Monitoring Infants By Automatic Video Processing

This work has, as its objective, the development of non-invasive and low-cost systems for monitoring and automatic diagnosing specific neonatal diseases by means of the analysis of suitable video signals. We focus on monitoring infants potentially at risk of diseases characterized by the presence or absence of rhythmic movements of one or more body parts. Seizures and respiratory diseases are specifically considered, but the approach is general. Seizures are defined as sudden neurological and behavioural alterations. They are age-dependent phenomena and the most common sign of central nervous system dysfunction. Neonatal seizures have onset within the 28th day of life in newborns at term and within the 44th week of conceptional age in preterm infants. Their main causes are hypoxic-ischaemic encephalopathy, intracranial haemorrhage, and sepsis. Studies indicate an incidence rate of neonatal seizures of 0.2% live births, 1.1% for preterm neonates, and 1.3% for infants weighing less than 2500 g at birth. Neonatal seizures can be classified into four main categories: clonic, tonic, myoclonic, and subtle. Seizures in newborns have to be promptly and accurately recognized in order to establish timely treatments that could avoid an increase of the underlying brain damage. Respiratory diseases related to the occurrence of apnoea episodes may be caused by cerebrovascular events. Among the wide range of causes of apnoea, besides seizures, a relevant one is Congenital Central Hypoventilation Syndrome (CCHS) \cite{Healy}. With a reported prevalence of 1 in 200,000 live births, CCHS, formerly known as Ondine's curse, is a rare life-threatening disorder characterized by a failure of the automatic control of breathing, caused by mutations in a gene classified as PHOX2B. CCHS manifests itself, in the neonatal period, with episodes of cyanosis or apnoea, especially during quiet sleep. The reported mortality rates range from 8% to 38% of newborn with genetically confirmed CCHS. Nowadays, CCHS is considered a disorder of autonomic regulation, with related risk of sudden infant death syndrome (SIDS). Currently, the standard method of diagnosis, for both diseases, is based on polysomnography, a set of sensors such as ElectroEncephaloGram (EEG) sensors, ElectroMyoGraphy (EMG) sensors, ElectroCardioGraphy (ECG) sensors, elastic belt sensors, pulse-oximeter and nasal flow-meters. This monitoring system is very expensive, time-consuming, moderately invasive and requires particularly skilled medical personnel, not always available in a Neonatal Intensive Care Unit (NICU). Therefore, automatic, real-time and non-invasive monitoring equipments able to reliably recognize these diseases would be of significant value in the NICU. A very appealing monitoring tool to automatically detect neonatal seizures or breathing disorders may be based on acquiring, through a network of sensors, e.g., a set of video cameras, the movements of the newborn's body (e.g., limbs, chest) and properly processing the relevant signals. An automatic multi-sensor system could be used to permanently monitor every patient in the NICU or specific patients at home. Furthermore, a wire-free technique may be more user-friendly and highly desirable when used with infants, in particular with newborns. This work has focused on a reliable method to estimate the periodicity in pathological movements based on the use of the Maximum Likelihood (ML) criterion. In particular, average differential luminance signals from multiple Red, Green and Blue (RGB) cameras or depth-sensor devices are extracted and the presence or absence of a significant periodicity is analysed in order to detect possible pathological conditions. The efficacy of this monitoring system has been measured on the basis of video recordings provided by the Department of Neurosciences of the University of Parma. Concerning clonic seizures, a kinematic analysis was performed to establish a relationship between neonatal seizures and human inborn pattern of quadrupedal locomotion. Moreover, we have decided to realize simulators able to replicate the symptomatic movements characteristic of the diseases under consideration. The reasons is, essentially, the opportunity to have, at any time, a 'subject' on which to test the continuously evolving detection algorithms. Finally, we have developed a smartphone App, called 'Smartphone based contactless epilepsy detector' (SmartCED), able to detect neonatal clonic seizures and warn the user about the occurrence in real-time.

Extent and nature of unlicensed and off-label medicine use in hospitalised children in Palestine

Objective of the study To determine the extent and nature of unlicensed/off-label prescribing patterns in hospitalised children in Palestine. Setting Four paediatric wards in two public health system hospitals in Palestine [Caritas children’s hospital (Medical and neonatal intensive care units) and Rafidia general hospital (Medical and surgical units)]. Method A prospective survey of drugs administered to infants and children <18 years old was carried out over a five-week period in the four paediatric wards. Main outcome measure Drug-licensing status of all prescriptions was determined according to the Palestinian Registered Product List and the Physician’s Desk Reference. Results Overall, 917 drug prescriptions were administered to 387children. Of all drug prescriptions, 528 (57.5%) were licensed for use in children; 65 (7.1%) were unlicensed; and 324 (35.3%) were used off-label. Of all children, 49.6% received off-label prescriptions, 10.1% received unlicensed medications and 8.2% received both. Seventy-two percent of off-label drugs and 66% of unlicensed drugs were prescribed for children <2 years. Multivariate analysis showed that patients who were admitted to the neonatal intensive care unit and infants aged 0–1 years were most likely to receive a greater number of off-label or unlicensed medications (OR 1.80; 95% CI 1.03–3.59 and OR 1.99; 95% CI 0.88–3.73, respectively). Conclusion The present findings confirmed the elevated prevalence of unlicensed and off-label paediatric drugs use in Palestine and strongly support the need to perform well designed clinical studies in children.

Avaliação do ganho de peso de bebês prematuros em relação ao leite materno cru e leite pasteurizado

This study aims to evaluate the weight gain of premature newborns fed with breast milk from their mothers' from those that are fed with breast milk from the milk bank. The research is the quantitative, descriptive and observational kind. It was conducted in the Neonatal Intensive Care Unit and Housing from the Maternity Hospital Escola Januário Cicco (MEJC), that is a reference for high risk pregnancy and birth in Rio Grande do Norte. The premature newborns included were following these parameters: gestational age from 26 to 37 weeks, initially hospitalized at UTIN, with oral diet, by means by gavage, cup and/or suction. Studies with premature newborns with a zero diet longer than seven days or complications that interfered in the evaluation of weight gain were excluded from this study. The sample was selected for convenience and had data of all newborns hospitalized at UTIN from the May to June of 2014 time period, followed to their discharge, ended by August of 2014 and had the inclusion parameters of the study. From the period of the data collection, 60 premature newborns entered the maternity and 39 of those were the sample of research. The project was approved by the Research Ethics Committee from UFRN, under CAAE nº 0699.0.000.294-11. The data was analyzed by means of descriptive and deduced statistics. The results indicated that the involved in the study, were born from mother with average age of 25,36 years, with less than nine years education 21 (53,8%), had the family income less than a minimum wage 24 (61,5%). Among the newborn, the female gender predominated 20 (51,3%), had cesarean delivery 25 (64,1%), had moderate prematurity 29 (74,5%), more of 1.500g 22 (556,4%). The birth weight average was 1.608,49g. The total of diets were 9.994, and an average of 256 for each newborn, in a 32,12 days of hospitalization time period. Most of the diet supplies were from the breast milk bank (50,34%), however 56,4% of the newborns had most of the diet from their mothers' milked breast milk. It was detected that 38,5% of the newborns had, in some given moment, artificial milk. The daily weight gain average of all newborns was 2,59g, but 35% of them had an average above 10g per day. From the newborn's group (n=25) that had medium weight gain, only 9 of them (36,0%) received mainly their own mothers' milked breast milk. It's been conclusive that most of the premature newborns gained weight predominantly from diets from the breast milk of the Milk Bank, showing the need of a bigger incentive to exclusive breast feeding.

The process of implementing a new baby-friendly hospital initiative for nurses: a grounded theory study

Maternity nursing practice is changing across Canada with the movement toward becoming “baby friendly.” The World Health Organization (WHO) recommends the Baby-Friendly Hospital Initiative (BFHI) as a standard of care in hospitals worldwide. Very little research has been conducted with nurses to explore the impact of the initiative on nursing practice. The purpose of this study, therefore, was to examine the process of implementing the BFHI for nurses. The study was carried out using Corbin and Strauss’s method of grounded theory. Theoretical sampling was employed, which resulted in recruiting and interviewing 13 registered nurses whose area of employment included neonatal intensive care, postpartum, and labour and delivery. The data analysis revealed a central category of resisting the BFHI. All of the nurses disagreed with some of the 10 steps to becoming a baby-friendly hospital as outlined by the WHO. Participants questioned the science and safety of aspects of the BFHI. Also, participants indicated that the implementation of this program did not substantially change their nursing practice. They empathized with new mothers and anticipated being collectively reprimanded by management should they not follow the initiative. Five conditions influenced their responses to the initiative, which were (a) an awareness of a pro-breastfeeding culture, (b) imposition of the BFHI, (c) knowledge of the health benefits of breastfeeding, (d) experiential knowledge of infant feeding, and (e) the belief in the autonomy of mothers to decide about infant feeding. The identified outcomes were moral distress and division between nurses. The study findings could guide decision making concerning the implementation of the BFHI.

Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Effects of Altered Prenatal Sensory Stimulation on Postnatal Contingency Learning in Bobwhite Quail Neonates (Colinus Virginianus)

Preterm infants are exposed to high levels of modified early sensory experience in the Neonatal Intensive Care Unit (NICU). Reports that preterm infants show deficits in contingency detection and learning when compared to full-term infants (Gekoski, Fagen, & Pearlman, 1984; Haley, Weinberg, & Grunau, 2006) suggest that their exposure to atypical amounts or types of sensory stimulation might contribute to deficits in these critical skills. Experimental modifications of sensory experience are severely limited with human fetuses and preterm infants, and previous studies with precocial bird embryos that develop in ovo have proven useful to assess the effects of modified perinatal sensory experience on subsequent perceptual and cognitive development. In the current study, I assessed whether increasing amounts of prenatal auditory or visual stimulation can interfere with quail neonates’ contingency detection and contingency learning in the days following hatching. Results revealed that augmented prenatal visual stimulation prior to hatching does not disrupt the ability of bobwhite chicks to recognize and prefer information learned in a contingent fashion, whereas augmented prenatal auditory stimulation disrupted the ability of chicks to benefit from contingently presented information. These results suggest that specific types of augmented prenatal stimulation that embryos receive during late prenatal period can impair the ability to learn and remember contingently presented information. These results provide testable developmental hypotheses, with the goal of improving the developmental care and management of preterm neonates in the NICU setting.

Compared with specialist registrars, experienced staff nurses shorten the duration of weaning neonates from mechanical ventilation

OBJECTIVE: To compare the overall performance of specially trained neonatal nurses acting autonomously, unsupervised, and without a protocol with specialist registrars when weaning neonates from mechanical ventilation.

DESIGN: Prospective, randomized, controlled trial.

SETTING: A single neonatal intensive care unit.

PATIENTS: Neonates requiring conventional mechanical ventilation (n = 50).

INTERVENTIONS: Infants on conventional ventilation were randomly assigned to receive either nurse-led (n = 25) or registrar-led (n = 23) weaning. A total of 48 infants completed the study (two infants in the registrar group were excluded when their parents withdrew consent).

MEASUREMENTS AND MAIN RESULTS: The main outcome measure, median weaning time, was 1200 mins (95% confidence interval [CI], 621-1779 mins) in the nurse group and 3015 mins (95% CI, 2650-3380 mins) in the registrar group (p = .0458). The median time from treatment assignment to the first ventilator change was 60 mins (95% CI, 52-68 mins) in the nurse group and 120 mins (95% CI, 103-137 mins) in the registrar group (p = .35). On average, the nurses made ventilator changes every 4.5 hrs (95% CI, 2.9-6 hrs) and the registrars every 7.2 hrs (95% CI, 5.4-9 hrs; p = .003). The median number (range) of backward steps taken per infant was 0 (0-5 steps) in the nurse group and 1 (0-5 steps) in the registrar group (p = .019).

CONCLUSIONS: The findings of this study suggest that additional domains of neonatal critical care could be reviewed for their potential transfer to appropriately prepared nurses.

Pediatric Nurses’ Information and Applications Related To Ethical Codes

Background: Ethics is defined as the entirety of moral principles that form the basis of individuals’ behavior; it can also be defined as “moral theory” or “theoretical ethics”. Objectives: To determinate information and applications related to ethical codes of pediatric nurses. Patients and Methods: Participants were nurses attending the Neonatal Intensive Care Unit Nursing Course and the Pediatric Nursing Course conducted in Istanbul between September 2011 and December 2012. A total of nurses attending the courses at the specified dates and who agreed to participate in the study were included in the analysis. Data were collected through a questionnaire that we developed in accordance with current literature on nursing ethics. Results: 140 nurses participated in this study. Information and applications were related to ethical codes of nurses including four categories; autonomy, beneficence, nonmaleficence, justice. The principle of confidentiality/keeping secrets. Exactly 64.3% of nurses reported having heard of nursing ethical codes. The best-known ethical code was the principle of justice. Furthermore, while the rates were generally low, some nurses engaged in unethical practices such as patient discrimination and prioritizing acquaintances. Conclusions: We conclude that most nurses working in pediatric clinics act in compliance with ethical codes. We also found that the majority of nurses wanted to learn about ethical codes. For this reason, we recommended that nurses working in clinics and future nurses in training be informed of the appropriate ethical behavior and codes.

The Effects of Instrumental Touching on Infant Pain Perception and the Effects of Eutectic Mixture of Local Anesthetics (EMLA) on the Reduction of Pain

Background: Premature infants, who have to spend the first week of their lives in neonatal intensive care units (NICUs), experience pain and stress in numerous cases, and they are exposed to many invasive interventions. The studies have shown that uncontrolled pain experienced during early life has negative and long-term side effects, such as distress, and such experiences negatively affect the development of the central nervous system Objectives: The purpose of the study was to examine the effects of touching on infant pain perception and the effects of eutectic mixture of local anesthetic (EMLA) on the reduction of pain. Patients and Methods: Data for the study were collected between March and August 2012 from the neonatal clinic of a university hospital located in eastern Turkey. The population of the study consisted of premature infants who were undergoing treatment, completed the first month and who were approved for Hepatitis B vaccine. The study consisted of two experimental groups and one control group. Information forms, intervention follow-up forms, and Premature Infant Pain Profile (PIPP) were used to collect the data. EMLA cream was applied on the vastus lateralis muscles of the first experimental group before the vaccination. The second experimental group was vaccinated by imitation (placebo), without a needle tip or medicine. Vaccination was carried out using instrumental touch in this group. A routine vaccination was applied in the control group. Results: Mean pain scores of the group to which EMLA was applied were lower in a statistically significant way (P < 0.05) compared to the pain scores of the other groups. Moreover, it was determined that even though invasive intervention was not applied to the newborns, the touching caused them to feel pain just as in the placebo group (P < 0.005). Conclusions: The results demonstrated that EMLA was an effective method for reducing pain in premature newborns, and the use of instrumental touch for invasive intervention stimulated the pain perception in the newborns.

The Role of Mucosal Defense in Intestinal Injury of Infants With Fetal Growth Retardation

Background: Infants with fetal growth retardation (FGR) are prone to intestinal disorders. Objectives: Aim of the study was to determine the role of mucosal defense ability in formation of gut injury in infants with FGR. Materials and Methods: 44 premature infants who were admitted to the Neonatal Intensive Care Unit were divided into two groups: 20 infants with FGR (FGR group) and 24 appropriate-for-gestational age newborns (AGA group). Control group consisted of 22 premature infants who were delivered after uncomplicated pregnancy. Gut barrier function was evaluated by detecting serum intestinal trefoil factor (ITF) and intestinal fatty acid binding protein (IFABP). The level of serum IFABP and ITF was measured by using ELISA method. Results: FGR group showed significantly higher ITF concentration than AGA group on the first days of life (P ˂ 0.01). High level of ITF in the FGR group significantly declines up to 7th - 10th day of life (P ˂ 0.01). This reduction was accompanied by increase of IFABP which is a marker of ischemic intestinal mucosal injury. Correlation analyses showed that ITF had a negative correlation with IFABP. Conclusions: Infants with fetal growth retardation are characterized by a high level of ITF on the first days of life. This protects intestinal mucosa under hypoxic conditions. Its subsequent decline accompanied by an increase of IFABP reflects the depletion of Goblet cells to secret ITF causing damage to the integrity of intestinal mucosal barrier.

Risk of Wheezing Attacks in Infants With Transient Tachypnea Newborns

Background: The most common reason of respiratory distress in the newborn is transient tachypnea of the newborn (TTN). There are some reports saying that TTN is associated with increased frequencies of wheezing attacks. Objectives: The aims of this study were to determine the risk factors associated with TTN and to determine the association between TTN and the development of wheezing syndromes in early life. Materials and Methods: In a historical cohort study, we recorded the characteristics of 70 infants born at the Shohadaye Kargar Hospital in Yazd between March 2005 and March 2009 and who were hospitalized because of TTN in the neonatal intensive-care unit. We called their parents at least four years after the infants were discharged from the hospital and asked about any wheezing attacks. Seventy other infants with no health problems during the newborn period were included in the study as the control group. Results: The rate of wheezing attacks in newborns with TTN was more than patients with no TTN diagnosis (P = 0.014). TTN was found to be an independent risk factor for later wheezing attacks (relative risk [RR] = 2.8). Conclusions: The most obvious finding of this study was that TTN was an independent risk factor for wheezing attacks. So long-term medical care is suggested for these patients who may be at risk, because TTN may not be as transient as has been previously thought.

Intervention éducationnelle visant à favoriser l’adaptation de la fratrie lors de l’hospitalisation de nouveau-nés prématurés à l’unité néonatale

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M. Sc.) en sciences infirmières option expertise-conseil en soins infirmiers

Intervention éducationnelle visant à favoriser l’adaptation de la fratrie lors de l’hospitalisation de nouveau-nés prématurés à l’unité néonatale

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M. Sc.) en sciences infirmières option expertise-conseil en soins infirmiers

Efeitos ventilatórios da fisioterapia respiratória com e sem hiperinsuflação manual em recém-nascidos pré-termos sob ventilação mecânica

Atualmente, os recém-nascidos nascem cada vez mais prematuros, dependendo de cuidados intensivos neonatais. Nesse sentido, a fisioterapia respiratória tem adquirido um espaço cada vez maior, e juntamente com uma equipe multidisciplinar presta assistência a esses recém-nascidos prematuros. Entre as diversas técnicas utilizadas pelos fisioterapeutas, a hiperinsuflação manual tem tido papel fundamental na remoção de secreções brônquicas. Objetivo: Avaliar os efeitos hemodinâmicos e respiratórios da fisioterapia respiratória, com ou sem a manobra de hiperinsuflação manual em recém-nascidos prematuros. Método: Participaram deste estudo 9 recém-nascidos prematuros com idade gestacional média 32,364 semanas, nascidos no Hospital Universitário Alzira Velano, no período de abril a novembro de 2015. Os recém-nascidos foram aleatoriamente divididos em 2 grupos: B, onde se realizou a fisioterapia respiratória associada a hiperinsuflação manual; e o grupo A, em que receberam somente a fisioterapia respiratória. Foram avaliados os seguintes parâmetros: frequência cardíaca, frequência respiratória e saturação de oxigênio, 5 minutos antes da realização dos procedimentos, 1 minuto e trinta minutos após os procedimentos. Resultados: Em relação à frequência cardíaca, a fisioterapia respiratória (FR) não demonstrou diferenças estatisticamente significativas nos momentos avaliados A1 (147,80), A2 (158,40) e A3 (151,20), bem como na fisioterapia respiratória associada à hiperinsuflação manual (FR+HM) nos mesmos momentos A1 (130,75), A2 (138,50) e A3 (137,25). Na frequência respiratória também não se verificou diferenças estatisticamente significativas nos momentos A1 (53,80), A2 (50,60) e A3 (46,60) com FR e nos mesmos momentos A1 (57,00), A2 (52,25) e A3 (59,50) com FR+HM. Na saturação de oxigênio, a FR nos momentos avaliados A1 (94,80), A2 (95,60) e A3 (95,60) não demonstrou alterações estatisticamente significativas como visto também na FR+HM nos mesmos momentos avaliados A1 (94,25), A2 (92,50) e A3 (95,00).Conclusão: Verificou-se com os resultados que as frequências cardíacas e respiratórias e a saturação de oxigênio não apresentaram diferenças estatisticamente significativas pré e pós realização da fisioterapia respiratória convencional ou associada à hiperinsuflação manual.

Impact de trois interventions: méthode mère kangourou, massage en incubateur et massage en position kangourou sur la croissance et le développement des enfants prématurés nés à moins de 33 semaines d’âge gestationnel

Cette recherche vise à étudier l’impact d’interventions réalisées par les parents dans l’unité néonatale de soins intensifs. Plus spécifiquement, le premier objectif est de documenter les effets différentiels de la Méthode Mère Kangourou « MMK » accompagnée ou non du Massage en incubateur «MI » ou du Massage en Position Kangourou « MPK » et des Soins Traditionnels «ST » accompagnés ou non du massage dans l’incubateur sur la croissance physique mesurée par le poids, la taille et le périmètre crânien pendant une période de 5 et 15 jours dans l’unité néonatale et l’impact à 40 semaines d’âge gestationnel. Le second objectif est de comparer, chez des enfants qui bénéficient de la « MMK » la valeur ajoutée du « MPK » ou du «MI » sur le neuro-développement à 6 et 12 mois d’âge corrigé de l’enfant. Un échantillon total de 198 enfants et leur famille a été recruté de la façon suivante dans trois hôpitaux de Bogota. Dans chaque hôpital, 66 sujets ont été répartis aléatoirement à deux conditions. Ces hôpitaux ont été choisis afin de tester les effets de diverses conditions expérimentales et de diminuer les bais de sélection. Dans chaque hôpital, deux techniques ont été assignées aléatoirement. Il s’agit, dans le premier, de la « MMK & MPK » vs « MMK & MI ». Dans le second, « MMK sans massage » vs « MMK & MI ». Dans le troisième, « MI » a été comparé aux « ST » ce qui implique une absence de contact physique continu des bébés avec leurs parents. Les résultats rapportés dans le premier article sont à l’effet que, dans le premier hôpital, il y a un effet compensatoire de l’intervention « MMK & MPK » sur la perte physiologique du poids de l’enfant prématuré dans les 15 premiers jours de vie avec un impact sur le poids à 40 semaines d’âge gestationnel, sur la durée du portage kangourou et sur la durée d’hospitalisation totale. Aucun effet sur le périmètre crânien ou la taille n’est apparu. Dans le deuxième hôpital, aucune différence significative n’est rapportée pour le poids sauf quand l’intervention est commencée après le 10ième jours de vie alors que l’enfant « MPK» semble grossir mieux que le «MMK avec MI». Finalement, dans le troisième hôpital il n’y a aucun effet du massage sur les variables anthropométriques, le groupe avec MI grossissant moins vite avec un léger impact sur le poids à 40 semaines. Cela pourrait être dû à la perte de chaleur due à l’ouverture de l’incubateur quand l’enfant est très immature. Dans le second article, les 66 enfants de l’hôpital sont répartis aléatoirement dans le groupe « MMK & MPK» vs le groupe « MMK & MI», ont complété, à 6 et 12 mois d’âge corrigé, un test de neuro-développement, le Griffiths. Les résultats à 6 mois ne montrent aucune différence entre les 2 interventions, mais a 12 mois le IQ semble dépendant du nombre de jours d’hospitalisation de l’enfant, cette durée d’hospitalisation correspond au temps que met l’enfant à se stabiliser physiquement et correspond également au temps que mettent la mère et l’enfant à s’adapter à la méthode kangourou. Une fois, l’adaptation kangourou réussie, la dyade mère enfant sort avec l’enfant toujours en position kangourou. Le temps d’hospitalisation correspond au temps que met l’enfant à être éligible à l’apprentissage de la MMK par la mère. À 12 mois les deux groupes montrent des résultats équivalents, mais des différences positives sont apparues pour le groupe « MMK & MPK» dans les sous échelle Coordination Oculo Manuelle et Audition et Langage du test Griffiths. Dans l’ensemble, les résultats suggèrent que la pratique des deux interventions non traditionnelles peut contribuer à une meilleure croissance physique dans nos cohortes. Le gain de poids du bébé, notamment, est affecté par l’intervention MPK (Hôpital 1) ou sans l’ajout du Massage (Hôpital 2). Par ailleurs, le massage en incubateur n’a pas de différence significative en comparaison aux soins traditionnels, ces interventions ont toutefois un impact mineur (tendances) sur le neuro développement à 6 et 12 mois d’âge corrigé dans cette étude.