Physiotherapy - Theses
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ItemNeurobehavioural development of infants born <30 weeks' gestational age between birth and one year corrected age( 2016)Background: Prematurity has become the second leading cause of mortality in children under 5 years worldwide. Very preterm infants who survive are at greater risk of both minor and major long-term neurodevelopmental dysfunction in areas including sensory and motor than infants born at term. Standardised assessments were developed in response to pioneering research that discovered the importance of infant's early movement patterns. Their use in the exploration of very preterm infants' individual movement and behavioural differences in the preterm period helps to inform clinical decision-making at a critical time of development. Early detection of at-risk very preterm infants is recommended; however little is known regarding the predictive validity of standardised neurobehavioural assessments in the neonatal nursery for long-term neurodevelopmental outcome. Aims: This thesis addresses three primary aims: 1) To evaluate which standardised neurobehavioural assessments are currently used in Neonatal Intensive Care Units (NICU) and Special Care Nurseries (SCN) throughout Australia and New Zealand. 2) To compare the physiological stress in infants born <30 weeks' gestation when undergoing clustered nursing cares versus standardised neurobehavioural assessments. 3) To examine the predictive relationship of standardised neurobehavioural assessments of infants born <30 weeks' gestation prior to term equivalent age and at term equivalent age for neurosensory-motor outcome at one year corrected age. Methods: This thesis involved three separate studies to address the aforementioned aims. Study 1 involved an electronic survey emailed to nurse unit managers of 179 Australian and New Zealand neonatal intensive care units and special care nurseries. Study 2 required extraction of heart rate and oxygen saturation data at 5 second intervals from videos of 34 infants' at 29-32 weeks' postmenstrual age that contained both standardised neurobehavioural assessments and clustered nursing cares. Study 3 was a prospective observational cohort study of 100 very preterm infants born <30 weeks' gestation. Serial standardised neurobehavioural assessments (General Movements; Premie-Neuro; Hammersmith Neonatal Neurological Examination; and Neonatal Intensive Care Unit Network Neurobehavioural Scale) were conducted in the neonatal nursery; initially weekly from birth to 32 weeks' postmenstrual age, and then fortnightly until term. At term equivalent age, infants were assessed using General Movements, the Hammersmith Neonatal Neurological Examination, and the Neonatal Intensive Care Unit Network Neurobehavioural Scale. At one year corrected age, infants were assessed using the Alberta Infant Motor Scale, the Neurosensory Motor Developmental Assessment, and the Touwen Infant Neurological Examination. A cohort of 100 term control infants were also assessed soon after birth and at one year of age. Results were compared between preterm and term children. The relationships at the preterm assessments and perinatal variables with one year outcome were determined. Results: Neonatal intensive care units were more likely to provide standardised neurobehavioural assessments and neurodevelopmental therapy than special care nurseries. Standardised neurobehavioural assessments caused less physiological stress than clustered nursing cares. Very preterm infants performed consistently lower on term and one year assessments than term controls. General Movements was the only assessment in the preterm period to predict outcome on one year assessments. Few perinatal variables were related to assessments at one year corrected age. Conclusions: Standardised neurobehavioural assessments are safe to use in medically stable infants from 29 weeks' postmenstrual age. General Movements in the preterm period were predictive of neurosensory-motor outcomes at one year corrected age. Future research is required to explore the predictive validity of preterm assessments at later ages in childhood for neurosensory-motor outcome.