-Dau Tsai
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan
| | - Emily W Y Tam
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Daphne Kamino
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Cecil Hahn
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Cristina Y Go
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Vann Chau
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Hilary Whyte
- Department of Paediatrics (Neonatology), 7979The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Diane Wilson
- Department of Paediatrics (Neonatology), 7979The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Carol McNair
- Department of Paediatrics (Neonatology), 7979The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Vicky Papaioannou
- Department of Otolaryngology, The 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah C Hugh
- Department of Surgery (Otolaryngology), Joseph Brant Hospital and McMaster University, Burlington, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology, The 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sakura Nishijima
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Bioscience and Bioinformatics, 12924Kyushu Institute of Technology, Fukuoka, Japan
| | - Toshimasa Yamazaki
- Department of Bioscience and Bioinformatics, 12924Kyushu Institute of Technology, Fukuoka, Japan
| | - Steven P Miller
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ayako Ochi
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Scala ML, Marchman VA, Godenzi C, Gao C, Travis KE. Assessing speech exposure in the NICU: Implications for speech enrichment for preterm infants. J Perinatol 2020; 40:1537-1545. [PMID: 32362660 PMCID: PMC8189318 DOI: 10.1038/s41372-020-0672-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/17/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Quantify NICU speech exposure over multiple days in relation to NICU care practices. METHODS Continuous measures of speech exposure were obtained for preterm infants (n = 21; 12 M) born <34 weeks gestational age in incubators (n = 12) or open cribs (n = 9) for 5-14 days. Periods of care (routine, developmental) and delivery source (family, medical staff, cuddler) were determined through chart review. RESULTS Infants spent 13% of their time in Care, with >75% of care time reflecting developmental care. Speech counts were higher during care than no care, for mature vs. immature infants, and for infants in open cribs vs. incubators. Family participation in care ranged widely, with the highest speech counts occurring during periods of intentional voice exposure. CONCLUSIONS Care activities represent a small portion of NICU experiences. Speech exposure during Developmental Care, especially with intentional voice exposure, may be an important source of stimulation. Implications for care practices are discussed.
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Affiliation(s)
- Melissa L Scala
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA.
| | | | - Claire Godenzi
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA
| | - Courtney Gao
- Program in Human Biology, Stanford University, Palo Alto, CA, USA
| | - Katherine E Travis
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA
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30
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Liszka L, Heiny E, Smith J, Schlaggar BL, Mathur A, Pineda R. Auditory exposure of high-risk infants discharged from the NICU and the impact of social factors. Acta Paediatr 2020; 109:2049-2056. [PMID: 32017237 DOI: 10.1111/apa.15209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
AIM To (a) define the early home auditory environment of high-risk infants within one month of neonatal intensive care unit (NICU) discharge, (b) compare auditory exposures in the home environment to the NICU environment, and (c) define relationships between maternal/infant factors and auditory exposures within the home. METHODS Seventy-three high-risk infants (48 high-risk infants in the NICU at term-equivalent age and 25 high-risk infants in the home following NICU discharge) had auditory exposures measured. RESULTS An average of 1.3 hours more noise (P ≤ .001) and 2 hours less silence (P = .01) were observed in the NICU compared with the home, but differences varied based on whether comparing to an open ward or private room. Infants with public insurance, lower household income and mothers without a college education were exposed to an average of 2.8, 3.0 and 2.3 hours more TV/electronic sounds respectively (P < .05). An average of 1744 fewer adult words (P = .03) were spoken in households with public insurance. There was an average of 3.1 hours less silence and 4.5 dB louder stimuli among households with lower income (P < .05). CONCLUSION Elucidating differences across environments can lead to interventions to foster appropriate auditory exposures to improve language development of high-risk infants.
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Affiliation(s)
- Lara Liszka
- Washington University Program in Occupational Therapy St. Louis Missouri
| | - Elizabeth Heiny
- Washington University Program in Occupational Therapy St. Louis Missouri
| | - Joan Smith
- Saint Louis Children's Hospital Department of Quality, Safety and Practice Excellence St. Louis Missouri
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute Baltimore Maryland
- Departments of Neurology and Pediatrics Johns Hopkins University School of Medicine Baltimore Maryland
| | - Amit Mathur
- Division of Neonatal‐Perinatal Medicine SSM Health Cardinal Glennon Children's Hospital St. Louis Missouri
| | - Roberta Pineda
- Washington University Program in Occupational Therapy St. Louis Missouri
- Department of Pediatrics Washington University School of Medicine St. Louis Missouri
- Chan Division of Occupational Science and Occupational Therapy University of Southern California Los Angeles California
- Department of Pediatrics Keck School of Medicine Los Angeles California
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Hutchinson G, Du L, Ahmad K. Incubator-based Sound Attenuation: Active Noise Control In A Simulated Clinical Environment. PLoS One 2020; 15:e0235287. [PMID: 32667931 PMCID: PMC7363066 DOI: 10.1371/journal.pone.0235287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Noise in the neonatal intensive care unit can be detrimental to the health of the hospitalized infant. Means of reducing that noise include staff training, warning lights, and ear coverings, all of which have had limited success. Single family rooms, while an improvement, also expose the hospitalized infant to the same device alarms and mechanical noises found in open bay units. Methods We evaluated a non-contact incubator-based active noise control device (Neoasis™, Invictus Medical, San Antonio, Texas) in a simulated neonatal intensive care unit (NICU) setting to determine whether it could effectively reduce the noise exposure of infants within an incubator. In the NICU simulation center, we generated a series of clinically appropriate sound sequences with bedside medical devices such as a patient monitor and fluid infusion devices, hospital air handling systems, and device mechanical sounds. A microphone-equipped infant mannequin was oriented within an incubator. Measurements were made with the microphones with the Neoasis™ deactivated and activated. Results The active noise control device decreased sound pressure levels for certain alarm sounds by as much as 14.4 dB (a 5.2-fold reduction in sound pressure) at the alarm tone’s primary frequency. Frequencies below the 2 kHz octave band were more effectively attenuated than frequencies at or above the 2 kHz octave band. Background noise levels below 40 dBA were essentially not impacted by the active noise control device. Conclusions The active noise control device further reduces noise inside infant incubators. Device safety and potential health benefits of the quieter environment should be verified in a clinical setting.
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Affiliation(s)
- George Hutchinson
- Invictus Medical, Inc., San Antonio, Texas, United States of America
- * E-mail:
| | - Lilin Du
- Invictus Medical, Inc., San Antonio, Texas, United States of America
| | - Kaashif Ahmad
- Pediatrix Medical Group, San Antonio, Texas, United States of America
- Baylor College of Medicine, San Antonio, Texas, United States of America
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32
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Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, Hay WW, Hoyos A, Anderson D, Bloomfield F, Griffin I, Embleton N, Rochow N, Taylor S, Senterre T, Schanler RJ, Elmrayed S, Groh-Wargo S, Adamkin D, Shah PS. "Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants. J Perinatol 2020; 40:704-714. [PMID: 32214217 DOI: 10.1038/s41372-020-0658-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/09/2022]
Abstract
Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants' actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Nutrition Services, Alberta Health Services, Calgary, AB, Canada.
| | - Barbara Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Roseann Nasser
- Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada
| | - Belal Alshaikh
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Misha Eliasziw
- Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | | | - Angela Hoyos
- Clínica del Country, Universidad el Bosque, Bogotá, Colombia
| | - Diane Anderson
- Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Frank Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ian Griffin
- Clinical and Translational Research, Biomedical research Institute of New Jersey, Cedar Knolls, NJ, USA
| | - Nicholas Embleton
- Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Niels Rochow
- Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sarah Taylor
- Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Richard J Schanler
- Neonatal Services, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Seham Elmrayed
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon Groh-Wargo
- Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - David Adamkin
- Pediatrics, University of Louisville, Louisville, KY, USA
| | - Prakesh S Shah
- Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
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A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant. Early Hum Dev 2020; 144:105000. [PMID: 32151905 PMCID: PMC7282956 DOI: 10.1016/j.earlhumdev.2020.105000] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
AIM To explore differences in maternal mental health and infant neurobehavioral outcome among infants who received and did not receive the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. STUDY DESIGN Eighty preterm infants (50 receiving standard-of-care and 30 receiving the SENSE program) born ≤32 weeks gestation were enrolled within the first week of life in a prospective quasi-experimental design, using a historical control group for comparison. Standard-of-care consisted of tactile (skin-to-skin, touch, holding) and olfactory (scent cloth, close maternal contact) interventions as determined to be appropriate by health care professionals and parents. The SENSE group received specific doses of tactile (skin-to-skin care, holding, massage, touch), auditory (human speech, music), olfactory (scent cloth, close maternal contact), kinesthetic/vestibular (movement, rocking/transfers), and visual (dim or cycled light) exposures, based on the infant's postmenstrual age and tailored to medical status and infant cues according to the SENSE program. The SENSE program includes the intentional delivery of positive, age-appropriate sensory exposures by parents (or a sensory support team, when parents are unavailable) each day of NICU hospitalization. Infant neurobehavioral outcome, as well as maternal mental health and confidence, were assessed prior to NICU discharge, using standardized measures. RESULTS Seventy-three infants were included in the final analysis. Mothers whose infants received the SENSE program demonstrated higher scores on the Maternal Confidence Questionnaire (p = 0.01). Infants who received the SENSE program demonstrated less asymmetry on the NICU Network Neurobehavioral Scale (p = 0.02; mean difference 0.9) and higher scores on the Hammersmith Neonatal Neurological Evaluation (p < 0.001; mean difference 4.8). DISCUSSION Preliminary evidence demonstrates improvements in maternal confidence and infant neurobehavioral performance following SENSE implementation.
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Doede M, Trinkoff AM. Emotional Work of Neonatal Nurses in a Single-Family Room NICU. J Obstet Gynecol Neonatal Nurs 2020; 49:283-292. [PMID: 32298637 DOI: 10.1016/j.jogn.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe the emotional work of neonatal nurses in a single-family room NICU. DESIGN Qualitative interpretive description. SETTING A single-family room NICU in the mid-Atlantic region of the United States. PARTICIPANTS Fifteen nurses who worked in the single-family room NICU. METHODS Data were collected from 110 hours of direct observation and 11 interviews over a 6-month period. We focused on emotional demands using triangulation between interviews and observations to identify themes. Conceptualization of emotional work informed interpretation. RESULTS Four themes emerged: Parents Living on the Unit, Isolation of Infants in Rooms, Nurses' Ability to Form Bonds and Establish Trust With Parents, and Sheltering Nurses and Parents From Stressful Events on the Unit. Parents living on the unit and the isolation of infants in private rooms increased the emotional work of nurses. Forming trust and bonds with parents and sheltering parents and themselves from stressful events on the unit decreased nurses' emotional work. CONCLUSION Care should be taken in NICU design because unit layout can affect the emotional work of nurses. Understanding how neonatal nursing practice is affected by unit layout can help nurses and those who design NICUs to create and promote optimal practice environments.
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Monson BB, Rock J, Cull M, Soloveychik V. Neonatal intensive care unit incubators reduce language and noise levels more than the womb. J Perinatol 2020; 40:600-606. [PMID: 32020037 DOI: 10.1038/s41372-020-0592-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/17/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the sound reducing characteristics of modern incubators in the neonatal intensive care unit (NICU) and to better characterize auditory and language exposures for NICU infants. STUDY DESIGN Sound frequency spectral analysis was conducted on language and noise audio acquired simultaneously inside and outside incubators located in the NICU. RESULTS Sound transmission into the incubators was nonuniform. Very low-frequency sounds (<100 Hz) were unattenuated or even slightly amplified inside the incubators. Maximal reduction was observed for low-to-mid frequencies (300-600 Hz) and high frequencies (>2000 Hz), which convey important language information. CONCLUSIONS Sound reductions observed across NICU incubator walls are more severe than those reported for sound transmission into the intrauterine environment, particularly for midrange frequencies that are important for language. Although incubator walls may serve as a protection against noxious noise levels, these findings reveal a potentially detrimental effect on language exposure for infants inside a NICU incubator.
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Affiliation(s)
- Brian B Monson
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA. .,Neuroscience Program, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Jenna Rock
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Molly Cull
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Pados BF, Davitt ES. Pathophysiology of Gastroesophageal Reflux Disease in Infants and Nonpharmacologic Strategies for Symptom Management. Nurs Womens Health 2020; 24:101-114. [PMID: 32101759 DOI: 10.1016/j.nwh.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/10/2019] [Accepted: 01/01/2020] [Indexed: 06/10/2023]
Abstract
Gastroesophageal reflux is common in young infants, particularly those born prematurely or with a history of medical complexity. The most recent clinical practice guidelines recommend the use of nonpharmacologic management strategies because of concerns about the safety of acid-reducing medications and a lack of evidence of their effectiveness. Our purpose in this article is to holistically review the pathophysiology of gastroesophageal reflux disease, identify symptom management targets, and describe nonpharmacologic strategies that nurses can implement and/or teach to parents to manage symptoms of gastroesophageal reflux. Strategies targeting stress, dysbiosis, food intolerances, feeding difficulties, and positioning are discussed. Nurses can work with families to identify factors contributing to gastroesophageal reflux disease and determine individualized strategies that can be used in lieu of, or in addition to, medication.
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Feeley N, Robins S, Genest C, Stremler R, Zelkowitz P, Charbonneau L. A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design. BMC Pediatr 2020; 20:38. [PMID: 31996178 PMCID: PMC6988355 DOI: 10.1186/s12887-020-1929-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023] Open
Abstract
Background The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants. Purpose To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs. Methods A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge. Results Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy. At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education. Conclusions Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.
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Affiliation(s)
- Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, B- 621, Montréal, Québec, H3T 1E2, Canada. .,Ingram School of Nursing, McGill University, Montréal, Canada.
| | - Stephanie Robins
- Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte Ste-Catherine Road, Montreal, Quebec, H3T 1E4, Canada
| | - Christine Genest
- Faculty of Nursing, University of Montreal, 2375 Côte Ste-Catherine Road, Montréal, Québec, H3T 1A8, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital Senior Investigator, Lady Davis Institute for Medical Research, 4333 Côte Ste-Catherine Road, Montréal, Québec, H3T 1E4, Canada
| | - Lyne Charbonneau
- Neonatology, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, Montréal, Québec, H3T 1E2, Canada
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Fontana C, De Carli A, Ricci D, Dessimone F, Passera S, Pesenti N, Bonzini M, Bassi L, Squarcina L, Cinnante C, Mosca F, Fumagalli M. Effects of Early Intervention on Visual Function in Preterm Infants: A Randomized Controlled Trial. Front Pediatr 2020; 8:291. [PMID: 32582595 PMCID: PMC7287146 DOI: 10.3389/fped.2020.00291] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: To determine the effectiveness of an early intervention program in enhancing visual function in very preterm infants. Methods: We conducted a RCT. We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA), without severe morbidities, and their families. Infants were randomized to either receive Standard Care (SC) or Early Intervention (EI). SC, according to NICU protocols, included Kangaroo Mother Care and minimal handling. EI included, in addition to routine care, parental training according to the PremieStart program, and multisensory stimulation (infant massage and visual interaction) performed by parents. Visual function was assessed at term equivalent age (TEA) using a prevalidated battery evaluating ocular spontaneous motility, ability to fix and follow a target, reaction to color, stripes discrimination and visual attention at distance. Results: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to protocol. Fifty-seven infants (EI = 27, SC = 30) were assessed at TEA. The two groups were comparable for parental and infant characteristics. In total, 59% of infants in the EI group achieved the highest score in all the nine assessed items compared to 17% in the SC group (p = 0.001): all infants in both groups showed complete maturation in four items, but EI infants showed more mature findings in the other five items (ocular motility both spontaneous and with target, tracking arc, stripes discrimination and attention at distance). Conclusions: Our results suggest that EI has a positive effect on visual function maturation in preterm infants at TEA. Trial Registration: clinicalTrial.gov (NCT02983513).
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Affiliation(s)
- Camilla Fontana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Agnese De Carli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Daniela Ricci
- Pediatric Neurology, Department of Human and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy.,Department of Ophthalmology, National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired, IAPB, Rome, Italy
| | - Francesca Dessimone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Sofia Passera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Matteo Bonzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Occupational Health Unit, Milan, Italy
| | - Laura Bassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cinnante
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
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Detmer MR, Evans K, Shina E, Walker K, DeLoach D, Malowitz JR. Multimodal Neurologic Enhancement Improves Preterm Infants' Developmental Outcomes: A Longitudinal Pilot Study. Neonatal Netw 2020; 39:16-23. [PMID: 31919289 DOI: 10.1891/0730-0832.39.1.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to identify the long-term developmental effects of a NICU music therapy intervention, Multimodal Neurologic Enhancement, provided to preterm infants in the NICU. DESIGN Prospective randomized controlled study with one control group and one experimental group. SAMPLE Participants were medically stable preterm infants with a birth age of 31 and 6/7 weeks or less, admitted to a level-III NICU. A total of 84 participants were enrolled, and 48 completed the study. MAIN OUTCOME VARIABLE Post-discharge developmental scores on the Mullen Scales of Early Learning: AGS Edition. RESULTS The experimental group performed significantly better than the control group on the Visual Reception and Early Learning Composite scores.
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The Growth and Development Unit. A proposed approach for enhancing infant neurodevelopment and family-centered care in the Neonatal Intensive Care Unit. J Perinatol 2019; 39:1684-1687. [PMID: 31582813 DOI: 10.1038/s41372-019-0514-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/12/2019] [Accepted: 08/15/2019] [Indexed: 11/08/2022]
Abstract
There is growing evidence that the neurosensory and social environment of the Neonatal Intensive Care Unit (NICU) has lasting effects on the neurodevelopment of the high-risk hospitalized infant. Thus, many NICUs are transitioning from traditional, medical healing approaches to enhanced family-centered developmental care approaches with the aim of improving infant outcomes and parental mental health. This commentary describes a transdisciplinary neurodevelopmental program based on key principles and recommendations from current and evolving evidence-based care practice guidelines. This clinical initiative, known as the Growth and Development Unit (GDU), was developed within the context of a 66-bed level III NICU. The process of program inception, key elements of program development, as well as program strengths and challenges are discussed.
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Pineda R, Roussin J, Heiny E, Smith J. Health Care Professionals' Perceptions about Sensory-Based Interventions in the NICU. Am J Perinatol 2019; 36:1229-1236. [PMID: 30577058 PMCID: PMC6635089 DOI: 10.1055/s-0038-1676536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The main objective of this article is to define perceptions of health care professionals regarding current use of sensory-based interventions in the neonatal intensive care unit (NICU). STUDY DESIGN A multidisciplinary group of NICU health care professionals (n = 108) defined the types of sensory-based interventions used in their NICU, the postmenstrual age (PMA) sensory-based interventions are administered, conditions under which sensory-based interventions are used, and personnel who administer sensory-based interventions. RESULTS The most commonly reported tactile intervention was infant holding (88% of respondents), the most common auditory intervention was recorded music/singing (69% of respondents), the most common kinesthetic intervention was occupational and physical therapy (85% of respondents), and the most common vestibular intervention was infant swings (86% of respondents). Tactile interventions were initiated most often at 24 to 26 weeks PMA (74% of respondents), auditory interventions at 30 to 32 weeks (60% of respondents), kinesthetic interventions at 30 to 32 weeks (76% of respondents), vestibular interventions at 33 to 34 weeks (86% of respondents), and visual interventions at 32 to 36 weeks (72% of respondents). Conditions under which sensory-based interventions were administered, and personnel who provided them, varied across settings. CONCLUSION Varied use of sensory-based interventions in the NICU were reported. While this study was limited by biased sampling and the identification of health care professionals' perceptions but not real-world practice, this information can be used to build a comprehensive approach to positive sensory exposures in the NICU.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica Roussin
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Elizabeth Heiny
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety and Practice Excellence, Saint Louis Children’s Hospital, St. Louis, Missouri
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Liszka L, Smith J, Mathur A, Schlaggar BL, Colditz G, Pineda R. Differences in early auditory exposure across neonatal environments. Early Hum Dev 2019; 136:27-32. [PMID: 31299550 PMCID: PMC6689434 DOI: 10.1016/j.earlhumdev.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/21/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To date, no study has compared preterm and full term auditory environments. AIM To define differences in auditory exposure for preterm infants at term equivalent age in the neonatal intensive care unit (NICU) compared to auditory exposure in hospital rooms on a labor and delivery ward after full term birth. STUDY DESIGN Ninety-eight infants (48 preterm infants born 28 weeks gestation in the NICU at term equivalent age and 50 full term infants in a hospital room on the labor and delivery ward within 4 days of birth) had auditory exposure measured over a single 16-hour period using the Language Environment Acquisition (LENA) device. RESULTS More language (p < 0.001) was observed on the labor and delivery ward than in the NICU, with an average of 3.3 h more language in a 16-hour period and an average of 14,110 more words spoken around infants in a 16-hour period on the labor and delivery ward (p < 0.001). More electronic sounds were observed in the NICU, with an average of 2.3 h more in the 16-hour period (p < 0.001). The average decibel level in the NICU was lower than in the hospital rooms on the labor and delivery ward (57.16 ± 2.30 dB, compared to 63.31 ± 2.22 dB; p < 0.001). CONCLUSION The NICU auditory environment for preterm infants is different than the auditory environment for full term infants, with less language, more electronic sounds, and quieter stimuli. This understanding can aid in developing appropriate interventions that enhance positive forms of auditory exposures.
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Affiliation(s)
- Lara Liszka
- Washington University Program in Occupational Therapy, St. Louis, MO
| | - Joan Smith
- Saint Louis Children’s Hospital Division of Excellence and Quality, St. Louis, MO
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine in St. Louis, MO
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD,Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine
| | - Graham Colditz
- Public Health Sciences, Washington University School of Medicine in St. Louis, MO,Institute for Public Health, Washington University in St. Louis, MO
| | - Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States of America; Department of Pediatrics, Washington University School of Medicine in St. Louis, MO, United States of America.
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Shellhaas RA, Burns JW, Barks JD, Hassan F, Chervin RD. Maternal Voice and Infant Sleep in the Neonatal Intensive Care Unit. Pediatrics 2019; 144:peds.2019-0288. [PMID: 31409691 PMCID: PMC6855818 DOI: 10.1542/peds.2019-0288] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Approximately 10% of US newborns require a NICU. We evaluated whether the NICU acoustic environment affects neonatal sleep and whether exposure to the mother's voice can modulate that impact. METHODS In a level IV NICU with single-infant rooms, 47 neonates underwent 12-hour polysomnography. Their mothers were recorded reading children's books. Continuous maternal voice playback was randomized to either the first or second 6 hours of the polysomnogram. Regression models were used to examine sleep-wake stages, entropy, EEG power, and the probability of awakening in response to ambient noise during and without voice playback. RESULTS After epochs with elevated noise, the probability was higher with (versus without) maternal voice exposure of neonates staying asleep (P = .009). However, the 20 neonates born at ≥35 weeks' gestation, in contrast to those born at 33 to 34 weeks, showed an age-related increase in percent time awake (R 2 = 0.52; P < .001), a decrease in overall sleep (R 2 = 0.52; P < .001), a reduction in rapid eye movement sleep bouts per hour (R 2 = 0.35; P = .003), and an increase in sleep-wake entropy (R 2 = 0.52; P < .001) all confined solely to the 6 hours of maternal voice exposure. These associations remained significant (P = .02 to P < .001) after adjustment for neurologic examination scores and ambient noise. CONCLUSIONS Hospitalized newborns born at ≥35 weeks' gestation but not at 33 to 34 weeks' gestation show increasing wakefulness in response to their mother's voice. However, exposure to the mother's voice during sleep may also help protect newborns from awakening after bursts of loud hospital noise.
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Affiliation(s)
| | - Joseph W. Burns
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, Michigan; and
| | | | - Fauziya Hassan
- Departments of Pediatrics and,Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan; and
| | - Ronald D. Chervin
- Neurology and,Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan; and
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A Community Hospital NICU Developmental Care Partner Program: Feasibility and Association With Decreased Nurse Burnout Without Increased Infant Infection Rates. Adv Neonatal Care 2019; 19:311-320. [PMID: 30893098 DOI: 10.1097/anc.0000000000000600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Volunteers can provide staff-directed sensory inputs to infants hospitalized in the NICU, but research on volunteer programs is limited. PURPOSE To evaluate the feasibility of a developmental care partner (DCP) program in a level III NICU and determine its relationship with provider burnout and infant infection rates. METHODS DCPs were trained to provide sensory input to infants, based on the behavioral cues observed by the occupational therapists and nursing staff, in medically stable infants. Feasibility was assessed by documenting the process of training and utilizing volunteers, as well as tracking duration and frequency of DCP visits. Staff burnout measures were assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) before and after implementation. Infant infection rates before and after the introduction of volunteers were compared. RESULTS Seventy-two volunteers were interested, and 25 (35%) completed the DCP competencies and provided sensory exposures to 54 neonates, who were visited an average of 8 times (range 1-15). Twelve (48%) DCPs did once-per-week visits, and 9 (36%) did at least 50 contact hours. MBI-HSS scores for staff emotional exhaustion (P < .001) and depersonalization (P < .006) were lower after DCP implementation. There were no differences in infant infection rates before and after DCP implementation (Fisher exact P = 1.000). IMPLICATIONS FOR PRACTICE Volunteer-based DCP programs may be feasible to implement in community hospitals and could help reduce staff emotional exhaustion and depersonalization without increasing the incidence of infant infections. IMPLICATIONS FOR RESEARCH Future research on NICU volunteer programs with larger sample sizes and different infant populations is warranted.
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Shanty L, Dowling R, Sonnenschein S, Hussey-Gardner B. Evaluation of an Early Language and Literacy Program for Parents of Infants in the NICU. Neonatal Netw 2019; 38:206-216. [PMID: 31470389 DOI: 10.1891/0730-0832.38.4.206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of a NICU parent education program on parents' early language and literacy practices, and on their confidence interpreting and responding to infant signals. DESIGN Single group, pre- and post-test, mixed-methods evaluation design. SAMPLE One hundred and four parents and other caregivers completed questionnaires before and after the one-hour program. Ten parents participated in follow-up interviews. MAIN OUTCOME VARIABLES Before and after sessions, participants reported on frequency of their current and intended early language and literacy practices, and their confidence interpreting and responding to infant signals. Participants also reported program satisfaction. Interview participants reported their behavior change one to two weeks later. RESULTS The program significantly increased intention to engage in more early language and literacy practices, and increased parent-reported knowledge of how and when to interact with their infants. The majority of interviewed parents reported engaging in these practices one to two weeks later.
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46
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McGowan EC, Vohr BR. Impact of Nonmedical Factors on Neurobehavior and Language Outcomes of Preterm Infants. Neoreviews 2019; 20:e372-e384. [PMID: 31261104 DOI: 10.1542/neo.20-7-e372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Preterm infants are at increased risk for adverse neurodevelopmental outcomes. The impact of maternal, NICU, and social environmental factors on early neurobehavior and language outcomes of preterm infants is recognized. There is a need for health care professionals to have a clear understanding of the importance of facilitating positive mother-infant relationships, and to address not only the infant's sensory and language environment, but also focus on adverse maternal mental health and social adversities to optimize infant outcomes.
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Affiliation(s)
- Elisabeth C McGowan
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
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Pineda R, Raney M, Smith J. Supporting and enhancing NICU sensory experiences (SENSE): Defining developmentally-appropriate sensory exposures for high-risk infants. Early Hum Dev 2019; 133:29-35. [PMID: 31054467 DOI: 10.1016/j.earlhumdev.2019.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/29/2019] [Accepted: 04/24/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There is evidence to support the use of positive sensory exposures (music, touch, skin-to-skin) with preterm infants in the neonatal intensive care unit (NICU), but strategies to improve their consistent use are lacking. The Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed to promote consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for the preterm infant every day of NICU hospitalization. METHODS A systematic and rigorous process of development of the SENSE program included an integrative review of evidence on sensory exposures in the NICU, stakeholder feedback, expert opinion, and focus groups. RESULTS SENSE implementation materials consist of parent education materials, tailored doses of sensory exposures for each postmenstrual age, an infant assessment of tolerance, bedside logs and implementation considerations for integrating the SENSE program into the NICU. DISCUSSION Research is needed to evaluate the SENSE program as an implementation strategy and to assess its impact on parent and infant outcomes.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States of America; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Mary Raney
- St. Louis Children's Hospital, St Louis, MO, United States of America
| | - Joan Smith
- St. Louis Children's Hospital, St Louis, MO, United States of America
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Kuhn P, Sizun J, Casper C. Recommendations on the environment for hospitalised newborn infants from the French neonatal society: rationale, methods and first recommendation on neonatal intensive care unit design. Acta Paediatr 2018; 107:1860-1866. [PMID: 30025190 DOI: 10.1111/apa.14501] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Hospitalised newborn infants may be stressed due to inappropriate sensory stimuli and early separation from their families, that can negatively impact their neurodevelopment. The French Group of Reflection and Evaluation of the Environment of Newborns (GREEN) issues guidelines based on environmental neonatology and family-centred care. The first recommendation focuses on private family rooms versus large shared rooms. METHODS These guidelines are based on a systematic evaluation of the literature providing different grades of evidence. Internal and external reviews by multidisciplinary experts examined the scientific evidence of all recommendations. The literature search was performed for the period January 1, 2000 to January 1, 2016 with the keywords 'single room' or 'private room' and 'neonatal intensive care unit'. RESULTS A total of 25 studies were retained. Most studies reported a positive impact of private rooms on the health of newborn infants and satisfaction of families. Private rooms could lead to sensory deprivation if there is low parental involvement with limited presence and to reduced interaction among caregivers. CONCLUSION We recommend that neonatal units should mostly have private rooms. With this architectural design, we recommend supporting the staff's needs for changes in the organisation and philosophy of care and to provide improved family support.
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Affiliation(s)
- Pierre Kuhn
- Service de Médecine et de Réanimation du nouveau-né; Hôpital Hautepierre; Strasbourg France
| | - Jacques Sizun
- Pôle de la Femme, de la Mère et de l'Enfant; CHRU de Brest; Brest France
| | - Charlotte Casper
- Unité de Néonatologie; Hôpital des Enfants; CHU Toulouse; Toulouse France
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Abstract
Technological advances in neonatal-perinatal medicine have led to a steady increase in the survival of preterm infants. Although the increase in survival is a remarkable success, children born preterm remain at high risk for brain injury and long-term neurodevelopmental deficits. Children born preterm may have abnormal muscle tone or movements, cognitive deficits, language impairments, and behavioral problems. This article reviews neurodevelopmental outcomes and factors that influence outcomes in preterm children during early childhood.
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Burnett AC, Cheong JLY, Doyle LW. Biological and Social Influences on the Neurodevelopmental Outcomes of Preterm Infants. Clin Perinatol 2018; 45:485-500. [PMID: 30144851 DOI: 10.1016/j.clp.2018.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although very preterm birth and very low birthweight are recognized risk factors for longer term developmental difficulties, there is a wide spectrum of outcomes for children and adolescents born preterm. Biological and social variables have the potential to explain this variability. Although current understanding of these influences and how they interact is incomplete, perinatal factors are related to permanent neurosensory impairments such as cerebral palsy, blindness, and deafness. Cognitive and academic outcomes are variably associated with biological and social variables across development, and the most robust correlates of behavior and mental health difficulties include early behavioral problems and family influences.
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Affiliation(s)
- Alice C Burnett
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria 3010, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Jeanie L Y Cheong
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3010, Australia; Neonatal Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, Level 7, 20 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Lex W Doyle
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria 3010, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3010, Australia; Newborn Research, The Royal Women's Hospital, Level 7, 20 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
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