Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age. The effects of alternative positioning on preterm infants in the neonatal intensive care unit: a randomized clinical trial. Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. Effect of an early intervention programme on low birthweight infants with cerebral injuries. Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects. Good two-year outcome for parents whose infants were admitted to a neonatal intensive care unit. How Satisfied Are Parents Supported by Nurses With the NIDCAP® Model of Care for Their Preterm Infant? Reducing Premature Infants' Length of Stay and Improving Parents' Mental Health Outcomes With the Creating Opportunities for Parent Empowerment (COPE) Neonatal Intensive Care Unit Program: A Randomized, Controlled Trial The effectiveness of music on pain among preterm infants in the neonatal intensive care unit: a systematic review Invasive antenatal procedures and requirement for neonatal intensive care unit admission Persistent Beneficial Effects of Breast Milk Ingested in the Neonatal Intensive Care Unit on Outcomes of Extremely Low Birth Weight Infants at 30 Months of Age Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit. A quasi-experimental trial on individualized, developmentally supportive family-centered care. Patterned feeding experience for preterm infants: study protocol for a randomized controlled trial Breast‐fed Low‐birth‐weight Premature Neonates: Developmental Assessment and Nutritional Intake in the First 6 Months of Life Effects of nesting and swaddling on the sleep duration of premature infants hospitalized in neonatal intensive care units Individualized Developmental Care for Very-Low-Birth-Weight Premature Infants Mothers' different styles of involvement in preterm infant pain care. Parents' report of sensory responsiveness and temperament in preterm infants. Hospital-based case management for medically fragile infants: results of a randomized trial. Consistent Management of Repeated Procedural Pain With Sucrose in Preterm Neonates: Is It Effective and Safe for Repeated Use Over Time? Mother-newborn contact in a randomized trial of kangaroo (skin-to-skin) care.
BACKGROUND To determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years . METHODS A prospect i ve phase-lag study was performed at an Austrian neonatal intensive care unit ( NICU ) . From January 2003 to December 2005 ( study period of conventional care ) and January 2007 to December 2009 ( study period of developmental care ) , we enrolled all infants born in Tyrol at less than 32 weeks of gestation . During this period a total of 261 of 359 preterm infants ( participation rate 72.7 % ) completed the follow-up visit at 2 years of age ; there were 124 children in the conventional and 137 in the developmental care group . The association between developmental care and delayed motor or mental development ( Bayley Scales of Infant Development II ; psychomotor or mental developmental index < 85 ) was analyzed by means of logistic regression analysis at a corrected age of 24 months . RESULTS Children in the developmental care group showed less psychomotor delay than did those in the control group ( developmental care group : 16.1 % , conventional care group 27.4 % ; adjusted odds ratio 0.37 [ 95 % confidence interval : 0.19 - 0.74 ] , P=0.005 ) . Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age . Regarding cognitive outcome , no significant difference was observed between these two groups . CONCLUSION Our data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants There is a paucity of studies that have investigated the developmental benefits of positioning in the neonatal intensive care unit . The purpose of this study was to investigate the effects of a new , alternative positioning device compared to traditional positioning methods used with preterm infants . In this r and omized , blinded clinical trial , one hundred preterm infants ( born ≤ 32 weeks gestation ) from a level III neonatal intensive care unit in the United States were enrolled at birth . Participants were r and omized to be positioned in the alternative positioning device or to traditional positioning methods for their length of stay in the neonatal intensive care unit . Infants were assessed using the NICU Network Neurobehavioral Scale between 35 - 40 weeks postmenstrual age . Clinical and feeding outcomes were also captured . Linear and logistic regressions were used to investigate differences in neurobehavioral outcome , feeding performance , and medical outcomes . Infants in the alternative positioning arm of the study demonstrated less asymmetry of reflex and motor responses on the NICU Network Neurobehavioral Scale ( p=0.04 ; adjusted mean difference=0.90 , 95 % CI 0.05 - 1.75 ) than those positioned using traditional positioning methods . No other significant differences were observed . Reduction in asymmetry among preterm infants is an important benefit of alternative positioning , as symmetrical movement and responses are crucial for early development . However , it will be important to follow this sample of preterm infants to determine the effects of early positioning on neurodevelopmental outcome in childhood BACKGROUND Acute pain is a significant stressor for preterm infants in neonatal intensive care units ( NICU ) ; however , little is known about the effects of acute pain on subsequent motor responses during clusters of tactile h and ling . AIMS ( 1 ) To compare facial , body and heart rate reactivity in preterm infants at 32 weeks gestational age ( GA ) during routine care-giving tasks following a rest period ( RCC : diapering , measuring abdominal girth and axillary temperature , mouth care ) with their responses to Clustered Care following blood collection ( PCC ) . ( 2 ) To examine how GA at birth affects patterns of stress and self-regulatory behaviors during RCC and PCC . STUDY DESIGN Within-group crossover design ( r and om order ) . SUBJECTS Preterm infants , N=54 ( mean GA at birth 29.3 + /- 2.2 weeks ; mean birth weight 1257 + /- 423 g ) were assessed at 32 weeks GA in the NICU . OUTCOME MEASURES The Newborn Developmental Care and Assessment Program ( NIDCAP ) and Neonatal Facial Coding System ( NFCS ) were coded from continuous bedside video recordings . Changes in mean heart rate ( HR ) were computed using custom physiologic software . RESULTS All infants had heightened facial , body and HR responses when CC followed a painful procedure compared to when they had not been h and led prior to CC . Infants born at earlier GA ( < 30 weeks ) had equal numbers of stress cues during RCC and PCC , but dampened self-regulatory behaviors during PCC . CONCLUSION Prior pain induces heightened biobehavioral reactivity in preterm infants during subsequent tactile procedures . In addition , clustering care is particularly stressful for infants born at earlier GA OBJECTIVE To evaluate associations between neonatal intensive care unit ( NICU ) room type ( open ward and private room ) and medical outcomes ; neurobehavior , electrophysiology , and brain structure at hospital discharge ; and developmental outcomes at 2 years of age . STUDY DESIGN In this prospect i ve longitudinal cohort study , we enrolled 136 preterm infants born < 30 weeks gestation from an urban , 75-bed level III NICU from 2007 - 2010 . Upon admission , each participant was assigned to a bedspace in an open ward or private room within the same hospital , based on space and staffing availability , where they remained for the duration of hospitalization . The primary outcome was developmental performance at 2 years of age ( n = 86 infants returned for testing , which was 83 % of survivors ) measured using the Bayley Scales of Infant and Toddler Development , 3rd Edition . Secondary outcomes were : ( 1 ) medical factors throughout the hospitalization ; ( 2 ) neurobehavior ; and ( 3 ) cerebral injury and maturation ( determined by magnetic resonance imaging and electroencephalography ) . RESULTS At term equivalent age , infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores ( P = .02 ; β = -0.52 [ CI -0.95 , -0.10 ] ) . At age 2 years , infants from private rooms had lower language scores ( P = .006 ; β = -8.3 [ CI -14.2 , -2.4 ] ) and a trend toward lower motor scores ( P = .02 ; β = -6.3 [ CI -11.7 , -0.99 ] ) , which persisted after adjustment for potential confounders . CONCLUSION These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment OBJECTIVE To determine the effect of an early intervention programme ( EIP ) on low birthweight infants with cerebral injuries . METHODS Subjects were 23 high-risk low birthweight infants ( periventricular leukomalacia 15 , intraventricular haemorrhage 5 , both 3 ) receiving care in the neonatal intensive care unit ( NICU ) at Nagasaki University Hospital . Subjects were r and omly assigned to the EIP  group ( n = 12 ) or the control group  ( n = 11 ) . Participants in the EIP group received a Neonatal Behavioral Assessment scale (NBAS)-based intervention combined with developmental support design ed to enhance the infants ' development and the quality of the parent-infant relationship . The control group received routine medical nursing care without the EIP . The EIP began prior to discharge from the NICU and lasted until 6 months of corrected age . All children were examined on the NBAS preintervention and again at 44 weeks postconceptional age . Maternal anxiety status ( STAI ) and maternal feelings of confidence in dealing with her baby ( LCC ) were measured pre and postintervention . Mental and motor development was assessed postintervention using the Bayley Scale of Infant Development . RESULTS Orientation and State Regulation of infant behavioural profiles , the STAI and LCC scores significantly improved in the EIP group ( mean difference ( 95 % CI ) : Orientation 0.7 ( 0.4 , 1.1 ) , State Regulation 0.9 ( 0.3 , 1.5 ) , STAI -5.5 ( - 9.1 , -1.9 , LCC 5.3 ( 4.2 , 6.5 ) ) , but not in the control group . Bayley mental developmental index ( MDI ) score in the EIP group was higher than in the control group , but there was no significant difference between the two groups ( mean difference ( 95 % CI ) : MDI 8.5 ( - 0.8 , 17.8 ) , PDI 6.7 ( - 1.9 , 15.4 ) ) . CONCLUSION The EIP has beneficial effects on neonatal neurobehavioural development and maternal mental health of low birthweight infants with cerebral injuries . This evidence suggests that short-term changes in maternal mental health and infant neurobehaviour promoted by an EIP may serve to initiate a positive interaction between parents and infants OBJECTIVE To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants . DESIGN R and omized controlled trial . SETTING Newborn intensive care unit . PATIENTS Thirty-eight singleton preterm infants , free of known congenital abnormalities , weighing less than 1250 g , born before 30 weeks ' gestation , mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours , r and omly assigned to a control or an experimental group . INTERVENTION Caregiving by nurses specifically trained in individualized developmental care ; observation and documentation of the infants ' behavior within 12 hours of admission , and subsequently every 10th day ; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists ; and the availability of special caregiving accessories . MAIN OUTCOME MEASURES Medical outcome , including average daily weight gain ; number of days the infant required mechanical ventilation , oxygen , gavage tube feeding , and hospitalization ; severity of retinopathy of prematurity , bronchopulmonary dysplasia , pneumothorax , and intraventricular hemorrhage ; pediatric complications ; age at discharge ; and hospital charges . Neurodevelopmental outcome , including Assessment of Preterm Infants ' Behavior scale and quantified electroencephalography ( 2 weeks after due date ) ; and Bayley Scales of Infant Development and Kangaroo Box Paradigm ( 9 months after due date ) . RESULTS The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support ; earlier oral feeding ; reduced incidence of intraventricular hemorrhage , pneumothorax , and severe bronchopulmonary dysplasia ; improved daily weight gain ; shorter hospital stays ; younger ages at hospital discharge ; and reduced hospital charges compared with the infants in the control group . At 2 weeks after their due date s , these infants also showed improved autonomic regulation , motor system functioning , self-regulatory abilities , and visual evoked potential measures ; and at 9 months , they had improved Bayley Mental and Psychomotor Developmental Index scores , as well as Kangaroo Box Paradigm scores . CONCLUSION Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome OBJECTIVE To evaluate the psychological functioning in parents whose infants were admitted to a neonatal intensive care unit ( NICU ) over the first 2 years of the infant 's life . METHODS Prospect i ve 2-year follow-up study of a r and om selection of NICU and control families . At baseline , 9 months , and 2 years , all parents received a clinical interview . Infants underwent a pediatric examination and Bayley II neurodevelopmental assessment at 2 years . Psychological distress is defined as having one or more of the following criteria : any psychiatric diagnosis on the Mini-International Neuropsychiatric Interview at 2 years ; Edinburgh Post Natal Depression Scale score more than 12.5 at 2 years ; Hospital Anxiety and Depression Scale score more than 11.0 at 2 years , receiving treatment with antidepressants/psychotherapy/counselling over the previous 15 months . RESULTS Overall , 300 families of infants admitted to a NICU and 120 control families were approached to take part in the study . There was no difference in psychological distress in NICU parents ( 30.8 % ) vs control parents ( 28.2 % ) . In fathers , there was no relationship between psychological distress and infant development measured using the Bayley II . In mothers , there was a relationship between psychological distress and the child 's mental development , which was most significant in infants with severe developmental delay . CONCLUSIONS There are no significant long-term negative psychological effects on parents whose infants were admitted to a NICU . Should interventions for parents be offered , they should focus on mothers whose infants are likely to have significant mental health development problems whether or not their infant is admitted to a NICU The main purpose of implementing the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ® ) in our neonatal intensive care unit from the perspective of quality of care was to bring about an improvement in the satisfaction of parents .  This was measured by means of the NICU-Parent Satisfaction Form and the Nurse Parent Support Tool .  Parents  were significantly more satisfied with care given according to NIDCAP ® principles than they were with the traditional care for their premature born babies OBJECTIVE . Although low birth weight premature infants and parents are at high risk for adverse health outcomes , there is a paucity of studies that test early NICU interventions with parents to prevent the development of negative parent-infant interaction trajectories and to reduce hospital length of stay . Our objective was to evaluate the efficacy of an educational-behavioral intervention program ( ie , Creating Opportunities for Parent Empowerment ) that was design ed to enhance parent-infant interactions and parent mental health outcomes for the ultimate purpose of improving child developmental and behavior outcomes . DESIGN , SETTING , AND PARTICIPANTS . A r and omized , controlled trial was conducted with 260 families with preterm infants from 2001 to 2004 in 2 NICUs in the northeast United States . Parents completed self-administered instruments during hospitalization , within 7 days after infant discharge , and at 2 months ' corrected age . Blinded observers rated parent-infant interactions in the NICU . INTERVENTION . All participants received 4 intervention sessions of audiotaped and written material s. Parents in the Creating Opportunities for Parent Empowerment program received information and behavioral activities about the appearance and behavioral characteristics of preterm infants and how best to parent them . The comparison intervention contained information regarding hospital services and policies . MAIN OUTCOME MEASURES . Parental stress , depression , anxiety , and beliefs ; parent-infant interaction during the NICU stay ; NICU length of stay ; and total hospitalization were measured . RESULTS . Mothers in the Creating Opportunities for Parent Empowerment program reported significantly less stress in the NICU and less depression and anxiety at 2 months ' corrected infant age than did comparison mothers . Blinded observers rated mothers and fathers in the Creating Opportunities for Parent Empowerment program as more positive in interactions with their infants . Mothers and fathers also reported stronger beliefs about their parental role and what behaviors and characteristics to expect of their infants during hospitalization . Infants in the Creating Opportunities for Parent Empowerment program had a 3.8-day shorter NICU length of stay ( mean : 31.86 vs 35.63 days ) and 3.9-day shorter total hospital length of stay ( mean : 35.29 vs 39.19 days ) than did comparison infants . CONCLUSIONS . A reproducible educational-behavioral intervention program for parents that commences early in the NICU can improve parent mental health outcomes , enhance parent-infant interaction , and reduce hospital length of stay Review question / objective The objective of this review is to synthesize the best available evidence related to the effectiveness of music as pain relieving method among preterm infants during painful procedures in the neonatal intensive care unit . Review questions are : Among preterm infants in the neonatal intensive care unit , is music effective in reducing pain scores ? physiological pain indicators ? behavioural pain indicators ? hormonal pain indicators ? Background Patients and context Preterm infants ( i.e. babies born at or before 37 gestational weeks ) compose a patient group of the most vulnerable to pain . Infants treated in a neonatal intensive care unit ( NICU ) are exposed to a variety of painful procedures ( e.g. heel prick , iv cannula insertion , endotracheal suctioning ) and to environmental stress ( e.g. noise , light ) . Simons et al.1 , for example , described an average 14 + /‐ 4 painful procedures during the first 2 weeks of life within a period of 24 hours among 151 neonates . Many studies have shown that repeated and sustained pain can have direct and long‐term consequences on the neurological and behavior‐oriented development of the neonates during the rapid development phase of the central nervous system . Pain can cause detectable physiological , behavioral and hormonal changes2,3,4 and contribute to the altered development of the pain system during later childhood and adolescence3,4,50 . Instead , live music such as singing is excellent type of music when it is steady , constant , quiet , soothing and directed to the infants6 . Graven7 emphasizes that recorded sound should not replace human voice exposure in the NICU ; therefore , health care providers should provide ample opportunity for the infant to hear parent 's voices live , such as singing or humming , in interactions between the parent and the infant at the bedside . The AmericanAcademy of Pediatrics Committee on Environmental Health has recommended safe levels of sound8 , and these recommendations have been up date d by an expert team of practitioners . Recommendations specify that continuous sound should not exceed an hourly equivalent sound level of 50 A‐weighted decibels (dBA)7,8,9 , and music as an auditory stimulus not exceed 75 dB in NICU6,8,10 . If earphones or other devices are used , sound sources should be kept at reasonable distances from the infant 's ear , played for brief periods and at levels below 55 dB7 . Music listening can be initiated with or without the involvement of a music therapist . In this review , music can be implemented for premature infants by a music therapist or any health care providers and it will include both recorded and live music . Outcomes Regardless of the type of music , several studies have investigated the short term effects of music on preterm infants , including the improvement in physiological outcomes ( e.g. oxygen saturation , heart rate , respiratory rate , and blood pressure ) , as well as in behavioural state ( e.g. crying , facial expression , body movements ) and pain scores6,11,12,13 . For example , Chou et al. 6 showed that premature infants receiving recorded music , that was the combination of womb sounds and the mother singing , with endotracheal suctioning had significantly higher oxygen saturation than when they did not receive music . Butt & Kisilewsky12 compared recorded music involving both the vocal and instrumental version of Brahms lullaby versus no music , and found that infants older than 31 weeks demonstrated significant reduction in heart rate , behavioral state and pain . In the study of Arnon et al.11 the infants receiving live music , compared with infants receiving recorded music or no music , had significantly reduced heart rate and behavioral scores during the post‐intervention period . Live music comprised of a lullaby sang by the female voice with frame drum and an accompanying harp . The same music was played by a tape recorder . Live music showed significant benefits , whereas no statistically significant changes were found for the recorded music and control groups . Teckenberg‐Jansson et al.13 indicated that music therapy combined with kangaroo care  decreased the pulse , slowed down the respiration and increased the transcutaneous oxygen saturation in preterm infants . The musical instruments used were a lyre and a female human voice , which hummed or sang . There is evidence that music has also positive consequences on long‐term outcomes , including length of hospitalization , weight gain , and non‐nutritive sucking10,13,14,15 . For example , in the study of Caine16 the preterm infants received music stimulation which consisted of recorded vocal music ( including lullabies and children 's music ) and routine auditory stimulation . Exposure to the music stimulation had many positive effects on preterm infants , such as it increased daily average weight , formula and caloric intake , and significantly reduced total hospital stays and stress behaviors for the experimental group . In addition , according to Lubetzky et al.10 exposure to music by Mozart significantly lowered energy expenditure among healthy preterm infants . Hartling et al.17 have published a systematic review on the efficacy of music for medical indicators in term and preterm neonates . Nine r and omized trials ( 1989‐2006 ) were included . According to the results of this review music may have positive effects on physiological parameters and behavioral states , and may reduce pain and improve oral feeding rates among the premature infants . The effects of music were evaluated during medical procedures ( circumcision , heel prick ) and for other indicators . In addition , Cignacco et al.18 conducted a systematic literature review on the efficacy of non‐pharmacological interventions in the management of procedural pain in preterm and term neonates during the period from 1984 to 2004 . According to this review there was no clear evidence that the method of music could have a pain‐alleviating effect on neonates . In the Cochrane Library , one systematic review is also available up to year of 2011 concerning  non‐pharmacological  management of infants and young children ( preterm , neonate , older up to three years ) during procedural pain19 , but this review did not consider music as an intervention . To date , there is also one meta‐ analysis published by St and ley20 concerning the efficacy of music therapy  for premature infants during the period from 1950 to 1999 . It concluded that music was beneficial for many outcomes among the preterm infants in the NICU . However , the results of this review were limited by the poor method ological quality of the included studies , and unclear reporting on the phases of review . In our systematic review , studies published in 2000 and after will be considered for inclusion in the review . The number of the RCT 's concerning the effectiveness of music  among the preterm infants in NICU is especially increased during the last few years , and these studies have not included in the previous systematic review s and meta‐ analysis Abstract Neonatal respiratory difficulties are increased following second trimester amniocentesis . In preterm , prolonged rupture of the membranes , respiratory outcome is particularly poor when rupture occurs in the first trimester . It therefore seems likely that first trimester/early amniocentesis ( EA ) would be associated with severe respiratory problems necessitating a high neonatal intensive care unit ( NICU ) admission rate . To test that hypothesis , the requirement for admission to the NICU of 278 infants whose mothers had undergone EA , 262 whose mothers had undergone chorion villus sampling ( CVS group ) and 264 controls whose mothers had undergone no invasive procedures were review ed as were their diagnoses if they needed admission . There was no significant difference in the mode of delivery , gestational age or gender distribution of the three groups and the median maternal age of the EA and CVS groups was similar . Nineteen EA , eight CVS and five control infants required admission to the NICU ( EA versus controls , P < 0.01 ; EA versus CVS plus controls , P < 0.005 ) . Nine EA , one CVS and four control infants had suffered respiratory problems ( EA versus CVS P < 0.05 ) . Logistic regression analysis demonstrated that immaturity and EA were significantly associated with a requirement for NICU admission . We conclude infants whose mothers have undergone EA may be at increased risk for NICU admission , this is partly due to respiratory problems but the association is uncommon BACKGROUND . We previously reported beneficial effects of breast milk ingestion by infants with extremely low birth weight in the NICU on developmental outcomes at 18 months ’ corrected age . The objective of this study was to determine whether these effects of breast milk in infants with extremely low birth weight persisted at 30 months ’ corrected age . METHODS . Nutrition data , including enteral and parenteral feeds , were prospect ively collected , and 30 months ’ corrected age follow-up assessment s were completed on 773 infants with extremely low birth weight who participated in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial . A total of 593 ingested some breast milk during the neonatal hospitalization , and 180 ingested none . Neonatal feeding characteristics and morbidities and 30-month interim history , neurodevelopmental outcomes , and growth parameters were analyzed . Children were divided into quintiles of breast milk volume to evaluate the effects of volume of human milk ingested during the NICU hospitalization . RESULTS . At 30 months , increased ingestion of breast milk was associated with higher Bayley Mental Developmental Index scores , higher Bayley behavior score percentiles for emotional regulation , and fewer rehospitalizations between discharge and 30 months . There were no differences in growth parameters or cerebral palsy . For every 10 mL/kg per day increase in breast milk , the Mental Developmental Index increased by 0.59 points , the Psychomotor Developmental Index by 0.56 points , and the total behavior percentile score by 0.99 points , and the risk of rehospitalization between discharge and 30 months decreased by 5 % . CONCLUSIONS . Beneficial effects of ingestion of breast milk in the NICU persist at 30 months ’ corrected age in this vulnerable extremely low birth weight population . Continued efforts must be made to offer breast milk to all extremely low birth weight infants both in the NICU and after discharge OBJECTIVE To examine how family-based interventions in the neonatal intensive care unit ( NICU ) may change  parental knowledge and behaviors and decrease stress . METHODS Eighty-four high-risk mother-infant dyads were r and omly assigned to two intervention and one control groups . Group 1 ( n = 28 ) participated in a demonstration of infant reflexes , attention , motor skills , and sleep-wake states . Group 2 ( n = 31 ) viewed educational material s. Group 3 ( n = 25 ) , controls , participated in an informal discussion . Parent-infant interactions ( Nursing Child Assessment Feeding Scale ) were videotaped . Mothers completed measures of stress ( Parenting Stress Index ) and knowledge of infant cues ( Knowledge of Preterm Infant Behavior Scale ) . RESULTS Mothers in both intervention groups evidence d greater knowledge and more contingent and sensitive interactions with their infants than did the control group . Stress also differed across groups , and all mothers reported scores above norms . CONCLUSIONS In a high-risk sample , short-term , family-based NICU interventions may enhance mothers ' knowledge , sensitivity , contingency , and stress OBJECTIVE To evaluate the impact of individualized , developmentally supportive family-centered care on infant physiological variables , growth , behavioral stress cues , return to sleep state , medical and developmental progress , complications , re source utilization , parental perception of the neonatal intensive-care unit experience , and overall parental satisfaction . DESIGN Quasi-experimental , repeated measures design . SETTING Developmental and a control nursery in a 78-bed , level II/III neonatal intensive-care unit . PARTICIPANTS A convenience sample of 114 premature infants and their parents . INTERVENTIONS Control group infants received the routine neonatal intensive-care unit st and ard of care . Experimental infants received routine care plus the addition of individualized , developmentally supportive family-centered interventions . MAIN OUTCOME MEASURES Between groups , there were no statistically significant differences in demographic factors , days to medical or developmental milestones , length of stay , or direct cost/case . Repeated measures analysis of variance determined that at every point of data collection , the average number of baseline , activity , and postactivity stress cues were lower in the developmentally supportive group . Infants in the developmental group had 8 % less sedatives/narcotics and 15 % less vasopressors costs than the control group . There were no differences in complication rates , parental perceptions of the neonatal intensive-care unit experience , or parental satisfaction between groups . CONCLUSIONS Preterm infants who received developmentally supportive family-centered care demonstrated fewer behavioral stress cues and comparable short-term outcomes and re source utilization than infants who received routine care Background Neurobehavioral disabilities occur in 5–15 % of preterm infants with an estimated 50–70 % of very low birth weight preterm infants experiencing later dysfunction , including cognitive , behavioral , and social delays that often persist into adulthood . Factors implicated in poor neurobehavioral and developmental outcomes are hospitalization in the neonatal intensive care unit ( NICU ) and inconsistent caregiving patterns . Although much underlying brain damage occurs in utero or shortly after birth , neuroprotective strategies can stop lesions from progressing , particularly when these strategies are used during the most sensitive periods of neural plasticity occurring months before term age . The purpose of this r and omized trial is to test the effect of a patterned feeding experience on preterm infants ’ neurobehavioral organization and development , cognitive function , and clinical outcomes . Methods This trial uses an experimental , longitudinal , 2-group design with 120 preterm infants . Infants are enrolled within the first week of life and r and omized to an experimental group receiving a patterned feeding experience from the first gavage feeding through discharge or to a control group receiving usual feeding care experience . The intervention involves a continuity of tactile experiences associated with feeding to train and build neuronal networks supportive of normal infant feeding experience . Primary outcomes are neurobehavioral organization as measured by Neurobehavioral Assessment of the Preterm Infant at 3 time points : the transition to oral feedings , NICU discharge , and 2 months corrected age . Secondary aims are cognitive function measured using the Bayley Scales of Infant and Toddler Development , Third Edition at 6 months corrected age , neurobehavioral development ( sucking organization , feeding performance , and heart rate variability ) , and clinical outcomes ( length of NICU stay and time to full oral feeding ) . The potential effects of demographic and biobehavioral factors ( perinatal events and conditions of maternal or fetal/newborn origin and immunologic and genetic biomarkers ) on the outcome variables will also be considered . Discussion Theoretically , the intervention provided at a critical time in neurologic system development and associated with a recurring event ( feeding ) should enhance neural connections that may be important for later development , particularly language and other cognitive and neurobehavioral organization skills . Trial registration NCT01577615 11 April 2012 A secondary analysis of a r and omized clinical trial in which the control group received routine breast-feeding care , consisted of women planning to breast-feed their low-birth-weight ( LBW ) premature infants  , was conducted . The purpose of this secondary analysis was to examine the nutrition of healthy premature LBW infants and its impact on their development . A longitudinal prospect i ve descriptive design was implemented measuring the same group of 50 healthy breast-feeding LBW premature infants from birth to 6 months corrected age . Developmental screening was performed at 6 months corrected age using the Bayley Scales of Infant Development to assess development in Mental scale , Motor scale , and Infant Behavioral record . Repeated measures analyses of variance were performed between the 3 gestational age groups and between the breast-fed and non – breast-fed groups . Bayley Scales of Infant Development Mental and Motor scales showed significant differences between the breast-fed and non – breast-fed groups at 6 months corrected age ( P < .014 and P < .013 , respectively ) . The nutrition of healthy premature LBW infants over time was recorded and described . Nutritional assessment indicated that human milk intake in some quantity decreased from 40 weeks corrected age to 6 months corrected age : 70 % to 26 % . These findings can be utilized in anticipatory guidance when caring for neonates and mothers in the neonatal intensive care unit to encourage mothers to provide their own milk and strive to breast-feed Background : In neonatal intensive care unit ( NICU ) , neonatal sleep is disrupted due to different factors . Due to the critical role of sleep in premature infants′ brain development , this study aim ed to investigate the effect of nesting and swaddling on the sleep duration of premature infants hospitalized in NICUs . Material s and Methods : In a crossover clinical trial , 42 preterm infants who met the inclusion criteria were enrolled . They were r and omly assigned to two groups of nest-swaddle and swaddle-nest .  Sleep status was evaluated by observation and use of Prechtl′s criteria . Then , duration s of total sleep time ( TST ) and quiet sleep time ( QST ) were recorded . Data were analyzed using repeated measure analysis of variance ( ANOVA ) . Results : Mean values of TST and QST during nesting and also swaddling periods were significantly higher than in the control period in both groups ( P < 0.001 ) . Mean values of TST and QST in the swaddling period were higher than in the nesting period in both groups , However , these differences were not significant ( P = 0.245 ) . Conclusions : Both swaddling and nesting could significantly increase the duration of TST and QST , compared to the control . There were no significant differences between the effects of these interventions on TST and QST . Therefore , using any of these methods is suggested to improve infants′  quality of sleep in NICU , with respect to the ward policies Forty very-low-birth-weight neonatal intensive care unit ( NICU ) infants with birth weights ≤1,250 g were r and omly assigned to treatment or control groups . Behavior of the treatment infants was systematic ally evaluated , and individualized developmentally oriented care plans were implemented to enhance stability . Treatment babies required fewer days of intermittent m and atory ventilation and continuous positive airway pressure and achieved full enteral feedings sooner . Length of hospital stay and hospital charges were less for treatment than control infants . There were favorable effects on treatment infants ' behavioral performance at 42 weeks ' postconceptional age . These results support the hypothesis that behaviorally sensitive , developmentally oriented care improves medical and neurodevelopmental outcome in the NICU OBJECTIVE To describe and underst and how mothers utilize the opportunity to actively participate in their preterm infants ' pain care using facilitated tucking by parents ( FTP ) . DESIGN Descriptive and exploratory study with postintervention interview . SETTING Finnish level III Neonatal Intensive Care Unit ( NICU ) . PARTICIPANTS Twenty-three mothers who had preterm infants born at gestational ages of 32 to 34 weeks . METHODS The parents ( N=45 ) of 29 preterm infants were taught to use FTP . In addition , all nurses in the NICU ( N=76 ) received the same education to support the parents ' use of FTP . After 2 to 4 weeks of FTP use , the mothers ( n=23 ) were interviewed using the Clinical Interview for Parents of High-Risk Infants with additional questions related to the infants ' pain care . The interviews were analyzed inductively with cross-case analysis and deductively with a previously developed coding scheme . RESULTS Facilitated tucking by parents was perceived positively and was used by all participating mothers . Three different styles of involvement in preterm infants ' pain care with FTP were identified . They formed a continuum from external to r and om and finally to internalized involvement . In external involvement , the pain care with FTP was triggered by outside factors such as nurses , whereas in r and om and internalized involvement the motivation emerged from a parent . Mothers with external involvement thought that any person could apply the FTP . In r and om involvement , mothers were mainly absent during painful procedures , although they saw themselves as the best caregivers . In internalized involvement , the responsibility for infant pain care was shared within the family . Mothers ' NICU-related stress and maternal attachment were associated with this variation . CONCLUSION This study showed that mothers ' are willing to actively participate in their preterm infants ' pain care . However , the participation is unique according to mother and her experiences before and during NICU admission . Nurses need to consider these differences in mothers when involving them in preterm infants ' pain care OBJECTIVES Although most infants born prematurely do not have major developmental problems , those with perinatal medical problems and lengthy stays in the neonatal intensive care unit are at risk for sensory modulation problems and developmental sequelae . This study compared sensory responsiveness in preterm and full-term infants and examined the relationship of sensory responsiveness to temperament and developmental function . METHOD Caregivers of infants with ( n = 45 ) and without ( n = 22 ) prematurity were asked to complete the  Sensory Rating Scale .  The preterm infants were also evaluated with the Bayley Scales of Infant Development , Second Edition ( BSID-II ) . RESULTS The preterm infants exhibited more frequent behaviors indicating tactile defensiveness and difficult temperament than did the full-term infants . When specific items were examined , the preterm infants displayed sensory-seeking behaviors and high activity levels . As measured by caregivers ' report , sensory responsiveness was significantly related to temperament . It was not related to BSID-II Mental and Psychomotor scale scores . CONCLUSION This study supports the findings of others that preterm infants have mild problems in sensory responsiveness and temperament . Correlational results do not support a definitive relationship between parents ' reports of their infants ' sensory responsiveness and developmental function A recent federal law has exp and ed the eligibility for multidisciplinary evaluation and assessment of infants suspected of developmental delay . At the same time , modern neonatal care has increased infant survival . These two developments have created a need for family education regarding the need for health and developmental intervention , as well as counseling to maintain family participation in these services . This study compares the education and counseling services of a hospital-based case management team with the traditional discharge and follow-up services of a neonatal intensive care unit ( NICU ) .  Subjects were the 10 % most medically severe infants discharged from a neonatal intensive care unit over a 16-month period . Preliminary data suggests a significantly greater number of families accessed community-based , coordinated , comprehensive health and developmental services when they received case management services . The data suggest that hospital professionals generally refer the most medically severe 3 % of this group for services under a traditional model . However , the additional 7 % referred under the transition model showed greater developmental benefits from the services during the first 6 months of life . These data support current federal initiatives for early intervention services which are family-centered , community-based and coordinated Objective : Preterm neonates undergo numerous painful procedures in the neonatal intensive care unit ( NICU ) .  Sucrose , with and without pacifiers , is effective and safe for relieving pain from single painful events . However , repeated use of sucrose for multiple painful procedures has not been adequately evaluated . The study objectives were to : 1 ) determine the efficacy and safety of consistent management of repeated procedural pain with sucrose ; and 2 ) explore the impact of consistent pain management on clinical outcomes and neurobiological risk status . Methods : Sixty-six preterm infants were r and omized to receive st and ard care ( positioning and swaddling ; n = 21 ) , sterile water plus pacifier ( n = 23 ) , or 24 % sucrose plus pacifier ( n = 22 ) prior to all painful procedures in the NICU during the first 28 days of life . Also , at a routine heel lance at 7 , 14 , 21 , and 28 days of life , data were collected to determine efficacy and immediate and long-term adverse events . Data on clinical outcomes and neurobiological risk status were collected at 28 days or NICU discharge . Results : There was no intervention by time interaction ( P = 0.60 ) . There was a significant main effect of intervention ( P = 0.03 ) between the sucrose plus pacifier group , and the st and ard care group ( P = 0.01 ) , but there was no main effect of time ( P = 0.72 ) . No group differences existed for adverse events , clinical outcomes , or neurobiological risk status . Discussion : Consistent management of painful procedures with sucrose plus pacifier was effective and safe for preterm neonates during their stay in the NICU . Further exploration of consistent pain management with sucrose on clinical , developmental , and neurobiological outcomes is required OBJECTIVE To describe the type and percent time of contact  0 - 48 hours postbirth for mother-preterm newborn ( infant ) dyads given kangaroo care ( skin-to-skin )  or st and ard care ( controls ) . DESIGN R and omized controlled trial with assignment by computerized minimization to  kangaroo care  ( n = 48 ) or  control ( n = 43 ) . SETTING Postpartum units and neonatal intensive-care units ( NICU ) . PARTICIPANTS Preterm infants 32 to less than 37 weeks gestation and their mothers . INTERVENTION Kangaroo ( skin-to-skin , SS ) care ( KC ) . MAIN OUTCOME MEASURES Type and percent time of mother-infant contact ( SS versus holding wrapped in blankets ) . RESULTS Analyses were based on four groups : assignment for infants in each group to postpartum or NICU . For KC dyads , SS postpartum was 22.0 % ; SS NICU was 7.5 % . KC wrapped holding postpartum was 11.6 % ; NICU was 1.8 % . For control dyads , wrapped holding postpartum was 13.9 % ; NICU was 6.1 % . CONCLUSION Amount of SS was much less than expected . Reasons include unavailability of infants or mothers and hospital staff interrupting contact . However , KC postpartum dyads were held wrapped almost as often as control postpartum dyads . Total contact time for KC dyads ( SS plus wrapped ) was more than double that of controls . These data suggest that hospital and social supports for families are needed to facilitate early initiation of SS , prolonged periods of mother-infant SS contact , and reduction of maternal stress
Conclusion Current evidence suggests that developmental care in only NICU setting could have significant effect on mental and motor development of preterm infants , especially at 12 months of age .
Background The aim of this study was to review the effects of developmental care in neonatal intensive care unit ( NICU ) setting on mental and motor development of preterm infants .