Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit
11/04/11 19:47
Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit
Liisa Holsti, PhD,
* Ruth E. Grunau, PhD,*‡§ Tim F. Oberlander, MD,*‡§ and Michael F. Whitfield, MD‡§
The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.
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Liisa Holsti, PhD,
* Ruth E. Grunau, PhD,*‡§ Tim F. Oberlander, MD,*‡§ and Michael F. Whitfield, MD‡§The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.
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Developmental Changes in the Responses of Preterm Infants to a Painful Stressor
11/04/11 19:40
Developmental Changes in the Responses of Preterm Infants to a Painful Stressor
Rachel Lucas-Thompson, Elise L. Townsend, Megan R. Gunnar, Michael K. Georgieff, Sixto F. Guiang, Raul F. Ciffuentes, Richard C. Lussky, and Elysia Poggi Davis
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The purpose of this investigation was to examine longitudinally gestational age and developmental differences in preterm infants' self-regulatory abilities in response to a painful stressor, as well as associations between behavioral and cardiovascular responses. Participants included 49 healthy premature infants. Behavioral and cardiovascular responses to a heel stick blood draw were compared between infants of 28–31 and 32–34 weeks gestational age at birth. Both gestational age groups displayed behavioral and cardiovascular indications of stress in response to the blood draw. However, both shortly after birth and several weeks later, infants born at younger gestational ages (28–31 weeks) were more physiologically reactive. Evidence that the behavioral stress responses of 28–31 weeks gestational age group preterm infants do not reflect their physiological responses suggests that evaluation of preterm infants’ experiences and risk require assessments of both physiology and behavior. The greater stress vulnerability of the 28–31 relative to the 32–34 week gestation infants and the implications of this for subsequent development are discussed.
Rachel Lucas-Thompson, Elise L. Townsend, Megan R. Gunnar, Michael K. Georgieff, Sixto F. Guiang, Raul F. Ciffuentes, Richard C. Lussky, and Elysia Poggi Davis
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The purpose of this investigation was to examine longitudinally gestational age and developmental differences in preterm infants' self-regulatory abilities in response to a painful stressor, as well as associations between behavioral and cardiovascular responses. Participants included 49 healthy premature infants. Behavioral and cardiovascular responses to a heel stick blood draw were compared between infants of 28–31 and 32–34 weeks gestational age at birth. Both gestational age groups displayed behavioral and cardiovascular indications of stress in response to the blood draw. However, both shortly after birth and several weeks later, infants born at younger gestational ages (28–31 weeks) were more physiologically reactive. Evidence that the behavioral stress responses of 28–31 weeks gestational age group preterm infants do not reflect their physiological responses suggests that evaluation of preterm infants’ experiences and risk require assessments of both physiology and behavior. The greater stress vulnerability of the 28–31 relative to the 32–34 week gestation infants and the implications of this for subsequent development are discussed.
Academic, Social, and Behavioral Outcomes at Age 12 of Infants Born Preterm
11/04/11 19:40
Academic, Social, and Behavioral Outcomes at Age 12 of Infants Born Preterm
Suzy Barcelos Winchester, Mary C. Sullivan, Amy Kerivan Marks, Thomas Doyle, Jennifer DePalma, and Margaret M. McGrath
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The effects of gradient levels of perinatal morbidity on school outcomes have been investigated at age 12 in four preterm groups, classified as healthy (no medical or neurological illness), medical morbidity, neurological morbidity, and small-for-gestational-age (SGA), and a full-term comparison group. Teachers report on academic competence, social skills, and problem behaviors. Data on school type, classroom setting, and school service use are gathered from school records. Preterm groups are found to be equivalent to full-term peers in social skills and problem behavior. Preterm groups with neurological and SGA morbidity have the lowest academic competence scores. Unexpectedly, preterm infants with medical morbidity have higher academic competence scores compared with the other preterm groups. School service use increases with greater perinatal morbidity and is contingent on multiple rather than single indicators of perinatal morbidity. Continued monitoring of preterm infants through early adolescence will ensure that appropriate school services and resources are available to maximize their school success.
Keywords: premature infants, academic competence, social skills, problem behaviors, early adolescents
Suzy Barcelos Winchester, Mary C. Sullivan, Amy Kerivan Marks, Thomas Doyle, Jennifer DePalma, and Margaret M. McGrath
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The effects of gradient levels of perinatal morbidity on school outcomes have been investigated at age 12 in four preterm groups, classified as healthy (no medical or neurological illness), medical morbidity, neurological morbidity, and small-for-gestational-age (SGA), and a full-term comparison group. Teachers report on academic competence, social skills, and problem behaviors. Data on school type, classroom setting, and school service use are gathered from school records. Preterm groups are found to be equivalent to full-term peers in social skills and problem behavior. Preterm groups with neurological and SGA morbidity have the lowest academic competence scores. Unexpectedly, preterm infants with medical morbidity have higher academic competence scores compared with the other preterm groups. School service use increases with greater perinatal morbidity and is contingent on multiple rather than single indicators of perinatal morbidity. Continued monitoring of preterm infants through early adolescence will ensure that appropriate school services and resources are available to maximize their school success.
Keywords: premature infants, academic competence, social skills, problem behaviors, early adolescents
Stability of Neuromotor Outcomes at 18 and 30 Months of Age After Extremely Low Birth Weight Status
11/04/11 19:38
Stability of Neuromotor Outcomes at 18 and 30 Months of Age After Extremely Low Birth Weight Status
Myriam Peralta-Carcelen, Marybeth Moses, Ira Adams-Chapman, Marie Gantz, and Betty R. Vohr
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Background
Extremely low birth weight (≤1000 g) children have increased rates of cerebral palsy and other abnormal neurologic findings.
Objective
To investigate the stability of neuromotor findings between 18 and 30 months' adjusted age in extremely low birth weight infants.
Methods
Seven hundred nineteen extremely low birth weight infants with assessments at 18 and 30 months' adjusted age were included in this analysis. At each visit a neurologic examination, the modified gross motor function classification system, and the Bayley Scales of Infant Development II were administered. Logistic regression models were constructed to assess neonatal factors and neuromotor function at 18 months of age associated with stability in neuromotor function.
Results
Eighty-four percent of the children had agreement in neurologic/motor function at both visits. However, classification changed from normal to abnormal in 6% and from abnormal to normal in 10%. Diagnosis of cerebral palsy was consistent for 91% of the children, and the gross motor function classification system score was consistent for 83%. In multivariate models, factors associated with decreased severity or absence of cerebral palsy diagnosis at 30 months of age were higher gestational age, no periventricular leukomalacia or severe intraventricular hemorrhage, and a gross motor function classification system score of 0 (normal) at the 18-month visit, whereas factors associated with a new cerebral palsy diagnosis at 30 months of age were postnatal steroid use, periventricular leukomalacia or severe intraventricular hemorrhage, a gross motor function classification system score of ≥1 at 18 months of age, and asymmetrical limb movement at 18 months of age.
Conclusions
Stability of neurologic diagnosis in 84% and cerebral palsy in 91% of the children is reassuring. However, for a significant percentage of children, the neurologic diagnosis changes between 18 and 30 months of age. The diagnosis of cerebral palsy may be delayed in some infants until an older adjusted age.
Keywords: neuromotor outcomes, extreme low birth weight, prematurity, cerebral palsy
Myriam Peralta-Carcelen, Marybeth Moses, Ira Adams-Chapman, Marie Gantz, and Betty R. Vohr
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Background
Extremely low birth weight (≤1000 g) children have increased rates of cerebral palsy and other abnormal neurologic findings.
Objective
To investigate the stability of neuromotor findings between 18 and 30 months' adjusted age in extremely low birth weight infants.
Methods
Seven hundred nineteen extremely low birth weight infants with assessments at 18 and 30 months' adjusted age were included in this analysis. At each visit a neurologic examination, the modified gross motor function classification system, and the Bayley Scales of Infant Development II were administered. Logistic regression models were constructed to assess neonatal factors and neuromotor function at 18 months of age associated with stability in neuromotor function.
Results
Eighty-four percent of the children had agreement in neurologic/motor function at both visits. However, classification changed from normal to abnormal in 6% and from abnormal to normal in 10%. Diagnosis of cerebral palsy was consistent for 91% of the children, and the gross motor function classification system score was consistent for 83%. In multivariate models, factors associated with decreased severity or absence of cerebral palsy diagnosis at 30 months of age were higher gestational age, no periventricular leukomalacia or severe intraventricular hemorrhage, and a gross motor function classification system score of 0 (normal) at the 18-month visit, whereas factors associated with a new cerebral palsy diagnosis at 30 months of age were postnatal steroid use, periventricular leukomalacia or severe intraventricular hemorrhage, a gross motor function classification system score of ≥1 at 18 months of age, and asymmetrical limb movement at 18 months of age.
Conclusions
Stability of neurologic diagnosis in 84% and cerebral palsy in 91% of the children is reassuring. However, for a significant percentage of children, the neurologic diagnosis changes between 18 and 30 months of age. The diagnosis of cerebral palsy may be delayed in some infants until an older adjusted age.
Keywords: neuromotor outcomes, extreme low birth weight, prematurity, cerebral palsy
Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth Special Outpatient Services in Early Childhood
11/04/11 07:46
Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth Special Outpatient Services in Early Childhood
Susan R. Hintz, MD, MSEpi, Douglas E. Kendrick, MStat, Betty R. Vohr, MD, W. Kenneth Poole, PhD, Rosemary D. Higgins, MD, and for the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network
To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months’ corrected age.
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Susan R. Hintz, MD, MSEpi, Douglas E. Kendrick, MStat, Betty R. Vohr, MD, W. Kenneth Poole, PhD, Rosemary D. Higgins, MD, and for the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network
To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months’ corrected age.
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