Development Interventions in Neonatal Care

Report
Development Interventions in
Neonatal Care
Washington, DC
September 28-30, 2006
Summary presented by: Sarah Meyer,
MSOTR/L
The NICU Experience and Early
Brain Development: Challenge,
Responsibility, Opportunity
Heidelise Als, PhD
Department of Psychiatry
Children’s Hospital Boston
Harvard Medical School
All NICU experience
Affects brain development
All NICU Care is
Brain Care.
H. Als, 2006
All Infants Count on:
Security
Protection
Intimacy
Infants experience the world in terms
of:
 Timing
 Duration
 Contour
 Intensity
Synactive Model of Developmental
Care
 A preterm infant is conceptualized within a
dynamic system formed by the interaction
among the infant, the caregiver, and the
environment.
 Preterm development is an ever expanding
process of differentiation of specific
subsystems.
Model of the Synactive Organization
of Behavioral Development Systems

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Autonomic
Motor
State
Attention/Interactive
Developmental Care
Framework for all NICU Care
NIDCAP
Newborn
Individualized
Developmental
Care and
Assessment
Program
Environment
–Community and setting
–Path to the infant
–Care area
–Bed space and bedding
–Infant’s immediate contact
ecology
Behavioral Development
Dual Antagonist Differential Inhibition
and Excitation Become Increasingly
Complex Function

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Approach – Avoidance
Towards – Away
Flexion – Extension
Calmness – Arousal/Agitation
Modulation - Disorganization
NIDCAP Observation –
Infant Behavior




At Rest
In Interaction with a Caregiver
Returning to Rest
On 24 Hour Ongoing Basis
Reading
Infants
Cues
“Understanding My Signals”
Behavioral Stress Cues

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Saluting
Leg extensions
Frown
Grimace
Grunting
Elimination
Yawn
Sneeze
Hiccups

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Arching
Gaze aversion
Change in heart rate
Drop in oxygen
saturations
 Color changes
 Sitting on air
Ways to Assist with Self Regulation
 Talk to infant first
before handling
 Give breaks between
changes in position
 Talk softly
 Only present one
stimulus at a time
 Provide boundaries
 Containment
 Grasping
 Bring hands to
face/midline
 Assist in maintaining
flexion
 Use constant firm
touch; not light fast
touch
The Individual Infant’s Behavior:
Guide for
 Parent support and inclusion
 Environmental structuring
 Bedside, care equipment and supply use
and arrangement
 All care planning and interaction
Summary Thoughts
 NIDCAP represent evidence-based best NICU
practice and therewith best brain acre
 All decisions are ultimately direct care decisions
and impact on infants and families
 System change requires changing hearts, minds,
eyes and hands, and political will
 Each of us has only one brain for life – all
experience matters. We matter. It matters how
we use and how we care for our brains and those
of the infants in our care.

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