20: Complementary and Alternative Medical Therapies in Neonatology

I. INTRODUCTION

The wave of complementary/alternative care sweeping the country has virtually bypassed neonatal intensive care units (NICUs). However, if we listen, we find families asking for complements to traditional care in many aspects of medicine. The consciousness that patients wanted around their deathbeds wasn't even on the radar screen of most hospitals when the hospice movement began. Today, a new sense of nurturant care is struggling to take shape in our NICUs. Complementary and alternative medical (CAM) therapies may be one adjunct to help soften the high-tech environment of an NICU by imbuing the nurturing elements one would expect to find around newborns.

Early exposure to the ex utero environment, long before development is capable of handling it, has myriad sequelae. We can't escape the evolving realization of environmental and epigenetic influences on the development of the immature brain. These infants require developmental care equal to their acute and chronic medical care. CAM therapies give us some options that might help ameliorate some of the routinely expected morbidities.

This chapter briefly describes some of the most popular and promising CAM therapies, explores how these options are used in the NICU, provides some evidence-based support, and presents ideas on potential future CAM expansions. The following standard categorizations of CAM modalities come from the National Center of Complementary Medicine:

1. Lifestyle therapies (called “developmental care” in neonatology). Examples included are light and color therapies, sound and music therapies, aromatherapy, kangaroo care and positioning, as well as avoidance of negative factors such as loud noises and bright lights.

2. Biomechanical therapies. Massage, reflexology, osteopathy/craniosacral, and chiropractic care.

3. Bioenergetic therapies. Acupuncture, healing touch, Reiki, and energy workers.

4. Biochemical therapies. Homeopathy and herbal medicine.

II. LIFESTYLE THERAPIES

Many CAM practices currently implemented in neonatal units are categorized under lifestyle therapies, but they are more commonly referred to in the NICU as developmental care intervention. Research shows that the environment of a newborn is an important influence on sensory, neural, and behavioral development. CAM therapies attempt to create an environment in the NICU that is reflective of the intrauterine environment.

1. Developmental care. Includes many interventions, both on the macro- and microenvironmental level. Many neonatal units have made tremendous efforts to modify existing nurseries or have designed new units with environmental modifications that include particular attention to noise levels, light exposure, organization of care, and family-centered care.

   1. Noise. Adverse environmental auditory stimuli are a common concern. Most who work in the NICU have difficulty with the constant and confusing barrage of alarms. Imagine trying to sleep in that environment. Many NICUs incorporate a system of noise assessment and regulation. We also know one of the drawbacks of incubators is the approximate 77-decibel noise level and minimal vestibular stimulation, which differs markedly from the in utero environment. Ex utero, the auditory system is not shielded by the maternal tissues that significantly attenuate frequencies. Ambient noise in the ...