Discusses the long-term outcome of premature babies who spend their
first months hooked up to machinery. Research by Harvard psychologist
Heidelise Als Ph.D. on the importance of gauging an infant's level of
distress; How she dramatically cut risks of medical problems by relaxing
the infants prior to medical procedures.
By
PT Staff, published on January 01, 1995
HEALTHPreemies
The survival of tiny premature babies is one of modern medicine's
great success stories. But one of the still-unwritten chapters is the
long-term outcome of the tiny babies who spend their first months hooked
up to machinery.
Such infants are at great risk for brain bleeds and lung disease
that give rise to neurodevelopmental disabilities from learning disorders
to emotional compromise. But a discovery by a Harvard psychologist may
give preterm babies a shot at a clean cognitive slate.
By observing the subtlest of behavioral signs--91 little things,
like whether a baby is arching its back or breathing hard--Heidelise Als,
Ph.D., can gauge an infant's level of distress. Then, merely by
administering all medical interventions while a baby's in a relaxed
state, she can dramatically cut the incidence of brain bleeds and lung
disease.
The trick is to tailor care to the needs of each infant, and relax
the infant before even sticking in a needle. It's a radical departure
from the way things are now done.
But in a rigorously controlled study, the results were striking.
Just one baby of 19 getting individualized care suffered a brain bleed,
while 10 of 19 infants getting standard care did. Six controls developed
severe chronic lung disease, but none of the test babies, Als reports in
the Journal of the American Medical Association.
The test babies left intensive care an average of eight weeks
earlier than controls. On cognitive and motor tests at nine months, the
test infants were on a par with full-term infants. The control infants
scored below the mean on both.
"How can looking at an infant developmentally and supporting its
regulation have anything to do with its lung disease?" asks Als, voicing
the incredulity of colleagues and medical journal editors. "But to a
psychologist it makes eminent sense. You are more relaxed; you don't have
to breathe so hard and fight against the ventilator. Your lungs should
heal faster because you require less energy to do it." Since we don't
have an animal model for the premature infant brain, we have to ask the
babies themselves what they need to support the developmental
process.
PHOTO: Premature baby
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