Developmental Care - the Older Preterm Infant
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Assessment of the Older Preterm Infant (37 plus weeks corrected gestation)
- Respond to infant cues for feeding, physical contact and social interaction.1,3
- Continue to assess for exhaustion and overload in infants with respiratory compromise.
Handling and interventions
- Tolerance of handling and interventions usually increases.
- States well defined with clear transitions.2
- Periods of alertness for socialization with development of longer attention spans.3
- Provide rhythmic care patterns (nappy change, feeding, socialization,) to enhance sleep/wake organization.4 Incorporate day/night patterns into interventions.
- Swaddle or contain (head and hands in the midline, shoulders forward, lower limbs flexed and adducted towards the midline) during uncomfortable or noxious procedures.2,7 Patting and stroking may be tolerated.3
- Hold infants for feeding-this includes tube feeding.
- Breastfeeding during or after painful procedures- individual assessment required.
- Continue Kangaroo Care opportunities for infants transitioning to oral feeding.21
- Sucrose for painful and uncomfortable procedures.
- Infant demonstrates a wide range of movements.
- Controlled movements increase.
- Trunk and extremities usually flexed at rest.
- Infant can self - regulate behaviour with movement and posture.3
- Infants in cots should be positioned on their backs (SIDS recommendation unless a special medical order) unswaddled allowing hand to mouth contact.
- For infants in cots who display limited flexion consider a nest or a swaddle below shoulder level. No nests or blankets around face.2,7
- Vary the position of the infant head for sleep and approach infant from a different side of the cot to avoid right sided head preference.20
- Continue Kangaroo Care opportunities for infants transitioning to oral feeding
- Supervised by parent, 'tummy' time either over parent's knees or on a floor matt. Also supervised side-lying position to promote hands to midline posture.20
- Swaddle infants that display signs of stress during bathing.
Light and Vision
- Generally shows preference for human face.
- Sees best at a distance of 20-25cm.
- Sight is still immature with much development to follow at 0-6 months.9,22
- Use low lighting levels and continue to protect from bright lights and direct sun light.
- Dim lights at night thereby promoting development of circadian rhythms.16,17
- Offer opportunities for visual stimulation if infant is displaying longer attention spans. 9
Sound and Hearing
- Response to noise is more consistent and organised.
- Can localize and discriminate sounds.
- Stress behaviours may still be displayed to certain loud sounds.
- Gradual onset of auditory stimuli preferred.3,11
- Avoid loud noise and multiple sound sources. Be aware of sound/noise levels in NICU.
- Ensure CPAP and Ventilator tubing is regularly cleared of H2O.
- Auditory stimulation as per baby's cues. Start with soft voice leading on to normal conversation volume/tone.
- Music audiotapes for infants in cots if parents wish - not to be set on continuous play.
- Suck, swallow and breathe co-ordination becomes more consistent and organized.
- Endurance for oral feeding increases.13-15
- Encourage hand to mouth contact.
- Encourage non-nutritive sucking during NG/OG feeds and for comfort.
- Offer standard small pacifier to encourage wider jaw excursion and therefore breast feeding and nutritive sucking patterns.
- Do not offer pacifier prior to painful procedure.
- Oral suction, only when clinically necessary.15,19,23
Smell and Taste
- Taste and smell receptors are thought to be functional.
- Physiologic responses to unpleasant olfactory stimuli have been documented by research. 3
- Encourage parents to hold infant during NG/OG feedings.
- Protect from noxious odours.
- Open alcohol wipes and antiseptic preparations away from the incubator and infant.
- Avoid use of strongly scented perfume.
- Dip pacifier or teat in milk prior to use after being soaked in Milton solution.
- Promote parental independence and enjoyment of maturing infant.
- Offer opportunity for education on deep-water bathing, massage techniques and infant development.3,5
- Als, H.(1986). A synactive model of neonatal behavioural development: a framework for assessment of neurobehavioral development in the premature infant and for support of infants and parents in the neonatal intensive care environment. Physical and occupational therapy in pediatrics,6,(3-4),3-53
- Taquino, L.T. & Lockeridge, T.(1999).Caring for Critically Ill Infants: Strategies to Promote Physiologic Stability and Improve Developmental Outcomes
- Turner, A., & Santangelo, S. Developmental and Behavioral Characteristics of the preterm infants. Santa Rosa: NICU INK.
- Peters, K.L.(1999). Infant Handling in the NICU: Does Developmental Care Make a Difference? An Evaluative Review of the Literature. Journal of Perinatal Nursing,13(3) 83-109
- Hinkler, P.K. & Moreno, L. A. Developmentally Supportive Care. Theory Application - A self study guide module. Childrens Medical Venture.
- Reid, T & Freer, Y. (2001). Developmentally Focused Nursing Care. In G. Boxwell. Neonatal Intensive Care Nursing (pp.14-44).London: Routledge.
- Short, M.A., Brooks-Brunn, J. A., Reeves, D. S., Yeager, J. & Thorpe, J. A. (1996). The Effects of Swaddling Versus Standard Positioning on Neuromuscular Development in Very Low Birth Weight Infants. Neonatal Network, 15,(4) 25-31.
- Ludington-Hoe, S., Ferreira, C., Swinth, J & Ceccardi, J.(2003). Safe criteria and procedure for kangaroo care with intubated infants. JOGNN, 32, 579-588.
- Oehler, J.M.(1993) Developmental Care of the Low Birth Weight Infants. Nursing Clinics of North America, 28, (2), 289-301.
- Fielder, A.R., & Moseley, M. J. (2000). Environmental Light and the Preterm Infant Seminars in Perinatology, 24 (4), 291-298.
- Moore K.L. & Persuad, T.V. N. (1998) The Developing Human. Philadelphia: Saunders.
- Kenner, C. & Wright Lott, J. (2003). Comprehensive Neonatal Nursing (3rd ed.). Philadelphia: Saunders.
- Gewolb, I., Vice, H., Frank L., Schweitzer-Kenney, E. L., Taciak, V. L, Bosma L.& James F.( 2001). Developmental patterns of rhythmic suck and swallow in preterm infants. Developmental Medicine & Child Neurology 43:22-27.
- Wolf, L. S.& Glass, R.(1992). Feeding and Swallowing Disorders in Infancy. Therapy Skill Builders:San Antonio
- Oetter, P., Richter E. W., Frick, & Sheila, M.(1995). M.O.R.E. Integrating the Mouth with Sensory and Postural Functions. (2nd ed.)Hugo, Minnesota: PDP Press.
- Brandon, D. H., Holditch-Davis, D. & Belyea, M. (2002). Preterm infants born at less than 31 weeks gestation have improved growth in cycled light compared with continuous near darkness. Journal of Pediatrics, Feb, 192-199.
- Mirmiran, M., & Ariagno, R. L. (2000). Influence of Light in NICU on the 'Development of Circadian Rhythms in Preterm Infants. Seminars in Perinatology, 24, (4), 247-257.
- Glass, P. (1999). The Vulnerable Neonate and the Neonatal Intensive Care Environment. In G. Avery, M. A. Fletcher & M. MacDonald (5th ed.). Neonatology Pathophysiology and Management of the Newborn (pp.91-108). Philadephia: Lippincott Williams & Wilkins.
- Pinelli, J. & Symington A.(2002). Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. The Cochrane Library 4:54.
- Duber, K. & Flake, M. (2003). Occipital flattening of positional origin. Canadian Nurse, 99, (1) 16-21.
- World Health Organisation (2003). Kangaroo mother care: a practical guide.
- Altimer, L. B. (2003). Management of the NICU Environment. In C. Kenner & J Wright Lott (3rd ed.). Comprehensive Neonatal Nursing, (pp.229-237). Philadelphia: Saunders.
- Pinelli, J. & Symington, A.( 2000). How Rewarding Can a Pacifier Be? A Systematic Review of Nonnutritive Sucking in Preterm Infants. Neonatal Network, 19,(8):41-48
- American Academy of Paediatrics. (1997). Noise: A Hazard for the Fetus and Newborn.-Policy Statement. Pediatrics,. 100, (4),1-9
- Cattaneo,A., Davanzo,R., Uxa, F., & Tamburlini,G. (1998) Recommendations for the implementation of Kangaroo Care for low birth weight infants. Acta Paediatr, 87, (4),440-445.
- Monterosso, L., Kristjanson, L., & Cole, J. (2002).Neurodevelopment and the Physiologic Effects of Positioning in Very Low Birth Weight Infants. JOGNN, 31 ,(2), 138-146.
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- Date last published: 31 December 2004
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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