Biomedical subjects

Heidelise Als

Publications and source records attributed to Heidelise Als.

4 recordsLinked to original sources

PubMed2005

The Assessment of Preterm Infants' Behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants.

The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological-evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous interaction with the environment. The subsystems of functioning assessed include the autonomic (respiration, digestion, color), motor (tone, movement, postures), state organization (range, robustness, transition patterns), attention (robustness, transitions), and self-regulation (effort, success) systems as well as the degree of facilitation required to support reorganization and subsystem balance. The environment is represented by a sequence of distal, proximal, tactile, and vestibular challenges, derived from the BNBAS. The APIB conceptualizes infant competence as the degree of differentiation of subsystem function and degree of modulation of subsystem balance at any stage in infant development. Infants are understood as actively seeking their next differentiation, while counting on good enough environments to assure progressing developmental competence. In the case of interference such as premature birth, the mismatch of expectation and actual experience causes misalignment, which may become developmentally costly. The assessment is a finely tuned dialogue between examiner and infant, which requires training, skill and self-knowledge. The APIB has well established inter-rater-reliability, concurrent and construct validity, and is clinically relevant for behavioral intervention and individually appropriate and supportive care.

Brain↗

PubMed2004

Early experience alters brain function and structure.

OBJECTIVE: To investigate the effects of early experience on brain function and structure. METHODS: A randomized clinical trial tested the neurodevelopmental effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Thirty preterm infants, 28 to 33 weeks' gestational age (GA) at birth and free of known developmental risk factors, participated in the trial. NIDCAP was initiated within 72 hours of intensive care unit admission and continued to the age of 2 weeks, corrected for prematurity. Control (14) and experimental (16) infants were assessed at 2 weeks' and 9 months' corrected age on health status, growth, and neurobehavior, and at 2 weeks' corrected age additionally on electroencephalogram spectral coherence, magnetic resonance diffusion tensor imaging, and measurements of transverse relaxation time. RESULTS: The groups were medically and demographically comparable before as well as after the treatment. However, the experimental group showed significantly better neurobehavioral functioning, increased coherence between frontal and a broad spectrum of mainly occipital brain regions, and higher relative anisotropy in left internal capsule, with a trend for right internal capsule and frontal white matter. Transverse relaxation time showed no difference. Behavioral function was improved also at 9 months' corrected age. The relationship among the 3 neurodevelopmental domains was significant. The results indicated consistently better function and more mature fiber structure for experimental infants compared with their controls. CONCLUSIONS: This is the first in vivo evidence of enhanced brain function and structure due to the NIDCAP. The study demonstrates that quality of experience before term may influence brain development significantly.

Brain↗

PubMed2003

A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects.

Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospitalization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

Caregivers↗

PubMed2003

Infant EEG spectral coherence data during quiet sleep: unrestricted principal components analysis--relation of factors to gestational age, medical risk, and neurobehavioral status.

EEG spectral coherence data in quiet sleep of 312 infants were evaluated, at 42 weeks post-menstrual age. All were medically healthy and living at home by time of evaluation. The sample consisted of prematurely bom infants with a wide spectrum of underlying risk factors, as well as healthy full-term infants. Initial 3040 coherence variables were reduced by principal components analysis in an unrestricted manner, which avoided the folding of spectral and spatial information into among-subject variance. One hundred fifty factors explained 90% of the total variance; 40 Varimax rotated factors explained 65% of the variance yielding a 50:1 data reduction. Factor loading patterns ranged from multiple spectral bands for a single electrode pair to multiple electrode pairs for a single spectral band and all intermediate possibilities. Simple left-right and anterior-posterior pairings were not observed within the factor loadings. By multiple regression analysis, the 40 factors significantly predicted gestational age at birth. By canonical correlation, significant relationships were demonstrated between the coherence factors and medical risk factors as well as neurobehavioral factors. Using discriminant analysis, the coherence factors successfully discriminated between infants with high and low medical risk status and between those with the best and worst neurobehavioral status. The two factors accounting for the most variance, and chosen across several analyses, indicated increased left central-temporal coherence from 6-24 Hz, and increased frontal-occipital coherence at 10 Hz, for the infants born closest to term with lowest medical risk factors and best neurobehavioral performance.

Electroencephalography↗