The National Institutes of Health recently contributed funds to a study (published online in Journal of Perinatology) regarding advancing growth and development within premature babies (click here for more details). The research was a randomized controlled trial, during which 183 infants who were born prematurely (anywhere between the 29th and 34th week of pregnancy) were assigned to a control group or an experimental group. The mothers of the control group were given classical instructions on how to care for preterm infants. The mothers of experimental group participated in an intervention called H-HOPE (Hospital to Home Transition- Optimizing Premature Infant’s Environment).
The H-HOPE intervention consisted of two different components. The first component, referred to as the ATVV (auditory, tactile, visual, and vestibular) portion, educated mothers on how to properly interact with their child to encourage development of social skills as well how to gently stimulate their child. This portion of treatment lasted fifteen minutes and was performed prior to feedings two times daily. The stimulation involved speaking with a quiet and soothing voice to the child followed by gently massaging the infant’s head, chest, arms, and abdomen (infant lying face up upon mother’s back) and then back and head (infant lying face down upon mother’s back). The researchers hypothesized that this type of intervention helps to stimulate fetal neurological development. The sequence concluded with a five minute segment during which the mother swaddled the infant in her arms and rocked the infant back and forth for five minutes. Throughout the treatment, the mother was encouraged to make as much eye contact as possible with the infant. This technique was continued until one month past the infants due date.
The second aspect of treatment involved educating mothers about the subtle (and often overlooked) cues from the premature infant which indicate that they are hungry. For example, whereas full term babies may cry to indicate that they are hungry, premature babies may simply move their hand towards their mouth without uttering a peep. In addition, the oral motor control required for an infant to feed independently does not develop until the 34tht week of pregnancy. Therefore, infants who are born prematurely often encounter feeding challenges which further interfere with growth. According to Dr. White-Traut, one of the head researchers, “Premature infants face increased health risks…so further complication, such as poor feeding and delayed growth, can worsen the problems they already face.” Therefore, sensitizing mother’s to these nuanced fetal cues are crucial in order to enable the mother to feed her child in a more optimal and timely manner. Furthermore, mothers were taught how to stimulate their infants and raise their level of alertness before eating to maximize the child’s feeding experience.
The results of the study are extremely promising. Following the ATVV portion of treatment, infants demonstrated a marked improvement in their feeding ability. This is reflected by increased weight and height gains. Furthermore, the infants were fed through a bottle connected to a sensor which measured the amount of active sucking versus rest periods during feedings. The infants in the experimental group demonstrated improved sucking abilities compared to the control group. According to Dr. Valerie Maholmes, chief of the Pediatric Trauma and Critical Illness Branch at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (which funded the research), “Premature infants who fail to gain sufficient weight are at a higher risk for delays and even impairments in cognitive ability and motor skills. We are hopeful that this intervention will prove to be an important tool in safeguarding the long-term health of an extremely vulnerable group of infants.”
Mothers of premature infants face a plethora of challenges, and a significant amount of their time and energy is spent on caring for their newborn. It is important for them to remember that one’s cup can only run over if it itself is full. Those who take care of themselves optimally can best take care of the many demands and needs of their premature newborn. And that’s where Revitalize Physical Therapy can help! Part of my sacred duty as a pelvic floor physical therapist includes attending to the post-partum needs of mothers, including treatment of urinary and/or fecal incontinence, episiotomy or abdominal cesarean section scarring, low back pain, pelvic misalignment, or diastasis recti (to name a few potential post-partum conditions). If you think that your pelvic musculoskeletal system is in need of attention after the stressors of labor and delivery or if you can relate to any of the aforementioned symptoms, please speak to your physician about a referral to pelvic floor physical therapy. I would love to have the opportunity to help you!