Infant Neurobehavioral Development

Abstract

The trend toward single-room neonatal intensive care units (NICUs) is increasing; however scientific evidence is, at this point, mostly anecdotal. This is a critical time to assess the impact of the single-room NICU on improving medical and neurobehavioral outcomes of the preterm infant. We have developed a theoretical model that may be useful in studying how the change from an open-bay NICU to a single-room NICU could affect infant medical and neurobehavioral outcome. The model identifies mediating factors that are likely to accompany the change to a single-room NICU. These mediating factors include family centered care, developmental care, parenting and family factors, staff behavior and attitudes, and medical practices. Medical outcomes that plan to be measured are sepsis, length of stay, gestational age at discharge, weight gain, illness severity, gestational age at enteral feeding, and necrotizing enterocolitis (NEC). Neurobehavioral outcomes include the NICU Network Neurobehavioral Scale (NNNS) scores, sleep state organization and sleep physiology, infant mother feeding interaction scores, and pain scores. Preliminary findings on the sample of 150 patients in the open-bay NICU showed a “baseline” of effects of family centered care, developmental care, parent satisfaction, maternal depression, and parenting stress on the neurobehavioral outcomes of the newborn. The single-room NICU has the potential to improve the neurobehavioral status of the infant at discharge. Neurobehavioral assessment can assist with early detection and therefore preventative intervention to maximize developmental outcome. We also present an epigenetic model of the potential effects of maternal care on improving infant neurobehavioral status.

The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants

“…52 Neonates have been shown to benefit from the initiation of stimulation programs during hospitalization. 53 In considering the sequential developmental importance of the premature infants'senses, as noted in past NICU studies, 54-57 the current study has taken into account the fact that the premature infants' immature sensory modalities such as hearing and vision are at risk for being overstimulated.…”

Individualized Developmental Care in Neonatal Intensive Care Unit: Current Approaches: Review

“…3,4 Bununla birlikte, 1980'li yılların başından itibaren preterm doğum oranlarında istikrarlı bir artış gözlenmiştir. 5 Dünya genelinde preterm doğum oranları %5-18 arasında değiş-mekte olup, ABD'de hafif bir düşüş göstererek %11,33, ülkemizde ise %11,97 düzeylerinde seyretmektedir. 6 Preterm bebekler için sağkalım oranlarındaki artışa olumsuz sağlık sonuçları ve morbidite riskinde artış eşlik etmektedir.…”

“…9 Preterm ve çok düşük doğum ağırlıklı bebeklerde nörodav-ranışsal ve fonksiyonel sonuçların değerlendirildiği çalışmalarda, ileriki yıllarda çocuklarda akademik başarıda azalma, dikkatin sürdürülmesinde yetersizlik gibi sorunlar doğum sırasındaki olgunlukları ile ilişkili bulunmuş, 10,11 ayrıca ince-kaba motor becerileri, seçici dikkat ve görsel algı puanlarının da kontrol grubuna göre düşük olduğu belirlenmiştir. 5,12 Yenidoğan yoğun bakım üniteleri (YYBÜ)'nde uygulanan destek tedavilerinin geliş-mesi ile prematüre bebeklerde bu nörogelişimsel sorunların varlığı daha fazla dikkat çekici hâle gelmiştir. YYBÜ'de bakımın amacı; tek başına sağka-lımdan çok, ağır morbidite ve gelişimsel sorunu olmayan çocukların sayısını artırmaktır.…”

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

“…41 Growth restriction 42 and maternal depression during pregnancy 43 are also related to epigenetic alterations in placental genes that in turn affect NNNS scores. These studies provide insight into molecular mechanisms related to newborn neurobehavior that could have long term implications for behavioral development 30,44,45 including the development of mental health disorders. 46,47 The NNNS has also been used with normal, healthy infants to examine methodological issues 7,48 and describe the range of variability of newborn neurobehavior in this population.…”

“…29 In addition, NNNS findings in preterm infants shortly before NICU discharge are more positive when there is more family centered care, developmental care and parent satisfaction and less maternal depression and parenting stress. 30 The NNNS may be useful in implementing developmental models of care in the NICU and identifying infants who may be at high risk for poor developmental outcome even without medical problems. The latter is supported by the long term predictive validity of the NNNS.…”