Care Developmental - supportive developmental care

By: Dalia Zilberstein, PhD ,RN, qualified NIDCAP
Responsible for supportive developmental care for Pagia, Meir Medical Center

The tremendous technological progress that has occurred in the field of neonatology (premature medicine) in the last two decades has resulted in high survival rates for very young premature babies. At the same time, there has been a noticeable change in the professionals' perception of the premature baby as well as in the awareness of his special needs. If in the past there was an almost exclusive reference to the medical needs of the preemie, nowadays the reference is also increasing to his early developmental needs, which are reflected in a therapeutic environment - the preemie - which is sometimes not sufficiently adapted to these needs.

The environment of the fetus is markedly different from the environment of the uterus. Sometimes, conditions prevail in preterm infants that are stress factors for the developing premature infant - such as noise, light, pain, or separation from the mother. Researchers from different fields believe that exposure to stress has effects on future development. This is probably due to the fact that the premature central nervous system is in an active and sensitive maturation process at the time of birth. Therefore, at the same time as the medical progress that occurred in premature babies, the concern among the professionals regarding the influence of the premature baby's environment, on the premature baby and its future development, increased. Today, the importance of adapting the environment and the style of care to the unique needs of the premature baby is clear, right from the beginning of his life in the hospital. Treatment guided by the principles of the approach Developmental Care responds to these needs.

The supportive developmental treatment is a neurodevelopmental approach to the treatment of preterm infants, which includes a variety of interventions designed to reduce stress in preterm infants. The approach was first developed by Dr. Heidi Ells from Harvard University, and has been adopted in recent years by many premature babies around the world. The approach advocates a treatment style adapted to the unique characteristics and needs of the premature baby, and providing optimal conditions for his early development. central to the understanding of the approach and its application. In addition, the neurodevelopmental approach considers the parents and the strengthening of the early bonds forged between the parent and the infant during his stay in the nursery, a cornerstone and an integral part of the care given to the baby in the nursery.

The main goals of the approach Developmental Care they:

• reduce the stress to which the premature infant is exposed (regulation stress).
• promote maturation and organization on the neurobehavioral level. (organization neurobehavioral)
• Promote the early relationship between parent and infant.

Today, there is an extensive evidence base in the literature about the positive effects of the neurodevelopmental approach (and in particular about the method ofNIDCAP) on the course of the preterm infant, on its development, and on the parents' abilities and their functioning. For action in the field of developmental therapy that supports different levels. First and foremost, appropriate training of the staff is required in topics such as brain development, behavior of premature infants, reactions to stress, abilities and difficulties of young premature infants. Daily actions such as bathing the premature baby or weighing him, laying him down and moving him, are done according to the spirit of the approach in a more gentle, relaxing and gradual way. The baby's behavior and reactions shape the way the various actions are done. The approach also includes attention to the environment and the style of care, and their adaptation to the needs and sensitivities of the premature baby.

Examples of this are: dimming the lights, partial covering of the incubators as well as the cribs, speaking in a low voice, quiet behavior in the nursery, promoting the "kangaroo" method and providing better conditions for this by placing curtains and comfortable armchairs that allow the parent to do a calm and prolonged "kangaroo" In addition, a special emphasis is placed on reducing pain during various operations, on maximum preservation

of undisturbed sleep, coordinating the doctor's examination of the premature baby's sleep cycle and waking times, laying him down in a flexible "nest" that gently maintains his curled-up position, wrapping the premature baby in cozy blankets and sheets that his parents bring from home, and a slow and gradual pace of treatment that allows the premature baby to adapt to changes and stimuli the different ones around him. The parents of premature babies are at the center of the action. The training and support for parents is intended, among other things, to promote the contact and relationship between them and their baby, right from the beginning of their shared developmental path. In the spirit of attitude, you as parents can contribute a lot to Pagia's well-being.

5 Top The same 5 things you can give a Pega right from the start of his journey in Pega

Breast milk: start pumping as soon as possible after birth, and according to the instructions of the Pegaia team. Remember that one of the secrets to success in pumping lies in the frequency of pumping. The professional recommendation is about 8 suctions a day. Breast milk is considered the best food for the premature digestive system. The first drops (colostrum) are also important, which can be collected with a small syringe and given to the preterm 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, among other things, on the baby's medical course, on his short-term and long-term development, on the mother's mood, and on the production of milk. "The 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 care team, each case individually.

Supportive, bounding and containing touch (Containment): Even when it is not possible to take your baby out to the "kangaroo" for various reasons, there are alternative ways to provide him/her with the supportive and loving touch he needs. Premature babies often enjoy continuous contact with the entire palm, while gathering the arms and legs, which spread or stretch when the baby is restless. Premature babies tend to enjoy less and even "get upset", when they are touched pointwise, only with a finger and short caresses. A "supportive" touch helps the baby very much to maintain the comfort and calmness he needs for recovery and growth. Gradually your baby will learn to recognize and identify the nature of your special touch.

Accompaniment during tube feeding: true, milk comes down by itself through the tube into your baby's stomach. However, this does not mean that the baby does not need accompaniment and support at this time. It is recommended that you take an active part in your baby's meal even during the tube feeding stages, because for him it is a meal for all intents and purposes. You can hold the probe and thus control the rate of milk flow according to the height of the syringe, or alternatively put your hands on your baby as explained above. Your baby will also be able to get his meal when you do "kangaroo". And in general, it is recommended to take care of the safety and calmness of your baby during the meal, thus making this time enjoyable for him.

Non-Nutritive Sucking: This is a sucking your baby does when you gently offer him the pacifier or his mother's breast. He doesn't really feed, he just sucks. 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 the meal, and also during the meal in the probe. However, this must be done gently, let the baby get used to the new stimulus in his mouth, and above all, examine 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 fitting the pacifier to the baby is important. Later on, it is recommended to bring an awake, active and "seeking" baby to his mother's breast during the "kangaroo" time.