• Print This
• Select Text Size:
• Comments
• 

At just 23 weeks and three days, tiny Natalie Castro entered the world with a tiny cry fitting for her 1-pound, 3-ounce frame. Doctors gave her a 10% to 20% chance of survival.

But her parents, Kenia Mendoza and Jesus Castro, and the NICU staff at Connecticut Children's Medical Center in Hartford never gave up hope.

"Seeing her so small was really hard," says Mendoza, who kept a four-month vigil by tiny Natalie's bedside. Babies in the NICU at Connecticut Children's are going home sooner, healthier, and have fewer developmental issues since the NICU adopted a developmentally supportive model of care called NIDCAP (Newborn Individual Developmental Care and Assessment Program) in June 2007.

NIDCAP is family centered and individualized to an infant's neurobehavioral goals and level of stability so each infant may realize optimal health and developmental outcome. Seeking to mirror the benefits of the mother's womb for these young preterm infants, the NIDCAP model supports developing relationships, minimizes outside stimuli, uses gentle-touch interventions, pain control, and other comfort measures such as skin-to-skin care, swaddling, and containment to support a baby during care and at rest.

"The difference is really quite noticeable," says Dorothy Vittner, RN, MSN, certified NIDCAP trainer and developmental specialist in the NICU at Connecticut Children's. "They are more content, eating better, and have decreased time on the ventilator and improved neuro-developmental outcomes."

Developmental care was created by NIDCAP Federation International Founder and President Heidelise Als, PhD, in 1984 and was adapted as a standard of care by the National Association of Neonatal Nurses in the early 2000s. "While not all NICUs practice the full NIDCAP methodology, many are working to adapt at least components of developmental care," Als says.

Connecticut Children's is one of 17 facilities worldwide (10 in the U.S.) recognized and certified by the NIDCAP Federation International as a NIDCAP training center. As a training center, the facility provides training to its own staff and staff at other hospitals.

Als, who also is director of Neurobehavioral Infant and Child Studies at Children's Hospital Boston and associate professor of psychology in the Department of Psychiatry at Harvard Medical School, became interested in newborn intensive care when she observed infants in a NICU in the early 1970s and noticed a dissonance in their care.

"Back then, the primary focus was about maintaining the lung function outside of the womb," explains Als. "These infants were all placed on their backs, often with restraints to prevent them from pulling out any cords and tubes. This seemed completely contradictory to what they wanted, which was to be in a tucked position with their hands to their faces as they are in the womb."

This led to early research conducted by Als and her colleagues that is changing the way NICU nurses and doctors around the country and world provide care. Als' research showed babies who receive individualized developmental care have improved growth and weight gain, decreased days on ventilators, decreased severity of lung disease, and fewer medical complications.

Babies have improved brain electrophysiological functions as measured with EEG and better brain structure as measured with magnetic resonance imaging, specifically indicating improved frontal lobe development, which is important in mental control, attention regulation, and executive function. Additional research on long-term outcomes has shown that babies have better attention and intellectual processing and improved neuropsychological functioning at later ages.

Vittner says she believes the developmentally supportive care and the daily love and support provided by Mendoza were critical to Natalie's successful outcome. Natalie left the hospital in her mother's arms at 5 pounds about five months after her birth.

During those five months, Mendoza held Natalie in skin-to-skin care daily until she had worked up to three to four hours. She read to Natalie, changed and fed her, and participated in her care as much as possible.

Developmental care is about paying attention to the physical environment as well as the social and emotional environment of the baby, says Vittner. That means interacting when the baby is ready to interact; learning to read infant's cues to know when he or she has had too much stimulation; keeping lights, sounds, and activity to a minimum; and supporting parents in bonding and participating in care.

To determine a baby's cues and responses to environmental stimuli, NIDCAP promotes the performance of NIDCAP observations and assessments. This observational tool involves evaluating an infant's behavior and noting when the baby is relaxed or is experiencing stress or discomfort. Using this information, a developmental care plan that best supports the infant's overall goals and efforts at self-regulation is developed and shared with the rest of the care team and parents.

"Supporting families and relationships are just as much a priority as technical competence," says Vittner. "Both play a critical role in the baby's growth and development."

---

Susan Meyers is a freelance writer. To comment, e-mail editorNE@nursingspectrum.com.

Reader Comments

You must adhere to the Terms of Service and Community Rules for Nurse.com when posting comments. Please do not post disparaging or offensive remarks. You may use links in your post.