Neurodevelopmental care in the NICU

Research output: Contribution to journalReview articlepeer-review

Abstract

Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.

Original languageEnglish (US)
Pages (from-to)298-308
Number of pages11
JournalMental Retardation and Developmental Disabilities Research Reviews
Volume8
Issue number4
DOIs
StatePublished - Dec 24 2002

Keywords

  • Developmental care
  • Early intervention
  • NICU
  • NIDCAP
  • Prematurity
  • Preterm development

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neuropsychology and Physiological Psychology
  • Genetics(clinical)

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