Do you ever have the opportunity to provide therapy services to babies after NICU discharge? At our hospital, all of the neonatal therapists take turns covering the NICU follow up clinic where we provide developmental evaluations at various time points for babies who qualify. Last week I was confronted with a situation that seems to be so very common among NICU graduates.
I was evaluating a little boy “Michael” who was born at 30 weeks and is now 2 years old. When I asked Michael’s mom if she had any concerns about Michael’s development or behavior, she began to describe the many challenges that Michael experiences daily. She told me that Michael screams and cries during his bath, hates getting his hands messy during mealtimes, covers his ears in public, and has frequent tantrums when she takes him on errands.
After their appointment, I try to remember Michael’s days in the NICU. Was he a baby who would drop his heart rate every time he was touched? Was he the baby who would be feeding like a champ, but then suddenly shut down if the room became chaotic? Did he always need firm swaddling and hands on containment for an extended time to transition to sleep state? Or was he a baby that tolerated handling and other stimuli reasonably well? Is there a way for us as therapists to better identify babies at high risk for sensory processing disorder in early childhood?
Researchers at Washington University in St. Louis conducted a study to describe the incidence of sensory processing disorder in former preterm infants at age 4-6 years. They also sought to define medical and socioeconomic factors associated with sensory processing disorder, and examine relationships between neurobehavior at term and later sensory processing disorder. The study enrolled thirty-two preterm infants born <30 weeks and conducted neurobehavioral assessment using the NICU Network Neurobehavioral Scale (NNNS) at term equivalent age, and the Sensory Processing Assessment for Young Children (SPA) at 4-6 years of age.
In this sample, 50% of children presented with a sensory processing disorder at age 4-6 years based on SPA scores. Additionally, the study did not identify any association between sensory processing disorder and medical and socioeconomic factors including gestational age at birth, sex, cerebral injury, presence of NEC or PDA, amount of respiratory support, days on TPN, surgeries, race, type of insurance, maternal age at birth, and maternal marital status. They did, however, find that more sub-optimal reflexes, and more signs of stress on the NNNS at term equivalent age was associated with having a sensory processing disorder at age 4-6 years.
The authors discuss the role of the NICU environment on the developing sensory system of the preterm infant, noting that sensory development begins in utero, but must continue to develop in the NICU, where their sensory systems can be bombarded with stimuli for which they are not developmentally prepared. They also note “it is unclear whether these early markers are indicative of the impairment that followed, or if the early impairment identified on the neurobehavioral exam resulted in altered sensory experiences, leading to subsequent sensory processing disorder.” This study demonstrates that standardized neurobehavioral testing can help identify those infants most at risk for sensory processing disorder in childhood.
Ryckman, J., Hilton, C., Rogers, C., & Pineda, R. (2017). Sensory processing disorder in preterm infants during early childhood and relationships to early neurobehavior. Early Human Development, 113, 18-22.