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van der Kemp J, Ketelaar M, Rentinck ICM, Sommers-Spijkerman MPJ, Benders MJNL, Gorter JW. Exploring Parents' Experiences and Needs During Disclosure of a Cerebral Palsy Diagnosis of Their Young Child: A Scoping Review. Child Care Health Dev 2024; 50:e13327. [PMID: 39343726 DOI: 10.1111/cch.13327] [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: 02/14/2024] [Revised: 07/07/2024] [Accepted: 08/14/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Parents often perceive the news that their child has cerebral palsy (CP) as overwhelming and shocking. They are at increased risk of parental stress and mental health problems, which in turn can affect the interaction between the parent and the child. Parental mental health outcomes are known to be affected by the process of disclosure of a diagnosis. In this study, we aimed to synthesize the current knowledge about parents' experiences and needs regarding communication during the disclosure of the diagnosis of their child with (or at risk of) CP. METHODS A scoping review following the methodological steps outlined by the Joanna Briggs Institute was performed using PubMed, Embase, CINAHL and PsycINFO. We qualitatively explored parent-reported experiences and needs across included studies, using thematic analysis. RESULTS A total of 19 studies were included. Six themes were identified, three in relation to experiences (i.e., preceding experiences and feelings, perceptions of the disclosure and emotional impact) and three in relation to needs (i.e., transparency in information, supportive attitude and having a say). Despite high variability across studies regarding parental needs, most studies reported the need for (i) honest and clear information, (ii) good communication skills amongst professionals and (iii) emotional and practical support after diagnosis. CONCLUSIONS Our findings suggest that parents' experiences and needs in the period when their child's diagnosis of (high risk of) CP is communicated are highly variable, due to an interplay of personal and contextual factors. To facilitate good communication during disclosure, it is crucial that health care professionals assess and understand this complex process and consider parents' needs for open communication and autonomy in the process. Therefore, professionals need to attune to parents' needs and their individual preferences regarding conversations about their child with (or at risk of) CP.
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Affiliation(s)
- J van der Kemp
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - M Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- CanChild, Center for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - I C M Rentinck
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P J Sommers-Spijkerman
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - M J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W Gorter
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- CanChild, Center for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
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Kim F, Maitre N. Grand Rounds: How Do We Detect Cerebral Palsy Earlier in Neonates ? J Pediatr 2024:114299. [PMID: 39277080 DOI: 10.1016/j.jpeds.2024.114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/27/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Irving Medical Center/New York-Presbyterian Children's Hospital of New York, New York, NY.
| | - Nathalie Maitre
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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3
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Sharma P, McPhail SM, Kularatna S, Senanayake S, Abell B. Navigating the challenges of imposter participants in online qualitative research: lessons learned from a paediatric health services study. BMC Health Serv Res 2024; 24:724. [PMID: 38867177 PMCID: PMC11170877 DOI: 10.1186/s12913-024-11166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The growth in online qualitative research and data collection provides several advantages for health service researchers and participants, including convenience and extended geographic reach. However, these online processes can also present unexpected challenges, including instances of participant fraud or scam behaviour. This study describes an incident of participant fraud identified during online focus group discussions and interviews for a PhD health services research project on paediatric neurodevelopmental care. METHODS We aimed to recruit carers of Australian children with neurodevelopmental disorders. Potential participants were recruited via a publicly available social media advert on Facebook offering $50 AUD compensation. Those who expressed interest via email (n = 254) were sent a pre-interview Qualtrics survey to complete. We identified imposters at an early stage via inconsistencies in their self-reported geographical location and that captured by the survey as well as recognition of suspicious actions before, during and after focus group discussions and interviews. RESULTS Interest in participation was unexpectedly high. We determined that all potential participants were likely imposters, posing as multiple individuals and using different IP addresses across Nigeria, Australia, and the United States. In doing so, we were able to characterise several "red flags" for identifying imposter participants, particularly those posing as multiple individuals. These comprise a combination of factors including large volumes and strange timings of email responses, unlikely demographic characteristics, short or vague interviews, a preference for nonvisual participation, fixation on monetary compensation, and inconsistencies in reported geographical location. Additionally, we propose several strategies to combat this issue such as providing proof of location or eligibility during recruitment and data collection, examining email and consent form patterns, and comparing demographic data with regional statistics. CONCLUSIONS The emergent risk of imposter participants is an important consideration for those seeking to conduct health services research using qualitative approaches in online environments. Methodological design choices intended to improve equity and access for the target population may have an unintended consequence of improving access for fraudulent actors unless appropriate risk mitigation strategies are also employed. Lessons learned from this experience are likely to be valuable for novice health service researchers involved in online focus group discussions and interviews.
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Affiliation(s)
- Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
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Bernstein SM, Barks MC, Ubel PA, Weinfurt K, Barlet MH, Farley S, Jiao MG, Bansal S, Fisher K, Lemmon ME. Prognostic Discordance Among Parents and Physicians Caring for Infants with Neurologic Conditions. J Pediatr 2023; 263:113677. [PMID: 37611734 PMCID: PMC10841319 DOI: 10.1016/j.jpeds.2023.113677] [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] [Received: 04/24/2023] [Revised: 07/09/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To determine the frequency, degree, and nature of prognostic discordance between parents and physicians caring for infants with neurologic conditions. STUDY DESIGN In this observational cohort study, we enrolled parents and physicians caring for infants with neurologic conditions in advance of a family conference. Parent-physician dyads completed a postconference survey targeting expected neurologic outcomes across 3 domains (motor, speech, and cognition) using a 6-point scale. Prognostic discordance was defined as a difference of ≥2 response options and was considered moderate (difference of 2-3 response options) or high (difference of 4-5 response options). Responses were categorized as differences in belief and/or differences in understanding using an existing paradigm. RESULTS Forty parent-physician dyads of 28 infants completed surveys. Parent-physician discordance about prognosis occurred in ≥1 domain in the majority of dyads (n = 28/40, 70%). Discordance was generally moderate in degree (n = 23/28, 82%) and occurred with similar frequency across all domains. Of parent-physician dyads with discordance, the majority contained a difference in understanding in at least 1 domain (n = 25/28, 89%), while a minority contained a difference of belief (n = 6/28, 21%). When discordance was present, parents were typically more optimistic in their predictions compared with physicians (n = 25/28, 89%). CONCLUSIONS Differing perceptions about the prognosis of critically ill infants are common and due to differences in both understanding and belief. These findings can be used to develop targeted interventions to improve prognostic communication.
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Affiliation(s)
- Sarah M Bernstein
- University of Utah School of Medicine, Salt Lake City, UT; Duke University Medical Center, Durham, NC.
| | - Mary C Barks
- Duke Margolis Center for Health Policy, Durham, NC
| | | | | | | | | | - Megan G Jiao
- Duke Margolis Center for Health Policy, Durham, NC
| | | | | | - Monica E Lemmon
- Duke University Medical Center, Durham, NC; Duke Margolis Center for Health Policy, Durham, NC
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Hurt L, Odd D, Mann M, Beetham H, Dorgeat E, Isaac TC, Ashman A, Wood F. What matters to families about the healthcare of preterm or low birth weight infants: A qualitative evidence synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107893. [PMID: 37473603 DOI: 10.1016/j.pec.2023.107893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE We examined what matters to families about the healthcare provided to preterm or LBW infants in hospital and the community, to ensure that care meets the needs of infants and parents. METHODS We searched databases to identify eligible studies examining the views and expectations of families. Study quality was assessed using the CASP checklist for qualitative studies. The GRADE-CERQual approach was used to assess confidence in review findings. Studies were sampled and data analysed using thematic synthesis. RESULTS 222 studies (227 papers) were eligible for inclusion. 54 studies (57 papers) were sampled based on data richness, methodological quality, and representation across settings. Eight analytical themes were identified. Confidence in results was moderate to high. What mattered was a positive outcome for the child; active involvement in care; being supported to cope at home after discharge; emotional support; the healthcare environment; information needs met; logistical support available; and positive relationships with staff. CONCLUSION Although parents and family members reported a variety of experiences in the care of their infant, we found high consistency in what matters to families. PRACTICE IMPLICATIONS This review identifies approaches to improve experiences of parents which are consistent with the Family Centred Care model of healthcare.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.
| | - David Odd
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | | | - Emma Dorgeat
- Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Fiona Wood
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
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Dorner RA, Boss RD, Burton VJ, Raja K, Robinson S, Lemmon ME. Isolated and On Guard: Preparing Neonatal Intensive Care Unit Families for Life with Hydrocephalus. Am J Perinatol 2022; 39:1341-1347. [PMID: 33454943 PMCID: PMC9619410 DOI: 10.1055/s-0040-1722344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study was aimed to characterize the parent experience of caring for a child with posthemorrhagic hydrocephalus and to describe parent preferences for counseling in the neonatal period and beyond. STUDY DESIGN This was a qualitative interview study. Parents of infants born preterm with posthemorrhagic hydrocephalus completed semistructured interviews. Data were analyzed using a content analysis approach. RESULTS Thematic saturation was reached on parent communication preferences after 10 interviews. Parent experiences of infant hydrocephalus broadly fell into two time periods, the neonatal intensive care unit (NICU) and after NICU discharge. The themes of uncertainty, isolation, hypervigilance, and the need for advocacy were common to each phase. CONCLUSION Parents expressed interest in the development of tiered NICU counseling tools that would provide evidence-based and family-centric information to (1) initiate connections with community and peer resources and (2) combat the isolation and hypervigilance that characterized their family experience of living with hydrocephalus. KEY POINTS · Infants with posthemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes.. · The parent experience of caring for a child with posthemorrhagic hydrocephalus is not well-described. In this interview study, parents described uncertainty, isolation, and hypervigilance.. · These findings call for structured NICU counseling and longitudinal family supports after discharge..
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Affiliation(s)
- Rebecca A Dorner
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Renee D Boss
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University, Phoebe R. Berman Institute of Bioethics, Baltimore, Maryland
| | - Vera J Burton
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Raja
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Shenandoah Robinson
- Department of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Monica E Lemmon
- Division of Pediatric Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
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Ethical considerations in the management of infants with severe intraventricular hemorrhage. Semin Perinatol 2022; 46:151599. [PMID: 35450739 DOI: 10.1016/j.semperi.2022.151599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intrinsic and extrinsic factors unique to neonatal care can complicate predictions of neurological outcomes for infants who suffer from severe intraventricular hemorrhage. While care decisions are driven by the same bioethical principles used in other domains, neurological prognostication can challenge concepts of futility, require careful examination of parental values, uncover biases and/or potentially compromise the best interests of the future child. In the following chapter we will review bioethical principles and relevant concepts, explore challenges to decision-making surrounding diagnoses of severe intraventricular hemorrhage and conclude with a brief review of practical approaches for counseling parents about neurodevelopmental impairment given the constraints of prognostic uncertainty and assumptions related to quality of life. We will argue that neurological findings alone, even in the setting of severe intraventricular hemorrhage, often do not constitute enough evidence for redirection of care but can be permissible when the entire neonatal condition is considered.
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8
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Haffner DN, Sankovic A. A Neurologist's Guide to Neonatal Neurodevelopmental Assessments and Preterm Brain Injury. Semin Pediatr Neurol 2022; 42:100974. [PMID: 35868724 DOI: 10.1016/j.spen.2022.100974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Abstract
Despite advances in medical care and improved survival of extremely preterm infants, rates of neurodevelopmental impairment remain high. Outcomes are significantly improved with early intervention, but infants must be appropriately identified to facilitate services. Neuroimaging provides important information regarding neurodevelopmental outcomes but prognosticating and communicating risk remains challenging. Standardized neonatal neurodevelopmental assessments provide supplemental information to aid in the identification of high-risk infants and counseling for their families.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States.
| | - Alexandra Sankovic
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States
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9
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Abstract
While medical advancements have led to improved survival of extremely premature infants, children remain at risk for brain injury and neurodevelopmental impairment. Brain imaging can offer insight into an infant's acute and long-term outcome; however, counseling parents about the results and implications of brain imaging remains challenging. The purpose of this article is to review the current literature and describe the challenges associated with counseling families of premature infants on neuroimaging findings. We propose a framework to guide clinicians in counseling parents about brain imaging results, informed by best practices in other disciplines: (FIGURE): 1) Formulate a plan 2) Identify parental needs and values 3) Give information 4) Acknowledge Uncertainty 5) Recognize and Respond to emotions 6) Discuss Expectations and Establish follow-up.
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Affiliation(s)
- Sarah M Bernstein
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | | | - Monica E Lemmon
- Departments of Pediatrics and Population Health Sciences, Duke University Medical Center, Duke-Margolis Center for Health Policy, DUMC 3936, Durham, NC 27710, United States.
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Lemmon ME, Wusthoff CJ, Boss RD, Rasmussen LA. Ethical considerations in the care of encephalopathic neonates treated with therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101258. [PMID: 34176763 PMCID: PMC8627487 DOI: 10.1016/j.siny.2021.101258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Engaging with ethical issues is central to the management of neonatal encephalopathy (NE). As treatment for these neonates evolves, new ethical issues will arise and many existing challenges will remain. We highlight three key ethical issues that arise in the care of neonates with NE treated with therapeutic hypothermia: facilitating shared decision making, understanding futility, and defining the boundaries between standard of care and research. Awareness of these issues will help clinicians counsel families in light of evolving treatments and outcomes.
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Affiliation(s)
- Monica E. Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, DUMC 3936, Durham, NC, 27710, USA,Corresponding author. (M.E. Lemmon)
| | - Courtney J. Wusthoff
- Departments of Neurology and Pediatrics, Stanford University, Stanford, 750 Welch Road, Suite 317, Palo Alto, CA, 94304, USA
| | - Renee D. Boss
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Berman Institute of Bioethics, 200 N. Wolfe St, Suite 2019, Baltimore, MD, 21287, United States
| | - Lisa Anne Rasmussen
- Division of Palliative Care, Department of Family Medicine, Department of Neurology, Department of Pediatrics, Larner College of Medicine, University of Vermont, UVM Medical Center Palliative Care, 111 Colchester Avenue, Main Campus, Smith 262, Burlington, VT, 05401-1473, USA.
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Svensson KA, Örtqvist M, Bos AF, Eliasson AC, Sundelin HE. Usability and inter-rater reliability of the NeuroMotion app: A tool in General Movements Assessments. Eur J Paediatr Neurol 2021; 33:29-35. [PMID: 34052727 DOI: 10.1016/j.ejpn.2021.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early intervention after perinatal brain insults requires early detection of infants with cerebral palsy (CP). General Movements Assessments (GMA) in the fidgety movement period has a high predictive value for CP. AIM To investigate the NeuroMotion™ app's usability regarding film quality and user experience and to assess the inter-rater reliability of GMA in a neonatal risk group. METHODS GMA, inter-rater reliability and film quality was assessed in a cohort consisting of 37 infants enrolled in a multicentre study of GMA as part of the Swedish neonatal follow-up program for high-risk infants. Some of these infants were filmed twice. For evaluation of user experience 95 parents of 52 infants were addressed with a web-based questionnaire. A GMA expert assessed film quality and performed GMA and three on-site assessors, individually performed GMA. Inter-rater reliability was computed using Krippendorff's alpha (k-alpha). RESULTS In all, 45 films showed good or excellent quality. The response rate of the questionnaire survey was 40% and revealed predominantly positive perceptions of the NeuroMotion™ app. GMA in 36 infants resulted in substantial agreement (k-alpha = 0.72, 95%CI = 0.3-1.0) between the three on-site assessors' consensus and the GMA expert. Inter-rater reliability for GMA between the on-site assessors was moderate (k-alpha = 0.48, 0.18-0.74). CONCLUSION The NeuroMotion™ app produces good technical quality films and the app user experience was overall positive. High agreement was observed between the on-site assessors and the GMA expert. The study design is feasible for more extensive GMA studies in cohorts of infants at risk of CP.
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Affiliation(s)
- Katarina A Svensson
- Linköping University, Linköping, Sweden; Crown Princess Victoria's Children's and Youth Hospital, University Hospital, Linköping, Sweden
| | - Maria Örtqvist
- Neonatal Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Arend F Bos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Heléne Ek Sundelin
- Linköping University, Linköping, Sweden; Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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12
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Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
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Leal Martins C, Chabrier S, Fluss J. Recognition, identification, and diagnosis announcement of neonatal arterial ischemic stroke: A combined exploratory quantitative and qualitative study on parents' lived experiences. Arch Pediatr 2021; 28:285-290. [PMID: 33715932 DOI: 10.1016/j.arcped.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To examine the epidemiology of neonatal arterial ischemic stroke (NAIS) and the chronology of care from early reported manifestations to formal diagnosis obtained by imaging. To explore how parents experienced the sequence of events, their own perception of potential diagnostic delay, diagnosis announcement, and prognosis discussion, and their current view of their child's quality of life. METHODS We retrospectively analyzed data of all NAIS cases that have been treated in our institution. Quantitative data came from both newborns' and mothers' medical records. Qualitative data were collected from parents in semi-structured interviews based on a standardized questionnaire composed of open-ended questions. RESULTS A total of 14 neonates were treated for NAIS in our institution between January 2008 and December 2017. The incidence of NAIS during this period was one out of 4258 births. The majority of neonates presented within 48 hours with a mean of 27h after birth, most often in the form of repetitive focal clonus (13/14). The mean time before diagnosis consideration and confirmation was 5 and 33h, respectively. Late consideration of early reported symptoms was identified as the main source of delay. Despite good reported health outcome, NAIS was associated with significant acute and long-standing parental emotional stress. CONCLUSION Maternity hospital caregivers' awareness of NAIS is crucial to reach early diagnosis. Improving this aspect would not only allow better early management, but also make it possible to set up acute neuroprotective strategies. Clinicians should be attentive to the modalities of diagnosis and prognosis announcements, which are associated with considerable stress and misconceptions.
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Affiliation(s)
- Cindy Leal Martins
- Pediatric Neurology Unit, Paediatric subspecialties Service, Geneva University Hospitals, Rue Willy-Donzé 6, 1211 Geneva 14, Switzerland
| | - Stéphane Chabrier
- CHU de Saint-Étienne, French Center for Paediatric Stroke, Inserm U1059, CIC1408, 42055 Saint-Étienne, France
| | - Joel Fluss
- Pediatric Neurology Unit, Paediatric subspecialties Service, Geneva University Hospitals, Rue Willy-Donzé 6, 1211 Geneva 14, Switzerland.
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14
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Adde L, Brown A, van den Broeck C, DeCoen K, Eriksen BH, Fjørtoft T, Groos D, Ihlen EAF, Osland S, Pascal A, Paulsen H, Skog OM, Sivertsen W, Støen R. In-Motion-App for remote General Movement Assessment: a multi-site observational study. BMJ Open 2021; 11:e042147. [PMID: 33664072 PMCID: PMC7934716 DOI: 10.1136/bmjopen-2020-042147] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine whether videos taken by parents of their infants' spontaneous movements were in accordance with required standards in the In-Motion-App, and whether the videos could be remotely scored by a trained General Movement Assessment (GMA) observer. Additionally, to assess the feasibility of using home-based video recordings for automated tracking of spontaneous movements, and to examine parents' perceptions and experiences of taking videos in their homes. DESIGN The study was a multi-centre prospective observational study. SETTING Parents/families of high-risk infants in tertiary care follow-up programmes in Norway, Denmark and Belgium. METHODS Parents/families were asked to video record their baby in accordance with the In-Motion standards which were based on published GMA criteria and criteria covering lighting and stability of smartphone. Videos were evaluated as GMA 'scorable' or 'non-scorable' based on predefined criteria. The accuracy of a 7-point body tracker software was compared with manually annotated body key points. Parents were surveyed about the In-Motion-App information and clarity. PARTICIPANTS The sample comprised 86 parents/families of high-risk infants. RESULTS The 86 parent/families returned 130 videos, and 121 (96%) of them were in accordance with the requirements for GMA assessment. The 7-point body tracker software detected more than 80% of body key point positions correctly. Most families found the instructions for filming their baby easy to follow, and more than 90% reported that they did not become more worried about their child's development through using the instructions. CONCLUSIONS This study reveals that a short instructional video enabled parents to video record their infant's spontaneous movements in compliance with the standards required for remote GMA. Further, an accurate automated body point software detecting infant body landmarks in smartphone videos will facilitate clinical and research use soon. Home-based video recordings could be performed without worrying parents about their child's development. TRIALS REGISTRATION NUMBER NCT03409978.
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Affiliation(s)
- Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Annemette Brown
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Pediatric and Adolescent and Department of Neurology and Physiotherapy, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Kris DeCoen
- Department of Neonatology, University Hospital Ghent, Gent, Belgium
| | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre og Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Daniel Groos
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Espen Alexander F Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siril Osland
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Henriette Paulsen
- Department of Physiotherapy and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ole Morten Skog
- Habilitation Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Wiebke Sivertsen
- Department of Pediatrics, Møre og Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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15
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Salah L, Chabrier S, Thébault G, Kossorotoff M. Parental and professional opinion regarding outcome after neonatal stroke. Dev Med Child Neurol 2020; 62:1450-1451. [PMID: 32654128 DOI: 10.1111/dmcn.14621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Lucie Salah
- Paediatric Neurology, French Centre for Paediatric Stroke, APHP University Hospital Necker-Enfants malades, Paris, France
| | - Stéphane Chabrier
- CHU Saint-Étienne, Inserm U1059, French Centre for Paediatric Stroke, Saint-Étienne, France
| | - Guillaume Thébault
- CHU Saint-Étienne, Inserm U1059, French Centre for Paediatric Stroke, Saint-Étienne, France.,University Paul Valéry Montpellier, University Montpellier, Montpellier, France.,Physical Medicine and Rehabilitation Department, CH Paul Coste Floret, Lamalou-les-bains, France
| | - Manoëlle Kossorotoff
- Paediatric Neurology, French Centre for Paediatric Stroke, APHP University Hospital Necker-Enfants malades, Paris, France
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16
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Fayed N, Cohen E, Houtrow A. Quality of life cannot be predicted from a brain scan. Dev Med Child Neurol 2020; 62:412. [PMID: 32037529 DOI: 10.1111/dmcn.14484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amy Houtrow
- Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
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