Abstract
Objective
Evaluate the effect of a manualized multisensory program, applied across NICU hospitalization, on infant and parent outcomes.
Study design
Seventy parent-infant dyads (born ≤32 weeks gestation) in a Level IV NICU were randomized at birth to the multisensory program or standard-of-care. Parents in the multisensory group administered prespecified amounts of age-appropriate, evidence-based sensory interventions to their infants each day during NICU hospitalization according to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program.
Results
Infants who received the SENSE program had more lethargy on the NICU Network Neurobehavioral Scale (NNNS) (p = 0.05), even after controlling for medical and social risk (p = 0.043), and had higher Communication scores on the Ages and Stages Questionnaire (p = 0.04) at 1-year corrected age, but this relationship failed to reach significance after controlling for medical and social risk (p = 0.12).
Conclusion
The SENSE program shows promise for improving outcomes, but more research with larger sample sizes is needed.
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References
Graven SN, Bowen FW Jr., Brooten D, Eaton A, Graven MN, Hack M, et al. The high-risk infant environment. Part 1. The role of the neonatal intensive care unit in the outcome of high-risk infants. J Perinatol. 1992;12:164–72.
Lickliter R. The integrated development of sensory organization. Clin Perinatol. 2011;38:591–603.
Field T. Alleviating stress in newborn infants in the intensive care unit. Clin Perinatol. 1990;17:1–9.
Pineda R, Durant P, Mathur A, Inder T, Wallendorf M, Schlaggar BL. Auditory exposure in the neonatal intensive care unit: room type and other predictors. J Pediatr. 2017;183:56–66 e3.
Pineda RG, Neil J, Dierker D, Smyser CD, Wallendorf M, Kidokoro H, et al. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. J Pediatr. 2014;164:52–60.e2.
Lickliter R. The role of sensory stimulation in perinatal development: Insights from comparative research for care of the high-risk infant. J Dev Behav Pediatr. 2000;21:437–47.
Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J Perinatol. 2016;37:323–32.
Smyser TA, Smyser CD, Rogers CE, Gillespie SK, Inder TE, Neil JJ. Cortical gray and adjacent white matter demonstrate synchronous maturation in very preterm infants. Cereb Cortex. 2016;26:3370–8.
Pineda RG, Tjoeng TH, Vavasseur C, Kidokoro H, Neil JJ, Inder T. Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit. J Pediatrics. 2013;162:470–6.e1.
Fu M, Zuo Y. Experience-dependent structural plasticity in the cortex. Trends Neurosci. 2011;34:177–87.
Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev. 2018;117:32–8.
Pineda R, Roussin J, Heiny E, Smith J. Health care professionals’ perceptions about sensory-based Interventions in the NICU. Am J Perinatol. 2019;36:1229–36.
Graven S, Browne J. Sensory development in the fetus, neonate, and infant: Introduction and overview. Newborn Infant Nurs Rev. 2008;8:169–72.
Pineda R, Raney M, Smith J. Supporting and Enhancing NICU Sensory Experiences (SENSE) Program. 2018. https://chan.usc.edu/research/clinical-tools/sense.
Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J Perinatol. 2017;37:323–32.
Pineda R, Raney M, Smith J. Supporting and enhancing NICU sensory experiences (SENSE): defining developmentally-appropriate sensory exposures for high-risk infants. Early Hum Dev. 2019;133:29–35.
Pineda R, Roussin J, Kwon J, Heiny E, Colditz G, Smith J. Applying the RE-AIM framework to evaluate the implementation of the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. BMC Pediatr. 2021;21:137.
Pineda R, Wallendorf M, Smith J. A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant. Early Hum Dev. 2020;144:105000.
Lester BM, Tronick E. NICU Network Neurobehavioral Scale (NNNS) Manual. Baltimore: Paul H. Brookes Pub. Co.; 2004.
Squires J, Twombly MS, Bricker D, Potter L .ASQ-3 User’s Guide: technical report. Baltimore: Brookes Publishing; 2009.
Pineda RG, Stransky KE, Rogers C, Duncan MH, Smith GC, Neil J, et al. The single-patient room in the NICU: maternal and family effects. J Perinatol. 2012;32:545–51.
Skene C, Franck L, Curtis P, Gerrish K. Parental involvement in neonatal comfort care. J Obstet Gynecol Neonatal Nurs. 2012;41:786–97.
Treyvaud K, Anderson VA, Howard K, Bear M, Hunt RW, Doyle LW, et al. Parenting behavior is associated with the early neurobehavioral development of very preterm children. Pediatrics. 2009;123:555–61.
Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity In public health clinical trials. J Public Health Dent. 2011;71:S52–S63.
Tronick E, Lester BM. Grandchild of the NBAS: the NICU network neurobehavioral scale (NNNS): a review of the research using the NNNS. J Child Adolesc Psychiatr Nurs. 2013;26:193–203.
Noble Y, Boyd R. Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review. Dev Med Child Neurol. 2012;54:129–39.
Dunn W. Infant/Toddler Sensory Profile 2. San Antonio: Pearson Education, Inc; 2014.
Speilberger C. State-Trait Anxiety Inventory for Adults. Menlo Park, CA: Mind Garden; 2005–2008.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.
Abidin RR. Parenting Stress Index Professional Manual. 3 ed. Odessa, FL: Psychological Assessment Resources, Inc.; 1995.
DeMier RL, Hynan MT, Harris HB, Manniello RL. Perinatal stressors as predictors of symptoms of posttraumatic stress in mothers of infants at high risk. J Perinatol. 1996;16:276–80.
Miles MS, Funk SG, Carlson J. Parental Stressor Scale: neonatal intensive care unit. Nurs Res. 1993;42:148–52.
Parker SJ, Zahr LK, Cole JG, Brecht ML. Outcome after developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status. J Pediatrics. 1992;120:780–5.
Bates JE, Freeland CA, Lounsbury ML. Measurement of infant difficultness. Child Dev. 1979;50:794–803.
Squires J, Twombly E, Bricker D, Potter L. Ages and Stages Questionnaires - 3. Baltimore, MD: Paul H. Brookes Publishing Co.; 2009.
Pineda RG, Tjoeng TH, Vavasseur C, Kidokoro H, Neil JJ, Inder T. Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit. J Pediatr. 2013;162:470–6 e1.
Volpe J, Inder T, Darras B, de Vries LS, du Plessis A, Neil J, et al. Volpe’s Neurology of the Newborn. Philadelpha, PA: Elsevier; 2018.
McGrath JM, Cone S, Samra HA. Neuroprotection in the preterm infant: further understanding of the short- and long-term implications for brain development. Newborn Infant Nurs Rev. 2011;11:109–12.
Filippa M, Lordier L, De Almeida JS, Monaci MG, Adam-Darque A, Grandjean D, et al. Early vocal contact and music in the NICU: new insights into preventive interventions. Pediatr Res. 2020;87:249–64.
Burnett AC, Cheong JLY, Doyle LW. Biological and Social Influences on the Neurodevelopmental Outcomes of Preterm Infants. Clin Perinatol. 2018;45:485–500.
Reynolds LC, Duncan MM, Smith GC, Mathur A, Neil J, Inder T, et al. Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior. J Perinatol. 2013;33:636–41.
de Souza Perrella VV, Marina Carvalho de Moraes B, Sanudo A, Guinsburg R. Neurobehavior of preterm infants from 32 to 48 weeks post-menstrual age. J Perinatol. 2019;39:800–7.
Provenzi L, Olson K, Giusti L, Montirosso R, DeSantis A, Tronick E. NICU Network Neurobehavioral Scale: 1-month normative data and variation from birth to 1 month. Pediatr Res. 2018;83:1104–9.
Scher MS, Ludington-Hoe S, Kaffashi F, Johnson MW, Holditch-Davis D, Loparo KA. Neurophysiologic assessment of brain maturation after an 8-week trial of skin-to-skin contact on preterm infants. Clin Neurophysiol. 2009;120:1812–8.
White-Traut R, Norr KF, Fabiyi C, Rankin KM, Li Z, Liu L. Mother-infant interaction improves with a developmental intervention for mother-preterm infant dyads. Infant Behav Dev. 2013;36:694–706.
Beebe B, Myers MM, Lee SH, Lange A, Ewing J, Rubinchik N, et al. Family nurture intervention for preterm infants facilitates positive mother-infant face-to-face engagement at 4 months. Dev Psychol. 2018;54:2016–31.
Hunter ML, Blake S, Simmons C, Thompson J, Derouin A. Implementing a Parent Education Program in the Special Care Nursery. J Pediatr Health Care. 2019;33:131–7.
O'Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health. 2018;2:245–54.
Acknowledgements
We wish to thank Kristen Connell, Tiffany Le, Christa Thompson, Marinthea Richter, Prutha Saptute, Mary Raney, Elizabeth Heiny Wedell, Anna Bukhstaber, Mary Politi, F. Sessions Cole, Elizabeth Kruvand, Aimee James, Allison King, Lily Hu, Bradley Schlaggar, and Carolyn Baum. We thank all the members of the sensory support team. We also wish to thank all the infants and families who made this research possible.
Funding
Research reported in this publication was supported by the Gordon and Betty Moore Foundation, the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Institute of Health, and the Intellectual and Developmental Disabilities Research Center at Washington University (NIH/National Institute of Child Health and Human Development P30 HD062171).
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RP and JS are authors of the SENSE program. The SENSE program is owned by the Washington University Office of Technology Management and is available to clinicians and researchers ‘at cost’ through exclusive distribution rights at University of Southern California. The authors receive no financial gain from purchases of the SENSE program.
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Pineda, R., Smith, J., Roussin, J. et al. Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU. J Perinatol 41, 2449–2462 (2021). https://doi.org/10.1038/s41372-021-01078-7
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DOI: https://doi.org/10.1038/s41372-021-01078-7
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