Poster group
Details of individual items:
poster
Our specific aims were to evaluate preterm infants' immediate physiologic & behavioral responsesto a multi-sensory intervention, and to describe & compare experimental and control group infants'neuromotor and mental development during the first year of life. This study took place in the NICU of a level III medical center in the United States from 1992-1996. AStress Reduction Program (SRP) was in place during the data collection time period, which aimed to reduce thelevel of handling, noise and light the infants received, while promoting optimal development. Infants diagnosedwith Periventricular Leukomalacia (PVL) or Grade III/IV Intraventricular Hemorrhage (IVH) were eligible at 32weeks gestation. A co-hort of Very Low Birthweight (VLBW) infants born between 23-26 weeks gestationwith normal neurosonograms was also recruited at 32 weeks gestation. Thirty-nine medically stable prematureinfants were randomly assigned to a control (Group C) or experimental group (Group E). Group C infants received routine nursery care; no additional stimulation was provided. Group Einfants received fifteen minutes of ATVV (Auditory, Tactile, Visual, and Vestibular) intervention, twicedaily, five days per week, for four weeks or until discharge to home. The Group E infants' mothers,trained to reliability prior to discharge, continued the ATVV intervention at home until the infant reachedtwo months corrected age. The intervention consisted of a ten-minute head-to-toe body massage (tactile),during which time the RN/mother attempted to maintain eye-to-eye contact (visual), while talking softly tothe infant (auditory). The massage was followed by five minutes of rocking (vestibular). The ATVVprogressed dependent on the infant's positive and negative behavioral cues. Our analysis of the infants' physiologic response (heart rate, respiratory rate, hemoglobin oxygensaturation, & body temperature) found that the means fluctuated yet remained within the limits of normalfor infants of these gestational ages. Behavioral state differences existed between Groups C & E in thepercentage of alertness (p<0.01) and in the percentage of alertness by week enrolled in the study (p<0.01). Infants in Group E who alerted the most in response to ATVV intervention had the shortest hospital stays (r-0.48; p0.037). Both PVL & IVH infants in Group C had a mean of 12 in-patient study days longer thancounterpart Group E infants (p0.014). Group C infants averaged significantly longer to progress from gavageto nipple feeding (16 verses 12 days). The proportion of nippled intake to gavage intake was significantly largerfor Group E (p0.04). At one year of age the injured experimental group had a 23% lower incidence of CPand had a 10-13 point higher score on the Bayley II. The small sample size (Group C 9; Group E 9)yielded non-significant comparisons between the groups for either measures. Strong alerting to the ATVV intervention is a predictor of rapid clinical improvement andassociated early discharge. The trend toward improvement in mental and motor performance and the lowerincidence of CP at one year suggests the need for a larger sample to document the long-term impact ofATVV intervention.
poster
Since the early 1980's, the survival of extremely premature infants has steadily increased as a result of advances in neonatal intensive care. However, questions remain about the risk of perinatal complications and long-term disability in survivors. We report our 15-year prospective experience with 608 extremely premature deliveries (23-26 weeks gestation) born between 1980-1994 in the sole tertiary center for a 29-county region. We studied changes in survival, neonatal complications, and developmental disabilities. Severe intracranial hemorrhage included Papile grades 3-4 or other parenchymal brain injury. Multidisciplinary follow-up evaluations were done at 6, 12 and 18 months of age adjusted for prematurity. Cognitive delay was defined as a Bayley MDI <70 and neuromotor delay as a Bayley PDI <70, an Infanib score < 69, or major neurologic disability with >30% delay in motor skills for age. Cerebral palsy required an established neurologic diagnosis but varied from severe to minimal impairment. Hearing or visual disability and strabismus were also noted. Results are presented and compared over 3 time periods (1980-84; 1985-89; and 1990-94). Both the total number of inborn extremely premature deliveries (138-182-288) and survival rate (9-27-34%) increased over time (p3D.0001). The proportion considered viable and treated aggressively in the NICU also increased (28-46-49%, p3D.0001) and was associated with a significant increase in survival (31-59-68%, p3D.0001). Survival increased for inborn deliveries but not transported infants and decreased with birth asphyxia. There was no change in the incidence of chronic lung disease (61-61-56%) or retinopathy (22-17-34%). However, severe intracranial hemorrhage showed a major decrease over time (51-29-26%, p3D.01). Prospective developmental follow-up of survivors showed a significant decrease over time in the incidence of cerebral palsy (33-34-11%, p3D.006) and major neuromotor delays (30-35-11%, p3D.01). There was no significant change in cognitive delays (22-16-12%, p3D.13), strabismus (18-21-15%), visual impairment (0-8-6%) or hearing loss (8-2-3%). In conclusion, we found that over the time period from 1980-94, the number of extremely premature deliveries in our region increased and was associated with increased survival and increased frequency of providing intensive neonatal care. Over the same time period, the incidence of cerebral palsy and major neuromotor delays declined and the rate of other medical and neurosensory disabilities remained stable.
poster
The Bayley Scales of Infant Development (BSID) have been used for 30 years to assess development in infants and toddlers 2-30 months of age. Although these scales were not designed to predict future intellectual function, they are often used clinically as predictors of IQ. This practice is of particular concern when applied to infants with brain damage, who may have uneven developmental profiles at different ages because of plasticity in the developing nervous system. The present study was conducted to determine whether the BSID were reliable predictors of future IQ in children with early focal brain damage and in typically developing controls. Thirteen children with pre-or peri-natal unilateral strokes, and 11 typically developing control children were studied. Each child received the BSID prior to 30 months of age, and subsequently either the Wechsler Preschool and Primary Scale of Intelligence--Revised (WPPSI-R) or the Wechsler Intelligence Scale for Children Revised (WISC-R) at a later date. There was an average of 6 years between the first and second testing. Correlational analyses failed to demonstrate any significant correlations between BSID scores and Wechsler IQs in either the focal lesion or control groups. In the focal lesion (FL) group, increased time between administration of the BSID and the Wechsler Scale was associated with a greater difference between mental test scores (i.e., Bayley Mental Scale and Wechsler Full Scale IQ [FSIQ] or Wechsler Verbal IQ [VIQ]). The mean BSID scores for FL children were below normal, whereas the mean Wechsler FSIQ and VIQ scores were in the average range. The results indicate that the BSID are not reliable predictors of IQ in either typically developing children or in children who suffered early focal brain damage. It is particularly important in a neurologically impaired population, to refrain from attempting to predict outcome until the brain has had time to 'reorganize.' Test scores in very young children may provide misleading information about the child's ultimate intellectual potential.
poster
How mothers interact with their infants often determines the way in which the infant engages with people and how the infant explores its physical environment. The expectation of most mothers is that their infants will engage in reciprocal interaction from the earliest age. Certainly by the end of the first year, mothers and infants will taken turns, social reference and provide clear social cues to one another. Often a sign that an infant is not developing along a normal trajectory is reflected in the way in which the mother interacts with the infant. Mothers may bypass their normal style when the infant is not functionally normal. The current report provides preliminary data on a group of infants who spent their first few days in the Neonatal Intensive Care Unit. The current sample is part of an ongoing study of infants born below normal birth weight or before full gestation. Thirty six infants and their mothers were observed serially according to the order they appeared in the follow-up study when they were between 10 and 12 months of age. Of these, 14 were classified as having some sort of brain injury at birth according to specific based on Brainstem Auditory Evoked Response, cranial ultrasound and a newborn neurobehavioral scale. The remaining 22 infants were judged to have no evidence of birth injury. Mothers and infants were observed interacting in a home-like laboratory setting at our Institute. Their behavior was videotaped through a one way screen so that both infant and mother behavior were visible. Subsequently they were coded using a modified version of a mother infant interaction which preserved sequence and timing of mother and infant behaviors. The coders had no information regarding the purpose of the study or the group membership of the infants. Results indicated that mothers of the brain injured and non-brain injured infants differed in their interactional style. Mothers of brain-injured infants showed a significantly more non-verbal 'looking' at their infants and significantly less social talking to their infants than did the non-brain injured infants. The results for the brain-injured infants are similar to results obtained in earlier studies of infants later identified as maltreated. These preliminary findings are interpreted in terms of a theory of social disengagement by mothers of infants who have been stigmatized by some early environmental or endogenous event. Maternal interactional style is a sensitive indicator of such stigmatization and may be used as an early predictor of dysfunctional parenting or need for interactional intervention.