Measuring preterm cumulative stressors within the NICU: The neonatal infant stressor scale

Background

Stress experiences, while pervasive, are less likely than painful experiences to be managed in still-hospitalised preterm infants.

Aim

We aimed to quantify the severity of common stressors for preterm infants with a view to providing a tool to manage presumed accumulated infant stress.

Methods and subjects

Seventeen doctors and 130 nurses who work in Neonatal Intensive and Special Care Nurseries rated the perceived stress severity of 44 acute events and 24 chronic living conditions for preterm infants at three ages (< 28 weeks, 28-32 weeks, > 32 weeks post-conceptional age) and for themselves. Acute items (such as heel lance) were organised into nursing, peripheral venous access, peripheral arterial access, central vascular access, ventilation, nutrition, medical procedures, surgery, radiology and miscellaneous categories. Chronic living conditions included items such as receiving intranasal oxygen and having a systemic infection.

Results

Doctors and nurses perceived nearly all items to be stressful to infants to some degree and to be equally stressful across ages. The degree of stress experienced by clinicians themselves was generally low and moderately correlated with presumed infant stress for the same items. Presumed infant stress was inversely related to clinician age.

Conclusion

Based on these results we developed the Neonatal Infant Stressor Scale to help track, measure and manage presumed accumulated stress in preterm neonates.     

Early gross motor development of preterm infants according to the Alberta Infant Motor Scale

OBJECTIVE: To systematically examine gross motor development in the first 18 months of life of preterm infants. STUDY DESIGN: A total of 800 preterm infants (356 boys), ages between 1 and 18 months and corrected for degree of prematurity, were assessed with the use of the Alberta Infant Motor Scale. RESULTS: Comparison of the mean Alberta Infant Motor Scale scores of the preterm infants with the norm-referenced values derived from term infants revealed that as a group, the preterm infants scored significantly lower at all age levels, even with full correction for degree of prematurity. CONCLUSIONS: In general, preterm infants exhibit different gross motor developmental trajectories compared with term infants in the first 18 months of life. The gross motor developmental profile of preterm infants may reflect a variant of typical gross motor development, which seems most likely to be specific for this population. As a consequence, adjusted norms should be used for proper evaluation and clinical decision-making in relation to preterm infants.     

NICU出院早产儿1岁时神经发育预后及干预依从性对其的影响

目的：了解NICU抢救存活早产儿在1岁时的神经发育状况及其影响因素,重点讨论干预依从性对其预后的影响。方法：患儿出院后予以早期干预指导和随访,1岁时进行智能发育测试（CDCC）评估,了解神经发育概况。按照智力发育指数（MDI）和精神运动发育指数（PDI）将患儿分为神经行为发育异常组（MDI或PDI任何一项＜70）、临界组（MDI或PDI任何一项为70~85之间）和正常组（MDI或PDI均＞85）。列举可能对神经行为发育产生影响的社会家庭因素和临床相关因素,利用单因素方差分析和卡方检验的方法进行筛选,对于可能的高危因素进行logistic回归分析,了解各因素相对危险度。根据家长对患儿进行干预的具体情况将其分为依从性良好（每周进行家庭干预≥4 d,每天干预时间合计超过30 min,并在1年内能够随访≥5次）和依从性差二组,进一步分析干预依从性对其神经发育预后的影响。结果：210例患儿CDCC评分正常、临界和异常者分别为123例（58.6％）、61例（29.0％）和26例（12.4％）,共有精神发育落后儿18例（8.6％）和脑瘫儿9例（4.3％）。干预依从性良好者（111例）的MDI及PDI得分,分别为97.15±17.38,94.23±18.55均明显高于干预依从性差者的89.87±18.92,87.20±19.12;干预依从性好组脑瘫的发生率（3/111,2.7％）也低于干预依从性差者（5/99,6.1％）。另外,父母亲文化水平、多胎、颅内出血、呼吸暂停等也是影响早产儿神经发育预后的危险因素。结论：早产儿是神经发育伤残的髙危人群,尤其是NICU抢救成活的危重新生儿。早期干预可以改善高危早产儿的神经发育预后。［中国当代儿科杂志,2007,9（3）：193-197］     

早期康复介入降低早产儿宫外生长发育迟缓的研究

目的 探讨早期康复介入对早产儿宫外生长发育迟缓（EUGR）及早期疾病发生的影响。方法 研究对象为生后24 h内入住新生儿重症监护室（NICU）、胎龄 < 34周、出生体重1 000~ < 2 000 g的适于胎龄早产儿。采用前瞻性、随机、对照研究法将研究对象分为康复干预组和对照组。康复干预组患儿在生命体征平稳后进行早期康复治疗,包括口部感觉及肌力训练和新生儿头部、胸部、腹部、四肢和手足的压力抚触。主要观察结果是两组早产儿达到独立经口喂养的时间、住院天数、EUGR发生率等。次要观察结果是两组早产儿疾病如呼吸暂停、喂养不耐受、败血症等发生情况。结果 共有97例早产儿符合入组标准且资料完整。其中对照组48例,干预组49例。干预组达到独立经口喂养时间短于对照组（P < 0.05）。干预组患儿的住院天数以及出院时纠正胎龄低于对照组（P < 0.05）。干预组的EUGR发生率低于对照组（P < 0.05）。干预组呼吸暂停、喂养不耐受和败血症的发生率低于对照组（P < 0.05）。结论 对NICU中的早产儿进行早期康复介入,可减少呼吸暂停和喂养不耐受的发生率,更早地完成独立经口喂养,降低EUGR的发生率。     

Recurrent otitis media with effusion in preterm infants with histologic chorioamnionitis--a 3 years follow-up study

Background

Recurrent otitis media with effusion (OME) is a leading cause of acquired hearing loss in childhood. Histological chorioamnionitis (HCA) is an important cause of preterm delivery and neonatal morbidity and mortality. Here, we tested the hypothesis of an association between recurrent OME during the first 3 years of life and HCA in very low birth weight (VLBW) infants.

Methods

A total of 110 randomly selected VLBW preterm newborns with HCA and 135 gestational age and gender-matched, HCA-negative VLBW infants were evaluated prospectively during the first 3 years of life for the presence of OME, as diagnosed on the basis of otoscopy, type B or C tympanogram, ipsilateral absence of transient evoked otoacoustic emissions responses, and ipsilaterally increased threshold at diagnostic auditory brain responses evaluation. Potential risk factors for OME were also examined in the two groups.

Results

The HCA-positive infants showed a ~ six times higher frequency of recurrent OME (P < 0.0001), increased frequency (> 5/yr) of clinical otitis media episodes (P = 0.000020), ~ five times higher frequency of adenoid hypertrophy (P < 0.00001), a significant seasonal pattern of birth with autumn predominance (P < 0.00001), and the first OME occurred earlier (P < 0.0001), as compared to the HCA-negative counterparts. Recurrent OME was significantly associated with HCA (O.R. = 17.76, 95% CI: 8.98-35.13, P < 0.00001), adenoid hypertrophy (O.R. = 9.96, 95% CI: 5.17-19.18, P < 0.00001), frequency of acute otitis episodes > 5/yr (O.R. = 8.91, 95% CI: 1.96-40.41, P = 0.0005), and birth in autumn (O.R. = 5.58, 95% CI: 2.79-11.12, P < 0.00001).

Conclusions

These findings indicate that HCA is a previously unrecognized risk factor for the development of recurrent bilateral OME in VLBW preterm infants during the first 3 years of life.     

The quality of general movements in the first ten days of life in preterm infants

Background

The assessment of the quality of general movements (GMs) in preterm infants early in life has been used mainly to determine temporary or permanent neurological dysfunction and not to predict outcome.

Aim

Assessing the quality and evolution of GMs during the first ten days of life in preterm infants, and relating them to clinical factors and neurological outcome at 24 months' post-term.

Methods

Using Prechtl's method, the GM quality was assessed in 45 preterm infants on days 2, 4, 6 and 10. They were related to clinical factors and outcome. After GM assessment, an extra item was scored: chaotic features (ChF). ChF was defined as chaotic GMs or poor repertoire GMs+chaotic movements.

Results

Abnormal GMs were seen mostly in early recordings. A better GM trajectory correlated with a higher birth weight, a higher gestational age and a lower Nursery Neurobiologic Risk Score (NBRS). Predictive value for normal outcome of at least one normal GM was 94%. Predictive value for abnormal outcome of only abnormal GMs was 21%. ChF were seen mostly in early recordings. Occurrence of ChF on day 2 correlated with lower serum calcium.

Conclusions

Preterm infants often showed abnormal GMs during the first few days. This was related mostly to a higher NBRS. Normalization of GMs during the first ten days was associated with a lower NBRS and was a reliable predictor for neurological outcome. ChFs could be a GM quality that is associated to lower calcium, indicating hyperexcitability of the nervous system.