12192 (178, 179, 180) Paper Presentation 5 – Sensory Issues

(178) Long-Term Effects of Cycled Light and Near Darkness on Preterm Infants Neurodevelopmental Outcomes
Debra Brandon, PhD RN CCNS, Duke University, Durham, NC
Coauthors:
Donna Ryan, MSN RN, Duke University School of Nursing, Durham, NC
Angel Barnes, BSN RN, Duke University, Durham, NC

Abstract
Purpose: This study evaluated the appropriate time for instituting cycled light (CL) for preterm infants born at ≤28 weeks gestation.

Methods: A longitudinal randomized design evaluated the effects of early (28 weeks PMA) and late (36 weeks PMA) CL on neurodevelopment. Seventy-eight infants born at ≤  28 weeks gestation were randomly assigned to receive CL at either 28 or 36 weeks PMA until hospital discharge. Infants were followed after hospital discharge until two years corrected age. The Amiel-Tison neurological examination assessed abnormalities in tone and the Bayley Scales of Infant Development assessed mental (MDI) and motor (PDI) abilities. Visual acuity was assessed with the preferential looking test.

Results: At 18 months, over 61% of the 75 infants examined had normal neurological exams. There were no intervention group effects, but as anticipated presence of neurological risk evidenced by either PVL or a Grade III or IV IVH was related to an abnormal neurological exam. Like the neurological exam, there were no intervention effects on the MDI or PDI and neurological risk was significantly related to MDI and PDI scores at both 9 and 18 months. There were no intervention group differences in visual acuity at 12 months, but as would be anticipated, presence of neurological risk was significantly related to an abnormal visual acuity score.

Discussion: CL promotes health and development through promotion of biological rhythms and has no deleterious effects on neurodevelopment. In addition, keeping infants in continuous near darkness after 28 weeks gestation had no advantages over CL.

Learning Objectives
1. Describe the research study methodology.
2. Explain the neurodevelopmental outcomes of extremely preterm infants with early and late cycled light.
3. Discuss the implications cycled light and circadian rhythm development.

Bibliography
Mirabella, G., et al., Visual development in very low birth weight infants. Pediatr Res, 2006. 60(4): p. 435-9. Vohr, B.R., et al., Neurodevelopmental outcomes of extremely low birth weight infants


(179) Music as an Evidence-Based Intervention for Premature Infants in the NICU
Michelle Fleiner, DNP RNC-NIC CCNS, Cardon Children's Medical Center/Banner Health, Mesa, AZ


Abstract
Background of Problem
Premature birth continues to be a significant health problem and those who work in the Neonatal Intensive Care environment are critically challenged to ensure not only technically sensitive care, but also developmentally appropriate care. The continuous and unpredictable nature of this environment is replete with invasive technology, alarms, human voice, and human action all in a setting unlike the intrauterine or home environment.
Purpose of Practice Change

While many units strive to create a home-like atmosphere and minimize unnecessary stressors, premature infants remain developmentally challenged. Appropriately timed exposure to recorded lullaby style music may be helpful in supporting a more predictable and soothing environment. The question for this evidence-based practice project is: In premature infants (P), does music therapy (I) compared to no music therapy (C), reduce the stress response (O)?

Supporting Research Evidence
Investigators report music has an inconsistent soothing effect by reducing heart rate or state of arousal or improving oxygenation in stable preterm infants. Some findings occur during and many occur immediately after the music intervention. In a meta-analysis with 290 subjects, music therapy in preterm infants had an overall large and consistent effect (d = .83, 95% confidence interval .68-.97). Stable preterm infants greater than 32 weeks postconceptional age without neurological problems, acute illness, or confirmed hearing loss may respond to lullaby style vocal and instrumental music up to 30 minutes in duration up to three times per week. This population was targeted for music in this evidence-based practice project.

Practice Change Methods
A quasi-experimental repeated measures design was used to implement the music with subjects acting as their own controls. After meeting criteria to receive music and obtaining informed consent, readiness for the music intervention was determined by the bedside nurse. Each music session included 15 minutes of heart rate, oxygen saturation and state of arousal data collection before, during and after the music. Each baby received up to 3 sessions per week for 2 weeks.

Results
Data collection is almost complete for approximately 22 babies. A three-way ANOVA is planned to compare the effects of time (i.e. before, during and after music), repeated measures (i.e. multiple music episodes) and sex (i.e. females versus males) and the interactions of each. Data analysis will be complete in December, 2009.

Comparison to Research & Recommendations
Assuming music makes a difference in this culturally diverse population, the focus will turn to creating a unit-based policy and procedure to offer music to stable premature infants without neurologic compromise. Sister hospitals will be encouraged to adopt the practice as well with support from myself to evaluate in their setting(s). Local and national presentations and publications are planned to disseminate this work. Future research should target neurologically impaired infant populations such as the drug exposed infant. Studies of the long term effects of music are needed, but difficult to design. This work will benefit from a collaboration among the disciplines of music therapy, nursing and developmental specialists.

Learning Objectives
1. Explore individual responses to music as an intervention.
2. Review the process of critical appraisal and synthesis of evidence related to use of music in the care of preterm infants.
3. Apply a model of behavior change to the nurse's role as an advocate for a music intervention.
4. Discuss the findings of a three way analysis of variance (ANOVA) to evaluate the soothing effects of music.

Bibliography
Arnon, S., Shapsa, A., Forman, L., Regev, R., Bauer, S., Litmanovitz, I., et al. (2006). Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth, 33(2), 131-136.
Bo, L. K., & Callaghan, P. (2000). Soothing pain-elicited distress in Chinese neonates. Pediatrics, 105(4), e49.
Butt, M. L., Kisilevsky, B. S. (2000). Music modulates behaviour of premature infants following heel lance. Canadian Journal of Nursing Research, 31(4), 17-39.
Chou, L., Wang, R., Chen, S., & Pai, L. (2003). Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning. Journal of Nursing Research, 11(3), 209-215.
Standley, J. M. (2002). A meta-analysis of the efficacy of music therapy for premature infants. Journal of Pediatric Nursing, 17(2), 107-113.


(180) Nursing's Role in Meeting the Goals of Newborn Hearing Screening
Amy Johnson, PhD RNC, University of Delaware, Newark, DE
Coauthor: Katy Griffith, MSN RN CPN, Union Hospital of Cecil County, Elkton, MD


Abstract
Purpose for the Session: To review the development of the Joint Committee on Infant Hearing position statements, examine legislation and health policy initiatives for universal newborn hearing screening, and determine nursings’ role in the NICU in meeting the goals.

Background and Importance: Newborn hearing screening programs are a protocol of care in hospital nurseries throughout the United States. This came about as individual states enacted legislation supporting the position statement of the American Academy of Pediatrics Joint Committee on Hearing calling for universal hearing screening of all newborn infants. Before this, only infants at risk for hearing loss as defined by specific factors were followed with auditory evaluations. Because hearing loss in newborns is not readily detectable, many infants at that time were not diagnosed with hearing loss later, resulting in devastating delays in language and communication development that could have been significantly less with early intervention.

Description of What Will Be Covered: A historical overview of the development of the Joint Committee on Hearing, Universal Hearing programs, and screening technology will be discussed. State and federal initiatives as well as hearing programs will be reviewed followed by a discussion of the application in the NICU and the role of the nurse.

Future Directions: The current goal is to screen all infants by one month of age, confirm hearing loss with audiologic examination by three months of age, and treat with comprehensive early intervention services before six months of age. How are we doing in meeting our goals?

Learning Objectives
1. Describe the development of universal hearing programs and the role of the American Academy of Pediatrics.
2. Discuss the proactive role of the NICU nurse in the program implementation and follow-up.

Bibliography
American Academy of Pediatrics (2007). Joint Committee on Infant Hearing Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs Pediatrics, 120: 898-921.

Harlor, A., Bower, C. (2009). Hearing Assessment in Infants and Children: Recommendations Beyond Neonatal Screening. Pediatrics, 124: 1252-1263.

Porter, H.L., Neely, S.T., Gorga, M.P. (2009). Using benefit-cost ratio to select Universal Newborn Hearing screening test criteria. Ear & Hearing, 30(4): 447-457.

Spivak, L., Sokol, H., Auerbach, C., Gershkovich, S. (2009). Newborn hearing screening follow-up: Factors affecting hearing and fitting by 6 months of age. American Journal of Audiology, 18(1):24-33.