Empowering Parents – Early Intervention for Preterm Infants Dr Alicia Spittle Click to edit Master title style
Victorian Infant Brain Study (VIBeS) Click to edit Master title style
Click to edit Master title style
Disclaimer • Every baby is different! • Please talk to your Paediatrician, MCHN or relevant health professional Click to edit Master title style
What, why, who, how and when of Early Intervention
Question How do you define preterm - is it related to how many weeks early the baby was delivered? Is it related to the baby's weight or a combination of these factors?
Prematurity definitions Gestational age at birth • Term = 37 -42 weeks • Preterm = less than 37 weeks • Late or moderate preterm = 32 to 36 weeks • Very preterm = less than 32 weeks • Very preterm = less than 32 weeks • Extremely preterm = less than 28 weeks Birth weight • Low birth weight = less than 2500g • Very low birth weight = less than 1500g • Extremely low birth weight = less than 1000g
How do prem babies grow up? • Developmental problems are related to gestational age Early childhood: • neurodevelopmental delay and recurrent health problems School age: • academic difficulties and behavioural problems • Adulthood: most children born preterm adjust remarkably well Saigal and Doyle, Lancet, 2007
Early Childhood Delay or difficulties • Gross motor • Fine motor • Feeding • Language • • Cognitive Cognitive Impairments or diagnosis • Cerebral palsy • Autism • ADHD • Intellectual impairment
What is Early Intervention (EI)? CHILD FAMILY DEFINITION EI consists of multidisciplinary services provided to children 0-5…promote child health, enhance emerging MOTOR competencies…minimize delays… remediate competencies…minimize delays… remediate COGNITIVE COGNITIVE emerging disabilities….prevent SOCIAL Click to edit Master title style deterioration…promote family functioning PREMATURE Shonkoff et al, 2000 DISABILITY AT RISK LOW SES
Why is “early” important? Click to edit Master title style
Question Early results of the LaPrem study indicate that late preterm babies have smaller brains? Is a smaller brain less effective or just smaller? Click to edit Master title style
Click to edit Master title style 2 nd Trimester Term
Developing in the womb versus neonatal intensive care Click to edit Master title style
Early experiences alters brain development Control Group Intervention Group Click to edit Master title style Als, Pediatrics, 2004
Who needs EI? Click to edit Master title style
Early Childhood • Delay or difficulties Gross motor • Prevention Fine motor • • Feeding • Language • Cognitive Click to edit Master title style • Impairments or diagnosis • Cerebral palsy • Autism Targeted early intervention • ADHD • Blind • Deaf
VIBeS Plus Children in study either receive standard care or our • – unique home intervention program • Our team visits the home to help improve parental mental health, parental-infant bonding and the infants’ development Click to edit Master title style
Behavioural problems at 2 years Intervention Control Impairment No impairments Impairment No impairments 0% 0% 0% 0% 20% 50% 50% Click to edit Master title style 80% Pediatrics 2009
Parental anxiety at 2 years Intervention Control Anxiety No anxiety Anxiety No anxiety 0% 0% 0% 0% 21% 43% 57% Click to edit Master title style 79%
What is the evidence for early intervention for infants born preterm? • Cochrane review • Included – randomised controlled trials – infants <37 weeks gestation – infants <37 weeks gestation – Early intervention began within first 12 months Click to edit Master title style – Focus on motor and/or cognitive Spittle A, Cochrane Database Systematic review, 2012
Cognitive outcome - infant age (<3 years) Click to edit Master title style
Cognitive outcome - preschool age (3-5 years) Click to edit Master title style
Cognitive outcome - School age (6-13 years) Click to edit Master title style
Motor outcome - infant age (<3 years) Click to edit Master title style
Question What are the day to day, practical things that you can do to help your prem develop post the first year. What is the research saying in this area? It feels like there is a big hole in the literature about how to support your prem baby (and child!), when they might not have any ongoing medical problems. What can be might not have any ongoing medical problems. What can be done to proactively help your prem thrive in the first three years of their lives? Click to edit Master title style
Infant discovery learning I am ready to learn! Click to edit Master title style
What do we know about discovery learning with infants? • Tasks are defined by adults • Infants discover the tasks that are relevant • The “relevance” of tasks can be influenced by environment environment How should we characterize the feedback from the • Click to edit Master title style environment? • Learning takes practice • Trial and error
Play with your baby Click to edit Master title style
Practice Click to edit Master title style
Sitting Click to edit Master title style
Baby walkers Click to edit Master title style
Encourage independence Click to edit Master title style
Jolly Jumpers Click to edit Master title style
Read to your baby Click to edit Master title style
Plagiocephaly • http://www.rch.org.au/kidsinfo/fact_sheets/Pl agiocephaly_misshapen_head/ Click to edit Master title style
Look after yourself • Next webinar Click to edit Master title style
Question Would you recommend all prems have regular reviews with staff who specialize in prematurity? For example, our GP/MHCN say early intervention not required for our daughter yet she is not meeting all milestones . Click to edit Master title style
Correct for prematurity • http://raisingchildren.net.au/articles/prematu re_baby_corrected_age.html • Corrected age = Chronological age – number of weeks preterm of weeks preterm • For example, a one-year-old who was born Click to edit Master title style three months early would have a corrected age of nine months.
Question • Do general illnesses such as colds/flus/ear infections etc add extra time onto development details? For example, our daughter is healthy, however she regularly has illnesses which knock her around. Click to edit Master title style
Delay vs impairment Signs to Watch for in Physical Development* � Difficulty lifting head � Pushes back with head � Keeps hands fisted and � Stiff legs with little or no movement lacks arm movement � Arms held back � Rounded back � Difficult to bring arms forward � Stiff legs Click to edit Master title style to reach out � Unable to lift head up � Arches back and stiffens legs � Poor head control � Uses one hand predominately � Inability to straighten � Rounded back back � Poor use of arms � Cannot take in sitting weight on legs � Difficulty crawling � Uses only one side of body to move www.pathways.org
Chronic Disease Management — GP services • http://www.health.gov.au/internet/main/publ ishing.nsf/Content/mbsprimarycare- chronicdiseasemanagement • GP coordinates plan • GP coordinates plan Click to edit Master title style
Question What is the most important thing that midwives can do to support parents with a premature baby? Click to edit Master title style
Support parents and infant Click to edit Master title style
Question Our baby was born at 32wks, no health concerns at birth but has been diagnosed with CP at 10 months. Four months down the line we are still waiting for intake with ECIS, VPRS and a proper diagnosis. Why is it so difficult? Click to edit Master title style We're currently doing everything privately but we're still looking for some therapy that focus on neuroplasticity, can you make a recommendation please
Question My ex28 weeker son who is now 4 was not referred for early intervention services. I have spent the last year getting him in the see all of the different types of therapists due to his obvious development delays and having mild cp and epilepsy. What is the best way for me to coordinate his intervention so Click to edit Master title style that he can have the best life possible. He is such a beautiful loving boy that his differences can be often overlooked by professionals.
Definition of CP • CP describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain Click to edit Master title style
Cerebral Palsy • Term = 0.1% • 32- 36 weeks = 0.7% • 28-31 weeks = 6.2% • 22-27 weeks = 14.6% • Average age of diagnosis = 19 months • Average age of diagnosis = 19 months Click to edit Master title style
Risk of Cerebral Palsy Click to edit Master title style
Click to edit Master title style NOVAK, 2014
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