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Water beds for babies?
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Two types of waterbeds were developed to impart compensatory vestibular-proprioceptive stimulation to premature infants. Twenty-one infants ranging in gestational age from 27 to 34 weeks and birthweights from 1,050 to 1,920 gm were included in this pilot study. Assignment to experimental and control groups was made by random design. The experimental group consisted of ten infants who were placed on a gently oscillating waterbed before the sixth postnatal day, where they remained for seven days. Their clinical progress was compared with that of a control group of 11 similar babies. Waterbed flotation was found to be a safe procedure; there was no significant effects on the infants' vital signs, weight, or frequency of emesis. Highly significant differences were found in the incidence of apnea between the two groups, with infants on the oscillating waterbed having significantly fewer apneic spells. Infants placed on the waterbed during the first four postnatal days benefited more than those placed later. A non-oscillating waterbed was found clinically useful for very small prematures with severe skin problems, for infants recovering from abdominal surgery, and for infants receiving parenteral nutrition.
The purpose of this study was to determine whether waterbeds enhance preterm infants' sleep and reduce irritability, and whether plain, continuously, or intermittently oscillating waterbeds are differentially effective in producing these effects. The baseline states and motility of 52 stable preterm infants were assessed on two consecutive days for 100 minutes each. The infants then were randomly assigned to four groups: a control group who remained on the incubator mattress, or to one of the three experimental groups, each using a different waterbed. On days 3 and 4 in the assigned test condition, the infants' states and motility were again assessed for 100 minutes each day. The results indicate that, compared with infants in the control group, infants assigned to any of the waterbed groups slept significantly more and better, had significantly fewer unsmooth movements, state changes, and transitional states, and were significantly less irritable. Differential treatment effects were found, with infants on continuously oscillating waterbeds showing the most marked reductions in irritability, restlessness, state changes, and unsmooth movements. Thus, to enhance restful sleep and to reduce irritability and/or restlessness, it would be clinically advantageous to use waterbeds in the care of preterm infants. Since even the simple, nonoscillating waterbed improved sleep and reduced restlessness, the use of these beds would be the least costly to achieve these effects.
This paper reports the results of an intervention study which assessed the effects of compensatory vestibular-proprioceptive stimulation provided by waterbed flotation on the neurobehavioral development of preterm infants. The subjects, who were randomly assigned to experimental and control groups before they were four days old, consisted of infants who were on ventilators for severe RDS. Twenty infants were tested with a new neurobehavioral assessment procedure when they were between 34 and 35 weeks conceptional age. The examiner, a pediatric neurologist, was unaware of the group status of the subjects he examined. The results showed that infants in the experimental group performed significantly better in attending and pursuing animate and inanimate visual and auditory stimuli, demonstrated more mature spontaneous motor behavior, showed significantly fewer signs of irritability and/or hypertonicity and were more than twice as often in th visually alert, inactive state. The assessment procedure, which can be used for longitudinal evaluation of infants ranging between 24 and 36 weeks conceptional age, shows promise of becoming generally useful as a research instrument. Our preliminary results show that the procedure discriminated between an experimental and control group, that inter-observer reliability was readily established and that test-retest reliability is very high in a number of important areas of neurobehavioral functioning.
Prevention of excessive heat loss is fundamental to survival of low birthweight (LBW) newborns. The use of infant incubators (INC) is beyond the resources of developing countries, and the space-heated room (SHR) has been the only feasible means of providing thermal protection to LBW newborns. Recently a thermostatically controlled, heated, water-filled mattress (HWM) has been developed as a potentially simpler and affordable alternative.
In a neonatal care ward of a referral hospital in Addis Ababa, 62 < 1 week old newborns, weighing 1000-1999 g, who were well enough to breathe comfortably in room air and tolerate oral feeds, were randomly allocated to INC, HWM or SHR and followed for 3 weeks. The level of cold stress as assessed by core-to-skin temperature gradient and the rate of weight gain were the main outcome measures.
The level of cold stress was lowest in the INC, intermediate in the HWM and highest in the SHR. Relative to the INC group, the HWM group exhibited a modest increase in the occurrence of clinically important hyperthermic or hypothermic deviations in core temperature (rate ratio (RR) = 2.3; 95% CI: 0.9, 5.6), and the SHR displayed a definite increase (RR = 4.0; 95% CI: 1.7, 9.3). During the first week, the rate of weight gain was highest in the INC group (3.6 g/kg/day), lowest in the SHR group (-2.3 g/kg/day, P < 0.05 versus INC) and intermediate in the HWM group (1.6 g/kg/day, P > 0.1 versus INC).
Care in the SHR produced clinically significant thermal stresses and was associated with deficient early neonatal growth, but the use of HWM may constitute a feasible and clinically acceptable alternative in providing warmth to LBW newborns during the neonatal period.
One hundred and seven infants aged < 32 weeks of gestation were stratified according to birthweight and randomly assigned to either a waterbed group (N = 53) or a mattress group (N = 54). All the infants were assessed on removal from the surface: 68 infants at 40 weeks gestation and 52 infants at four, eight, 12 and 18 months adjusted age. At the 18‐month assessment, outcome was classified as normal, suspicious or abnormal. There were no significant differences between the groups any age. The results suggest that the use of the waterbed as a positional surface in the neonatal intensive‐care unit has no influence on the motor development of very low‐birthweight infants.
RÉSUMÉ
Effets de matelas hydriques chez les nourrissons de tres faibte poids de naissance sur le développement neuro‐musculaire
Sélectionnés en fonction du poids de naissance, 107 nourrissons nés à moins de 32 semaines de gestation ont été répartis au hasard dans un groupe reposant sur un matelas hydrique (N = 53) ou sur un matelas traditionnel (N ‐ 54). Tous les nourrissons ont étéévalues en dehors de la surface de repos habituelle: 68 nourrissons à 40 semaines d'âge conceptuel et 52 nourrissons a quatre, huit, 12 et 18 mois d'âge ajusté. A l'evaluation des 18 mois, le développement fut classé comme normal, douteux ou anormal. II n'y eu pas de différence significative entre les groupes à aucun âge. Les résultats suggèArent que l'utilisation d'un matelas hydrique comme surface de support dans une unité de soins intensifs neo‐nataux n'a pas d'influence sur le développement moteur des nourrissons de très faible poids de naissance.
ZUSAMMENFASSUNG
Die Verwendung von Wasserbetten für Frühgeborene mil sehr niedrigem Geburtsgewicht: Einfhtß auf die neuromotorische Entwicklung
107 Neugeborcne mil einem Gestationsalter <32 Wochen wurden nach ihrem Geburtsgewicht eingeteilt und willkürlich einer Wasserbettgruppe (N = 53) oder einer Matratzengruppe (N = 54) zugeteilt. Alle Kinder wurden zu verschiedenen Zeiten untersucht, 68 mit einem Gestationsalter von 40 Wochen und 52 mit vier, acht, 12 und 18 Monaten. Bei der Untersuchung mit 18 Monaten wurde de Outcome als normal, ungewiß oder abnorm eingestuft. In keiner Altersstufe fand sich zwischen den Gruppen ein signifikanter Unterschied. Die Ergebnisse lassen vermuten, daß die Verwendung von Wasserbetten in der Ncugeborenen‐Intensivstation keinen Einfluß auf die motorische Entwicklung bei Frühgeborenen mit sehr niedrigem Geburtsgewicht hat.
RESUMEN
Uso de las catnas de agua en lactantes de muy bajo peso al nacer. Su efecto sobre el desarrollo neuromotor
Ciento siete lactantes de menos de 32 semanas de edad gestacional fueron estratificados de acuerdo con el peso al nacer y asignados al azar a un grupo de cama de agua (N = 53) o a uno con colchón (N = 54). Todos los niños fueron evaluados al ser retirados de la superficie correspondiente: 68 a las 44 semanas de gestacion y 52 a los cuatro, ocho, 12 y 18 meses de edad ajustada. En la evaluateón de los 18 meses, el curso se clasifico en normal, sospechoso y anormal. No hubo diferencias significativas entre los grupos a ninguna edad. Los resultados sugieren que el uso de la cama de agua como superficie posicional en la unidad de cura intensiva neonatal, no tiene ninguna influencia sobre el desarrollo motor en los niños con muy bajo peso al nacer.
To evaluate the thermal responses and weight gain in preterm infants nursed in a cot on a heated, water-filled mattress (HWM) compared with infants receiving care in an air-heated incubator and to compare mothers' stress, anxiety levels and perceptions of their infants in the two groups.
Stable preterm infants weighing 1300 to 1500 g were enrolled, being randomly allocated to either the study group (n = 41) receiving care in a cot on an HWM, or the control group (n = 33) receiving incubator care. The mean daily body temperature and episodes of cold stress and hyperthermia were recorded. Weight gain (g kg(-1) body weight d(-1)) was also calculated. The mothers completed questionnaires on their perceptions of their infants, and their anxiety and stress levels before randomization, and 2-3 wk later during the trial.
The mean body temperature was similar for the first week of the trial (study group 36.9 degrees C vs controls 36.9 degrees C). There were no significant differences in the incidence of cold stress, while more hyperthermic episodes were seen in the study group (p = 0.03). There were no significant differences in weight gain during the first (study group 21.4 g vs controls 19.6 g) or second weeks of the trial (study group 20.5 g vs controls 19.2 g). Neonatal morbidity did not differ between the groups. There were no differences in mothers' perceptions of their babies, or feelings of stress or anxiety.
There were no differences between infants cot-nursed on an HWM and those receiving incubator care, with the exception of episodes of high temperature. The results suggest that the HWM may be used safely for low-weight preterm infants.