Effects of Reading to Preterm Infants on Baby and Parents' Well Being
Condition: Parental Infant Bonding; Cardio-respiratory Stability in Preterm NICU Infants
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      Reading to children is believed to be beneficial to cognitive and mental development.This
      study will examine the response of premature Neonatal Intensive Care Unit (NICU) infants to
      bedside reading by measuring changes in heart rate, blood pressure, breathing and oxygen
      levels. The investigators will follow rates of common preterm health issues while in the
      hospital and time to hospital discharge. Effects of bedside reading on parental stress and
      infant bonding will be measured and compared to usual rates of these indicators to determine
      if reading to babies reduces stress and enhances bonding.
    

Detailed description: 
      The NICU at Georgetown University Hospital cares for approximately 100 infants per year in
      the study population between 26-34 weeks gestation. We have a patient population where
      parental daily visits are the norm, allowing for a study using live voices.

      The investigators will approach parents of infants who meet entry criteria who are nearing
      one week of age after consultation with the clinical care team to determine stability. All
      preterm infants admitted to the NICU who are deemed stable enough to participate by the
      primary team will be approached for study participation.

      After parental consent is obtained, the parents will be given an initial questionnaire to
      assess demographic data such as parental education and attitudes regarding reading to
      infants. Parents will be given a picture book with rhythmic sound patterns for reading aloud
      to their infant. Bedside nurses will help guide parents to the best time for infant reading.
      Time of parent reading (start and stop time) will be recorded in the infant's chart. Mothers
      and fathers will be allowed to read to the infant at separate reading times. A decibel
      monitor placed at the opening of the incubator will display the decibel level of parental
      voice.

      Parents will be asked to read to their babies for at least 15 minutes but not more than 60
      minutes per session. The total reading time for any 24 hour period can be up to 90 minutes.

      Reading will occur with the infant in an incubator, in an open warmer or crib or while being
      held by parents. If the infant is in an incubator, parents will read with the portal closest
      to the parent open. For those babies who are in an open crib or warmer the parents will read
      close enough to the bedside so as not to be heard by neighboring patients. In older infants
      who are stable enough for kangaroo care or are out of bed being held by parents, reading can
      occur at those times, if desired by the parents. The Infant's location (in incubator, open
      bed, kangaroo care or parental holding) will be recorded in a study bedside binder.

      Parents may also make a 30 minute recording on a digital recording device which can be played
      back to the baby twice per day if the parents are not expected to visit and the total reading
      time has not been met. Nursing staff will alternate between mother and father recorded
      sessions when neither parent is present and the total reading time for the day has not
      occurred.

      Enrolling 80 infant/parent pairs will allow for subgroup analysis of Cardio Respiratory
      Events (CREs) in different corrected gestational ages (grouped into two cohorts 26-30
      completed weeks and 31-34 completed weeks) and for comparison in effect of maternal and
      paternal voices. The study will not dictate who reads when both parents are present, but will
      encourage fathers to read if their visits are less frequent than mother's.

      To assess changes in CREs, during NICU admission we will continuously record infant heart
      rate, respiratory rate, oxygen saturation, and CREs via software capable of downloading data
      directly from infant monitors used for routine clinical monitoring in the NICU, reducing
      variations in bedside charting and supplying a more complete documentation of the infant's
      cardiopulmonary status. Assessment of parental reading impact will be assessed at least three
      times per week and up to twice per day. Monitoring equipment is limited to recording three
      infants at one time so number of infants monitored per day will be impacted by total number
      of infants in the study at one time.

      Changes in heart rate, respiratory rate, numbers of desaturation and apnea or bradycardia
      events will be scored for 3 reading session epochs; one hour before reading, during reading
      and one hour after parent reading will be measured. We will also compare CRE scores of
      reading times to CRE scores of similar periods throughout the day (eg 30 minutes before and
      after feedings). Enrolled infants who require high frequency ventilation will be temporarily
      withdrawn until the infant returns to conventional ventilation. If an infant is deemed too
      ill to participate by the primary team due to worsening in clinical status, he or she may be
      temporarily withdrawn until the primary team decides he/she is again stable enough to
      participate.

      Parent-infant bonding will be assessed via a questionnaire administered four times during the
      study: before enrollment, at hospital discharge (average expected length of time 6 weeks) and
      3-months after discharge. Attitudes toward reading to infants and patterns of reading at home
      after discharge will also be recorded and compared.

      Frequency of parent-infant reading after discharge will be compared to historical controls
      via survey of families whose infants have been discharged from the NICU prior to the study
      initiation and exposure to subsequent study-initiated reading education efforts. This control
      group will be polled for parental education, feelings on reading to infants and frequency of
      that behavior at home in the first 3 months after hospital discharge to obtain a historical
      baseline for our study population. Parents of the prospective reading group will receive the
      same questionnaire at 3 months after discharge and these results will be compared.

      Data on CREs will be recorded at multiple time points for the duration of care within an
      incubator and outcomes followed to hospital discharge, an average of 8 weeks. Parent-infant
      reading patterns will be followed up to 3 months after hospital discharge.
    

Intervention name(s): Parental Reading Aloud
Intervention type(s): Other
Intervention description(s): Infants will be exposed to parental reading aloud or to a recording of the parent's voice reading during times of cardio-respiratory monitoring.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Preterm Infants; Bedside Reading aloud; Parental wellbeing; Parental Bonding; cardio-respiratory stability