Chapter 22: Complementary and Integrative Medical Therapies in Neonatology

I. INTRODUCTION

The use of complementary and alternative therapies continues to grow in this country and abroad. Integrative medicine is a newer term that emphasizes integration of complementary therapies with conventional medicine. In integrative medicine, health professionals are expanding their view of Western medicine to a more holistic perspective. Integrative care has emerged in neonatal intensive care units (NICUs) throughout the globe as an attempt to create a more neuroprotective environment and provide a more nurturing, family-friendly environment.

Early exposure to the ex utero environment, long before development is capable of handling it, has a myriad of sequelae. We cannot 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. Integrative 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 integrative therapies, explores how these options are used in the NICU, provides some evidence-based support of integrative therapies, and presents ideas on potential future integrative expansions. Broad categories that integrative therapies address include the following:

1. Lifestyle therapies (called “developmental care” in neonatology). Examples include light and color therapies, music therapy, aromatherapy, kangaroo care, and attention to environmental influences, such as bright lights and loud noises.

2. Biomechanical therapies. Example include massage, reflexology, and osteopathy/craniosacral therapy.

3. Bioenergetic therapies. Examples include acupuncture/acupressure, therapeutic/healing touch, and reiki.

4. Biochemical therapies. Examples include homeopathy and herbal medicine.

II. LIFESTYLE THERAPIES

Lifestyle therapies 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.

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. Many NICUs incorporate a system of noise assessment and regulation. Ex utero, the auditory system is not shielded by the maternal tissues, which significantly attenuate frequencies. Ambient noise in the NICU may cause distress, and attempts have been made to minimize the noise using ear plugs or using sound to negate other sounds, called sonic acoustic masking. Single-family rooms create a more home-like environment and have proved to be successful in terms of noise abatement. However, there is concern of lack of stimulation for infants who do not have regular visitation by family members.

   2. Light. Regulation of ambient light in the NICU is also an important concern. Constant exposure to light can result in disorganization of an infant’s state. Unit lighting is now designed or modified to regulate light and to include developmentally supportive circadian ...