Transcript Developmental Aspects in the NICU

Developmental Aspects in the NICU
Jackie Sampers, Ph.D.
Angie Stidham
Missy Stamper
Objectives
• To share current thinking of developmental care in
the NICU
• To review currently used developmental
interventions for hospitalized high-risk infants
• To describe current developmental research at UK
• To familiarize the participants in current research
in developmental cares nationally
Background – The New Age
• BASICS, Baby Awareness and Support through
Interactive Computer Systems provides families of
baby’s in the NICU with helpful information.
• Information is provided in an easy-to-use touch
screen system in down to earth language.
• BASICS reinforces the information provided to
families by medical professionals.
Background Continued
• All information in the systems was
developed with parents who had baby’s in
the NICU.
• BASICS helps families know what
questions to ask medical professionals.
• Use of technology to support infant
transition into community based services
Content on BASICS
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Medical Conditions
Tips from Families
NICU Equipment
Reading Baby’s Cues
NICU Team Members
Community Services
Medical Terms
Nathan’s Story
Containment
• Containment involves the gentle
holding of the infant in the incubator
or crib.
• It can be used when an infant is too
sick to be held outside the crib or
can support the infant during painful
medical procedures.
Containment Tips
• Support can be provided when the infant is
on their tummy, back or laying on their side.
• The legs are supported in a flexed position.
The infant can stretch out, but then the
caregiver can help them return to a tucked
and secure position.
• The caregiver uses their other hand to
support the upper body and arms.
• Some caregivers like to gently caress the top
of the babies head.
Containment
• Approach Cues
• Avoidance Cues
Nesting
• Babies are use to being inside their mommy
with firm support, the rolls can help them to
feel boundaries and they can push up against
the sides of the rolls comforting them.
• Nesting can be done while the infant is in the
NICU and placed on a monitor that helps to
ensure that the baby is physiologically stable.
• The infant can be supported with rolls or
other commercially available products.
Nesting Tips
• Supports can help keep the baby calm and
can support good positioning of the baby.
• Rolls can be used to build up the sides of the
bed, but you must be careful not to have any
loose bedding around the face. Also, rolls
must be placed under the bedding/sheets, so
that the baby cannot push-up under the rolls.
• Remember always safety first; never let
blankets, rolls or clothing get around the
babies face.
Nesting
• Approach Cues
– Good state control
– Hands to face
– Body relaxed (legs and
hip softly flexed)
– Good support of mid
line motor movements
• Avoidance Cues
– Head position too far
to the side
– Baby sinking into the
surface
– Arching positions
Watch for good positioning: no frog legs
Pacifier
• A pacifier is a fairly common intervention with
the newborn and can help the baby by
providing a very supporting intervention.
• Research has strongly supported the use of
pacifiers with infants in the NICU. Many
studies suggest that pacifiers can help the
infant to stay calm, support the transition to
oral feeding, increase oxygenation and some
even suggest that it can help with growth and
development in some ill infants.
Pacifier Tips
• Care must be taken to find the right pacifier,
just the right size
• Shapes should be considered
• Sometimes we remember to give the infant the
pacifier when there is a painful procedure, be
very careful, because the infant can grow to
associate the pacifier with pain if that is the
only time it is given.
• Some infants have difficulty moving from the
pacifier to the breast for feeding, the lactation
consultant can help.
Pacifier
• Approach Cues
– Good physiological
stability
– State control
• Avoidance Cues
– Tongue thrust
– Cry
– Movements into
extension
– Arching
Kangaroo Care
• Just like a Kangaroo keeps the baby
close to them and provides skin-to-skin
contact, parents can provide similar
experiences for their babies in the
NICU.
• Moms or Dads can provide
• It can help families to feel closer to their
ill baby and many mothers report that it
helps them relax to breastfeed.
Kangaroo Tips
• Safety is important and most hospitals have rules
about who can participate in Kangaroo Care and
how it should be done step-by-step.
• While the parent is seated comfortably in a semiinclined position the nurse will place the baby to
the chest. Baby is then snuggled in with the
caregiver's clothing and/or covered with blankets.
• With early trials nurse will need to monitor the
infant's temperature and stability, in the
beginning the kangaroo time should be limited.
• Other stimulation should be limited.
Kangaroo Care
• Approach Cues
• Avoidance Cues
– Arching
– Physiological
instability
(temperature,
respirations, or heart
rate)
Stroking
• To start with keep it simple with skin-toskin and no extras.
• When stroking the baby, touch from the
chest out to arms and chest down to
feet.
Stroking Tips
• Caution the infant may perceive a very light
stoking as irritating, like tickling is to an adult.
• To get the most benefit from this intervention
provide the infant with skin-to-skin contact.
• At first the baby may be very sensitive for
smells and chemicals, so don't use lotions or
perfumes.
• For the very fragile infants music during
stroking may be too much stimulation.
Stroking
• Approach Cues
– Visual regard to
caregiver
– Body tucking – nice
flexion
– Quiet awake
– Hand clasp
• Avoidance Cues
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Change in state control
Changes in skin color
Tremors
Startles
Hyper-alert
Jerky movements
Positioning
• For very ill infants there is a tendency for the
infant to be supported the infant in one stable
position.
• Some infants like to keep their legs held our
stiffly or may keep their hands laying flat on the
bed by their head, this can be a challenge to
good positioning. Other infants may arch their
backs in a C position.
• To support good positioning, there are both
commercially available products and
homemade supports.
Positioning Tips
• Support the infant's head to both the right and
left.
• Place pictures in the bed or if toys are part of
their environment be sure to move the toys
from one side to the other.
• Be sure to talk to the baby from both the right
and left.
• Side lying can support the infant's ability to see
their hands and clasping their hands at midline
• Good position can help to prevent problems
later in life.
Positioning
• Approach Cues
– Flexion
– Tuck positioning
– Good visual regard in
all fields
– Localization of sound
to both sides
• Avoidance Cues
– Frog leg postures
– Any posture that is
obligatory for the
infant
Reading
• Regular reading times can start even while
the infant is in the hospital.
• Communication patterns develop very early
and reading to your infant using with feeling,
expression and varying the rhythm can keep
the infant's interest.
• This early reading can also support very early
pre-language development.
• Reading has other benefits to the infant,
reading can give the infant practice in looking
towards parent’s face and as they get older
finding your voice.
Reading Tips
• The parent’s voice is familiar to the baby.
• Reading to your baby can be a soothing
activity even for the very ill infant.
• Don't be afraid to read the same books over
and over again to the child, this will support
familiarity.
• If the parent has be away from their baby,
record on a taper recorded the stories that
you have read over and over to the infant, so
that he can be comforted while you are away.
Reading
• Approach Cues
– Quiet Awake State
– Ohh face
– Swiping movement
towards book or face
• Avoidance Cues
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Fatigue
Gaze avert
Cry
Startles
Increased tonicity
Caregiver Supported
Orientation
• Awake times provide opportunities for brief
interactions with family members, where the
infant is supported in using their senses to
orient to stimulation.
• Usually these early sights and sounds should
use the caregivers face and voice.
• When the baby gets really good at the activity
they will watch you as you move across the
room, up and down, and all around.
• Awareness of sound is also a big step for the
infant.
Caregiver Oriented Tips
• Use caregiver face for most interactions
• If toys are used, be careful that they don’t
over-stimulate
• Be sure toys are placed in the line of vision
Caregiver Oriented Cues
• Approach Cues
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Visual fixation
Relaxed face muscles
Engaged infant
Swiping towards
caregiver face
– Open hand
• Avoidance Cues
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Gaze aversion
Hyper-alert face
Finger splay
Salute
Tremors
Fisting
Multi-modal
• Multi-modal is a fancy way of saying
way of saying providing the infant with
activities that have a sight, sound and
sometimes a touch or smells to them.
• Multi-modal stimulation, two or more
types of play, is typically reserved for
the very stable infants who are about to
go home free of oxygen and monitor.
Multi-modal Tips
• Not all infants in the NICU can tolerate this
level of stimulation and may actually need to
be protected from an over-stimulating
environment. Usually, most ill infants can
only handle one type of stimulation at a time.
• Some babies may become so over-stimulated
that they have physiological or health
problems during or following the stimulation.
Controversial Interventions
• Hydrotherapy
– Limited research
– Only recommended fro
medically stable
infants with good body
temperature stability
– Must be physician
approved before
initiation
• Waterbeds
Summary
• Developmental cares can support the infant and
the family.
• Developmental interventions must be infant
specific. Gestational, chronological and adjusted
age must be considered as well as health status.
• Families should be provided information that
helps them to become an active member of the
care team.
Qualitative Research
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Parent Consumer Advisors
Focus Groups
Expert Reviewers
Surveys
Qualitative Data from
Parent Surveys
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Other Focus Groups
• Medical Review Group
• Community Services Group
• Expert Reviews
Effectiveness of BASICS
• The study examines:
– How information reduces stress?
– Does information support interactions between
medical staff and families?
– How does information influence family satisfaction
with hospital services?
Early Identification of Motor
Problems