Neurodevelopmental Support

Neurodevelopmental care is an approach to the intensive care of preterm and sick full-term infants in a NICU that supports neuromaturation and that also provides care for acute and chronic illnesses. Just as the intrauterine environment influences fetal development, the NICU environment influences the development of infants born preterm. The elements that make up the provision of neurodevelopmental support include NICU design and lighting, nursing routines and care plans, feeding methods, management of pain, attention to sensory input, activity and signs of stress, and the involvement of the parents in the care of their infants (Aucott et al., 2002). Although a number of studies have been conducted to evaluate the efficacies of various aspects of neurodevelopmental support in improving the outcomes for infants born preterm, few have yielded conclusive results. Conducting good randomized controlled trials has proven to be quite difficult and expensive. Neurodevelopmental support is an important area that requires further study, both for the efficacy of the interventions that are used and for obtaining a better understanding of how NICU interventions support (or interfere with) the neuromaturation of infants born preterm.

The NICU presents preterm infants with an overwhelming amount of stimuli because of the active hospital environment and the infant's exposure to multiple medical procedures (Aucott et al., 2002; Gilkerson et al., 1990). To minimize adverse stimuli and to support neuromaturation, NICUs therefore seek to implement strategies that mimic the intrauterine environment and that provide more appropriate stimuli that are geared to the infant's state of alertness and responses (Aucott et al., 2002; Conde-Agudelo et al., 2005; Phelps and Watts, 2005; Pinelli and Symington, 2005; Stevens et al., 2005; Symington and Pinelli, 2005; Vickers et al., 2005). For example, attention to how infants are positioned and handled can influence the development of their posture and muscle tone. Some NICUs have adopted more comprehensive approaches to developmental care, including kangaroo care and the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) (Conde-Agudelo et al., 2003; Symington and Pinelli, 2005).

It is not unusual for parents of critically ill neonates to feel overwhelmed by the technology that they encounter in the NICU and to have difficulty connecting to their newborn infant underneath all the NICU equipment. Family-centered NICU care is more of a philosophy than a program (Malusky, 2005) and involves providing families with comfortable seating, rocking chairs, privacy, and liberal visiting hours; encouraging them to bring in family photos or tapes of their voices; and saving bathing and feeding for family visits.

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