While advances in perinatal care have resulted in decreased mortality rates in preterm neonates, morbidity rates remain significantly high. In addition to cerebral palsy, hearing loss, visual impairments and developmental delay, long term follow up studies have identified other important neurosensory impairments that may not become evident until preschool or school age such as cognitive and behavioural problems.
The process of developmental care involves creating an environment for the infant that minimises stress while providing developmentally appropriate experience for the infant and family.
Developmental care refers to interventions that
These interventions include
The education and involvement of the parents or carers is critical to the infant's social, emotional and physical well being and is a crucial factor in the process of family centred developmental care.
This is a comprehensive program of systematic behavioural observation methodology. Observations of the infant occur before and during care giving and are used as a measure of the infant's tolerance to the environment and caregiving activities. They become the basis for individualised goals and developmental interventions that are aimed at reducing the detrimental effects of a NICU environment. Implementation of NIDCAP requires NICU developmental care teams and training and certification of staff. There are currently no facilities for this training in Australia.
This refers to the ability of the infant to maintain a balance between the five subsystems
Examples would include the infant's respiratory status, muscle tone, posture, facial expressions, colour, visceral responses and visual attention. How these behaviours are affected by external stimuli, either positive or negative, give information about the infant's ability to cope and organise their responses.
This is a system of care giving in response to the infant's behavioural cues, including the appropriate provision and modification of sensory stimulation
This includes the
The threshold for cochlear damage for adults is 80-85 decibels and the newborn will have a lower threshold than this as the immature cochlear is more sensitive. In the nursery noises of this magnitude include closing portholes with a snap or placing bottles on the top of the plexiglass incubator.
Ssound level recommendations for the nursery environment (Aust and NZ guidelines) - background noise should not exceed an hourly Leq 40-45 DB(A).
Interventions to reduce noise include
Lighting should be adjustable - the adjustment level range of 100-600 lux is recommended ( Aust and NZ guidelines). Constant bright light in the nursery can interfere with natural diurnal rhythms and overstimulate the infant.
Interventions to maintain appropriate individualised light environment include
Infants are positioned with
Parents are involved in decisions about interventions where possible. This promotes their understanding of their infant's behaviour and allows them also to practice cue based care. This allows them to experience positive interactions with their baby and empowers them to recognize behavioural cues and become more confident caring for their baby.
This involves caring for the infant while recognizing the behavioural cues or stress responses and providing an appropriate strategy such as timeout or modification of care as appropriate.
Clustering of cares encourages a minimum handling approach and protects periods of deep sleep by minimizing the number of times an infant needs to be woken up or disturbed. If an infant is unable to cope with a particular cluster of care (observation of stress cues) then cluster fewer care procedures next time if possible.
Minimise painful procedures and provide appropriate pain relief measures.
During these procedures the use of some comforting techniques can reduce stress responses. These include non-nutritive sucking (dummy, cotton bud with breast milk or sucrose), containment of infant's arms and or legs (swaddle or gently holding hands together on chest and/or hold legs tucked up), or grasping a finger.
Support for breast feeding or alternatives as required with the emphasis again on individualized family centred care. Follow the infant's cues and pace the feeds, according to the infant's capacity to organise sucking, swallowing and breathing.
Offer the infant opportunities to suck on a dummy or other suitable object, such as a finger, her own hands or a suitable toy. Use of non-nutritive sucking during tube feeding is helpful in the transition to suck feeds.
Provide continuity of caregivers whenever possible. Develop caregiver groups for longer stay infants.
Handling of infants to minimise stress and uncontrolled responses. Contain the infant using hands or a light swaddle to keep them in a flexed and contained position. Move infant slowly and keep them in contact with the supporting surface whenever possible. Introduce touch slowly and allow time for the infant to respond and adjust to a change in position.
Provide opportunities for kangaroo care when possible.
Kangaroo care is early, prolonged and continuous skin to skin contact between a parent and a low birth weight infant. It has been shown to
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