The Importance of Rhythmic Stimulation for Preterm Infants in the NICU

The fetal environment provides the fetus with multiple potential sources of rhythmic stimulation that are not present in the NICU. Maternal breathing, heartbeats, walking, dancing, running, speaking, singing, etc., all bathe the fetus in an environment of varied rhythmic stimuli: vestibular, somatosensory, tactile, and auditory. In contrast, the NICU environment does not offer the same proportion of rhythmic stimulation. After analyzing the lack of rhythmic stimulation in the NICU, this review highlights the different proposals for vestibular and/or auditory rhythmic stimulation offered to preterm infants alone and with their parents. The focus is on the beneficial effects of auditory and vestibular stimulation involving both partners of the mother–infant dyad. A preliminary study on the influence of a skin-to-skin lullaby on the stability of maternal behavior and on the tonic emotional manifestations of the preterm infant is presented as an example. The review concludes with the importance of introducing rhythmic stimulations in the NICU.

Download Full-text

Kangaroo Baby Care: Just a Nice Experience or an Important Advance for Preterm Infants?

PEDIATRICS ◽

10.1542/peds.85.4.604 ◽

1990 ◽

Vol 85 (4) ◽

pp. 604-605

Author(s):

ANDREW WHITELAW

Keyword(s):

Intensive Care ◽

Home Care ◽

Preterm Infant ◽

Preterm Infants ◽

Premature Infants ◽

Neonatal Intensive Care ◽

Developed Countries ◽

Important Advance ◽

Skin Contact ◽

Skin To Skin

"Kangaroo baby care" or "skin-to-skin contact" describes the practice of holding a preterm infant naked (except for a diaper) between the mother's breasts. The baby's face pokes out of the top of the mother's dress like a baby kangaroo's. Rey and Martinez in Bogota, Colombia1 pioneered the home care of premature infants as small as 1000 g, the mother being taught to hold her baby head-up kangaroo-style to encourage lactation, prevent aspiration, and reduce rejection. Education and motivation of the mother in the care of preterm infants makes obvious sense in the developing world, but kangaroo baby care has also been applied in many developed countries in conjunction with neonatal intensive care rather than as a replacement for incubators and monitors.2-4

Download Full-text

Short-Term Ultramicronized Palmitoylethanolamide Therapy in Patients with Myasthenia Gravis: a Pilot Study to Possible Future Implications of Treatment

CNS & Neurological Disorders - Drug Targets ◽

10.2174/1871527318666190131121827 ◽

2019 ◽

Vol 18 (3) ◽

pp. 232-238 ◽

Cited By ~ 5

Author(s):

Emanuela Onesti ◽

Vittorio Frasca ◽

Marco Ceccanti ◽

Giorgio Tartaglia ◽

Maria Cristina Gori ◽

...

Keyword(s):

Pilot Study ◽

Myasthenia Gravis ◽

Repetitive Nerve Stimulation ◽

Beneficial Effects ◽

Antibody Titers ◽

The Stability ◽

Ultramicronized Palmitoylethanolamide ◽

Open Pilot

Background: The cannabinoid system may be involved in the humoral mechanisms at the neuromuscular junction. Ultramicronized-palmitoylethanolamide (μm-PEA) has recently been shown to reduce the desensitization of Acetylcholine (ACh)-evoked currents in denervated patients modifying the stability of ACh receptor (AChR) function. <p> Objective: To analyze the possible beneficial effects of μm-PEA in patients with myasthenia gravis (MG) on muscular fatigue and neurophysiological changes. <p> Method: The duration of this open pilot study, which included an intra-individual control, was three weeks. Each patient was assigned to a 1-week treatment period with μm-PEA 600 mg twice a day. A neurophysiological examination based on repetitive nerve stimulation (RNS) of the masseteric and the axillary nerves was performed, and the quantitative MG (QMG) score was calculated in 22 MG patients every week in a three-week follow-up period. AChR antibody titer was investigated to analyze a possible immunomodulatory effect of PEA in MG patients. <p> Results: PEA had a significant effect on the QMG score (p=0.03418) and on RNS of the masseteric nerve (p=0.01763), thus indicating that PEA reduces the level of disability and decremental muscle response. Antibody titers did not change significantly after treatment. <p> Conclusion: According to our observations, μm-PEA as an add-on therapy could improve muscular response to fatigue in MG. The possible modulation of AChR currents as a means of eliciting a direct effect from PEA on the conformation of ACh receptors should be investigated. The co-role of cytokines also warrants an analysis. Given the rapidity and reversibility of the response, we suppose that PEA acts directly on AChR, though further studies are needed to confirm this hypothesis.

Download Full-text

Necrotizing enterocolitis and the microbiome: Current status and future directions

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa604 ◽

2020 ◽

Author(s):

Robert Thänert ◽

Eric C Keen ◽

Gautam Dantas ◽

Barbara B Warner ◽

Phillip I Tarr

Keyword(s):

Risk Factors ◽

Preterm Infant ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Clinical Characteristics ◽

Gastrointestinal Disorder ◽

Current Status ◽

Future Directions ◽

Barrier Integrity ◽

Microbial Dysbiosis

Abstract Decades of research have failed to define the pathophysiology of necrotizing enterocolitis (NEC), a devastating pediatric gastrointestinal disorder of preterm infants. However, recent evidence suggests that host-microbiota interactions, in which microbial dysbiosis is followed by loss of barrier integrity, inflammation, and necrosis, are central to NEC development. Thus, greater knowledge of the preterm infant microbiome could accelerate attempts to diagnose, treat, and prevent NEC. Here, we summarize clinical characteristics of and risk factors for NEC, the structure of the pre-event NEC microbiome, how this community interfaces with host immunology, and microbiome-based approaches that might prevent or lessen the severity of NEC in this very vulnerable population.

Download Full-text

Sensory Stimulation in the NICU Environment: Devices, Systems, and Procedures to Protect and Stimulate Premature Babies

Children ◽

10.3390/children8050334 ◽

2021 ◽

Vol 8 (5) ◽

pp. 334

Author(s):

Francesco Massimo Vitale ◽

Gaetano Chirico ◽

Carmen Lentini

Keyword(s):

Music Therapy ◽

Preterm Infants ◽

Noise Pollution ◽

Sensory Stimulation ◽

Normative Values ◽

Control Groups ◽

Beneficial Effects ◽

Stressful Environment ◽

Premature Babies ◽

Systematic Control

Prematurity deprives infants of the prenatal sensory stimulation essential to their correct development; in addition, the stressful environment of the NICU impacts negatively on their growth. The purpose of this review was to investigate the effects of NICU noise pollution on preterm infants and parents. We focused on the systems and projects used to control and modulate sounds, as well as on those special devices and innovative systems used to deliver maternal sounds and vibrations to this population. The results showed beneficial effects on the preterm infants in different areas such as physiological, autonomic, and neurobehavioral development. Although most of these studies highlight positive reactions, there is also a general acknowledgement of the current limits: small and heterogeneous groups, lack of structured variable measurements, systematic control groups, longitudinal studies, and normative values. The mother’s presence is always preferred, but the use of music therapy and the devices analyzed, although not able to replace her presence, aim to soften her absence through familiar and protective stimuli, which is a very powerful aid during the COVID-19 pandemic.

Download Full-text

Effects of skin-to-skin care on electrical activity of the diaphragm in preterm infants during Neurally adjusted Ventilatory assist

Early Human Development ◽

10.1016/j.earlhumdev.2021.105379 ◽

2021 ◽

pp. 105379

Author(s):

Yuta Kato ◽

Ayumi Takemoto ◽

Chiyo Oumi ◽

Tomomi Hisaichi ◽

Yuki Shimaji ◽

...

Keyword(s):

Electrical Activity ◽

Preterm Infants ◽

Skin Care ◽

Neurally Adjusted Ventilatory Assist ◽

Ventilatory Assist ◽

Skin To Skin

Download Full-text

Transcutaneous Oxygen Tension During Nonnutritive Sucking in Preterm Infants

PEDIATRICS ◽

10.1542/peds.74.4.539 ◽

1984 ◽

Vol 74 (4) ◽

pp. 539-542

Author(s):

Roberto Paludetto ◽

Steven S. Robertson ◽

Maureen Hack ◽

Chandra R. Shivpuri ◽

Richard J. Martin

Keyword(s):

Heart Rate ◽

Respiratory Rate ◽

Preterm Infants ◽

Oxygen Tension ◽

Sleep State ◽

Transcutaneous Oxygen Tension ◽

Transcutaneous Oxygen ◽

Beneficial Effects ◽

Nonnutritive Sucking ◽

Postconceptional Age

The effects of nonnutritive sucking on transcutaneous oxygen tension, heart rate, and respiratory rate were studied sequentially in 14 sleeping preterm infants breathing room air. Transcutaneous oxygen tension increased during nonnutritive sucking in infants between 32 and 35 weeks postconceptional age, but not in those between 36 and 39 weeks. This response was not associated with a change in respiratory rate or sleep state, although heart rate tended to increase. These data offer further support for the beneficial effects of nonnutritive sucking in preterm infants.

Download Full-text

Kernicterus in Preterm Infants; Lest We Forget (To Turn on the Lights)

PEDIATRICS ◽

10.1542/peds.90.5.757 ◽

1992 ◽

Vol 90 (5) ◽

pp. 757-759

Author(s):

N. KEVIN IVES

Keyword(s):

Intensive Care ◽

Preterm Infant ◽

Preterm Infants ◽

Neonatal Jaundice ◽

Current Issue ◽

Historical Review ◽

Term Infants ◽

Turn On ◽

Treatment Thresholds ◽

One Act

Watchko and Oski have a reputation for stimulating debate on the topic of neonatal jaundice. As scriptwriters of "Vigintiphobia: a one-act play,"1 they questioned the `standard practice' applied to the management of jaundice in otherwise healthy term infants. In the current issue of Pediatrics2 they again court controversy by turning their attention to treatment thresholds and the risk of kernicterus in jaundiced preterm infants. We are provided with a thoroughly researched historical review of the risk of kernicterus in the preterm infant from 1950 to the 1990s. The story is presented as a journey of experience from the pre-intensive care era, through the so-called `low bilirubin kernicterus era' (1965 through 1982), to the present.

Download Full-text

Association between early onset of skin-to-skin contact and mother-infant interaction at hospital discharge and six months of corrected age among preterm infants

Early Human Development ◽

10.1016/j.earlhumdev.2021.105525 ◽

2021 ◽

pp. 105525

Author(s):

Cynthia Ribeiro do Nascimento Nunes ◽

Nathalia Freitas de Faria ◽

Juliana Rodrigues Peixoto Arruda ◽

Marcelle D'Ávila Diniz Bartholomeu ◽

Gislene Cristina Valadares ◽

...

Keyword(s):

Hospital Discharge ◽

Preterm Infants ◽

Early Onset ◽

Skin Contact ◽

Skin To Skin

Download Full-text

Stabilizing immature breathing patterns of preterm infants using stochastic mechanosensory stimulation

Journal of Applied Physiology ◽

10.1152/japplphysiol.00058.2009 ◽

2009 ◽

Vol 107 (4) ◽

pp. 1017-1027 ◽

Cited By ~ 52

Author(s):

Elisabeth Bloch-Salisbury ◽

Premananda Indic ◽

Frank Bednarek ◽

David Paydarfar

Keyword(s):

Preterm Infants ◽

Respiratory Control ◽

Behavioral State ◽

Mean Square ◽

Breathing Patterns ◽

Nonlinear Properties ◽

Improved Stability ◽

Postconceptional Age ◽

The Stability ◽

Large Improvement

Breathing patterns in preterm infants consist of highly variable interbreath intervals (IBIs) that might originate from nonlinear properties of the respiratory oscillator and its input-output responses to peripheral and central signals. Here, we explore a property of nonlinear control, the potential for large improvement in the stability of breathing using low-level exogenous stochastic stimulation. Stimulation was administered to 10 preterm infants (postconceptional age: mean 33.3 wk, SD 1.7) using a mattress with embedded actuators that delivered small stochastic displacements (0.021 mm root mean square, 0.090 mm maximum, 30–60 Hz); this stimulus was subthreshold for causing arousal from sleep to wakefulness or other detectable changes in the behavioral state evaluated with polysomnography. We used a test-retest protocol with multiple 10-min intervals of stimulation, each paired with 10-min intervals of no stimulation. Stimulation induced an ∼50% reduction ( P = 0.003) in the variance of IBIs and an ∼50% reduction ( P = 0.002) in the incidence of IBIs > 5 s. The improved stability of eupneic breathing was associated with an ∼65% reduction ( P = 0.04) in the duration of O2 desaturation. Our findings suggest that nonlinear properties of the immature respiratory control system can be harnessed using afferent stimuli to stabilize eupneic breathing, thereby potentially reducing the incidence of apnea and hypoxia.

Download Full-text