Developmental and family-oriented intensive care of premature babies
Why individualized developmental care is important
It is normal for an intensive care unit to be focused on tasks and protocols, which for your newborn represents complete separation from its parents, sensory overload and often frequent experiences of invasive and painful events. A ‘foetal baby’ - a baby that came into the world too early - still expects your daily rhythm and muted influences from the outside world: sound, smell, taste, and visual and tactile sensations. Since your baby cannot tell us how it feels, it shows us, using three main systems of communication:
- The autonomic nervous system: changes in breathing patterns, changes in heart rate, changes in skin colour, hiccups, straining bowel, coughing, sneezing, yawning, and tremors.
- The motor system: changes in muscle tone, and frantic, diffuse activities including spreading and bending fingers, making grimaces and sticking out its tongue.
- Stress signals: diffuse sleep states or panic, tense and worried wakefulness, expression of anxiety, persistent crying or crying with changed sound, rapid changes of state, and irritability.
In order to help your newborn, the principle of individualized developmental care was developed based on long-term observations. The approach is based on reading these behavioural signs and creating an individualized care plan for a baby in order to reduce the divergence between the expectations of the immature brain and the actual experience in the intensive care environment. Individualized developmental care of your newborn includes:
- A detailed observation of your newborn's behaviour as the basis for recommendations on how to best reduce stress and improve its development.
- Education and counselling of parents with trained staff in applying these principles.
- Improved medical well-being as well as neurobehavioral and emotional functioning of your newborn, and improved parental confidence.
How is individualized developmental care applied?
Individualized developmental care is applied by:
- Having an appropriate environment in the room (e.g., the position of the incubator in relation to windows, sinks, tables, etc., lighting, sound and activities).
- Adapting the environment in the incubator or bed (e.g., use of a nest and incubator cover).
- Using self-regulation aids (e.g., positioning, sucking or grasping aids, and eye protection).
- Determining the time of and coordinating activities related to care (e.g., daily rhythm, grouping of interventions).
Image 1. Covers for incubators
Image 2. Lamps with focused light
Image 3. Positive touch
Image 4. Correct positioning
Family participation in individualized developmental care
Family-oriented care is an integral part of individualized developmental care where parents participate in the daily care of their newborn that is in hospital. The basic approach is a partnership of parents and health workers in which health workers change from their role as the primary caregivers of newborns to the role of being mentors to parents in undertaking newborn care. Family-oriented care is carried out according to a plan made by the parents and health professionals according to the needs of the newborn. To implement family-oriented care, armchairs are placed next to the incubator, with rooms often specially designed for this purpose, where the family stays with their baby.
Image 5. Application of care next to the incubator
Image 6. Family room
Positive effects of individualized developmental care
Individualized developmental care has many positive effects on your infant: a shorter time using a ventilator and oxygen therapy, less frequent occurrence of chronic lung disease and bleeding in the brain, better feeding, a shorter hospital stay, less likelihood to return to intensive care, better brain maturation, better attention, communication, fine and gross motor skills, fewer developmental disabilities, and lower treatment costs.
