WORLD DAY OF THE PREMATURE INFANT
NEEDS AND APPROACHES AT THE ASPACE CATALONIA FOUNDATION
From the ASPACE CATALUNYA Foundation, and on the occasion of World Premature Infant Day, we want to share how we accompany children and families in the first stages of life, both from the CDIAP ASPACE early care service and from the new 'SMALL ASPACE day hospital.
The data from the Public Health Secretariat of Catalonia in the 2021 Perinatal Health Report indicate that almost 7% of babies are born prematurely and, of these, 10% have extreme prematurity.
Since in 1999 the early care center (CDIAP ASPACE), began its career in the care of the population 0-6 years of age in the district of Sants Montjuic, the evolution of the intervention in premature infants has been remarkable in recent decades, on the one hand due to the increase in prevalence and on the other, due to the medical progress that has allowed greater survival at a lower gestational age.
Initially, the focus was on ensuring the survival of the babies, given that the risk of complications was very high, and gradually attention has been specialized towards the integral neurodevelopment of the child.
Currently, professional teams have much more knowledge about the possible repercussions associated with prematurity.
It should be noted, however, that prematurity represents an initial risk in neurodevelopment and that there is a wide range of difficulties, from no affectation, to serious or severe and this will largely determine the design of the therapeutic plan.
In the case of premature infants who share characteristics of high biological risk due to perinatal antecedents, there is evidence of neurological variables related to alterations in vision, hearing, motor function and early signs of cerebral palsy.
Neuropsychological disorders related to intellectual level, memory, attentional lability, communication and relationship, language and learning difficulties may also appear in these children.
Early intervention is one of the fundamental pillars to ensure adequate neurodevelopment in the early stages of life and to offer specialized resources to support these children and their families.
It is a trans and multidisciplinary approach that includes interventions from different disciplines.
First of all, we will detail the approach carried out by the CDIAP ASPACE according to each professional profile, and then the characteristics and specificity of the highly complex patients that has prompted the creation of the HOSPITAL DE DIA PETIT ASPACE.
Approach from CDIAP ASPACE
Physiotherapy and psychomotor development
Physiotherapy is an essential part of the early care program for premature infants, as they are often at risk of psychomotor developmental delays or disorders secondary to the immaturity of the nervous system or complications from prematurity.
The physiotherapists of CDIAP ASPACE attend to the needs of children, enabling the achievement of motor control and psychomotor development: the emergence of visual and optical perceptive functions, the regulation of muscle tone, static and dynamic postures, postural changes, the emergence of displacement, sensory integration and participation in shared body games that facilitate body awareness and the emergence of the body schema, while adjusting to the needs and maturational moment of each child.
Psychological intervention
Premature infants are particularly vulnerable and require an approach that is not only therapeutic but also preventive, in a comprehensive view of health and well-being, to promote their cognitive and affective-emotional development, and prevent the underlying pathology from becoming complicated with sequelae or with added damage.
As professionals in psychology, we detect the warning signs to make an early intervention in psychopathology and minimize the risk of disconnection from the environment.
Parents of a premature baby can often feel fear, anxiety, or feelings of loss for having had a birth experience for which they were not prepared. Establishing a bond with your child can be complicated by the physical separation experienced (incubator, hospital) and fear of the future.
The accompaniment in this process and the support to the family will allow them to advance in their process as well as in the look of their child and create a healthy bond minimizing possible psychological/mental alterations.
Speech therapy in premature infants
Prematurity poses a risk of suffering delays in the acquisition and/or disorders of communication and language skills, which increases with lower gestational age. In addition, premature infants can often have difficulties with sucking, swallowing and feeding.
The intervention offered to families by CDIAP ASPACE includes a comprehensive approach to the basics of communication, such as joint attention, eye contact, turns in action and language, recognition and interest around the world, as well as the more purely linguistic, comprehensive and expressive aspect. The aim is not only to work on site with the concepts described, but to provide the family with tools to stimulate communication and inter and intrapersonal language and promote the overall development of the child.
In the same way, an early approach to the difficulties in sucking, swallowing and feeding will favor the development of the bond, a relationship with the moment of feeding more pleasurable and will ensure the appropriate weight gain.
Neuropaediatrics and neurodevelopment
Epigenetics and prematurity are closely related, as environmental factors during the first moments of life can influence the expression of genes in premature babies. Preterm infants often face physiological stress situations, such as the need for respiratory assistance or special nutrition, which can cause epigenetic changes in DNA that affect their long-term development. These changes can influence areas such as the immune system, neurological growth and risk of future disease, making early and personalized care essential to mitigate their effects and promote healthy development.
The figure of the neuropediatrician at CDIAP ASPACE together with the other therapists will assess, in constant coordination with the reference hospital services, the need for complementary tests, as well as maintain a close relationship with the team and with the families.
The importance of Social Work
Sometimes, in addition to the stressful situation that families experience due to the baby's vulnerability, other socio-familial factors can be added that cause an impact on physical, social and emotional well-being.
In this situation where different difficulties and/or needs may appear, the social worker, in addition to coordinating with other services in the network, if necessary, offers the family containment and emotional support, guidance and support to the parenting, advice and information on the services, aids and benefits they can access in each specific case (recognition of disability, recognition of dependency, CUME...)
The CDIAP ASPACE multidisciplinary team works together to assess the specific needs of each child, identify possible challenges and establish comprehensive early intervention therapeutic plans.
Approach from PETIT ASPACE DAY HOSPITAL
Patients with high health complexity in Catalonia
In Catalonia, in the last 20 years, there has been a 400% increase in children with extreme prematurity (Source: National Institute of Statistics) and in 2023 more than 650 children under the age of 3 will be detected with multiple disabilities.
The Aspace Catalunya Foundation, sensitive to this reality, will start a DAY HOSPITAL in September 2024 for comprehensive health care for patients aged 0-3 years with high neurological complexity and multiple disabilities.
These children require an intensive and multidisciplinary therapeutic approach of a BIO PSYCHOSOCIAL nature with a perspective of integrating services and networking with the community.
The care model of L'HOSPITAL DE DIA PETIT ASPACE
HOSPITAL DE DIA PETIT ASPACE is a supraterritorial, innovative and pioneering public health service in Catalonia, designed to provide specialized and comprehensive care to children aged 0 to 3 years with high neurological complexity, cerebral palsy and multiple disabilities.
The main objective of this service is to improve the quality of life of children and their families, through a multidisciplinary approach that integrates medical, nursing, mental health, psychostimulation and intensive rehabilitation treatments.
Patients accessing this service must meet clinical and complexity criteria that indicate the need for specialized health care (multiple health conditions, severe functional limitations, high need for specialized medical resources).
The PETIT ASPACE day hospital provides comprehensive care based on a bio-psycho-social care model and complemented with the theoretical framework of the CIF (adapted to 0-3 years) where the therapeutic objectives and intervention are considered from an understanding functioning, health and disability. (In 2001, the World Health Organization).
Each patient is cared for by a multidisciplinary team made up of professionals from neuropaediatrics, nursing, neurorehabilitation, psychology, physiotherapy, speech therapy and social work.
The purpose of the interventions is participation, activity, social interactions, health condition in its natural context (CIF -OMS 2001) and in a work centered on the family.
The main focus of the service is close collaboration with families and local agents, providing health, emotional and psychological care and support to help them adapt to the new reality and actively participate in care and development of their children.
CONCLUSIONS
Brain development is a complex process resulting from the interaction between genetics, environment and the scope of socialization and reaches its maximum intensity in the first stages of life.
This is the reason that justifies the importance of intervention from the first stages.
FUNDACIÓ ASPACE CATALUNYA is committed to this early approach, offering two early childhood care services, CDIAP Sants-Montjuic (Department of Social Rights and Inclusion, sectorized) and HOSPITAL DE DIA PETIT ASPACE (Department of Health, of a supraterritorial nature).
