Development Interventions in Neonatal Care

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Development Interventions in Neonatal Care

• Washington, DC
• September 28-30, 2006
• Summary presented by Sarah Meyer, MSOTR/L

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The NICU Experience and Early Brain Development
Challenge, Responsibility, Opportunity

• Heidelise Als, PhD
• Department of Psychiatry
• Childrens Hospital Boston
• Harvard Medical School

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• All NICU experience
• Affects brain development
• All NICU Care is
• Brain Care.
• H. Als, 2006

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All Infants Count on

• Security
• Protection
• Intimacy

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Infants experience the world in terms of

• Timing
• Duration
• Contour
• Intensity

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Synactive Model of Developmental Care

• A preterm infant is conceptualized within a
  dynamic system formed by the interaction among
  the infant, the caregiver, and the environment.
• Preterm development is an ever expanding process
  of differentiation of specific subsystems.

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Model of the Synactive Organization of Behavioral
Development Systems

• Autonomic
• Motor
• State
• Attention/Interactive

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Developmental Care Framework for all NICU Care
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NIDCAP

• Newborn
• Individualized
• Developmental
• Care and
• Assessment
• Program

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Environment

• Community and setting
• Path to the infant
• Care area
• Bed space and bedding
• Infants immediate contact ecology

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Behavioral Development Dual Antagonist
Differential Inhibition and Excitation Become
Increasingly Complex Function

• Approach Avoidance
• Towards Away
• Flexion Extension
• Calmness Arousal/Agitation
• Modulation - Disorganization

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NIDCAP Observation Infant Behavior

• At Rest
• In Interaction with a Caregiver
• Returning to Rest
• On 24 Hour Ongoing Basis

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• Reading
• Infants
• Cues
• Understanding My Signals

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Behavioral Stress Cues

• Saluting
• Leg extensions
• Frown
• Grimace
• Grunting
• Elimination
• Yawn
• Sneeze
• Hiccups

• Arching
• Gaze aversion
• Change in heart rate
• Drop in oxygen saturations
• Color changes
• Sitting on air

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Ways to Assist with Self Regulation

• Talk to infant first before handling
• Give breaks between changes in position
• Talk softly
• Only present one stimulus at a time
• Provide boundaries

• Containment
• Grasping
• Bring hands to face/midline
• Assist in maintaining flexion
• Use constant firm touch not light fast touch

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The Individual Infants BehaviorGuide for

• Parent support and inclusion
• Environmental structuring
• Bedside, care equipment and supply use and
  arrangement
• All care planning and interaction

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Summary Thoughts

• NIDCAP represent evidence-based best NICU
  practice and therewith best brain acre
• All decisions are ultimately direct care
  decisions and impact on infants and families
• System change requires changing hearts, minds,
  eyes and hands, and political will
• Each of us has only one brain for life all
  experience matters. We matter. It matters how
  we use and how we care for our brains and those
  of the infants in our care.