Developmental Care Research Articles

Effect of a portable therapeutic baby nest designed for neonates on physiological parameters, comfort and pain levels during venous blood sampling: a randomised controlled trial.

In Turkey, paediatric emergency departments often lack the specialised environments required for invasive procedures on neonates. Given their developmental vulnerability, it is crucial to use interventions that reduce discomfort and support physiological stability. This study introduces the portable therapeutic baby nest (PTBN), designed to provide developmentally supportive care aligned with the principles of the Newborn Individualized Developmental Care and Assessment Program. This two-phase study included 80 term neonates (40 per group). First, the PTBN was developed from February to April 2022. Second, its effectiveness was evaluated through a randomized controlled trial conducted from May to September 2022. The experimental group underwent venous blood sampling in the PTBN, and the control group on a standard stretcher. All procedures were video-recorded and assessed by two blinded nurses using the Physiological Parameter Monitoring Form, COMFORTneo and Neonatal Infant Pain Scale (NIPS). Baseline characteristics were similar across groups (p>0.05). During and after sampling, the PTBN group had significantly lower heart and respiratory rates, higher oxygen saturation and lower NIPS and COMFORTneo scores compared with controls (p<0.05). The PTBN improved physiological stability, comfort and pain outcomes during venous sampling in neonates. NCT05442619.

A Pilot Study: Sleep and Activity Monitoring of Newborn Infants by GRU-Stack-Based Model Using Video Actigraphy and Pulse Rate Variability Features

We introduce a novel system for automatic assessment of newborn and preterm infant behavior—including activity levels, behavioral states, and sleep–wake cycles—in clinical settings for streamlining care and minimizing healthcare professionals’ workload. While vital signs are routinely monitored, the previously mentioned assessments require labor-intensive direct observation. Research so far has already introduced non- and minimally invasive solutions. However, we developed a system that automatizes the preceding evaluations in a non-contact way using deep learning algorithms. In this work, we provide a Gated Recurrent Unit (GRU)-stack-based solution that works on a dynamic feature set generated by computer vision methods from the cameras’ video feed and patient monitor to classify the activity phases of infants adapted from the NIDCAP (Newborn Individualized Developmental Care Program) scale. We also show how pulse rate variability (PRV) data could improve the performance of the classification. The network was trained and evaluated on our own database of 108 h collected at the Neonatal Intensive Care Unit, Dept. of Neonatology of Pediatrics, Semmelweis University, Budapest, Hungary.

Multi-Method, Partner-Engaged Process to Document Adaptations for ATTAIN NAV: Family Navigation for Autism and Mental Health.

Autistic youth often experience co-occurring mental health needs, yet they have multi-level barriers to accessing needed care. To address these barriers, the ATTAIN NAV (Access to Tailored Autism Integrated Care through Family Navigation) intervention was co-designed with caregiver and healthcare partners and delivered by lay health navigators to facilitate access to and engagement with mental health services for school-age autistic youth. This manuscript describes the multi-method, partner-engaged, longitudinal adaptation process to (1) identify intervention content and implementation refinements prior to the hybrid trial and (2) track ongoing research, intervention, and implementation adaptations during the trial and their impacts on study outcomes. The adaptation processes used the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (Miller et al., 2021) to guide data collection and evaluation approaches. From the qualitative co-design activities with caregivers (n = 5), primary care providers (n = 6), developmental care clinicians (n = 4), and health informatics staff (n = 3), several intervention content and implementation adaptations were identified and integrated prior to the trial. From the longitudinal adaptation tracking process during the trial, a total of 19 adaptations were documented throughout the implementation trial. The adaptations were related to maintaining the feasibility and acceptability of the study procedures (32%), increasing family recruitment/engagement (26%), increasing the acceptability of the intervention components (16%), increasing physician recruitment/engagement (11%), expanding mental health resources (5%), complying with partnered healthcare organization policy (5%), and increasing navigator workflow efficiency (5%). Findings offer a structured and replicable approach adoptable by non-traditional mental health intervention and implementation research.

Neonatal Neurocardiac Care: Strategies to Optimize Neurodevelopmental Outcomes in Congenital Heart Disease.

Neonatal Neurocardiac Care: Strategies to Optimize Neurodevelopmental Outcomes in Congenital Heart Disease.

Strengthening Parental Capabilities: Examining the Role of Interdisciplinary Support in Enhancing Parental Well-Being and Capabilities in Developmental Disability Care

Purpose: The purpose of this study was to explore parents’ lived experiences raising children with developmental disabilities (DDs), examine their emotional and physical challenges, and investigate the role of interdisciplinary support in strengthening parental capabilities. Materials and Methods: A qualitative descriptive study was conducted using two focus groups (n = 23 parents). Data were analyzed using Braun and Clarke’s six-step thematic analysis. Results: Five major themes emerged: (1) acceptance and emotional journey, (2) healthcare system navigation challenges, (3) educational and community integration barriers, (4) the development of coping strategies and support systems, and (5) resilience and positive growth. Parents reported significant emotional challenges but demonstrated remarkable resilience when supported by comprehensive care systems. Conclusions: The findings highlight the need for integrated support systems that address both the practical and emotional needs of parents raising children with DDs. Healthcare providers and community stakeholders must work collaboratively to create more inclusive and supportive environments for these families.

The effect of newborn individualized developmental care and assessment program (NIDCAP) on pain caused by eye examination for ROP screening.

BackgroundEye examination is one of the painful procedures for infants. Eye screening for retinopathy of prematurity (ROP) is an essential intervention to prevent visual impairment in preterm infants. However, Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a well-established framework for all of the interventions on premature infants, and pain management is the main subject of this program.PurposeThe aim of this study is to determine the effect of NIDCAP on the pain caused by eye examination for ROP screening.MethodsIn this non-randomized controlled clinical trial, 60 infants were classified in two groups (30 infants in the intervention group and 30 infants in the control group). The infants of the intervention group underwent NIDCAP protocols before, during, and after the examination and the infants of the control group received routine cares. Then, according to PIPP tool, level of pain in the two groups was evaluated.ResultsThe two groups were homogeneous in terms of demographic variables. The results showed that the interventions group experienced significantly lower increases in heart rate during exams (p = 0.001). The reduction of oxygen saturation during the examination in the intervention group was less than the control group, which was not statistically significant (p = 0.577). The two groups have no difference in behavioral status score during examination. While facial scores during the examination in the intervention group were significantly lower than the control group (p = 0.011). In terms of the total score of pain during examination, the newborns of the intervention group have a significantly lower pain score than the control group (p = 0.033).

Developmental Care in the Early Years in Pediatric Intensive Care Patients as a Strategy to Mitigate Pediatric Post-Intensive-Care Syndrome: A Narrative Review.

Survivors after pediatric critical care often have adverse sequelae in domains of cognition, executive function, attention, memory, visual-spatial skills, language, motor function, behavior, and emotional functioning, the post-intensive-care syndrome pediatric (PICS-p). The time from birth to approximately age 2 years is a period of rapid structural and functional brain development. The fundamental structural and functional architecture of the brain is in place by the second year of life. This narrative review focuses on how we, in the pediatric intensive care unit (PICU), can work towards maximizing each patient's full potential despite adverse experiences during hospitalization. In part I, concepts relevant to understanding the effects of hospitalization in PICU on brain development are clarified, including concepts of toxic stress and trauma, sensitive periods and cascades, experience-expectant neural plasticity in the early years, and resilience and buffering of adversity focused on relational care. In part II, evidence is presented that these concepts are important because they describe the effects of early childhood adversity that are pervasive on physical health, cognitive, and emotional outcomes throughout the lifespan. Evidence is presented to show that intervention to improve these outcomes can be effective. In part III, the concepts and evidence are synthesized by focusing on the opportunity before us, what we must and can do better while patients are in the PICU, in order to improve their long-term lifelong outcomes. We present evidence to argue that we in pediatric critical care must take a public-health approach to address the key environmental conditions necessary for optimal early childhood development and hence facilitate children's ability to thrive. Future research must aim to determine what works best and what does not work in the PICU. Early childhood investments to improve lifelong outcomes have great potential to help patients and reduce the growing burden of healthcare costs.

Perspectives on Implementing European Newborn Health Standards: Insights From Parent Representatives and Healthcare Professionals.

To address disparities in the care for preterm infants, the European Standards of Care for Newborn Health were developed in a co-creation process. The aim of this study was to provide an overview of their implementation state based on the perspectives of parent representatives and healthcare professionals (HCPs), including implementation barriers and facilitators. Online questionnaires were developed and pre-tested to assess validity/usability. Representatives of parent organisations and healthcare societies participated. Data were analysed using descriptive and qualitative content analyses. Overall, 23 parent representatives and 76 HCPs from 24 countries participated. Regarding implementation gaps, parents mentioned Follow-up care (14/23) and NICU design (13/23). HCPs selected Infant- and family-centred developmental care (34/76), also being considered as the most urgent priority by both groups (16/23; 34/76). Medical care and Birth and transfer were seen as implementation successes by both groups (parents: 14/23 & 11/23; HCPs: 46/76 & 50/76). Most frequently mentioned barriers included missing resources and inadequate infrastructure. Information dissemination, interdisciplinary collaboration and training opportunities were considered facilitators. The implementation state varied across topics, with parents and HCPs being frequently of the same opinion. Strengthening collaboration among stakeholders could provide an opportunity to improve future implementation efforts.

Newborn Behavioral Observation (NBO) at different stages of the perinatal journey

Newborn Behavioral Observation (NBO) at different stages of the perinatal journey

Impact of Interventions From a Secondary Home-Based Palliative Care Unit on Caregiver Burden in Kerala, India.

Caregivers in low- and middle-income countries (LMICs) experience severe caregiver burden manifested as physical, emotional, developmental, social, and financial strain. The burden experienced by caregivers becomes severe in the case of patients in need of secondary palliative care since the care recipients are completely dependent on caregivers for activities of daily living (ADLs) and instrumental activities of daily living (iADLs) and require advanced nursing care and symptom management. The paper examines the interventions implemented by the best-performing secondary home-based palliative care (HBPC) unitin Kerala, focusing on the provision of caregiving services and resources, and evaluates their impact on perceived caregiver burden. Using in-depth interviews, qualitative data on aspects of caregiver burden and the impact ofintervention by the HBPC unit were collected from 10 caregivers selected purposively to reflect the heterogeneity of the caregiver population. A multidimensional tool, the Caregiver Burden Scale (CBS), was developed to measure the impact of the HBPC unit on caregiver burden. A sample of 36 caregivers was selected using proportional random sampling from among the caregivers of 93 patients registered at the HBPC unit in 2021.Quantitative data on palliative care services provided by the secondary palliative care unit, activities of the HBPC unit, frequencyand duration of home care visits, particulars of caregivers, and details of caregiving services and resources were collected and analyzed. Additionally, the device CBS was also administered to the selected sample of caregivers. The domains of caregiver burden impacted by the HBPC unitare found to be time burden, emotional burden, physical burden, social burden, developmental burden, coping up burden, and quality care burden. Of all these domains, notable impact is seen in the developmental and quality care domains. This impact resulted from the HBPC unittargeting the health of caregivers, supporting caregiving services, and providing caregiving resources. The HBPC unit cared for caregivers' physical and emotional well-being and enabled them to maintain social relationships. In addition, medication management, advanced nursing care, and support for ADLs were provided during home care visits. The team, by coordinating with the local self-government (LSG) and other institutions, provided caregiving resources, including care facilities and caregiving education. The experience of the intervention of the best-performing secondary home-based palliative care team in Kerala depicts that aholistic interventionin the form of provision of caregiving servicesand caregiving resources from the palliative team can have a positive impact on the various domains of caregiver burden.

Loss to Follow-up and Developmental Delay in the Neonatal High-Risk Infant Follow-up Clinic.

Neonatal follow-up (NFU) clinics provide developmental assessments for infants at high risk for developmental delays. Disparities in NFU attendance and loss to follow-up (LTF) are well documented, but it is not known whether patients who are LTF have different developmental outcomes. The population of patients LTF from the NFU clinic is assumed to be homogenous, but we hypothesize there is a subpopulation of patients LTF who are receiving developmental care elsewhere. Our objective was to compare the baseline characteristics and developmental outcomes of infants who completed follow-up, infants who were LTF but seen by others in the community, and infants who were LTF but not seen by others (true LTF).Retrospective cohort study at a regional specialty center, including 262 patients referred to the NFU clinic who were born between 2014 and 2017, with a 24-month total follow-up period, such that assessment of all follow-up outcomes (NFU clinic attendance outcome, and clinician assessed developmental delay) was complete prior to March 2020. Multivariable logistic regression was used to model the odds of developmental delay, true LTF, and referral to developmental services at initial hospital discharge.Of 262 patients, 86 (33%) were LTF from the NFU clinic. Of these, 55 (64%) had developmental assessments by other providers. Of those LTFs from NFU but seen by other providers, the prevalence of clinician-assessed developmental delay at 24 months was 67%, compared with 45% of those who completed the NFU clinic (p < 0.001). Social risk factors (younger mothers, late or no prenatal care, maternal smoking, or referral for a social reason) were associated with higher odds of true LTF, but no different odds of referral to developmental services at hospital discharge.A majority of patients LTF from the NFU clinic had developmental assessments by others (64%). Social risk factors were associated with true LTF and missed developmental assessments. · Sixty-four percent of patients with LTF had developmental assessments by other providers.. · Social risk factors were associated with higher odds of true LTF.. · Infants with social risk factors were not referred to developmental services early..

Longitudinal outcomes in Noonan syndrome.

Longitudinal outcomes in Noonan syndrome.

AN OVERVIEW OF NEUROPROTECTIVE STRATEGIES IN PRETERM NEONATES

With advances in antenatal and neonatal therapy and care, the survival of preterm neonates, especially extremely immature, has increased. Brain injury occurs significantly more often in preterm neonates compared to full-term neonates, which is associated with a higher risk of neurodevelopmental disorders. Three common and frequent forms of preterm brain injury are intraventricular hemorrhage, white and gray matter injury. There are numerous antenatal, intrapartum and postnatal strategies in order to reduce risk of preterm brain injury and poor neurodevelopmental outcome. First of all, studies showed that antenatal corticosteroid and magnesium sulfate administration in case of threatened preterm delivery has an importance role in reducing the risk for preterm brain injury and neurodevelopmental disabilities. Also, delayed cord clamping and many interventions in early neonatal period, such as maintenance of optimal ventilation and hemodynamic stability, blood glucose monitoring concentration, recognition of neonatal seizures and administration of anti-seizure medications, use of caffeine and optimal nutrition affect the improvement of the neurological development of the preterm neonates. At the end of the 20th century, a special program for the care and assessment of the behavior of neonates, Neonatal Individualized Developmental Care and Assessment Program, was developed, which is used today in many neonatal intensive care units in order to minimize developmental delays of preterm neonates. A number of drugs and interventions whose possible neuroprotective effects are being investigated include mild hypothermia, erythropoietin, melatonin, allopurinol, stem cell therapy, maternal vitamin D supplementation during pregnancy, exosomal-based therapy, et al.

Proprioceptive developmental care and parental mental health

Proprioceptive developmental care and parental mental health

Neuropsychology's Role in Multidisciplinary Follow-Up Care of Neurologically Complex Infants and Toddlers.

Neuropsychology's Role in Multidisciplinary Follow-Up Care of Neurologically Complex Infants and Toddlers.

Assessment of pain and support for parents in the neonatal unit

Assessment of pain and support for parents in the neonatal unit

The Impact of Pacifiers and Positioning on Pain Management in Neonates: Meta-Analysis.

The Impact of Pacifiers and Positioning on Pain Management in Neonates: Meta-Analysis.

"This is the best ward round I have ever been a part of": Implementing Developmental Care Ward Rounds in A Tertiary Neonatal Unit in The UK.

"This is the best ward round I have ever been a part of": Implementing Developmental Care Ward Rounds in A Tertiary Neonatal Unit in The UK.

Using Social Network Analysis to Understand the Effect of Developmental Care Education

Using Social Network Analysis to Understand the Effect of Developmental Care Education

The Impact of a Developmental Care Skin-To-Skin Quality Improvement Project as Part of our Process of Becoming A NIDCAP Certified Unit.

The Impact of a Developmental Care Skin-To-Skin Quality Improvement Project as Part of our Process of Becoming A NIDCAP Certified Unit.