Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. The effects of alternative positioning on preterm infants in the neonatal intensive care unit: a randomized clinical trial. Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age. Individualized Developmental Care for Very-Low-Birth-Weight Premature Infants Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects. Neonatal intensive care unit stress is associated with brain development in preterm infants Good two-year outcome for parents whose infants were admitted to a neonatal intensive care unit. A Three-Center, Randomized, Controlled Trial of Individualized Developmental Care for Very Low Birth Weight Preterm Infants: Medical, Neurodevelopmental, Parenting, and Caregiving Effects Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU. Randomised trial of a parenting intervention during neonatal intensive care Effect of an early intervention programme on low birthweight infants with cerebral injuries. Early Sensitivity Training for Parents of Preterm Infants: Impact on the Developing Brain Hospital-based case management for medically fragile infants: results of a randomized trial. A quasi-experimental trial on individualized, developmentally supportive family-centered care. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18months in preterm infants The effect of parent training in music and multimodal stimulation on parent-neonate interactions in the neonatal intensive care unit. Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit.
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 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 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 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 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 Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants , much of the variation in outcome remains unexplained . The impact on brain development of 1 potential factor , exposure to stressors in the neonatal intensive care unit , has not yet been studied in a systematic , prospect i ve manner 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 ABSTRACT . Medical , neurodevelopmental , and parenting effects of individualized developmental care were investigated in a three-center , r and omized , controlled trial . A total of 92 preterm infants , weighing less than 1250 g and aged less than 28 weeks , participated . Outcome measures included medical , neurodevelopmental and family function . Quality of care was also assessed . Multivariate analysis of variance investigated group , site , and interaction effects ; correlation analysis identified individual variable contributions to significant effects . The results consistently favored the experimental groups . The following contributed to the group effects : shorter duration of parenteral feeding , transition to full oral feeding , intensive care , and hospialization ; lower incidence of necrotizing enterocolitis ; reduced discharge ages and hospital charges ; improved weight , length , and head circumferences ; enhanced autonomic , motor , state , attention , and self-regulatory functioning ; reduced need for facilitation ; and lowered family stress and enhanced appreciation of the infant . Quality of care was measurably improved . Very low birth weight infants and their parents , across diverse setting s , may benefit from individualized developmental care 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 the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development  following a very premature birth . Design : Cluster-r and omised controlled trial , with a crossover design and three-month washout period . Setting : Six neonatal intensive care units . Patients : Infants born < 32 weeks ’ gestation . Intervention : The Parent Baby Interaction Programme ( PBIP ) is a supportive , educational intervention delivered by research nurses in the neonatal intensive care unit , with optional home follow-up for up to six weeks after discharge . Main outcome measures : Parenting stress at 3 months adjusted age , as measured by the Parenting Stress Index ( PSI ) . Other outcomes included the Neurobehavioural Assessment of the Preterm Infant ( NAPI ) and maternal interaction as assessed by the Nursing Child Assessment Teaching Scale ( NCATS ) and the responsivity subscale for Home Observation for Measurement of the Environment ( HOME ) . Results : 112 infants were recruited in the intervention phases and 121 in the control phases . Mean st and ardised NAPI scores at 35 weeks did not differ between the PBIP and control groups . Both groups had low but similar NCATS caregiver scores before discharge ( 36.6 in the PBIP group and 37.4 in control , adjusted mean difference −0.7 , 95 % CI −2.7 to 1.4 ) . At three months , adjusted age mean PSI scores for the PBIP group were 71.9 compared with 67.1 for controls ( adjusted mean difference 3.8 , 95 % CI −4.7 to 12.4 ) . NCATS scores and HOME responsivity scores were similarly distributed between the groups . Conclusion : This early , nurse-delivered , parent-focused interaction programme intervention had no measurable effects on short-term infant neurobehavioural function , mother – child interaction or parenting stresses 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 After birth , preterm infants face a stressful environment , which may negatively impact early brain development and subsequent neurobehavioral outcomes . This r and omized controlled trial involving 45 women with infants < 30-wk gestation , assessed the effectiveness of training parents  in reducing stressful experiences . Intervention consisted of 10 sessions in the Neonatal Intensive Care Unit ( NICU ) . Postintervention , at term-equivalent ( 40-wk postmenstrual age ) , magnetic resonance imaging ( MRI ) was performed to evaluate brain structure and development . Quantitative volumetric techniques were used to estimate overall and regional brain volumes for different tissue types including CSF , CGM , DNGM , UWM , and MWM . DTI was used to evaluate the integrity and maturation of white matter by ADC and FA . Maturation and connectivity of white matter , characterized by diffusion MR measures of ADC and FA , were significantly enhanced in the intervention group , who displayed greater restriction in ADC and increase in FA . There were no significant effects on either brain volumes or on short-term medical outcomes . Thus , sensitivity training for parents in the NICU is associated with improved cerebral white matter micro-structural development in preterm infants 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 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 ABSTRACT Procedural pain in the neonatal intensive care unit triggers a cascade of physiological , behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm , who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development . The aim of this study was to examine relationships between cumulative procedural pain ( number of skin‐breaking procedures from birth to term , adjusted for early illness severity and overall intravenous morphine exposure ) , and later cognitive , motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age ( CCA ) , and further , to evaluate the extent to which parenting factors modulate these relationships over time . Participants were N = 211 infants ( n = 137 born preterm ⩽32 weeks gestational age [ GA ] and n = 74 full‐term controls ) followed prospect ively since birth . Infants with significant neonatal brain injury ( periventricular leucomalacia , grade 3 or 4 intraventricular hemorrhage ) and /or major sensori‐neural impairments , were excluded .  Poorer cognition and motor function were associated with higher number of skin‐breaking procedures , independent of early illness severity , overall intravenous morphine , and exposure to postnatal steroids . The number of skin‐breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation . In general , greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months , but not at 18 months CCA , however , specific protocol s for morphine administration were not evaluated . Lower parenting stress modulated effects of neonatal pain , only on cognitive outcome at 18 months This study examined the effects of  parent training in music and multimodal stimulation on the quantity and quality of parent-neonate interactions and the weight gain and length of hospitalization of premature and low birthweight ( LBW ) infants in a Neonatal Intensive Care Unit ( NICU ) . Twenty sets of parents and premature LBW infants participated in the study . Parents in the experimental group ( n = 10 ) received approximately one hour of instruction in appropriate uses of music , multimodal stimulation including massage techniques , and signs of infant overstimulation and techniques for its avoidance .  Parent-neonate interactions , specifically parent actions and responses and infant stress and nonstress behaviors , were observed for subjects in both groups . Infant stress behaviors were significantly fewer and appropriateness of parent actions and responses were significantly greater for experimental infants and parents than for control subjects . Parents in the experimental group also self-reported spending significantly more time visiting in the NICU than did parents of control infants . In addition , length of hospitalization was shorter and average daily weight gain was greater for infants whose parents received training , although these differences were not significant . A one month , postdischarge follow-up showed little difference between experimental and control group parent-infant interactions in the home 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
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 .