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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal intensive care practices harmful to the developing brain
1Division of Neonatology, Department of Pediatrics, KEM Hospital, Pune 411 011, India. kemhrc@vsnl.com
Insights
Survival of extremely low birth weight infants is increasing, but NICU stays are long. Developmental care strategies are crucial to minimize neurodevelopmental impairment in these vulnerable newborns.
Area of Science:
- Neonatal care
- Neurodevelopmental pediatrics
- Perinatology
Background:
- Increasing survival rates for extremely low birth weight (ELBW) infants present challenges in NICU care.
- The NICU environment differs drastically from the womb, potentially impacting infant brain development.
- Neurodevelopmental impairment is a significant concern for ELBW infants.
Purpose of the Study:
- To highlight the importance of developmental support for ELBW infants.
- To identify environmental and medical factors in the NICU that negatively affect infant neurodevelopment.
- To advocate for humanized care to improve developmental outcomes.
Main Methods:
- Review of existing literature on ELBW infant development and NICU environments.
- Analysis of sensory, procedural, and medical factors impacting neurodevelopment.
- Synthesis of evidence supporting developmentally supportive care strategies.
Main Results:
- The NICU environment (noise, light, procedures) can adversely affect infant development.
- Radiation exposure (X-rays, CT scans) and certain medications (steroids, aminoglycosides, frusemide) pose risks to brain and hearing.
- Developmental care is essential for mitigating negative impacts.
Conclusions:
- Humanized, developmentally supportive care is vital for enhancing neurodevelopmental outcomes in ELBW infants.
- Minimizing environmental stressors and iatrogenic risks is crucial.
- Proactive developmental support can improve long-term health for ELBW survivors.
Abstract:
There has been a marked increase in the survival of extremely low birth weight (ELBW) infants, but these babies have a long stay in the NICU. Strategies to decrease their neurodevelopmental impairment become very important. The maximum development of the brain occurs between 29-41 weeks. From the warm, dark, acquatic econiche, where the baby hears pleasant sounds like the mother's heart beat, the baby suddenly finds itself in the dry, cold, excessively bright, noisy, environment of the NICU. Noise, bright light, painful procedures, and ill-timed caregiving activities, adversely affect the infant's development. Excessive radiation from X-rays of babies on the ventilator and CT scans also affect the brain. Medications like steroids for chronic lung disease also cause damage to the brain. Aminoglycides and frusemide are known to cause hearing impairment. Hence a developmentally supportive, humanized care will go a long way in enhancing the developmental outcome of these babies.
