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OBJECTIVE: This study was conducted to quantify physiologic and behavioral responses to multisensory intervention in the NICU, to determine its safety for use with infants diagnosed with PVL (periventricular leukomalacia), and to determine the potential effects on neurobehavioral function during hospitalization and on neurodevelopmental responses at four months corrected age. DESIGN: Not given. SETTING: The Special Care Nursery of a level III hospital in a large Midwestern city. POPULATION: Medically stable and feeding infants with a gestational age of 24-33 weeks at birth. Infants had documented PVL and absence of chromosomal disorders. Infants were randomly assigned to a control or experimental group. INTERVENTIONS: In addition to routine care, infants assigned to the experimental group (Group E) received 15 minutes of multisensory (ATVV) stimuli: auditory stimuli via female human voice; tactile stimuli of light stroking; visual stimuli, eye-to-eye contact; and vestibular, or rocking stimuli. Each infant in Group E received ATVV twice per day, 5 days per week, for four weeks, or until discharge. A research assistant recorded physiologic measures such as heart rate, respiratory rate, pulse oximetry, muscle tone, infant color. Seven categories of infant behavioral state (BS) were judged over each 46-min intervention period: quiet sleep, active sleep, drowsiness, quiet alert, active alert, crying and indeterminate. Short-term behavioral responses were measured with the Brazelton Neonatal Behavioral Assessment (BNBAS). Infant developmental status at four months corrected age was evaluated with the Bayley Scales of Infant Development. MAIN OUTCOME MEASURE(S): There were no linear or quadratic differences in the distribution of behavioral states between the two groups. Repeated measures ANOVA tests revealed significant linear responses in Group E for respiratory and SaO2 and a significant quadratic response for heart rate. Infants assigned to Group E experienced an average of a nine-day-shorter length of hospitalization from the onset of study to discharge when compared with Group C. There was no significant difference between the groups' weight on day one, nor were significant differences identified between the two groups over the course of the study. The results of the Bayley assessments showed no significant differences between groups at four months of age, corrected for prematurity. RESULTS/CONCLUSIONS: The multi-modal nature of the intervention protocol may be a crucial factor with regard to safety, as published research has revealed that tactile stimulation alone, for example, is more likely to produce high heart rates above 200 bpm. Group E's earlier discharge cannot be explained by weight gain patterns or neurobehavioral function measured prior to hospital discharge. However, tests of neurodevelopmental function at four months corrected age failed to reveal differences between the two groups. The small sample size may have limited the ability to detect differences in the groups prior to intervention. Research to develop our understanding of the underlying mechanisms of infant response to the ATVV intervention should measure the development of autonomic homeostatic regulation, specifically with respect to emerging sympathetic response and related regulation of state and feeding ability. [CINAHL abstract] [ABSTRACT FROM AUTHOR] |
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