An educational programme in neonatal intensive care units (SEPREVEN): a stepped-wedge, cluster-randomised controlled trial.

BACKGROUND: Patients in neonatal intensive care units (NICUs) are at high risk of adverse events. The effects of medical and paramedical education programmes to reduce these have not yet been assessed. METHODS: In this multicentre, stepped-wedge, cluster-randomised controlled trial done in France, we randomly assigned 12 NICUs to three clusters of four units. Eligible neonates were inpatients in a participating unit for at least 2 days, with a postmenstrual age of 42 weeks or less on admission. Each cluster followed a 4-month multifaceted programme including education about root-cause analysis and care bundles. The primary outcome was the rate of adverse events per 1000 patient-days, measured with a retrospective trigger-tool based chart review masked to allocation of randomly selected files. Analyses used mixed-effects Poisson modelling that adjusted for time. This trial is registered with ClinicalTrials.gov, NCT02598609. FINDINGS: Between Nov 23, 2015, and Nov 2, 2017, event rates were analysed for 3454 patients of these 12 NICUs for 65 830 patient-days. The event rate per 1000 patient-days reduced significantly from the control to the intervention period (33·9 vs 22·6; incidence rate ratio 0·67; 95% CI 0·50-0·88; p=0·0048). INTERPRETATION: A multiprofessional safety-promoting programme in NICUs reduced the rate of adverse events and severe and preventable adverse events in highly vulnerable patients. This programme could significantly improve care offered to critically ill neonates. FUNDING: Solidarity and Health Ministry, France.

Preterm infant showed better object handling skills in a neonatal intensive care unit during silence than with a recorded female voice.

AIM: This study compared whether preterm infants showed better tactile abilities during silence or when they heard a prerecorded female voice at different intensities. METHODS: We studied 74 preterm infants of 28-35 weeks' postconceptional age who were admitted to a French neonatal intensive care unit from 2014 to 2017. They were presented with wooden objects, one smooth and one angled, at various points during silence (n = 26) or while listening to a female voice at +5 (n = 24) or +15 decibels (n = 24) inside their incubator. We compared the conditions to see if there was any difference in how the infants handled the objects and also compared familiar and unfamiliar objects. RESULTS: The preterm infants showed better handling skills and only displayed effective discrimination, during silence. We found that 27.1% of the infants exposed to female voices failed to get habituated to the object, compared to 7.7% in the silence condition (p < 0.05) and success during the voice conditions required more trials (6.1 vs. 5.3) than the silence condition (p = 0.05). The different voice intensities made no difference. CONCLUSION: Being exposed to a female voice had a negative impact on preterm infants' tactile sensory learning, regardless of its intensity.

Intermanual transfer of shapes in preterm human infants from 33 to 34 + 6 weeks postconceptional age.

This study investigated the ability of preterm infants to learn an object shape with one hand and discriminate a new shape in the opposite hand (without visual control). Twenty-four preterm infants between 33 and 34 + 6 gestational weeks received a tactile habituation task with either their right or left hand followed by a tactile discrimination task in the opposite hand. The results confirmed that habituation occurred for both shapes and both hands. Infants subsequently held the novel shape longer in the opposite hand. The results reveal that preterm infants are capable of intermanual transfer of shape information. In spite of the immaturity of the corpus callosum in preterm infants, its development seems to be sufficient to allow some transfer of information between both hands.

Influence of swaddling on tactile manual learning in preterm infants.

BACKGROUND AND AIM: Swaddling is a well-known technique in developmental care programs as there is some evidence that swaddling is an appropriate stress-reducing method for preterm infants in the NICU. However, no experimental study has investigated the influence of swaddling in a learning context. This study aimed to assess the impact of swaddling on tactile manual abilities in preterm infants. METHODS: Two phases were introduced for all infants: habituation (successive presentation of the same object, prism or cylinder in the left hand), followed by discrimination (presentation of a new-shaped object). The infants were assigned to one of the two conditions (swaddled; non-swaddled). RESULTS: Forty preterm infants were included (between 28 and 35 weeks' postconceptional age). First, swaddled and non-swaddled infants exhibited similar tactile habituation abilities. However, all infants needed more time and more trials to habituate to the cylinder than to the prism. Second, they all exhibited an effective discrimination, but the importance of the increase in holding time for the new-shaped object varied according to the habituated-shape and the condition. Moreover, stress intensity was higher in non-swaddled infants during tactile exploration. Finally, infants with greater previous swaddling experience during the week preceding the test took more time and more trials to habituate to the object, regardless of the condition. CONCLUSION: Swaddling preterm infants during sensory learning did not influence the tactile memorization process but would improve the use of their attentional resources. Swaddling seems to provide favorable conditions for sensory learning by improving attention to tactile stimuli. CLINICAL TRIAL REGISTRATION: This trial, EMMASENS, has been registered at www.clinicaltrials.gov (identifier NCT04315428).

[Communicating with premature newborns through touch]. / Communiquer par le toucher avec le nouveau-né prématuré.

How does the premature newborn perceive the outside world? The first sense developed by the foetus is touch. Through the physiology of sensoriality and brain maturation, touch can constitute an essential vector in communicating with and caring for the premature child.

Bacteriological screening of breast milk samples destined to direct milk donation: Prospective evaluation between 2007 and 2016.

This study analyzes the bacteriological quality of breast milk samples destined to direct milk donation to preterm infants under 34 Gestational Weeks (GW) hospitalized in a neonatology and a neonatal intensive care unit of a French university hospital. All samples of breast milk destined to direct milk donation between April 2007 and December 2016 were included. A sample was defined as compliant if its total flora was less than 106 Colony Forming Units per milliliter (CFU/mL) and in the absence of Staphylococcus aureus and other pathogens. A total of 777 samples were taken from 629 mothers. The overall non-compliance rate for the initial sample was 21.3%; 63 samples (10.0%) had a total flora ≥ 106 CFU/mL, 63 (10.0%) were contaminated by a pathogenic bacteria and 8 (1.3%) were non-compliant because of both. An increase of the non-compliance rate was observed between 2008 and 2016 (10.2%-26.1%). The increase of the total flora non-compliance rate began in 2011, in link with the doubling of the number of samples taken, to reach a peak in 2013 then decreased in link with development of portable pump. No statistically significant difference of the presence of S. aureus in breast milk was observed. For the other pathogenic bacteria, the rate increased significantly in 2014. The increase of the non-compliance rate could be explained by a decrease of best practices in milk collection. Education of mothers should be strengthened.

Sound Interferes with the Early Tactile Manual Abilities of Preterm Infants.

Premature birth is a sudden change of the sensory environment of a newborn, while their senses are still in development, especially in the stressful and noisy environment of the NICU. The study aimed to evaluate the effect of noise on the early tactile manual abilities of preterm infants (between 29 and 35 weeks PCA). Infants were randomly assigned to one of the two conditions: Silence and Noise. For each condition, two phases were introduced: a habituation phase (repeated presentation of the same object, prism or cylinder), followed by a test phase (presentation of the familiar or a novel object). In the Silence condition, they received the tactile habituation and test phases: In the Noise condition, they went through the same phases, while an alarm sounded. Sixty-three preterm infants were included. They displayed a strong and effective ability to memorize tactile manual information and to detect the difference between two shape features, but this ability seems to be impaired by the concomitant exposure to an alarm sound. This study is the first to highlight the effect of a negative stimulus on sensory functioning in premature infants. It reinforces the importance of developing environmental measures to lower the sound level in NICUs.

The effect of postnatal age on the early tactile manual abilities of preterm infants.

BACKGROUND: Although preterm infants possess early tactile manual abilities, the influence of the postnatal experience has not yet been systematically examined. AIMS: To investigate whether early tactile manual habituation, discrimination and recognition (following interference) of shape in preterm infants are modified by postnatal age. STUDY DESIGN: Prospective study. SUBJECTS: Forty preterm infants were assessed from the post-conceptional age (PCA) of 34 weeks. Two groups were made up according to postnatal age (PNA): low PNA (PNA≤10 days of life) and high PNA (PNA≥12 days of life). OUTCOME MEASURES: An object (prism or cylinder) was presented repeatedly in the left hand, and holding times of the object were recorded during each trial. RESULTS: Holding time was shorter for all preterm infants following successive presentation of the same object irrespective of postnatal age range. In the discrimination phase, the mean holding time for the novel object was longer than holding times in the last two habituation trials, in both PNA groups. Finally, the mean holding time of the familiar object presented in the recognition phase was shorter than the holding time of the novel object presented previously, but only in the low PNA group. CONCLUSIONS: Tactile manual habituation and discrimination of shape information is present in preterm infants at a post-conceptional age of 34 weeks, independently of postnatal age. However, tactile manual recognition of familiar shapes following interference is affected by length of postnatal experience. The significance of this last result is discussed in detail.

Tactile sensory capacity of the preterm infant: manual perception of shape from 28 gestational weeks.

OBJECTIVE: Recent studies have shown that from the postconceptional age of 33 weeks, preterm infants are able to memorize tactile information about the shape of an object by using their hands, and can detect differences with another shape. This study aimed to investigate tactile abilities earlier on in development, in very preterm and mildly preterm human infants. METHODS: Infants were assigned to 2 groups according to postconceptional age: very preterm (before 32 weeks) and mildly preterm (from 32 to 33+6 weeks). The test consisted of the repeated presentation of an object (prism or cylinder) in the left hand. The experiment was conducted in 3 phases: habituation (repeated presentation of the same object), discrimination (presentation of a novel object), followed by recognition (presentation of the familiar object). RESULTS: Forty-eight newborns were recruited (24 very preterm; 24 mildly preterm). During habituation, each infant showed a decrease in the holding time of the object. Then, when a novel shape was put into the preterm newborn's hand, holding time increased. Finally, when the familiar shape was presented again, the holding time decreased. Preterm infants can memorize by touch specific features that differentiate prism and cylinder shapes, discriminate between them, and recognize them after interference. CONCLUSIONS: From 28 weeks, and from the first days of life, the preterm newborn is endowed with tactile sensory capacities. The tactile stimulations that are presented to preterm infants during their hospitalization should be adapted while respecting their sleep-wake rhythms.

The manual habituation and discrimination of shapes in preterm human infants from 33 to 34+6 post-conceptional age.

BACKGROUND: Grasping at birth is well-known as a reflex in response to a stimulation of the palm of the hand. Recent studies revealed that this grasping was not only a pure reflex because human newborns are able to detect and to remember differences in shape features. The manual perception of shapes has not been investigated in preterm human infants. The aim of the present study was to investigate manual perception by preterm infants. METHODOLOGY/PRINCIPAL FINDINGS: We used a habituation/reaction to novelty procedure in twenty-four human preterm infants from 33 to 34+6 post-conceptional age. After habituation to an object (prism or cylinder) in one hand (left or right) in a habituation phase, babies were given either the same object or the other (novel) object in the same hand in a test phase. We observed that after successive presentations of the same object, a decrease of the holding time is observed for each preterm infant. Moreover, a significant increase of the holding time is obtained with the presentation of the novel object. Finally, the comparison between the current performance of preterm infants and those of full-term newborns showed that preterm babies only had a faster tactile habituation to a shape. CONCLUSION/SIGNIFICANCE: For the first time, the results reveal that preterm infants from 33 to 34+6 GW can detect the specific features that differentiate prism and cylinder shapes by touch, and remember them. The results suggest that there is no qualitative, but only quantitative, difference between the perceptual abilities of preterm babies and those of full-term babies in perceiving shape manually.