How NICU design and infant and family-centered developmental care act synergistically to support babies and families.

Recommended NICU Design Standards and Infant and Family Centered Developmental Care standards have complementary goals. Design standards focus on environmental modifications necessary to enhance NICU baby and family experiences and outcomes. Infant and Family Developmental Care Standards focus on the functional aspects of babies' and families' experience, including the caregiving environment. When applied in the NICU environment of care, both complementary evidence-based standards can function synergistically to promote better outcomes for babies and families.

Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit.

OBJECTIVE: Developmental family-centered care is evolving as an essential intensive care practice component for newborns and families. Research supports developmental care and the resulting positive outcomes for infants and families. STUDY DESIGN: An interprofessional and parent committee utilized a systematic review and consensus process to evaluate the evidence for intensive care practice. Infant- and family-centered developmental care was described, practice components identified, and evidence-based standards and competencies articulated. RESULTS: Consensus process results included articulation of Standards, Competencies and Recommended Best Practices for Infant and Family Centered Developmental Care (IFCDC), including components of systems thinking, positioning and touch, sleep and arousal, skin-to-skin contact, reduction of pain and stress for infants and families, and feeding. CONCLUSIONS: Successful IFCDC-recommended practices provide opportunities to integrate the family with the interprofessional team, standardize practice, and improve outcomes.

Developmental care for high-risk newborns: emerging science, clinical application, and continuity from newborn intensive care unit to community.

Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.

Eating as a neurodevelopmental process for high-risk newborns.

Many high-risk and preterm infants have difficulty with successful feeding and subsequent optimal growth during their stay in the neonatal intensive care unit as well as in the months after discharge. Environmental, procedural, and medical issues necessary for treatment of the hospitalized infant present challenges for the development of successful eating skills. Emerging data describe eating as a predictable neurodevelopmental process that depends on the infant's organization of physiologic processes, motor tone and movement, level of arousal, and ability to simultaneously regulate these processes.

Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit.

OBJECTIVE: To examine how family-based interventions in the neonatal intensive care unit (NICU) may change parental knowledge and behaviors and decrease stress. METHODS: Eighty-four high-risk mother-infant dyads were randomly assigned to two intervention and one control groups. Group 1 (n = 28) participated in a demonstration of infant reflexes, attention, motor skills, and sleep-wake states. Group 2 (n = 31) viewed educational materials. Group 3 (n = 25), controls, participated in an informal discussion. Parent-infant interactions (Nursing Child Assessment Feeding Scale) were videotaped. Mothers completed measures of stress (Parenting Stress Index) and knowledge of infant cues (Knowledge of Preterm Infant Behavior Scale). RESULTS: Mothers in both intervention groups evidenced greater knowledge and more contingent and sensitive interactions with their infants than did the control group. Stress also differed across groups, and all mothers reported scores above norms. CONCLUSIONS: In a high-risk sample, short-term, family-based NICU interventions may enhance mothers' knowledge, sensitivity, contingency, and stress.

Early relationship environments: physiology of skin-to-skin contact for parents and their preterm infants.

Skin-to-skin care involves the mother placing her diaper-clad infant upright between her breasts in direct skin contact. The practice has evolved worldwide to be an intervention strategy in neonatal intensive care units for premature infants and their mothers. Few adverse outcomes have been noted in thermoregulation, cardiovascular changes, or behavioral organization. Findings have been positively related to better infant physiologic and neurobehavioral outcomes, maternal breastfeeding success, and positive attachment relationships. The early, intimate, and physiologically stabilizing benefits of skin-to-skin care provide for a new conceptualization of the optimal environment for preterm infants in intensive care.

Mean noise amounts in level II vs level III neonatal intensive care units.

PURPOSE: To compare mean noise amounts in Level II NICUs with those in Level III NICUs after controlling statistically for the number of infants per unit. STUDY DESIGN: A between-group design was used in measuring noise amounts. SAMPLE: Noise amounts were sampled using a central site procedure during two time periods of approximately 25 minutes each (total time approximately 50 minutes) in five Level II NICUs and seven Level III NICUs in Colorado. MAIN OUTCOME VARIABLE: Average noise amounts (in dB) from two time periods of approximately 25 minutes each (total time approximately 50 minutes). RESULTS: Mean noise amounts were significantly higher in Level III NICUs (mean = 54.89 dB) than in Level II NICUs (mean = 49.07 dB). This result remained statistically significant even after correcting statistically for total number of babies present in each NICU during noise measurements.

Developmental progression of feeding skills: an approach to supporting feeding in preterm infants.

Infants born prematurely, with congenital or acquired medical conditions, or who have extended stays in the neonatal intensive care unit (NICU) are at higher risk of developing feeding and nutritional problems than are full-term, healthy newborns. Because of the complex nature of feeding, it is necessary to have a thorough understanding of the developmental nature of this skill. The importance of recognizing stability in the physiologic, motor and state systems and using stability to determine both readiness to begin nipple feeding and progress in feeding, is discussed. Intervention strategies to promote stability leading to successful feeding are also described. Viewing infant feeding from a developmental skill acquisition perspective can guide the caregiver in determining how challenging it is for the infant, and therefore is useful in supporting the progression of feeding.