Rosemarie Bigsby

Single-Family Room Care and Neurobehavioral and Medical Outcomes in Preterm Infants

OBJECTIVE: To determine whether a single-family room (SFR) NICU, including factors associated with the change to a SFR NICU, is associated with improved medical and neurobehavioral outcomes. METHODS: Longitudinal, prospective, quasi-experimental cohort study conducted between 2008 and 2012 comparing medical and neurobehavioral outcomes at discharge in infants born <1500 g. Participants included 151 infants in an open-bay NICU and 252 infants after transition to a SFR NICU. Structural equation modeling was used to determine the role of mediators of relations between type of NICU and medical and neurobehavioral outcomes. RESULTS: Statistically significant results (all Ps ≤.05) showed that infants in the SFR NICU weighed more at discharge, had a greater rate of weight gain, required fewer medical procedures, had a lower gestational age at full enteral feed and less sepsis, showed better attention, less physiologic stress, less hypertonicity, less lethargy, and less pain. NICU differences in weight at discharge, and rate of weight gain were mediated by increased developmental support; differences in number of medical procedures were mediated by increased maternal involvement. NICU differences in attention were mediated by increased developmental support. Differences in stress and pain were mediated by maternal involvement. Nurses reported a more positive work environment and attitudes in the SFR NICU. CONCLUSIONS: The SFR is associated with improved neurobehavioral and medical outcomes. These improvements are related to increased developmental support and maternal involvement.

Infant colic and feeding difficulties

Aims: To examine the relation between colic and feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. Methods: Forty three infants (and their mothers) were enrolled between 6 and 8 weeks of age. Infants were divided into two groups, colic (n = 19) and comparison (n = 24), based on a modified Wessel rule of three criteria for colic. Families were assessed at two visits; one occurred in the laboratory and one occurred in a paediatric radiology office. Outcome measures included the clinical assessment of infant oral motor skills, behavioural observation of mother-infant feeding interactions, maternal questionnaires on infant crying, sleeping and feeding behaviours, and the occurrence of gastro-oesophageal reflux (GOR) in the infants using abdominal ultrasound. Results: Infants in the colic group displayed more difficulties with feeding; including disorganised feeding behaviours, less rhythmic nutritive and non-nutritive sucking, more discomfort following feedings, and lower responsiveness during feeding interactions. Infants in the colic group also had more evidence of GOR based on the number of reflux episodes on abdominal ultrasound as well as maternal report of reflux. Mothers in the colic group reported higher levels of parenting stress. Conclusions: Results provide the first systematic evidence of feeding problems in a subgroup of infants with colic. Data also illustrate the impact of these difficulties on parental and infant functioning. The association between feeding difficulties and colic suggests the potential for ongoing regulatory problems in infants presenting with clinically significant colic symptoms.

Effects of prefeeding oral stimulation on feeding performance of preterm infants

ObjectiveTo investigate the effects of a prefeeding oral stimulation program on the feeding performance of preterm infants.MethodsA crossover design was used. Nineteen preterm infants who were in the transitional time to full oral feeding served as their own controls. A 5-min oral stimulation program was applied to infants prior to feeding in two of 4 feedings on two consecutive days. Feeding, behavioral state, and physiological parameters of infants in the intervention and control feeding conditions were compared using SPSS software.ResultsThere were two significant findings: (1) Compared to the control condition, infants in the intervention condition achieved a greater intake rate in the initial 5 min of the feeding (P = 0.021). (2) After receiving oral stimulation, a higher percentage of infants moved to the drowsy or quiet alert state from sleep or restlessness before feeding, both on Day 1 (P= 0.016) as well as Day 2 (P = 0.016). No significant differences were found in other feeding parameters, feeding-induced physiological changes (peripheral oxygen saturation levels and pulse rate) and behavioral states between two feeding conditions.ConclusionsOral stimulation had a modulating effect on the prefeeding behavioral states and short-lived beneficial effects on the feeding efficiency of preterm infants.

Assessment and evaluation of the high risk neonate: the NICU Network Neurobehavioral Scale.

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant. The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. These are infants who are at increased risk for poor developmental outcome because of insults during prenatal development, such as substance exposure or prematurity or factors such as poverty, poor nutrition or lack of prenatal care that can have adverse effects on the intrauterine environment and affect the developing fetus. The NNNS assesses the full range of infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence. The NNNS is a noninvasive neonatal assessment tool with demonstrated validity as a predictor, not only of medical outcomes such as cerebral palsy diagnosis, neurological abnormalities, and diseases with risks to the brain, but also of developmental outcomes such as mental and motor functioning, behavior problems, school readiness, and IQ. The NNNS can identify infants at high risk for abnormal developmental outcome and is an important clinical tool that enables medical researchers and health practitioners to identify these infants and develop intervention programs to optimize the development of these infants as early as possible. The video shows the NNNS procedures, shows examples of normal and abnormal performance and the various clinical populations in which the exam can be used.

Family-Based Intervention with High-Risk Infants and Their Families

A model of family-based intervention for high-risk infants hospitalized in the neonatal intensive care unit and their families is presented. The theoretical underpinnings, principles, and nature of the intervention are described. The adaptation of the model from a clinical–research demonstration project to a clinical consultation service is highlighted, with particular emphasis on the practical application of the model. Domains of the intervention include infant behavior, family organization and functioning, caregiving environment, and home discharge/community resources. Three case illustrations are provided to demonstrate the breadth of the intervention and how it can be individualized based upon the presentation of the infant and family.

SELF-REGULATORY BEHAVIOR AND CARDIORESPIRATORY REACTIVITY AT ONE AND THREE MONTHS IN TERM AND PRETERM INFANTS. † 81

SELF-REGULATORY BEHAVIOR AND CARDIORESPIRATORY REACTIVITY AT ONE AND THREE MONTHS IN TERM AND PRETERM INFANTS. † 81

Eight Month Motor Outcome in Cocaine/Opiate Exposed Infants 50

As an ancillary study to the NICHD multisite Maternal Lifestyles (MLS) study, we administered the Posture and Fine Motor Assessment of Infants(PFMAI) to eight month old infants at the Providence site. The 32 item PFMAI measures quality of overall fine and gross motor skill acquisition in summary scores: the quality of reaching and grasping of different objects, and mobility/stability in prone/supine, sitting, quadruped and standing. It was validated in a normative mid-western sample of preterm and term infants. The purpose of this study was to define the impact of prenatal cocaine/opiate exposure on gross and fine motor development. The sample included 29 infants exposed to cocaine/opiates in utero (EXP) and 38 comparison infants not exposed to cocaine/opiates in utero (COMP). The two groups were similar in birth weight and gender. Background exposure to alcohol, marijuana or tobacco occurred in both groups. T-test results showed no significant differences between EXP and COMP on fine motor or gross motor overall or subscale scores. The fine motor (FM) and gross motor (GM) summary scores were similar between the MLS EXP and COMP groups and the Ohio sample as shown below.