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The high-risk infant environment. Part 2. The role of caregiving and the social environment
S N Graven1, F W Bowen, D Brooten
1Department of Community and Family Health, College of Public Health, University of South Florida, Tampa 33612-3805.
Insights
Neonatal intensive care unit (NICU) environments and care practices can cause long-term disabilities in high-risk infants. Further research is needed to assess and mitigate these environmental risks for improved infant outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Health
- Environmental Health
Background:
- Neonatal intensive care units (NICUs) are critical for treating premature and critically ill infants.
- Advances in NICU technology have improved survival rates and outcomes for high-risk neonates.
- Despite improvements, some infants experience long-term disabilities linked to NICU environments and care, not solely their initial condition.
Purpose of the Study:
- To highlight the impact of NICU environments and care practices on long-term infant outcomes.
- To underscore the need for evaluating environmental factors that may exacerbate infant morbidities.
- To advocate for comprehensive follow-up assessments that include sensory and developmental functions.
Main Methods:
- Review of accumulating evidence on environmental factors and care practices in NICUs.
- Analysis of studies investigating the interaction between NICU environments and disease processes.
- Examination of current follow-up assessment limitations for high-risk infants.
Main Results:
- Environmental factors and care practices in NICUs can interact with disease processes, increasing morbidity and potentially mortality.
- Evidence suggests adverse effects on visual function and other sensory systems in infants exposed to NICU environments.
- Many NICU-related issues may cause delayed recovery or discomfort without producing currently assessed long-term disabilities.
Conclusions:
- NICU environments and care practices pose risks for long-term infant disabilities, including developmental, behavioral, and sensory deficits.
- Current follow-up assessments may not capture the full spectrum of potential NICU-related problems.
- Further research and improved assessment strategies are necessary to ensure the safety and well-being of infants in NICUs.
Abstract:
Neonatal intensive care units are essential for the successful care of very immature and sick infants. The technology of NICUs has contributed significantly to the reduction of neonatal mortality and improvement of neonatal outcome. While the outcome for high-risk neonates has vastly improved over the past three decades, a number of infants sustain injuries and complications that result in long-term disabilities. It is now clear that some of the long-term problems of high-risk infants are a result of the environment and care practices and are not attributable to the original disease or condition that necessitated intensive care. There is accumulating evidence that environmental factors and care practices can interact with disease processes in ways that can increase morbidity, and possibly mortality. In addition to developmental and behavioral problems, there is growing evidence of effects on visual function and perhaps other sensory systems. Many of the environmental and care factors may cause delay in recovery and increase NICU time or unnecessary discomfort, yet not produce long-term disabilities or problems, as currently assessed. Many of the potential behavioral and developmental problems, as well as many of the potential problems with visual, auditory, and other modes of sensory discrimination, are not included in the usual follow-up assessments. The absence of data or the limitations of existing studies are not a cause for comfort or the assumption that the environment and care practices are safe or not harmful.(ABSTRACT TRUNCATED AT 250 WORDS)