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

项目摘要 该项目的长期目标是改善早产儿及其父母的健康和福祉。 早产儿出生时需要在新生儿重症监护病房(NICU)进行医疗护理，并可能 在他们生命的头几个月里，他们暴露在重复的、痛苦的刺激中，他们是 与父母分离，通常不会获得类似于 如果不是早产，他们会得到什么。此外，父母往往不知道何时以及如何 与他们在NICU的婴儿接触。然而，早期积极的感官体验很重要，因为它们 在重要时期促进大脑发育，可作为帮助家长的工具 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进行积极的多感官干预，但这些干预措施 经常以不一致的方式应用，减少了他们的好处。通过严谨和科学的过程，我们 制定了一项结构化的多感官干预计划，名为支持和加强NICU 感官体验(SENSE)，包括基于证据的特定剂量和有针对性的时机 干预措施，如按摩、听觉暴露、摇摆、握住和皮肤对皮肤护理。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 行为线索。多感官干预被设计为在NICU的每一天进行 由父母住院，他们接受教育并得到支持，以提供这些服务。一支感官支持团队 在父母无法达到每天感官暴露的目标量的空隙中。建议数 这项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、脑活动(幅度积分脑电)和婴儿发育结果 通过2岁，特别注意语言的结果。215对亲子情侣 早产儿出生≤孕32周，并被纳入第四级新生儿重症监护室将在1周内登记 出生。婴儿将被随机分配到SENSE多感官计划或接受标准护理 NICU留了下来。Sense计划将结构化的、易于操作的多感官干预与 家长参与，在NICU复杂的医疗环境中优化结果。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 在NICU出院前、6个月、1年和2年，根据早产儿进行了调整。两者之间的差异 将对团体进行调查。NICU住院期间的脑活动，包括在有和没有不同的情况下 感官暴露，也将进行调查。预期的结果是感觉多感官程序 将对改善结果产生积极影响。重要的是，SENSE计划已经实施 在美国和海外的250家医院中，这种做法很容易，因此有很大的潜力产生广泛和长期的影响。

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.