An extended stay in the newborn intensive care unit (NICU) places newborns, preterm and term, at an increased risk for alterations in neurodevelopment.
Review essential components of developmentally supportive care; recommend strategies to protect neurodevelopment in the NICU.
Premature infants admitted to the NICU lose the protection of the intrauterine environment, placing them at risk for alterations in neurodevelopment. It is vital for neonatal healthcare professionals and families to adapt and optimize the NICU environment in order to protect the preterm brain during critical and sensitive periods of development. All care delivered to hospitalized newborns has the potential to positively or negatively impact neurodevelopment. Developmentally supportive care is a holistic, family-centered philosophy of care that promotes neurodevelopment of preterm infants, decreases discordance between the womb and NICU environments, and alters the micro- and macro-environments to match the infant capabilities. Critical to this philosophy of care is the development of a positive parent-infant relationship that is lifelong and essential for long-term development. Parents are recognized as partners of the healthcare team. The following recommendations are aligned with the developmental care core measures published by the National Association of Neonatal Nurses (NANN).
MAJOR RECOMMENDATIONS: PROMOTE A HEALING ENVIRONMENT
A healing environment of care includes not only the physical environment but also the culture of an organization that recognizes patients as human beings with physical, social, psychological, and spiritual needs. A healing environment reduces stress and anxiety and promotes harmony of mind, body, and spirit, which positively affects health. The working environment defines the NICU culture; therefore, healthcare workers should strive to create a positive environment/culture so that safe, effective, and evidenced-based care can be delivered. Professionals in the NICU are challenged to provide a healing environment to infants and families during one of the most vulnerable and frightening periods of their lives. Compassionate professionals should guide parents through their shock, fear, and grief experiences by providing physical, emotional, and psychological support. This will empower families to parent, advocate, and partner with medical professionals to care for their babies. The physical surroundings of the NICU should be welcoming, aesthetically pleasing, and provide space and privacy for parents to engage with their infants. Specific design recommendations are set forth by the Committee to Establish Recommended Standards for Newborn ICU Design. The healing environment for the infant includes care that minimizes pain and stress, promotes uninterrupted sleep, supports the developing sensory system, encourages parental attachment, optimizes nutrition, provides a neutral thermal environment, and meets the infant’s medical needs to restore health. Such an environment allows medical professionals to deliver individualized, age appropriate, and neuroprotective care for every infant in their care.
Practice Option #1: Provide Appropriate Sensory Exposure