Neuroprotective Care in the NICU
Neuroprotective, Family-Centered, Developmental Care
Neuroprotective Care is dedicated to recognizing each neonate as a unique creation from God. By providing “whole-baby care” supported by evidenced-based practices, our goal is to protect the developing brains of newborns during NICU hospitalization for the purpose of optimizing the quality of life and ensuring the best possible future for babies and their families.
- A NICU culture that is dedicated to evidence-based “whole-baby care” with the goal of improved long-term physical, mental and emotional outcomes.
- A commitment to providing ongoing education and support for NICU staff around evidence-based practices that support neuroprotection of neonates.
- An understanding that families are the most important component in achieving better long-term outcomes for babies.
- An environment that supports parent-infant attachment through compassionate, clinically and culturally appropriate opportunities for parent-infant interactions.
- An atmosphere of mutual trust and collaboration between NICU staff and families.
- A recognition that every member of the neuroprotective team has something unique and important to bring to neonates and their families.
- An acknowledgement that neonates and their families will carry their NICU experience with them for the rest of their lives.
- An attitude of gratitude for the privilege of being allowed to play a role in the unfolding of a new life.
Core Measure 1 – The Healing Environment
The baby’s environment after birth impacts every aspect of development in critical ways that either promote or hinder healing and growth. Because premature babies are no longer protected in the womb, their physiologic and neuroprotective needs are dramatically changed. To provide a healing environment for preterm and sick term babies in the NICU, careful attention must be paid to the sensory environment of temperature, touch, proprioception, smell, taste, sound, and light and the physical environment of space, privacy, and safety. Skin-to-skin contact provides the most healing environment for babies outside the womb, is the foundation for all aspects of neuroprotective care., and should be provided whenever possible in the NICU. A psychologically nurturing atmosphere where trust and respect are fostered among NICU staff, parents and babies is essential to the creation and maintenance of a healing environment.
Core Measure 2 – Partnering with Parents
The most important factor impacting neurodevelopmental outcomes of premature and sick babies is family involvement. The quality of parent-infant bonding, which is always altered by a NICU experience, is the most important factor in determining the quality of life after NICU discharge. For most parents, having a baby in the NICU is a crisis that includes profound shock, anxiety, and ongoing stress. While these early reactions are normal and expected, the NICU can become a place of healing for parents too if they are welcomed by NICU staff, facilitated in getting to know and connect with their baby, and empowered to become confident and competent in parenting their child. Skin-to-skin contact is the most potent tool for promoting connectedness between parents and their baby. It is vitally important that parents are included as active members of the NICU team and are welcomed and encouraged to participate as partners in every aspect of their baby’s care and decision-making processes.
Core Measure 3 – Positioning and Handling
While inside the womb, the fetus is supported in a flexed, tucked position and contained in an enclosed space, surrounded by soft, well-defined boundaries. This protective space was designed to promote optimal development of the unborn baby’s rapidly developing body and brain. Skin-to-skin contact provides an opportunity to “continue gestation” in the closest approximation of the womb environment available in the NICU. While we can never replace the womb, NICU staff and parents can provide supportive positioning and gentle, careful handling of premature and sick babies that promote their continued physical and neurodevelopment outside the womb. Doing so will help to minimize the short- and long-term consequences of spending such a critical period of life in the artificial and high tech environment of the NICU instead of in the developmentally expected environment of the womb.
Core Measure 4 – Safeguarding Sleep
Sleep is extremely important during all stages of life, but for babies in the NICU, it is particularly vital for healing, growth, and brain development. Development of normal sleep cycles is essential for early neurosensory, learning and memory development. Skin-to-skin contact promotes optimal maturation of sleep cycling. Because sleep is so important for neurodevelopment, sleep of babies in the NICU should be managed as carefully as oxygenation and feeding. By working together to recognize stages of sleep, NICU staff and parents can protect babies from unnecessary sleep interruptions. Maintaining a quiet environment, shielding from bright lights, doing cares during awake times or periods of light sleep, and providing frequent and prolonged skin-to-skin contact are all ways to safeguard sleep in the NICU.
Core Measure 5 – Minimizing Stress and Pain
From the first moments after birth, the premature or sick baby is subjected to the artificial environment of the NICU, which often includes developmentally unexpected sounds, lights, touch and painful procedures. Even bathing, weighing, and diaper changes can be stressful and even painful for premature or sick newborns. Separation from mother may be the most profound source of stress in the hospitalized baby. Skin-to-skin contact is known to significantly reduce pain and stress for term and premature babies. Because pain and stress directly affect physiologic stability, as well as cognitive and emotional development, NICU staff and parents should learn to recognize the behavioral signs of infant pain and stress and respond in ways that prevent and minimize physical and emotional suffering whenever possible.
Core Measure 6 – Protecting Skin
Skin is the largest organ of the body and has many functions including thermoregulation, fat storage and insulation, fluid and electrolyte balance, protection against absorption of bacteria and toxins, and is a conduit of sensory information to the brain. The immature skin of premature babies is very different from the skin of full-term babies. Protecting skin involves bathing practices, use of humidity, emollients and adhesives, prevention of skin breakdown and wound care. NICU staff and parents can work together to carefully assess the skin of hospitalized babies and ensure its protection and optimum functioning of all its important roles. Skin-to-skin contact provides an opportunity for parents and babies to connect in ways that support physiologic stability, immune protection, breastfeeding, brain development, bonding and attachment.
Core Measure 7 – Optimizing Nutrition
Human milk is the optimal food for the vast majority of babies and has a well-documented history of reducing mortality, preventing serious illness, and supporting brain development for both term and preterm babies. Breastmilk is more than food; it is medicine for babies in the NICU. However, breastfeeding and breastmilk expression in the NICU can be challenging and mothers need support and encouragement to continue providing the food that is so vital to their babies’ short- and long-term wellbeing. Early and frequent skin-to-skin contact is essential for breastfeeding success by increasing milk production for mothers and bringing babies into proximity to the breast as they learn to breastfeed. Careful attention must be paid to nutrition and growth of babies in the NICU as their needs vary with gestational age and physical conditions. NICU staff and parents can partner in assessing a baby’s feeding readiness to be sure that breast and/or bottle feedings are experienced in a developmentally appropriate, functional, safe and nurturing manner to support the physical, neurodevelopmental, and emotional needs of babies in the NICU.