Developmental care is a philosophy utilized by the entire interdisciplinary team to coordinate medical, nursing, and parental interventions based on the developmental needs for a particular patient. This philosophy of care is to support the infant and their families with a focus on environmental influences affecting neurologic development. Developmental care encourages frequent assessment and responses to a baby’s needs. These responses are meant to decrease the stress of the preterm neonates in the neonatal intensive care unit (NICU), according to the Northern Neonatal Network’s guideline for family-centered developmental care.
Why use developmental care?
Neonatal medicine is an ever-expanding field. Babies born at progressively earlier gestational ages are able to survive due to advancements in modern medicine. Mortality rates have declined with the fast-paced achievements of neonatal medicine. However, evidence exists to suggest increased morbidity for neonates born prematurely or acutely unwell. Long-term studies have identified more subtle problems including neurosensory impairments such as cognitive delays and behavioral difficulties. “These can have a significant influence on a child and their families’ way of life.” Developmental guidelines for interventions, handling, inclusion of family and nursing protocols help to optimize neurodevelopmental outcomes for NICU infants and their families.
What is the goal of developmental care?
As caregivers, we want to protect the infant’s brain and create an environment suitable for neurobehavioral development of the infant. According to the Network, the outside environment now needs to mimic the inside environment, which is crucial for normal brain development. The inside environment provides containment and allows for the baby to maintain a supported flexed posture with limited noise and light exposure, as well as, protected sleep cycles with no separation from the baby’s mother. The goal is to support more positive experiences for the baby and thus achieve more positive outcomes for even the littlest of our patients.
How do we implement developmental care?
In the NICU, we use developmental care to support the infant and their families with individualized care which focuses on the environmental influences including handling, positioning, light, and sounds. The amniotic fluid serves as tactile sensory stimulus for the infant while in utero. When the infant is in the NICU, they are exposed to various touch stimuli versus constant tactile stimulus. Studies suggest that even routine handling during procedures can have adverse effects on the infant such as bradycardia, hypoxia, sleep disruptions, increased intracranial pressure and behavioral agitation.
One way to overcome this overwhelming tactile stimuli is to swaddle the infant. A systemic review published in Pediatrics found that swaddled infants have improvement in physiological and behavioral states such as lower heart rate, alleviates pain, prevents hypothermia and calms the infant. It also induces and prolongs sleep with fewer startles. The Network’s guideline suggests that these same benefits can also be achieved by the practice of developmental positioning utilizing positioning aids. Developmental positioning also provides the musculoskeletal support of flexed & midline postures, encourages self soothing behaviors and helps to conserve the baby’s body temperature and energy thus growth and weight are promoted.
Gentle human massage and touch is another intervention that can help decrease stress levels of premature babies. A Research in Nursing & Health study found that gentle human touch increases respiratory regularity, improves sleep cycles, motor activity and behavioral distress during periods of gentle touch. Gentle massages have been reported to help improve weight gain, improved pain alleviation, reduced postnatal complications, improved physiological and behavioral states, shorter hospital stay and improved performance in developmental scores.
The NICU is quite often an overstimulating environment. Behaviors, which should be modeled by staff and taught to the parents can ease the constant stream of auditory and visual stimulation. The NICU staff can control the lights and sounds of the outside environment. A 2013 study published in Indian Pediatrics recommends that we keep the infant on a schedule to allow for uninterrupted rest and decrease stress by using non-nutritive sucking, kangaroo care with parents, swaddling, and containment.
In summary, developmental care should be utilized for all preterm infants during their adaption to extrauterine life. Creating a positive environment and protecting neurobehavioral development is crucial to an infant’s long term outcomes. Implementing developmental care practices such as positioning, swaddling, nonnutritive sucking, gentle human touch and massage can help alleviate pain and provide better outcomes for the premature babies and their families.
- Developmental Care in the NICU - June 7, 2017