1. Premature Infants & the NICU Medical & Psychological Issues
November 13, 2007

2. Description 250,000 newborn infants admitted to NICU’s annually in US
Most are born premature, at low birth weight, or both
Premature infant = born prior to 37th week of gestation
Low birth weight = less than 5.5 pounds

3. Description
Majority of Infants born as early as 25 weeks gestation survive
5-7% of North American infants are born prematurely
Most are hospitalized until approx. their due date

4. Causes of Prematurity
Social, biological, & environmental factors

6. Causes of Prematurity
Prenatal care, no drugs, & healthy diet reduce chances
Most premature births occur in middle-class women

7. The Premature Infant Immature organ development
Difficulties adapting to the extrauterine environment
Physical appearance
Lanugo
Absence of fat
Elongated head

8. Premie Development Three stages of premie development Early premie
Developing premie
Older premie

9. Impact of NICU Lack of patterning to stimulation
Infants can learn to “tune out” stimuli
Social signals may receive no response
Fail to learn effective ways of eliciting responses from caregivers
Social signaling may be diminished or extinguished through lack of response

10. Positive Changes in the NICU
Minimize unneccesary contact
Relocate or quiet noisy equipment
Shield infants’ isolettes from light
Provide day-night cycles in terms of light & activity
Supply pleasant visual and auditory stimulation
Provide gentle touch

11. Transition to Home
Anxiety about assuming full responsibility of care for the infant
Infant may be less than optimally responsive & still may be medically fragile
Infant irritability
Parent fatigue
Parent concern for infant’s developmental progress

12. Prematurity & Later Development
Growth & health
Cognitive development

13. Prematurity & Later Development
Socio-emotional & behavioral development
Temperament
Bonding & attachment
Behavior problems

14. Parenting a Premature Infant
Social risk factors
Low income
Lower education
Minority cultural backgrounds
Coping strategies
Finding meaning in experience was superior t other coping methods 18 months post-discharge

15. Parenting a Premature Infant
Other family members
Fathers
Grandmothers
Siblings

16. Parenting a Premature Infant
Family-focused interventions
Support groups
Teach parents to care & stimulate child
Provide intervention beyond NICU stay

17. Role of Pediatric Psychologist
Support & services provide to family
Devote attention to PARENT needs
Organize parent support groups
Provide child-rearing advice
Be link between families and staff
Provide grief counseling, when needed

18. Role of Pediatric Psychologist
Participation in follow-up clinics
Assess developmental status of child
Refer for early intervention services
Design IFSP, when warranted
Address parenting & family concerns (e.g., maternal depression, marital conflict, sibling adjustment)