COMMUNICATION DEVELOPMENT OF HIGH-RISK NEONATES FROM ADMISSION TO ...

164 Pages·2007·3.76 MB·English

COMMUNICATION DEVELOPMENT OF HIGH-RISK
NEONATES FROM ADMISSION TO DISCHARGE FROM
A KANGAROO MOTHER CARE UNIT

BY

ALETHEA McINROY

Submitted in fulfilment of the requirements for the degree of

M. COMMUNICATION PATHOLOGY
(Speech-Language Pathology)

IN THE

DEPARTMENT COMMUNICATION PATHOLOGY
FACULTY OF HUMANITIES

UNIVERSITY OF PRETORIA

SUPERVISOR: PROF A. KRITZINGER
CO-SUPERVISOR: MRS U. ZSILAVECZ

JANUARY 2007
ACKNOWLEDGEMENTS

Prof Alta Kritzinger for her proficient guidance and enthusiasm throughout the
study.
Mrs Ursula Zsilavecz as co-supervisor.
Dr Elise van Rooyen for her assistance during the data collection in the Kangaroo
mother care (KMC) unit at Kalafong hospital.
Dr M. J. van der Linde at the Department of Statistics for the statistical processing of
the data and his enthusiasm about the study.
My parents David and Yvonne for encouraging and assisting me in the wonderful
opportunity to endeavour on this amazing journey. I thank you for your never ending
love, support, prayers and trust.
My sister Natalie for her constant care, love and encouragement.
My spiritual parents Francois and Ansa for their guidance, encouragement and love.
Kalafong hospital for allowing me to complete the data collection in their KMC unit.
The participants and their mothers for their cooperation and patience, which made
this study possible.
Mrs Marlene Kromberg for the language editing.

The person who gives meaning to life and everything I do in this life, my Lord Jesus
Christ. Thank you for Your endless grace and provision and that You always know the
end from the beginning.

Jeremiah 29:11
For I know the thoughts that I think toward you, says the Lord, thoughts of peace and not
of evil, to give you a hope and a future.
i
CONTENTS

CHAPTER 1
PERSPECTIVES ON KANGAROO MOTHER CARE
RESEARCH AND STATEMENT OF THE PROBLEM

1.1 INTRODUCTION 1
1.2 PERSPECTIVES ON KANGAROO MOTHER CARE (KMC)
RESEARCH 3
1.3 PROBLEM STATEMENT AND RATIONALE 11
1.4 DESCRIPTION OF TERMINOLOGY
1.4.1 COMMUNICATION DEVELOPMENT 12
1.4.2 HIGH-RISK NEONATES OR INFANTS 12
1.4.3 RISK FACTORS 13
1.4.4 PREMATURITY 13
1.4.5 LOW BIRTH WEIGHT 13
1.4.6 KANGAROO MOTHER CARE 14
1.4.7 DEVELOPMENTALLY APPROPRIATE CARE 14
1.4.8 MOTHER-INFANT ATTACHMENT 14
1.4.9 MOTHER-INFANT INTERACTION 14
1.4.10 EARLY COMMUNICATION INTERVENTION 14
1.5 CHAPTER OUTLAY
1.5.1 CHAPTER 1 15
1.5.2 CHAPTER 2 15
1.5.3 CHAPTER 3 15
ii
1.5.4 CHAPTER 4 15
1.5.5 CHAPTER 5 16
1.6 CONCLUSION 16
1.7 SUMMARY 16

CHAPTER 2
DEVELOPMENT OF THE HIGH-RISK NEONATE

2.1 INTRODUCTION 17
2.2 PREMATURITY AND LOW BIRTH WEIGHT AS RISK
FACTORS FOR DEVELOPMENTAL DELAYS IN THE
SOUTH AFRICAN CONTEXT 19
2.3 BRAIN DEVELOPMENTAL PROCESSES DURING THE
FETAL PERIOD 21
2.4 THEORETICAL PERSPECTIVES ON THE
NEUROLOGICAL DEVELOPMENT OF THE HIGH-RISK
NEONATE 25
2.5 DEVELOPMENT OF FEEDING BEHAVIOUR IN THE
HIGH-RISK NEONATE 29
2.6 COMMUNICATION DEVELOPMENT OF HIGH-RISK
NEONATES 31
2.7 PARENT-INFANT INTERACTION 33
2.8 CONCLUSION 36
2.9 SUMMARY 37
iii
CHAPTER 3
METHOD

3.1 INTRODUCTION 38
3.2 AIMS 39
3.3 RESEARCH DESIGN 39
3.4 ETHICAL CONSIDERATIONS
3.4.1 RESPECT FOR PERSONS 41
3.4.2 BENEFICENCE AND NON-MALEFICENCE 43
3.4.3 DISTRIBUTIVE JUSTICE 44
3.5 SAMPLE
3.5.1 SELECTION CRITERIA 45
3.5.2 SELECTION PROCEDURES 46
3.5.3 SAMPLE SIZE 47
3.5.4 DESCRIPTION OF SAMPLE 48
3.6 MATERIAL AND APPARATUS 50
3.7 PROCEDURES
3.7.1 PILOT STUDY 53
3.7.2 RELIABILITY AND VALIDITY 59
3.7.3 DATA COLLECTION PROCEDURES 61
3.7.4 DATA RECORDING PROCEDURES 61
3.7.5 DATA ANALYSIS PROCEDURES 62
3.8 SUMMARY 62
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CHAPTER 4
RESULTS AND DISCUSSION

4.1 INTRODUCTION 64
4.2 DESCRIPTION OF DIFFERENT CHARACTERISTICS
OF NEONATAL DEVELOPMENT FROM THE TIME
OF ADMISSION TO DISCHARGE FROM THE KMC
UNIT
4.2.1 HISTORY OF PERINATAL CONDITIONS
AND MEDICAL CARE OF THE
PARTICIPANTS 65
4.2.2 THE DIFFERENT STATES AND STATE
TRANSITIONS OF THE PARTICIPANTS
AND THEIR ABILITY TO ESTABLISH
ORGANIZED BEHAVIOUR 71
4.2.3 THE DEVELOPMENT OF NEONATAL
FEEDING SKILLS IN THE CONTEXT
OF A KMC PROGRAMME 78
4.2.4 NEONATAL COMMUNICATION
DEVELOPMENT 85
4.2.5 MOTHER-NEONATE COMMUNICATION
INTERACTION 90
4.2.6 THE ENVIRONMENT OF THE KMC UNIT 94
4.3 CONCLUSION 96
4.4 SUMMARY 96
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CHAPTER 5
CONCLUSION AND RECOMMENDATIONS

5.1 BRIEF SUMMARY OF MOST IMPORTANT
RESULTS 98
5.2 CONCLUSION AND IMPLICATIONS
5.2.1 HISTORY OF PERINATAL CONDITIONS
AND MEDICAL CARE OF THE
PARTICIPANTS 99
5.2.2 THE DIFFERENT STATES AND STATE
TRANSITIONS OF THE PARTICIPANTS
AND THEIR ABILITY TO ESTABLISH
ORGANIZED BEHAVIOUR 100
5.2.3 THE DEVELOPMENT OF NEONATAL
FEEDING SKILLS IN THE CONTEXT
OF A KMC PROGRAMME 102
5.2.4 NEONATAL COMMUNICATION
DEVELOPMENT 103
5.2.5 MOTHER-NEONATE COMMUNICATION 103
INTERACTION
5.2.6 THE ENVIRONMENT OF THE KMC UNIT 104
5.3 CRITICAL EVALUATION OF THE STUDY 104
5.4 RECOMMENDATIONS FOR FURTHER RESEARCH 107
5.5 CONCLUSION 108

REFERENCES 113
vi
APPENDICES
APPENDIX A - INFORMED CONSENT 129
APPENDIX B - PARTICIPANT INFORMATION LEAFLET
AND INFORMED CONSENT 132

APPENDIX C - INFORMED CONSENT FROM HOSPITAL 135
APPENDIX D - DATA-COLLECTION PROTOCOL FOR
HIGH-RISK NEONATES 137
APPENDIX E - FACULTY OF HUMANITIES ETHICAL
APPROVAL LETTER 150
APPENDIX F - FACULTY OF HEALTH SCIENCES
ETHICAL APPROVAL LETTER 151
vii
LIST OF TABLES

TABLE 1. DESCRIPTION OF THE PARTICIPANTS AND
THEIR MOTHERS 49
TABEL 2. EVALUATION MATERIAL USED FOR DATA
COLLECTION 51
TABLE 3. DESCRIPTION OF THE THREE PARTICIPANTS
AND THEIR MOTHERS USED FOR THE PILOT
STUDY 54
TABLE 4. COMMUNICATION DEVELOPMENT OF
PARTICIPANTS OVER TIME 58
TABLE 5. HISTORY OF PERINATAL CONDITIONS AND
MEDICAL CARE OF THE PARTICIPANTS IN THE
NICU AND HIGH CARE 66
TABLE 6. BEHAVIOURS DISPLAYING THE VARIOUS
PRECURSORS OF LANGUAGE AND COGNITIVE
DEVELOPMENT 87
TABLE 7. COMPONENTS OF MOTHER-NEONATE
INTERACTION 92
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LIST OF FIGURES

FIGURE 1. KNOWLEDGE BASE REQUIRED FOR THE
DESCRIPTION OF NEONATAL DEVELOPMENT
WITHIN A KMC PROGRAMME 19
FIGURE 2. TIMELINE OF MAJOR PROCESSES OF FETAL
BRAIN DEVELOPMENT 23
FIGURE 3. THEORETICAL PERSPECTIVES ON PRE-TERM
NEONATAL DEVELOPMENT 28
FIGURE 4. PERINATAL FACTORS IN THE NICU THAT
INFLUENCE THE PARTICIPANTS’ RISK
PROFILE 70
FIGURE 5. PARTICIPANTS’ DEVELOPMENTAL STATES
OVER TIME 72
FIGURE 6. STATES OF ALERTNESS ACCORDING TO THE
PARTICIPANTS’ DEVELOPMENTAL STATES 74
FIGURE 7. DEVELOPMENT OF ORGANIZED BEHAVIOUR
DURING ROUTINE CARE ACTIVITIES
PERFORMED BY THE MOTHERS OVER TIME 76
FIGURE 8. PARTICIPANTS’ METHODS OF FEEDING OVER
FOUR TIMES OF DATA COLLECTION 79
FIGURE 9. PARTICIPANTS’ STATE OF ALERTNESS DURING
FEEDING TIMES ACCORDING TO THEIR
DEVELOPMENTAL STATES 81
FIGURE 10.PARTICIPANTS’ NUTRITIVE SUCKING SKILLS
DURING EACH DEVELOPMENTAL STATE 82
FIGURE 11.THE ORAL-MOTOR FEEDING PATTERNS OF THE