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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 January 1, 1995 - last reviewed on June 9, 2016
Preemies
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
