1.Concept.
Early intervention is all types of training to improve the intellectual abilities of preterm infants by providing a variety of sensory stimulation and environmental enrichment education to at-risk infants. It is used for infants and toddlers whose development (mainly referring to neurological and mental development) deviates from normal or may deviate from normal.
Measures are taken to improve the development of these infants and toddlers, or to catch up with the development of normal children or to enhance their self-care skills. Early intervention can reverse deviations from normal neurological and psychiatric development and allow infants and toddlers to reach their full potential. The key to treatment is early detection, early diagnosis, early intervention and early treatment, the earlier the start, the better the results.
2.Intervention objects.
The target of early intervention is mainly the surviving high-risk children who are affected by high-risk factors in the perinatal period, and the high-risk factors are divided into fetal period, delivery period and neonatal period by period.
1. High-risk factors in the fetal period: genetic factors, early pregnancy bleeding, gestational hypertension syndrome, intrauterine infection, toxic and harmful substances during pregnancy, maternal diseases (anemia, heart, liver, kidney, diabetes, etc.), fetal growth retardation, multiple births, intrauterine distress, umbilical cord encirclement, placenta praevia, placenta abruptio, placental dysfunction, etc.
2. High-risk factors during delivery: neonatal asphyxia, obstructed labor, cesarean section, birth injury. 3. High-risk factors during the neonatal period: preterm birth, low birth weight (<2500g) neonatal ischemic-hypoxic encephalopathy, severe hyperbilirubinemia, intracranial hemorrhage, central nervous system infection.
3. Screening and diagnostic methods.
①Neonatal Behavioral Ability Assay (NBNA): A 20-item neurological assay for newborns in China established by drawing on the advantages of the Brazelton neonatal behavior estimation score in the United States and the Amiel-Tison neuromotor assay in France, combined with our own experience. those with NBNA scores <35 are classified as high-risk infants for management.
②The 52-item neuromotor examination, edited by Bao Xiulan, screens by checking consciousness response, audiovisual condition, primitive reflex, motor ability, muscle tone examination, abnormal posture examination, etc.
③Newborn hearing screening.
④Auxiliary examination: cranial ultrasound or CT, fundus examination, electroencephalogram, etc.
4.Intervention methods.
①Referring to “Newborn Behavior and Education from 0 to 3 years old” to develop early interventions, starting after 7d when the condition stabilizes, sensory stimulation massage, visual, auditory, head lifting and limb movement training in the neonatal period, about half an hour or more each time, at least 2 times a day; perception, visual and auditory, language, memory and movement training in the infant period.
② Direct intervention to the newborn visual and auditory stimulation, focus on massage, passive gymnastics, swimming and other motor training, and according to the law of infant motor development to do head lifting, turning over, sitting, crawling, standing and walking and other active motor training.
③For children with moderate to severe brain injury, we apply movement therapy to promote normal movement development, inhibit abnormal movement and posture, and gradually promote children to produce correct movement.
④Physical electric therapy, cognitive function training and medication (monosialoganglioside, sodium cytarabine, salvia injection, cerebroprotein hydrolysate, lysine inositol vitamin B12 oral solution) should be selected according to the child’s condition (10 days as a course of treatment).
5. Post-discharge follow-up and intervention.
Follow-up of newborns can help early detection of children with deviations from normal physical or neurological development and timely early intervention to reduce the degree of disability. In addition, follow-up visits also allow retrospective epidemiological surveys and prospective clinical randomized controls to explore the incidence, risk factors and pathogenesis of neurodevelopmental disability. Follow-up should be initiated 7-10 days after hospital discharge to assess neonatal recovery from disease.
Subsequent visits should be monthly up to 1 year of age and every 3 months from 1 to 2 years of age. The content includes physical developmental measurements, 52 neuromotor items, Bailey intelligence test, GMFM gross motor assessment check, etc. We also provide planned training for parents to introduce the basic knowledge of child development and to continue family early intervention for the children. Children with abnormal development will continue to be treated according to the neurodevelopmental treatment method.