Individualized developmental care for very low-birth-weight infants: a critical review

Promoting sound development of preterm infants in the name of developmental neuroscience: Beyond advanced life support and neuroprotection

Despite the increased survival opportunities for extremely preterm infants, their long-term cognitive outcomes remain poor, with increased incidence of cognitive impairments in childhood and reduced opportunities to attend higher education in young adulthood compared to their term-born peers. Given that a considerable fraction of preterm infants develop cognitive impairments even without apparent sentinel events at birth and cerebral lesions on MRI assessed at term equivalent age, future strategies to improve the outcome may need to address cerebral dysfunction, which cannot be explained by the classical understanding of the injury cascade triggered by hypoxia-ischaemia around birth. Developmental care has been proposed to minimize neurodevelopmental impairments related to preterm birth. However, considerable modes of cares, environmental settings and procedures provided by the developmental care of current style appear to offer little benefit to the sound development of infants. Although it is obvious that advanced life support and neuroprotective treatments fall far short in compensating for the burden of preterm birth, researchers need to make further effort to fill the knowledge gap in the cerebral function of foetuses and newborn infants before establishing evidence-based developmental care. Clinicians need to develop an ability to translate the findings from basic and translational studies incorporating their potential biases and limitations. Care for newborn infants needs to be reassessed, including but not limited to developmental care, in the context that any sensory input and motor reaction of preterm infants may ultimately affect their cognitive functioning.

Light Reduction Capabilities of Homemade and Commercial Incubator Covers in NICU

Reduction of high-risk neonates' exposure to aversive light stimulation is an important component of developmentally supportive care. In neonatal intensive care unit (NICU), usually light is reduced by reducing the room's light level or by using incubator covers. Many types of incubator covers are in use, including homemade and commercial covers. A comparative study was used to determine the light reducing capabilities of 19 homemade incubator covers, 2 commercial covers, and 1 receiving blanket. The covers were tested by covering and uncovering an incubator and an oxygen hood in the NICU during daytime and nighttime lightings. The light reducing capabilities value was determined for each cover using an Extech light dosimeter when the cover was placed over and removed from an oxyhood, and an incubator. The study showed that the light reducing capability of the commercial covers was 91.2%, the homemade covers capability was 72.1%, and the receiving blankets capability was 55.1%. A significant difference between the commercial and homemade covers was found (F = 452.50, P < 0.00). Commercial incubator covers are the most effective covers to achieve light reduction; homemade covers can be effective if made large enough so that they completely cover all sides of the incubator.

Teamwork in the neonatal intensive care unit

Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of rehabilitation professionals, and models of service delivery vary from hospital to hospital based on philosophy, resources, and other considerations. To provide quality care for infants and families, cohesive team dynamics are required including professional competence, mutual respect, accountability, effective communication, and collaboration. This article highlights the contribution of each member of the NICU team. The dynamics of team collaboration are presented with the goal of improving outcomes of infants and families.

Integrative literature review defining evidence-based neurodevelopmental supportive care of the preterm infant

Neurodevelopmental supportive care (NDSC) is a well-researched topic and extensive evidence is available on its benefits in terms of the outcome for preterm infants. The programs, strategies, and individual elements of NDSC have been evaluated; however, knowledge and implementation of the developmental care approach is fragmented and the evidence base for elements of NDSC that make up the holistic model is not explicitly documented. The aim of this study was to identify and critically appraise the methodologic quality of relevant research studies and synthesize the current best available evidence of NDSC. A comprehensive investigation of NDSC including studies using research methods other than clinical trials may provide a combination of results from several primary studies, therefore an integrative literature review was utilized as the method of choice. Sixteen research articles were found to be of good methodologic quality and level and strength of evidence after critical appraisal. They described or defined the elements of NDSC explicitly. Extraction of data from these articles contributed to the formulation of 25 conclusion statements. Each of these statements could be grouped under 9 categories that resulted from a process of synthesis, and each of these categories could be substantiated from its literature support, clinical impact, and supporting evidence, including the specific literature references and volume and level of evidence associated with that element of NDSC, providing the evidence base for defining NDSC.

Evaluation of a developmental care training programme for neonatal nurses

Although the impact of developmental care on premature infants has been investigated at length, often the issue of professional development and training related to this type of care has not been examined. The aim of the present study was to evaluate the impact of a developmental care training programme on nurses' behaviours and cognitive attributes with regard to the prevention of overstimulation of premature infants. The Theory of Reasoned Action (TRA) was the framework underlying the study. This programme evaluation used a quasi-experimental one group pre-test/post-test design. Participants were nurses working in a neonatal intensive care unit. Data were collected by self-administered questionnaires. Significantly higher post-test scores were observed for knowledge and for a variety of theoretical constructs. The results of this study showed the potential of such training programmes to help nurses implement developmental care.

A comparison of the light-reduction capacity of commonly used incubator covers

PURPOSE

The use of incubator covers to enhance preterm infants' rest and recovery is common in the NICU. However, the kinds of covers used vary extensively among and within nurseries. Few data exist on the effectiveness of different types of covers in reducing light levels to the infant. This study compared several types of commonly used incubator covers as to efficacy of light reduction.

DESIGN

A descriptive, comparative design was used in this study.

SAMPLE

Twenty-three incubator covers were tested, including professional, receiving blanket, hand-crocheted, three-layer quilt, and flannel.

MAIN OUTCOME VARIABLE

The percentage of light level reduction of different incubator covers under various ambient light level settings.

RESULTS

The amount of light reduction provided by incubator covers varies depending on type of fabric as well as percentage of incubator surface shielded by the cover. Dark-colored covers provided greater light reduction than bright/light-colored covers when covers identical in fabric type were compared. The light-reduction efficiency of the covers varied depending on the level of ambient light. Covers provided less light reduction in higher ambient light levels.

Effectiveness of developmental intervention in the neonatal intensive care unit: implications for neonatal physical therapy

PURPOSE

Interdisciplinary team members interact with infants to facilitate progressive physiologic stability. The focus of the physical therapist's role is promotion of sensorimotor development in infants born preterm. The aim of this review was to examine evidence for physical therapist practice in the neonatal intensive care unit (NICU) as it relates to developmental intervention (DI) for infants born prematurely and to present the evidence of physical therapy techniques used in the NICU.

SUMMARY OF KEY POINTS

A literature review was performed resulting in identification of 26 articles that examined specific developmental intervention techniques. The articles were critiqued based on their design. Twelve articles were rated highly, indicating that sensory techniques implemented by physical therapists appear to be an appropriate and effective component of DI. The general consensus was that there is a lack of large, well-controlled, randomized studies in this area of pediatric outcome research.

CONCLUSIONS

Neonatal physical therapy falls under the umbrella of DI. There is substantial agreement about the benefits of DI, but the multimodal and interdisciplinary nature of the evidence limits the ability to identify the effectiveness of any one healthcare professional in the provision of DI in the NICU.

Considerations in planning a newborn developmental care program in a community hospital setting

The effectiveness of developmental care has primarily been evaluated in large tertiary neonatal intensive care units (NICUs) and has shown some promise in enhancing the developmental outcomes of premature newborns cared for in these settings. These interventions have never been prospectively evaluated outside of tertiary care settings. This article attempts to define and critically review developmental care. The differences between large teaching hospital NICUs and smaller community hospital units are highlighted. An overview of developmental care strategies is provided, along with considerations and resources available to support the implementation of developmental care in the community setting.

Outcomes of developmental care in an Australian neonatal intensive care nursery

OBJECTIVE

To evaluate the outcomes of implementation of a developmental care model in an Australian tertiary NICU.

STUDY DESIGN

A retrospective chart audit was used to determine the differences between predevelopmental and developmental care outcomes for infants, parents, the unit, and nursing.

SAMPLE

Two subsets of infants were selected for comparison: one of infants receiving predevelopmental care (n = 42) and another of infants receiving developmental care (n = 42).

RESULTS

Infants receiving developmental care required less time on total parenteral nutrition, required less exogenous surfactant, and had less documented feeding intolerance. Changes were observed in ambience and in the use of space for providing parent-infant care. Also observed was the individualized expertise of nursing staff and of parents.

Components of developmental care and the evidence for their use in the NICU

Developmental care, a philosophy of care that requires rethinking the relationships between infants, families, and healthcare providers, is in place in the majority of neonatal intensive care units in the United States. Developmental care includes a variety of activities designed to manage the environment and individualize the care of the premature infant based on behavioral observations. The goal is to promote a stable, well-organized infant who can conserve energy for growth and development. Research about the effects of developmental care has shown a trend toward improved short-term physiologic, development, and resource utilization outcomes for infants up to 24 months of age, but benefits beyond this age are unclear. Most of the research has focused on developmental care as a whole, but there is also strong scientific evidence for specific components of developmental care. The NICU care provider should use developmental care interventions that are clearly supported by evidence, and use others based on judgment and the infant's responses.

Infant handling in the NICU: does developmental care make a difference? An evaluative review of the literature

Infant handling and disruptions in the neonatal intensive care unit are environmental stressors over which nurses have the most control. Two of the major goals of developmental care are individualizing care by decreasing infant disruptions and handling by caregivers, and modulating or attenuating infant responses to the care they receive. However, it has yet to be established to what extent these goals have been achieved. This article will provide a comparative review of selected literature to ascertain what effect, if any, the introduction of developmental care has had on infant handling or disruption in the neonatal intensive care unit.

Effects on oxygen saturation levels of handling premature infants within the concepts of kinaesthetic infant handling: pilot study

Preterm infants are exposed to many stressors within the neonatal intensive care environment. Since these are associated with medical and developmental problems, a reduction of stress factors is desirable. Handling is a very common occurrence and is associated with stress. Kinaesthetic infant handling (KIH) offers practical guidance on handling for nurses and has been widely implemented in Germany, although there is no direct experimental evidence to support its use. The findings of this pilot study suggest a beneficial effect on the SpO2 for infants who were handled using KIH. Since this was a pilot study with a small sample size, caution has to be exercised with this finding. Therefore, the main purpose of the study was: (1) to identify the weaknesses and strengths of the chosen study design; and (2) to perform a power analysis in order to determine a sufficient sample size for the full experiment.

Environmental impact of the NICU on developmental outcomes

The neonate, especially the premature one, is both dependent on and vulnerable to the intensive care environment to support physiologic and neurobehavioral organization. Concerns about this environment have led to suggestions that it may be a major contributing factor in the persistent incidence of behavioral and learning problems among preterm infants. By modifying the neonatal intensive care environment to provide a more developmentally supportive milieu, we can better meet the infant's physiologic and neurobehavioral needs, support the infant's emerging organization, and foster growth and development.