High Prevalence of Abnormal General Movements in Hospitalized Very Low Birth Weight Infants.

OBJECTIVE: Abnormal general movements (GMs) are predictive of later risk of motor impairments in preterm infants. The goals of this study are to (1) describe the implementation of the GM assessment (GMA) in a neonatal intensive care unit (NICU) and (2) investigate the prevalence and evolution of abnormal GMs in very low birth weight (VLBW) infants. STUDY DESIGN: Observational study of GMs in VLBW infants (gestational age [GA] <32 weeks and/or birth weight [BW] <1,500 g) following GMA implementation in a level-IV NICU. All VLBW infants admitted between November 2017 and April 2019 were eligible for the GMA. Infants were excluded if they required high-frequency ventilation or if they could not be unbundled for video acquisition. GMAs were scored weekly by at least 2 GMA-certified providers. RESULTS: The GMA was performed in 121 VLBW infants with a mean (standard deviation [SD]) GA of 28.3 (2.6) and BW of 1,113 (400 g). Only 28% of infants had normal GMs on initial assessment (32.9 ± 2.7 weeks' GA), while 61 and 11% had poor repertoire and cramped-synchronized GMs, respectively. At NICU discharge (37.6 ± 3.4 weeks corrected GA), 45 and 21% of infants were classified as having poor repertoire and cramped-synchronized GMs, respectively. Most infants with cramped-synchronized GMs on initial assessment had persistent abnormal GMs at discharge. In contrast, only one infant with normal GMs on first assessment developed cramped-synchronized GMs. CONCLUSION: Abnormal GMs are common in VLBW infants, including a high prevalence of the more concerning cramped-synchronized movement pattern. The GMA can be successfully performed in VLBW infants. The GMA may be helpful in identifying infants at increased risk of later motor impairments, as well as assisting clinicians, in the stratification of infants who may benefit from additional brain imaging and/or an intensive hospital-based interventions. KEY POINTS: · Abnormal GMs are common in VLBW infants.. · Poor repertoire in the most prevalent pattern observed.. · Infants at risk for abnormal motor outcomes can be identified in the NICU..

A Maternal-Administered Multimodal Neonatal Bundle in Hospitalized Very Preterm Infants: A Pilot Study.

BACKGROUND: Premature infants are at an increased risk for developing cerebral palsy (CP). Evidence-based strategies designed to promote healthy brain development and facilitate adaptation after brain injury in infants still admitted to the neonatal intensive care unit (NICU) represent a novel approach that may lead to improved long-term outcomes. PURPOSE: To investigate the feasibility of a maternal-administered early intervention bundle in very preterm infants prior to NICU discharge. METHODS: A pilot trial evaluating a maternal-administered NICU-based bundle of interventions in preterm infants (≤32 weeks' gestational age and/or ≤1500 g birth weight). The impact of the bundle on short-term developmental outcomes of infants, as well as maternal stress, anxiety, and depression, is evaluated. RESULTS: The intervention bundle was implemented in 11 mother-infant dyads (including 1 set of twins) for a median of 8 weeks and was overall well received. Vocal soothing, scent exchange, and comforting touch were feasible, performed at or above the predetermined goal of 71% of the time (5/7 days), while kangaroo care and infant massage were not. Maternal stress, anxiety, and depression were decreased during the study time. IMPLICATIONS TO PRACTICE: A neonatal multimodal intervention bundle provided by mothers is feasible. IMPLICATIONS TO RESEARCH: Additional randomized controlled studies are needed to determine whether this type of bundled interventions can (1) improve the neurodevelopmental outcomes of participating infants and (2) improve long-term parental outcomes, including decreased burden of anxiety and depression, as well as improved attachment and optimal patterns of social interaction.

Heart rate ranges in premature neonates using high resolution physiologic data.

OBJECTIVE: There are limited evidence-based published heart rate ranges for premature neonates. We determined heart rate ranges in premature neonates based on gestational and post-menstrual age. STUDY DESIGN: Retrospective observational study of premature neonates admitted to the neonatal intensive care unit at the University of Virginia between January 2009 and October 2015. We included gestational ages between 23 0/7 weeks and 34 6/7 weeks. We stratified data by gestational and post-menstrual age groups. RESULTS: Over two billion heart rate values in 1703 neonates were included in our study. We established percentile-based reference ranges based on gestational and post-menstrual age. Our results demonstrate a slight increase in the initial weeks after birth, followed by a gradual decline with age. The baseline heart rate is lower with advancing gestational age. CONCLUSIONS: Knowing heart rate reference ranges in the premature neonatal population can be helpful in the bedside assessment of the neonate.

Dexamethasone effect on heart rate variability in preterm infants on mechanical ventilation.

BACKGROUND: Dexamethasone is administered to some preterm infants with chronic lung disease to facilitate weaning from mechanical ventilation. Heart rate characteristics (HRC), including heart rate variability (HRV), may be impacted by glucocorticoids and may predict extubation readiness. A commercially available monitor developed for sepsis detection continuously calculates HRV and an HRC index, which are inversely related. OBJECTIVES: Determine the impact of dexamethasone on HRV and the HRC index, in relation to extubation success. METHODS: We identified 109 preterm infants who received dexamethasone while on mechanical ventilation and had HRC index monitoring data available. Average hourly HRV and HRC index were compared the day before and the day after initiation of dexamethasone in three groups: infants who remained on mechanical ventilation, those who were successfully extubated, and those who were extubated and required reintubation in < 3 days. RESULTS: There was a significant increase in HRV and decrease in the HRC index the day after dexamethasone was started (HRV 16.2±0.5 vs 27.6±1.1 ms; HRC index 1.51±0.11 vs. 0.79±0.06 mean SE, p < 0.001). The 63 infants who were extubated within a day of starting dexamethasone had significantly higher HRV compared to those who remained on mechanical ventilation. There was no difference in HRV or its change with dexamethasone in the 45 infants who remained successfully extubated compared to the 18 infants who required reintubation within 3 days. CONCLUSION: Dexamethasone improves HRV and lowers the HRC index in preterm infants with chronic lung disease on mechanical ventilation.