assessment-evaluation-high-risk-neonate-nicu-network-neurobehavioral

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant.  The NICU Network Neurobehavioral Scale ...

Brown University

Women & Infants Hospital of Rhode Island

Occupational therapists working with infants in neonatal intensive care units (NICUs) make positioning recommendations to optimize self-regulation, with little published data supporting this practice. In this retrospective descriptive study, 15 hospitalized preterm infants (M(gestational age) = 32 weeks) were videotaped during non-caregiving periods in order to record the frequency of specific behaviors in relation to six infant positions (prone nested, prone un-nested, side-lying nested, side-lying un-nested, supine nested, and supine un-nested). Behaviors coded were those that suggest infant stress or motor efforts at self-regulation, as defined for the original study. Mixed effects regressions and post-hoc Tukey Honestly Significant Difference tests were used to analyze the data, after the calculation of a ratio of the number of behaviors in each position. Higher ratio values reflect a greater occurrence of behaviors. The number of motor self-regulatory and stress behaviors were related to infant position, with the highest ratios of behaviors observed in side-lying un-nested and the lowest in prone nested. Behavior ratios did not differ between prone un-nested and prone nested, nor between supine un-nested and supine nested. More self-regulatory and stress behaviors were related to longer periods of fussing and crying. Longer periods of light sleep were related to fewer stress behaviors. Infants performed the fewest stress behaviors in prone nested, prone un-nested, or side-lying nested. These positions may benefit infants in the NICU by reducing the need for motor-based self-regulatory behaviors and potentially conserving energy for growth.

Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions.

Features of the Neonatal Intensive Care Unit Network Neurobehavioral Scale that make the examination useful for clinical application are described. Clinical applications in various settings and populations are described. This is followed by a summary of the clinical significance of the examination according to the packages of administration. We then explain how to use the summary scores clinically, writing a clinical summary and the clinical interpretation of the summary scores. Finally, we present a case study with a clinical summary and a work sheet that clinicians may find useful for clinical consultation with caregivers and parents.

Clinical use of the Neonatal Intensive Care Unit Network Neurobehavioral Scale.

The current study examined the pattern of motor development across the first 18 months of life in infants with in utero exposure to cocaine to determine how prenatal drug effects and level of exposure relates to motor development. Motor development was examined at 1, 4, 12, and 18 months of age (corrected for prematurity). Infants were divided into cocaine exposed (n=392) and comparison (n=776) groups. Exposure status was determined by meconium assay and maternal self-report with alcohol, marijuana, tobacco, and opiates present in both groups. Motor skills were assessed at 1 month using the NICU Network Neurobehavioral Scale (NNNS), at 4 months using the posture and fine motor assessment of infants (PFMAI), at 12 months using the Bayley Scales of Infant Development-Second Edition (BSID-II), and at 18 months using the Peabody Developmental Motor Scales (PDMS). Examiners masked to exposure status performed all assessments. Motor scores were converted to standard (z) scores, and hierarchical linear modeling (HLM) was used to examine the change in motor skills from 1 to 18 months of age. Infants with exposure to cocaine showed low motor skills at their initial status of 1 month but displayed significant increases over time. Both higher and lower levels of tobacco use related to poorer motor performance on average. Heavy cocaine use related to poorer motor performance as compared to no use, but there were no effects of level of cocaine use on change in motor skills.

Predictors of motor development in children prenatally exposed to cocaine.

Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit.

To investigate the effects of a prefeeding oral stimulation program on the feeding performance of preterm infants.

Effects of prefeeding oral stimulation on feeding performance of preterm infants.

We examined the effects of cheek and jaw support on the feeding ability of inefficient feeders born prematurely.

Effectiveness of cheek and jaw support to improve feeding performance of preterm infants.

The trend toward single-room neonatal intensive care units (NICUs) is increasing; however scientific evidence is, at this point, mostly anecdotal. This is a critical time to assess the impact of the single-room NICU on improving medical and neurobehavioral outcomes of the preterm infant. We have developed a theoretical model that may be useful in studying how the change from an open-bay NICU to a single-room NICU could affect infant medical and neurobehavioral outcome. The model identifies mediating factors that are likely to accompany the change to a single-room NICU. These mediating factors include family centered care, developmental care, parenting and family factors, staff behavior and attitudes, and medical practices. Medical outcomes that plan to be measured are sepsis, length of stay, gestational age at discharge, weight gain, illness severity, gestational age at enteral feeding, and necrotizing enterocolitis (NEC). Neurobehavioral outcomes include the NICU Network Neurobehavioral Scale (NNNS) scores, sleep state organization and sleep physiology, infant mother feeding interaction scores, and pain scores. Preliminary findings on the sample of 150 patients in the open-bay NICU showed a "baseline" of effects of family centered care, developmental care, parent satisfaction, maternal depression, and parenting stress on the neurobehavioral outcomes of the newborn. The single-room NICU has the potential to improve the neurobehavioral status of the infant at discharge. Neurobehavioral assessment can assist with early detection and therefore preventative intervention to maximize developmental outcome. We also present an epigenetic model of the potential effects of maternal care on improving infant neurobehavioral status.

Article	Year
Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions. The American journal of occupational therapy : official publication of the American Occupational Therapy Association\| PubMed ID: 12785667	2003
Clinical use of the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Pediatrics\| PubMed ID: 14993527	2004
Predictors of motor development in children prenatally exposed to cocaine. Neurotoxicology and teratology\| PubMed ID: 15734272	2005
Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. The American journal of occupational therapy : official publication of the American Occupational Therapy Association\| PubMed ID: 17153572	2006
Effects of prefeeding oral stimulation on feeding performance of preterm infants. Indian journal of pediatrics\| PubMed ID: 20814844	2010
Effectiveness of cheek and jaw support to improve feeding performance of preterm infants. The American journal of occupational therapy : official publication of the American Occupational Therapy Association\| PubMed ID: 21218679	2010
Infant neurobehavioral development. Seminars in perinatology\| PubMed ID: 21255702	2011

Rosemarie Bigsby

Biography

JoVE Journal Publications

Other Publications