title: Parents' report of sensory responsiveness and temperament in preterm infants. Infant behavioral assessment and intervention program in very low birth weight infants improves independency in mobility at preschool age. Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm Neonatal intensive care unit stress is associated with brain development in preterm infants Early experience alters brain function and structure. Early Sensitivity Training for Parents of Preterm Infants: Impact on the Developing Brain Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects. Prediction of participation and sensory modulation of late preterm infants at 12 months: a prospective study. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Eight Years Later, Are We Still Hurting Newborn Infants?
abstract: OBJECTIVES Although most infants born prematurely do not have major developmental problems , those with perinatal medical problems and lengthy stays in the neonatal intensive care unit are at risk for sensory modulation problems and developmental sequelae . This study compared sensory responsiveness in preterm and full-term infants and examined the relationship of sensory responsiveness to temperament and developmental function . METHOD Caregivers of infants with ( n = 45 ) and without ( n = 22 ) prematurity were asked to complete the  Sensory Rating Scale .  The preterm infants were also evaluated with the Bayley Scales of Infant Development , Second Edition ( BSID-II ) . RESULTS The preterm infants exhibited more frequent behaviors indicating tactile defensiveness and difficult temperament than did the full-term infants . When specific items were examined , the preterm infants displayed sensory-seeking behaviors and high activity levels . As measured by caregivers ' report , sensory responsiveness was significantly related to temperament . It was not related to BSID-II Mental and Psychomotor scale scores . CONCLUSION This study supports the findings of others that preterm infants have mild problems in sensory responsiveness and temperament . Correlational results do not support a definitive relationship between parents ' reports of their infants ' sensory responsiveness and developmental function OBJECTIVE To evaluate the effects of the Infant Behavioral Assessment and Intervention Program ( © ) ( IBAIP ) in very low birth weight infants on sensory processing and daily activities at preschool age . STUDY DESIGN Follow-up of children included in a r and omized controlled trial . Eighty-six infants were enrolled in post-discharge IBAIP until 6 months corrected age , and 90 infants received st and ard care .  At 3.5 years of age , the  Sensory Profile-Dutch version ( SP-NL ) and Pediatric Evaluation of Disability Inventory-Dutch version ( PEDI-NL ) were administered . For comparison , parents of 41 term-born children also completed the SP-NL . RESULTS Seventy-six children ( 88 % ) in the IBAIP group and 75 children ( 83 % ) children in the control group were examined at 44 months corrected age . After adjustment for pre-r and omization differences in perinatal characteristics , the IBAIP group outperformed the control group significantly on SP-NL domains of oral sensory processing and sensory processing related to endurance/tone and PEDI-NL domains of mobility . The control group only scored significantly lower than the term group on the SP-NL domain endurance/tone . The very low birth weight groups performed significantly below the PEDI-NL 's norm . CONCLUSION In line with the positive developmental effects of the IBAIP until 24 months corrected age , independency in mobility in daily activities was improved at 3.5 years Abstract Alterations in neural activity due to pain and injury in early development may produce long‐term effects on sensory processing and future responses to pain . To investigate persistent alterations in sensory perception , we performed quantitative sensory testing ( QST ) in extremely preterm ( EP ) children ( n = 43 ) recruited from the UK EPICure cohort ( born less than 26 weeks gestation in 1995 ) and in age and sex matched term‐born controls ( TC ; n = 44 ) . EP children had a generalized decreased sensitivity to all thermal modalities , but no difference in mechanical sensitivity at the thenar eminence . EP children who also required neonatal surgery had more marked thermal hypoalgesia , but did not differ from non‐surgical EP children in the measures of neonatal brain injury or current cognitive ability . Adjacent to neonatal thoracotomy scars there was a localized decrease in both thermal and mechanical sensitivity that differed from EP children with scars relating to less invasive procedural interventions or from those without scars . No relationship was found between sensory perception thresholds and current pain experience or pain coping styles in EP or TC children . Neonatal care and surgery in EP children are associated with persistent modality‐specific changes in sensory processing . Decreases in mechanical and thermal sensitivity adjacent to scars may be related to localized tissue injury , whereas generalized decreases in thermal sensitivity but not in mechanical sensitivity suggest central ly mediated alterations in the modulation of C‐fibre nociceptor pathways , which may impact on responses to future pain or surgery Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants , much of the variation in outcome remains unexplained . The impact on brain development of 1 potential factor , exposure to stressors in the neonatal intensive care unit , has not yet been studied in a systematic , prospect i ve manner OBJECTIVE To investigate the effects of early experience on brain function and structure . METHODS A r and omized clinical trial tested the neurodevelopmental effectiveness of the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) .  Thirty preterm infants , 28 to 33 weeks ' gestational age ( GA ) at birth and free of known developmental risk factors , participated in the trial . NIDCAP was initiated within 72 hours of intensive care unit admission and continued to the age of 2 weeks , corrected for prematurity . Control ( 14 ) and experimental ( 16 ) infants were assessed at 2 weeks ' and 9 months ' corrected age on health status , growth , and neurobehavior , and at 2 weeks ' corrected age additionally on electroencephalogram spectral coherence , magnetic resonance diffusion tensor imaging , and measurements of transverse relaxation time . RESULTS The groups were medically and demographically comparable before as well as after the treatment . However , the experimental group showed significantly better neurobehavioral functioning , increased coherence between frontal and a broad spectrum of mainly occipital brain regions , and higher relative anisotropy in left internal capsule , with a trend for right internal capsule and frontal white matter . Transverse relaxation time showed no difference . Behavioral function was improved also at 9 months ' corrected age . The relationship among the 3 neurodevelopmental domains was significant . The results indicated consistently better function and more mature fiber structure for experimental infants compared with their controls . CONCLUSIONS This is the first in vivo evidence of enhanced brain function and structure due to the NIDCAP . The study demonstrates that quality of experience before term may influence brain development significantly After birth , preterm infants face a stressful environment , which may negatively impact early brain development and subsequent neurobehavioral outcomes . This r and omized controlled trial involving 45 women with infants < 30-wk gestation , assessed the effectiveness of training parents  in reducing stressful experiences . Intervention consisted of 10 sessions in the Neonatal Intensive Care Unit ( NICU ) . Postintervention , at term-equivalent ( 40-wk postmenstrual age ) , magnetic resonance imaging ( MRI ) was performed to evaluate brain structure and development . Quantitative volumetric techniques were used to estimate overall and regional brain volumes for different tissue types including CSF , CGM , DNGM , UWM , and MWM . DTI was used to evaluate the integrity and maturation of white matter by ADC and FA . Maturation and connectivity of white matter , characterized by diffusion MR measures of ADC and FA , were significantly enhanced in the intervention group , who displayed greater restriction in ADC and increase in FA . There were no significant effects on either brain volumes or on short-term medical outcomes . Thus , sensitivity training for parents in the NICU is associated with improved cerebral white matter micro-structural development in preterm infants OBJECTIVE To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants . DESIGN R and omized controlled trial . SETTING Newborn intensive care unit . PATIENTS Thirty-eight singleton preterm infants , free of known congenital abnormalities , weighing less than 1250 g , born before 30 weeks ' gestation , mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours , r and omly assigned to a control or an experimental group . INTERVENTION Caregiving by nurses specifically trained in individualized developmental care ; observation and documentation of the infants ' behavior within 12 hours of admission , and subsequently every 10th day ; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists ; and the availability of special caregiving accessories . MAIN OUTCOME MEASURES Medical outcome , including average daily weight gain ; number of days the infant required mechanical ventilation , oxygen , gavage tube feeding , and hospitalization ; severity of retinopathy of prematurity , bronchopulmonary dysplasia , pneumothorax , and intraventricular hemorrhage ; pediatric complications ; age at discharge ; and hospital charges . Neurodevelopmental outcome , including Assessment of Preterm Infants ' Behavior scale and quantified electroencephalography ( 2 weeks after due date ) ; and Bayley Scales of Infant Development and Kangaroo Box Paradigm ( 9 months after due date ) . RESULTS The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support ; earlier oral feeding ; reduced incidence of intraventricular hemorrhage , pneumothorax , and severe bronchopulmonary dysplasia ; improved daily weight gain ; shorter hospital stays ; younger ages at hospital discharge ; and reduced hospital charges compared with the infants in the control group . At 2 weeks after their due date s , these infants also showed improved autonomic regulation , motor system functioning , self-regulatory abilities , and visual evoked potential measures ; and at 9 months , they had improved Bayley Mental and Psychomotor Developmental Index scores , as well as Kangaroo Box Paradigm scores . CONCLUSION Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome The aim of the study was to prospect ively assess the differences in participation and sensory modulation between late preterm infants ( LPI ) and term babies , and to predict it by LPI characteristics . The study population includes 124 late preterm infants at gestational age between 34 and 35 6/7 weeks who were born at the same medical center . The control group comprised of 33 term babies ( 18 boys , 15 girls ) , born during the same period and location ( mean age 12.47 , SD = 0.73 ) .  Sensory modulation  was assessed by the test of sensory functions in infants and the infant/toddler sensory profile and for assessment of participation and parents ' satisfaction we used question naires . Term infants had better sensory modulation than LPI . Approximately 10 % of the sensory modulation of participants in the study was explained by gestational age and head circumference .  LPI participation and parental satisfaction decreased in the LPI group . Among all the explanatory variables only multiple gestations and head circumference contributed to the explained variance of participation ( 16 % ) , and parents ' satisfaction ( 13 % ) . At age of 1 year , children born as late preterm are at increased risk of developing sensory modulation disorder , showing less participation , and result ing in less parental satisfaction Background Sensory experience is the basis for learning in infancy . In older children , abnormal sensory reactivity is associated with behavioural and developmental disorders . We hypothesised that in preterm infants , abnormal sensory reactivity during infancy would be associated with perinatal characteristics and correlate with 2-year neurodevelopmental outcomes . Methods We conducted a prospect i ve observational study of infants with birth weight ≤1500 g using the Test of Sensory Function in Infants ( TSFI ) in the first year . Infants with gestational age ≤30 weeks were tested with the  Bayley Scales of Infant and Toddler Development III ( BSID III ) at 24 months . Results Of the 72 participants evaluated at 4–12 months corrected age ( median 8 months ) , 59 ( 82 % ) had a least one TSFI score concerning for abnormal sensory reactivity . Lower gestational age was associated with abnormal reactivity to deep pressure and vestibular stimulation ( p<0.001 ) . Poor ocular-motor control predicted worse cognitive and motor scores in early childhood ( OR 16.7 ; p=0.004 ) , but was tightly correlated to the presence of severe white matter injury . Poor adaptive motor function in response to tactile stimuli predicted worse BSID III motor ( p=0.01 ) and language scores ( p=0.04 ) at 2 years , even after adjusting for confounders . Conclusions Abnormal sensory reactivity is common in preterm infants ; is associated with immaturity at birth , severe white matter injury and lower primary caregiver education ; and predicts neurodevelopmental delays . Early identification of abnormal sensory reactivity of very preterm infants may promote parental support and education and may facilitate improved neurodevelopment OBJECTIVES To determine the mortality and morbidity for infants weighing 401 to 1500 g ( very low birth weight [ VLBW ] ) at birth by gestational age , birth weight , and gender . STUDY DESIGN Perinatal data were collected prospect ively on an inborn cohort from January 1995 through December 1996 by 14 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network and were compared with the corresponding data from previous reports . Sociodemographic factors , perinatal events , and the neonatal course to 120 days of life , discharge , or death were evaluated . RESULTS Eighty four percent of 4438 infants weighing 501 to 1500 g at birth  survived until discharge to home or to a long-term care facility ( compared with 80 % in 1991 and 74 % in 1988 ) . Survival to discharge was 54 % for infants 501 to 750 g at birth , 86 % for those 751 to 1000 g , 94 % for those 1001 to 1250 g , and 97 % for those 1251 to 1500 g . The incidence of chronic lung disease ( CLD ; defined as receiving supplemental oxygen at 36 weeks ' postmenstrual age ; 23 % ) , proven necrotizing enterocolitis ( NEC ; 7 % ) , and severe intracranial hemorrhage ( ICH ; grade III or IV ; 11 % ) remained unchanged between 1991 and 1996 . Furthermore , 97 % of all VLBW infants and 99 % of infants weighing < 1000 g at birth had weights less than the 10th percentile at 36 weeks ' postmenstrual age . Mortality for 195 infants weighing 401 to 500 g was 89 % , with nearly all survivors developing CLD . Mortality in infants weighing 501 to 600 g was 71 % ; among survivors , 62 % had CLD , 35 % had severe ICH , and 15 % had proven NEC . CONCLUSIONS Survival for infants between 501 and 1500 g at birth continued to improve , particularly for infants weighing < 1000 g at birth . This improvement in survival was not associated with an increase in major morbidities , because the incidence of CLD , proven NEC , and severe ICH did not change . However , poor postnatal growth remains a major concern , occurring in 99 % of infants weighing < 1000 g at birth . Mortality and major morbidity ( CLD , severe ICH , and NEC ) remain high for the smallest infants , particularly those weighing < 600 g at birth Objective : To study whether new pharmacological and nonpharmacological guidelines lowered numbers of painful procedures  in neonates and changed the amount and frequency of analgesic therapy as compared to the results of our previous study in 2001 . Design : A prospect i ve observational study . Setting : Level III NICU of the Erasmus MC-Sophia Children 's Hospital , Rotterdam . Participants : Neonates admitted at postnatal ages less than 3 days with length of stay at least 72 h. Main Outcome Measures : Number of all potentially painful procedures and analgesic therapy  recorded at the bedside during the first 14 days of NICU stay . Results : A total number of 21,076 procedures were performed in the 175 neonates studied during 1,730 patient-days ( mean 12.2 ) . The mean number of painful procedures per neonate per day was 11.4 ( SD 5.7 ) , significantly lower than the number of 14.3 ( SD 4.0 ) in 2001 ( p < 0.001 ) . The use of analgesics  was 36.6 % compared to 60.3 % in 2001 . Sixty-three percent of all peripheral arterial line insertions failed versus 37.5 % in 2001 and 9.1 % venipunctures failed versus 21 % in 2001 . Conclusions : The mean number of painful procedures per NICU patient per day declined . Nonpharmacological pain- or stress-reducing strategies like NIDCAP and sucrose were fully embedded in our pain management . As further reduction of the number of painful procedures is unlikely , we should apply more nonpharmacological interventions and explore newer pharmacological agents
target: Results of this review support the presence of sensory modulation problems in preterm children .
  Sensory modulation problems may play a key role in underst and ing neurocognitive and behavioral sequelae in preterm children .
  Some support is found for a dose-response relationship between both white matter brain injury and length of NICU stay and sensory modulation problems
background: BACKGROUND Neurodevelopmental sequelae in preterm born children are generally considered to result from cerebral white matter damage and noxious effects of environmental factors in the neonatal intensive care unit ( NICU ) .
  Cerebral white matter damage is associated with sensory processing problems in terms of registration , integration and modulation .
  However , research into sensory processing problems and , in particular , sensory modulation problems , is scarce in preterm children .
  AIM This review aims to integrate available evidence on sensory modulation problems in preterm infants and children ( < 37 weeks of gestation ) and their association with neurocognitive and behavioral problems .