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Culbreth R, Self-Brown S, Spratling R, Spears CA, Osborne MC, Melnyk BM. Adaptation of SafeCare, an evidence-based parenting program, for caregivers of infants in the neonatal intensive care unit. Appl Nurs Res 2024; 78:151817. [PMID: 39053997 DOI: 10.1016/j.apnr.2024.151817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 07/30/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND While there are several parenting programs for NICU caregivers, no studies, to our knowledge, have developed parenting programs aimed at preventing child maltreatment that specifically address these parental factors: parental stress, parental self-efficacy, and positive parent-infant interaction. OBJECTIVES The objectives of this study were to: 1) Identify adaptations and/or augmentations needed to optimize SafeCare® for NICU caregivers, and 2) Examine the acceptability and preliminary effects of the adapted SafeCare NICU (SCNC) program with NICU caregivers. METHODS This study consisted of two phases: formative (phase one) and pilot (phase two). For phase one, 5 NICU former caregivers and 5 NICU staff were interviewed to make relevant, NICU-specific adaptations for SCNC. Phase two consisted of a pilot study, where 13 current NICU caregivers were enrolled in the adapted SCNC program. Outcomes included acceptability and preliminary effects of parental stress, parental self-efficacy, and parent-infant interaction. RESULTS Adaptations to SafeCare consisted of adding a pre-session to discuss individualized experiences, incorporation of adjusted developmental milestones, a NICU-specific resource sheet, and individualized adaptations to activities based on relevant medical concerns. Out of the 13 participants, 8 completed SCNC (61.5 % retention rate). Participants indicated significant reductions in stress after SCNC (Parental stress index score = 61.7) compared to baseline (79.2, p = 0.02). Among participants who completed SCNC (n = 8), all stated they supported this program for implementation among NICU caregivers. DISCUSSION The adapted SCNC demonstrated acceptability among NICU caregivers.
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Affiliation(s)
- Rachel Culbreth
- American College of Medical Toxicology, 10645 N Tatum Blvd, Phoenix, AZ 85028-3068, USA; Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30302, USA.
| | - Shannon Self-Brown
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30302, USA
| | - Claire A Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Melissa C Osborne
- Wellstar College of Health and Human Services, Kennesaw State University, 520 Parliament Garden Way NW, MD 4102, Kennesaw, GA 30144, USA
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Li Y, Zhang J, Yang C, Xia B. Effects of maternal sound stimulation on preterm infants: A systematic review and meta‐analysis. Int J Nurs Pract 2022; 29:e13039. [PMID: 35187754 DOI: 10.1111/ijn.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/20/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the effects of maternal sound stimulation on preterm infants. BACKGROUND With an increased focus of studies on maternal sound stimulation for preterm infants, there is a need for an up-to-date systematic review and meta-analysis of randomized controlled trials to measure the effects of maternal sound stimulation on preterm infants. DESIGN A systematic review and meta-analysis. DATA SOURCES We searched PubMed, EMBASE, the Cochrane Library, CINAHL Complete, VIP Journal Integration Platform, China National Knowledge Infrastructure, Wanfang Data and China Biology Medicine disc from database establishment to 28 April 2021. REVIEW METHODS We conducted the meta-analysis using Review Manager 5.3. Integrative description was used for data that were not suitable for meta-analysis. RESULTS A total of 380 studies between 1979 and 2021 were retrieved and 26 were included in this systematic review. Maternal sound stimulation could significantly reduce the pain level and increase the comfort level of preterm infants during a painful procedure. Compared with routine care, maternal sound stimulation could help preterm infants achieve better physiological stability by reducing their heart rate and increasing their oxygen saturation. CONCLUSION Maternal sound stimulation is a feasible and effective intervention for preterm infants, which is highly recommended in the clinical setting.
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Affiliation(s)
- Yawei Li
- School of Health Sciences Wuhan University Wuhan China
- Henan Provincial Health Publicity and Education Center Zhengzhou China
| | - Jun Zhang
- School of Health Sciences Wuhan University Wuhan China
| | - Chao Yang
- School of Health Sciences Wuhan University Wuhan China
| | - Biying Xia
- Ruijin Hospital, School of Medicine Shanghai Jiaotong University Shanghai China
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York SJ, Rencken G, Ogunlana MO, Dawood A, Govender P. Expert opinions on knowledge-translation interventions for occupational therapists working with neonates in South Africa: A Delphi study. Health SA 2022; 27:1724. [PMID: 35281286 PMCID: PMC8905405 DOI: 10.4102/hsag.v27i0.1724] [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: 06/23/2021] [Accepted: 10/22/2021] [Indexed: 11/02/2022] Open
Abstract
Background Aim Setting Method Results Conclusion Contribution
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Affiliation(s)
- Samantha J. York
- Private, Samantha Campbell Occupational Therapy, Durban, South Africa
| | - Gina Rencken
- Department of Occupational Therapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Michael O. Ogunlana
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Physiotherapy, Federal Medical Centre Abeokuta, Ogun State, Nigeria
| | - Ayesha Dawood
- Department of Occupational Therapy, General Justice Gizenga Mpanza Regional Hospital, Durban, South Africa
| | - Pragashnie Govender
- Department of Occupational Therapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Héon M, Aita M, Lavallée A, De Clifford-Faugère G, Laporte G, Boisvert A, Feeley N. Comprehensive mapping of NICU developmental care nursing interventions and related sensitive outcome indicators: a scoping review protocol. BMJ Open 2022; 12:e046807. [PMID: 35105609 PMCID: PMC8808373 DOI: 10.1136/bmjopen-2020-046807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Neurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions have emerged as a philosophy of care aimed at protecting and enhancing preterm infant's development and promoting parental outcomes. In the past two decades, many authors have suggested DC models, core measures, practice guidelines and standards of care but outlined different groupings of interventions rather than specific interventions that can be used in NICU clinical practice. Moreover, as these DC interventions are mostly implemented by neonatal nurses, it would be strategic and valuable to identify specific outcome indicators to make visible the contribution of NICU nurses to DC. OBJECTIVES The overarching objective of this review is to identify the nature, range, and extent of the literature regarding DC nursing interventions for preterm infants in the NICU. The secondary twofold objectives are to highlight interventions that fall into identified categories of DC interventions and suggest nursing-sensitive outcome indicators related to DC interventions in the NICU. INCLUSION CRITERIA Papers reporting on or discussing a DC nursing intervention during NICU hospitalisation will be included. METHODS AND ANALYSIS The Joanna Briggs Institute's methodology for scoping reviews will be followed. CINAHL, MEDLINE, Embase, PubMed, Web of Science, Scopus, ProQuest and PsycInfo databases from 2009 to the present will be searched. Any type of paper, published in English or French, will be considered. Study selection and data extraction will be conducted by pairs of two review authors independently. A qualitative content analysis will be conducted. ETHICS AND DISSEMINATION No Institutional Review Board ethical approbation is needed. Results of this review will be presented in scientific meetings and published in refereed papers.
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Affiliation(s)
- Marjolaine Héon
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Quebec Network on Nursing Intervention Research/Réseau de Recherche en Interventions en Sciences Infirmières du Québec (RRISIQ), Montreal, Quebec, Canada
| | - Marilyn Aita
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Quebec Network on Nursing Intervention Research/Réseau de Recherche en Interventions en Sciences Infirmières du Québec (RRISIQ), Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Gwenaëlle De Clifford-Faugère
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Geneviève Laporte
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Boisvert
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- NICU, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Nancy Feeley
- Quebec Network on Nursing Intervention Research/Réseau de Recherche en Interventions en Sciences Infirmières du Québec (RRISIQ), Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
- Centre for Nursing Research and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Lee H, Park JH, Cho H. Analysis of research on developmentally supportive care for prematurity in neonatal intensive care unit: a scoping review. CHILD HEALTH NURSING RESEARCH 2022; 28:9-22. [PMID: 35172077 PMCID: PMC8858779 DOI: 10.4094/chnr.2022.28.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose The purpose of this study was to identify the gaps in research related to developmentally supportive care in the neonatal intensive care unit (NICU). The ultimate goal was to explore directions of further research on developmentally supportive care for premature patients. Methods The Arksey and O'Malley scoping review method was used. Articles on developmentally supportive care for preterm infants in the NICU, written in English or Korean, were identified through electronic search engines. A total of 279 papers were identified in the initial search, of which 22 full-text papers were included in this review. Results Several nursing studies have been published in the past 5 years. The important elements of developmentally supportive care were family-centered care and management of the NICU environment. The primary developmentally supportive care interventions were training programs to promote the care competency of NICU nurses. Conclusion It is necessary to actively develop comprehensive developmental support interventions that consider the various elements of developmentally supportive care for preterm infants. Additional studies should be done to develop programs that provide direct intervention for premature infant and their families.
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Affiliation(s)
- Hanna Lee
- Doctoral Candidate, Department of Nursing, Wonkwang University, Iksan ‧ Charge Nurse, Department of Nursing, Wonkwang University Hospital, Iksan, Korea
| | - Ji Hyeon Park
- Graduate Student, Department of Nursing, Wonkwang University, Iksan, Korea
| | - Haeryun Cho
- Associate Professor, Department of Nursing, Wonkwang University, Iksan, Korea
- Corresponding author Haeryun Cho Department of Nursing, Wonkwang University, 460 Iksn-daero, Iksan 54538, Korea TEL: +82-63-850-6020 FAX: +82-63-850-6060 E-MAIL:
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A Survey of Neonatal Nurses Perspectives on Voice Use and Auditory Needs with Premature Infants in the NICU. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168471. [PMID: 34444220 PMCID: PMC8393431 DOI: 10.3390/ijerph18168471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exposure to the voice and language during the critical period of auditory development associated with the third trimester is thought to be an essential building block for language. Differences in the auditory experience associated with early life in the NICU may increase the risk of language delays for premature infants. NICU nurses are fundamental in the care of premature infants; how they use their voices may be important in understanding auditory experiences in the NICU. This study examined voice use behaviors of NICU nurses in the United States and their current knowledge of early auditory development. METHOD An opt-in, online questionnaire. RESULTS Nurses reported using their voice more as the age of infants approached term gestation and speaking to infants was the most common type of voice use. Both infant and nurse factors influenced reported voice use decisions in the NICU. Nurses did not believe the NICU auditory environment to be sufficient to meet early auditory needs of premature infants but did believe that premature infants are exposed to adequate voice sounds. CONCLUSIONS A gap in knowledge regarding the importance of early exposure to voice sounds may be a barrier to nurses using their voices to support early auditory development.
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Raghupathy MK, Rao BK, Nayak SR, Spittle AJ, Parsekar SS. Effect of family-centered care interventions on motor and neurobehavior development of very preterm infants: a protocol for systematic review. Syst Rev 2021; 10:59. [PMID: 33602324 PMCID: PMC7890856 DOI: 10.1186/s13643-021-01612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, very preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born very preterm, family-centered care (FCC) might promote developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on the motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect infant development. METHODS Systematic review will be carried out by including (a) quasi-randomized controlled trials and randomized controlled trials (b) of very preterm born infants (born < 32 weeks of gestation), and their primary caregivers will be included in the review (c) who received FCC-based interventions such as collaborative interaction between a healthcare professional and a parent, home program, home visits, and parent education, and (d) measure motor and neurobehavioral function. Electronic databases such as Scopus, PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database-specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, a meta-analysis will be undertaken to assess the effect of the FCC on the motor and neurobehavior of premature infants. CONCLUSION The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings. SYSTEMATIC REVIEW REGISTRATION Protocol has been registered in PROSPERO on August 26, 2020.
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Affiliation(s)
- Manasa Kolibylu Raghupathy
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Bhamini Krishna Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - Shubha R Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Charafeddine L, Masri S, Sharafeddin SF, Kurdahi Badr L. Implementing NIDCAP training in a low-middle-income country: Comparing nurses and physicians' attitudes. Early Hum Dev 2020; 147:105092. [PMID: 32502945 DOI: 10.1016/j.earlhumdev.2020.105092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides developmentally supportive environment for preterm infants and their families. Few studies evaluated staff perceptions about NIDCAP implementation and its effect on infant and parents and working conditions. AIMS To assess the perception and experience of NICU staff during the NIDCAP implementation. STUDY DESIGN Cross-sectional anonymous online survey. SUBJECTS 57 NICU staff (29 nurses and 28 doctors) who were present at least one year prior to and during the implementation of NIDCAP training in a tertiary care center. OUTCOME MEASURES A standard questionnaire addressing attitude, perceived behavioral control, subjective norm, intention, behavior and NIDCAP impact related to NICU conditions was used after initiating developmental care activities and NIDCAP training in the unit from June 2014 to May 2018. RESULTS Forty-six doctors and nurses filled the questionnaire; they scored ≥3 out of 5 on all the questionnaire items. Nurses scored significantly higher than doctors (mean 4.00 ± 036) versus (3.57 ± 0.30) (p < 0.001) on the overall NIDCAP score. Specifically, nurses scores were significantly higher for attitude (p < 0.001), perceived behavioral control (p = 0.029); subjective norm (p = 0.011), intention (p = 0.024) and behavior (p < 0.001) questions. CONCLUSION The implementation of NIDCAP in a low-middle income country was perceived as a positive experience for both nurses and doctors: It was thought to have improved infant care and wellbeing as well as the staff relationship with parents, however working conditions remained a challenge. More studies are needed to address areas of improvement for implementation.
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Affiliation(s)
- Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut (AUB), Beirut, Lebanon.
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut (AUB), Beirut, Lebanon
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Küçük Alemdar D, İnal S. The Effect of Individualized Developmental Care Practices in Preterm Infants. Complement Med Res 2019; 27:97-104. [DOI: 10.1159/000504357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
Abstract
Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.
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Abstract
BACKGROUND Premature infants experience stressors such as external stimulation with sounds, light, touch, and open positioning in NICU that negatively affect outcomes. PURPOSE The purpose of this study was to measure the effectiveness of a developmental positioning intervention on length of stay, weight gain, and tone/flexion compared with neonates without structured positioning. METHODS Study design was quasi-experimental with nonequivalent groups. A retrospective chart review of 50 neonates with the inclusion criteria of 34 weeks of gestation or less and no anomalies provided a preintervention sample. After the education in-service on positioning, a convenience sample of 27 infants was enrolled. Infant Position Assessment Tool was used as a visual guide for positioning and scoring by the researcher for intervention fidelity. Hammersmith scoring was completed by the occupational therapist prior to discharge. FINDINGS The postintervention group was younger and sicker than the control group (P < .05). The postintervention sample (M = 7.05 where 7 = 29 to <30 weeks of gestation) was younger than the preintervention sample (M = 7.22). The postintervention sample was smaller (M = 1302.15 g) than the preintervention sample (M = 1385.94 g). Results showed that the postintervention group had clinically significant weight gain and mean Hammersmith score (3.28) was higher showing positioning positively affected tone and flexion scores. IMPLICATIONS FOR PRACTICE With greater structure and consistent attention to developmental positioning, outcomes are positively affected. IMPLICATIONS FOR FUTURE RESEARCH Further research with larger sample sizes will identify stronger associations and relationships between positioning and outcome measures.
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Rubio-Grillo MH. Performance of an occupational therapist in a neonatal intensive care unit. Colomb Med (Cali) 2019; 50:30-39. [PMID: 31168167 PMCID: PMC6536043 DOI: 10.25100/cm.v50i1.2600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/03/2017] [Accepted: 01/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The following article constitutes an effort to make explicit an experience in neonatology within the framework of the exercise of occupational therapy, a discipline belonging to the health sciences. The occupational therapist (OT) in the Neonatal Intensive Care Unit in which he participates in an interdisciplinary health group. Exalts the interaction of person-environment-occupation-performance. Encourage self-regulation of the baby. Encourages family participation in co-participation in routine activities. OBJECTIVE To determine the realities and knowledge about the practice of OT in the Neonatal Intensive Care Unit (NICU) by the occupational therapist in the interaction between the baby, the occupation, the caregivers and the environment of the NICU. METHODS A systematic exploratory review of the performance of the OT in the NICU was made. RESULTS The results transcended the thematic variables, the theories, the methods, the approaches, the characteristics of the baby, the occupations, and the contexts of the management of the premature baby. CONCLUSION The education in concepts concerning the occupation of the baby, the interaction with her/his environment and her/his caregivers, the procedures, the guide for the stimulation as the modification of the physical, temporal and social environment facilitate the self-regulation of the baby and we will all be working in pro of your recovery.
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Affiliation(s)
- María Helena Rubio-Grillo
- Universidad del Valle, Facultad de Salud, Escuela de Rehabilitación Humana, Grupo SINERGIA, Cali, Colombia
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Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran. J Pediatr Nurs 2019; 45:e79-e88. [PMID: 30630639 DOI: 10.1016/j.pedn.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/29/2018] [Accepted: 12/29/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU. DESIGN & METHODS A purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004). RESULTS Six themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver. CONCLUSIONS The findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers. PRACTICE IMPLICATIONS Health care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.
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Lejeune F, Brand L, Palama A, Parra J, Marcus L, Barisnikov K, Debillon T, Gentaz E, Berne‐Audéoud F. Preterm infant showed better object handling skills in a neonatal intensive care unit during silence than with a recorded female voice. Acta Paediatr 2019; 108:460-467. [PMID: 30144160 DOI: 10.1111/apa.14552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/11/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
Abstract
AIM This study compared whether preterm infants showed better tactile abilities during silence or when they heard a prerecorded female voice at different intensities. METHODS We studied 74 preterm infants of 28-35 weeks' postconceptional age who were admitted to a French neonatal intensive care unit from 2014 to 2017. They were presented with wooden objects, one smooth and one angled, at various points during silence (n = 26) or while listening to a female voice at +5 (n = 24) or +15 decibels (n = 24) inside their incubator. We compared the conditions to see if there was any difference in how the infants handled the objects and also compared familiar and unfamiliar objects. RESULTS The preterm infants showed better handling skills and only displayed effective discrimination, during silence. We found that 27.1% of the infants exposed to female voices failed to get habituated to the object, compared to 7.7% in the silence condition (p < 0.05) and success during the voice conditions required more trials (6.1 vs. 5.3) than the silence condition (p = 0.05). The different voice intensities made no difference. CONCLUSION Being exposed to a female voice had a negative impact on preterm infants' tactile sensory learning, regardless of its intensity.
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Affiliation(s)
- Fleur Lejeune
- Child Clinical Neuropsychology Unit FPSE University of Geneva Geneva Switzerland
- Sensorimotor, Affective and Social Development Unit FPSE University of Geneva Geneva Switzerland
| | - Laure‐Anne Brand
- Intensive and Regular Neonatal Care Unit CHRU Grenoble Grenoble France
| | - Amaya Palama
- Sensorimotor, Affective and Social Development Unit FPSE University of Geneva Geneva Switzerland
| | - Johanna Parra
- Intensive and Regular Neonatal Care Unit CHR Chambery Chambery France
| | - Leïla Marcus
- Intensive and Regular Neonatal Care Unit CHRU Grenoble Grenoble France
| | - Koviljka Barisnikov
- Child Clinical Neuropsychology Unit FPSE University of Geneva Geneva Switzerland
| | - Thierry Debillon
- Intensive and Regular Neonatal Care Unit CHRU Grenoble Grenoble France
| | - Edouard Gentaz
- Sensorimotor, Affective and Social Development Unit FPSE University of Geneva Geneva Switzerland
- CNRS Grenoble France
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Borges Nery P, Snider L, Camelo JS, Zachary B, Fatima K, Jessica G, Annette M. The Role of Rehabilitation Specialists in Canadian NICUs: A 21st Century Perspective. Phys Occup Ther Pediatr 2019; 39:33-47. [PMID: 30265831 DOI: 10.1080/01942638.2018.1490846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
UNLABELLED Rehabilitation specialists are an integral part of the team in the neonatal intensive care unit (NICU). New approaches to rehabilitation practice in the NICU have evolved over the past decade that aim to promote child health and development. AIMS The aim of this study was to describe the current roles of the occupational therapist (OT), physical therapist (PT) and speech-language pathologist (SLP) in Canadian NICUs as compared to the roles documented in an earlier national survey conducted 15 years ago. METHODS A telephone survey was conducted across Canadian NICUs and each telephone interview was recorded by a research assistant. In total, 42 questionnaires were completed across 25 health care institutions. RESULTS Eighty percent of the PT, 93.7% of OT and 50% of SLP provided direct services to neonates in the NICU. The results demonstrated that the therapists were involved with case discussion (85.7%), decision-making (97.6%), referrals to other services (97.6%) and discharge planning (97.6%). Splinting (87.5%) and feeding (100%) were most often carried out by OT, whereas chest physiotherapy (65%) and range of motion (100%) were predominantly provided by PT. Changes in the role of rehabilitation specialists over the last decade predominantly included enhanced collaboration with the NICU team, more frequent use of standardized outcome measures and use of interventions supported by evidence. CONCLUSION In comparison with results of the previous survey of rehabilitation practices in Canadian NICUs, rehabilitation specialists now have more dedicated time in the NICU and more frequently use standardized measures and apply interventions that are supported by recent scientific studies.
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Affiliation(s)
- Pamela Borges Nery
- a Department of Pediatrics , Ribeirão Preto Medical School University of São Paulo , São Paulo , Brazil.,b Centro Universitário Estácio de Ribeirão Preto , Ribeirão Preto , Brazil
| | - Laurie Snider
- c School of Physical & Occupational Therapy , McGill University , Montreal , QC , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , QC , Canada.,e Research Institute-McGill University Health Centre and Montreal Children?s Hospital , Montreal , QC , Canada
| | - José Simon Camelo
- a Department of Pediatrics , Ribeirão Preto Medical School University of São Paulo , São Paulo , Brazil
| | - Boychuck Zachary
- c School of Physical & Occupational Therapy , McGill University , Montreal , QC , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , QC , Canada.,e Research Institute-McGill University Health Centre and Montreal Children?s Hospital , Montreal , QC , Canada
| | - Khodary Fatima
- c School of Physical & Occupational Therapy , McGill University , Montreal , QC , Canada
| | - Goldschleger Jessica
- c School of Physical & Occupational Therapy , McGill University , Montreal , QC , Canada
| | - Majnemer Annette
- c School of Physical & Occupational Therapy , McGill University , Montreal , QC , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , QC , Canada.,e Research Institute-McGill University Health Centre and Montreal Children?s Hospital , Montreal , QC , Canada
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Abstract
BACKGROUND Individualized developmental care (IDC) is a collection of evidence-based practices that include adapting care practices based on the infant's behavioral and developmental state, involving parents and families in the infant's care, and providing an environment that minimizes over stimulation of the infant. PURPOSE To clarify the definition of IDC in the neonatal intensive care unit (NICU) and to provide guidelines for implementation of IDC for healthcare professionals through a concept analysis. METHOD/SEARCH STRATEGY A literature review involving a search of multiple electronic databases from January 1982 to November 2016 was performed along with presentation of a model case and attributes of IDC. CONCLUSIONS This concept analysis defines and provides guidelines for implementing an individualized developmentally sound environment for infants born premature and their families. IMPLICATIONS FOR PRACTICE All NICUs need to strive to provide an environment that supports and promotes IDC. Education needs to be provided to healthcare providers and parents regarding IDC practices. IMPLICATIONS FOR RESEARCH Further research into short- and long-term outcomes of IDC is needed. Research into whether IDC is being implemented by NICUs is also needed.
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Early Initiation of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduces Length of Stay: A Quality Improvement Project. J Pediatr Nurs 2017; 32:59-63. [PMID: 27923536 DOI: 10.1016/j.pedn.2016.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 10/22/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022]
Abstract
Infants born at ≤32weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization. Half (50.6%) of the infants admitted to this 84-bed Level IV Neonatal Intensive Care Unit (NICU) with a gestational age of ≤32weeks were referred for NIDCAP. The specific aims of this quality improvement project were to 1) compare the age at discharge for infants meeting inclusion criteria enrolled in NIDCAP with the age at discharge for those eligible infants not enrolled in NIDCAP; and 2) investigate the timing of initiation of NIDCAP (e.g., within six days of admission) on age at discharge. During the 12month period of data collection, infants enrolled in NIDCAP (M=27.85weeks, SD=1.86) were 2.02weeks younger than those not enrolled in NIDCAP (M=29.87weeks, SD=2.49), and were 2.32weeks older at discharge (M=38.28weeks, SD=5.10) than those not enrolled in NIDCAP (M=35.96weeks, SD=5.60). Infants who enrolled within 6days of admission were discharged an average of 25days sooner (p=0.055), and at a younger post-menstrual age (by 3.33weeks on average), than those enrolled later (p=0.027).
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Nelson AM, Bedford PJ. Mothering a Preterm Infant Receiving NIDCAP Care in a Level III Newborn Intensive Care Unit. J Pediatr Nurs 2016; 31:e271-82. [PMID: 26883058 DOI: 10.1016/j.pedn.2016.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED The purpose of the study is to describe the unique meaning and significance of the essential elements of mothering a preterm infant receiving Newborn Individualized Developmental Care and Assessment Program (NIDCAP) care in a level III NICU. The overall aim was to promote an increased understanding among healthcare practitioners of the experience of this group of women. DESIGN AND METHODS The authors utilized an existential-phenomenologic method to investigate the experience of 7 mothers of a preterm infant 30weeks gestation or less at birth. RESULTS Analysis of interview transcripts revealed one overarching theme, parenting with permission, and three essential themes with nine underlying subthemes: choosing to participate (subthemes: managing, settling in, making friends), dealing with people (subthemes: meeting needs, facing judgment, and recognizing not everyone is 'on board,' and coming to feel like a mother (subthemes: overcoming fear, gaining understanding, and feeling empowered). CONCLUSIONS/PRACTICE IMPLICATIONS Mothers universally praised NIDCAP for the education and support it provided them. However findings also suggest that great sensitivity and patience is required by professionals to assist mothers to overcome their fear, gain confidence, and participate in NIDCAP without feeling judged. In addition private rooms were found to hold great significance for mothers and should be maintained for the entire hospitalization whenever possible. Finally, ongoing NIDCAP education/support for staff and regular team meetings to discuss and problem-solve concerns are suggested. This might address inconsistent adherence to the NIDCAP care plan by some nurses, which is the greatest source of maternal conflict and frustration.
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Affiliation(s)
| | - Pamela J Bedford
- Pediatric Services, Elliot Health System, New Hampshire's Hospital for Children, Manchester, NH
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Cardin AD, Rens L, Stewart S, Danner-Bowman K, McCarley R, Kopsas R. Neuroprotective Core Measures 1–7: A Developmental Care Journey: Transformations in NICU Design and Caregiving Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhang X, Lee SY, Chen J, Liu H. Factors Influencing Implementation of Developmental Care Among NICU Nurses in China. Clin Nurs Res 2014; 25:238-53. [PMID: 25155801 DOI: 10.1177/1054773814547229] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main aim of this article is to describe current developmental care nursing practices among registered nurses (RNs) working in neonatal intensive care units (NICUs) in China and to explore selected personal and unit characteristics related to developmental care implementation. A convenience sample of 207 RNs participated in this descriptive, cross-sectional exploratory study. A tool of Practice Standards for Individualized, Family-Centered Developmental Care was used to collect the data. The findings indicate that Chinese NICU nurses are not implementing developmental care consistently. Higher patient caseloads, fewer work hours per day, higher level of education, and fewer years worked in NICUs are the significant predictors for lower implementation of developmental care. NICU nurses in China currently carry out developmental care based mainly on their accumulated clinical experience rather than their educational experience. More systematic developmental care training for NICU nurses and more support at both unit and hospital levels are necessary in China.
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Affiliation(s)
- Xin Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shih-Yu Lee
- Hungkuang University, Taiwan, Republic of China
| | - Jingli Chen
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huaping Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Maitra K, Park HY, Eggenberger J, Matthiessen A, Knight E, Ng B. Difficulty in Mental, Neuromusculoskeletal, and Movement-Related School Functions Associated With Low Birthweight or Preterm Birth: A Meta-Analysis. Am J Occup Ther 2014; 68:140-8. [DOI: 10.5014/ajot.2014.009985] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. Our objective was to perform a meta-analysis to investigate whether low birthweight (LBW) or preterm birth was associated with difficulty in mental, neuromusculoskeletal, and movement-related school function tasks.
METHOD. Two search strategies produced 40 studies that met the inclusion criteria for the meta-analysis and yielded 549 effect sizes (d). Heterogeneity was evaluated by obtaining Q and I-squared values. Egger’s regression intercept test and a funnel plot were used to check for publication bias.
RESULTS. Children born LBW exhibited considerable difficulties in mental (d = −0.655, p < .0001) and neuromusculoskeletal and movement-related tasks (d = −0.391, p < .0001) compared with children of normal birthweight. Children born preterm also exhibited significant difficulties compared with full-term children in mental, neuromusculoskeletal, and movement-related tasks (d = −0.237, p < .0001).
CONCLUSION. Deficits in mental and motor functions in children born LBW or preterm appear to have significant effects on school readiness and academic achievement.
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Affiliation(s)
- Kinsuk Maitra
- Kinsuk Maitra, PhD, OTR/L, is Chair and Professor, Department of Occupational Therapy, College of Nursing and Health Sciences, Florida International University, 11200 SW Eighth Street, MMC, AHC3 443, Miami, FL 33199;
| | - Hae Yean Park
- Hae Yean Park, PhD, OT, is Postdoctoral Fellow, Department of Occupational Therapy, Florida International University, Miami
| | - Jaime Eggenberger
- Jaime Eggenberger, Erin Knight, and Betty Ng are Students, Department of Occupational Therapy, Florida International University, Miami
| | - Angela Matthiessen
- Jaime Eggenberger, Erin Knight, and Betty Ng are Students, Department of Occupational Therapy, Florida International University, Miami
| | - Erin Knight
- Jaime Eggenberger, Erin Knight, and Betty Ng are Students, Department of Occupational Therapy, Florida International University, Miami
| | - Betty Ng
- Angela Matthiessen, MSOT, OTR/L, is Director, CreatAbility, Inc., Atlanta, GA
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Burguet A, Menget A, Chary-Tardy AC, Savajols E, Abed N, Thiriez G. [Variables determining the amount of care for very preterm neonates: the concept of medical stance]. Arch Pediatr 2013; 21:134-41. [PMID: 24355651 DOI: 10.1016/j.arcped.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/18/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the amount of medical interventions on very preterm neonates (24-31 weeks of gestation) in two French university tertiary care centers, one of which is involved in a Neonatal Developmental Care program. A secondary objective is to assess whether this difference in medical interventions can be linked to a difference in mortality and morbidity rates. METHODS We prospectively included all very preterm neonates free from lethal malformation born live in these two centers between 2006 and 2010. These inclusion criteria were met by 1286 patients, for whom we compared the rate of five selected medical interventions: birth by caesarean section, chest intubation in the delivery room, surfactant therapy, pharmacological treatment of patent ductus arteriosus, and red blood cell transfusion. RESULTS The rates of the five medical interventions were systematically lower in the center that is involved in Neonatal Developmental Care. There was no significant difference in survival at discharge with no severe cerebral ultrasound scan abnormalities between the two centers. There were, however, significantly higher rates of bronchopulmonary dysplasia and nosocomial sepsis and longer hospital stays when the patients were not involved in a Neonatal Developmental Care program. DISCUSSION This benchmarking study shows that in France, in the first decade of the 21st century, there are as many ways to handle very preterm neonates as there are centers in which they are born. This brings to light the concept of medical stance, which is the general care approach prior to the treatment itself. This medical stance creates the overall framework for the staff's decision-making regarding neonate care. The different parameters structuring medical stance are discussed. Moreover, this study raises the problematic issue of the aftermath of benchmarking studies when the conclusion is an increase of morbidity in cases where procedure leads to more interventions.
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Affiliation(s)
- A Burguet
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France; Inserm-UMR S 953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, hôpital Cochin, 75014 Paris, France; UMPC université Paris 06, UMR S 953, 75005 Paris, France.
| | - A Menget
- Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France
| | - A-C Chary-Tardy
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - E Savajols
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - N Abed
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - G Thiriez
- Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France
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Kardaş Özdemir F, Güdücü Tüfekci F. The effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants: the effect of mother's scent and flexion position. J Clin Nurs 2013; 23:3036-44. [DOI: 10.1111/jocn.12407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Fatma Güdücü Tüfekci
- Pediatric Nursing Department; Health Science Faculty; Atatürk University; Erzurum Turkey
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Heemskerk AM, Leemans A, Plaisier A, Pieterman K, Lequin MH, Dudink J. Acquisition guidelines and quality assessment tools for analyzing neonatal diffusion tensor MRI data. AJNR Am J Neuroradiol 2013; 34:1496-505. [PMID: 23518355 DOI: 10.3174/ajnr.a3465] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diffusion tensor imaging is a valuable measure in clinical settings to assess diagnosis and prognosis of neonatal brain development. However, obtaining reliable images is not straightforward because of the tissue characteristics of the neonatal brain and the high likelihood of motion artifacts. In this review, we present guidelines on how to acquire DTI data of the neonatal brain and recommend high-quality data acquisition and processing as an essential means to obtain accurate and robust parametric maps. Sudden head movements are problematic for DTI in neonates, and these may lead to incorrect values. We describe strategies to minimize the corrupting effects both in terms of acquisition (eg, more gradient directions) and postprocessing (eg, tensor estimation methods). In addition, tools are described that can help assess whether a dataset is of sufficient quality for further assessment.
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Affiliation(s)
- A M Heemskerk
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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Ohlsson A, Jacobs SE. NIDCAP: a systematic review and meta-analyses of randomized controlled trials. Pediatrics 2013; 131:e881-93. [PMID: 23420913 DOI: 10.1542/peds.2012-2121] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The "synactive" theory of neurobehavioral development forms the basis of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Our objective was to assess the effectiveness of NIDCAP in improving outcomes in preterm infants. METHODS Medline, CINAHL, Embase, PsychInfo, The Cochrane Library, Pediatric Academic Societies' Abstracts and Web of Science were searched in July 2010 and February 2012. The studies selected were randomized controlled trials testing the effectiveness of NIDCAP on medical and neurodevelopmental outcomes. The authors abstracted baseline characteristics of infants and outcomes. The risk of bias was assessed by using Cochrane criteria. RevMan 5.1 was used to synthesize data by the use of relative risk and risk difference for dichotomous outcomes and mean or standardized mean difference for continuous outcomes. RESULTS Eleven primary and 7 secondary studies enrolling 627 neonates were included, with 2 of high quality. The composite primary outcomes of death or major sensorineural disability at 18 months corrected age or later in childhood (3 trials, 302 children; relative risk 0.89 [95% confidence interval 0.61 to 1.29]) and survival free of disability at 18 months corrected age or later in childhood (2 trials, 192 infants; relative risk 0.97 [95% confidence interval 0.69 to 1.35]), were not significantly different between the NIDCAP and control groups. With the sensitivity analysis that excluded the 2 statistically heterogeneous outlying studies, there were no significant differences between groups for short-term medical outcomes. CONCLUSIONS This systematic review including 627 preterm infants did not find any evidence that NIDCAP improves long-term neurodevelopmental or short-term medical outcomes.
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Affiliation(s)
- Arne Ohlsson
- Department of Paediatrics, University of Toronto, Ontario, Canada.
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Abstract
PURPOSE The purpose of this case report was to determine how current physical therapy (PT) practice in the neonatal intensive care unit (NICU), with 1 infant, adhered to the neonatal PT decision-making framework that was developed as part of the NICU practice guidelines for clinical care. SUMMARY OF KEY POINTS Most PT interventions implemented in this NICU were supported by the algorithm, with some steps more readily implemented than others. CONCLUSIONS This case report highlights the utility of the NICU clinical decision-making algorithm for not only assisting with developing an evidence-based PT plan of care for an infant at high risk but also its usefulness in revealing NICU programmatic and policy strengths and areas for improvement. RECOMMENDATIONS FOR CLINICAL PRACTICE The NICU developmental and therapeutic teams are encouraged to conduct similar endeavors to assess the quality of PT care in their NICUs.
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Marcus L, Lejeune F, Berne-Audéoud F, Gentaz E, Debillon T. Tactile sensory capacity of the preterm infant: manual perception of shape from 28 gestational weeks. Pediatrics 2012; 130:e88-94. [PMID: 22732168 DOI: 10.1542/peds.2011-3357] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Recent studies have shown that from the postconceptional age of 33 weeks, preterm infants are able to memorize tactile information about the shape of an object by using their hands, and can detect differences with another shape. This study aimed to investigate tactile abilities earlier on in development, in very preterm and mildly preterm human infants. METHODS Infants were assigned to 2 groups according to postconceptional age: very preterm (before 32 weeks) and mildly preterm (from 32 to 33+6 weeks). The test consisted of the repeated presentation of an object (prism or cylinder) in the left hand. The experiment was conducted in 3 phases: habituation (repeated presentation of the same object), discrimination (presentation of a novel object), followed by recognition (presentation of the familiar object). RESULTS Forty-eight newborns were recruited (24 very preterm; 24 mildly preterm). During habituation, each infant showed a decrease in the holding time of the object. Then, when a novel shape was put into the preterm newborn's hand, holding time increased. Finally, when the familiar shape was presented again, the holding time decreased. Preterm infants can memorize by touch specific features that differentiate prism and cylinder shapes, discriminate between them, and recognize them after interference. CONCLUSIONS From 28 weeks, and from the first days of life, the preterm newborn is endowed with tactile sensory capacities. The tactile stimulations that are presented to preterm infants during their hospitalization should be adapted while respecting their sleep-wake rhythms.
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Affiliation(s)
- Leïla Marcus
- Service de Médecine et de Réanimation Néonatale, Hôpital Couple Enfant, Grenoble, France.
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Abstract
BACKGROUND Cerebral MRI performed on preterm infants at term-equivalent 30 weeks' gestational age (GA) is increasingly performed as part of standard clinical care. OBJECTIVE We evaluated safety of these early MRI procedures. MATERIALS AND METHODS We retrospectively collected data on patient safety of preterm infants who underwent early MRI scans. Data were collected at fixed times before and after the MRI scan. MRI procedures were carried out according to a comprehensive guideline. RESULTS A total of 52 infants underwent an MRI scan at 30 weeks' GA. Although no serious adverse events occurred and vital parameters remained stable during the procedure, minor adverse events were encountered in 26 infants (50%). The MRI was terminated in three infants (5.8%) because of respiratory instability. Increased respiratory support within 24 h after the MRI was necessary for 12 infants (23.1%) and was significantly associated with GA, birth weight and the mode of respiratory support. Hypothermia (core temperature < 36°C) occurred in nine infants (17.3%). Temperature dropped significantly after the MRI scan. CONCLUSION Minor adverse events after MRI procedures at 30 weeks GA were common and should not be underestimated. A dedicated and comprehensive guideline for MRI procedures in preterm infants is essential.
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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.
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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.
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