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Applied Longitudinal Data Analysis Modeling Change And Event Occurrence

Necrotizing enterocolitis (NEC) is a disease affecting premature infants with potentially devastating complications in the neonatal intensive care unit (NICU). Inadequate knowledge regarding the underlying pathophysiology of this disease has contributed to the minimal progress made in decreasing the incidence and severity of NEC. Because of an improved survival rate of the most immature infants, the number of diagnosed cases of NEC is anticipated to increase. Unfortunately, decades of research have failed to reduce the risk or improve the prognosis of NEC, magnifying the need for risk-reduction strategies for decreasing significant NEC-related morbidity and mortality. Advancements in our understanding of this disease process have facilitated the development of several strategies that have been investigated in the risk reduction of NEC. This article discusses the pathophysiology and causes of NEC and presents strategies investigated regarding risk reduction of this devastating disease.

Necrotizing enterocolitis: have we made any progress in reducing the risk?

Music therapy in the Neonatal Intensive Care Unit (NICU) is a young but globally expanding field of interdisciplinary interest. This integrative review provides a comprehensive as well as method-overriding, interdisciplinary critical overview of empirical results on music therapy with premature infants and their parents in neonatal care covering evidence from 43 articles between 1970 and 2010. The research outcomes illustrate that music therapy seems to be beneficial for premature infants, especially in terms of pacification and stabilization. It also emphasizes that the premature infants' perceptive faculties and capabilities are actively engaged in music therapy to a greater extent than has been recognized in the literature thus far. However, some authors caution against the potential danger of over stimulating the premature infant and therefore recommend professional use of music therapy and general awareness in this sensible field. So far, research has predominantly focused on the short-term influence...

http://www.muzikoterapeuti.hr/wp-content/uploads/2013/11/Music-therapy-for-premature-infants-and-their-parents.pdf

Music therapy for premature infants and their parents: an integrative review

OBJECTIVES: Recorded music risks overstimulation in NICUs. The live elements of music such as rhythm, breath, and parent-preferred lullabies may affect physiologic function (eg, heart and respiratory rates, O 2 saturation levels, and activity levels) and developmental function (eg, sleep, feeding behavior, and weight gain) in premature infants. METHODS: A randomized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome, clinical sepsis, and/or SGA (small for gestational age) served as their own controls in 11 NICUs. Infants received 3 interventions per week within a 2-week period, when data of physiologic and developmental domains were collected before, during, and after the interventions or no interventions and daily during a 2-week period. RESULTS: Three live music interventions showed changes in heart rate interactive with time. Lower heart rates occurred during the lullaby ( P P = .04). Sucking behavior showed differences with rhythm sound interventions ( P = .03). Entrained breath sounds rendered lower heart rates after the intervention ( P = .04) and differences in sleep patterns ( P P = .01) and sucking behavior ( P = .02) were higher with parent-preferred lullabies. Music decreased parental stress perception ( P CONCLUSIONS: The informed, intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function. Entrained with a premature infant’s observed vital signs, sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet–alert states. Parent-preferred lullabies, sung live, can enhance bonding, thus decreasing the stress parents associate with premature infant care.

https://pediatrics.aappublications.org/content/pediatrics/early/2013/04/10/peds.2012-1367.full.pdf

The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants

To support effective exploration, it is often stated that interactive visualizations should provide rapid response times. However, the effects of interactive latency on the process and outcomes of exploratory visual analysis have not been systematically studied. We present an experiment measuring user behavior and knowledge discovery with interactive visualizations under varying latency conditions. We observe that an additional delay of 500ms incurs significant costs, decreasing user activity and data set coverage. Analyzing verbal data from think-aloud protocols, we find that increased latency reduces the rate at which users make observations, draw generalizations and generate hypotheses. Moreover, we note interaction effects in which initial exposure to higher latencies leads to subsequently reduced performance in a low-latency setting. Overall, increased latency causes users to shift exploration strategy, in turn affecting performance. We discuss how these results can inform the design of interactive analysis tools.

https://idl.cs.washington.edu/files/2014-Latency-InfoVis.pdf

The Effects of Interactive Latency on Exploratory Visual Analysis

Longitudinal methods are the methods of choice for researchers who view their phenomena of interest as dynamic. Although statistical methods have remained largely fixed in a linear view of biology and behavior, more recent methods, such as the general linear mixed model (mixed model), can be used to analyze dynamic phenomena that are often of interest to nurses. Two strengths of the mixed model are (1) the ability to accommodate missing data points often encountered in longitudinal datasets and (2) the ability to model nonlinear, individual characteristics. The purpose of this article is to demonstrate the advantages of using the mixed model for analyzing nonlinear, longitudinal datasets with multiple missing data points by comparing the mixed model to the widely used repeated measures ANOVA using an experimental set of data. The decision-making steps in analyzing the data using both the mixed model and the repeated measures ANOVA are described.

A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points.

Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study

Background: Feeding breastmilk to premature infants decreases morbidity but is often limited owing to an insufficient milk supply and delayed attainment of lactogenesis stage II. Early initiation of milk expression following delivery has been shown to increase milk production in mothers of very low-birth-weight (VLBW) infants. Although recommendations for milk expression in this population include initiation within 6 hours following delivery, little evidence exists to support these guidelines. This study compared milk volume and timing of lactogenesis stage II in mothers of VLBW infants who initiated milk expression within 6 hours following delivery versus those who initiated expression after 6 hours. Subjects and Methods: Forty mothers of VLBW infants were grouped according to when they initiated milk expression following delivery. Group I began milk expression within 6 hours, and Group II began expression after 6 hours. Milk volume was measured daily for the first 7 days and on Days 21 and 42. ...

Association of Timing of Initiation of Breastmilk Expression on Milk Volume and Timing of Lactogenesis Stage II Among Mothers of Very Low-Birth-Weight Infants

PURPOSE Elevated sound levels in the NICU may contribute to undesirable physiologic and behavioral effects in preterm infants. This study describes sound levels in a busy NICU in the southeastern U.S. and compares the findings with recommended NICU noise level standards. DESIGN NICU sound levels were recorded continuously at nine different locations within the NICU. Hourly measurements of loudness equivalent (Leq) sound level, sound level exceeded 10 percent of the time (L10), and maximum sound level (Lmax) were determined. SAMPLE Sound levels were sampled from nine different locations within the NICU. MAIN OUTCOME VARIABLE Sound levels are described using the hourly, A-weighted Leq, L10, and Lmax. RESULTS The overall average hourly Leq (M = 60.44 dB, range = 55-68 dB), L10 (M = 59.26 dB, range = 55-66 dB), and Lmax (M = 78.39, range = 69-93 dB) were often above the recommended sound levels (hourly Leq <50 dB, L10 <55 dB, and 1-second Lmax <70 dB). In addition, certain times of day, such as 6-7 AM and 10 AM-12 noon, were noisier than other times of day.

Elevated sound levels within a busy NICU.

This study explored effects of exposure to maternal voice on short-term outcomes in very low birth weight preterm infants cared for within an neonatal intensive care unit (NICU) without an ongoing program of developmental care. Using a comparative design, 53 infants born during their 27th to 28th postmenstrual week were sampled by convenience. Experimental groups were exposed to maternal voice during two developmental time periods. Group 1 listened to a recording of their mothers reciting a rhyme from 28 to 34 postmenstrual weeks. Group 2 waited 4 weeks and heard the recording from 32 to 34 weeks. The control group received routine care. The primary analysis of combined experimental groups compared to the control group revealed that the experimental infants experienced significantly fewer episodes of feeding intolerance and achieved full enteral feeds quicker compared to the control group. Further, in an analysis evaluating all three groups separately, it was noted that Group 1 experienced significantly fewer episodes of feeding intolerance compared to the control group. Study findings warrant further investigation of exposure to maternal voice and the developmental timing at which exposure is begun.

/pdf/maternal-voice-and-short-term-outcomes-in-preterm-infants-1gn37s02y7.pdf

Charlene Krueger

Papers

A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points.

Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study

Association of Timing of Initiation of Breastmilk Expression on Milk Volume and Timing of Lactogenesis Stage II Among Mothers of Very Low-Birth-Weight Infants

Elevated sound levels within a busy NICU.

Maternal voice and short‐term outcomes in preterm infants