NEURODEVELOPMENT APPROPRIATE CARE OF THE NEONATE Best Practice

NEURODEVELOPMENT: APPROPRIATE CARE OF THE NEONATE Best Practice NICU

THE GOLDEN HOUR FOR ADMISSION TO THE NICU

Golden Hour interventions: • • • Thermoregulation Weight Place in developmentally position as appropriate BP x 1 (preferably right arm) Glucose monitoring Evaluation of respiratory status, placement on respiratory support & administration of surfactant (as needed and per provider order) Establish IV access & initiate fluids as ordered Evaluation of cardiac status. Place on cardiac monitor Admission labs X-rays for line placement, ET tube position, and baseline pathology Administer medications as ordered (Vitamin K, erythromycin ointment, antibiotics) within first hour

APPROPRIATE ENVIRONMENT

• HOB should be elevated 30 degrees until in an open crib • Minimize noise- be cognizant of conversation, isolette doors, phones, alarms, utilize “ear muffs” • Protect eyes from light with isolette covers, eye shield, dim lights as possible • Always admit to a preheated, humidified isolette and complete admission with the top down

POSITIONING AND MOVEMENT

Developmentally Appropriate Positioning -72 hours midline positioning (head aligned) -Neck neutral, aligned, head slightly flexed forward -Shoulders rounded forward towards the midline -Hands touching face -Hips/pelvis aligned and softly flexed -Knees, ankles, feet aligned and softly flexed -Utilize positioning aids as needed -Group and organize care-giving activities; allow recovery time between care Slow, careful movements responding to baby’s cues Do not raise bottom higher than head, especially during diaper changes, roll side to side as needed. Goal is < 10 degrees.

THERAPEUTIC POSITIONING BENEFITS

THERAPEUTIC POSITIONING …. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Helps contribute to a decreased length of stay Helps decrease the days on ventilation Contributes to increased weight gain Helps decrease the days on oxygen Minimizes musculoskeletal abnormalities Improves neurodevelopmental outcomes Promotes proper joint alignment and symmetry Supports neuromuscular development Promotes self-soothing and behavioral organization Extended position affects acquiring developmental motor skills and can interfere with oral feeding skills

Positioning in the NICU should simulate the wombthe flexed, contained, midline posture of the infant in utero. These external supports provide a temporary substitute for the immature infant’s immature motor control. The boundaries and positioning aids that you provide can help your patient in many more ways than just comfort!

THE END!

• • • Developmentally Supportive Care Theory and Application: A Self-Study module. Children's Medical Ventures: #94078. Second edition. 2007. Gardner, S. L. , Carter, B. S. , Enzman-Hines, M. I. , & Hernandez, J. A. (2016). "The Neonate and the Environment: Impact on Development". Merenstein & Gardner's handbook of neonatal intensive care (8 th ed. ). St. Louis, Mo. : Mosby Elsevier. 262 -314. Kenner, C. , & Mc. Grath, J. (2004). Developmental Care of Newborns & Infants: A Guide for Health Professionals. St. Louis, MO: Mosby. Altimier , L &Philips, R. (2018) Neuroprotective Care of Extremely Preterm Infants in the First 72 Hours after Birth. Critical Care Nursing Clinics of North America. Doi. 1016/j. cnc, 2018. 07. 010 Hunter, J. , Lee A. & Altimier, L. (2015) Neonatal Intensive Care Unit. Occupational Therapy for Children and Adolescents. St. Louis. Elsevier, 2015, p. 595 -635 Philips- Mother and Child Care. Infant Positioning Assessment Tool (IPAT)