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Developmental patterns of physiological response to a multisensory intervention in extremely premature and high-risk
Rosemary C White-Traut1, Michael N Nelson, Jean M Silvestri
1University of Illinois at Chicago, College of Nursing, Department of Maternal-Child Nursing, 60612, USA.
Insights
Premature infants with central nervous system (CNS) injury, specifically periventricular leukomalacia (PVL), may have altered autonomic nervous system development. Multisensory interventions did not normalize heart rate (HR) patterns in these infants.
Area of Science:
- Neonatal physiology
- Developmental neuroscience
- Clinical pediatrics
Background:
- Premature infants are at risk for central nervous system (CNS) injury, impacting physiological development.
- Autonomic nervous system (ANS) regulation, reflected in heart rate (HR), respiratory rate (RR), and oxygen saturation (SaO2), is crucial for premature infant well-being.
- Periventricular leukomalacia (PVL) is a common CNS injury in preterm infants, potentially affecting ANS maturation.
Purpose of the Study:
- To compare developmental patterns of HR, RR, and SaO2 in premature infants with and without CNS injury.
- To evaluate the impact of an auditory, tactile, visual, and vestibular (ATVV) multisensory intervention on these physiological parameters.
- To assess if CNS injury, specifically PVL, influences the response to multisensory interventions.
Main Methods:
- A cohort of 37 premature infants (23-32 weeks gestational age) with and without CNS injury (PVL and/or intraventricular hemorrhage) were studied.
- Infants were randomized into control and experimental groups, with the latter receiving twice-daily ATVV intervention from 33 weeks postconceptional age (PCA).
- Continuous monitoring of HR, RR, and SaO2 was performed during baseline, intervention, and postintervention periods between 33-35 weeks PCA.
Main Results:
- Between 33-35 weeks PCA, control infants and non-CNS injured experimental infants showed a significant decrease in resting mean HR; RR and SaO2 remained stable.
- Premature infants with PVL who received the ATVV intervention exhibited increased HR, even at rest, contrasting with the typical decline.
- The study observed differing physiological responses to the intervention based on the presence and type of CNS injury.
Conclusions:
- The lack of a typical weekly HR decline in PVL infants receiving the intervention suggests impaired autonomic nervous system maturation.
- PVL may increase the risk of concerning decelerative HR changes and associated clinical compromise in premature infants.
- Close monitoring of infants with PVL during potentially stressful procedures is recommended, and further research is needed to tailor multisensory interventions for this population.
Objective:
To compare the developmental patterns of heart rate (HR), respiratory rate (RR), and hemoglobin oxygen saturation (SaO2) of premature infants with and without central nervous system (CNS) injury, and evaluate whether a multisensory intervention altered this development.
Sample:
Thirty-seven premature infants born at 23-26 weeks with normal head ultrasounds or at 24-32 weeks and diagnosed with periventricular leukomalacia (PVL) and/or intraventricular hemorrhage (IVH) were studied at 33-35 weeks postconceptional age.
Design:
Infants were randomly assigned to control and experimental groups. The experimental group infants received auditory, tactile, visual, and vestibular (ATVV) multisensory intervention twice daily from 33 weeks postconceptional age (PCA) until hospital discharge.
Main Outcome Measures:
HR, RR, and SaO2 were continuously monitored during baseline, intervention, and the 30-minute postintervention period.
Results:
Between 33 and 35 weeks PCA, control group infants with and without CNS injury and experimental group infants without CNS injury had a significant decrease in resting mean HR, whereas RR and SaO2 remained stable. The infants with PVL who received the intervention showed increases in HR even at rest.
Conclusions:
The absence of a weekly decline in HR for experimental group infants with PVL suggests that PVL may affect maturation of the autonomic nervous system and increase risk of decelerative HR changes and associated clinical compromise. Infants diagnosed with PVL should be closely monitored during procedures or interventions that may be stressful or involve handling. Further research is needed to tailor multisensory interventions for infants with PVL.
