Effects of Instruction on Parent Competency During Infant Handling in a Neonatal Intensive Care Unit.

PURPOSE: The primary purpose of this study was to investigate the effectiveness of 3 different methods for delivering instruction on infant handling to parents in the neonatal intensive care unit (NICU). METHODS: Ninety-six parents in the NICU received instruction. Parents were taught the same 3 infant-handling techniques after random assignment to the (1) direct, (2) video, or (3) written-pictorial instructional groups. After baseline competency assessment, parents received instruction according to their group. A masked evaluator assessed parent performance, and parents rated instructional effectiveness. RESULTS: All groups significantly improved handling performance. The direct and video groups performed 2 handling activities significantly better than the written-pictorial group. No significant differences were found between the direct and video groups. All groups perceived the instruction as effective. CONCLUSIONS: Direct and video instructions are equally effective in teaching parents to perform simple whole motor tasks in the NICU, and parents welcome the instruction.

Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants.

OBJECTIVE: To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age. STUDY DESIGN: In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g). RESULTS: ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants. CONCLUSION: NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.

Neonatal brain magnetic resonance imaging before discharge is better than serial cranial ultrasound in predicting cerebral palsy in very low birth weight preterm infants.

OBJECTIVE: To compare the value of serial cranial ultrasound (US) with a single magnetic resonance imaging (MRI) before discharge in very low birth weight preterm infants to predict cerebral palsy (CP). METHODS: Infants who weighed <1250 g at birth and were <30 weeks' gestational age underwent conventional brain MRI at near term (36-40 weeks' postmenstrual age) using 1.5 Tesla MRI scanner. Sagittal and axial T1 and T2 fluid attenuated inversion recovery and gradient recalled echo images were obtained. Cranial US was also obtained at least twice during the first 2 weeks of life. MRI and US images were interpreted by 2 independent radiologists, who were masked to clinical outcome, and scored as follows: category 1, no abnormality; category 2, subependymal hemorrhage or mineralization; category 3, moderate to severe ventriculomegaly; category 4, focal parenchymal abnormality with or without ventriculomegaly. For the purpose of this study, 1 and 2 were categorized as "normal," and 3 and 4 were categorized as "abnormal." The infants were assessed at a mean age of 20 and 31 months using the Amiel-Tison standardized neurodevelopmental examination. RESULTS: The sensitivity and specificity of MRI for predicting CP were 71% and 91% at 20 month and 86% and 89% at 31 months, respectively. The sensitivity and specificity of US for predicting CP were 29% and 86% at 20 months and 43% and 82% at 31 months. CONCLUSIONS: As a predictor of outcome for CP, MRI at near-term in very low birth weight preterm neonates is superior to US. However, both US and MRI demonstrate high specificity.

Preterm neonatal neurological examination.

This chapter covers the purposes for which a neurological examination of a neonate may be performed. A brief description is given, of assessments currently in use. More extensive information is provided on the elements of the Neurobehavioral Assessment of the Preterm Infant (NAPI), an assessment which has been used extensively by this author and others (see references at www-med.stanford.edu/school/pediatrics/NAPI/index). Medical and environmental factors that impact on the neurobehavioral performance of an infant are outlined. Two detailed case studies give insight to the complexity of the initial hospital stay of extremely low birth weight infants of short gestational age. The results of NAPIs for each of these cases are explained and the relation to long term outcome at 18 months is presented.

Infant heart transplantation at Stanford: growth and neurodevelopmental outcome.

OBJECTIVE: To evaluate the growth and neurodevelopmental outcome of 18 surviving Stanford patients who received heart transplantations before their second birthday. METHODS: We compared the growth and neurodevelopmental outcome of these 18 patients with a second group of age-matched comparison patients who underwent other heart surgery requiring cardiopulmonary bypass. RESULTS: Difficulties with growth and development were more common in the transplant group as were neurologic abnormalities. Speech and language delays as well as hearing problems were also more common in the transplant group. CONCLUSION: Multicenter prospective longitudinal neurodevelopmental outcome studies of infant heart transplant patients should be conducted to provide a more efficient basis for evaluating management protocols and assessment of long-term outcomes and of the need for early intervention services.