Neurosensory Stimulation Among Preterm Infants

Abstract

“Born too soon” makes a neonate more vulnerable and increases the risk of both mortality and morbidity. These preterm infants have a higher chance of developing motor, cognitive and behavioral impairments compared with infants born at term [1–3]. Thirteen percent of live born babies in India are preterm [4]. Multiple births with assisted reproductive techniques, young or advanced maternal age, low maternal body mass index, short inter-pregnancy intervals, pre-existing non-communicable disease, hypertensive disease of pregnancy, infections, increasing psychological stress and medically induced prematurity are some of the causes for increasing frequency of preterm births. Apart from immediate survival, long term outcome in relation to growth and development is also intriguing among preterm babies. As the survival of preterm babies is exponentially increasing owing to advances in perinatal medicine and better neonatal care, focusing on their long term outcomes and minimizing neurodisability is of paramount importance. Cerebral palsy, mental retardation, blindness and deafness are some of the adverse neurodevelopmental outcomes noted among preterm babies and many of these disabilities can be modified by early stimulation before the disability is established. “Early intervention” refers to the process of manipulating the child’s environment to promote cognitive and neurological development [5]. The preterm infant’ sd eveloping brain has significant interactions with the NICU environment which can affect the outcome. Despite the CNS insult in the preterm baby, neuronal migration, differentiation, synaptogenesis, myelination and synaptic connections continue to occur. A recent Cochrane review showed that early intervention programmes for preterm infants had a positive influence on cognitive and motor outcomes during infancy, with the cognitive benefits persisting into pre-school age [3]. The Trivandrum model of ‘early stimulation therapy’ was effective at 1 y. The beneficial effect also persisted at 2 y, without any additional interventions in the second year [6]. Late preterm neonates constitute an important subgroup and require special attention. According to a study from Pondicherry, late preterm babies constituted 55 % of all live preterm births and had higher morbidities like respiratory distress, seizures, shock, and jaundice compared to term controls [7]. This special group would probably form the best captive population for providing early stimulation.