Development Interventions in Neonatal Care Washington, DC September 28-30, 2006 Summary presented by: Sarah Meyer, MSOTR/L

The NICU Experience and Early Brain Development: Challenge, Responsibility, Opportunity Heidelise Als, PhD Department of Psychiatry Children’s Hospital Boston Harvard Medical School

All NICU experience Affects brain development All NICU Care is Brain Care. H. Als, 2006

All Infants Count on:  Security  Protection  Intimacy

Infants experience the world in terms of:  Timing  Duration  Contour  Intensity

Synactive Model of Developmental Care  A preterm infant is conceptualized within a dynamic system formed by the interaction among the infant, the caregiver, and the environment.  Preterm development is an ever expanding process of differentiation of specific subsystems.

Model of the Synactive Organization of Behavioral Development Systems  Autonomic  Motor  State  Attention/Interactive

Developmental Care Framework for all NICU Care

NIDCAP NewbornIndividualizedDevelopmental Care and AssessmentProgram

Environment –Community and setting –Path to the infant –Care area –Bed space and bedding –Infant’s immediate contact ecology

Behavioral Development Dual Antagonist Differential Inhibition and Excitation Become Increasingly Complex Function  Approach – Avoidance  Towards – Away  Flexion – Extension  Calmness – Arousal/Agitation  Modulation - Disorganization

NIDCAP Observation – Infant Behavior  At Rest  In Interaction with a Caregiver  Returning to Rest  On 24 Hour Ongoing Basis

ReadingInfantsCues “Understanding My Signals”

Behavioral Stress Cues  Saluting  Leg extensions  Frown  Grimace  Grunting  Elimination  Yawn  Sneeze  Hiccups  Arching  Gaze aversion  Change in heart rate  Drop in oxygen saturations  Color changes  Sitting on air

Ways to Assist with Self Regulation  Talk to infant first before handling  Give breaks between changes in position  Talk softly  Only present one stimulus at a time  Provide boundaries  Containment  Grasping  Bring hands to face/midline  Assist in maintaining flexion  Use constant firm touch; not light fast touch

The Individual Infant’s Behavior: Guide for  Parent support and inclusion  Environmental structuring  Bedside, care equipment and supply use and arrangement  All care planning and interaction

Summary Thoughts  NIDCAP represent evidence-based best NICU practice and therewith best brain acre  All decisions are ultimately direct care decisions and impact on infants and families  System change requires changing hearts, minds, eyes and hands, and political will  Each of us has only one brain for life – all experience matters. We matter. It matters how we use and how we care for our brains and those of the infants in our care.