While in the NICU?
A developmental care plan is essential to help your baby survive and thrive in the NICU environment. What is a developmental care plan? Simply stated, it is a variety of interventions staff and parents can do to help control the NICU environment according to the needs of each premature infant. The care plan should enhance the infant’s physiological stability, behavior and gestational age. The care team within the NICU is assessed of and response to the infant’s changing needs. Interventions are designed to allow for neurobehavioral development of the infant.
There are a variety of interventions used to decrease stress such as lighting and NICU noise, scheduling of infant’s care, incorporating parent involvement, swaddling, kangaroo care, infant massage, non-nutritive sucking and developmental activity.
Let me show you an example of a developmental care plan. It will help you see what and how it should done and implemented”
Baby A was born at 26 weeks, 4 days gestation, which makes her a micro preemie. She is observed by a therapist/developmental specialist to get a better understanding on how to support her and she communicates with others.
Her current home is a Giraffe bed, which is a special bed that helps Baby A to continue to grow/thrive outside her mother’s womb. It is temperature controlled and contains humidity which will help her skin from losing body heat.
Baby A has severely immature lungs and is currently intubated to help her breathing from a machine called a ventilator. She also has IV’s placed in her umbilical cord-one for nutrition and the other is for meds/blood pressure readings.
Usually observations occur while nursing care is performed (temp, diaper, vitals and assessment). There is a little background noise and her space has very little light so that the light will not hurt her premature eyes. Baby A’s care is done every 4 hours so that she can rest and grow. Most of her growing happens when she is in a deep sleep. It is also when her brain develops the most. So it is really important to not interrupt her when she is sleeping.
There are positioning devices being used with Baby A to mimic her still being in the womb in a flexed/rolled up position. Such devices would be a snuggle up, a Z-flo mattress and a Freddy frog-these keep her flexed and rounded position. These supports are very important as Baby A’s muscles are still forming and are weak and are not strong enough to maintain her positioning.
Because Baby A was born so prematurely, she lacks the muscle tone and strength to calm herself when stressed by her environment. They can self-console if given containment with hands, good positioning and rest breaks as she needs them. She can demonstrate self-calming activities such as clasping her fingers together, foot bracing against snuggly and grasping her breathing tube or sucking on her tiny pacifier. Respiratory wise, Baby A was exhausted from her care given, and she was allowing the ventilator breathing for her.
What Baby A was exhibiting are challenges to her prematurity, which are stress/discomfort and limited energy. If one looks closely, her signs of stress are subtle (changes in heart rate, respiratory rate, frown and wrinkled brow). Baby A is trying to maintain her vital signs (autonomic nervous system). Remember a baby born prematurely no longer is within a protected environment of her mother’s womb. She is now in a NICU environment that is so different that was anticipated and has to fight stress such as gravity, noise, light, and painful procedures. EVERY interaction she encounters will have an effect on her developing brain.
Goals for Baby A
Adapting to her new life in the NICU and being able to handle tactile stimulation during care while in a relaxed and comfortable manner. Maintaining her vitals and letting the ventilator help her breathe when she is fatigued. Nursing/Ancillary staff (Respiratory, X-ray , and OT) are to help Baby A into a deep uninterrupted sleep by use of bedding, positioning aids and kept contained. This allows her body to grow, mature and heal.
Challenges for Baby A
Baby A is facing many challenges while in the NICU. Most premature babies have very low endurance and tolerance to breathe well, especially with hands-on care, painful procedures. She needs to be able to maintain a tucked, flexed and rounded position without of bedding or containment from her family and caregivers. It is difficult to do as a preemie! Gravity is not her friend and with her muscles with low tone and weakness, gravity will allow her arms and legs to go out into extension. This will disorganize her.
The noise and light are not always optimal in the NICU. She was in dim lighting and muted noise when still in the womb. Her nervous system is premature and not ready for much sensory input. So lights, noise, touch and vestibular movement can be stressful and disruptive to her sleep.
How can Baby A thrive in the NICU
Baby A can be helped by providing a calm, quiet and comfortable sleeping space so she can get into a deep sleep that helps her to grow and mature. She requires a quiet environment to help her brain development.
Lighting over her bed should be off or on a low setting and there should be a cover over her isolette/Giraffe bed to ensure dim lighting. Visual systems are still premature and the harsh bright lights can be harmful to her developing eyes. Sight is the last and slowest sense to develop. Only after 24-36 weeks can baby’s pupils adjust to light.
Overpowering smells can cause Baby A stress as well. Her sense of smell is also premature and she could have reactions to scents too potent such as perfume, deodorant, powders, cigarette smoke, etc. Having clean clothes on and minimal smells will help her to keep her calm and more organized.
Having parents doing kangaroo care and have skin-to-skin contact. This helps Baby A stay warm when out of her warm isolette, but provides crucial bonding needed with her parents. Always encourage and support her family so they provide as much care as possible for her when in the NICU. Currently simple things like doing “preemie holds” through hand containment, gentle face washing, taking her temperature and changing her diaper allow them to be “parents”.
Special thanks to Patti Scull, MSN, RNC for providing information towards this blog!!