UBC Graduate Research

Preschool outcomes in infants born less than or equal to 25 weeks gestational age : an integrative review of the litterature Colby, Lindsay Bryant


Aim: To conduct an integrative review of the outcome literature for preterm infants born ≦25 weeks gestation at preschool age and synthesize the findings with available outcome data from BC Women’s Hospital Neonatal Follow-Up Clinic with a critical lens for its utility to nurses speaking with parents. Methods: Whittemore and Knafl’s methodology for integrative reviews was used. An electronic search of four databases, MEDLINE (OVID), CINAHL, PsycINFO and EBM Reviews was conducted using 96 key words that acknowledged a wide scope of outcomes, including neurodevelopmental outcomes, physical and health outcomes, functional outcomes, and parent/teacher-reports of outcomes. The selection criteria were articles that: differentiated the reporting of outcomes of infants ≦25 weeks gestation from other groups; included a clear description of assessment protocols, impairment definitions, population characteristics, and medical treatments; and were published in English between January 2006 and August 2016. Of 1237 identified abstracts, 87 articles were selected and 78 were excluded. Nine studies were included in the data set. Articles were characterized using these variables: assessment age, assessment tools, impairment definition, and reporting for gestational ages. Individual study results were categorized using these headings: survival with or without impairment, impairment rates, developmental quotients, motor function, cognitive function, behaviour, sensory-communication function, growth, and health. Results: Integration of the study findings with results from the BC Women’s Hospital Neonatal Follow-Up Clinic was limited by the small article sample size and the heterogeneity of the sample set. Results were integrated for moderate-severe impairment, gestational age, overall development, and growth. Gaps were found in outcomes that included children’s cognition, behaviour, and health, and parents’ perceptions. A thematic analysis produced four themes: correlates of outcomes, comorbidities, message framing, and factors that affect reporting outcomes and interpreting data. Conclusion: Findings from the integrative review revealed both positive and negative outcomes for EPT infants. The findings suggest that, in addition to published empirical results, interpreted unit-specific outcome data following reporting guidelines, be presented from a balanced perspective. Acknowledging infants’ potential for healthy development and recognizing parents’ need for hope underpins effective nurse-family communication regarding extremely premature infants’ developmental outcomes and selection of appropriate nursing interventions.

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