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Development and Developmental Care Supporting neonatal outcomes PowerPoint Presentation

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Description : Check out this medical titled "Development and Developmental Care Supporting neonatal outcomes” by Robinder G. Khemani MD, MsCI.

This medical is about neonatal development and developmental care which are critical for supporting positive outcomes for premature and critically ill infants.

Tags : Supporting neonatal outcomes, neonatal development, neonatal developmental care, premature infants, critically ill infants, Neonatal-Perinatal Medicine, Neonatal-Perinatal Medicine

Published on : Jun 01, 2023 | Views : 880 | Downloads : 0

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Slide 1-

Introduction This presentation is being provided as an example of a staff education module. The material on the slide may act as a guide but is not prescriptive. It should be adapted to your own site using your own materials. The narrative on the slide notes is a guide to help guide your own presentation.
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Development and Developmental CareSupporting neonatal outcomes
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Dreams…shattered
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YES, we can “get” there! One family Stats: 18 months of Breastfeeding 66 rounds presented by Mom/ Dad 372 hours of skin-to-skin by Mom & Dad Education, education, education Sending home a happy healthy family … Priceless!
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Objectives The importance of an environment that supports: neuroprotective developmental care appropriate positioning and handling to promote development neurobehavioral stability that supports neurologic systems the decrease of iatrogenic consequences
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Impact of prematurity Autonomic system is underdeveloped 2 known causes for alteration in brain development: stress & pain Fearful and vulnerable Sleep deprivation Ability to self-regulate severely diminished
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High risk for a variety of problems musculoskeletal development, flexor/extensor abnormalities oral aversion, skin sensitivity (pain) cognitive defects poor academic achievement & behavioral disorders psychiatric disorders parenting challenges
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Neuro-protective developmental care Creates an environment that manages the infant’s stress and pain while offering a calming and soothing approach that keeps the whole family involved in the infant’s care and development
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Health professionals & parents working together Healing Environment, Partnering with Families, Positioning & Handling, Safeguarding Sleep, Decreasing Pain & Stress, Protecting Skin, Optimizing Nutrition
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NICU GOAL:…..through the dark I could be Gabriel’s mom, I was taught touch, the feeling, the interaction, and how all that became Gabriel's “best medicine”
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to help learners connect with the baby’s experience
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What do YOU see in the picture in your role as a nurse? What do PARENTS see in the picture?
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What do YOU see in the picture in your role as a nurse? What do PARENTS see in the picture?
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Normal fetal development Musculoskeletal system develops In a gravity-free buoyant environment With freedom to move and receive developmentally appropriate stimulation, (tactile, vestibular, auditory and visual sensory stimulation) Provides positive sensory input for brain development
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Full-term infant 3rd trimester neural connections reinforced, emphasizes flexion & midline orientation as a normal baseline- uterine wall provides secure boundaries At birth Early motor control for ongoing development
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Preterm infant Incomplete development of muscle tissue, joint structures, bone density Muscle tone hypotonic Limbs abducted, externally rotated, lie flat in a frog leg position Spontaneous resting position flat, extended, asymmetrical, head to one side (usually right) Difficult to maintain flexed position, cannot alter position for pain & discomfort Lack internal or mechanical motor control, increased episodes of startle, twitches
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Early neurosensory development impacted NOT a gravity-free & buoyant environment NOT a positive intrauterine environment, (position, touch, sound, comfort and light) Can impact developing brain Preterm infant
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The preterm infant Added to the problem illness, energy depletion, gravity & weight of medical lines Over time, active extension, arching and asymmetry become dominant
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Preterm infant/full-term infant
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GOAL: 520 grams infant @ term versus term infant at birth
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Term-corrected 4 months corrected
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4 months corrected
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Expectations at 4 months-corrected Development of head control Head turns both ways (no flat head) Focus and follow with both eyes Equal movement of limbs, clasping of hands, hands to mouth Early eye-hand coordination reach and grasp In prone pushes up on arms, preparing to roll Attends to voice, watches & begins to imitate some sounds, laughs
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To optimize neuro-protective care in the NICU Provide appropriate positioning/handling to Support infants’ state regulation Decrease sensory overload Reduce physiologic distress, reduce disorganization Promote development Therefore Provide care-giving slowly and confidently Introduce one stimulus at a time Allow infant to set pace, withdraw stimulus if over stimulated & provide hands on containment Reinstate baseline environmental supports after any procedure & flex the infant
Slide 28-

Position & handle in flexion, containment & alignment During all care taking activities, ensure midline, tucked position Bathing, weighing, feeding Diaper changes/temperature taking, mouth care, girth measurement Avoid hyperextension of neck & shoulder retraction During procedures, blood tests, lumbar puncture Attaching back to cpap, etc. Feeding, sleeping, holding
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Communicating
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Handling
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Promote development & enhance comfort (self-regulation) REMEMBER: Preemie flip, extremely stressful Supportive turning and lifting Facilitate smooth movement against gravity Avoid torque/tension from medical lines
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If this was a uterus, the legs would have pushed through the wall!
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Boundaries should promote development, i.e. shoulders forward, not in extension Should not be constrained but lie in a flexible nest that encourages a return to postural flexion, as in the uterus
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Allow for normal, not stressed movement. Should not be constrained but occurs in a flexible nest that encourages a return to postural flexion, as in the uterus
Slide 37-

Avoid “frog-legged” position
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Bathing has been described in the literature as an extremely stressful form of stimulation for a preterm infant due to: extra energy expenditure change in temperature abnormal positioning
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Swaddle bathing
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Educating/supporting parents
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Teaching parents
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Self-soothing
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shoulders rounded, hands to mouth/face, head in midline, slightly flexed
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Play
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Back to sleep, prone for play
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All positions (if no medical lines), shoulders rounded, hands to mouth/face, head in midline, slightly flexed
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Feeding
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Principles of positioning promote development, postural security, self-regulation, energy conservation Encourage flexed position Place head in midline, slight flexion Support shoulders so they are forward Encourage hands together and near mouth Flex hips and knees (not frog–leg) Encourage midline orientation & symmetry, equal Use of both arms/legs, opportunity for head to be in many positions Provide boundaries (rolls), until 36 weeks gest. (or before) Allow to lie and be held in different positions
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Achieving our goals Communication challenges Lack of consistency between staff and parents Avoid when difficult Shift change Must reflect a partnership Convey reassurance and support Parent the most consistent caregiver
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Consequence of asymmetry Ignoring one side of the body Flat misshapen head, Positional Plagiocephaly, Decreased use of the opposite side
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Consequence of asymmetry: torticollis
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“Hope”24 weeks, 680 grams
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Development at its best!“Sophie” 26 weeks, 510 grams
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“It’s like landing on a cushion before you know you are falling” Mount Sinai, NICU Dad
Slide 57-

Infant positioning assessment tool Coughlin Mary RN/MS, Lohman Mary Beth OTR/BCP and Gibbins Sharyn RN/PhD. Reliability and Effectiveness of an Infant Positioning Assessment Tool to Standardize Developmentally Supportive Positioning Practices in the Neonatal Intensive Care Unit. Newborn and Infant Nursing Reviews. 2010. 10(2): 104-106.
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References Liu WF, Laudert S, Perkins B, MacMillan-York E, Martin S and Graven S. The development of potentially better practices to support the neurodevelopment of infants in the NICU. Journal of Perinatology. 2007. 27: S48-S74. Laudert S, Liu WF, Blackington S, Perkins B, Martin S, MacMillan-York E, Graven S and Handyside J. Implementing potentially better practices to support the neurodevelopment of infants in the NICU. Journal of Perinatology. 2007. 27: S75-S93. Milgrom Jeannette, Newnham Carol, Anderson Peter J, Doyle Lex W, Gemmill Alan W, Lee Katherine, Hunt Rod W, Bear Merilyn and Inder Terrie. Early Sensitivity Training for Parents of Preterm Infants: Impact on the Developing Brain. PEDIATRIC RESEARCH. 2010. 67(3): 330-335. Gibbins Sharyn RN/PhD, Hoath Steven B MD, Coughlin Mary RN/MS, Gibbins Alan and Franck Linda RN/PhD. The Universe of Developmental Care: A New Conceptual Model for Application in the Neonatal Intensive Care Unit. Foundations in Newborn Care. 2008. 8(3): 141-147.
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Coughlin Mary, Gibbins Sharyn and Hoath Steven. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Journal of Advanced Nursing. 2009. 65(10): 2239-2248. Oberg Gunn Kristin, Campbell Suzann K, Girolami Gay L, Ustad Tordis, Jorgensen Lone and Kaaresen. Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences. BMC Pediatrics. 2012. 12(15): 1-9. Watson Anne BS/PhD/BSN/RN. Understanding Neurodevelopment Outcomes of Prematurity: Education Priorities for NICU Parents. The Long Road Home. 2010. 10(4): 188-193. References
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Montirosso Rosario PsyD, Del Prete Alberto MD, Bellu Roberto MD, Tronick Ed PhD and Borgatti Renato MD. Level of NICU Qualtiy of Developmental Care and Neurobehavioral Performance in Very Preterm Infants. PEDIATRICS. 2012. 129(5): e1129-e1137. Bracht Marianne RN/RSCN, O’Leary Lori MEd, Lee Shoo K MBBS/FRCPC/PhD and O’Brien Karel MB/BCh/BAO/FRCPC/MSc. Implementing Family-Integrated Care in the NICU: A Parent Education and Support Program. The Long Road Home. 2013. 13(2): 115-126. Jeanson Elizabeth PT DPT. One-to-One Bedside Nurse Education as a Means to Improve Positioning Consistency. Newborn and Infant Nursing Reviews. 2013. 13: 27-30. References
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Altimier Leslie RN/MSN/DNPc/NEA-BC and Phillips Raylene M MD/MA/IBCLC/FAAP. The Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care. Newborn and Infant Nursing Reviews. 2013. 13: 9-22. McGrath Jacqueline M PhD/RN/FNAP/FAAN, Lussier Mary M BSN/RN/IBCLC and Briere Carrie-Ellen BSN/RN/CLC. Bottlefeeding the Breastfed Infant in the Neonatal Intensive Care Unit. Newborn and Infant Nursing Reviews. 2013. 13: 5-6. Quraishy Karyn MSPT/CEMI/CST, Bowles Susan M DNP/RNC-NIC and Moore James PhD/PT/PCS. A Protocol for Swaddled Bathing in the Neonatal Intensive Care Unit. Newborn and Infant Nursing Review. 2013. 13: 48-50. References
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Coughlin Mary RN/MS, Lohman Mary Beth OTR/BCP and Gibbins Sharyn RN/PhD. Reliability and Effectiveness of an Infant Positioning Assessment Tool to Standardize Developmentally Supportive Positioning Practices in the Neonatal Intensive Care Unit. Newborn and Infant Nursing Reviews. 2010. 10(2): 104-106. Sweeney Jane K PT/PhD/PCS and Gutierrez Teresa PT/MS/PCS. Musculoskeletal Implications of Preterm Infant Positioning in the NICU. Journal of Perinatal and Neonatal Nursing. 2002. 16(1): 58-70. Vaivre-Douret Laurence PhD/OTR and Golse Bernard MD/PhD. Comparative Effects of 2 Positional Supports on Neurobehavioral and Postural Development in Preterm Neonates. Journal of Perinatal and Neonatal Nursing. 2007. 21(4): 323-330. References
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Hill Sharon MA/PT, Engle Sandra MPT, Jorgensen Jeremiah MPT, Kralik Ann MPT and Whitman Kari MPT. Effects of Facilitated Tucking During Routine Care of Infants Born Preterm. Pediatric Physical Therapy. 2005. 17: 158-163. McMahon Susan E PT/DPT/PCS. Enhancing Motor Development in Infants and Toddlers: A Multidisciplinary Process for Creating Parent Education Materials. Newborn and Infant Nursing Reviews. 2013. 13: 35-41. Hendricks-Munoz Karen DMD/MPH/FAAP, Prendergast Carol C EdD, Caprio Martha C MD and Wasserman Randi S MD. Developmental Care: The Impact of Wee Care Developmental Care Training on Short-tern Infant Outcome and Hospital Costs. Newborn and Infant Nursing Reviews. 2(1): 39-45. Aucott Susan, Donohue Pamela K, Atkins Eileen and Allen Marilee C. Neurodevelopmental Care in the NICU. Mental Retardation and Developmental Disabilities Research Reviews. 2002. 8: 298-308. References