Individual Care of Preterm Babies
Individual Care of Preterm Babies
Nature is supreme the way it looks after all the needs of the baby in the womb.
The baby is gently rocked in the warm amniotic fluid and is well protected from infections and effectively shielded against light and sound. The baby is comfortably â¬Ånested in a flexed posture with hands in the midline close to his mouth. The uterine blood flow provides a soothing music effect.
Premature Baby in Incubator (Fig: 1)
Birthing is a traumatic experience both for mother and her baby. Apart from the discomfort and trauma associated with the process of delivery, the baby is suddenly thrust into a world of bright lights, loud sounds and cold environment. Due to advances in technology, the survival of preterm babies has improved but the quality of life among the survivors has not significantly improved.
Technology-oriented Newborn Care
During the last three to four decades technology has revolutionizes the care of preterm babies. The earlier relatively humanized approaches in the care of preterm babies by gentle handling and â¬Åmasterly inactivity has been replaced by the use of aggressive and invasive hi-tech modalities to provide life support to tiny babies to improve their survival. The babies should be handled with gentle touch, love and compassion and the nurses should feel â¬Åconnected and â¬Åtuned to the babies under their care.
Principles of Individualized Care
We should create a bay-friendly womb like ambience and ecology in the NICU to simulate in-utero environment. The nurses should be trained to provide individualized developmentally supportive care to preterm babies by adopting a â¬Åflexible approach. All the health care professionals in the NICU should be gentle, considerate and compassionate in providing care to preterm babies'.
Early and intensive participation by family members in the care of preterm babies should be encouraged to promote bonding, facilitate physical growth and neuromotor development.
Baby-friendly ecology in the NICU
It is a common observation that very low birth weight (VLBW) babies are being looked after in an unpleasant, noisy, too bright and aggressive-invasive environment
High noise level may cause damage to the cochlea and preterm babies have 5 times greater risk of development of hearing loss compared to term babies. The health personnel should learn the art of speaking softly and walking gracefully in the nursery. Telephone rings should be replaced by blinking lights. Instead of air compressors, centralized sources of compressed air, oxygen and suction should be used. The incubator can be covered with a blanket or specially made cover to dampen the noise and light reaching the baby.
When nursery illumination is maintained uniformly bright during the day and night, it may adversely affect the circadian biologic rhythm leading to reduced release of growth hormone and poor weight gain. Dim lighting has been shown to improve duration of sleep, decrease motor activity, reduce heart rate, improve tolerance of feeds and increase weight gain of medically stable preterm babies. The windows of the NICU should be covered with screens and blinds. The eyes should be shielded or covered while using procedure light or during phototherapy.
Positioning and handling
All efforts should be made to provide babies with as comfortable a positioning as possible although it is impossible to achieve in-utero comfort levels and cushioning. When a baby is handled roughly, he feels uncomfortable by squirming, crying and recoiling his arms and legs.
New born Baby (Fig: 2)
Infant should be provided with midline orientation to facilitate hand-to-mouth activities which are self-soothing. The hands of the baby should be left free so that he can get them to his face to suck his fingers or just touch his face. Putting on a small diaper or placing soft material between the legs provides comfort to the baby. The baby must be handled minimally and gently with clean and warm hands. When hands of the caretaker are busy in doing the procedure, the flexed legs of the infant can be enclosed in a blanket to provide containment.
Feeding with human milk
Nothing is more humanized and natural for a baby than providing feeding with human milk to all babies .The milk of a mother, should be given to her baby because milk is not only species specific, it is indeed baby specific; extremely preterm babies cannot self feed and they are given expressed breast milk (EBM) through a nasogastric tube.
Rhythmic Gentle Stimulation
The preemies should be provided with developmentally supportive care to meet their neuro behavioural and physiologic needs in order to foster their normal physical growth and neuropsychological development. The care in the NICU should not be merely task-oriented but the nurses should feel â¬Åconnected or â¬Åtuned with babies under their care and provide individualized care to promote emotional and neuropsychological development of the babies.
Tactile and Vestibular development
The tactile stimulation should be provided by gently touching the head or back of the baby while speaking softly in a soothing voice. The baby should be positioned in such a way so that he is able to suck his fingers or hand or is able to touch his face. The mother should be encouraged to provide intermittent skin-to-skin contact to her premature baby admitted in the NICU. It provides comfort, warmth and â¬Åspecial smell of the mother to the baby.
Music is credited to have numerous qualities and capabilities and it has been shown even to enhance the growth of plants. The baby can be made to listen to the taped voice of parents and family members on and off. This enhances parent-infant bonding and gives family members the sense of involvement in the care of their baby.
Development of the visual system
Babies should be picked up and encouraged to develop an eye-to-eye contact. Babies often turn to the source of diffuse light. Visual stimuli can be provided with the help of bright toys and pictures.
A picture with distinct facial pattern can be placed on the incubator or crib wall in line with gaze of the baby. Dim-light encourage babies to open their eyes and look around.
Stimulation of Olfactory system
The baby should not be exposed to unpleasant or noxious odours. Alcohol, betadine, or other skin scrub bottles should be opened away from the baby. Skin-to-skin contact provides pleasant and â¬Åspecial smell of the mother to the baby. Babies are sensitive and attracted to the smell of the mother's milk, which is used for rooting the nipple during breast-feeding.
Conclusions and Recommendations
Individual care is not an alternative to hi-tech care but is complementary in order to provide best or holistic care to preterm babies. We should strive to provide a good mix and balance between technology- based care and human Individual care to preterm babies. The lighting should be kept dimmed with a day-night pattern. The sound level should be low and light kept dimmed to have â¬Ëquiet periods during each shift. The baby should be provided with a comfortable â¬Ånest and kept on the side or prone with flexion of limbs. The nurses should be trained to provide an individualized and developmentally supportive care. Nothing is more humanized than feeding the baby with milk of her mother because milk is not only species specific; it is baby-specific.
Nurse with Premature Baby (Fig: 3)
Early and intensive family participation in the care of preterm babies is important for their organization; growth and development. We should demystify NICU and actively involve and inform the parents about the care and Condition of their baby.
Mother should be encouraged to provide the benefits of skin-to-skin contact to her baby. She should be asked to touch talk, feed and take care of her baby and provide necessary tactile visual and auditory stimuli. Mothers are more likely to look after their babies with devotion and compassion and this is likely to augment the forces of healing and promote the process of recovery of high-risk and sick preterm babies.
All efforts should be made to enhance the survival of preterm babies but our goal should be to improve the quality of life among those who survive.