Neonatal Assessment Manual Score: Is There a Role of a Novel, Structured Touch-Based Evaluation in Neonatal Intensive Care Unit?

Abstract

Despite the technological improvements in monitoring preterm infants in the neonatal intensive care unit, routine care in the neonatal ward is primarily based on manual procedures. Although manual clinical procedures play a critical role in neonatology, little attention has been paid to palpation as a clinical assessment tool. Palpation is a clinical evaluation tool that relies mostly on the senses of touch and proprioception. Based on recent studies investigating the role and clinical effectiveness of touch in full-term and preterm babies, this paper proposes an evaluative touch-based procedure-the Neonatal Assessment Manual Score (NAME) model-that could be useful in the neonatal ward and describes its rationale. The operator applies gentle light pressures to the infant's body. In essence, the touch stimulates low-threshold afferent fibers that could influence the interoceptive cerebral network and the autonomic nervous system, thus altering the blood flow and breathing rhythm. These events could change how bodily fluids distribute among body segments and hence the body volume. The volume modification could be felt manually through haptic perception owing to the high sensitivity of the fingers. On the basis of their clinical conditions and stage of development, infants will respond differently to the applied pressures. Evaluating the infant's response, the operator produces a score of "bad," "marginal," or "good" for communicating quickly and clearly the infant's conditions to other professionals. Because the NAME model is intended for every professional who is used to touch-based procedures, if future studies confirmed its validity and reliability in clinical practice, the NAME model could become a part of the neonatal ward routine care for better assessing and managing the infant's conditions, even during emergencies.

The neonatal assessment manual score (NAME) for improving the clinical management of infants: a perspective validity study

“…The NAME model is a touch-based manual examination that produces two scores: 1) categorical, that includes three levels: “Bad,” “Marginal,” and “Good” – and 2) numerical – a 1-to-9 Likert scale (Table 1 ). The estimated time to perform the NAME is about 90 s [ 18 ].…”

“…The operator evaluates how the infant reacts to light mechanical stimuli – pressure and distension – applied to the cranial and the sacral region of the body. The operator assesses two parameters: a) the compliance, that is whether the body changes its volume accordingly to the mechanical stimuli applied, and b) the homogeneity, that is whether the infant’s tissues adapt to the mechanical stimuli in the same way throughout the body [ 18 ]. The operator then gives the NAME score (Table 1 ).…”

“…The Neonatal Assessment Manual scorE (NAME) model – a new assessment procedure in the neonatology field – was developed for overcoming these difficulties [ 18 ]. The NAME aims to evaluate the infant’s general clinical conditions through the assessment of how the body tissues respond and adapt to manual stimulation, i.e., static light touch.…”

“…The NAME aims to evaluate the infant’s general clinical conditions through the assessment of how the body tissues respond and adapt to manual stimulation, i.e., static light touch. It is designed to produce a score that could correlate with the infant’s clinical condition and therefore improve their clinical management [ 18 ]. Moreover, it is designed to be used by every NICU professional with enough experience in the neonatal ward [ 18 ].…”

“…It is designed to produce a score that could correlate with the infant’s clinical condition and therefore improve their clinical management [ 18 ]. Moreover, it is designed to be used by every NICU professional with enough experience in the neonatal ward [ 18 ]. Since the rationale underlying the NAME model was described elsewhere (see [ 18 ] for more details of the NAME model significance), the present paper aims to begin the NAME validation process, investigating the model’s face, content and, as a preliminary analysis, construct validity.…”