Neonatal developmental care makes SENSE: implementation of an evidence-based guideline for developmentally appropriate multi-modal positive sensory exposures.

Background: There is increasing awareness of the contribution of the neonatal intensive care (NICU) environment and the importance of developmental care (DC) interventions to long-term outcomes in high-risk infants. Care at the project site reflected that given at many hospitals, where positive sensory experiences and negative sensory mitigation are done but inconsistently. There was not a guideline in place for DC interventions. Setting: The project site housed a newly renovated single-family room (SFR) NICU with 12 licensed Level II beds and ability to flex to 19 beds. Neonates at gestational ages ≥28 weeks, requiring critical care for a variety of reasons make up the patient population. Purpose: This project assessed the implementation of the Supporting and Enhancing NICU Sensory Experiences (SENSE©) Program in a Level II NICU in a suburban setting in the southeast United States as a way to increase the consistent application of positive sensory experiences in routine caregiving. Procedures: Staff were educated on neurodevelopment and neurosupportive care and oriented to SENSE©. Program-provided materials were supplied in the unit. Families were oriented to SENSE© via a program-provided educational website, and interventions were supplied per evidence-based sensory guidelines for gestational age (GA). Measures: Nurses’ integration of developmentally supportive practices in routine care were assessed before education/implementation and then again after 14 weeks of program implementation. Data was collected from bedside SENSE© medical log sheets and analyzed to assess the use of DC interventions as prescribed by SENSE©

The self-reported perceptions of the multi-disciplinary team regarding standards of neurodevelopmental supportive care in the neonatal intensive care unit

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg June 2018.Premature infant mortality and poor neurodevelopmental outcomes are great concerns worldwide as well as in South African Neonatal Intensive Care Units (NICUs). The Neurodevelopmental Supportive Care (NDSC) approach focuses on the improvement of neurodevelopmental outcomes by promoting a uterinelike environment by limiting noxious stimuli provided by the NICU environment. It is evident that developmental outcomes in the NICU need to be optimised and this can occur through further education and training of the multi-disciplinary team (MDT) on the application of NDSC guidelines in these units. In order to develop and implement such a programme, it is vital to first determine the perceptions of the MDT on the current standards of NDSC before a training programme can be developed and implemented. The aim of this study was to determine the self-reported perceptions of the MDT regarding the current standards of developmental care in two public-sector NICUs in Gauteng. A quantitative, cross sectional survey design was used to describe the selfreported perceptions of the MDT (qualified specialists, doctors, nurses and all therapists) working in the NICUs. Data was collected by making use of an existing checklist, the Instrument for Neurodevelopmental Supportive Care. The quantitative data gained from the questionnaire was studied manually, ultimately portraying a great deal of optimal as well as high-risk practices. The prevalence of high-risk practices for both hospitals was found to be evidently higher compared to the optimally applied elements. It included the categories of NICU design, family-centred philosophy, environmental stimulation, pain management, knowledge of preterm infant development as well as feeding. Very few significant differences were identified between the two participating hospitals, thus making it apparent that the participating MDT members perceive that a lot of room for improvement is present regarding the application of NDSC in the NICUs of the two participating hospitals. Key words: South Africa, NICU, Neurodevelopmental Supportive Care, developmental care, preterm infant, Multi-disciplinary teamLG201

Maternal perceptions about sensory interventions in the neonatal intensive care unit: An exploratory qualitative study

Background: Mothers play an important role in providing positive sensory experiences to their infants during NICU hospitalization. However, little is known regarding maternal perceptions about sensory-based interventions in the NICU. Further, understanding maternal perceptions was an important part of the process during development of the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. Methods: Twenty mothers of very preterm infants were interviewed after NICU discharge and asked open-ended questions about sensory-based interventions they performed in the NICU and probed about their perceptions related to the development of a sensory-based guideline and the use of volunteers to provide sensory-based interventions when unable to be present in the NICU. Interviews were transcribed and uploaded into NVivoV.12 for content analysis. Results: Mothers reported that kangaroo care was a common sensory intervention they performed in the NICU. Of the 18 mothers who commented on the development of a sensory-based guideline, 17 (94%) said they would be accepting of one. Among 19 mothers, 18 (95%) supported volunteers conducting sensory-based interventions in their absence. Identified themes included: 1) Perceptions about development of a sensory-based guideline, 2) Perceptions of interactions with healthcare providers, 3) Maternal participation in sensory interventions, 4) Maternal experience, and 5) Emotions from mothers. Conclusion: Maternal perceptions regarding the development of a sensory-based guideline were favorable, and the SENSE program has since been finalized after incorporating important insights learned from stakeholders in this study. Mothers\u27 perceptions were tied to their NICU experiences, which elicited strong emotions. These findings highlight important considerations when developing family-centered interventions

Protecting Against Pain And Stress In The Nicu: An Evidence-Based Eye Examination Guideline

Purpose: The purpose of this project was to create an evidence-based Neonatal Intensive Care Unit (NICU) eye examination guideline and associated resources that supported use of non-pharmacological interventions and emphasized the importance of parent education and involvement from both an interdisciplinary and occupational therapy perspective. Literature Review: Although medically necessary, researchers and practitioners in the NICU interdisciplinary field have discussed pain and stress associated with preterm infant eye examinations (American Academy of Pediatrics [AAP], 2016; Fierson, 2018; Francis, 2016; Pollaci et al., 2020; Samra & McGrath, 2009). Pain and stress likely impact sensory and overall brain development (AAP, 2016; Brummelte et al., 2012; Jeanson, 2019; Ranger et al., 2013; Vinall & Grunau, 2014), as well as occupational outcomes (Hills, 2019; Jeanson, 2019). Some research has aimed to determine the effectiveness of using non-pharmacological interventions for pain and stress (Disher, Cameron, Mitra, Cathcart, & Campbell-Yeo, 2018; Francis, 2016; Pollaci et al., 2020). Parents providing non-pharmacological support to their infants may promote greater infant emotional recovery (Filippa et al., 2019; Jeanson, 2019). Methodology: To form the basis of this project, a literature review/needs assessment was completed between May and December of 2021. PubMed, the Advances in Neonatal Care Journal, an OT Practice Magazine, and websites from the American Occupational Therapy Association, AAP, Centers for Disease Control and Prevention, National Eye Institute, and the National Association of Neonatal Therapists, were all searched and used. Sources chosen for this review were published between 2005 and 2021. Due to the nature of research related to this project, 10 out of 26 resources included were published either in or prior to 2017. Product: An evidence-based interdisciplinary eye examination guideline and associated resources were created for the NICU. Summary: This project emphasized occupational therapists’ use of non-pharmacological interventions for pain and stress management, occupational therapists’ understanding of visual development and the environment, as well as interdisciplinary and parent collaboration. This project was one of the first, if not the first, to create a NICU eye examination guideline initially inspired by and created within the field of occupational therapy. Future research is imperative to promote product sustainability

INCREASING PARENT CONFIDENCE AND INVOLVEMENT IN THE NICU: AN OCCUPATIONAL THERAPY EDUCATIONAL GUIDE

Research shows that 40% of mothers with preterm infants in the neonatal intensive care unit (NICU) reported feelings of depression, and 23% reported experiencing post-traumatic stress symptoms, with that number increasing to 40% after discharge (Harris et al., 2018). Factors that contributed to this included a lack of social support, a lack of empowerment, perceived less capability in their new roles, and the stressful experiences that can happen in this setting (Matricardi et al., 2013; Sabnis et al., 2019). A similar study found that at discharge, 69.8% of parents reported that they were not confident in providing the necessary care to their infant without the support of the NICU providers and 47.2% reported that their infant required complex home care post-discharge. Parents also reported that returning to their daily routine took roughly 4 to 11 months post-discharge (Jiménez-Palomares et al., 2021). Occupational therapy has a significant role in this setting by facilitating parents’ involvement in their care while also increasing their confidence to continue care at discharge (Harris et al., 2018; Reynolds et al., 2013)

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy International Clinical Practice Guideline Based on Systematic Reviews:International Clinical Practice Guideline Based on Systematic Reviews

IMPORTANCE: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline

The Wee Care Neuroprotective NICU Program (Wee Care): The Effect of a Comprehensive Developmental Care Training Program on Seven Neuroprotective Core Measures for Family-Centered Developmental Care of Premature Neonates

AbstractThe impact of neuroprotective care on preterm infants has been investigated at length, yet professional development and training related to this type of care has not been extensively examined. The Wee Care Neuroprotective NICU program (Wee Care; Philips Healthcare, Andover, MA), a comprehensive developmental care training program (Philips Healthcare) is an evidence-based total change management program designed to optimize the neonatal intensive care unit (NICU) environment and caregiving practices. The Wee Care Neuroprotective NICU program is based on a recently developed Neonatal Integrative Developmental Care Model (© Koninklijke Philips N.V., 2014. All rights reserved).), which utilizes a holistic approach in describing seven core measures for neuroprotective family-centered developmental care of premature neonates of the lotus flower. The seven core measures are depicted on petals of a lotus as the Healing Environment, Partnering with Families, Positioning and Handling, Safeguarding Sleep, Minimizing Stress and Pain, Protecting Skin, and Optimizing Nutrition. The overlapping petals of the Neonatal Integrative Developmental Care (IDC) model IDC model demonstrate the integrative nature of neuroprotective care (Fig. 1). Items on the inside of the lotus flower represent core measure 1, the Healing Environment; which highlight the significance of the developing sensory system, as well as the physical environment in which the neonate now lives. The aim of this quality improvement project was to determine the effect of the comprehensive Wee Care Neuroprotective NICU program (Wee Care) on seven neuroprotective core measures for neuroprotective family-centered neuroprotective developmental care of premature neonates. The sample consisted of 81 hospital NICU sites from 27 US states as well as Belgium and the Netherlands which had implemented the Wee Care comprehensive neuroprotective care training program and had completed pre- and post-site surveys. A secondary data analysis of the extant Wee Care database of pre and post-testing surveys was done to evaluate the training program. The results demonstrated that the Wee Care Neuroprotective NICU training program was effective in improving seven neuroprotective core measures for family-centered developmental care of premature neonates. Each core measure as well as the overall composite core measures score (core measures 1–7) showed statistically significant improvement post training (p < .001). The positive impact of the Wee Care program was independent of the level of NICU, the type of hospital, the presence of a labor and delivery service, or the program year of implementation. The Wee Care Program has been shown to be beneficial based on seven neuroprotective core measures for neuroprotective family-centered developmental care of premature and sick neonates. The transformational training program incorporates evidence-based literature, and standardizes clinical practices for all staff, therefore enhancing consistency in quality. The program improves overall neonatal care and practices and should be widely implemented in NICU's wanting to enhance neuroprotective care of premature and/or sick infants

Bright Beginnings: Quick Tips for Occupational Therapists in the Level II Nursery

In 2004 there were 790 infants born prematurely in Wyoming (Freudenthal, 2006). Currently, the highest level of infant care available in Wyoming is a Level II nursery. In Wyoming, infants born prematurely with special medical needs are typically transported to specialized NICU\u27s in surrounding states. The limited contact that medical staff, including occupational therapists (OT\u27s), in rural facilities have with critically or moderately ill infants creates a lack of competency with the unique medical care needs of the infants. According to Gordon (2003) nearly half of America\u27s babies start out their lives in a rural community (p. 3). Furthermore, research indicates that the provision of care in rural areas is substandard to care in urban/suburban areas due to lack of adequate training and resources secondary to a lower population of infants born prematurely. Gordon (2003) also indicated that such deficiencies in training have less impact in urban and suburban areas, which have seen a proliferation of level II units. Outcomes of infants born in suburban areas are superior to those of neonates born in rural locations (p 3). Research supported a need for a resource guide for OT\u27s who provide care to infants born prematurely in Level II nurseries in rural areas. The development of the resource guide is based on an extensive literature review; guided visits to a Neonatal Intensive Care Unit (NICU) and a rural Level II nursery; personal experience in NICU and rural Level II nursery environments; and discussions with medical professionals within both settings. The authors were able to identify the areas of need to be included within the product portion of the scholarly project. Knowles\u27 Theory of Andragogy was used in the development of the resource guide. Based on the results from the literature review, it was found that OT\u27s possess a need for resource guide to be utilized while caring for infants born prematurely in a rural Level II nursery. Further findings from the literature indicated that the needs ofthe infant, parent, and therapist require equal consideration in order for care to be most effective (American Occupational Therapy Association, 2006). The specific needs of the infant, parent, and therapist identified within the literature where addressed within the product portion of the scholarly project. Bright Beginnings: Quick Tips/or Occupational Therapists in the Level II Nursery is intended to be used by the OT throughout the evaluation and treatment process of the infant born prematurely

Evidence-based service modules for a sustained home visiting program

The Centre for Community Child Health (CCCH) at the Murdoch Childrens Research Institute and the Royal Children’s Hospital has undertaken two literature reviews to inform the design of a sustained home visiting program for vulnerable families with young children; the program is now known as \u27right@home\u27. This project is being led by a collaboration between three organisations: The Australian Research Alliance for Children and Youth (ARACY), CCCH, and the University of New South Wales. The first literature review undertaken by CCCH (Sustained home visiting for vulnerable families and children: A review of effective programs (McDonald et al., 2012) (hereon in referred to as the Home visiting review of effective programs) sought to answer the question ‘what works in home visiting programs?’ The conclusion reached was that it was not possible to answer the question definitively, either because the evidence regarding the ‘components’ of home visiting programs is contradictory or contested, or the evidence is not available. As the home visiting review of effective programs focused on what was delivered (ie. the efficacy of different manualised programs), rather than how services were delivered (ie. the effect of the manner in which services were delivered and the nature of the relationships established between service providers and parents), a second literature review was undertaken: Sustained home visiting for vulnerable families and children: A literature review of effective processes and strategies (Moore et al., 2012) (hereon in referred to as the Home visiting review of effective processes and strategies). The home visiting review of effective processes and strategies identified converging evidence from a number of sources to support the idea that the process aspects of service delivery matter for outcomes – how services are provided is as important as what is provided. A number of key elements of effective service delivery processes have been repeatedly identified in the research literature and these represent the threshold features or bedrock on which all services should be based: if services are not delivered in accordance with these process features, then efforts to change people’s behaviour will be less effective (Moore et al., 2012). The evidence also indicated that the identification of goals, and of strategies to achieve these goals, needs to be done in partnership with parents. However, while the ultimate choice of strategies should be made by parents, the strategies on offer used must be evidence-based. Therefore, service providers should be able to draw on a suite of evidence-based strategies to address the range of challenges that parents face in caring for their children (Moore et al., 2012). In the light of the findings of this second literature review, it was decided that the right@home home visiting program would not involve the delivery of a manualised program. Rather, service delivery would be based on the processes of effective engagement and partnership, while the content of the program would take two forms: standard modules that are delivered to all participants, and e.g. information on the stages of child development), and evidence-based ‘service modules’ (i.e. specific strategies) that could be deployed to address issues that are of particular concern to individual parents.&nbsp; Related identifer: ISSN 2204-340

Impact of a novel relaxation method of touch on neonatal neurobehavioral development among very preterm infants

Title from PDF of title page, viewed on May 28, 2013Dissertation advisor: Marco BrottoVitaIncludes bibliographic references (pages 132-139)Thesis (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2013Infants born very preterm (< 30 weeks estimated gestational age [EGA]) annually and are at greatest risk to develop significant neurodevelopmental abnormalities. These neurodevelopmental abnormalities are the result of complex conditions involving the interaction between multiple biological, genetic, and environmental risks. In an effort to manipulate and support the extra-uterine environment, infant massage has been aimed at decreasing stress and optimizing the infant's sensory experience. However, the majority of existing infant massage studies has varying protocols, are limited to healthy or convalescing preterm infants greater than 32 weeks postmenstrual age (PMA), and are seldom contingent on infant behavioral cues. The M Technique is a gentle, structured, comforting touch method aimed at limiting stress and anxiety in fragile intensive care patients who are unable to tolerate conventional massage. Little is known about the effects of this technique on infants born very preterm. Therefore, the purpose of this matched case-control pilot study was to systematically test the cumulative effect of the M Technique on infant neurodevelopment, growth velocity, and physiologic and behavioral state in hospitalized very preterm infants in a Midwestern academic level IV neonatal intensive care unit (NICU). Results indicate that very preterm infants who received the M Technique over a 5-week period did not differ significantly in neurobehavioral developmental and growth velocity compared to control infants. However, very preterm infants who received the M Technique had improved physiologic stability and more quiet sleep states from baseline to 10 minutes post the M Technique intervention over all three time points, suggesting improved physiologic stability and more quiet sleep state over time. Research regarding the type, timing, and duration of comforting touch in infants born very preterm starting at 30 weeks' PMA is lacking. Preliminary findings from this study support an infant-driven (e.g., where the protocol is based on each infant response or cues) M Technique intervention to promote comfort and relaxation in highrisk infants born very preterm. A longitudinal research design with a larger sample size is needed to confirm and expand on the effects and potential mechanisms of the M Technique on neurobehavior and growth velocity.Introduction -- Integrative review -- Theoretical framework and methods -- Feasibility study -- Results -- Discussion -- Appendix A. IRB authorization agreement between UMKC and WUSTL -- Appendix B. Informed consent -- Appendix C. Infant demographics -- Appendix D. NICU Network Neurobehavioral Scale (NNNS) -- Appendix E. Anderson Behavioral State Scale (ABSS) -- Appendix F. SLCH research grant award letter -- Appendix G. NANN small grant award lette