development interventions in neonatal care washington, dc september 28-30, 2006 summary presented...
TRANSCRIPT
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Development Interventions in Development Interventions in Neonatal CareNeonatal Care
Washington, DCWashington, DCSeptember 28-30, 2006September 28-30, 2006
Summary presented by: Sarah Meyer, Summary presented by: Sarah Meyer, MSOTR/LMSOTR/L
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The NICU Experience and Early The NICU Experience and Early Brain Development: Challenge, Brain Development: Challenge,
Responsibility, OpportunityResponsibility, OpportunityHeidelise Als, PhDHeidelise Als, PhD
Department of PsychiatryDepartment of PsychiatryChildren’s Hospital BostonChildren’s Hospital BostonHarvard Medical SchoolHarvard Medical School
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All NICU experienceAll NICU experienceAffects brain developmentAffects brain development
All NICU Care isAll NICU Care isBrain Care.Brain Care.
H. Als, 2006H. Als, 2006
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All Infants Count on:All Infants Count on:
SecuritySecurityProtectionProtection IntimacyIntimacy
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Infants experience the world in terms Infants experience the world in terms of:of:
TimingTiming DurationDuration ContourContour IntensityIntensity
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Synactive Model of Developmental Synactive Model of Developmental CareCare
A preterm infant is conceptualized within a A preterm infant is conceptualized within a dynamic system formed by the interaction dynamic system formed by the interaction among the infant, the caregiver, and the among the infant, the caregiver, and the environment.environment.
Preterm development is an ever expanding Preterm development is an ever expanding process of differentiation of specific process of differentiation of specific subsystems.subsystems.
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Model of the Synactive Organization Model of the Synactive Organization of Behavioral Development Systemsof Behavioral Development Systems Autonomic Autonomic MotorMotor StateState Attention/InteractiveAttention/Interactive
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Developmental Care Developmental Care Framework for all NICU CareFramework for all NICU Care
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NIDCAPNIDCAP
NewbornNewborn
IndividualizedIndividualized
DevelopmentalDevelopmental
Care and Care and
AssessmentAssessment
ProgramProgram
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EnvironmentEnvironment
–Community and settingCommunity and setting
–Path to the infantPath to the infant
–Care areaCare area
–Bed space and beddingBed space and bedding
–Infant’s immediate contact Infant’s immediate contact ecologyecology
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Behavioral Development Behavioral Development Dual Antagonist Differential Inhibition Dual Antagonist Differential Inhibition and Excitation Become Increasingly and Excitation Become Increasingly
Complex FunctionComplex Function
Approach – AvoidanceApproach – Avoidance Towards – AwayTowards – Away Flexion – ExtensionFlexion – Extension Calmness – Arousal/AgitationCalmness – Arousal/Agitation Modulation - DisorganizationModulation - Disorganization
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NIDCAP Observation –NIDCAP Observation –Infant BehaviorInfant Behavior
At RestAt Rest In Interaction with a CaregiverIn Interaction with a Caregiver Returning to RestReturning to Rest On 24 Hour Ongoing BasisOn 24 Hour Ongoing Basis
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ReadingReading
InfantsInfants
CuesCues““Understanding My Signals”Understanding My Signals”
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Behavioral Stress CuesBehavioral Stress Cues
SalutingSaluting Leg extensionsLeg extensions FrownFrown GrimaceGrimace GruntingGrunting EliminationElimination YawnYawn SneezeSneeze HiccupsHiccups
ArchingArching Gaze aversionGaze aversion Change in heart rateChange in heart rate Drop in oxygen Drop in oxygen
saturationssaturations Color changesColor changes Sitting on airSitting on air
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Ways to Assist with Self RegulationWays to Assist with Self Regulation
Talk to infant first Talk to infant first before handlingbefore handling
Give breaks between Give breaks between changes in positionchanges in position
Talk softlyTalk softly Only present one Only present one
stimulus at a timestimulus at a time Provide boundariesProvide boundaries
ContainmentContainment GraspingGrasping Bring hands to Bring hands to
face/midlineface/midline Assist in maintaining Assist in maintaining
flexionflexion Use constant firm Use constant firm
touch; not light fast touch; not light fast touchtouch
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The Individual Infant’s Behavior:The Individual Infant’s Behavior:Guide forGuide for
Parent support and inclusionParent support and inclusion Environmental structuringEnvironmental structuring Bedside, care equipment and supply use Bedside, care equipment and supply use
and arrangementand arrangement All care planning and interactionAll care planning and interaction
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Summary ThoughtsSummary Thoughts
NIDCAP represent evidence-based best NICU NIDCAP represent evidence-based best NICU practice and therewith best brain acrepractice and therewith best brain acre
All decisions are ultimately direct care decisions All decisions are ultimately direct care decisions and impact on infants and familiesand impact on infants and families
System change requires changing hearts, minds, System change requires changing hearts, minds, eyes and hands, and political willeyes and hands, and political will
Each of us has only one brain for life – all Each of us has only one brain for life – all experience matters. We matter. It matters how experience matters. We matter. It matters how we use and how we care for our brains and those we use and how we care for our brains and those of the infants in our care.of the infants in our care.