Developmental Interventions In Neonatal Care Washington, DC 2006

1. Developmental Interventions In Neonatal CareWashington, DC 2006 Highlights Patricia Boyle, PT LDSH NICH EI Consultant

2. The Earliest Relationship: The Nature of Maternal-Fetal Synchrony • Presented by Janet DiPietro, Ph.D a Developmental Psychologist in Baltimore Maryland • Mothers and fetuses have a second by second relationship beginning at least at 20 weeks. • Questions? Does preterm maternal-fetal synchrony set the stage for postnatal synchrony in maternal-child interaction?

3. The Earliest Relationship • Prenatally are mothers who are more physiologically responsive to fetal movements more responsive to their infant’s behaviour? • Are fetuses who are more reactive to maternal stress more engaged and interactive as children? • Are fetuses “paying attention”?

4. The Earliest Relationship • Mothers are given a stressful psychological test (Stroop test) • Infants respond by becoming less motorically active and have increased variability in their heart rate • Mothers given relaxation activities also causes decreased fetal movement and an increase in heart rate variability. • Is the fetus “orienting” to differences in the intrauterine sensory environment?

5. The Earliest Relationship • Greater maternal anxiety and perceived stress during pregnancy has been associated with more ACCELERATED developmental skills at age 2.(Stress affects the development of the fetus in a positive way????) • Women who were more negative ABOUT their pregnancy their infants had delayed motor development and poorer social engagement

6. The Earliest Relationship • Take home message??? • Embrace stress • But be positive??? • More research needed

7. The Earliest Relationship • The Psychophysiology of the maternal-fetal relationship • Psychophysiology,41 (2004),510-520 DiPietro et al

8. Effect of Movement and Posture on the Respiratory and GI system • John Chappel, MA PT, Morristown New Jersey • Heidelise Als, PhD reveals in her Synactive Theory of Development the delicate interplay between the physiologic and motoric systems.

9. Respiration and GI • Any impulse entering the spinal cord at any level could cause any structure innervated by any neurological structure emanating from that level to be stimulated • Hands on ribcage • Respiratory system is a system that responds well when not restricted

10. Respiratory and GI • How does the baby’s physical environment impact respiration and GI • NG tubes • Extended upper extremity posture • Excessive hip flexion • Diaper Tightness • The “Vulcan Feeding Pinch”

11. The “Vulcan Feeding Pinch”

12. The Hyoid bone • Free floating bone with no other bony attachments • Supports the tongue and muscles associated with speech and SWALLOWING • Until six months of age the hyoid is at the level of C1 • C1 gets “stuck” with excessive extensive force

13. The Hyoid bone • Force to C1 : a large amount of force over a short time – precipitous delivery – may be responsible for TTN (Transient tachypnea of the newborn) • Force to C1 : A small amount of force over a long period of time – The “Vulcan Feeding Pinch”

14. The Vulcan Feeding Pinch • C1 gets jammed in extension over C2 and C3 • Pressure over C1 compresses the 4th ventricle which houses the vagal nerve • Vagal nerve innervates the stomach, lungs affects heart rate, innervates the larynx which keeps the airway open for breathing, affects peristalsis