By: Dalia Zilberstein, PhD ,RN, certified NIDCAP
Responsible for developmental support treatment for Pegiya, Meir Medical Center
The tremendous technological advances that have occurred in the field of neonatology (premature infant medicine) over the past two decades have led to high survival rates for very young premature infants. At the same time, there has been a significant change in the perception of the premature infant by professionals, as well as in the awareness of their special needs. While in the past there was almost exclusive attention to the medical needs of the premature infant, today there is increasing attention to their early developmental needs, which are expressed in a therapeutic environment – the preemie – which is sometimes not sufficiently adapted to these needs.
The environment of the preterm infant is significantly different from the environment of the womb. Sometimes, conditions prevail in premature infants that constitute stress factors for the developing preterm infant – such as noise, light, pain, or separation from the mother. Researchers from various fields believe that exposure to stress has effects on future development. This is probably due to the fact that the central nervous system of the preterm infant is in an active and sensitive maturation process at the time of birth. Therefore, in parallel with the medical advances that have occurred in premature infants, concern has increased among professionals regarding the effect of the preterm infant's environment on the preterm infant and its future development. Today, the importance of adapting the environment and the style of care to the unique needs of the preterm infant, right from the beginning of his or her journey as a preterm infant, is clear. Treatment guided by the principles of the Developmental Care Responds to these needs.
Supportive developmental therapy is a neurodevelopmental approach to treating premature infants, which includes a variety of interventions designed to reduce stress in premature infants. The approach was first developed by Dr. Heidi Els of Harvard University, and has been adopted in recent years by many premature infants around the world. The approach advocates a treatment style that is tailored to the unique characteristics and needs of the premature infant, and to providing optimal conditions for its early development. The individual consideration of the premature infant's behavior and its sensitivity thresholds on the physiological and motor levels is a central component in understanding and implementing the approach. In addition, the neurodevelopmental approach sees parents and the strengthening of the early bonds that are formed between the parent and the premature infant during his or her stay in the premature infant, as a cornerstone and an integral part of the care provided to the premature infant.
The main objectives of the approach are: Developmental Care they:
- Reduce the stress to which the premature baby is exposed (regulation stress).
- To promote maturation and organization at the neurobehavioral level. (organization neurobehavioral)
- Promote early bonding between parent and premature baby.
Today, there is an extensive evidence base in the literature about the positive effects of the neurodevelopmental approach (and in particular the method ofNIDCAP) on the progress of the premature infant in the preterm unit, on his development, and on the parents' abilities and functioning. There are various levels to working in the field of developmental care that supports this. First and foremost, appropriate training of the team is required in subjects such as brain development, behavior of premature infants, reactions to stress, and abilities and difficulties of young premature infants. Daily activities such as bathing the premature infant or weighing him, putting him to bed, and moving him are done in accordance with the spirit of the approach in a more gentle, calming, and gradual manner. The baby's behavior and reactions shape the way in which the various activities are done. The approach also includes attention to the environment and the style of care, and adapting them to the needs and sensitivities of the premature infant.
Examples of this are: dimming the lights, partially covering the incubators and cribs, speaking in a low voice, being quiet in the delivery room, promoting the "kangaroo" method and providing better conditions for this by placing screens and comfortable chairs that allow the parent to do calm and prolonged "kangaroo" care. In addition, special emphasis is placed on reducing pain during various procedures, on maximum preservation of
of uninterrupted sleep, coordinating the doctor's examination with the sleep cycle and wake times of the premature baby, laying him in a flexible "nest" that gently maintains his collected posture, wrapping the premature baby in cozy blankets and bedding that his parents bring from home, and a slow and gradual pace of care that allows the premature baby to adapt to the changes and various stimuli around him. The parents of premature babies are at the center of the action. The guidance and support for parents is intended, among other things, to promote contact and connection between them and their baby, from the very beginning of their shared developmental journey. In the spirit of the approach, you as parents can contribute greatly to the well-being of a premature baby.
Top 5 things you can give a premature baby from the very beginning of his or her journey as a premature baby
Breast milk: Start pumping as soon as possible after birth, and according to the instructions of the midwife. Remember that one of the secrets to success in pumping lies in the frequency of pumping. The professional recommendation is about 8 pumpings a day. Breast milk is considered the best food for the immature digestive system of the premature baby. The first drops (colostrum) are also important, which can be collected with a small syringe and given to the premature baby when he starts eating. Some call this first milk "liquid gold". See an extended reference in the chapter about breast milk.
Kangaroo holding (Skin to Skin): This holding, in which the baby clings to the mother's or father's bare chest, has many positive effects, including on the baby's medical progress, on his short-term and long-term development, on the mother's mood, and on milk production. "Kangaroo" has been studied in many works. The recommendation to hold premature babies in this special way is clear and agreed upon, of course in consultation and coordination with the treating team, each case on its own merits.
Supportive, Containing, and Containing Touch: Even when it is not possible to take your baby out for "kangaroo" care for various reasons, there are alternative ways to provide him/her with the supportive and loving touch he/she needs. Premature babies often enjoy continuous touch with the entire palm of the hand, while gathering the hands and feet, which spread out or stretch out when the baby is not calm. Premature babies tend to enjoy it less and even "get irritated" when you touch them in a specific way, with just a finger and short strokes. "Supportive" touch greatly helps the baby maintain the comfort and calm that he/she needs to recover and grow. Gradually, your baby will learn to recognize and identify the nature of your special touch.
Support during tube feeding: It is true that milk flows down the tube into your baby's stomach on its own. However, this does not mean that the baby does not need support and guidance during this time. It is recommended that you take an active part in your baby's meal even during the feeding stages through the tube, as this is a meal for him in every sense of the word. You can hold the tube and thus control the rate of milk flow based on the height of the syringe, or alternatively, place your hands on your baby as explained above. Your baby will also be able to receive his meal when you do "kangaroo care". In general, it is recommended to ensure your baby's safety and calmness during mealtime, thus making this time enjoyable for him.
Non-Nutritive Sucking: This is sucking that your baby does when you gently offer him a pacifier or his mother's breast. He is not really being fed, he is just sucking. This activity is important for the development of the baby's sucking ability, and also contributes to calmness and relaxation. It is recommended to offer the baby a pacifier before meals, and also during meals using a tube. However, this must be done gently, letting the baby get used to the new stimulation in his mouth, and especially observing his reactions. The baby will not always want the pacifier. Sometimes it will take him a few seconds to get used to it and be ready to accept it in his mouth. There are special pacifiers for very small premature babies, and adjusting the pacifier to the baby is important. Later, it is recommended to bring an awake, active, and "seeking" baby closer to his mother's breast during "kangaroo" care.
