Developmental Care Research Articles

Science Desk - Reflecting on motor cortex and it's place in developmental care

Science Desk - Reflecting on motor cortex and it's place in developmental care

Nesting Technique : It’s Effects on Preterm Cardiorespiratory Indicators

Background: Premature infant born with immature body system, their organs are not ready for extra uterine life, and they are unable to deal with external stress, which could alter body functions such as cardio-respiratory function. In addition, poor muscle tone increases the chance of developing an abnormal posture. To reduce this instability, applying developmental care such as nesting is vital to promote cardio-respiratory stability, maintain position, and reduce stress in preterm. Objectives: The study aims to assess the impact of the nesting technique on preterm cardio-respiratory parameters in various positions (supine, prone, and right lateral). Methodology: The research used randomized controlled trial design. By simple random sampling technique was choose 60 preterm infant, and they were divided into four groups equally (supine, prone, right lateral, and control group). The cardio-respiratory parameters (heart rate, respiratory rate, and oxygen saturation) were measured before and after applying the nesting and positioning techniques for 3 consecutive days. Data were analyzed by Statistical Package for Social Sciences (SPSS) program. Results: The study results showed a significant difference in the mean score of cardio-respiratory after three days of nesting technique with lateral, supine, and prone position groups at p= 0.000. While the control group showed there was non-significant change in the mean score of HR, RR, and Spo2 at p > 0.05. Conclusion: The Study concluded that the nesting technique was effective for stabilizing the cardio-respiratory parameters of preterm infants. The authors recommended routinely using nesting with the ideal position technique in preterm as a part of developmental care at the neonatal intensive care unit

Psychometric properties of the Turkish version of the developmental care scale for neonates with congenital heart disease.

Developmental care for newborns with congenital heart disease (CHD) improves cardiac and respiratory patterns. According to the American Heart Association, developmental care in newborns with CHD is important for improving neurodevelopmental outcomes. This study aimed to evaluate the validity and reliability of the Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease. This was a methodological, descriptive study conducted with 169 nurses from a tertiary-level NICU. The Demographical Information Form and the Developmental Care Scale for Neonates with Congenital Heart Disease were used to collect the data. The scales' language and content validity, construct validity, and internal consistency were also assessed. The scale consists of 31 items and four subscales. Factor loadings ranged from 0.44 to 0.82 and explained 65% of the total variance. Fit indices indicate that the model is acceptable. Cronbach's α was 0.95 for the entire instrument, 0.91 for developing the external environment subscale, 0.94 for assessing family well-being, 0.86 for the caregiver activities toward the neonate, and 0.82 for the basic need subscale. Item-total correlations ranged between 0.34 and 0.75, according to the item analysis results. The Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease is valid and reliable. The use of this scale could improve the performance of neonatal intensive care nurses in providing developmental care to newborns with CHD as well as the quality of care.

Early parental vocal contact in neonatal units: rationale and clinical guidelines for implementation.

This paper aims to present clear and evidence-based proposals for the integration of Early Parental Vocal Contact into the clinical practices of neonatal units. In the first part, we present a comprehensive rationale exploring the ontogenesis of voice perception in both term and preterm newborns that establishes a foundational understanding. This knowledge serves as a crucial starting point for developing evidence-based auditory and multisensory interventions aimed at fostering the developmental trajectory of preterm infants. Drawing insights from neuroscience and brain development, our proposals underscore the significance of tailoring auditory environments within neonatal settings. Special attention is given to the unique needs of preterm infants, factoring in their gestational age and maturation levels. In the second part clinical guidelines for implementation are provided and healthcare professionals are supported to assist parents in modulating their vocal interactions, aligning them with the infant's responses. Furthermore, we provide practical suggestions for engaging in discussions with parents about the content, duration, and frequency of vocal interventions. Finally, we delve into the potential roles of caregivers, parents, and health professionals within this enriched parental vocal interactional environment. Our perspective is firmly grounded in an infant and family-centered developmental care philosophy, aiming to enhance the overall well-being and the neurodevelopment of preterm infants in neonatal units.

Pengaruh Pemberian Informasi tentang Asuhan Perkembangan pada BBLR terhadap Tingkat Pengetahuan dan Sikap Perawat di Rumah Sakit Al Islam Bandung

Development care is an effort to modify the environment and respond to changes in the behavior of newborns, especially in infants Low Birth Weight, The purpose of this study was to determine the effect of training on developmental care on nurses' ability to care for babies with low birth weight. The design of this study used "quasi experiment pre and post test control", which involved 19 nurses in the perinatology room of Al Islam Bandung Hospital. The results showed a significant increase in the mean score of nurses' knowledge, attitudes and actions after the intervention (p value = 0,000, α = 0.05). This training is effective in increasing nurses' knowledge and attitudes. The recommendation of this study is the need for socialization to all health workers supported by the hospital policy to implement development care and evaluate the implementation of development care in LBW care.

Effect of Nesting and Swaddling on Sleep Duration of Preterm Neonate Hospitalized at Tertiary Care Centre of Eastern Nepal

Background: All preterm neonates’ sleep is disturbed during hospitalization period due to various stressful environmental factors and human error and without focusing in individual developmental care. This impacts neonatal neurological development as well as normal growth resulting lifelong disabilities. Thus, modification of the environment by intervening developmental care could minimize the iatrogenic effect and neuro-developmental delay by decreasing stressful environment. This study was conducted to assess the effect of nesting and swaddling on sleep duration of preterm neonates during hospitalization at B.P.Koirala Instituted of Health sciences (BPKIHS). Methods: True experimental (post-test control design) study conducted among 36 preterm neonates, admitted in Nursery and Neonatal Unit of BPKIHS. The objective of this study was to assess the effect of nesting and swaddling on sleep duration. Consecutive sampling technique was used for total sample size then after random allocation is applied for creates the samples into two groups: experimental and control. Performa was used to collect socio-demographic characteristics. Sleep duration was recorded in self-administer observation form base on the observational behavior characteristics scoring of neonatal sleep by AASM (American Academy of sleep Medicine). As intervention, nesting and swaddling were performed in experimental group, then the sleep was video-recorded for 2 hours for each neonate. Finally, data were analyzed using descriptive and inferential statistics. Results: Among the enrolled neonates, there were 23 male (63.9%) and 13 female (36.1%) preterm. There was significant difference in sleep duration between experimental and control group. The mean ± SD of sleep duration was 59.22 ± 22.61 minute in experimental group and 39.50 ± 8.06 minute in control with p-value 0.001. The mean sleep duration was not associated with other selected study variables except the performed intervention. Conclusions: Nesting and Swaddling can be used as convenient and effective method to increase neonatal sleep duration or rest period.

Effect of Developmental Supportive Care on Behavioral Cues of Preterm Neonates

Background: Developmental care consists of modifying the neonatal intensive care unit to reduce stress and improve the optimal mind and behavioral development of the preterm neonate. Aim: Evaluate the effect of preterm neonates' developmental supportive care on behavioral cues of preterm neonates. Research design: A quasi-experimental design was used. Sample: a convenient sample of 50 preterm neonates, in addition and 50 nurses who were responsible for providing care for those preterm neonates. Setting: In the Neonatal Intensive Care Unit (NICU) of Maternity University Hospital at El-Shatby in Alexandria. Method: Preterm neonates' behavioral cues were evaluated before the implementation of developmental care of preterm neonates. Heart rate, respiration, and oxygen saturation were documented immediately before, immediately after, and ten minutes after receiving developmental supportive care by the nurses. Tools: three tools was used for collecting the data; characteristics of preterm neonates, preterm neonate's physiological conditions, and behaviour cues of preterm neonates checklist to assess signs of stability and signs of distress Results: It was observed that the signs of preterm distress before receiving developmental care decreased directly after the program application and receiving developmental care, and then somewhat declined ten minutes later. A statistically significant difference was found between preterm behavior cues before implantation of developmental care, directly after receiving developmental care, and ten minutes later. Conclusion: Preterm neonates exhibited stable behavioral cues and fewer stress signs after application of the developmental supportive care. Recommendation: Proper pre-service and in-service training for newly recruited nurses and in-service training program for nurses about the most recent developmental supportive care interventions for preterm neonates to improve their performance about developmental supportive care to enhance preterm neonates behavior stability.

성인기 발달장애인 복지 현장의 도전적 행동 교육과정 개발 요구 분석

This study explored effective strategies for preventing and managing challenging behaviors in adults with developmental disabilities by utilizing focus group interviews (FGIs) with 18 participants, including caregivers, frontline service providers, and experts in challenging behavior interventions. The primary objective was to identify the types, causes, and prevalence of challenging behaviors in adult developmental disability care settings and to determine the essential requirements for developing a comprehensive training program for service providers. The findings revealed that Participants emphasized the importance of creating supportive and preventive environments to mitigate challenging behaviors and highlighted the need for systematic training programs and ongoing professional development for service providers. This study provides critical insights for developing training programs aimed at enhancing the capacity of service providers to effectively support adults with developmental disabilities. It may inform future policy initiatives in this area.

Executive and attentional functioning interventions in preterm children: a systematic review.

This systematic review, performed in accordance with the PRISMA guidelines, seeks to summarize the interventions that have been developed in order to improve executive functioning and attention in children born prematurely. The PICOS framework helped guide the structure and relevant terms selected for the study. Electronic systematic searches of the databases PubMed (NLM), Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and Ovid PsycINFO were completed in March 2022. This review focuses on interventions that target attention and executive functioning in prematurely born children between birth and 12 years old, with outcome measures assessed between 3 and 12 years old, even if the age range in the study can exceed our own parameters. Data extraction included sample characteristics, country of recruitment, type of intervention, description of the intervention group and control group, outcome measures, and overall results. An assessment of the quality of methodology of studies was performed through an adaptation of the Downs and Black checklist for both randomized and nonrandomized studies in healthcare interventions. An assessment of the risk of bias was also presented using the Cochrane risk of bias tool for randomized trials 2.0. A total of 517 premature children received an intervention at some point between birth and early adolescence. Eleven different interventions were assessed in 17 studies, with rating of the quality of methodology and outcomes ranging from lower quality studies (44% quality rating) to robust studies (96% quality rating) in terms of reporting standards, external and internal validity, and power. Five of those studies focused on interventions administered in the neonatal intensive care unit or shortly postdischarge (e.g., the Mother-Infant Transaction Program and the Newborn Individualized Developmental Care and Assessment Program, documented in two articles each [11%] or the Infant Behavioral Assessment and Intervention Program assessed in one study [about 5%]), while 12 articles reported on interventions administered between the ages of 1.5-12 years old [mostly computerized cognitive training programs such as Cogmed (23%) and BrainGame Brian (17%)]. Of the 17 articles examined, 12 (70%) showed positive short-term outcomes postintervention and 3 (17%) demonstrated positive long-term results with small to large effect sizes (0.23-2.3). Among included studies, 50% showed an overall high risk of bias, 21.4% showed some concerns, and 28.6% were low risk of bias. Due to the heterogeneity of the programs reviewed, the presented findings should be interpreted as descriptive results. A careful and individualized selection from the various available interventions should be made based on the target population (i.e., age at intervention administration and outcome testing) before implementing these program protocols in clinical settings.

Assessment and Prognostic Resources for Gross Motor Development in a Child with Cerebral Palsy Related to Congenital Zika Syndrome.

This article describes how the Gross Motor Ability Estimator (GMAE) software can provide important information based on the Gross Motor Function Measure (GMFM)-66 score of a child with congenital Zika syndrome.A child was assessed at 9, 17, and 25 months of age through the GMFM-66. At 2 years, the child's gross motor ability was estimated and classified according to the Gross Motor Function Classification System (GMFCS).At 2 years of age, the child in this case required assistance to roll and was unable to maintain antigravity trunk posture in sitting position, typical abilities of GMFCS level V.GMAE can be useful to guide health professionals that care for children with lifelong physical and developmental care needs. This is the first study that demonstrated how to use the GMAE in this specific population.

Comparison of parent or caregiver-completed development screening tools with Bayley Scales of Infant Development: a systematic review and meta-analysis

BackgroundParent/caregiver-completed developmental testing (PCDT) is integral to developmental care in children; however, there is limited information on its accuracy. In this systematic review, we compared the diagnostic accuracy of PCDT...

Penerapan Nesting terhadap Kualitas Tidur Bayi Berat Lahir Rendah (BBLR) di RSUD Ir. Soekarno Sukoharjo

Babies born with LBW conditions are more susceptible to disease and have a smaller chance of survival. Low birth weight (LBW) babies can cause developmental disorders both cognitively and motorically. Sleep is an important stage in repairing the neurological system in newborn babies. Poor quality sleep can cause illness and also cause psychological problems in LBW babies. Various developmental care efforts are made to minimize the negative impacts that arise during the treatment period, namely by optimizing the sleep quality of LBW babies, one way is by implementing nesting. Find out the results of the implementation of Nesting on the Sleep Quality of Low Birth Weight (LBW) Babies at the Ir. Soekarno Sukoharjo Regional Hospital. This type of research is a case study that uses descriptive pretest posttest design research methods and uses measurements of baby sleep quality. The results of the application to 2 respondents which were carried out for 2 days showed that there was an effect of nesting on improving the sleep quality of LBW babies. There were differences in the results before and after the nesting intervention on the sleep quality of LBW babies.

Early Childhood Care Coordination Through 211: A Randomized Clinical Trial.

Early intervention services can improve outcomes for children with developmental delays. Health care providers, however, often struggle to ensure timely referrals and services. We tested the effectiveness of telephone-based early childhood developmental care coordination through 211 LA, a health and human services call center serving Los Angeles County, in increasing referral and enrollment in services. In partnership with 4 clinic systems, we recruited and randomly assigned children aged 12 to 42 months with upcoming well-child visits and without a known developmental delay, to intervention versus usual care. All children received developmental screening and usual clinic care. Intervention children also received telephone connection to a 211 LA early childhood care coordinator who made referrals and conducted follow-up. Primary outcomes at a 6-month follow-up included parent-reported referral and enrollment in developmental services. Secondary outcomes included referral and enrollment in early care and education (ECE). Logistic regression models were used to estimate the odds of outcomes, adjusted for key covariates. Of 565 families (282 intervention, 283 control), 512 (90.6%) provided follow-up data. Among all participants, more intervention than control children were referred to (25% vs 16%, adjusted odds ratio [AOR] 2.25, P = .003) and enrolled in (15% vs 9%, AOR 2.35, P = .008) ≥1 service, and more intervention than control children were referred to (58% vs 15%, AOR 9.06, P < .001) and enrolled in (26% vs 10%, AOR 3.75, P < .001) ECE. Telephone-based care coordination through 211 LA is effective in connecting young children to developmental services and ECE, offering a potentially scalable solution for gaps and disparities.

Caregivers' perspectives of early developmental tele-assessments in challenging circumstances.

Outbreaks, such as the COVID-19 pandemic in 2020, exacerbate barriers to accessing early childhood developmental care. Tele-assessment may serve as an innovative approach to developmental monitoring to overcome service delivery amidst challenging circumstances. It is vital to collect caregivers' perspectives of this potential service delivery method to inform clinical decision making. This study aimed to determine caregivers' perspectives of interview-based early developmental tele-assessment in a South African context. Thirty caregivers of children (aged birth - 36 months) completed a caregiver-report developmental assessment via a telecommunications platform, as well as an online questionnaire probing their perspectives on the tele-assessment. Most participants (96.7%,n= 29 out of 30) rated their overall experience of the tele-assessment as positive; however, 53.8% (n= 14 out of 26 that answered the question) indicated that they would additionally still prefer in-person assessment. Tele-assessment appears to be a viable approach for caregivers to access developmental care during circumstances such as COVID-19.Contribution:This study provided valuable insight into a novel approach using interview-based early developmental tele-assessment and the perspectives of caregivers thereof.

Nonpharmacological Interventions to Mitigate Procedural Pain in the NICU: An Integrative Review.

Small infants experience a myriad of stimuli while in the Neonatal Intensive Care Unit (NICU), with many being painful or stressful experiences, although medically necessary. To determine what is known about nonpharmacological developmental care interventions used in the NICU to mitigate procedural pain of infants born under 32weeks gestation. Five electronic databases were searched: Medline, CINAHL, Scopus, Embase and the Cochrane Library. The inclusion criteria were as follows: experimental and nonexperimental studies from all publication years with infants born at less than 32weeks gestational age; peer-reviewed research articles studying nonpharmacological interventions such as skin-to-skin care, facilitated tucking, nonnutritive sucking, hand hugs, and swaddling; and English language articles. Our search yielded 1435 articles. After the elimination of 736 duplicates, a further 570 were deemed irrelevant based on their abstract/titles. Then, 124 full-text articles were analyzed with our inclusion and exclusion criteria. Twenty-seven studies were reviewed. Sucrose, facilitated tucking, pacifier, skin-to-skin care, and human milk appeared to lessen pain experienced during heel sticks, suctioning, nasogastric tube insertions, and echocardiograms. All nonpharmacological interventions failed to prove efficacious to adequately manage pain during retinopathy of prematurity (ROP) examinations. Evidence review demonstrates that healthcare practitioners should use nonpharmacological measures to help prevent pain from day-to-day procedures in the NICU including heel sticks, nasogastric tube insertions, suctioning, echocardiograms, and subcutaneous injections. Future research is necessary to better understand and measure how pain is manifested by very small premature infants. Specific research on mitigating the pain of examinations for retinopathy of prematurity is also needed.

Prioritizing family-centered developmental care: insights from parents of children with critical congenital heart disease: a qualitative study

As survivors of early cardiac surgery are at high risk of neurodevelopmental impairments, systematic health observations of children with critical congenital heart disease (CCHD) throughout childhood are recommended to enable early diagnosis and offer interventions to optimize neurodevelopment. A qualitative study using thematic analysis was performed to explore parents’ concerns, experiences, and needs regarding the development and received developmental care of their child (0–10 years) during hospital admission and beyond. Data were collected using semi-structured online interviews with 20 parents of children with CCHD. Four major themes were identified: (1) “impact of diagnosis and disease on the family-system,” (2) “parental concerns from diagnoses and beyond,” (3) “the need for information,” and (4) “the need for individualized and family-centered care.” The main themes can be divided into 13 sub-themes as impact, concerns, and needs are influenced by various impactful moments from diagnosis and afterwards. Conclusion: This study confirms the importance of early identification of neurodevelopmental problems by experienced healthcare professionals, especially in the early years when parental expectations and concerns about their child’s neurodevelopment are lower. A tailor-made family-centered follow-up program should be offered, which pays attention to both the neurodevelopment of patients with CCHD as well as the mental wellbeing of the entire family system. Furthermore, an online portal is recommended with a variety of reliable, controlled, understandable information from which parents can obtain the desired information to understand better the consequences of specific heart condition and to provide their child with the best possible guidance.What is Known:• Survivors of early cardiac surgery are at high risk of neurodevelopmental impairments; systematic health observations of children with CCHD throughout childhood are strongly recommended.What is New:• Parents need a tailor-made family-centered follow-up program, which pays attention to both the neurodevelopment of patients with CCHD as well as the mental wellbeing of the entire family system.• An online portal offering diverse, trustworthy information and sources would effectively meet parents’ needs by providing accessible insights into the potential consequences of specific heart conditions and guiding them in supporting their child optimally.

The newborn individualised developmental care and assessment program: A model of care for infants and families in hospital settings.

The Newborn Individualised Developmental Care and Assessment Program (NIDCAP) is an intervention and education programme that uses developmental observation for multidisciplinary healthcare professionals (HCP) caring for high-risk infants and families. Infants prosper with the ongoing co-regulation process of infant and family that is influenced by the physical and social environment. The Template for Intervention Description and Replication (TIDieR) Guidelines were applied to the NIDCAP intervention. The estimation of the individual infant's current goals is described from direct observation of behaviour in the context of ongoing care delivery. The infant's behaviour guides all caregivers to articulate current strengths and functioning for the development of individualised plans of care and support. The NIDCAP Nursery Program supports the full integration of NIDCAP into the healthcare system. NIDCAP is a system-based, process-oriented, attuned and responsive intervention for individualised developmental care for infants and families. Evidence shows NIDCAP significantly improves medical outcomes, with less time on the ventilator, improved weight gain, decreased length of stay, improved developmental outcomes and enhanced infant and family relationships. Evidence suggests that NIDCAP as an intervention improves parental competence, decreases stress for HCP teams and improves HCP satisfaction. NIDCAP improves outcomes for infants and families requiring hospital care.

Positioning Preterm Newborns for Cardiorespiratory Stability A Global Insight

This study assessed the effects of supine, prone, and right lateral positioning on the cardiorespiratory indicators of preterm newborns using a randomized controlled trial with 60 participants. Measurements of heart rate, respiratory rate, and oxygen saturation were taken before and after the application of these positions over three days. Results indicated significant improvements in all cardiorespiratory parameters in the intervention groups (p = 0.000), while the control group showed no significant changes. The findings suggest that strategic positioning can be an effective part of developmental care in neonatal intensive care units, enhancing the stabilization of vital functions in preterm newborns. Highlights: Strategic Positioning: Enhances cardiorespiratory stability in preterm newborns. Methodological Rigor: Employs a robust randomized controlled trial. Practical Implications: Recommends routine NICU positioning strategies. Keywords: Preterm Newborns, Cardiorespiratory Stabilization, NICU, Positioning Strategies, Randomized Controlled Trial.

The effect of developmental care on the length of hospital stay and family centered care practice for very low birth weight infants in neonatal intensive care units: A cluster randomized controlled trial

The effect of developmental care on the length of hospital stay and family centered care practice for very low birth weight infants in neonatal intensive care units: A cluster randomized controlled trial

Asuhan Keperawatan Pada Bayi BBLR Yang Terpasang CPAP Dengan Penerapan Terapi Nesting dan Posisi Pronasi Terhadap Status Hemodinamik

Background: BBLR refers to a disruption in the respiratory system of a baby caused by unstable physiological functions, including temperature, pulse, and oxygen saturation. One strategy for managing the condition is the implementation of continuous positive airway pressure (CPAP), a non-invasive technique. Developmental care further reinforces the efficacy of CPAP. One specific effort in providing developmental care is to modify the position of newborns to a comfortable state via nesting. Objective: This scientific paper seeks to examine the effects of nesting therapy and pronation posture on the hemodynamic status of low weight newborns in the BBLR population. CPAP is installed in the Perinatology Room of RSUD Kabupaten Tangerang. Method: Provision of Nursing Care Intervention and innovation in the application of nesting and pronation position against hemodynamics. Results: Based on case studies in managed patients, there were changes in hemodynamic status such as pulse, breathing and temperature in patients before and after treatment.