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 Breaking
news
Developmental
Care
by
Carol Turnage Carrier, MSN, RN, CNS
Traditionally,
neonatal intensive care has been based on medical and nursing
caregiving tasks, not necessarily carried out in response to infants’
behavioral cues. Over the last 20 years, support for relationship-based,
individualized developmental care has been gaining acceptance
in neonatal intensive care units (NICU).
A
recent meta-analysis conducted on studies of developmental care
noted significant reduction in duration of ventilator days and
number of days on supplemental oxygen. Neurodevelopmental outcomes
using the Bayley Scales of Infant Development were improved in
treatment infants at 9 and 12 months but not at 2 years. Repeated
studies with similar findings suggest this approach is not harmful
and may well support important clinical outcomes.
The
major assumption of individualized developmental care is that
infants can communicate through physical and behavioral responses.
Communication by the infant, observable during rest, procedures,
and recovery from procedures, is seen through 3 basic subsystems
of functioning :
- Autonomic/Physiologic: respiratory pattern and fluctuations,
color changes, heart rate, oxygen saturation, blood pressure,
and visceral signals such as gagging, hiccoughing, or spitting
up after a stressful event.
- State: range in states of consciousness, clarity of states,
ease and frequency of transition, ability to maintain quality
alert states, and self-calming ability.
- Motor: general posture, tone, and quality of movement.
Ongoing
assessment allows caregivers to identify the thresholds, vulnerabilities,
and strengths of individual infants. Goals of individualized assessment
and planning are
- to reduce stress and pain experienced by high-risk or preterm
infants;
- to enhance and support self-regulatory (calming) behaviors
of infants;
- to promote development with appropriate stimulation as an
infant is ready;
- to promote normal movement and orthopedic development; and
- to facilitate the parent-infant relationship from birth.
Potential
threats to normal infant development in hospital settings are
unpredictable experiences, the changing environment, painful procedures,
and multiple caregivers. Collaboration among caregivers informed
on the unique clinical and behavioral details of their patients
supports communication and a more consistent approach to the care
of each infant.
Thus,
developmental care is more than providing stimulation or activities
for hospitalized infants. By observing infants’ individual responses,
the astute caregiver can tailor care to reduce pain and stress,
promote rest, or support emerging abilities. In all caregiving
disciplines, awareness of an infant’s communication cues and immediate
response to an infant’s needs distinguish developmental care from
traditional, task-related care.
photo:
Carol Turnage Carrier evaluates a neonate in the Newborn Center
at Texas Children's Hospital; photo by Paul Kurtz, courtesy of
Texas Children's Hospital
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