Neurorehabilitation after neonatal intensive care: evidence and challenges

Maitre, Nathalie L.

doi:10.1136/archdischild-2013-305920

Cited by 43 publications

(38 citation statements)

References 40 publications

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“…Mobility programs expedite return to activities of daily living and reduce lengths of stay and cost, without affecting safety events, but they have not been adequately prospectively studied in children 10,25,26 . A single center quality initiative has shown that mobility interventions for critically ill children can be increased without negative safety effects 19 .…”

Section: Discussionmentioning

confidence: 99%

“…However, the neonatal ICU population has evidence supporting guidelines for disability risk assessment and interventions, some of which may translate to the younger PICU population 26–29 . Neuromuscular junction blockade agents are associated with ICU-acquired weakness, with patients demonstrating decreased motor evoked response amplitudes on nerve conduction studies 30,31 .…”

Section: Discussionmentioning

confidence: 99%

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Physical and occupational therapy utilization in a pediatric intensive care unit

Cui

LaPorte

Civitello

et al. 2017

Journal of Critical Care

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Purpose To characterize the use of physical therapy (PT) and occupational therapy (OT) consultation in our pediatric intensive care unit (PICU). Materials and Methods We studied children aged 1 week – 18 years admitted to a tertiary care PICU for ≥ 3 days. Patient characteristics, details of PT and OT sessions and adverse events were collected. A multivariable logistic regression was performed to determine factors associated with receipt of PT and OT consultation with propensity analysis followed by a regression for factors associated with outcome. Results Of 138 children studied, 40 (29%) received PT and OT consultation. Services were initiated 6.9 ± 10.0 (mean ± standard deviation) days after PICU admission. Range of motion (83%) was the most common therapy provided and 28% of patients were ambulated. Sixty-four of 297 (21.5%) sessions were deferred and 7 (2.4%) sessions were terminated early due to physiologic instability with no serious adverse events. Children who received PT and OT were older, more likely to require neuromuscular blocking agents, and had lower pre-PICU POPC scores (all p<0.05). Conclusions Data are needed to inform on the efficacy of rehabilitative therapies initiated in the ICU to improve outcome for critically ill children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physical and occupational therapy utilization in a pediatric intensive care unit

Cui

LaPorte

Civitello

et al. 2017

Journal of Critical Care

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“…Abnormal tactile processing and neurological thresholds are associated with worse cognitive, motor and language outcomes in preterm infants[5,6]. Promoting optimal development and function in newborns hospitalized in NICUs may help establish the sensory building blocks of cognition, behavior and communication[33]. …”

Section: Associations Between Painful and Supportive Experiences In Tmentioning

confidence: 99%

The Dual Nature of Early-Life Experience on Somatosensory Processing in the Human Infant Brain

et al. 2017

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Summary Every year 15 million preterm infants are born, and most spend their first weeks in neonatal intensive care units (NICUs)[1]. Although essential for the support and survival of these infants, NICU sensory environments are dramatically different from those in which full-term infants mature, and, thus, likely impact the development of functional brain organization[2]. Yet, the integrity of sensory systems determines effective perception and behaviour[3,4]. In neonates, touch is a cornerstone of interpersonal interactions and sensory-cognitive development[5–7]. NICU treatments used to improve neurodevelopmental outcomes rely heavily on touch[8]. Yet, we understand little of how brain maturation at birth (i.e. prematurity) and quality of early-life experiences (e.g. supportive vs. painful touch) interact to shape the development of the somatosensory system[9]. Here, we identified the spatial, temporal and amplitude characteristics of cortical responses to light touch differentiating them from sham stimuli in full-term infants. We then utilized this data-driven analytical framework to show that the degree of prematurity at birth determines the extent to which brain responses to light touch (but not sham) are attenuated at the time of discharge from the hospital. Building on these results, we showed that when controlling for prematurity and analgesics, supportive experiences (e.g. breastfeeding, skin-to-skin care) are associated with stronger brain responses, whereas painful experiences (e.g. skin punctures, tube insertions) are associated with reduced brain responses to the same touch stimuli. Our results shed crucial insights into the mechanisms through which common early perinatal experiences may shape the somatosensory scaffolding of later perceptual, cognitive and social development.

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“…Progression and influences on infant neurodevelopment (modified from Maitre review of Neurorehabilitation) . The neonatal brain at birth is immature and is influenced by prenatal, birth and postnatal events.…”

Section: Introductionmentioning

confidence: 99%

Parenting style associations with sensory threshold and behaviour: a prospective cohort study in term/preterm infants

et al. 2019

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Aim Early‐life atypical sensory functioning and behavioural profiles are often associated with long‐term developmental problems, especially in former preterm infants. We tested whether parenting style is associated with atypical sensory threshold or behavioural outcomes in preterm and term infants assessed during early childhood. Methods We prospectively evaluated parenting style for a cohort of term and preterm infants who had previous assessments of sensory development and behaviour. We used standardised tools to evaluate parenting style, sensory neurological threshold at one year, and internalising and externalising behavioural tendencies at two years. Covariates included gestational age, sex and maternal education. Results For the entire cohort (n = 82), children of more permissive parents were 2.7 times more likely to demonstrate abnormal sensory neurological thresholds compared to children of parents with less permissive styles (CI: 1.4–4.9). More permissive parenting scores were also associated with 2.4 times increased internalising (CI: 1.3–4.2) and 3.0 times increased externalising (CI: 1.6–5.6) tendencies. In the preterm group only, higher authoritative parenting scores were associated with fewer behavioural problems. Conclusion Permissive parenting is associated with worse infant sensory and behavioural outcomes. Authoritative parenting is associated with fewer behavioural problems in preterm children. Modification of parenting style may improve sensory development and behavioural outcomes.

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Neurorehabilitation after neonatal intensive care: evidence and challenges

Cited by 43 publications

References 40 publications

Physical and occupational therapy utilization in a pediatric intensive care unit

Physical and occupational therapy utilization in a pediatric intensive care unit

The Dual Nature of Early-Life Experience on Somatosensory Processing in the Human Infant Brain

Parenting style associations with sensory threshold and behaviour: a prospective cohort study in term/preterm infants

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