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EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
ShannonUsher,MSOT,OTR/L,NTMTC
TheseHandoutsarenotintendedtobeusedOutsideofNTMCRecer6fica6onII
PropertyofCrea6veTherapyConsultants©NotforDuplica6on
EnvironmentofCareLiteratureReview
ShannonUsher,MSOT,OTR/L,NTMTC
Toallresearcherswhohavespentstudyingtheneurodevelopmentoftheprematureinfant.Your
researchguidesourclinicalpractice.
ThankYou!
* Systematicreview&meta-analysisofrandomizedcontrolledtrials;clinicalguidelinesbasedonsystematicreviewsormeta-analyses
* Oneormorerandomizedcontrolledtrials* Controlledtrial(norandomization)* Case-controlorcohortstudy* Systematicreviewofdescriptive&qualitativestudies* Singledescriptiveorqualitativestudy* Expertopinion
Source:Melnyk,B.M.&Fineout-Overholt,E.(2011).Evidence-basedpracticeinnursingandhealthcare:Aguidetobestpractice.Philadelphia:Lippincott,Williams&Wilkins.
LevelsofEvidence
* Nonpharmacologicalapproachestoreducestress* NICUDesign* SoundExposure* Skin-to-Skin* InfantMassage
EnvironmentofCare
� SwaddledBathing� PositioningandHandling� OralFeeding� NeonatalTherapy� StaffEducation
Pandey,M.,Datta,V.,Rehan,H.(2013)RoleofSucroseinReducingPainfulresponsetoorogastrictubinsertioninpretermneonates.IndianJournalofPediatrics,80(6),476-82.* DoubleBlindedRandomizedControlledTrial* Subjects:ClinicallyStablepreterminfantswithinfirst7daysoflife* TestSubjectsReceivedSucrose,ControlSubjectsrecievedwater* EvaluatedPainusingPrematureInfantPainProfile(PIPP),HeartRate
andSpO2changes* Results:PostprocedurePIPPscorewassignificantlylowerintest
subjectscomparedtocontrols
NonpharmacologicApproachestoReducingStress
Naughton,K.(2013).Thecombineduseofsucroseandnonnutritivesuckingforproceduralpaininbothtermandpretermneonatesanintegrativereviewoftheliterature.AdvancesinNeonatalCare,13(1),9-19.* Integrativeliteraturereview* Synergisticeffectcombiningsucrosewithnonnutritivesucking
NonpharmacologicApproachestoReducingStress
EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
ShannonUsher,MSOT,OTR/L,NTMTC
TheseHandoutsarenotintendedtobeusedOutsideofNTMCRecer6fica6onII
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Ho,L.,Ho,S.,Leung,D.,So,W.,Chan,C.(2016).Afeasibilityandefficacyrandomizedcontrolledtrialforswaddlingforcontrollingpaininpreterminfants.JournalofClinicalNursing,25(3-4),472-482.* Randomizedcontrolledtrial* Subjects:54preterminfantsbetween30-37weeksGA.* Infantswereassignedtoeitheracontrolgroup(standardcare)or
swaddlinggroup* Painwasassessedduringheelstick* Results:PIPPscores,SpO2andHRweresignificantlylowerin
swaddlinggroupcomparedtocontrols
NonpharmacologicApproachestoReducingStress
Hartley,K.Miller,C.,Gephart,S.(2015).Facilitatedtuckingtoreducepaininneonates:evidenceforbestpractice.AdvancesinNeonatalCare,15(3),201-208.* MetaAnalysis* Facilitatedtuckreducespain* Maybeusedasearlyas23weeks
NonpharmacologicApproachestoReducingStress
* ProvideSucroseandpacifierpriortoallpainfulprocedures,includingroutineprocedureslikeOGtubeinsertions* Makesurethereareconsistentandsafepoliciesandprocedurestoguideprovingsucrose* Swaddleinfantswhenable* Facilitatedtuckasanalternativetoswaddlingorskintoskin
ClinicalApplication
Lester,B.,Hawes,K.,Abar,B.,Sullivan,M.,Miller,R.,Bigsby,R.,Laptook,A.,Salisbury,A.,Taub,M.,Lagasse,L.,Padbury,J.(2014).Singlefamilyroomcareandneurobehavioralandmedicaloutcomesinpreterminfants.Pediatrics,134(4),754-760.* Subjects:Preterminfantsweighing<1500grams
151admittedopen-bayNICU 252preterminfantsadmittedtosinglefamilyrooms* Results:Improvedmedicalandneurobehavioraloutcomesat
discharge,maternalinvolvementandpsychosocialstatus,family-centeredcare,developmentalsupport,andnurses’attitudesrelatedtosinglefamilyrooms
NICUDesign
Pineda,R.,Neil,J.,Dierker,D.,Smyser,C.,Wallendorf,M.,Kidokoro,H.,Reynolds,L.,Walker,S.,Rogers,C.,Mathur,A.,VanEssen,D.,Inder,T.(2014)AlterationsinBrainStructureandNeurodevelopmentalOutcomeinPretermInfantsHospitalizedinDifferentNeonatalIntensiveCareUnitEnvironments.JournalofPediatrics,164,52-60.* ProspectiveLongitudinalCohortStudy* Subjects:136Preterminfants<30weeksGA* Randomlyassignedtoeithersinglefamilyroomoropenbayunit* Results:Infantsinprivateroomshadtrendtowardhavinglower
electroencephalographcerebralmaturationscoresattermequivalentandlowerlanguageandtrendtowardlowermotorscoresat2years.
NICUDesign
* OpenBayNICUs* Ensuresensorystimulationisappropriateandnot
noxious* SingleFamilyRooms* Ensureinfantsareprovidedwithenoughinteractionand
sensoryexposure,especiallyiffamilyvisitationislimited* PlayanactiveroleonyourNICUdesigncommittee
ClinicalApplication
EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
ShannonUsher,MSOT,OTR/L,NTMTC
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Caskey,M.,Stephens,B.,Tucker,R.,Vohr,B.(2014).AdultTalkintheNICUwithPretermInfantsandDevelopmentalOutcomes.JournalofPediatrics.133(3),e578-584* Subjects:36medicallystablepreterminfants* Recordedvoiceexposureat32and36weeksPMA* Followupwascompletedat7and18monthsCA* Results:HigherwordcountduringtheNICU
admissionwasassociatedwithhighercumulativecognitiveandlanguageandreceptivecommunicationat7mothsCAandhigherexpressivecommunicationscoresat18monthsCA
SoundExposure
Webb,A.,Heller,H.,Benson,C.,Lahav,A.(2015).Mother’svoiceandheartbeatsoundelicitauditoryplasticityinthehumanbrainbeforefullgestation.ProceedingsoftheNationalAcademyofSciencesoftheUnitedStatesofAmerica,112(10),3152-3157.* Randomizedcontrolledtrial* Subjects:40preterminfantsbornbetween25-32
weeksGA* Randomlyassignedtoeithercontrolgroup
(routinehospitalsounds)ortestgroup(audiorecordingsofmother’sheartbeatandvoice)* Results:At30daysoflifeinfantsinthetestgroup
hadsignificantlylargerbilateralauditorycortex
SoundExposure
Doheny,L.,Hurwitz,S.,Insoft,R.,Ringer,S.,Lahav,A.(2012).Exposuretobiologicalmaternalsoundsimprovescardiorespiratoryregulationinextremelypreterminfants.PediatricsInternational,25(9),1591-1594.* Subjects:14preterminfantbornbetween26-32
weeksGA* Infantsservedastheirowncontrol* Comparedcardiorespiratoryeventswhen
exposedtoroutinehospitalsoundstorecordingsofmaternalvoiceandheartbeat* Results:Lowerfrequencyofeventsduring
maternalsoundstimulationcomparedtoroutinehospitalsounds
SoundExposure
Standley,J.(2012).MusictherapyresearchintheNICU:anupdatedmetaanalysis.NeonatalNetwork,31(5),311-316.* Metaanalysis* NICUMusictherapywashighlybeneficial* GreatestBenefits:* LiveMusic* InitiatedEarlyintheNICUstay(<1000grams,<28
weeksGA)* Uses:pacification,reinforcementofsuckingandpart
ofamultimodal,multilayeredstimulation
SoundExposure
* Educatemoms* Talktotheirbaby* Bringinbookstoread* Sing
* Skin-to-skinholding* Talk,read,singtothebabieswhileyoucareforthem* ImplementamusictherapyprograminyourNICU* ProvideCDplayers/radiosforbabieswhen
developmentallyappropriate
ClinicalApplication
Feldman,R.,Rosenthal,Z.,Eidelman,A.(2014)Maternal-pretermskin-toskincontactenhanceschildphysiologicorganizationandcognitivecontrolinthefirst10yearsoflife.BiologicalPsychology,75(1)56-64.* Subjects:146preterminfantsat32weeksPMA* Testsubjectsreceivedskin-to-skinholdingfor1hourperdayfor14
consecutivedayscomparedtocontrolswhoreceivedroutine,incubatoronlycare
* Followupcompletedat3,6,12and24months,5yearsand10years* Outcomes:* 6months-10yearfollowupshowedimprovedautonomicfunctioning,
maternalattachment,reducedmaternalanxiety,andenhancedchildcognitivedevelopmentandexecutivefunctions
* 10yearfollowupshowedbetterneuropsychologicalability,autonomicfunctionandsleepefficiency,marginallyquickerrecoveryfromstress,mildercortisolstressactivityandautonomicreactionstostress.Mothersdemonstratedgreaterreciprocityduringinteractions
Skin-to-skin
EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
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Baley,J.&CommitteeonFetusandNewborn(2015).Skin-to-skincarefortermandpreterminfantsintheneonatalICU.Pediatrics,136(3),596-599.* Benefitsandrisksofskin-to-skinwerediscussed* Benefits:* Improvedmilkproduction* Longerdurationofbreastfeeding* Improveattachmentandbonding* Strengthensfamilyroleincareofinfant* Increasedparentsatisfaction* Bettersleeporganization* Longerdurationofquietsleep* Decreasedpainperceptions.
* Risk:Mustensureanopenairwayduringskintoskinholding
Skin-to-skin
Luong,K.,Nguyen,T.,Thi,D.,Carrara,H.,Bergman,N.(2015).Newlybornlowbirthweightinfantsstabilisebetterinskin-to-skincontactthanwhenseparatedfromtheirmothers:arandomisedcontrolledtrial.ActaPaediatrica,105(4),381-390.* RandomizedControlledTrial* 100preterminfantswithbirthweight1500-2000grams* Testsubjects:Transitionedtoextrauterinelifeskin-to-skin* Controlgroup:Receivedstandardhospitalcareandadmittedtoresuscitationroomthentoincubators* Observedtransitiontoextrauterinelife6hoursafterbirthusingstabilityofcardio-respiratorysysteminpreterms* Results:TestsubjectshadbetterSCRIPscores,neededlessrespiratorysupport,IVYluidsandantibioticsduringremainderofhospitalstay
Skin-to-skin
Moore,H.(2015).ImprovingKangarooCarePolicyandImplementationintheNeonatalIntensiveCareUnit.JournalofNeonatalNursing,21(4),157-160.* Analyzedcurrentevidencebasedpracticeofskin-to-skinintheNICU* Results:Researchsupportsskin-to-skinwithpreterminfants,however,thefollowingbarriersexist:* InsufYicientNursingEducation* InsufYicientParentEducation* ManagerialSupport* Overalllackofstandardkangaroocarepolicy
Skin-to-skin
* Skintoskinshouldbeprovidedassoonaspossible,asoftenaspossible,foraslongaspossible!* Creatingpoliciesandproceduresforstaffto
followforskintoskin* Educationalcompetenciestoensurestaff
comfortwithtransfersandpositioning* Creatingacomfortableenvironmentfor
parentssothattheyenjoytheirtimeholdingtheirinfant* Ex:Skintoskinchairs,Wraps,Mirrors,Water,
DVDplayers
ClinicalApplication
Badr,L.,Abdallah,B.,Kahale,L.(2015).Ameta-analysisofpreterminfantmassage:anancientpracticewithcontemporaryapplications.AmericanJournalofMaternalChildNursing,40(6),344-358.* MetaAnalysis* 34studiesmetinclusioncriteria* Results:Massageimprovesdailyweightgainandmentalscores
InfantMassage
Juneau,A.,Aita,M.,Heon,M.(2015).Reviewandcriticalanalysisofmassagestudiesfortermandpreterminfants.NeonatalNetwork,34(4),165-177.* SystematicLiteratureReview* TermInfantBenefits:* Improvedweightgain* ImprovedGrowth* ImprovedSleep* DecreasedHyperbilirubinemia
* PretermInfantBenefits:* Improvedweightgain* Decreasedresponsetopain* Increasedinteractionswithparents.
InfantMassage
EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
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Hahn,J.,Lengerich,A.,Byrd,R.,Stoltz,R.,Hench,J.,Byrd,S.,Ford,C.(2016).Neonatalabstinencesyndrome:theexperienceofmassage.CreativeNursing,22(1),45-50* QualitativeStudy* Subjects:InfantswithadiagnosisofNAS,atleast48hoursold,>32weeksPMA,>1500gramsandalerttimebeforefeeding* Educatedmomhowtocompleteinfantmassage* Interviewscompletedwithmomaftereducationand2weeksafterdischarge* Results:Empowerment,EnjoymentandBondingandCalmandComfortwerethethemesderived
InfantMassage
* BenefitsofMassage* ImprovedWeightGain* ImprovedMentalScores* ImprovedHeartRateVariability* ImprovedNeurobehavioral
States* DecreasedPainResponse* ImprovedMaternalOutcomes* ImprovedBreastfeeding
ClinicalApplication
� ImprovedPhysiologicParameters
� ImprovedBoneFormation� ImprovedImmunologic
Markers� ImprovedBrainMaturity� ImprovedTemperature� ImprovedInteractionswith
Parents� ImprovedGrowthVelocity
* Educatestaffonthebenefitsandimportanceofneonatalmassage* EnsurepoliciesareinplacetosupportmassageintheNICU* Createeducationalhandoutsorreferencesforstaffandfamily* UsethisinformationforGrantwriting
ClinicalApplication
Edraki,M.,Paran,M.,Montaseri,S.,RazaviNejad,M.,&Montaseri,Z.(2014).Comparingtheeffectsofswaddledandconventionalbathingmethodsonbodytemperatureandcryingdurationinprematureinfants:arandomizedclinicaltrial.JournalofCaringSciences,3(2),83-91.* Subjects:50preterminfants* Testsubjectsreceivedswaddledbathandcontrolsubjectsreceivedconventionalbath* Results:Meantemperatureandcryingweresignificantlylowerinswaddledbathinggroupcomparedtocontrols
SwaddledBathing
Quraishy,K.,Bowles,S.,Moore,J.(2013).Aprotocolforswaddledbathingintheneonatalintensivecareunit.Newborn&InfantNursingReviews.13(1):48-50.* Createdswaddledbathingguidelinesbasedonlackofresearch* Recommendationsincluded:* Swaddling* WaterTemperaturebetween100-102degrees* Bathlimitedto8minutes
SwaddledBathing
* Swaddledbathingshouldbeprovidedforallbathingprocedures,regardlessofPMA
* Educationneedstobecompletedwithstafftoensureconsistencyofbathingproceduresandfamiliestoensurecomfortpriortodischarge
* SwaddledBathingProcedures:* Swaddlewithablanketduringsubmersionorbedbath* Watertemperaturebetween100-102degrees* Bathsshouldbelimitedto8minutes
* Adaptationsfordifferentdiagnosismayinclude:* ProgressivebathsforELBWorExtremelyprematureinfants* Warmerbed/radiantheatforsmallerinfants* TherapeuticbathforthoseinfantswithNeonatalAbstinenceSyndrome
ClinicalApplication
EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
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Madlinger-Lewis,L.,Reynolds,L.,Zarem,C.,Crapnell,T.,Inder,T.,&Pineda,R.(2014).Theeffectsofalternativepositioningonpreterminfantsintheneonatalintensivecareunit:arandomizedclinicaltrial.ResearchinDevelopmentalDisabilities,35(2),490-497.* RandomizedControlledTrial* Subjects:100preterminfantsborn<32weeksGA* Comparedalternativepositioning(DandleRoobyDandleLion
Medical)totraditionalpositioning(swaddling,snuggleup,bendybumper,sleepsackandblakletrolls)* Results:Attermequivalentinfantsinthealternativepositioning
grouphadlessassymetryofreflexeandmotorresponses
PositioningandHandling
Liao,S.M-C.,Rao,R.,&Mathur,A.M.(2015).Headpositionchangeisnotassociatedwithacutechangesinbilateralcerebraloxygenationinstablepreterminfantsduringthefirstthreedaysoflife.AmericanJournalofPerinatology,32(7),645-652.* Subjects:22preterminfantsborn<30weeksGA* Cerebraloxygensaturationwasmonitoredwithheadinmidline,headturned45-60degreestowardtheleftandheadturned45-60degreestotherightfor30minutesperiods* Results:InrelativelystablepretermSpO2remainedwithinnormallimitswhenheadwasturnedfrommidlinetoeitherside.
PositioningandHandling
Nuysink,J.,Eijsermans,M.J.,vanHaastert,I.C.,Koopman-Esseboom,C.,Helders,P.J.,deVries,L.S.,&vanderNet,J.(2013).Clinicalcourseofasymmetricmotorperformanceanddeformationalplagiocephalyinverypreterminfants.JournalofPediatrics,163(3),658-665.* Subjects:120preterminfants<30weeksGAorBirthweight<1000
grams* Examinedpositionalpreferencesanddeformationalplagiocephaly
attermequivalent,3monthsand6monthsCA* Results:* Positionalpreferenceswas65.8%attermequivalent,36.7%at3months
CAand15.8%at6monthsCA* Deformationalplagiocephalywas30%attermequivalent,50%of3
monthsCAand23.3%at6monthsCA
PositioningandHandling
Collett,B.R.,Aylward,E.H.,Berg,J.,Davidoff,C.,Norden,J.,Cunningham,M.L.,&Speltz,M.L.(2012).Brainvolumeandshapeininfantswithdeformationalplagiocephaly.Child’sNervousSystem,28(7),1083-1090.* Subjects:20childrenwithdeformationalplagiocephaly(DP)and21
childrenwithoutdeformationalplagiocephalywiththemeanageof7.9months* MRIimaginingandneurodevelopmentalassessmentusingBayley
ScalesofInfantandToddlerDevelopment* Results:ChildrenwithDPhadgreaterasymmetryandflatteningof
posteriorbrainandcerebellarvermis,shorteninganddifferingorientationofthecorpuscallosum.AswellaslowerscoresontheBSID-III
PositioningandHandling
Collett,B.R.,Gray,K.E.,Starr,J.R.,Heike,C.L.,Cunningham,M.L.,&Speltz,M.L.(2013).Developmentatage36monthsinchildrenwithdeformationalplagiocephaly.Pediatrics,131(1),e109-e115.* Subjects:224childrenat36monthswithdeformationalplagiocephaly(DP)and231childrenwithoutdeformationalplagiocephaly* Results:ChildrenwithDPscoredloweronallscalesoftheBSID-IIIthanchildrenwithoutDP
PositioningandHandling
* Maximizemotordevelopmentwithuseofdevelopmentalequipment* UsethisresearchtoapplyforagranttoaccessfundingforyourNICU
* DeformationalPlagiocephaly* EducationtofamiliesduringtheNICUadmissionandalso
howtoavoidupondischarge
ClinicalApplication
EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII
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Wellington,A.&Perlman,J.(2015).Infant-drivenfeedinginprematureinfants:Aqualityimprovementproject.ArchivesofDiseaseinChildhoodFetal&NeonatalEdition.doi:10.1136/archdischild-2015-308296* Qualityimprovementprojectevaluatingtimetofullfeedingsand
dischargefollowingInfantDrivenFeedingApproach(IDF)orPractitionerDriveFeeding(PDF)
* Subjects:Categorized<28weeksGA,28-31weeksGAand32-34GA* Results:* PMAatfullnipplefeedingsandatdischargewassignificantlylowerinthe
IDFgroup* <28weeks:Fulloralfeedings17dayssooneranddischarged9dayssooner* 28-31weeks:Fulloralfeedings11dayssooneranddischarged9dayssooner* 32-34weeks:Fulloralfeedings3dayssooneranddischarged3dayssooner
OralFeeding
Asadollahpour,F.,Yadegari,F.,Soleimani,F.,&Khalesi,N.(2015).Theeffectsofnon-nutritivesuckingandpre-feedingoralstimulationontimetoachieveindependentoralfeedingforpreterminfants.IranianJournalOfPediatrics,25(3),e809.* RandomizedControlledTrial* Subjects:32preterminfants26-32weeksPMA* Groups:NNS,pre-feedingoralstimulationandcontrol* Results:* NNSreachedfulloralfeedings7.55dayssoonerthancontrols* Oralstimulationreachedfulloralfeedings6.07dayssooner
OralFeeding
Niela-Vilen,H.,Axelin,A.,Melender,H.,Salantera,S.(2015).Aimingtobeabreastfeedingmotherinaneonatalintensivecareunitandathome:athematicanalysisofpeer-supportedgroupdiscussiononsocialmedia.Maternal&ChildNutrition,11(4),712-726.* Subjects:22motherswhohadgivenbirthtopremature
infant<35weeksPMA* Analyzedthemespostedonsocialmedialsite* Results:Mainthemesincluded;thebreastfeedingparadox
inhospital,the'realitycheck'ofbreastfeedingathomeandthebreastfeedingexperienceaspartofbeingamother.
OralFeeding
* Ensureyourhospitalhasaninfantdriven/cuebasedfeedingpolicyinplacethatisconsistentlyfollowed* HoldinfantsduringtheirNG/OGfeedingsandofferinga
pacifiertoprovideNNSinpreparationoforalfeeding* Treatmentrecommendationfortherapistscouldincludeoral
stimulation* Staypresentintheroomwithmomduringbreastfeedingattemptstoensuremom’scomfortandinfant’struesuccesswithbreastfeedingpriortodischarge
ClinicalApplication
FrolekClark,G.J.&Schlabach,T.L.(2013).Systematicreviewofoccupationaltherapyinterventionstoimprovecognitivedevelopmentinchildrenagesbirth–fiveyears.TheAmericanJournalofOccupationalTherapy,67,425-430.* SystematicLiteratureReview* Results:EducationbyOTstoparentswithpreterminfants
helpedtheparentstobemoresensitivetotheirchild’sneedsandmoreresponsiveintheirinteractions
NeonatalTherapy
Spittle,A.,Orton,J.,Anderson,P.J.,Boyd,R.,&Doyle,L.W.(2015).Earlydevelopmentalinterventionprogramsprovidedposthospitaldischargetopreventmotorandcognitiveimpairmentinpreterminfants.CochraneDatabaseofSystematicReviews,11,CD005495.* Metaanalysis* Reviewedtheeffectivenessofearlyinterventionwheninitiated
inthefirst12monthsforthoseinfantsborn<37weeksgestation* Results:Therapeuticinterventionimprovedcognitiveoutcomes
atinfantage(0-2years)andpreschoolage(3-<5years)butdidnotfindthatthiseffectwassustainedthroughschoolage(5-17years)
NeonatalTherapy
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Spittle,A.J.,Lee,K.J.,Spencer-Smith,M.,Lorefice,L.E.,Anderson,P.J.,&Doyle,L.W.(2015).Accuracyoftwomotorassessmentsduringthefirstyearoflifeinpreterminfantsforpredictingmotoroutcomeatpreschoolage.PLoSOne,10(5),e0125854.* AnalysisofthepredictivevalidityoftheAlbertaInfantMotorScale(AIMS)and
theNeuro-SensoryMotorDevelopmentalAssessment(NSMDA)* Subjects:99infantsborn<30weeksgestation* Followupassessmentscompletedat4,8and12monthsCA* Results:* MotorimpairmentontheMABC-2wasmostaccuratelypredictedbytheAIMSat4
months* CPwasmostaccuratelypredictedbytheNSMDAat12months.* Thelikelihoodratioformotorimpairmentincreasedwiththenumberofdelayed
assessments.* WhencombiningboththeNSMDAandAIMSthebestaccuracywasachievedat4
months.
NeonatalTherapy
* Parenteducationisahugeopportunityforneonataltherapists!* AlbertaInfantMotorScaleandNeuro-SensoryMotorDevelopmentAssessmentmaybeusefultoolsinassessingandpredictinglaterneuromotoroutcomes* Weneedmoreresearchinregardstoneonataltherapistseffectiveness
ClinicalApplication
Jeanson,E.(2013).One-to-onebedsidenurseeducationasameanstoimprovepositioningconsistency.Newborn&InfantNursingReviews.13(1):27-30* Nursetonurseeducationisthebestwaytogetstaff‘buy
in* Havingateamthatrandomlyassessperformance
improvedpositioning.* Immediatefeedingwithhandsoncorrectionofpositioning
allowednursestoseefirsthandwhatadifferenceproperpositioningcancreate.
StaffEducation
Hendricks-Munoz,K.,Mayers,R.(2014)AneonatalnursetrainingprograminKangarooMotherCareDecreasedbarrierstoKMCUtilizationintheNICU.AmericanJournalofPerinatology.31(11)987-992.* Provided7.5hoursofeducationtostaffonskin-to-skin,both
lectureandhandsontraining* Results:Aftertheeducationandsimulation:* Staffcompetencyincreasedfrom30%-92%whenKMCwas
practicedwithintubationandventilation* DiscomfortwithprovidingKCMdroppedto0%* Actualpracticeofskin-to-skinwitheligiblebabiesincreasedfrom
26.5%to85.9%
StaffEducation
* EducationShouldIncludetheFollowing* Clearpoliciesorguidelinestoguidepractices* Peertopeereducation* Interactivetrainingopportunitiesinacontrolled
environment* Atthebedsideasmuchaspossibletominimizeotherdailycaregivinginterruptions
* Instantfeedbackchangessolearnerisabletovisualizehowachangepositivelyaffectstheoutcome
ClinicalApplication
Wheretogofromhere?