ecse 641 spring 2015 (ward, 2010) 8/27/2015 ecse 641

ECSE 641 Spring 2015

(Ward, 2010)

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Neonatal Intensive Care Unit –NICUSpecial Care Nursery-SCNStaffEquipmentDevelopmental interventions

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NICU/SCNStaff

NeonatologistPediatricianNeonatal Nurse PractitionerNursesInterns and ResidentsConsulting Physicians (cardiologist,

orthopedist, neurologist, etc…)Other- Occupational, Physical, Speech

Therapists04/19/23 ECSE 641

Medical care is the primary concern in the NICU.

Equipment, lighting, and monitors are designed to optimize medical interventions.

Several reviews suggest that the NICU environment provides abnormal stimuli (timing of handling, excessive light and noise levels).

These factors have been hypothesized to contribute to the brain of the infant born preterm developing differently than the brain of the infant born at term.

NICU/SCN

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NICU/SCNEquipment

Equipment in NICU

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Developmental Interventions

“Developmental intervention encompasses specific procedures used to minimize the infant’s stress and also techniques used to promote infant organization.” Mahoney & Cohen. Effectiveness of Developmental Intervention in the Neonatal Intensive Care Unit: Implications for Neonatal Physical Therapy. Pediatric Physical Therapy. 2005

The infants “job” in the NICU is to sleep and grow (gain weight).

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Developmental Interventions in the NICU also include Family Centered Care (FCC).

Examples of core beliefs of FCC include that: the family is the constant in the infants life.

Service systems and providers will change, but the family will remain.

diversity among families is acknowledged (racial, ethnic, socioeconomic and cultural differences).

families and providers are partners in the care of the infant and families should receive complete, objective information about their child.

NICU/SCNDevelopmental Interventions

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Evolved from Deprivation and Overstimulation theories.Deprivation Theory- Infant is deprived of

normal newborn experiences and is confined to a restricted environment.

Overstimulation Theory- Infant is bombarded with excessive stimulation (bright lights, high noise levels, constant caregiving).

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Developmental Interventions are strategies designed to reduce inappropriate stimulation increase appropriate patterns of stimulation

based on an infant’s individual responses.


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Developmental InterventionsSigns of Infant Disorganization

Physiological SignsSkin color changes Change in breathing rate and/or heart

rate HiccoughSpitting up/gaggingSneezingYawning

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Motor SignsChange in muscle tone – high or low

Frantic flailing Finger splayArching Salute of armsGrimace

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Behavioral SignsWhimperingFrownFussyIrritableGaze aversionStaringEye floating- random eye movements with no

focus


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Development Interventions Developmental Interventions are designed to

help the infant move from a disorganized state to an organized state.

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Developmental InterventionsSigns of Organization

Physiologic SignalsSmooth, even breathing patternStable skin colorNo sign of disorganization

http://www.vort.com/products/188.html04/19/23 ECSE 641

Motor SignalsStable muscle toneSteady posture -no fluctuation in muscle

toneClasping hands Hands to mouthGrasping (blanket, finger)Sucking


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Behavioral SignalsDistinct sleep patternsMaintaining quiet alert stateRelaxed facial expressionRelaxed arms and legs“Ooh” faceVisual and auditory attending


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Developmental InterventionsSome strategies that will help infants

organize and have access to uninterrupted sleep include: Environmental strategiesPositioning strategiesHandlingCluster careSkin to skin or kangaroo care

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Developmental InterventionsEnvironmental strategies

Lighting (dimmer lights/diurnal light cycle) Diurnal lighting cycles- 24-hour, day-night cycles with

brighter lighting for a portion of the 24-hour period (usually at least 12 hours), and dimmer lighting for the remainder of the 24-hour period

Noise level Institute designated “quiet periods” when phones

are changed to a flashing light system instead of ringing, post pone care giving activities, limit conversation around isolettes, place a blanket over the isolette.

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Developmental InterventionsPositioning strategies

Prone and sidelying (avoid W-supine), promote flexion and hands to mouth

Handling StrategiesContain limbs when changing positions, move slowly

and gentlyCluster Care

Allows for extended periods of restSkin to Skin or Kangaroo Care

Fosters maternal bonding and results in improved maternal confidence in caring for her preterm infant.

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Developmental InterventionsPositioning Strategies

Supine W-positionPromotes extension

Side lyingContainmentPromotes flexionHands to mouth

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Kangaroo Care/Skin to Skin

http://www.sonstodads.com/kangaroo- care.htm

http://www.cssd.us/body.cfm?id=1116

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Individualized neuro-developmental care and family centered care have been associated with: Reduced number of apnea spells Improved oxygenationFaster weight gainImproved state organization

Referral to an early intervention program frequently occurs prior to the infants discharge from the NICU.


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NICU/SCNUnderstanding My SignalsVideo of NICU

VCU/MCV NICU 1VCU/MCV NICU 2VCU/MCV NICU 3

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Overview to the Part C Program Under IDEA

Congress established this program in 1986 in recognition of "an urgent and substantial need" to:enhance the development of infants and toddlers

with disabilities;reduce educational costs by minimizing the need

for special education through early intervention;minimize the likelihood of institutionalization and

maximize independent living; and,enhance the capacity of families to meet their

child's needs.http://www.nectac.org/partc/partc.asp#overview04/19/23 ECSE 641

A federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilitiesages birth through age 2 years and their families.

http://www.nectac.org/partc/partc.asp#overview

The Program for Infants and Toddlers with Disabilities (Part C of IDEA)

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In order for a state to participate in the program it must assure that early intervention will be available to every eligible child and its family.


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State governors must designate a lead agency to receive the grant and administer the program

Appoint an Interagency Coordinating Council (ICC), including parents of young children with disabilities, to advise and assist the lead agency.

Currently, all states and eligible territories are participating in the Part C program.



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The Lead Agency in Virginia is: The Department of Behavioral Health and Developmental Services


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Determining Eligibility for Services in EI

Diagnosed condition with a high probability of development delay and/or

25% or greater developmental delay in one or more developmental areas and/or

Atypical development

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Eligibility for EI Services

Additions to list of diagnosed conditions28 weeks or less gestational age28 days or more in the NICUPVL

(http://cerebralpalsy.org/about-cerebral-palsy/cause/periventricular-leukomalacia/)

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Part CVCU's Early Intervention Professional Develo

pment Center

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Additional ResourcesCampbell, S. , Palisano, R., & Orlin, M.

(2012). Physical therapy for children (4th ed.). St. Louis, Missouri: Elsevier.

Creger, P. (1995). Developmental interventions for preterm and high-risk infants: Self study modules for professionals. Tucson, Arizona: Therapy Skill Builders.

Vergara, E. & Bigsby, R. (2004). Developmental &therapeutic interventions in the NICU. Baltimore: Paul H. Brooks.

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ecse 641 spring 2015 (ward, 2010) 8/27/2015 ecse 641

Documents

medical interventions

infant organization

deprivation theory infant

overstimulation theory

medical care

nicuscn equipment equipment

nicu environment

behavioral signs