Multisensory interventions to improve neurodevelopmental outcomes of preterm infants hospitalized in the neonatal intensive care unit

多感官干预可改善新生儿重症监护病房住院早产儿的神经发育结局

• 批准号: 10570879
• 负责人: Amit Mohan Mathur
• 金额: $ 66.72万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10570879
• 关键词: 2 year old; Address; Admission activity; Age; Attention; Auditory; Behavioral; Biological Markers; Birth; Brain; Caring; Cerebrum; Complex; Cues; Development; Dose; Electroencephalography; Emotional; Enrollment; Environment; Environmental Exposure; Evidence based intervention; Exposure to; Family; Future; Goals; Health; Hospitalization; Hospitals; Hour; Human; Infant; Intervention; Knowledge; Language; Life; Masks; Massage; Measures; Medical; Mental Health; Monitor; Music; Neonatal Intensive Care Units; Newborn Infant; Outcome; Pain; Parent-Child Relations; Parents; Pathway interactions; Pattern; Personal Satisfaction; Predisposition; Pregnancy; Premature Infant; Process; Public Health; Publishing; Randomized; Reporting; Research; Risk; Sampling; Sensory; Sensory Thresholds; Skin; Skin Care; Specific qualifier value; Standardization; Stimulus; Structure; Tactile; Testing; Time; Toddler; Touch sensation; Veins; Work; early experience; evidence base; experience; extreme prematurity; high risk infant; improved; improved outcome; infant outcome; intervention program; language outcome; multisensory; neonatal brain; neurodevelopment; premature; primary outcome; procedural pain; programs; sensory mechanism; sensory stimulus; social; standard of care; therapy design; tool; treatment as usual; volunteer

Project Summary The long-term goal of this project is to improve the health and well-being of preterm infants and their parents. Very preterm infants necessitate medical care in the neonatal intensive care unit (NICU) at birth and can be hospitalized for their first several months of life, where they are exposed to repetitive, painful stimuli, are separated from their parents, and often do not receive positive, timed sensory exposures that are similar to what they would have received if not born early. In addition, parents often do not know when and how to engage with their infant in the NICU. However, early positive sensory experiences are important, as they enhance brain development during an important period of time and can be used as a tool to help parents participate during NICU hospitalization and establish early parent-child relationships to optimize development. Although there is evidence to support positive multisensory interventions in the NICU, these interventions are often applied in an inconsistent manner, reducing their benefit. Through a rigorous and scientific process, we have developed a structured multisensory intervention program, titled Supporting and Enhancing NICU Sensory Experiences (SENSE), which includes specific doses and targeted timing of evidence-based interventions such as massage, auditory exposure, rocking, holding, and skin-to-skin care. The interventions are based on the infant’s developmental stage and are adapted based on the infant’s medical status and behavioral cues. The multisensory interventions are designed to be conducted during each day of NICU hospitalization by the parents, who are educated and supported to provide them. A sensory support team fills in gaps when parents are unable to reach the targeted amount of sensory exposures each day. The proposed work aims to determine the effect of multisensory interventions on parent mental health, parent-child interaction, brain activity (amplitude integrated electroencephalography), and infant developmental outcomes through age 2 years, with specific attention to language outcome. Two-hundred fifteen parent-infant dyads of preterm infants born ≤ 32 weeks gestation and admitted to a Level IV NICU will be enrolled within 1 week of birth. Infants will be randomized to either the SENSE multisensory program or to the standard of care during the NICU stay. The SENSE program combines structured, easy-to-conduct, multisensory interventions with parent engagement to optimize outcomes in the complex medical environment of the NICU. Standardized assessments of parent mental health, infant neurodevelopment, and parent-child interaction will be conducted prior to NICU discharge and at 6 months, 1 year, and 2 years, adjusted for prematurity. Differences between groups will be investigated. Brain activity during NICU stay, including in the presence and absence of different sensory exposures, will also be investigated. The expected outcome is that the SENSE multisensory program will have a positive effect on improving outcomes. Importantly, the SENSE program has been implemented with ease in >250 hospitals in the US and abroad, so there is great potential for broad and long-term impact.

项目概要 该项目的长期目标是改善早产儿及其父母的健康和福祉。 极早产儿出生时需要在新生儿重症监护病房 (NICU) 接受医疗护理，并且可以 在出生后的最初几个月住院，他们会受到重复的、痛苦的刺激， 与父母分离，并且常常得不到与父母类似的积极、定时的感官暴露 如果他们不早出生的话他们会得到什么。此外，父母常常不知道何时以及如何 与新生儿重症监护病房 (NICU) 中的婴儿互动。然而，早期积极的感官体验很重要，因为它们 在重要时期增强大脑发育，可作为帮助父母的工具 在 NICU 住院期间参与并建立早期亲子关系以优化发展。 尽管有证据支持在 NICU 中采取积极的多感官干预措施，但这些干预措施 通常以不一致的方式应用，从而降低了其效益。通过严格、科学的流程，我们 开发了一个结构化的多感官干预计划，名为“支持和增强 NICU” 感官体验 (SENSE)，包括基于证据的具体剂量和目标时间 干预措施包括按摩、听觉暴露、摇晃、抱持和肌肤接触护理。干预措施 以婴儿的发育阶段为基础，并根据婴儿的医疗状况和情况进行调整 行为线索。多感官干预旨在在 NICU 的每一天进行 父母住院治疗，并接受教育和支持。感官支持团队填补 当父母无法达到每天的感官接触目标量时。拟议的 工作旨在确定多感官干预对父母心理健康、亲子关系的影响 相互作用、大脑活动（幅度积分脑电图）和婴儿发育结果 到 2 岁，特别关注语言成果。两百一十五对父母与婴儿 妊娠 ≤ 32 周出生并入住 IV 级 NICU 的早产儿将在出生后 1 周内入组 出生。婴儿将被随机分配到 SENSE 多感官计划或标准护理组 NICU 住院。 SENSE 计划将结构化、易于实施的多感官干预措施与 家长参与以优化 NICU 复杂医疗环境中的结果。标准化 将对父母心理健康、婴儿神经发育和亲子互动进行评估 NICU 出院前以及 6 个月、1 年和 2 年时（针对早产进行调整）。之间的差异 团体将受到调查。 NICU 住院期间的大脑活动，包括存在和不存在不同的情况 感官暴露也将受到调查。预期结果是 SENSE 多感官程序 将对改善结果产生积极影响。重要的是，SENSE计划已经实施 可以在美国和国外超过 250 家医院轻松使用，因此具有广泛和长期影响的巨大潜力。