1
|
Markkula A, Pyhälä-Neuvonen R, Stolt S. Interventions and their efficacy in supporting language development among preterm children aged 0-3 years - A systematic review. Early Hum Dev 2024; 195:106057. [PMID: 38901388 DOI: 10.1016/j.earlhumdev.2024.106057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Preterm children have a higher risk for linguistic delays than full-term infants but are rarely provided with language intervention at an early age. Knowledge on early language interventions targeted to preterm children is scarce, and efficacy of the interventions is rarely reported. AIM This systematic review aims to identify interventions for preterm children aged 0-3 years with at least one language outcome. Efficacy of the interventions and quality of the study reports were evaluated. STUDY DESIGN The article search was carried out in six databases: EBSCOhost, Scopus, ERIC, LLBA, Ovid, and Web of Science. Effect sizes (Hedges' g) were calculated for language outcomes. Quality of the study reports was assessed using the levels of evidence system by the American Speech-Language-Hearing Association. RESULTS The 28 studies identified were divided into three groups: interventions at Neonatal Intensive Care Unit, interventions during the first year, and interventions during the second and/or third years. Most of the interventions focused on supporting child-care and general development. Of the interventions, 61 % were efficacious in supporting language development of preterm children. The most promising results regarding efficacy were interventions conducted during the second and/or third years (80 %). Quality of the reports varied from high/good (89 %) to low (11 %). CONCLUSION The 28 existing studies provide limited evidence of the efficacy of very early interventions promoting language development of preterm children. However, especially the results for interventions conducted during the second and/or third years show promise. More studies, particularly language-focused interventions with longer follow-ups, are needed.
Collapse
Affiliation(s)
- Anna Markkula
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Riikka Pyhälä-Neuvonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Suvi Stolt
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Schneider J, Harari MM, Faure N, Lacroix A, Borghini A, Tolsa JF, Horsch A. Joint observation in NICU (JOIN): A randomized controlled trial testing an early, one-session intervention during preterm care to improve perceived maternal self-efficacy and other mental health outcomes. PLoS One 2024; 19:e0301594. [PMID: 38662661 PMCID: PMC11045081 DOI: 10.1371/journal.pone.0301594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Parents of preterm infants in the Neonatal Intensive Care Unit (NICU) environment may experience psychological distress, decreased perceived self-efficacy, and/or difficulties in establishing an adaptive parent-infant relationship. Early developmental care interventions to support the parental role and infant development are essential and their impact can be assessed by an improvement of parental self-efficacy perception. The aims were to assess the effects of an early intervention provided in the NICU (the Joint Observation) on maternal perceived self-efficacy compared to controls (primary outcome) and to compare maternal mental health measures (perceived stress, anxiety, and depression), perception of the parent-infant relationship, and maternal responsiveness (secondary outcomes). METHODS This study was a monocentric randomized controlled trial registered in clinicatrials.gov (NCT02736136), which aimed at testing a behavioural intervention compared with treatment-as-usual. Mothers of preterm neonates born 28 to 32 6/7 weeks gestation were randomly allocated to either the intervention or the control groups. Outcome measures consisted of self-report questionnaires completed by the mothers at 1 and 6 months after enrollment and assessing perceived self-efficacy, mental health, perception of the parent-infant relationship and responsiveness, as well as satisfaction with the intervention. RESULTS No statistically significant group effects were observed for perceived maternal self-efficacy or the secondary outcomes. Over time, perceived maternal self-efficacy increased for mothers in both groups, while anxiety and depression symptoms decreased. High satisfaction with the intervention was reported. CONCLUSIONS The joint observation was not associated with improved perceived maternal self-efficacy or other mental health outcomes, but may constitute an additional supportive measure offered to parents in a vulnerable situation during the NICU stay.
Collapse
Affiliation(s)
- Juliane Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- The Sense, Innovation, and Research Center, Lausanne, Switzerland
| | - Mathilde Morisod Harari
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Noémie Faure
- Centre Sages-Femmes, Vevey, Switzerland
- UniVers Famille, Châtel-St-Denis, Switzerland
| | - Alain Lacroix
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | | | - Jean-François Tolsa
- Department of Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Department of Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | | |
Collapse
|
3
|
Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2024; 2:CD005495. [PMID: 38348930 PMCID: PMC10862558 DOI: 10.1002/14651858.cd005495.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Infants born preterm are at increased risk of cognitive and motor impairments compared with infants born at term. Early developmental interventions for preterm infants are targeted at the infant or the parent-infant relationship, or both, and may focus on different aspects of early development. They aim to improve developmental outcomes for these infants, but the long-term benefits remain unclear. This is an update of a Cochrane review first published in 2007 and updated in 2012 and 2015. OBJECTIVES Primary objective To assess the effect of early developmental interventions compared with standard care in prevention of motor or cognitive impairment for preterm infants in infancy (zero to < three years), preschool age (three to < five years), and school age (five to < 18 years). Secondary objective To assess the effect of early developmental interventions compared with standard care on motor or cognitive impairment for subgroups of preterm infants, including groups based on gestational age, birthweight, brain injury, timing or focus of intervention and study quality. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and trial registries in July 2023. We cross-referenced relevant literature, including identified trials and existing review articles. SELECTION CRITERIA Studies included randomised, quasi-randomised controlled trials (RCTs) or cluster-randomised trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age (GA). Interventions could commence as an inpatient but had to include a post discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. The control groups in the studies could receive standard care that would normally be provided. DATA COLLECTION AND ANALYSIS Data were extracted from the included studies regarding study and participant characteristics, timing and focus of interventions and cognitive and motor outcomes. Meta-analysis using RevMan was carried out to determine the effects of early developmental interventions at each age range: infancy (zero to < three years), preschool age (three to < five years) and school age (five to < 18 years) on cognitive and motor outcomes. Subgroup analyses focused on GA, birthweight, brain injury, time of commencement of the intervention, focus of the intervention and study quality. We used standard methodological procedures expected by Cochrane to collect data and evaluate bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Forty-four studies met the inclusion criteria (5051 randomly assigned participants). There were 19 new studies identified in this update (600 participants) and a further 17 studies awaiting outcomes. Three previously included studies had new data. There was variability in the focus and intensity of the interventions, participant characteristics, and length of follow-up. All included studies were either single or multicentre trials and the number of participants varied from fewer than 20 to up to 915 in one study. The trials included in this review were mainly undertaken in middle- or high-income countries. The majority of studies commenced in the hospital, with fewer commencing once the infant was home. The focus of the intervention programmes for new included studies was increasingly targeted at both the infant and the parent-infant relationship. The intensity and dosages of interventions varied between studies, which is important when considering the applicability of any programme in a clinical setting. Meta-analysis demonstrated that early developmental intervention may improve cognitive outcomes in infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.27 standard deviations (SDs), 95% confidence interval (CI) 0.15 to 0.40; P < 0.001; 25 studies; 3132 participants, low-certainty evidence), and improves cognitive outcomes at preschool age (intelligence quotient (IQ); SMD 0.39 SD, 95% CI 0.29 to 0.50; P < 0.001; 9 studies; 1524 participants, high-certainty evidence). However, early developmental intervention may not improve cognitive outcomes at school age (IQ: SMD 0.16 SD, 95% CI -0.06 to 0.38; P = 0.15; 6 studies; 1453 participants, low-certainty evidence). Heterogeneity between studies for cognitive outcomes in infancy and preschool age was moderate and at school age was substantial. Regarding motor function, meta-analysis of 23 studies showed that early developmental interventions may improve motor outcomes in infancy (motor scale DQ: SMD 0.12 SD, 95% CI 0.04 to 0.19; P = 0.003; 23 studies; 2737 participants, low-certainty evidence). At preschool age, the intervention probably did not improve motor outcomes (motor scale: SMD 0.08 SD, 95% CI -0.16 to 0.32; P = 0.53; 3 studies; 264 participants, moderate-certainty evidence). The evidence at school age for both continuous (motor scale: SMD -0.06 SD, 95% CI -0.31 to 0.18; P = 0.61; three studies; 265 participants, low-certainty evidence) and dichotomous outcome measures (low score on Movement Assessment Battery for Children (ABC) : RR 1.04, 95% CI 0.82 to 1.32; P = 0.74; 3 studies; 413 participants, low-certainty evidence) suggests that intervention may not improve motor outcome. The main source of bias was performance bias, where there was a lack of blinding of participants and personnel, which was unavoidable in this type of intervention study. Other biases in some studies included attrition bias where the outcome data were incomplete, and inadequate allocation concealment or selection bias. The GRADE assessment identified a lower certainty of evidence in the cognitive and motor outcomes at school age. Cognitive outcomes at preschool age demonstrated a high certainty due to more consistency and a larger treatment effect. AUTHORS' CONCLUSIONS Early developmental intervention programmes for preterm infants probably improve cognitive and motor outcomes during infancy (low-certainty evidence) while, at preschool age, intervention is shown to improve cognitive outcomes (high-certainty evidence). Considerable heterogeneity exists between studies due to variations in aspects of the intervention programmes, the population and outcome measures utilised. Further research is needed to determine which types of early developmental interventions are most effective in improving cognitive and motor outcomes, and in particular to discern whether there is a longer-term benefit from these programmes.
Collapse
Affiliation(s)
- Jane Orton
- Royal Women's Hospital, Parkville, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Tanya Tripathi
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Roslyn Boyd
- The University of Queensland, Brisbane, Australia
| | - Peter J Anderson
- Department of Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute and the University of Melbourne, Parkville, Australia
| |
Collapse
|
4
|
Ortinau CM, Smyser CD, Arthur L, Gordon EE, Heydarian HC, Wolovits J, Nedrelow J, Marino BS, Levy VY. Optimizing Neurodevelopmental Outcomes in Neonates With Congenital Heart Disease. Pediatrics 2022; 150:e2022056415L. [PMID: 36317967 PMCID: PMC10435013 DOI: 10.1542/peds.2022-056415l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Neurodevelopmental impairment is a common and important long-term morbidity among infants with congenital heart disease (CHD). More than half of those with complex CHD will demonstrate some form of neurodevelopmental, neurocognitive, and/or psychosocial dysfunction requiring specialized care and impacting long-term quality of life. Preventing brain injury and treating long-term neurologic sequelae in this high-risk clinical population is imperative for improving neurodevelopmental and psychosocial outcomes. Thus, cardiac neurodevelopmental care is now at the forefront of clinical and research efforts. Initial research primarily focused on neurocritical care and operative strategies to mitigate brain injury. As the field has evolved, investigations have shifted to understanding the prenatal, genetic, and environmental contributions to impaired neurodevelopment. This article summarizes the recent literature detailing the brain abnormalities affecting neurodevelopment in children with CHD, the impact of genetics on neurodevelopmental outcomes, and the best practices for neonatal neurocritical care, focusing on developmental care and parental support as new areas of importance. A framework is also provided for the infrastructure and resources needed to support CHD families across the continuum of care settings.
Collapse
Affiliation(s)
- Cynthia M. Ortinau
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Christopher D. Smyser
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Lindsay Arthur
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Erin E. Gordon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Haleh C. Heydarian
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joshua Wolovits
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Nedrelow
- Department of Neonatology, Cook Children’s Medical Center, Fort Worth, Texas
| | - Bradley S. Marino
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Victor Y. Levy
- Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Palo Alto, California
| |
Collapse
|
5
|
Intervención temprana en la unidad de cuidado intensivo neonatal con seguimiento en casa dirigidas a las habilidades motoras de niños prematuros. MOVIMIENTO CIENTÍFICO 2022. [DOI: 10.33881/2011-7191.mct.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introducción: La prematurez es una importante causa de morbimortalidad perinatal asociado a un mayor riesgo neurológico esto debido a que entre las semanas 20 y 37 de gestación ocurre un rápido crecimiento cortical, particularmente de las áreas sensoriomotoras lo cual afecta potencialmente el neurodesarrollo. Desde diferentes campos se han propuesto estrategias que buscan prevenir que el cerebro sea lesionado por la estimulación intensa y dolorosa conocidas como “Cuidados centrados en el desarrollo”. Sin embargo, se reporta escasa literatura disponible a nivel nacional que proporcione evidencia de la efectividad de la intervención temprana que favorezca el desarrollo de las habilidades motoras de los bebés en la Unidad de Cuidado intensivo neonatal (UCIN). Por lo cual, el objetivo de este estudio es conocer las estrategias de intervención temprana utilizadas para mejorar las habilidades motoras en bebés prematuros según lo reportado en la literatura. Método: Se llevó a cabo una revisión de literatura en 3 bases de datos (Scopus, Clinicalkey y ScienceDirect) durante los años 2016 a 2020. Resultados: Se revisaron 7 artículos cuyo idioma prevalente es el inglés sobre estrategias de intervención que inician en la UCIN y continúan con seguimiento en el hogar. Conclusiones: En algunos estudios no se logra evidenciar claramente una dosificación de las intervenciones realizadas. A su vez, la participación activa de los padres es fundamental para la adquisición de habilidades motoras en esta población, donde el fisioterapeuta es primordial en el entrenamiento, guía y acompañamiento del proceso con la familia.
Collapse
|
6
|
Ferber SG, Als H, McAnulty G, Klinger G, Weller A. Multi-level hypothalamic neuromodulation of self-regulation and cognition in preterm infants: Towards a control systems model. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 9:100109. [PMID: 35755927 PMCID: PMC9216652 DOI: 10.1016/j.cpnec.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
Preterm infants, age-corrected for prematurity, score on average, 10 points lower on IQ tests than full-term infants tested at comparable ages. This review focuses on the potential contribution of the hypothalamus to cognitive neuro-regulatory development in preterm infants through its bidirectional neural connections with the prefrontal cortex and its neuroendocrine activity. It aims to clarify the central role of the hypothalamus in preterm high stress situations and in influencing cognitive development via its connectivity to the cerebral cortex. The review further evaluates epigenomic sensitivity to environmental inputs. Recent results suggest that an optimal range of DNA methylations (via a continuous process of decreasing levels of receptor methylations that are too high, and increasing levels that are too low) appears necessary in order to reach an adaptive level of receptor availability. Several studies have demonstrated amelioration of preterm infants' stress while in the Newborn Intensive Care Unit (NICUs) and following discharge. The authors postulate that feedback mechanisms and correction signals are the basis for a hypothalamic homeostatic modulating function, a "hypothalamic resistance response", which may account for the stress reduction brought about by in- and post-NICU early interventions and their results of promoting self-regulation and cognition.
Collapse
Key Words
- Cognitive
- Controlled process variable, (CPV)
- Corticotropin-releasing hormone, (CRH)
- Epigenetics
- Hypothalamic pituitary adrenal axis, (HPA axis)
- Hypothalamic pituitary gonadal axis, (HPG axis)
- Hypothalamic pituitary thyroid axis, (HPT axis)
- Hypothalamus
- Lateral hypothalamus, (LH)
- Magnetic resonance imaging, (MRI)
- Neuro-regulatory development
- Newborn intensive care unit, (NICU)
- Oxytocin, (OT)
- Prefrontal cortex
- Prefrontal cortex, (PFC)
- Premature infants
- Set point, (SP)
Collapse
Affiliation(s)
- Sari Goldstein Ferber
- Department of Psychology and the Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Heidelise Als
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gloria McAnulty
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gil Klinger
- Department of Neonatology, Schneider Children's Medical Center, Sackler Medical School, Tel Aviv University, Petach Tikvah, Israel
| | - Aron Weller
- Department of Psychology and the Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| |
Collapse
|
7
|
Dean B, Ginnell L, Boardman JP, Fletcher-Watson S. Social cognition following preterm birth: A systematic review. Neurosci Biobehav Rev 2021; 124:151-167. [PMID: 33524414 DOI: 10.1016/j.neubiorev.2021.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 01/15/2023]
Abstract
Social cognitive abilities are affected by preterm birth, but pathways to, and risk factors for this outcome are not well mapped. We examined direct assessment tasks including objective coding of parent-child play to chart social development in infancy and pre-school years. A systematic search and data-extraction procedure yielded seventy-nine studies (4930 preterm and 2109 term children, aged birth - five years), for inclusion. We detected a pattern of reduced social attention in the first 12 months of life with evidence of reduced performance in social cognitive tasks later in the preschool years. However, we did not identify a consistent, distinctive preterm social phenotype in early life. Instead, the interactive behaviour of preterm infants reflects factors from outside the social cognitive domain, such as attention, language, and socioeconomic status. By combining data across samples and measures we revealed the role of domain-general skills, which may in future prove fruitful intervention targets.
Collapse
Affiliation(s)
- Bethan Dean
- MRC Centre for Reproductive Health, University of Edinburgh, UK
| | - Lorna Ginnell
- MRC Centre for Reproductive Health, University of Edinburgh, UK
| | | | | |
Collapse
|
8
|
Givrad S, Hartzell G, Scala M. Promoting infant mental health in the neonatal intensive care unit (NICU): A review of nurturing factors and interventions for NICU infant-parent relationships. Early Hum Dev 2021; 154:105281. [PMID: 33229068 DOI: 10.1016/j.earlhumdev.2020.105281] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Premature and medically vulnerable infants experience early and sometimes prolonged separation from their parents, intrusive and unnatural environments, painful and distressing procedures, difficulties with physiological regulation, increased biological and neurological vulnerabilities, and grow up to have higher rates of neurocognitive and psychosocial difficulties. Parents of infants born prematurely or with medical vulnerabilities, in turn, experience significant distress and are a psychiatrically vulnerable population, with very high rates of depression, anxiety, and posttraumatic stress disorder. The combination of these factors cause significant challenges for some of these infants and parents in developing an early optimal relationship and connection. Given the critical importance of early relationships with main caregivers for infant mental health and long-term developmental outcomes, we review various targets of intervention to promote healthy infant and parent mental health and bonding thereby facilitating an optimal infant-parent relationship in the NICU population.
Collapse
Affiliation(s)
- Soudabeh Givrad
- Weill Cornell Medicine, 525 East 68th street, box 140, New York, NY 10065, United States of America.
| | - Georgina Hartzell
- Weill Cornell Medicine, 525 East 68th street, box 140, New York, NY 10065, United States of America.
| | - Melissa Scala
- Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, United States of America.
| |
Collapse
|
9
|
Baraldi E, Allodi MW, Smedler AC, Westrup B, Löwing K, Ådén U. Parents' Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9326. [PMID: 33322234 PMCID: PMC7764273 DOI: 10.3390/ijerph17249326] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/29/2022]
Abstract
With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent-child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent's own emotional state.
Collapse
Affiliation(s)
- Erika Baraldi
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden;
| | - Mara Westling Allodi
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden;
| | | | - Björn Westrup
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.W.); (K.L.); (U.Å.)
| | - Kristina Löwing
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.W.); (K.L.); (U.Å.)
- Karolinska University Hospital Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, 171 76 Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.W.); (K.L.); (U.Å.)
- Karolinska University Hospital Neonatal Unit, 171 76 Stockholm, Sweden
| |
Collapse
|
10
|
Milette I, Martel MJ, Ribeiro da Silva M, Coughlin McNeil M. Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the Neonatal Intensive Care Unit. Part A: Background and Rationale. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN. Can J Nurs Res 2019; 49:46-62. [PMID: 28841058 DOI: 10.1177/0844562117706882] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.
Collapse
Affiliation(s)
- Isabelle Milette
- 1 NNP, Neonatal Intensive Care Unit, Mother and Child University Hospital Center Sainte-Justine, Montréal, Québec, Canada.,2 Quebec Nursing Intervention Research Network (RRISIQ), Québec, Canada
| | - Marie-Josée Martel
- 2 Quebec Nursing Intervention Research Network (RRISIQ), Québec, Canada.,3 University of Quebec in Trois-Rivières, Trois-Rivières, Canada.,4 Associate researcher, Sainte-Justine University Hospital Research Center, Montréal, Québec, Canada.,5 Regular researcher, Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), University of Quebec in Trois-Rivières, Trois-Rivières, Canada
| | | | | |
Collapse
|
11
|
Serlachius A, Hames J, Juth V, Garton D, Rowley S, Petrie KJ. Parental experiences of family-centred care from admission to discharge in the neonatal intensive care unit. J Paediatr Child Health 2018; 54:1227-1233. [PMID: 29874396 DOI: 10.1111/jpc.14063] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/15/2018] [Accepted: 04/15/2018] [Indexed: 11/28/2022]
Abstract
AIM It has been increasingly recognised that family-centred care (FCC) is associated with enhanced well-being for both parents and infants in paediatric settings, including the neonatal intensive care unit (NICU). Over the past 4 years, our NICU has increasingly adopted a collaborative philosophy of care. The purpose of the study was to examine parental experiences of FCC during both the admission and discharge time points in order to examine differences in parents' experiences and identify areas for improvement. METHODS We conducted interviews at two time points (admission and discharge) with 83 parents (mothers and fathers) of premature and medically fragile infants and analysed the data using thematic analysis. RESULTS Three key themes (and sub-themes) were identified: disempowerment, hierarchy between parents and staff and the father's peripheral role. The themes were equally prevalent across admission and discharge. CONCLUSIONS The challenges relating to FCC reported by parents at both admission and discharge represent some of the key barriers that parents still face in terms of being truly involved in the care of their infant in the NICU. Similar themes at both time points suggest that parents need equal amounts of support during their stay in NICU, irrespective of the level of care the infant is receiving and whether they are approaching discharge. Implications for improving FCC more generally are discussed.
Collapse
Affiliation(s)
- Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jessica Hames
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vanessa Juth
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States
| | - Dale Garton
- Newborn Service, Auckland City Hospital, Auckland, New Zealand
| | - Simon Rowley
- Newborn Service, Auckland City Hospital, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
12
|
Navne LE, Svendsen MN, Gammeltoft TM. The Attachment Imperative: Parental Experiences of Relation-making in a Danish Neonatal Intensive Care Unit. Med Anthropol Q 2017; 32:120-137. [PMID: 28872187 DOI: 10.1111/maq.12412] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/06/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
In this article, we explore how parents establish relations with extremely premature infants whose lives and futures are uncertain. Drawing on ethnographic fieldwork in a Danish Neonatal Intensive Care Unit (NICU), we engage recent discussions of the limits of conventional anthropological thinking on social relations and point to the productive aspects of practices of distance and detachment. We show that while the NICU upholds an imperative of attachment independently of the infant's chances of survival, for parents, attachment is contingent on certain hesitations in relation to their infant. We argue that there are nuances in practices of relationmaking in need of more attention (i.e., the nexus of attachment and detachment). Refraining from touching, holding, and feeding their infants during critical periods, the parents enact detachment as integral to their practices of attachment. Such "cuts" in parent-infant relations become steps on the way to securing the infant's survival and making kin(ship). We conclude that although infants may be articulated as "maybe-lives" by staff, in the NICU as well as in Danish society, the ideal of attachment appears to leave little room for "maybe-parents."
Collapse
Affiliation(s)
- Laura E Navne
- Department of Health Services Research, University of Copenhagen
| | - Mette N Svendsen
- Department of Health Services Research, University of Copenhagen
| | | |
Collapse
|
13
|
Abstract
[Purpose] To investigate the effects of Neuro-Development Treatment on development in the preterm infants. [Subjects and Methods] A total of 96 premature infants were recruited for this study; 62 low birth weight preterm infants (<2.5 kg, high risk infants for developmental delay) and 34 premature infants (>2.5 kg, low risk infants for developmental delay). High risk infants were divided into intervention group (32 infants) and control group (30 infants) at time of admission. Low risk infants were into comparative group (34 infants). All infants received general nursing care in Neonatal Intensive Care Unit. Additionally, Intervention group received Neuro-Development Treatment for 15 minutes 4 times per week up to 40 week postconceptional age. We evaluated Test of Infant Movement Performance at baseline, 2 weeks after and 40 week postconceptional age. [Results] In score on Test of Infant Movement Performance there was more increase in intervention group than in control group and comparative group. [Conclusion] According to findings in this study, we find that Neuro-Development Treatment in Neonatal Intensive Care Unit has an effect on development in the preterm infants.
Collapse
Affiliation(s)
- Eun-Ju Lee
- Department of Physical Therapy, College of Health Science, Kyungsung University, Republic of Korea
| |
Collapse
|
14
|
Hughes AJ, Redsell SA, Glazebrook C. Motor Development Interventions for Preterm Infants: A Systematic Review and Meta-analysis. Pediatrics 2016; 138:peds.2016-0147. [PMID: 27638931 DOI: 10.1542/peds.2016-0147] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXTS Preterm infants are at an increased risk of neurodevelopmental delay. Some studies report positive intervention effects on motor outcomes, but it is currently unclear which motor activities are most effective in the short and longer term. OBJECTIVE The aim of the study was to identify interventions that improve the motor development of preterm infants. DATA SOURCES An a priori protocol was agreed upon. Seventeen electronic databases from 1980 to April 2015 and gray literature sources were searched. STUDY SELECTION Three reviewers screened the articles. DATA EXTRACTION The outcome of interest was motor skills assessment scores. All data collection and risk of bias assessments were agreed upon by the 3 reviewers. RESULTS Forty-two publications, which reported results from 36 trials (25 randomized controlled trials and 11 nonrandomized studies) with a total of 3484 infants, met the inclusion criteria. A meta-analysis was conducted by using standardized mean differences on 21 studies, with positive effects found at 3 months (mean 1.37; confidence interval 0.48-2.27), 6 months (0.34; 0.11-0.57), 12 months (0.73; 0.20-1.26), and 24 months (0.28; 0.07-0.49). At 3 months, there was a large and significant effect size for motor-specific interventions (2.00; 0.28-3.72) but not generic interventions (0.33; -0.03 to -0.69). Studies were not excluded on the basis of quality; therefore, heterogeneity was significant and the random-effects model was used. LIMITATIONS Incomplete or inconsistent reporting of outcome measures limited the data available for meta-analysis beyond 24 months. CONCLUSIONS A positive intervention effect on motor skills appears to be present up to 24 months' corrected age. There is some evidence at 3 months that interventions with specific motor components are most effective.
Collapse
Affiliation(s)
- Anita J Hughes
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; and
| | - Sarah A Redsell
- School of Nursing and Midwifery, Anglia Ruskin University, Cambridge, United Kingdom
| | - Cris Glazebrook
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; and
| |
Collapse
|
15
|
Mousavi SS, Chaman R, Khosravi A, Mohagheghi P, Mousavi SA, Keramat A. The Needs of Parents of Preterm Infants in Iran and a Comparison With Those in Other Countries: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e4396. [PMID: 28203326 PMCID: PMC5294933 DOI: 10.5812/ijp.4396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 03/06/2016] [Accepted: 03/27/2016] [Indexed: 11/24/2022]
Abstract
Context Proper accountability to needs of preterm infants’ parents requires recognition of these needs and how they change in different conditions. The aim of this study was to assess the needs of parents of preterm infants in Iran, as compared to those in other regions in the world. Evidence Acquisition A search of Iranian databases (Iran Medex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) was conducted, with no time limitations, to 5 October 2014. Using standard tools, all quantitative studies that considering the parental needs of preterm infants and parental support were extracted. The STROBE checklist was used for the evaluation of the studies. Thirty-one studies were extracted in the qualitative evaluation, of which 17 were included in the meta-analysis. The variance between the studies was analyzed using tau-squared (Tau2) and review manager 5 software. Results The results obtained using the nurse-parent support tool (NPST) showed that mothers considered that all the fields of support were of great importance. The parental needs in Iran were similar to those of parents in other regions worldwide. However, the mean score for Iranian parents’ assessment of the support they received was 2.20 ± 0.06, whereas it was 3.84 ± 0.72 for other countries. The mean scores for parents’ assessment of the provision of emotional, informational appraisal, and instrumental support in Iran were 1.73 ± 0.06, 2.1 ± 0.06, 1.54 ± 0.6, and 3.44 ± 0.04, respectively, compared to 3.18 ± 1.34, 4.11 ± 0.5, 4.26 ± 0.18, and 4.51 ± 0.14, respectively, in other countries. Conclusions Parents always prefer the priorities of their babies to their individual needs. Given the lower scores for the parental assessment of received support in Iran, it is important to focus on these specific items in providing interventions to meet the needs of Iranian parents.
Collapse
Affiliation(s)
| | - Reza Chaman
- Associate Professor, Epidemiology, Department of Community Medicine, Yasuj University Of Medical Sciences, Yasuj, IR Iran
| | - Ahmad Khosravi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Parisa Mohagheghi
- Associate Professor, Iran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Abbas Mousavi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
- Corresponding author: Afsaneh Keramat, Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran. Tel: +98-2332395054, Fax: +98-2332394800, E-mail:
| |
Collapse
|
16
|
Gallo KP, Hill LC, Hoagwood KE, Olin SCS. A Narrative Synthesis of the Components of and Evidence for Patient- and Family-Centered Care. Clin Pediatr (Phila) 2016; 55:333-46. [PMID: 26116351 PMCID: PMC5555419 DOI: 10.1177/0009922815591883] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A narrative synthesis was conducted to determine typical patient- and family-centered care (PFCC) components and their link to outcomes in pediatric populations. 68 studies with PFCC interventions and experimental designs were included. Study features were synthesized based on 5 core PFCC components (i.e., education from the provider to the patient and/or family, information sharing from the family to the provider, social-emotional support, adapting care to match family background, and/or s decision-making) and 4 outcome categories (health status; the experience, knowledge, and attitudes of the patient/family; patient/family behavior; or provider behavior). The most common PFCC component was education; the least common was adapting care to family background. The presence of social-emotional support alone, as well as educational interventions augmented with shared decision-making, social-emotional support, or adaptations of care based on family background, predicted improvements in families' knowledge, attitudes, and experience. Interventions that targeted the family were associated with positive outcomes.
Collapse
Affiliation(s)
- Kaitlin P. Gallo
- The Child Study Center at NYU Langone Medical Center, New York, NY
| | | | | | | |
Collapse
|
17
|
Wu YC, Hsieh WS, Hsu CH, Chang JH, Chou HC, Hsu HC, Chiu NC, Lee WT, Chen WJ, Ho YW, Jeng SF. Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 48:1-12. [PMID: 26524725 DOI: 10.1016/j.ridd.2015.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36-38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers' responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI]=-1.60 [-3.07 to -0.13], p=0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI]=-0.84 [-1.57 to -0.10], p=0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants' emotion regulation in response to stress at toddler age.
Collapse
Affiliation(s)
- Ying-Chin Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chin Hsu
- Department of Child and Family Development, University of Georgia, GA, USA
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-J Chen
- Graduate Institute of Epidemiology, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Ho
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
18
|
Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015; 2015:CD005495. [PMID: 26597166 PMCID: PMC8612699 DOI: 10.1002/14651858.cd005495.pub4] [Citation(s) in RCA: 236] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infants born preterm are at increased risk of developing cognitive and motor impairment compared with infants born at term. Early developmental interventions have been provided in the clinical setting with the aim of improving overall functional outcomes for these infants. Long-term benefits of these programmes remain unclear. OBJECTIVES Primary objective To compare the effectiveness of early developmental intervention programmes provided post hospital discharge to prevent motor or cognitive impairment in preterm (< 37 weeks) infants versus standard medical follow-up of preterm infants at infancy (zero to < three years), preschool age (three to < five years), school age (five to < 18 years) and adulthood (≥ 18 years). Secondary objectives To perform subgroup analyses to determine the following.• Effects of gestational age, birth weight and brain injury (periventricular leukomalacia (PVL)/intraventricular haemorrhage (IVH)) on cognitive and motor outcomes when early intervention is compared with standard follow-up. ∘ Gestational age: < 28 weeks, 28 to < 32 weeks, 32 to < 37 weeks. ∘ Birth weight: < 1000 grams, 1000 to < 1500 grams, 1500 to < 2500 grams. ∘ Brain injury: absence or presence of grade III or grade IV IVH or cystic PVL (or both) or an abnormal ultrasound/magnetic resonance image (MRI) before initiation of the intervention.• Effects of interventions started during inpatient stay with a post-discharge component versus standard follow-up care.• Effects of interventions focused on the parent-infant relationship, infant development or both compared with standard follow-up care.To perform sensitivity analysis to identify the following.• Effects on motor and cognitive impairment when early developmental interventions are provided within high-quality randomised trials with low risk of bias for sequence generation, allocation concealment, blinding of outcome measures and selective reporting bias. SEARCH METHODS The search strategy of the Cochrane Neonatal Review Group was used to identify randomised and quasi-randomised controlled trials of early developmental interventions provided post hospital discharge. Two review authors independently searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Advanced, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE (1966 to August 2015). SELECTION CRITERIA Studies included had to be randomised or quasi-randomised controlled trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age. Interventions could commence on an inpatient basis but had to include a post-discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. Rates of cerebral palsy were documented. DATA COLLECTION AND ANALYSIS Two independent review authors extracted and entered data. Cognitive and motor outcomes were pooled by four age groups: infancy (zero to < three years), preschool age (three to < five years), school age (five to < 18 years) and adulthood (≥ 18 years). Meta-analysis using RevMan 5.1 was carried out to determine the effects of early developmental interventions at each age range. Subgroup analyses focused on gestational age, birth weight, brain injury, commencement of the intervention, focus of the intervention and study quality. MAIN RESULTS Twenty-five studies met the inclusion criteria (3615 randomly assigned participants). Only 12 of these studies were randomised controlled trials with appropriate allocation concealment. Variability was evident with regard to focus and intensity of the intervention, participant characteristics and length of follow-up. Meta-analysis led to the conclusion that intervention improved cognitive outcomes at infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.32 standard deviations (SDs), 95% confidence interval (CI) 0.16 to 0.47; P value < 0.001; 16 studies; 2372 participants) and at preschool age (intelligence quotient (IQ); SMD 0.43 SDs, 95% CI 0.32 to 0.54; P value < 0.001; eight studies; 1436 participants). However, this effect was not sustained at school age (IQ: SMD 0.18 SDs, 95% CI -0.08 to 0.43; P value = 0.17; five studies; 1372 participants). Heterogeneity between studies for cognitive outcomes at infancy and at school age was significant. With regards to motor outcomes, meta-analysis of 12 studies showed a significant effect in favour of early developmental interventions at infancy only; however, this effect was small (motor scale DQ: SMD 0.10 SDs, 95% CI 0.01 to 0.19; P value = 0.03; 12 studies; 1895 participants). No effect was noted on the rate of cerebral palsy among survivors (risk ratio (RR) 0.82, 95% CI 0.52 to 1.27; seven studies; 985 participants). Little evidence showed a positive effect on motor outcomes in the long term, but only five included studies reported outcomes at preschool age (n = 3) or at school age (n = 2). AUTHORS' CONCLUSIONS Early intervention programmes for preterm infants have a positive influence on cognitive and motor outcomes during infancy, with cognitive benefits persisting into preschool age. A great deal of heterogeneity between studies was due to the variety of early developmental intervention programmes tested and to gestational ages of included preterm infants; thus, comparisons of intervention programmes were limited. Further research is needed to determine which early developmental interventions are most effective in improving cognitive and motor outcomes, and to discern the longer-term effects of these programmes.
Collapse
Affiliation(s)
- Alicia Spittle
- Murdoch Childrens Research Institute and the University of MelbourneVIBeS Office, 5th FloorFlemington RoadParkvilleMelbourneAustralia3052
| | - Jane Orton
- Royal Women's Hospital2nd Floor, Flemington RoadParkvilleMelbourneAustralia3052
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Royal Children’s HospitalDepartment of Clinical SciencesFlemington RoadMelbourneVictoriaAustralia3052
| | - Roslyn Boyd
- University of QueenslandBrisbaneQueenslandAustralia
| | - Lex W Doyle
- The University of MelbourneDepartment of Obstetrics and GynaecologyParkvilleVictoriaAustralia3052
| | | |
Collapse
|
19
|
Kiechl-Kohlendorfer U, Merkle U, Deufert D, Neubauer V, Peglow UP, Griesmaier E. Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age. Infant Behav Dev 2015; 39:166-72. [DOI: 10.1016/j.infbeh.2015.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
|
20
|
Ma L, Yang B, Meng L, Wang B, Zheng C, Cao A. Effect of early intervention on premature infants' general movements. Brain Dev 2015; 37:387-93. [PMID: 25052783 DOI: 10.1016/j.braindev.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED This study is to investigate the characteristics of premature infants' general movements (GMs) and the effect of early intervention on their GMs. METHODS The survey was carried among 285 premature infants. (1) Before intervention, the correlation between the gestational age/ birth weight and the GMs was evaluated. (2) The cases were divided into early intervention group (n=145) and control group (n=140), each group was divided into <32 weeks, 32-34 weeks and >34 weeks group according to gestational age. The early intervention was begun at the 3rd day after birth to 54th week gestational age. The rate of GMs among each group was compared after intervention. RESULTS (1) Before intervention, gestational age/birth weight was negatively correlated with the rate of cramped-synchronized (CS) (r=-0.988, r=-0.95, p<0.01), while no correlation with the rate of poor repertoire (PR) (r=0.122, r=0.168, p>0.05). (2) After intervention, for the writhing movement, there was no significant difference (χ2=0.509, 1.401, 0.519, p>0.05) between the early intervention group and the control group. Nevertheless, for the fidgety movement, there was significant difference (χ2=7.921, χ2=5.763, p<0.05) between the two groups, especially in <32 weeks group (χ2=5.578, 4.067 p<0.05) and in >34 weeks group (χ2=5.757, p<0.05). CONCLUSIONS (1) It shows that the lower birth weight or the younger delivery gestational age, the more abnormal GMs in premature infants. (2) Early intervention could improve the fidgety movements of premature infant.
Collapse
Affiliation(s)
- Liang Ma
- Department of Pediatrics, The Affiliated Union Hospital, Bin Zhou Medical College, China
| | - Bingshang Yang
- Department of Rehabilitation, Qilu Hospital, Shandong University, China
| | - Lingdan Meng
- Department of Pediatrics, The Affiliated Union Hospital, Bin Zhou Medical College, China
| | - Baohong Wang
- Department of Pediatrics, The Affiliated Union Hospital, Bin Zhou Medical College, China
| | - Chunhui Zheng
- Department of Pediatrics, The Affiliated Union Hospital, Bin Zhou Medical College, China
| | - Aihua Cao
- Department of Pediatrics, Qilu Hospital, Brain Science Research Institute, Shandong University, China.
| |
Collapse
|
21
|
|
22
|
Wu YC, Leng CH, Hsieh WS, Hsu CH, Chen WJ, Gau SSF, Chiu NC, Yang MC, Hsu HC, Yu YT, Wu YT, Chen LC, Jeng SF. A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: effects and mediators. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2384-2393. [PMID: 24973546 DOI: 10.1016/j.ridd.2014.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.
Collapse
Affiliation(s)
- Ying-Chin Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Hon Leng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei J Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Chin Yang
- Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hui-Chin Hsu
- Department of Child and Family Development, University of Georgia, GA, USA
| | - Yen-Ting Yu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Chiou Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
23
|
Kadivar M, Seyedfatemi N, Akbari N, Haghani H. The effect of narrative writing on maternal stress in neonatal intensive care settings. J Matern Fetal Neonatal Med 2014; 28:938-43. [DOI: 10.3109/14767058.2014.937699] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
24
|
|
25
|
Spittle A, Orton J, Anderson P, Boyd R, Doyle LW. Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev 2012; 12:CD005495. [PMID: 23235624 DOI: 10.1002/14651858.cd005495.pub3] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants born preterm are at increased risk of developing cognitive and motor impairments compared with infants born at term. Early developmental interventions have been used in the clinical setting with the aim of improving the overall functional outcome for these infants. However, the long-term benefit of these programmes remains unclear. OBJECTIVES To review the effectiveness of early developmental intervention post-discharge from hospital for preterm (< 37 weeks) infants on motor or cognitive development. SEARCH METHODS The Cochrane Neonatal Review group search strategy was used to identify randomised and quasi-randomised controlled trials of early developmental interventions post hospital discharge. Two review authors independently searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE Advanced, CINAHL, PsycINFO and EMBASE (1966 through to October 2012). SELECTION CRITERIA Studies included had to be randomised or quasi-randomised controlled trials of early developmental intervention programmes that began within the first 12 months of life for infants born at < 37 weeks with no major congenital abnormalities. Intervention could commence as an inpatient; however, a post-discharge component was necessary to be included in this review. The outcome measures were not pre-specified other than that they had to assess cognitive ability, motor ability or both. The rates of cerebral palsy were also documented. DATA COLLECTION AND ANALYSIS Data were extracted and entered by two independent review authors. Cognitive and motor outcomes were pooled in four age groups - infancy (zero to < three years), pre-school age (three to < five years), school age (five to 17 years) and adulthood (≥ 18 years). Meta-analysis was carried out using RevMan 5.1 to determine the effects of early developmental intervention at each age range. Subgroup analysis was carried out in relation to gestational age, birthweight, brain injury, commencement of intervention and focus of intervention. MAIN RESULTS Twenty-one studies met the inclusion criteria (3133 randomised patients). Only 10 of these studies were RCTs with appropriate allocation concealment. There was variability with regard to the focus and intensity of the intervention, subject characteristics and in length of follow-up. Meta-analysis concluded that intervention improved cognitive outcomes at infant age (developmental quotient (DQ): standardised mean difference (SMD) 0.31 standard deviations (SD); 95% confidence interval (CI) 0.13 to 0.50; P < 0.001; 13 studies; 2147 patients), and pre-school age (intelligence quotient (IQ); SMD 0.45 SD; 95% CI 0.34 to 0.57; P < 0.001; six studies; 1276 patients). However, this effect was not sustained at school age (IQ: SMD 0.25 SD; 95% CI -0.10 to 0.61; P = 0.16; five studies; 1242 patients). There was significant heterogeneity between studies for cognitive outcomes at infant and school ages. In regards to motor outcomes, meta-analysis of 10 studies showed a significant effect in favour of early developmental interventions; however, the effect was small (motor scale developmental quotient (DQ): SMD 0.10 SD; 95% CI 0.00 to 0.19; P = 0.04; 10 studies; 1745 patients). There was no effect on the rate of cerebral palsy in survivors; risk ratio (RR) 0.89; 95% CI 0.55 to 1.44; five studies; 737 patients). There was little evidence for a positive effect on motor outcomes in the long term, with only five of the included studies reporting outcomes at pre-school or school age. AUTHORS' CONCLUSIONS Early intervention programmes for preterm infants have a positive influence on cognitive and motor outcomes during infancy, with the cognitive benefits persisting into pre-school age. There is a great deal of heterogeneity between studies due to the variety of early developmental intervention programmes trialled and gestational ages of the preterm infants included, which limits the comparisons of intervention programmes. Further research is needed to determine which early developmental interventions are the most effective at improving cognitive and motor outcomes, and on the longer-term effects of these programmes.
Collapse
Affiliation(s)
- Alicia Spittle
- Murdoch Childrens Research Institute and the University of Melbourne, Parkville, Australia.
| | | | | | | | | |
Collapse
|
26
|
Browne JV, Talmi A. Developmental Supports for Newborns and Young Infants with Special Health and Developmental Needs and Their Families: The BABIES Model. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.nainr.2012.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
27
|
Kynø NM, Ravn IH, Lindemann R, Fagerland MW, Smeby NA, Torgersen AM. Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: A randomized controlled study. Infant Behav Dev 2012; 35:916-26. [DOI: 10.1016/j.infbeh.2012.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/20/2012] [Accepted: 09/14/2012] [Indexed: 11/28/2022]
|
28
|
Brecht C, Shaw RJ, Horwitz SM, John NHS. Effectiveness of therapeutic behavioral interventions for parents of low birth weight premature infants: A review. Infant Ment Health J 2012; 33:651-665. [PMID: 24532861 PMCID: PMC3925006 DOI: 10.1002/imhj.21349] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, eighteen new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend towards early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.
Collapse
Affiliation(s)
- Carrie Brecht
- Department of Psychiatry and Behavioral Sciences and Department of Psychology, PGSP-Stanford Psy.D. Consortium
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Sarah M Horwitz
- Department of Psychiatry, New York University School of Medicine
| | | |
Collapse
|
29
|
Cho Y, Hirose T, Tomita N, Shirakawa S, Murase K, Komoto K, Nagayoshi M, Okamitsu M, Omori T. Infant Mental Health Intervention for Preterm Infants in Japan: Promotions of Maternal Mental Health, Mother–Infant Interactions, and Social Support by Providing Continuous Home Visits until the Corrected Infant Age of 12 Months. Infant Ment Health J 2012. [DOI: 10.1002/imhj.21352] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
30
|
Abstract
This article provides an integrative review of the effectiveness of and possible developmental mechanisms associated with preventive interventions for preterm children. An analysis of randomized clinical trials carried out within the last 15 years was framed within a contemporary developmental model emphasizing the role of parental adjustments to preterm children's characteristics. Evidence suggested positive outcomes could be understood in terms of improvements in developmental pathways associated with parental sensitive-responsiveness and child participation in intensive intervention-oriented child care. Implications for the critical role of the Medical Home model for preventive interventions for preterm children were discussed.
Collapse
Affiliation(s)
- Michael J Guralnick
- Center on Human Development and Disability, Departments of Psychology and Pediatrics, University of Washington, Seattle, WA 98195-7920, USA.
| |
Collapse
|
31
|
A Neurobehavioral Intervention Incorporated into a State Early Intervention Program is Associated with Higher Perceived Quality of Care Among Parents of High-Risk Newborns. J Behav Health Serv Res 2012; 41:381-9. [DOI: 10.1007/s11414-012-9283-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Laing S, Spence K, McMahon C, Ungerer J, Badawi N. Challenges in conducting prospective research of developmentally directed care in surgical neonates: a case study. Early Hum Dev 2012; 88:171-8. [PMID: 21911278 DOI: 10.1016/j.earlhumdev.2011.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 07/18/2011] [Accepted: 08/08/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evaluation is fundamental to evidence-based practice. Due to practical constraints inherent in real-world clinical environments, however, innovations in clinical practice are often implemented without rigorous research. We set out to evaluate the effectiveness of developmentally directed care in surgical neonates using a randomised controlled trial with a Newborn Individualized Care and Assessment Program (NIDCAP) intervention. AIM The aim of this paper is to inform future studies by sharing lessons learnt in conducting prospective research of a practice-intervention in a critical care setting. METHOD Three intervention components were used to assess implementation: number of NIDCAP observations; infant allocation to project nurses, and consistency of care. Barriers to implementation were identified through discussions with nurses who had key roles. RESULTS Insufficient episodes of NIDCAP observation and infant allocation to project nurses, and lack of consistency of care indicated that the intervention had not been successfully implemented. Barriers to implementation (fast 'turnover' of patients, unpredictable changes in medical status, staff/skill shortages, and inconsistent care) were attributed to the competing demands between service provision and research in a busy critical care context. CONCLUSIONS The findings regarding barriers to successful implementation of NIDCAP in this case study are relevant to any critical care setting where complex interventions are under consideration, as similar challenges are plausible across a range of clinical contexts. Adopting a critical methodologically-informed approach to appraise implementation and evaluate complex interventions is essential.
Collapse
Affiliation(s)
- Sharon Laing
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | | | | | | |
Collapse
|
33
|
Nordhov SM, Rønning JA, Ulvund SE, Dahl LB, Kaaresen PI. Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial. Pediatrics 2012; 129:e9-e16. [PMID: 22184645 DOI: 10.1542/peds.2011-0248] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the effectiveness of an early intervention program on behavioral outcomes at corrected age of 5 years for children with birth weights (BWs) of <2000 g. METHODS A randomized controlled trial of a modified version of the Mother-Infant Transaction Program was performed. Outcomes were measured by the Child Behavior Check List report (parents) and Strengths and Difficulties Questionnaire at 5 years (parents and preschool teachers). RESULTS A total of 146 infants were assigned randomly (intervention group: 72 infants; reference group: 74 infants). A term group was recruited (75 infants). The mean BWs were 1396 ± 429 g for the intervention group, 1381 ± 436 g for the control group, and 3619 ± 490 g for the term reference group. Parents in the intervention group reported significantly fewer behavioral problems measured by both instruments at 5 years. There were no differences in behavior problems reported by preschool teachers. Significantly more children in the preterm control group scored within the clinical area of both instruments. CONCLUSION This modified version of the Mother-Infant Transaction Program led to fewer behavioral problems reported by parents at corrected age of 5 years for children with BWs of <2000 g.
Collapse
Affiliation(s)
- S Marianne Nordhov
- Department of Pediatrics, University Hospital of North Norway, N-9038 Tromsø, Norway.
| | | | | | | | | |
Collapse
|
34
|
Browne JV. Developmental care for high-risk newborns: emerging science, clinical application, and continuity from newborn intensive care unit to community. Clin Perinatol 2011; 38:719-29. [PMID: 22107900 DOI: 10.1016/j.clp.2011.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.
Collapse
Affiliation(s)
- Joy V Browne
- JFK Partners Center for Family and Infant Interaction, University of Colorado Anschutz Medical Campus, 13121 East 19th Avenue, Aurora, CO USA.
| |
Collapse
|
35
|
Philbin MK, Ross ES. The SOFFI Reference Guide: text, algorithms, and appendices: a manualized method for quality bottle-feedings. J Perinat Neonatal Nurs 2011; 25:360-80. [PMID: 22071621 PMCID: PMC3909685 DOI: 10.1097/jpn.0b013e31823529da] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Support of Oral Feeding for Fragile Infants (SOFFI) method of bottle-feeding rests on quality evidence along with implementation details drawn from clinical experience. To be clear, the SOFFI Method is not focused on the amount of food taken in but on the conduct of the feeding and the development of competent infant feeding behavior that, consequently, assures the intake of food necessary for growth. The unique contribution of the SOFFI method is the systematic organization of scientific findings into clinically valid and reliable, easily followed algorithms, and a manualized Reference Guide for the assessments, decisions, and actions of a quality feeding.A quality feeding is recognized by a stable, self-regulated infant and a caregiver who sensitively (responsively) adjusts to the infant's physiology and behavior to realize an individualized feeding experience in which the infant remains comfortable and competent using his nascent abilities to ingest a comfortable amount of milk/formula. The SOFFI Reference Guide and Algorithms begin with prefeeding adjustments of the environment and follow step by step through a feeding with observations of specific infant behavior, decisions based on that behavior, and specific actions to safeguard emerging abilities and the quality of the experience. An important aspect the SOFFI Reference Guide and Algorithms is the clarity about pausing and stopping the feeding on the basis of the infant's physiology and behavior rather than on the basis of the amount ingested. The specificity of each observation, decision, and action enables nurses at all levels of experience to provide quality, highly individualized, holistic feedings. Throughout the course of feeding in the NICU, the nurse conveys to parents the integrated details (observations, decisions, and actions) particular to their infant, thus passing on the means for parents to become competent in quality feeding, to enjoy feeding time into the future, and to gain in confidence as they watch their infants grow.
Collapse
|
36
|
McManus BM, Nugent JK. Feasibility study of early intervention provider confidence following a neurobehavioural intervention for high-risk newborns. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.623228] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
37
|
Als H, McAnulty GB. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants. CURRENT WOMEN'S HEALTH REVIEWS 2011; 7:288-301. [PMID: 25473384 PMCID: PMC4248304 DOI: 10.2174/157340411796355216] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
State-of-the-art Newborn Intensive Care Units (NICUs), instrumental in the survival of high-risk and ever-earlier-born preterm infants, often have costly human repercussions. The developmental sequelae of newborn intensive care are largely misunderstood. Developed countries eager to export their technologies must also transfer the knowledge-base that encompasses all high-risk and preterm infants' personhood as well as the neuro-essential importance of their parents. Without such understanding, the best medical care, while assuring survival jeopardizes infants' long-term potential and deprives parents of their critical role. Exchanging the womb for the NICU environment at a time of rapid brain growth compromises preterm infants' early development, which results in long-term physical and mental health problems and developmental disabilities. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) aims to prevent the iatrogenic sequelae of intensive care and to maintain the intimate connection between parent and infant, one expression of which is Kangaroo Mother Care. NIDCAP embeds the infant in the natural parent niche, avoids over-stimulation, stress, pain, and isolation while it supports self-regulation, competence, and goal orientation. Research demonstrates that NIDCAP improves brain development, functional competence, health, and life quality. It is cost effective, humane, and ethical, and promises to become the standard for all NICU care.
Collapse
Affiliation(s)
- Heidelise Als
- Department of Psychiatry, Harvard Medical School, and Neurobehavioral Infant and Child Studies, Department of Psychiatry (Psychology) Children’s Hospital Boston
| | - Gloria B. McAnulty
- Department of Psychiatry, Harvard Medical School, and Neurobehavioral Infant and Child Studies, Department of Psychiatry (Psychology) Children’s Hospital Boston
| |
Collapse
|
38
|
Pal SM, Maguire CM, Bruil J, Cessie S, Zwieten P, Veen S, Wit JM, Walther FJ. Very pre-term infants' behaviour at 1 and 2 years of age and parental stress following basic developmental care. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2010. [DOI: 10.1348/026151007x205290] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
39
|
Laing S, McMahon C, Ungerer J, Taylor A, Badawi N, Spence K. Mother-child interaction and child developmental capacities in toddlers with major birth defects requiring newborn surgery. Early Hum Dev 2010; 86:793-800. [PMID: 20888152 DOI: 10.1016/j.earlhumdev.2010.08.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/22/2010] [Accepted: 08/31/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evidence exists of the important role of the mother-child relationship in child development, yet with the exception of prematurity, little is known of the impact of biologic risk on this relationship. AIMS We investigated the quality of the mother-child interaction in association with early development in toddlers who had newborn surgery for major birth defects. METHODS Ninety-three toddlers (Mean age=24.7 months, SD=4.6) requiring newborn surgery for major birth defects, underwent developmental testing and participated in a videotaped free play interaction with their mothers. Interactions were rated using the National Institute of Child Health and Human Development schema. Interaction ratings were compared with normative data and within group differences were also examined in relation to child developmental status. RESULTS Overall mean interaction ratings were suboptimal and significantly different from normative data; with the exception of child negative mood. Forty-one children (44%) had developmental delay. Mother and child interactive behaviour ratings were consolidated into three factors (Maternal Responsivity, Maternal Intrusiveness, and Child Positive Interactivity) for multivariate analyses. Compared to children developing normally, those with developmental delay showed significantly less positive interactivity and had mothers who were less responsive and more intrusive. Child behaviour with the tester was related to child behaviour with the mother. CONCLUSION Quality of mother-child interaction is nonoptimal in children with major birth defects requiring newborn surgery. Mothers of infants with developmental delay are most at risk of interaction difficulties and may benefit from early identification and timely intervention.
Collapse
Affiliation(s)
- Sharon Laing
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia.
| | | | | | | | | | | |
Collapse
|
40
|
Baron IS, Rey-Casserly C. Extremely Preterm Birth Outcome: A Review of Four Decades of Cognitive Research. Neuropsychol Rev 2010; 20:430-52. [DOI: 10.1007/s11065-010-9132-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/27/2010] [Indexed: 02/05/2023]
|
41
|
Abstract
PURPOSE (1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. KEY POINTS Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. CONCLUSIONS Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.
Collapse
|
42
|
Janssens A, Uvin K, Van Impe H, Laroche SMF, Van Reempts P, Deboutte D. Psychopathology among preterm infants using the Diagnostic Classification Zero to Three. Acta Paediatr 2009; 98:1988-93. [PMID: 19709094 DOI: 10.1111/j.1651-2227.2009.01488.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare the prevalence of psychopathology in infants born preterm with matched full-term infants at the corrected age of 1 year. METHODS Between June 2003 and April 2005, a case-control longitudinal cohort study was conducted at the neonatal unit of the University Hospital of Antwerp, Belgium. We prospectively enrolled 123 live-born infants between 25 and 35 weeks of gestation and/or infants with a birth-weight of <1500 g. Thirty full-term infants were recruited among day care centres in the region. Diagnoses were based on the Diagnostic Classification Zero to Three (DC: 0-3), using the MacArthur Communicative Developmental Inventory Dutch version, Infant-Toddler Sensory Profile, Bayley Scales of Infant Development II, Parent Infant Relationship Global Assessment Scale and Functional Emotional Assessment Scale. RESULTS At the (corrected) age of 12 months, 89 infants were eligible for follow-up and complete data were available for 69 (77%) infants. Fifty-four percentage of the preterm infants fulfilled one or more DC 0-3 diagnoses. Premature infants had significantly more diagnoses than full-term infants on axis I, axis III and axis V of the DC: 0-3. CONCLUSION In this study, the prevalence of psychopathology was significantly higher among preterm infants in comparison with full-term infants. This study did not confirm previous findings of higher rates of relationship disorders among preterm infants.
Collapse
Affiliation(s)
- A Janssens
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.
| | | | | | | | | | | |
Collapse
|
43
|
[NIDCAP (Neonatal Individualized Developmental Care and Assessment Program): definition, practical aspects, published data]. Arch Pediatr 2009; 16:827-9. [PMID: 19541186 DOI: 10.1016/s0929-693x(09)74168-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
44
|
Peters KL, Rosychuk RJ, Hendson L, Coté JJ, McPherson C, Tyebkhan JM. Improvement of short- and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial. Pediatrics 2009; 124:1009-20. [PMID: 19786440 DOI: 10.1542/peds.2008-3808] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our objective was to determine the impact of Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based care on length of stay of very low birth weight (VLBW) infants. Secondary outcome measures were days of ventilation, incidence of chronic lung disease, and 18-month neurodevelopmental outcomes. METHODS This cluster-randomized, controlled trial took place in a large NICU in Canada, with follow-up evaluation at 18 months of age, from September 1999 to September 2004. One hundred VLBW singleton infants and 10 VLBW twin sets were assigned randomly to NIDCAP-based or control care, and 90% participated in follow-up assessments. The intervention was NIDCAP-based care (N = 56), that is, care by NIDCAP-educated staff members and behavioral observations. The control group (N = 55) received standard NICU care. Statistical analyses were adjusted for cluster randomization. Although the intervention was not blinded, the pediatricians making the decisions to discharge the infants were not involved in the study, and the follow-up staff members were blinded with respect to group. RESULTS NIDCAP group infants had reduced length of stay (median: NIDCAP: 74 days; control: 84 days; P = .003) and incidence of chronic lung disease (NIDCAP: 29%; control: 49%; odds ratio: 0.42 [95% confidence interval: 0.18-0.95]; P = .035). At 18 months of adjusted age, NIDCAP group infants had less disability, specifically mental delay (NIDCAP: 10%; control: 30%; odds ratio: 0.25 [95% confidence interval: 0.08-0.82]; P = .017). CONCLUSION NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly.
Collapse
Affiliation(s)
- Kathrine Leigh Peters
- Faculty of Nursing, Perinatal Clinical Research Centre, University of Alberta, Edmonton, Canada
| | | | | | | | | | | |
Collapse
|
45
|
Delobel-Ayoub M, Arnaud C, White-Koning M, Casper C, Pierrat V, Garel M, Burguet A, Roze JC, Matis J, Picaud JC, Kaminski M, Larroque B. Behavioral problems and cognitive performance at 5 years of age after very preterm birth: the EPIPAGE Study. Pediatrics 2009; 123:1485-92. [PMID: 19482758 DOI: 10.1542/peds.2008-1216] [Citation(s) in RCA: 280] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors. PATIENTS AND METHODS The Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neurodevelopmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire. RESULTS Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors. CONCLUSIONS Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention.
Collapse
Affiliation(s)
- Malika Delobel-Ayoub
- Institut National de la Santé et de la Recherche Médicale, U558, 37 Allées Jules Guesde, 31073 Toulouse Cedex, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ullenhag A, Persson K, Nyqvist KH. Motor performance in very preterm infants before and after implementation of the newborn individualized developmental care and assessment programme in a neonatal intensive care unit. Acta Paediatr 2009; 98:947-52. [PMID: 19397529 DOI: 10.1111/j.1651-2227.2009.01258.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare motor performance in supine position at the age of 4-months corrected age (CA) in very preterm (VPT) infants cared for in a neonatal intensive care unit (NICU) before and after the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). METHODS Assessments of motor performance in supine position according to level of motor development and quality of motor performance were made, using the Structured Observation of Motor Performance in Infants (SOMP-I). SUBJECTS VPT infants cared for in a NICU at a Swedish university hospital before, Group A (n = 68), and after, Group B (n = 58), the implementation of developmentally supportive care based on NIDCAP. RESULTS The infants who were treated after the introduction of NIDCAP showed higher level of motor development in the arms/hands and trunk. No significant group differences were noted in total deviation score for the respective limbs, but lower frequency of lateral flexion in head movements, extension-external rotation-abduction, extension-internal rotation-adduction and varus and valgus position in the feet was found in the NIDCAP group, compared with those treated before the introduction. CONCLUSION The infants who were treated after NIDCAP care had been implemented showed a higher level of motor development in arms/hand and trunk and fewer deviations in head, legs and feet at 4-months CA than infants treated before NIDCAP implementation. The observed changes may be due to NIDCAP and/or improved perinatal and neonatal care during the studied time period.
Collapse
Affiliation(s)
- Anna Ullenhag
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | |
Collapse
|
47
|
Wallin L, Eriksson M. Newborn Individual Development Care and Assessment Program (NIDCAP): a systematic review of the literature. Worldviews Evid Based Nurs 2009; 6:54-69. [PMID: 19413582 DOI: 10.1111/j.1741-6787.2009.00150.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Important advancements have been made in the care of preterm infants. Health services have introduced various methods aimed at promoting attachment, breastfeeding, and neurological development. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), developed to stimulate preterm infants at levels adapted to the child's degree of neurological maturity, is increasingly being used. OBJECTIVES The aim was to investigate the impact of NIDCAP on the psychomotor development, neurological status, medical/nursing care outcomes, and parental perceptions. A further aim was to evaluate the cost-related effects of NIDCAP. DATA EXTRACTION AND ANALYSIS A literature search up to September 2007 was performed. The reviewed papers were assessed for methodological quality and only statistically significant findings were extracted. FINDINGS The evidence compiled on the effects of NIDCAP is based on 12 articles from six randomized controlled trials that included approximately 250 children. Each of the studies was assessed as having medium quality. Most of the studies were small and many investigated a huge number of outcome variables, which decreased their scientific strength. On outcome variables in which a significant difference was found between the intervention (NIDCAP) and control groups, most studies showed better results for the NIDCAP group. This was particularly valid for cognitive and psychomotor development. Four studies also showed a reduced need for respiratory support for the NIDCAP group. No studies were identified that weighed the total cost of NIDCAP against its effects. CONCLUSIONS Despite promising findings, primarily on cognitive and motor development, the scientific evidence on the effects of NIDCAP is limited. Shortcomings in design and methods in the reviewed studies hamper far-reaching claims on the effectiveness of the method. Scientific grounds for assessing the effects of NIDCAP would be substantially enhanced by a sufficiently comprehensive study with extended follow-up and a clear focus on a few important outcome variables.
Collapse
Affiliation(s)
- Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute and Clinical Research Utilization (CRU), Karolinska University Hospital, Stockholm, Sweden.
| | | |
Collapse
|
48
|
Maguire CM, Walther FJ, van Zwieten PHT, Le Cessie S, Wit JM, Veen S. Follow-up outcomes at 1 and 2 years of infants born less than 32 weeks after Newborn Individualized Developmental Care and Assessment Program. Pediatrics 2009; 123:1081-7. [PMID: 19336365 DOI: 10.1542/peds.2008-1950] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This was a randomized, controlled trial to investigate the effect of Newborn Individualized Developmental Care and Assessment Program on growth, cognitive, psychomotor, and neuromotor development at 1 and 2 years in infants born at <32 weeks' gestational age. METHODS Infants were randomly assigned within 48 hours of birth to the newborn individualized developmental care and assessment program group (intervention) or basic developmental care group (control group [ie, incubator covers and nests]). At 1 and 2 years' corrected age, growth was measured and standardized neurologic examinations were administered. Mental and psychomotor development was assessed by using the Dutch version of the Bayley Scales of Infant Development II. Neurologic outcome, Psychomotor Developmental Index, and Mental Developmental Index scores were combined a total outcome measure. RESULTS One hundred sixty-eight infants were recruited (intervention: 84; control: 84). Four infants (newborn intervention: 3; control: 1) were excluded because they were admitted less than or died within the first 5 days, leaving a total of 164 infants who met inclusion criteria. In-hospital mortality was 8 of 81 in the intervention group and 3 of 83 in the control group. At 1 year of age 148 children (intervention: 70; control: 78) and at 2 years of age 146 children (intervention: 68; control: 78) were assessed. There was no significant difference in growth at 1 and 2 years of age. There was no significant difference found in neurologic outcomes or mental and psychomotor development at 1 and 2 years of age. When neurologic outcome, Mental Developmental Index and Psychomotor Developmental Index scores were combined, there still remained no significant difference. CONCLUSIONS Newborn individualized developmental care and assessment program developmental care showed no effect on growth or neurologic, mental, or psychomotor development at 1 and 2 years of age in infants born at <32 weeks. Duration of the intervention was not associated with neurologic and developmental outcome.
Collapse
Affiliation(s)
- Celeste M Maguire
- Department of Pediatrics, Leiden University Medical Center, J-6-S, PO Box 9600, 2300 RC, Leiden, Netherlands
| | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Cho J, Miles MS, Holditch‐Davis D, Belyea M. Effect of gender on the interactions between mothers and their medically at‐risk infants. J Reprod Infant Psychol 2009. [DOI: 10.1080/02646830701760528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|