Development Interventions in Development Interventions in Neonatal CareNeonatal Care

Washington, DCWashington, DCSeptember 28-30, 2006September 28-30, 2006

Summary presented by: Sarah Meyer, Summary presented by: Sarah Meyer, MSOTR/LMSOTR/L

The NICU Experience and Early The NICU Experience and Early Brain Development: Challenge, Brain Development: Challenge,

Responsibility, OpportunityResponsibility, OpportunityHeidelise Als, PhDHeidelise Als, PhD

Department of PsychiatryDepartment of PsychiatryChildren’s Hospital BostonChildren’s Hospital BostonHarvard Medical SchoolHarvard Medical School

All NICU experienceAll NICU experienceAffects brain developmentAffects brain development

All NICU Care isAll NICU Care isBrain Care.Brain Care.

H. Als, 2006H. Als, 2006

All Infants Count on:All Infants Count on:

SecuritySecurityProtectionProtection IntimacyIntimacy

Infants experience the world in terms Infants experience the world in terms of:of:

TimingTiming DurationDuration ContourContour IntensityIntensity

Synactive Model of Developmental Synactive Model of Developmental CareCare

A preterm infant is conceptualized within a A preterm infant is conceptualized within a dynamic system formed by the interaction dynamic system formed by the interaction among the infant, the caregiver, and the among the infant, the caregiver, and the environment.environment.

Preterm development is an ever expanding Preterm development is an ever expanding process of differentiation of specific process of differentiation of specific subsystems.subsystems.

Model of the Synactive Organization Model of the Synactive Organization of Behavioral Development Systemsof Behavioral Development Systems Autonomic Autonomic MotorMotor StateState Attention/InteractiveAttention/Interactive

Developmental Care Developmental Care Framework for all NICU CareFramework for all NICU Care

NIDCAPNIDCAP

NewbornNewborn

IndividualizedIndividualized

DevelopmentalDevelopmental

Care and Care and

AssessmentAssessment

ProgramProgram

EnvironmentEnvironment

–Community and settingCommunity and setting

–Path to the infantPath to the infant

–Care areaCare area

–Bed space and beddingBed space and bedding

–Infant’s immediate contact Infant’s immediate contact ecologyecology

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

Complex FunctionComplex Function

Approach – AvoidanceApproach – Avoidance Towards – AwayTowards – Away Flexion – ExtensionFlexion – Extension Calmness – Arousal/AgitationCalmness – Arousal/Agitation Modulation - DisorganizationModulation - Disorganization

NIDCAP Observation –NIDCAP Observation –Infant BehaviorInfant Behavior

At RestAt Rest In Interaction with a CaregiverIn Interaction with a Caregiver Returning to RestReturning to Rest On 24 Hour Ongoing BasisOn 24 Hour Ongoing Basis

ReadingReading

InfantsInfants

CuesCues““Understanding My Signals”Understanding My Signals”

Behavioral Stress CuesBehavioral Stress Cues

SalutingSaluting Leg extensionsLeg extensions FrownFrown GrimaceGrimace GruntingGrunting EliminationElimination YawnYawn SneezeSneeze HiccupsHiccups

ArchingArching Gaze aversionGaze aversion Change in heart rateChange in heart rate Drop in oxygen Drop in oxygen

saturationssaturations Color changesColor changes Sitting on airSitting on air

Ways to Assist with Self RegulationWays to Assist with Self Regulation

Talk to infant first Talk to infant first before handlingbefore handling

Give breaks between Give breaks between changes in positionchanges in position

Talk softlyTalk softly Only present one Only present one

stimulus at a timestimulus at a time Provide boundariesProvide boundaries

ContainmentContainment GraspingGrasping Bring hands to Bring hands to

face/midlineface/midline Assist in maintaining Assist in maintaining

flexionflexion Use constant firm Use constant firm

touch; not light fast touch; not light fast touchtouch

The Individual Infant’s Behavior:The Individual Infant’s Behavior:Guide forGuide for

Parent support and inclusionParent support and inclusion Environmental structuringEnvironmental structuring Bedside, care equipment and supply use Bedside, care equipment and supply use

and arrangementand arrangement All care planning and interactionAll care planning and interaction

Summary ThoughtsSummary Thoughts

NIDCAP represent evidence-based best NICU NIDCAP represent evidence-based best NICU practice and therewith best brain acrepractice and therewith best brain acre

All decisions are ultimately direct care decisions All decisions are ultimately direct care decisions and impact on infants and familiesand impact on infants and families

System change requires changing hearts, minds, System change requires changing hearts, minds, eyes and hands, and political willeyes and hands, and political will

Each of us has only one brain for life – all Each of us has only one brain for life – all experience matters. We matter. It matters how experience matters. We matter. It matters how we use and how we care for our brains and those we use and how we care for our brains and those of the infants in our care.of the infants in our care.