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Pineda R, Misikoff M, Ghahramani S, Smith J, Mathur A. Description and evidence on the supporting and enhancing neonatal intensive care unit sensory experiences (SENSE) program. Acta Paediatr 2024. [PMID: 38809111 DOI: 10.1111/apa.17293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
AIM To describe the supporting and enhancing neonatal intensive care unit (NICU) sensory experiences (SENSE) program, associated research and opportunities for further study. METHODS A review of current materials on SENSE program implementation, publications related to SENSE development, and research on program implementation and patient outcomes was conducted to describe the SENSE program and its associated research. RESULTS The SENSE program combines structured, evidence-based, multisensory interventions with parent engagement in order to optimise outcomes in the complex NICU environment. Through a stepwise and scientific process, the SENSE program was developed to include specific doses and targeted timing (based on the infant's postmenstrual age, PMA) of evidence-based interventions such as massage, auditory exposure, rocking, holding and skin-to-skin care for parents to provide their infants each day of NICU hospitalisation. It is adapted in context of concurrent medical interventions, infant behavioural responses, as well as NICU culture. The program is feasible to implement, acceptable to staff, and related to infants receiving more developmentally appropriate sensory exposures. Adaptations related to NICU culture and parent involvement have been reported. Research has identified relationships of the SENSE program to improved parent confidence, neurobehaviour and feeding at term age as well as improved communication 1 year of age. CONCLUSION The literature related to the SENSE program is promising, but more research on efficacy and implementation is needed.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California, USA
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
- Program in Occupational Therapy, Washington University, St. Louis, Missouri, USA
| | - Maya Misikoff
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Sahar Ghahramani
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Amit Mathur
- Department of Pediatrics, St. Louis University, St. Louis, Missouri, USA
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Pineda R, Kellner P, Gruskin BA, Smith J. Organizational Barriers to and Facilitators of the Successful Implementation and Sustainability of the Supporting and Enhancing NICU Sensory Experiences (SENSE) Program. Am J Occup Ther 2024; 78:7801205180. [PMID: 38271664 DOI: 10.5014/ajot.2024.050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
IMPORTANCE The Supporting and Enhancing NICU Sensory Experiences (SENSE) program is an evidence-based intervention that promotes daily, positive sensory exposures for infants in the neonatal intensive care unit (NICU). Understanding program implementation across sites may aid in optimizing strategies for uptake of the program and subsequently improve outcomes for infants and families. OBJECTIVE To investigate health care professionals' perceptions of implementing the SENSE program. DESIGN The SENSE Program Implementation Survey was developed using Proctor et al.'s model and the BARRIERS scale to probe organizational practices across sites worldwide. SETTING Survey distributed to 211 hospitals with a SENSE program license obtained before March 2020. PARTICIPANTS One hundred fourteen NICU personnel (response rate = 54%). OUTCOMES AND MEASURES The survey sought to understand barriers and facilitators, adaptations during implementation, and associated costs. RESULTS Of the 53% (n = 57 of 107) of respondents who had implemented the SENSE program, many (n = 14; 31%) experienced quick timing (<1 mo) to use, including spread to nearly all infants in their NICU within 6 mo (n = 18; 35%). Most reported the program was used to educate families ≤3 days of birth (n = 20/59; 34%). Most of the sensory interventions in the program were performed by parents (n = 38; 67%) and therapists (n = 44; 77%). Barriers and facilitators at the organizational and individual levels were identified. No additional staff were hired to implement the program. CONCLUSIONS AND RELEVANCE Given perceived successes and challenges, strategic enhancement of implementation can inform future administrations of the SENSE program. Plain-Language Summary: This study provides occupational therapists who are interested in implementing the SENSE program (Supporting and Enhancing NICU Sensory Experiences) with an understanding of common barriers, facilitators, costs, and adaptations, which can be used to advocate for program implementation in NICUs to improve outcomes for preterm infants worldwide.
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Affiliation(s)
- Roberta Pineda
- Roberta Pineda, PhD, OTR/L, CNT, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles; Department of Pediatrics and Neonatology, Keck School of Medicine and Children's Hospital of Los Angeles, Los Angeles, CA; Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles; and Adjunct Faculty, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO;
| | - Polly Kellner
- Polly Kellner, MSOT, OTR/L, is Clinical Research Specialist and Occupational Therapist, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Bethany A Gruskin
- Bethany A. Gruskin, MSOT, OTR/L, is PhD Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Joan Smith
- Joan Smith, PhD, RN, NNP-BC, FAAN, is Director, Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO
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Richter M, Angell A, Kellner P, Smith J, Pineda R. Infant and Parent Outcomes Related to NICU-Based Co-occupational Engagement. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:3-12. [PMID: 36945755 DOI: 10.1177/15394492231160690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Neonatal intensive care unit (NICU) co-occupations may impact parent-infant outcomes. The main objective of this study was to explore relationships between parent and infant outcomes based on whether sensory-based interventions (co-occupations) occurred most often between parent-infant dyads or provider/volunteer-infant dyads. Thirty-five families received the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, which includes education defining specific amounts of sensory exposures for infants to receive each day of NICU hospitalization (with a preference for parent delivery). Infant sensory experiences in the NICU were logged, and dyads were grouped based on who conducted most of the sensory interventions with the infant in the NICU into a Parent-Infant Co-occupation group or Other Administered group. The Parent-Infant Co-occupation group had infants with less lethargy on the NICU Network Neurobehavioral Scale (p = .04), and parents with lower scores on the Parental Stress Scale (p = .003) and State-Trait Anxiety Inventory-state (p = .047). Parent-infant engagement in co-occupations was related to parental mental health and infant neurobehavior.
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Affiliation(s)
- M Richter
- University of Southern California, Los Angeles, CA, USA
| | - A Angell
- University of Southern California, Los Angeles, CA, USA
| | - P Kellner
- University of Southern California, Los Angeles, CA, USA
| | - J Smith
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - R Pineda
- University of Southern California, Los Angeles, CA, USA
- Washington University, St. Louis, MO, USA
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Arimitsu T, Fukutomi R, Kumagai M, Shibuma H, Yamanishi Y, Takahashi KI, Gima H, Seto Y, Adachi H, Arai H, Higuchi M, Ohgi S, Ohta H. Designing artificial circadian environments with multisensory cares for supporting preterm infants' growth in NICUs. Front Neurosci 2023; 17:1152959. [PMID: 37694118 PMCID: PMC10491019 DOI: 10.3389/fnins.2023.1152959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Previous studies suggest the importance of stable circadian environments for fetuses to achieve sound physiology and intrauterine development. This idea is also supported by epidemiological and animal studies, in which pregnant females exposed to repeated shifting of light-dark cycles had increased rates of reproductive abnormalities and adverse pregnancy outcomes. In response to such findings, artificial circadian environments with light-dark (LD) cycles have been introduced to NICUs to promote better physical development of preterm infants. Such LD cycles, however, may not be fully effective for preterm infants who are less than 30 weeks gestational age (WGA) since they are too premature to be adequately responsive to light. Instead, circadian rhythmicity of incubated preterm infants less than 30 WGA may be able to be developed through stimulation of the non-visual senses such as touch and sound.
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Affiliation(s)
- Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
- The Japan Developmental Care Study Group, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
| | - Rika Fukutomi
- Section of Pediatric Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Mayuko Kumagai
- Department of Nursing, Akita University Graduate School of Medicine, Akita, Japan
| | - Hayato Shibuma
- Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan
| | - Yoko Yamanishi
- Department of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Kei-ichi Takahashi
- Department of Occupational Therapy, Akita University Graduate School of Medicine, Akita, Japan
| | - Hirotaka Gima
- The Japan Developmental Care Study Group, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yoshitaka Seto
- Maternity and Perinatal Care Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroyuki Adachi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Hirokazu Arai
- Department of Neonatology, Akita Red Cross Hospital, Akita, Japan
| | - Masakatsu Higuchi
- The Japan Developmental Care Study Group, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
- Department of Occupational Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | - Shohei Ohgi
- The Japan Developmental Care Study Group, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
| | - Hidenobu Ohta
- The Japan Developmental Care Study Group, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
- Department of Occupational Therapy, Akita University Graduate School of Medicine, Akita, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Asai Hospital, Chiba, Japan
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Pineda R, Kellner P, Guth R, Gronemeyer A, Smith J. NICU sensory experiences associated with positive outcomes: an integrative review of evidence from 2015-2020. J Perinatol 2023; 43:837-848. [PMID: 37029165 PMCID: PMC10325947 DOI: 10.1038/s41372-023-01655-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
To inform changes to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, studies investigating sensory-based interventions in the NICU with preterm infants born ≤32 weeks were identified. Studies published between October 2015 to December 2020, and with outcomes related to infant development or parent well-being, were included in this integrative review. The systematic search used databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar. Fifty-seven articles (15 tactile, 9 auditory, 5 visual, 1 gustatory/olfactory, 5 kinesthetic, and 22 multimodal) were identified. The majority of the sensory interventions that were identified within the articles were reported in a previous integrative review (1995-2015) and already included in the SENSE program. New evidence has led to refinements of the SENSE program, notably the addition of position changes across postmenstrual age (PMA) and visual tracking starting at 34 weeks PMA.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Guth
- Center for Clinical Excellence, BJC HealthCare, St. Louis, MO, USA
| | | | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
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Pineda R, Kellner P, Ibrahim C, Smith J. Supporting and Enhancing NICU Sensory Experiences (SENSE), 2nd Edition: An Update on Developmentally Appropriate Interventions for Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:961. [PMID: 37371193 DOI: 10.3390/children10060961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
The Supporting and Enhancing NICU Sensory Experiences (SENSE) program promotes consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for preterm infants each day of NICU hospitalization to optimize infant and parent outcomes. The initial development included an integrative review, stakeholder input (NICU parents and healthcare professionals), and feasibility focus groups. To keep the program updated and evidence-based, a review of the recent evidence and engagement with an advisory team will occur every 5 years to inform changes to the SENSE program. Prior to the launch of the 2nd edition of the SENSE program in 2022, information from a new integrative review of 57 articles, clinician feedback, and a survey identifying the barriers and facilitators to the SENSE program's implementation in a real-world context were combined to inform initial changes. Subsequently, 27 stakeholders (neonatologists, nurse practitioners, clinical nurse specialists, bedside nurses, occupational therapists, physical therapists, speech-language pathologists, and parents) carefully considered the suggested changes, and refinements were made until near consensus was achieved. While the 2nd edition is largely the same as the original SENSE program, the refinements include the following: more inclusive language, clarification on recommended minimum doses, adaptations to allow for variability in how hospitals achieve different levels of light, the addition of visual tracking in the visual domain, and the addition of position changes in the kinesthetic domain.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA 90089, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Carolyn Ibrahim
- Department of Health Sciences, Rush University, Chicago, IL 60612, USA
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO 63110, USA
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de Castro KN, Benson JD, Thomas H, Manuel V, Mitra S. Feasibility of Implementing a Modified SENSE Program to Increase Positive Sensory Experiences for Preterm Infants in the Neonatal Intensive Care Unit (NICU): A Pilot Study. Phys Occup Ther Pediatr 2023; 43:109-128. [PMID: 35903855 DOI: 10.1080/01942638.2022.2104150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the feasibility of implementing the Supporting and Enhancing NICU Sensory Experiences (SENSE) program with adaptations to increase positive sensory exposure for infants born preterm, support neonatal neurodevelopment, and decrease parent stress. METHODS Eight infants born between 28 and 33 weeks were recruited within one week of birth. Parents, trained in the program, delivered the SENSE protocol. The first author provided up to 1 h of sensory input on weekdays when a parent could not be present. RESULTS Recruitment and retention rates were 87.5% and 100%, respectively. Recruitment and initial parent education and training averaged 37.5 min. On average, parents were present in the NICU 85.1% of days; they participated in SENSE for an average of 515.5 min. SENSE dose recommendations were not consistently met. Weekly infant assessments and regular parent check ins averaged 22.5 and 13.8 min, respectively. Post-assessments revealed normal scores on a neurodevelopmental assessment, low parent stress, and high parent satisfaction. CONCLUSIONS The recruitment and retention rates suggest high demand to participate. Outcomes for parent stress and neonatal neurodevelopment support continuation of SENSE. Time commitment for implementation, coupled with supporting families in meeting dose recommendations, suggest a need for a neonatal therapist to promote sustainability.
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Affiliation(s)
| | - Jeryl D Benson
- Department of Occupational Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Hillary Thomas
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Vinit Manuel
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sanjay Mitra
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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A feasibility randomized controlled trial of a NICU rehabilitation program for very low birth weight infants. Sci Rep 2022; 12:1729. [PMID: 35110644 PMCID: PMC8810863 DOI: 10.1038/s41598-022-05849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/19/2022] [Indexed: 11/09/2022] Open
Abstract
Motor disability is common in children born preterm. Interventions focusing on environmental enrichment and emotional connection can positively impact outcomes. The NICU-based rehabilitation (NeoRehab) program consists of evidence-based interventions provided by a parent in addition to usual care. The program combines positive sensory experiences (vocal soothing, scent exchange, comforting touch, skin-to-skin care) as well as motor training (massage and physical therapy) in a gestational age (GA) appropriate fashion. To investigate the acceptability, feasibility and fidelity of the NeoRehab program in very low birthweight (VLBW) infants. All interventions were provided by parents in addition to usual care. Infants (≤ 32 weeks' GA and/or ≤ 1500 g birthweight) were enrolled in a randomized controlled trial comparing NeoRehab to usual care (03/2019-10/2020). The a priori dosing goal was for interventions to be performed 5 days/week. The primary outcomes were the acceptability, feasibility and fidelity of the NeoRehab program. 36 participants were randomized to the intervention group and 34 allocated to usual care. The recruitment rate was 71% and retention rate 98%. None of the interventions met the 5 days per week pre-established goal. 97% of participants documented performing a combination of interventions at least 3 times per week. The NeoRehab program was well received and acceptable to parents of VLBW infants. Programs that place a high demand on parents (5 days per week) are not feasible and goals of intervention at least 3 times per week appear to be feasible in the context of the United States. Parent-provided motor interventions were most challenging to parents and alternative strategies should be considered in future studies. Further studies are needed to evaluate the relationship between intervention dosing on long term motor outcomes.
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Pineda R, Smith J, Roussin J, Wallendorf M, Kellner P, Colditz G. Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU. J Perinatol 2021; 41:2449-2462. [PMID: 34012055 PMCID: PMC8516670 DOI: 10.1038/s41372-021-01078-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate the effect of a manualized multisensory program, applied across NICU hospitalization, on infant and parent outcomes. STUDY DESIGN Seventy parent-infant dyads (born ≤32 weeks gestation) in a Level IV NICU were randomized at birth to the multisensory program or standard-of-care. Parents in the multisensory group administered prespecified amounts of age-appropriate, evidence-based sensory interventions to their infants each day during NICU hospitalization according to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. RESULTS Infants who received the SENSE program had more lethargy on the NICU Network Neurobehavioral Scale (NNNS) (p = 0.05), even after controlling for medical and social risk (p = 0.043), and had higher Communication scores on the Ages and Stages Questionnaire (p = 0.04) at 1-year corrected age, but this relationship failed to reach significance after controlling for medical and social risk (p = 0.12). CONCLUSION The SENSE program shows promise for improving outcomes, but more research with larger sample sizes is needed.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jessica Roussin
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | | | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Graham Colditz
- Department of Surgery, Washington University, St. Louis, MO, USA
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