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Biomedical subjects

H Als

Publications and source records attributed to H Als.

At least 19 recordsLinked to original sources
PubMed2004

Prolonged T*2 values in newborn versus adult brain: Implications for fMRI studies of newborns.

The neonatal brain possesses higher water content, lower macromolecular concentration, and reduced synaptic density than is found in the brain of a 1-year-old child. Changes in MRI characteristics of brain such as relaxation times accompany rapid changes in brain during early postnatal development. It was hypothesized that T(*)(2) values found in newborns would be significantly higher than those found in 9-month-old children and adults as measured at 1.5 T. Spoiled gradient echo measurements of T(*)(2) within the brains of newborns, 9-month-olds, and adults confirmed this hypothesis. The results have implications with regard to functional MRI studies in newborns since, in general, BOLD signal optimization is achieved when echo times TE are set equal to the T(*)(2) values of the tissue of interest. Since significantly longer T(*)(2) values are found in newborns, it is suggested that the TE values employed for fMRI studies of newborns should be increased to maximize BOLD signal intensity changes and improve the overall reliability of fMRI results in newborns.

Adult↗
PubMed2000

Neurobehavioral functioning of healthy preterm infants of varying gestational ages.

Little information is available regarding the behavioral repertoire of healthy, yet prematurely born, infants. To address this problem, the Assessment of Preterm Infants' Behavior (APIB) was used 10 to 14 days after birth in a cross-sectional comparison of 42 healthy newborn infants: 16 full-term infants (gestational age at birth [GA] = 40 weeks), 13 close to full-term infants (GA = 37 weeks), and 13 preterm infants (GA = 34 weeks). Groups differed on four background variables that were used as covariates in subsequent analyses. Significant group differences were found on 12 of 29 outcome variables, including measures of autonomic, motor, state, attention/interaction, and self-regulatory systems, as well as a measure of overall behavioral organization. Pairwise comparison showed that preterm and full-term infants differed on all 12 variables whereas preterm and close to full-term infants differed on 11 of the 12 variables. Furthermore, full-term and close to full-term infants differed on 4 of the 12 variables, including measures of the autonomic, motor, and state systems. Full-term and close to full-term infants were behaviorally more similar to one another than either group was to the preterm infants, yet there were important differences even between full-term and close to full-term infants.

Cross-Sectional Studies↗
PubMed1998

Developmental care in the newborn intensive care unit.

Developmental care is a framework that encompasses all care procedures as well as social and physical aspects in the newborn intensive care unit. Its goal is to support each individual infant to be as stable, well-organized, and competent as possible. The infant's physiologic and behavioral expression of current functioning is seen as the reliably available guide for caregivers to estimate the infant's current strengths, vulnerabilities, and thresholds to disorganization; to identify the infant's own strategies and efforts in collaborating toward best progress; and to implement care in a way that enhances the infant's stability and competence. The family is understood to be the infant's primary coregulator. It is the caregivers' responsibility to maximize opportunities to enhance each infant's and family's strengths and reduce apparent stressors. Studies of the effectiveness of developmental care also identify implications for staff education and challenges for nursery-wide implementation.

Caregivers↗
PubMed1997

The role of relationship-based developmentally supportive newborn intensive care in strengthening outcome of preterm infants.

This article details the conceptual framework, clinical application, and efficacy of a relationship-based developmentally supportive approach to newborn intensive care referred to as NIDCAP (Newborn Individualized Developmental Care and Assessment Program). Outcomes of the approach are reported in regard to infant health and development, reduction of hospital costs, and family adaptation. The approach is guided by a neurodevelopmental framework for understanding preterm infants and depends on the capacities of professionals to collaborate with one another and with families in support of the infants' medical, developmental, and emotional well-being. The primary vehicle for clinical implementation is detailed behavioral observation with subsequent recommendations for individualized caregiving based on the infant's current functioning and apparent developmental goals. A series of essential components of developmentally oriented caregiving are described, including strategies for coordinated discharge planning, and linkage to community services. The voices of individual clinicians highlight the process of change from protocol-based to relationship-based care.

Adaptation, Psychological↗
PubMed1996

Effectiveness of individualized neurodevelopmental care in the newborn intensive care unit (NICU).

The individual infant's neurodevelopmental process provides an integrative framework for the delivery of medical care needed to assure the infant's survival and quality of outcome. The infant's neurobehavioral functioning and expression provides an opportunity for caregivers to estimate the individual infant's current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infant's strategies in collaborating in his or her best progression. This perspective supports caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infant's strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neurodevelopment approach to NICU care will be presented, and suggest implications for staff education and nursery-wide implementation.

Brain↗
PubMed1995

Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence.

OBJECTIVE: We assessed the effectiveness of individualized developmental support in the special care nursery for low-risk preterm infants. SETTING: A university-affiliated teaching hospital. PARTICIPANTS: Twelve healthy full-term infants, and 24 low-risk preterm infants randomly assigned to a control or an experimental group. DESIGN: The preterm control group received standard care and the preterm experimental group received individualized developmental care at the same special care nursery. OUTCOME MEASURES: Medical, behavioral (Assessment of Preterm Infants' Behavior and Prechtl's Neurological Examination of the Full-Term Newborn Infant), and electrophysiologic outcome (using quantitative electroencephalography with topographic mapping) of all three groups was assessed 2 weeks after the expected due date. RESULTS: No between- or among-group medical differences were seen for this low-risk, healthy sample. The preterm experimental group showed behavioral and electrophysiologic performances comparable to those of the full-term group, whereas the preterm control group performed significantly less well. Behavioral measures suggested significantly poorer attentional functioning for the preterm control group. Electrophysiologic results implicated the frontal lobe. CONCLUSIONS: Individualized developmental intervention supports neurobehavioral functioning as measured at 2 weeks post-term. It appears to prevent frontal lobe and attentional difficulties in the newborn period, the possible causes of behavioral and scholastic disabilities often seen in low-risk preterm infants at later ages.

Child Development↗
PubMed1994

Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects.

OBJECTIVE: To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants. DESIGN: Randomized controlled trial. SETTING: Newborn intensive care unit. PATIENTS: Thirty-eight singleton preterm infants, free of known congenital abnormalities, weighing less than 1250 g, born before 30 weeks' gestation, mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours, randomly assigned to a control or an experimental group. INTERVENTION: Caregiving by nurses specifically trained in individualized developmental care; observation and documentation of the infants' behavior within 12 hours of admission, and subsequently every 10th day; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists; and the availability of special caregiving accessories. MAIN OUTCOME MEASURES: Medical outcome, including average daily weight gain; number of days the infant required mechanical ventilation, oxygen, gavage tube feeding, and hospitalization; severity of retinopathy of prematurity, bronchopulmonary dysplasia, pneumothorax, and intraventricular hemorrhage; pediatric complications; age at discharge; and hospital charges. Neurodevelopmental outcome, including Assessment of Preterm Infants' Behavior scale and quantified electroencephalography (2 weeks after due date); and Bayley Scales of Infant Development and Kangaroo Box Paradigm (9 months after due date). RESULTS: The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support; earlier oral feeding; reduced incidence of intraventricular hemorrhage, pneumothorax, and severe bronchopulmonary dysplasia; improved daily weight gain; shorter hospital stays; younger ages at hospital discharge; and reduced hospital charges compared with the infants in the control group. At 2 weeks after their due dates, these infants also showed improved autonomic regulation, motor system functioning, self-regulatory abilities, and visual evoked potential measures; and at 9 months, they had improved Bayley Mental and Psychomotor Developmental Index scores, as well as Kangaroo Box Paradigm scores. CONCLUSION: Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome.

Child Development↗
PubMed1994

The influence of neonatal intensive care unit caregiving practices on motor functioning of preterm infants.

OBJECTIVES: Experimental design intervention studies have demonstrated that a model of individualized developmental care based on specific behavioral observation improves medical and behavioral outcome for very small preterm infants. It is proposed that infants who were not directly involved in an experimental intervention study per se, but were patients in a neonatal intensive care unit (NICU) where such studies took place and the model was adopted as the standard of care, demonstrate some of the same benefits as the infants in the experimental study. METHOD: The study was a retrospective descriptive analysis of an existing data set. The functioning of two cohorts of infants, comparable medically and demographically and cared for in an NICU where developmental care research was conducted and subsequently adopted as the standard of care, was measured after discharge with the Assessment of Preterm Infants' Behavior (APIB). Cohort I was cared for before the first study of individualized developmental care in the NICU; Cohort II was cared for after the individualized developmental care approach was adopted as the standard of care for the NICU. RESULTS: Cohort II infants demonstrated better scores than Cohort I infants on 8 out of 23 summary variables, 6 of which reflect improved motor functioning. They also showed significantly better scores on 7 of the 17 specific motor variables of the APIB. CONCLUSION: Infants cared for in an NICU with an individualized developmental care approach showed improved motor system functioning compared to infants cared for in the same NICU before the approach was adopted. It is speculated that the individualized developmental approach to care based in the synactive theory of development contributed to the documented improvements. This finding would indicate that functioning of preterm infants, particularly in terms of their motor systems, can be influenced by modification in caregiving.

Cohort Studies↗
PubMed1993

Brain electrical correlates of psychological measures: strategies and problems.

We explore relationships between brain electrical activity and cognitive performance where qEEG data are correlated with psychological variables gathered at a different time. For a population of 202 healthy adults using univariate and multivariate correlation techniques in a split half replication design, we confirm prior findings that subjects with better psychological scores show shorter evoked potential (EP) latency, suggesting that speed of processing is an important factor in cognitive performance. By canonical correlation we demonstrate a consistent, replicable relationship between electrophysiological and behavioral data. We suggest that reliance upon univariate correlation may have fueled early controversies about relationships between electrophysiology and IQ. In addition we correlate psychological factors with the entire qEEG data set (both EP and spectral analyzed EEG) and demonstrate the use a multidimensional image graphics techniques to assist in visual assessment of the resulting correlation matrices.

Adult↗
PubMed1991

Neurobehavioral organization of the newborn: opportunity for assessment and intervention.

A functional model has been formulated that attempts to specify the behavioral subsystems of functioning that exemplify in their respective interplay an infant's individuality of behavioral functioning in the manner in which they move from stable to disorganized functioning and in the flexibility with which they maintain organized functioning in the face of varied exogenous and endogenous events. Based on this model, Als and colleagues have attempted to develop systematic assessments, the APIB and the K-Box Paradigm, to quantify the degree of differentiation and modulation of these behaviorally defined subsystems of functioning. It is hypothesized that the differences documented via these assessments are brain based (i.e., part of the child's biological makeup, which is influenced by the intrauterine and extrauterine environment, be it sensory and/or drug exposure, and which shows a recognizable pattern along a definable trajectory).

Behavior↗
PubMed1990

Quantified neurophysiology with mapping: statistical inference, exploratory and confirmatory data analysis.

Topographic mapping of brain electrical activity has become a commonly used method in the clinical as well as research laboratory. To enhance analytic power and accuracy, mapping applications often involve statistical paradigms for the detection of abnormality or difference. Because mapping studies involve many measurements and variables, the appearance of a large data dimensionality may be created. If abnormality is sought by statistical mapping procedures and if the many variables are uncorrelated, certain positive findings could be attributable to chance. To protect against this undesirable possibility we advocate the replication of initial findings on independent data sets. Statistical difference attributable to chance will not replicate, whereas real difference will reproduce. Clinical studies must, therefore, provide for repeat measurements and research studies must involve analysis of second populations. Furthermore, Principal Components Analysis can be employed to demonstrate that variables derived from mapping studies are highly intercorrelated and data dimensionality substantially less than the total number of variables initially created. This reduces the likelihood of capitalization on chance. The need to constrain alpha levels is not necessary when dimensionality is low and/or a second data set is available. When only one data set is available in research applications, techniques such as the Bonferroni correction, the "leave-one-out" method, and Descriptive Data Analysis (DDA) are available. These techniques are discussed, clinical and research examples are given, and differences between Exploratory (EDA) and Confirmatory Data Analysis (EDA) are reviewed.

Brain↗
PubMed1990

Behavioral and electrophysiological evidence for gestational age effects in healthy preterm and fullterm infants studied two weeks after expected due date.

We investigated the effects of gestational age at birth on behavioral and electrophysiological measures of 135 medically healthy infants, studied at 42 weeks postconception, and stratified into 3 groups--early-born preterms, 26-32 weeks (n = 55); middle-group preterms, 33-37 weeks (n = 43); and fullterms, 38-41 weeks (n = 37). Subjects were studied behaviorally with the Assessment of Preterm Infants' Behavior (APIB) and electrophysiologically with brain electrical activity mapping (BEAM). Fullterms showed significantly better behavioral function than both preterm groups. Less difference was found between the preterm groups. EEG spectral and photic evoked response were of significantly less amplitude for the preterms than the fullterms. Path analysis showed gestational age effects on behavioral (3 of 6) and electrophysiological (13 of 17) variables due to postnatal complications. We conclude that some differences attributable to gestational age at birth are explained by the cumulative effect of minor but unavoidable complications associated with premature birth. We speculate that remaining effects may result from developmentally inappropriate sensorimotor stimulation consequent to the premature experience of an extrauterine environment.

Arousal↗
PubMed1990

Imaging procedures and developmental outcomes in the neonatal intensive care unit.

Behavioural and environmental modification techniques in the neonatal intensive care unit for oxygen-dependent premature infants with chronic lung disease have been shown to result in a decrease in the number of days of respirator support and number of days of supplemental oxygen therapy. Long-term neurodevelopment outcome was significantly better for infants in the experimental therapy group who received specialized environmental modification to decrease stressful stimuli. We present results of cranial ultrasound and chest radiograph studies in this very high-risk population and suggest that such studies represent additional stressful stimuli that should be scheduled with consideration of an overall behavioral infant care plan.

Bronchopulmonary Dysplasia↗
PubMed1986

Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: neonatal intensive care unit and developmental outcome.

We hypothesize that the respiratory and functional states of the very low birth weight infant with bronchopulmonary dysplasia can be improved in the neonatal intensive care unit by prevention of inappropriate sensory input. To test this hypothesis, we developed for preterm newborns a behavior observation method that catalogues specific reaction patterns according to putative stress and relaxation behaviors. We then collected behavioral information and heart rate, respiratory rate, and transcutaneous PO2 readings before, during, and after routine care-giving interventions. Eight control and eight experimental infants were selected for study based on the following criteria: birth weight less than 1,250 g, gestational age less than 28 weeks, on the respirator greater than 24 hours in first 48 hours of life at greater than or equal to 0.60 FiO2 for more than two hours during first 48 hours of life. Additionally, the two groups were comparable on other medical and demographic variables, including severity of respiratory status for the first ten days and incidence of intraventricular hemorrhage, patent ductus arteriosus, and socioeconomic status. Systematic observations were conducted on days 10, 20, and 30 after birth and at 36 and 40 weeks postconception. For the intervention infants, our observations were discussed with the infants' primary nurses, and individualized modifications for each infant's care plan were implemented based on these observations. Experimental infants showed significantly briefer stays on the respirator (P less than .01) and in increased FiO2 (P less than .05). Their feeding behavior was normalized significantly earlier (P less than .01). Experimental infants also showed significantly better behavioral regulation scores at 1 month after their mothers' estimated dates of confinement (post-EDC), as measured with the Assessment of Preterm Infants' Behavior, significantly better Mental and Psychomotor Developmental Indices at 3, 6, and 9 months post-EDC, as measured with the Bayley Scales of Infant Development, and significantly better behavioral regulation scores at 9 months post-EDC, as measured in a videotaped play observation. Measurements of weight, height, and head circumference at 3, 6, and 9 months post-EDC showed no differences. All assessments were performed by one of two trained testers not familiar with the goals of the study or the group status of the infant. These results support the hypothesis that very low birth weight preterm babies profit significantly both medically and developmentally from individualized behavioral care in the neonatal intensive care unit.

Bronchopulmonary Dysplasia↗
PubMed1982

Regional obstetric anesthesia and newborn behavior: a reanalysis toward synergistic effects.

The Brazelton Neonatal Behavioral Assessment Scale was administered to 54 term, healthy infants on days 1, 2, 3, 4, 5, 7, and 10. Infants were divided into 8 groups of maternal obstetrical medication. A separate drug factor score was computed from 4 variables: time from (1) first and (2) last drug administration to delivery, (3) number of different drugs, and (4) drug administrations. In order to determine the additive effects of drug and other obstetric factors on neonatal behavior, the drug group and drug factor score plus length of labor, parity, and the ponderal index were used in a series of multiple regression analyses to predict Brazelton scale cluster scores on each day. In a second set of multiple regressions, these variables were used to predict the infant's rate of behavioral change as estimated by the slopes of the Brazelton scale cluster scores across the 7 days. The results indicated that the combined effect of the predictor variables significantly explained 10%-28% of the variance in neonatal behavior. It was hypothesized that the effects of low levels of medication are subtle but may be unmasked when medication effects are studied in combination with other factors that may potentiate drug effects.

Alphaprodine↗