Abstract:

Preterm birth conveys a significant risk of developmental delays and disabilities. Medical complications, early exposure to noxious sensory stimulation in the neonatal intensive care unit (NICU) and altered parent-infant interactions contribute to disturb brain ontogenesis. Developmental intervention programs for preterm children have shown to improve early motor, cognitive and socio-emotional development along with parental well-being. These programs promote techniques that foster infant stability and competences by modifying the physical environment to reduce stress while optimizing developmentally appropriate stimulation. However, their application in a real-life setting is hindered by significant costs and resource needs which limits intervention delivery by health care professionals. Therefore, the goal of our project was to develop and test the feasibility of a family-focused educational program of developmentally-supportive care for preterm infants to improve infant development and parental outcomes through a multi-modal approach using web-based technologies.

The educational program addresses five themes for which contents were developed following an extensive literature review. These include (1) interpretation of behavioural cues and environmental modification to promote infant well-being; (2) adapted flexion positioning to prevent musculoskeletal deformities; (3) oral feeding support; (4) enhancement of parent-infant interactions through developmentally-adapted daily care practices; (5) anticipatory guidance of preterm infant development and stimulation activities. Based on Knowles’s theory of adult learning, where the learning process is learner-directed, problem-centered and driven by immediate experience, each self-guided module is accompanied by developmental and behavioral activities that can be easily replicated in everyday life to consolidate knowledge acquisition. Central to our intervention program is a web-based platform that contains material on the five topics in a written and videotaped format as well as online access to an expert in child development (referred as intervener). As a complement to the web-based structure, one person-to-person learning-teaching encounter is given along with group workshops in the NICU delivered by a single intervener. This multi-modal format facilitates different learning styles as well as knowledge diffusion and access.

We are conducting a prospective exploratory clinical trial with a historical comparison cohort to document the effects of our educational program on infant development and parental well-being (parenting stress, parental satisfaction and sense of competence) during the first year following NICU discharge. 100 families (50 per arm) of infants born before 30 weeks of complete gestation are enrolled and compared on the different outcomes. We are also documenting content relevance and ease of use and application among the parents.

With the increasing number of preterm survivors at risk of developmental delays/disabilities, our innovative educational program permits early prevention of developmental problems with developmentally-supportive techniques that will minimize the effects of the NICU environment, and improvement of developmental and functional outcomes of preterm infants through stimulation activities. Finally, our easily diffusible online educational platform provides great potential for growth and community outreach, especially in remote areas.

Keywords:

Neurodevelopment, preterm birth, developmental care, early developmental intervention, web-based.