The Developmental Participation Skills Assessment: Development and Content Validation.

Purpose: The Developmental Participation Skills Assessment (DPS) is designed to assist clinicians who work with hospitalized infants in thoughtfully and accurately identifying infant readiness and the capacity for an infant's participation during caregiving interactions as well as offering an opportunity for the caregiver(s) to reflect upon the experience. Non-contingent caregiving impairs an infant's autonomic, motor and state stability which interferes with regulation and negatively impacts neurodevelopment. By providing an organized way to assess readiness for care and capacity to participate in care, the infant may experience less stress and trauma. The DPS is completed by the caregiver following any caregiving interaction. Methods: Following a literature review, the development of the DPS items were extrapolated from well-established tools to achieve the most evidence-based criteria. Following item inclusion generation, the DPS went thru five phases of content validation: (a) Initial tool development and use by five NICU professionals as part of their developmental assessment. Expansion of the use of the DPS to include three more hospital NICUs within the health system (b) Item adjustment and use as part of a bedside training program at a Level IV NICU (c) Focus group of professionals using the DPS provided feedback and scoring was added (d) Pilot of DPS by multidisciplinary focus group in a Level IV NICU (e) Feedback form sent to 20 NICU experts and content of DPS finalized with reflective portion added. Main Outcome Variable: The establishment of an observational instrument, the Developmental Participation Skills Assessment, provides a means for identifying infant readiness, assessing the quality of infant participation, and prompting clinician reflective processing. Results: A total of 50 professionals across the Midwest (4 OT, 2 PT, 3 SLP, 41 nurses) utilized the DPS as a part of standard practice throughout the phases of development. Assessments were completed on both full-term and preterm hospitalized infants. Professionals within these phases utilized the DPS with infants within a wide range of adjusted gestational ages from 23 weeks to 60 weeks (20 weeks post term). Infants ranged in severity from breathing room air to being intubated on a ventilator. After all phases of development and expert panel feedback, with an additional 20 neonatal experts, the final result was the formation of an easy-to-use observational tool for assessing infant readiness prior to caregiving, participation during caregiving, and stability following caregiving. In addition, there is the opportunity for the clinician to reflect following the caregiving interaction in a concise, consistent way. Conclusion: Identifying readiness, and assessing the quality of the infant's experience while also prompting clinician reflection following the experience has the potential to reduce toxic stress for the baby and promote mindfulness and contingency in caregiving.

Development of Sensory Processing in Premature Infants and Implications for Evidence-Based Music Therapy in the NICU.

The purpose of this article is to provide an overview of the development of sensory processing in premature infants with implications for music therapists providing evidence-based care in a NICU. An overview of sensory processing and sensory processing disorders in premature infants is included, with specific emphasis on development of sensory systems of premature infants. Implications for developmentally appropriate music as therapy for premature infants are identified. Evidence-based NICU-MT can be combined with nursing care to reduce the risks of sensory processing disorder for the developing premature infant.

Fluid and Electrolyte Management in the Neonate: Potassium and Phosphorus.

Maintenance of electrolyte balance in the neonate is challenging in the context of illness or prematurity. Imbalances in potassium and phosphorus can occur in neonates, ranging from benign and clinically insignificant to those that can be life-threatening. An individualized approach to fluid and electrolyte management is based on the neonate's gestational age, day of life, maintenance needs, deficits, and ongoing losses. This article reviews normal and abnormal potassium and phosphorus values along with management strategies. Using a case scenario, the reader can apply concepts outlined in this article to management of critically ill neonates with electrolyte disturbances.