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Brief Guide To Developmental Care

The document discusses the NIDCAP approach to caring for preterm infants. It aims to minimize stress and provide developmentally supportive care by observing babies' responses and individualizing care based on their abilities. It provides examples of how to reduce noise, light, and stress during procedures through positioning, timing, preparation, and comfort measures.

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madimadi11
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112 views

Brief Guide To Developmental Care

The document discusses the NIDCAP approach to caring for preterm infants. It aims to minimize stress and provide developmentally supportive care by observing babies' responses and individualizing care based on their abilities. It provides examples of how to reduce noise, light, and stress during procedures through positioning, timing, preparation, and comfort measures.

Uploaded by

madimadi11
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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The NIDCAP Approach:

Making Interventions easier for


babies

• Studies have shown that noxious stimuli in the neonatal period have a detrimental
effect on neurodevelopment. Preterm infants are particularly unable to fully manage
environmental stimuli, and demonstrate over-reactive responses and poor tolerance
of even minimal input. Loss of control and stress responses become frequent
unless those caring for these babies recognise signs of distress, and adjust care
and handling accordingly.
• The Newborn Individualised Developmental Care and Assessment Program
(NIDCAP) aims to provide this baby-centred developmentally supportive care, to
minimise the risks of overloading immature sensory systems. It was developed in
the mid-eighties, and NIDCAP training centres are now found around the world. The
leading UK centre is the Winnicott Baby Unit at St. Mary's Hospital, London.
• The major instrument used is formalised observations during routine cares and
interventions, and whether the baby becomes stressed (avoidance behaviour) by
overwhelming stimuli or whether the accept a stimulus that is appropriate by moving
towards it and demonstrating self-regulation by stabilising of physiological
parameters. The level of acceptance of stimuli will obviously increase as a baby
matures.
• This assessment then establishes an individual support program dependent on the
ability of a baby's immature nervous system to tolerate the environment they find
themselves in on a neonatal unit. It is designed to provide comfort, reduce pain and
stress; and provide a suitable environment to promote neurological development.
• Imagine what it would be like to be nosily woken from sleep, abruptly turned over,
exposed to bright light and then have a painful procedure performed before being
put back to bed and left alone. This is often a daily routine for our babies, and we
must make an effort to reduce the impact of these necessary interventions on them.
• Although our units are not implementing the full NIDCAP program at present, there
are many simple interventions that can be used from the program to make
procedures as painless as possible.

This is our aim -an unstressed, settled baby,


who has the opportunity for restful sleep to
aid neurodevelopment.
Light and Noise
• Hearing develops before vision during fetal life and studies have shown that
inappropriate stimulation of one sensory system not only affects the development of
that system but disrupts the natural order of development, leading to disruption of
other senses as they try to mature.
• Babies are used to muffled sounds inutero, and it is important not to expose babies
to excessive noise, as this disturbs restful sleep which is vitally important for growth
and development.

The SoundEar® displays one the walls of the


nurseries are visual reminders to reduce the
noise on the unit. The green light indicates
acceptable levels of noise. The red warning
light comes on when noise reaches 65
decibels, with a amber light caution light
appearing at 60 decibels, the level of normal
conversation.

• Noises that we barely notice can be very disturbing for small babies. For example
putting blood bottles on top of an incubator can generate 80 decibels of noise inside
it, equivalent to the noise level of heavy traffic. Closing the incubator doors without
care is louder to the baby than a pneumatic drill would be to us (100 decibels). Sleep
can be disturbed by sound as quiet as 35 decibels.
• Noise can be reduced by turning off alarms promptly, closing incubator doors, and
bin lids carefully and taking care when placing items on top the incubator . It is also
important to avoid talking loudly over the babies’ beds.
• It is important to minimise lighting levels at all time by using low level lighting in the
nurseries and shielding the babies from bright light, which has a strong arousal effect
on preterm babies despite their immature visual system. The other advantage of dim
rooms are that people tend to make less noise.

Incubator covers shield our babies


from light, as well as muffling
environmental sounds

• It is particularly important to have very dim lighting at night to facilitate normal


day/night cycles.
• Do not use extra lighting unless absolutely necessary, and the use of Wee-sights can
prevent the need for bright overhead lamps.
Positioning
• Preterm babies do not have the muscle strength to position themselves against
gravity, and a baby laid supine with no support will adopt the classic frog-like
posture of external rotation of hips and shoulders, and extended arms.
• This position for long periods of time can lead to reduced muscle tone and
consequently delay in motor development.
• It is important to try to maintain a flexed position mimicking the fetal position in the
womb, with the hands in the mid-line to assist with hand to face movement , which
the baby finds soothing. This may not always be possible because of the presence
of lines and monitoring, but has the dual advantages of aiding muscle development
and calming the baby.

Boundary to maintain
side-lying Hands
in
midline

Rolled sheet between legs to


keep them in a natural
position

Brace for feet, aids


self-comforting

Boundaries makes babies


feel secure

Ability to bring hand to


face for comfort

Rolled sheet under hips to maintain flexion


• Side-lying and the prone position are preferable, as demonstrated above, and these
are maintained by the use of nests, bendy bumpers and bedding rolls
Approach to procedures

• Timing
– Try not to interrupt essential restful sleep, and observe unit rest times unless
absolutely necessary.
– Try to combine procedures to avoid repeated interruptions, but let babies rest
after prolonged procedures.
– Ask the nurse looking after the baby when would be a good time; to fit in with
feeds, cares etc., however this may not always be possible, especially in
intensive care.
• Prepare
– Have all equipment to hand to avoid repeatedly disturbing the baby.
– If you need to use a bright light ensure baby’s eyes are shielded (may be
under sterile towel, or use phototherapy goggles)

Use screens to respect the


baby’s privacy during long
procedures and when other
parents are present

• Comfort
– We currently do not use oral sucrose as a comfort measure but a dummy can
be used, as can using a small amount of milk if possible.
– Babies and also seek comfort from grasping an assistants finger, bedding or
a soft toy; and the baby bracing their feet against the cot, bedding or hands.
– Stroking can be arousing and irritating, but still hands cupped on the head,
bottom or feet can work to calm the baby
– Ask someone to help comfort the baby while you carry out the procedure by
holding, helping to retain the dummy, and assisting with clasping hands
together, or hand to face movements.

Still hands performing containment


holding
• Proceed slowly
– Do not jump straight into the procedure, instead use a staged approach. First
talk to the baby, then touch their hand gently to prepare them slowly that
something is about to happen.

Gentle
hand
Baby nest holding
supports hip prepares
flexion the baby for
whilst in a the coming
supine procedure
position

– Proceed slowly, allowing the baby time to adjust. If you need to change the
baby’s position, do it slowly, maintaining the flexed position as much as
possible. Only uncover the part of the body needed, keep the rest tucked
inside the boundary.
– Do not twist limbs, as this is painful.
– If the baby demonstrates physiological stress (tachycardia, desaturation),
pause the procedure and ask for help to sooth the baby before proceeding.
• Finishing
– Leave the baby as you found them, paying particular attention to positioning,
and making the baby comfortable.
– Withdraw slowly; so continue talking to the baby when you have finished.
– Stay, or ask someone else to provide soothing contact until the baby has
settled.
– Update parents

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