Joy V. Browne

Mean noise amounts in level II vs level III neonatal intensive care units.

Purpose: To compare mean noise amounts in Level II NICUs with those in Level III NICUs after controlling statistically for the number of infants per unit. Study design: A between-group design was used in measuring noise amounts. Sample: Noise amounts were sampled using a central site procedure during two time periods of approximately 25 minutes each (total time approximately 50 minutes) in five Level II NICUs and seven Level III NICUs in Colorado. Main outcome variable: Average noise amounts (in dB) from two time periods of approximately 25 minutes each (total time approximately 50 minutes). Results: Mean noise amounts were significantly higher in Level III NICUs (mean = 54.89 dB) than in Level II NICUs (mean = 49.07 dB). This result remained statistically significant even after correcting statistically for total number of babies present in each NICU during noise measurements.

Developmental care for high-risk newborns: Emerging science, clinical application, and continuity from newborn intensive care unit to community

Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.

Eating as a Neurodevelopmental Process for High-Risk Newborns

Many high-risk and preterm infants have difficulty with successful feeding and subsequent optimal growth during their stay in the neonatal intensive care unit as well as in the months after discharge. Environmental, procedural, and medical issues necessary for treatment of the hospitalized infant present challenges for the development of successful eating skills. Emerging data describe eating as a predictable neurodevelopmental process that depends on the infants organization of physiologic processes, motor tone and movement, level of arousal, and ability to simultaneously regulate these processes.

Considerations for touch and massage in the neonatal intensive care unit.

AN EXPANDING BODY OF research has documented the short-term advantages of gentle touch and massage for healthy term infants and some growing and medically stable preterm infants. These findings have provided the impetus for extension of massage techniques to very small, fragile newborns, promoting the utilization of new personnel in NICUs specifically to provide massage therapy for newborns. It is important, before engaging in these approaches, for professionals in the NICU to consider the potential impact of massage on the infant and the family. It is also imperative that professionals in the NICU take into account the current growing knowledge base regarding developmental care and the implications for decision making regarding provision of stimuli of any sort to fragile, sick newborns in the NICU.

The Newborn Developmental Specialist: Definition, Qualifications and Preparation for an Emerging Role in the Neonatal Intensive Care Unit.

Rapid expansion of information associated with developmental intervention lias resulted in increasing numbers of professionals practicing in neonatal intensive care units (NICUs). Complex individual, team, and systems approaches thai go beyond current disciplinary knowledge and practice are necessary to ensure the ongoing growth and quality of NICU developmental programs. This article defines the emerging role of the Newborn Developmental Specialist as one which provides interdisciplinary leadership, education, mentoring, and systems change skills necessary for comprehensive developmental programs and describes the training and experience necessary to practice in this advanced practice position.

Foundations of Developmental Care

Advances in neonatal care have led to better survival for high-risk newborns, but serious questions remain regarding neurodevelopmental outcomes. The impact on the developing brain of the physical, care-giving, and family environments has received growing attention. In large part, the catalyst for bringing these research findings into clinical practice came from national meetings and study groups of scientists, clinicians, administrators, and architects headed by Dr Stanley Graven. This volume is designed to aggregate current thinking about neonatal neurodevelopment, thereby helping clinicians understand and apply this knowledge to the developmental challenges of high-risk newborns under intensive care. It recognizes contributions of basic science to our understanding of development from molecular function to neurophysiology to later observable behavior. We highlight two themes that are consistently represented throughout the authors’ articles. First, development is continuous from the fetus to the newborn to the older infant. Fetal learning is essential for attachment to the mother and to assure protection and survival. Infant learning influences not only immediate behavioral organization and long-term developmental outcomes, but perhaps generational epigenetic change as well. Stressful, painful, or nonsupportive experiences likely influence long-term developmental outcomes, potentially to the next generation. However, infants also show resilience in brain development, which has implications for the application of early, individualized, relationshipbased intervention from fetal to newborn to growing infant periods. Second, during the continuous developmental process, there are sensitive periods when brain development is particularly malleable and expectant of well-timed, appropriately organized input from the environment. During these sensitive periods, it is essential that the infant, based on his or her specific behaviorally communicated needs, receive the most appropriately organized and timed input from the caregiving environment, and in particular from the mother. Individualized developmental care using the Newborn Individualized Developmental Care and Assessment Program, which includes

Developmental Care in Advanced Practice Neonatal Nursing Education

Neonatal nursing education for the future is being influenced by two forces: expanding knowledge of infant development and health care reform. In response to the former and in anticipation of the latter, the University of Colorado School of Nursing incorporated developmentally based, family-centered care concepts in its recent revision of the masters program in neonatal nursing.