Effect Of Newborn Behavioral Observation (NBO) on Parent-Infant Interaction and On the Development of Haemodynamically Stable Pre-Term Infants admitted at NICU (Experimental Study).

•        From total 68 sample size 34 infants will be selected for experimental group (who receive NBO) and 34 infants under controlled group (who received standard of care without NBO).

•       Experimental group: The principal investigator (PI) will involve in experimental study as he is certified in conducting newborn behavioral observations (NBO). Through family centered approach of NBO rapport building will be initiated and parents will ask about their experience of their baby and explained about the importance of these newborn behaviors. 18 items infant focused newborn observations (NBO) will be administered in a flexible way on different states of infants (habituation items when infant is in deep sleep, motor responses, responsiveness to parent’s voices and face when infant will be in alert state) under experimental group.

•       The caregiver(mother) will be observing those behaviors along with therapist. The observations of the infants are recorded on the NBO sheet and on anticipatory guidance checklist (which provide the intervention to baby by parents) will be made to guide the parents.

•       Anticipatory guidance to the parents as an important form of intervention

Newborn behavioral observations (NBO)

Anticipatory guidance provided by the therapist to parents

Newborn behavioral observations(NBO)

Anticipatory guidance provided by the therapist to parents

|1. habituation to light

Sleep patterns will be  discuss with parent for interaction and intervention with the baby

10.visual response

Vision guidance will be  by providing stimulation, awareness to parents about the visual capacities.

|2. habituation to sound

**Sleep protection by environmental modifications,  Swaddling,**Consolabality .

11. orientation to voice

Hearing of baby by helping parents aware about the infants tolerance to the auditory stimulation. Stress signals.

|3. muscle tone of legs and arm

Muscle tone by facilitatory such as light touch heavy joint compression, etc. and inhibitory techniques by swaddling and regular****handling of baby, support.

12. orientation to sound

Hearing  helping them aware about the infants tolerance to the auditory stimulation.

|4. rooting

Feeding cues of infants and discuss about appropriate technique and stimulation.

13. visual tracking

Communication cues by discussing signs of stress cues and approach cues.

|5.sucking

Feeding cues of infants and discuss about appropriate technique and stimulation.

14. crying

Crying and Soothability by different comforting and consolidation techniques.

|6.hand grasp

Touch and contact by holding, handling and swaddling.

15. Soothability

Self soothing by helping parent to understand infants self soothing techniques hand to mouth or any other methods.

|7. shoulder and neck tone

**Muscle tone by facilitatory and inhibitory techniques,**handling, support.

16.state regulation

State regulation by discussing overall organization of the infants behavior.

provide concept of goodness of fit by helping parents to adopt to unique states of infants.

|8. crawling response

Sleep and safety infant be put down to sleep on her back-back to sleep -to avoid risk sudden infant death syndrome (SIDS)

17.response to stress

|9.response to face and voice

Social interaction by helping parents to understand kinds of interactions and stimulation best for the infants.

18. activity level

Stimulation threshold by discussing kinds of stimulation that may overwhelm the child and how parents can modify through support and environmental support. Also discuss about strategies help to settle the infant like holding, swaddling.

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                                                                                                                                                                                                                                                                                                                                                                                             The details of other interventions and implications for caregiving mentioned above in NBO.

The administered items of NBO whether habituation or motor are scored on a three-point scale, with one point being assigned to weak (weak neck tonus, for instance) or altered responses (very intense stress signal instance), two points to transition behaviors, and three to well-established behaviors (easy habituation to light and sound, for instance) in first visit of NBO in NICU.

•           In further visits if infants will be in different state per say crying the other NBO behaviors like consolability, state regulation and will be scored on the same case record form and followed up of the intervention which was given in first visit. So, likewise everyday when therapist will be visiting NICU he will be taking follow up of the interventions which was taught before to the parents.

•       Through above the Infant’s strengths and areas where he/she needs support will be enlisted and therapist will provide appropriate anticipatory caregiving strategies (positioning, tone management, improve sleep quality, swaddling, improve Oro-motor functions, facilitate the capacity for self -regulation) as an intervention that helps to promotes the development of a positive Clinician–Family Partnership.

•       Controlled group : The co-investigator will provide the intervention toinfants under controlled group will be provided with standard of care treatment without performing newborn behavioral observation (NBO).

•        As these infants will be from NICU unit so during performing any items if infants level of arousal falls below normal, skin becomes pale and show irregular breathing then will either take pause or discontinued further items Use of traffic like Metaphor,  where green light denotes stable state of infant so to continue with further items, yellow light denotes stress on infant so need to take pause before administering further items and after pause once infant becomes stable then further items carried out with adequate pause in between and red light  signifies that discontinue with further items as infant is showing severe stress signs liketremulousness and startles with irregular breathing not recovering even after adequate rest interval and send the infant back to ward and informed immediately to the on duty neonatologist ).

•       Parents also taught about these stress signs while providing NBO and providing appropriate specific interaction like startles, tremulousness or change in skin Colour, breathing patterns during interacting and providing anticipatory strategies.

•       Though the methodology will have multiple scales and assessment but they will be used at different time frames.

•       The following are the details of followed up which will be measured 1 moth of corrected age of the baby at different settings.

•       The outcome of parent-infant relationship will be measured by using, post-partum bonding questioner at Occupational therapy OPD (079) this questionnaire is a self reported and fill up by the caregiver (mother) in a language best understood by them.as translations are done in Hindi , Marathi and English language ,and neurodevelopmental outcome of this relationship on baby will be measured by BSID-4 when infants from both groups will visit at KMC OPD of KEM Hospital.

•        Here the BSID will help in assessing the impact of this parent-infant relationship on development on infant and screen out the risk of developing neuro-developmental delays, in these preterm infants so future early intervention will be plan.

Assessments

Settings where   assessments will be taken

|NBO as a intervention along with multiple followed ups

NICU unit of KEM hospital

|Postpartum bonding questionnaire (PBQ)

At occupational therapy department 079 of KEM hospital after 1 month of their corrected age

|Neurodevelopmental outcomes will be measured by using BSID-4

At the KMC OPD of KEM hospital after 1 month o their corrected age

 â€¢       The total score of parent-infant interaction through PBQ and neuro-developmental outcomes by on both groups will be calculated and then comparison will be made between experimental and control groups to know the effectiveness of NBO.