Interventions focused on protecting the delicate, immature central nervous system of premature and ill newborns are defined as “developmental care”.
Creating an environment that reduces noxious stimuli, promotes positive development and minimizes the negative effects of illness is highly desired. Neonatal nurseries have become increasingly concerned about the negative effects of the NICU environment and have begun to identify preventive strategies and integrate changes in this highly technical, over stimulating environment.
Modern NICU is quite different than the previous ones with dimmed lights, crib covers and decibel metres easily visualized.
Noise in the NICU
Most of the technical apparatus used in the NICU generate a significant amount of noise. Excessive noise stimulates the preterm or ill newborns leading to agitation and crying. Agitation causes decreased oxygenation, increased ICP and elevated heart and respiratory rate. Noise also disrupts the seep wake cycle and may delay recovery and the ability to have positive interaction with care givers because of fatigue and overstimulation.
Noise levels in the NICU are noted to range from 50-80 decibels. Immature delicate auditory structures may be damaged at this noise eve suppurated by ototoxic effects of medication frequently used in NICU.
Incubator motors, routine care activities like placing glass formula bottles on the bedside tables, closing drawers packaged supplies etc all generate an average of 50-70 decibels. Noise from staff talking, radios and monitors can add to this cacophony all these can result in cochlear damage and disrupt normal growth and development.
Interventions
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Loud talk, loud devices and playing radios near radiant warmers and incubators should be avoided. “Quite hours” should be instituted each day when noise producing activities are curtailed and lights dimmed.
- Isolated doors should be opened and closed gently and drawers should be padded.
- Ceiling should be designed with noise absorbing materials.
Light in the NICU
Attempts to provide more normal lighting conditions have resulted in several studies on the effects of cycling lights by alternating periods of bright light and dimmed light. Infants subjected to the cycled lighting conditions spend more time in sleep states and have increased weight gain, lower motor activity levels and lower heart rates.
Also of great concern is the possible damaging effect on the developing optic structures also at risk for retinopathy of prematurity.
Safe levels of lights in NICU have not yet been established but shielding infants from light may prove beneficial in promoting trust, behavioral stability and recovery.
Interventions
- Head of the table, crib or incubators should be shaded.
- Nursing light levels should be reduced for 12 hrs periods reach day in stable infants.
- Individual lighting should be considered over each bedside with a dimmer switch to control light intensity.
Positioning
Body alignment affects many physiologic and neurobehavioral parameters making positioning of the baby every important. Body position affects gastric emptying and skin integrity as well as neurobehavioral development. Activities such as hand to mouth ability, midline orientation, flexion and self soothing abilities can be enhanced through facilitating body positions. Infants younger than 30 weeks due to gross hypotonic, critically ill newborns and babies receiving neuromuscular blocking agents must receive positioning assistance.
Interventions
- Position should be changed 2-3 hourly in extremely immature or ill infants
- Infant should be “nested” with blanket roll or other positioning aids.
Protocols being considered for infants undergoing common surgical procedures include an initial postoperative bolus of an opiate with a continuous drip of opiate for a variable period of time and then change to a non opiate medication. Opiates are readily reversed if the infant becomes apneic or hypotensive after the drug is given which is uncommon with the dose of -.1 mg/kg B.W. Oral sucrose has been shown to reduce crying when offered during a painful procedure.
