Poster group
Details of individual items:
poster
Differences in early infant feeding have been suggested as a major factorinfluencing early growth and early growth faltering, in turn, has been foundto be associated with poorer cognitive development (Skuse et al, 1994).Very preterm infants are at particularly high risk for both continuous poorgrowth and cognitive developmental deficits (Wolke, 1998; Gutbrod et al, inpress). When studying feeding, two distinct components need to be takeninto consideration; firstly the type, quantity and frequency of feeds beingoffered to the infant and secondly, the infant's competency in theoral-motor mechanisms involved in feeding. Both of these factors controlthe amount and density of food intake. Research suggests that veryprematurely born infants may be severely disadvantaged as regards both thesecomponents of feeding. There is much evidence for the benefits of humanbreast milk over other alternatives: reduced incidence of infection (Howieet al, 1990; Dewey et al, 1995; Pisacane et al, 1992); reduced incidence ofallergic disorders (Saarinsen et al, 1995); and an increased IQ, mostsignificantly in pre-term infants (Morley et al, 1988; Lucas et al, 1992).Unfortunately, however, a smaller proportion of preterm infants thanfull-term infants are breastfed. In addition, the normal hunger-satietyregulation present in full-term, healthy infants may not work efficiently ininfants born very preterm (ie the infant may not wake up and cry for a feedwhen expected, nor finish a feed due to fatigue/fragility) (Wolke et al,1998). Many preterm infants also exhibit initial oral-motordisorder/dysfunction which effects their feeding efficiency. It is unclearhow frequently these problems persist after reaching 'term'. Finally, thereis an increased incidence of intrauterine growth retardation (IUGR) in verypreterm infants (30-40% as opposed to 10% in the full-term population).IUGR has been found to have long-term consequences for growth in preterm andfull-term infants. All these issues, together with medical complicationsearly in the neonatal period, may adversely effect growth.The GAIN study (Growth in At-risk Infants) investigates whether IUGR,medical complications and early feeding characteristics are the majordeterminants of poor growth in very preterm infants. GAIN is alongitudinal, observational study of 90 infants born very preterm (ie before32 weeks gestation). The infants were recruited into the study from threelarge neonatal intensive care units over a period of 18 months in 1998-99.Obstetric and medical data was obtained and the infants and their mothersseen at term and 3 months corrected age. Assessments included the recordingof sucking behaviour during a milk feed using a mercury strain gauge andplethysmograph, detailed questions regarding the infant's feed, sleeping andcrying behaviours, and anthropometric data (ie weight, length and headcircumference). 24% of the sample were small-for-gestational-age (SGA).Data will be presented on the type, frequency and quantities taken at feeds;whether feeds are initiaetd by the mother or infant; and the oral-motorcompetency of the infants at both term and 3 months corrected age. Therelative contribution of medical risk factors, IUGR, feeding characteristicsand infant demand characteristics (eg irritability) to physical growth willbe presented.
poster
There is evidence that early experiences affect subsequent development and/or maturation in profound and long-lasting ways. However, the precise relationship between biological maturation and the influences of early environmental experiences continues to be explored, especially in high-risk preterm infants who have experienced a different beginning due to their untimely birth. Not only are preterm infants born early with systems that have not yet matured enough to function independently, but the highly technical environment of the NICU - although lifesaving--- provides stimulants and stressors that are often challenging for the preterm infant to integrate and manage without extensive medical and developmental support . Moreover, it must be noted that preterm infants are not a homogeneous group, there are generally considerable variations in their medical and neurological histories, as well as their abilities to adapt and respond to the environment related to their degree of maturation and development. Little research exists which addresses the differences in feeding skills between preterm infants at term and normal full term infants. Studies comparing the sucking behavior of full term infants and infants born at less than 34 weeks gestation indicate that significant maturation of the mechanics of feeding occurs during the last few months of gestation. The purpose of this research was to further examine and quantify the differences between sucking abilities of preterm infants at term (40 weeks post-conceptional age) and newly born full term infants. We hypothesized that although there would be differences in the patterns of sucking indicators, the differences could be more attributed to experience than maturation. The sample consisted of two hundred forty six infants at forty weeks post-conceptional age. Infants were placed in one of three gestational age (GA) groups, 24-29 weeks GA, 30-32 weeks GA and 38-42 weeks GA or term. The Kron Nutritive Sucking Apparatus was used to examine the micro-structure of feeding behaviors. Full term infants were assessed during the second 48 hours of life during a regularly scheduled morning feeding in the newborn nursery. Preterm infants were evaluated during their follow-up visit at 40 weeks post-conceptional age (PCA). There were significant difference among the three groups in the several of the sucking parameters: number of bursts (p< .006), intersuck interval (p<.036), sucks per burst (p<.026), suck width (p3D.000) and intersuck width (p3D.000). Extremely early born preterm (EEB) infants were not found to be as competent as either the full term infants or the healthy more mature preterm infants. The most competent group of infants at the time of data collection was the healthy more mature preterm infants. These infants appeared to benefit from the increased experience provided by being born early. It is important to note however, that the EEB preterm infants had more variable amounts of experience than more mature preterm infants. This variability may have been related to the increased frequency and duration of neonatal complications that often delay the initiation of oral feeding for these infants. Thus, differences in sucking behaviors were noted as a function of gestational age and the interaction of maturation and experience.Supported by NIH, NINR grant # R01NR02093-04A3.
poster
Infant feeding skills progress dramatically from suckling to self-feeding, often with spoon and cup, by the end of the first year. Self-feeding skills support nutrient intake adequate for infant needs. Feeding skill progression parallels neuromotor development of head, neck, trunk, arms, hands, and fingers (Gesell & Ilg, 1937). Progression to self -feeding also depends on mental development and the ability to communicate needs, preferences, and desires. Infants born prematurely and at very low birth weight (VLBW, 1500 grams or less) may not progress in feeding skills as expected, particularly towards the end of the first year, adjusted age, because of their higher risk of developmental delay (Bennett, 1997). Knowledge concerning the progression of feeding skills of VLBW infants through the first post-term year and the extent to which motor and mental development influences this progression could advance understanding of a clinically important functional skill, and aid clinicians in determining the type of support infants need to develop feeding skills. The purpose of this study was to explore stability or change in VLBW infants' accomplishment of expected feeding skills through the first post-term year, and to examine the contribution to feeding skills of mental and motor development. The feeding of 40VLBW infants by their mothers was observed and video-taped in the home at 1, 4, 8, and 12 months post-term age. On average, at birth, Infants weighed 892 grams (SD 236) and were 26.6 weeks gestation (SD 1.90). Mothers averaged 13 years of schooling (range 8-21 years); about 65% were minority, primarily African American. Trained observers assessed feeding skills with an observational instrument that included checklist items (observed, not observed). Most items were derived from Gesell & Ilg's (1937) normative study. Inter-rater agreement for approximately 20% of the observed feedings ranged from 83 to 91%. The proportion of expected feeding skills accomplished was computed to determine skill progression for each of the four observations. The Bayley II Mental and Motor Scales were used to assess development at 4 and 12 months post-term age. The proportion of feeding skills accomplished ranged from .55 to .63 (SD .16 - .20). This proportion remained stable, on average, across the four assessments (p > .05), as demonstrated by general linear mixed model analysis. The Motor Scale Score did not contribute significantly to the proportion of feeding skills accomplished. Although the Mental Scale Score did not contribute to this proportion early in the first year, the contribution later in the first year was significant (p < .05). Study findings indicate that very low birth weight infants progress consistently relative to expected feeding skills for age through the first post-term year. The significant contribution of mental developmental to feeding skills later in the first year suggests that abilities that support infants in communicating needs, preferences, and goals to the mother may make a difference in skill development. Infants with a higher Mental Score may have elicited more self-feeding practice opportunities from caregivers. Whether or not this occurs and how practice supports feeding skill progression are questions for further study.
poster
The frequency, proportion, and duration of desaturation episodes (oxygensaturation < 90% and ( 20 seconds) between supine and prone placementwere compared in ventilated premature infants during their first week oflife.Twenty-eight premature infants who were undergoing intermittentmandatory ventilation were included. Infants were within 25-36 weeks ofgestation, less than seven days of postnatal age, no sedation orcongenital abnormalities. A two-period crossover design was used. Eachinfant was randomly assigned to position sequence of supine/prone orprone/supine. Infants were placed supine for two hours and prone for twohours. During the study protocol, care procedures were minimized andventilator weaning did not occur.Prone infants, compared to supine infants, had higher SpO2 (96.5% vs.95.7%, p < .01) and fewer episodes of oxygen desaturation (.86 vs. 4.47,p < .01, n 14). No significant difference was found in the proportionand duration of oxygen desaturation of 86-89%, 85-80%, and less than 80%between prone and supine positions. Seventy-four percent of totaldesaturation episodes were associated with vigorous motor activity andcrying.Prone placement can assist physiological stability for ventilatedpremature infants in their first week of life. This may facilitateinfants' extrauterine adaptation.
poster
no abstract
poster
Preterm infants` outcomes vary with illness and degree of neurological> insult, but unpredictable variations exist even among the most healthy> preterm infants. Evidence suggests that continuous bright light levels in> particular, may have negative effects on health. However, little data> exists to suggest how much and when light stimulation is appropriate.> While the intrauterine environment consists of primarily darkness within> rich circadian variations provided by the mother, it is impossible for> nurseries to provide both darkness and a circadian environment. This> study utilized a longitudinal randomized experimental design to examine> the timing and effects of cycled light (day/night) and continuous near> darkness throughout hospitalization on the health of preterm infants <31> weeks gestation. > Sixty three infants were enrolled at birth and randomly assigned to one of> three intervention groups, (1) near darkness from birth to 32 weeks> gestation followed by cycled light until discharge, (2) cycled light> throughout hospitalization, or (3) near darkness throughout the> hospitalization with cycled light at 36 weeks gestation in preparation for> discharge to the home environment. Cycled light promotes the development> of circadian rhythms, but it is unclear at what time cycled light is> appropriate for the most immature preterms. These groups allowed for> comparison of continuous near darkness and cycled light as well as the> timing of the onset of cycled light. Near darkness and cycled light were> provided using isolette and basinett covers. The clinical setting has no> natural light. Near darkness was defined as lux levels between 5 and 10> at level of the infant's eye 22 hours per day with a transition hour> during change of shifts every 12 hours. Cycled light was defined as 10> hours of continuous darkness followed by a transition hour and 10 hours of> continuous light (200 lux) followed by another transition hour. The> outcome variables included average weekly weight gain, length of> hospitalization, number of ventilator days, auditory functioning as> measured by the BAER, and development of retinopathy of prematurity and> maturation of retinal vascularity.> The developmental pattern for weight gain per week was determined by> calculating a mixed general linear models over post-conceptional age using> intervention group, birth weight, severity of illness, caloric intake, and> length of intervention as covariants. The analysis did not reveal a> significant intervention effect. The near darkness/cycled light group and> the cycled light group each had an average weekly weight gain of 111 grams> per kilogram and the continuos near darkness group had an average weekly> weight gain of 91 grams per kilogram. Length of hospitalization and> ventilation days were analyzed using an ANOVA, between groups design.> Again, there were no significant effects, after controlling for birth> weight and severity of illness. Differences in auditory functioning as> measured by a screening BAER exam, was analyzed using a Fisher's exact> also revealed no significant differences. Development of retinopathy of> prematurity and maturation of retinal vascularity analysis is ongoing.> While previous findings have suggested that continuous bright light is> detrimental to the health and development of preterm infants, these> findings suggest that there is no advantage of continuous darkness over> cycled light for health. Further study should examine whether cycled> light has advantage regarding development and circadian patterns. Also,> it would be important to transition preterm infants to day/night cycling> prior to discharge home.
poster
Neonatal problems in groups of extreme preterm children seem to overruleboth nature and nurture, as no gene effects and no SES effects were found(Koeppen-Schomerus et al., 1999; Wolke, 1998). Not all children in thesegroups show developmental problems and a careful description and delineationof the neonatal characteristics that are associated with long term outcomeis important. Within groups with neonatal risk factors, subgroups at highercan be identified. Characteristics like brain damage, as reflected by intraventricular hemorrhage (IVH), or severe respiratory difficulty are known toaffect later development (De Vries, 1996; Greenough, 1999). Data of ourfollow up clinic show that degree of immaturity (gestational age 25-27weeks) and dysmaturity (birthweight < Percentile 2.3) are important as well,see table 1.To conclude: in order to study further which infants show developmentalproblems or not, future studies should take into account a risk profile ofsubgroups of extreme preterm infants that includes description or controlof the number of extreme dysmature or immature infants. It is not enough anymore to describe a study group as extreme preterm or ELBW.Table 1 Results of Bayley mental scales at 6, 12 and 24 months corrected agefor different subgroup of preterms < 34 weeks gestational age. <<...>> ReferencesGreenough, A. (1999) Chronic lung disease in the newborn. In: Rennie, J.M. &Roberton, N.R.C. (Eds.) Textbook of neonatology, third edition. ChurchillLivingstone, London.De Vries, L.S. (1996) Neurological assessment of the preterm infant. ActaPaediatrica, 85, 765-771.Koeppen-Schomerus, G. Eley, T. Plomin, R. The interaction of gestational agewith genetic and environmental influences on cognitive and languagedevelopment in 2-year old twins.Poster presented at the 19th conference of the Society for Reproductive andInfant Psychology, september 7-9, 1999.Wolke, D. (1998) Psychological development of prematurely born children.Archives of disease in childhood, 78, 567-570.
poster
The Neurobehavioral Assessment of the Preterm Infant (NAPI, Korner & Thom, 1991) is a developmental assessment designed for use with preterm infants. It is slow-paced and gentle, not including more aversive items from other newborn assessments (e.g., pin prick). Therefore, NAPI administration should not cause any adverse effects for the infant. In fact, the vestibular stimulation and tactile/kinesthetic stimulation that occurs during administration may be beneficial to the preterm infant, as Field (1999) has demonstrated that touch has a positive influence on weight gain during hospitalization. Our clinical experience, however, suggests that parents and health care personnel still may be reluctant to permit NAPI administration, particularly when the preterm infant is small. Although Morrow (1990) has demonstrated that NAPI administration does not affect preterm infant oxygenation, parents and health care workers often express concerns that NAPI administration may 'tire' the infant and negatively impact the infant's feeding ability. The aim of this study, then, was to investigate whether NAPI administration reduced the amount of milk consumed on later feedings. Methods. Thirty-nine preterm infants (15 males; 34 Caucasian; GA ( 32 weeks) participated. All infants were hospitalized in the Level II (with an exception to treat infants up to 26 weeks gestational age who do not require surgery) Neonatal Intensive Care Unit (NICU) of a regional, rural hospital. Fourteen infants were ventilated (mean of 3 days). Infants with any significant medical complications were excluded from participation. The NAPI was administered shortly before hospital discharge when the infant was on full nipple feeding, in order to preclude the influence of health status on feeding pattern. NAPI administration began approximately 45-60 minutes prior to the next scheduled feeding in order to achieve maximal alertness while minimizing the influence of prandial condition. The assessment took approximately 30 - 45 minutes. Examiners were blind to the hypotheses of the study. The amount of formula or breastmilk that the infant consumed before, immediately after, and on the next subsequent feeding after NAPI administration were obtained from the baby's medical chart after hospital discharge. The amount consumed at the next subsequent feeding was examined to investigate any delayed effects of NAPI administration. A repeated measures ANOVA design was used to test study hypotheses. Results & Discussion. There were no significant differences in the amount of formula or breastmilk consumed at the feeding before NAPI administration and the amount consumed immediately after NAPI administration, F(1, 38) 3D 1.48, p>.20. There was no evidence of a delayed effect on feeding amount, as there also were no differences between the amount eaten before evaluation and the amount eaten at the next subsequent feeding F(1,38) 3D .60, p >.40. Because the 'tiring' effect may be more evident in earlier-born infants, infants were divided into two gestational age groups: very preterm (< 31 weeks) and preterm (31 - 32 weeks). There were no differences between preterm groups in the amount consumed before and immediately after NAPI administration, or before and the next subsequent feeding. These results extend those of Morrow (1990) by demonstrating that NAPI administration does not affect infant feeding, as well as oxygenation. Taken together, these findings suggest that early neurobehavioral examination does not stress or tire the premature infant, and can be used safely to examine early developmental progress.
poster
no abstract
poster
During human development, there are complex developmental changes in brain, sensory-motor,and cognitive functioning. However, our understanding of relationships among brain,sensory-motor and cognitive development remains incomplete for normally and abnormallydeveloping children. The present study focuses on neurobehavioral development of childrenborn prematurely and fullterm. Participants were studied from birth through three years of age,and included children born fullterm (n3D24) and preterm (born at less than 33 weeks gestation and1501 grams, n3D57). From birth through four-six weeks postnatal, the children were videotapedfor analysis of spontaneous movements, and they received developmental testing at regularintervals through three years. At three years, the children received a battery of tests includingstandardized (Stanford-Binet Intelligence Scale, Mullen Scales of Early Learning) andexperimental (hand tapping, associated finger movements, visual recognition memory)assessments, assessment of hand preference/use, and assessments of socioeconomic status, homeenvironment, and behavioral problems. Specifically addressed were relationships among: (1)delivery-brain status (normal fullterm, preterm with and without brain injury as documented withbrain ultrasound scans), (2) frequency of neonatal spontaneous body segment movements (head,arms, legs, trunk), and at three years, (3) handedness (right, mixed3Dleft plus bilateral), (4) motorcontrol (hand tapping, associated finger movements, Mullen motor scale), (5) cognitive abilities(Stanford-Binet, Mullen language scales, visual recognition memory), and social-psychologicalvariables (e.g., socioeconomic status). Data were analyzed with inferential statistics andcorrelations. A sample of the results, focusing on children born prematurely, are presented in thisabstract (results for both fullterm and preterm groups will be included in the poster). Across theneonatal measures of spontaneous movements, and the three year measures of hand tapping,associated finger movements, Mullen Scales, visual recognition memory, and Stanford-Binet,children born prematurely performed significantly more poorly than children born fullterm. Mostgenerally, preterm children with documented brain injury did not significantly differ from thepreterm children without documented brain injury for the neonatal and three year behavioralmeasures. Relationships among social-psychological variables and testing results at three yearswere complex and not strong enough to account for differences between preterm and fulltermchildren. An interesting series of results showed that the premature group had a significantlyhigher percentage of mixed handedness than the fullterm group at three years, and thathandedness in the preterm group was significantly related to rates of spontaneous movementsduring the neonatal period, i.e., preterm neonates with lower rates of spontaneous movementsdisplayed mixed handedness at three years. Further, the results of hand tapping, associated fingermovement, and language tests at three years indicates that infants born prematurely may haveproblems with development of hemispheric dominance, e.g., reversed asymmetry. The overallresults for the preterm group indicate that prematurity alone, regardless of associated ultrasounddocumentation of brain injury, is a risk factor for neurobehavioral development. Brain scanstudies using high resolution PET, MRI and DTI are currently in progress to further evaluate theissues of neonatal brain injury and development of hemispheric dominance in preterm andfullterm children.
poster
Objective : To evaluate the effects of varying the position for preterm newborns lie (alternating between their backs front or side) for preventing muscular and postural deformities. This reduced the occurrence of acquired deformities (muscle and bone-joint) and thus encouraged immediate normal motor development (without muscular restriction), and hence provided better conditions for an objective neurological andpsychomotor evaluation.Methods: This longitudinal prospective case-control study was a randomized, double blind trial in a neonatal unit on 60 low-risk preterm infants (31-36 gestational weeks) who were normal on neuro-pediatric examination at birth. Each child underwent neurological and neuropsychomotor examination when it left the ward. The positions of the treated infants were varied (back, front and side) using a specially designed mattress that helped maintain the position of the baby. The control babies were laid on their fronts, as this is the standard position used on the ward, but with an orthopedic support under their hips. Results: Comparative analysis of each item in the neurological examination of the babies when they left the ward indicated significant differences between the control and treated babies, although the overall scores of all babies remained within the normal range. Certain items of passive muscle tone indicated significant disorders in the control group, such as axis hypertension (X2 18.468, p>0.0001), limited arm extension (t -2.238, p 0.091). Certain features of active muscle tone were also significantly different (X2 11.390, p 0.0225), indicating a measure of imbalance of the body axis in the controls. The neuromotor evaluation (assessing behavior and neuro-psycho-sensory, neuro-psychomotor, postural and orthopedic parameters) also indicated significant abnormalities in the control babies, indicating slight deviations due to muscle shortening which affected the neuromotor and behavioral character of the babies.Conclusion: We believe that it is worthwhile adopting preventive measures for the overall physiological posture of the body in preterm infants although the risk of cerebral lesions is low.
poster
The role of perinatal risks in the continuity or discontinuity of development is ambiguous. Within a population consisting of both risk and non-risk infants those affected by biological hazards are likely to constitute, at least in the early period, a distinct, somewhat handicapped subgroup. Within the risk samples, however, the effects of perinatal insults are usually related to a host of unknown factors which make the outcome hard to predict. Our ongoing follow-up study is concerned with the developmental patterns in infants born prematurely. In this presentation findings of the first data collection points will be reported. Thirty-five preterm infants who were born at gestational ages of 29-32 weeks, with birth weights less than 2000 grams, and had no severe perinatal complications participated in the study. The Brazelton Neonatal Assessment Scale (BNBAS) was administered to the babies at two weeks post-term. At 6-8 months corrected age the infants were tested using the Bayley Scales of Infant Development (BSID-II) and were observed in interacting with their mothers in feeding and free play situation. The measured variables of perinatal status had some albeit limited effects on the neonatal behavioural organisation. The restricted heterogeneity of the sample was likely to attenuate the correlations. BNBAS items related to the newborn organismAEs energy reserves and reactivity predicted both the MDI and PDI. A few correlations suggested some continuity in behavioural characteristics but the perinatal risk seemed to confound the patterns. Links between neonatal baby variables and later maternal behaviour are interpreted as indicators of a transactional mechanism.
poster
Objective In the ULM STUDY we investigated maternal attachment representation and its impact on emotional, cognitive and somatic development of very low birth weight infants (< 1500 g). A preventive psychotherapeutic intervention program was offered to promote adequate coping strategies and to support a secure mother-infant-attachment relationship. The motherB4s experience of the premature birth sometimes reactivates former separation conflicts and losses. An unresolved state of mind is characterized by a disorganized language style when talking about losses or abuse in childhood. This classification has been found to correlate with psychopathological development in infants and adults and can be seen as a risk factor. The main question is, if risk factors 'unresolved trauma' (Ud) and the 'experience of the premature birth' decrease adaquate maternal coping strategies and increase maternal anxiety state in the first two years. In addition we compared the intervention group and control group refering to this above question.Method: 88 mothers and their preterm infants were recruited into a two year longitudinal study. After randomisation 44 mothers received an intervention program, and 44 did not. To assess maternal attachment we conducted the Adult Attachment Interview of Main & Goldwyn (1994). The coding analysis of the unresolved state of mind (Ud) was done seperately. We further gave questionnaires to assess maternal coping strategies and anxiety states to several points of time to gain a longitudinal perspective. The intervention program consisted of attachment focussed individual setting, group psychotherapy, a home visit and a sensitivity training by video-feedback.Results: The distribution of the maternal attachment representations, whether secure-autonomous (F), dismissing (Ds) or preoccupied (E) and the separate rating of the unresolved state of mind (Ud) will be presented for intervention group and control group. Interaction effects between maternal trauma (Ud) and premature birth and its impact on coping strategies and anxiety state at different points of time will be presented for both groups. Discussion: The role of the attachment based psychotherapeutic intervention will be discussed for the special sub-group of mothers with unresolved state of mind. Special emphasis will be placed on the coping with premature birth in this risk group.