The impact of a sensory developmental care programme for very low birth weight preterm infants in the neonatal intensive care unit.

Nieder-Heitmann, Esther (2010-03)

Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2010.

Thesis

AFRIKAANSE OPSOMMING: AGTERGROND Dit is bekend dat vroeggebore babas met ʼn baie lae geboortemassa ʼn hoër insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is as besonders belowend. Met die aanvang van hierdie studie was daar nog geen empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie benaderings bevestig het nie. Daar was dus ʼn behoefte vir ʼn empiries-nagevorsde program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore baba se sensoriese sisteme. DOEL Die doel met die studie was om die invloed te bepaal van ʼn Sensoriese Ontwikkelingsorgprogram (‘Sensory Developmental Care Programme’), wat ʼn spesifieke kangaroemoedersorg- protokol insluit, op die sensoriese ontwikkeling van die vroeggebore baba met 'ʼn baie lae geboortemassa tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). METODOLOGIE ʼn Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit 89 vroeggebore babas met ʼn baie lae geboortemassa wat in ʼn periode van 24 maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad, Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op 18 maande (gekorrigeerde ouderdom) is ʼn assessering met die Griffiths Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings en die Bonferoni t-prosedure om die effek van die Sensoriese Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met 18 maande (gekorrigeerde ouderdom) te bepaal. RESULTATE Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek), gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling (p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03); visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01). GEVOLGTREKKING Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander neonatale intensiewe sorgeenhede aangewend kon word.

ENGLISH ABSTRACT: BACKGROUND Premature infants of very low birth weight are known to be inclined to developmental, medical, behavioural and various learning deficiencies by the time they reach schoolgoing age. Concerns have been raised about the effect of the neonatal intensive care unit environment on the sensory development of the premature infant and how this could contribute to these deficiencies. Various approaches claim to address this problem, of which kangaroo mother care and developmental care have in the literature been singled out as particularly promising. However, at the commencement of this study no empirical studies had been reported in the literature to confirm any of the claims of these approaches. Therefore, a need existed for an empirically researched programme that could be practically applied in the neonatal intensive care unit with a view to reducing environmental stressors regarding the sensory systems of the premature infant. AIM The aim of this study was to determine the influence of a Sensory Developmental Care Programme, which incorporated a specific kangaroo mother care protocol, on the sensory development of the very low birth weight premature infant, up to the age of 18 months (corrected age). METHODOLOGY A randomised controlled study was conducted. The study sample consisted of 89 very low birth weight premature infants, admitted during a 24-month period to the neonatal care unit at Tygerberg Hospital in Cape Town, South Africa. The infants were recruited by means of certain criteria and then randomly assigned to one of two groups: 1) the intervention group was cared for according to the Sensory Developmental Care Programme for ten recorded days; and 2) the control group that received the standard care of the unit, also for ten days. The intervention group consisted of 45 infants of whom 22 completed the study, while the control group consisted of 44 infants of whom 20 completed the study. Both study groups were followed up at six, 12 and 18 months (corrected age) when the Test of Sensory Functions in Infants was used to do a sensory developmental assessment. At 18 months (corrected age) a Griffiths Developmental Scale assessment was also conducted to determine function in other areas of development. Test results were analysed using repeated measures of ANOVA, and the Bonferoni t procedure to determine the effect that the Sensory Developmental Care Programme had on the sensory development of the infant up to 18 months (corrected age). RESULTS The results of the comparison of the performance of both groups (group effect), measured by the Test of Sensory Functions in Infants are of great importance to this study. The intervention group had a significant difference on the total score (p<0.00), as well as on the following four of the five sub-tests scores: reactivity to tactile deep pressure (p<0.03); adaptive motor functions (p<0.03); visual-tactile integration (p<0.00); and reactivity to vestibular stimulation (p<0.01). CONCLUSION The results of this study signify that the infants in the intervention group benefited from the Sensory Developmental Care Programme concerning their sensory functions up to the age of 18 months (corrected age). The Sensory Developmental Care Programme was demonstrated to be both practical and successful in terms of its aims. The Programme could therefore be fruitfully utilised in other neonatal intensive care units.

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