The first three years of life are a crucial time period for rapid brain growth and normal development. This growth and development relies heavily upon the surrounding environment and positive external stimulation. Now imagine a baby spending months, if not years, in the neonatal intensive care unit (NICU), an environment filled with noxious stimuli—loud monitors, bright lights, painful procedures and if a patient is acutely ill, limited positive physical interactions. A great obstacle, then, is how to provide babies the best care to ensure normal neurodevelopmental growth.
“Many of our NICU patients are already at particularly increased risk due to their underlying diagnoses and prolonged hospitalizations,” said neonatologist Allison Black, M.D. “Some patients stay in the unit up to two years,” she said. Black, along with therapists, nurses, and educators who care for the babies, felt they could do more to optimize their environment, care, and, ultimately, their neurodevelopmental growth and long-term outcomes.
They created a neuroprotective team two years ago to provide the initiatives needed to improve an infant’s neurodevelopmental care. This multidisciplinary team, composed of occupational, physical and speech therapists, care coordinators, physicians, neonatal nurse practitioners, bedside nurses, and nursing educators, is designed to improve communication and alignment among the multitude of health care providers who work with the infant.
The team first focused on providing education and increased awareness about neurodevelopmental care to staff and families through a “carnival,” – hands-on skills labs, simulations, learning modules and didactic education. Topics included safe sleep practices, wound and skin care, kangaroo care, feeding, developmental and sensory issues in premature infants, and the use of developmental products such the Dandle WRAP™, which can promote neuromuscular development and self-regulatory ability. More than 200 nurses participated.
The team continues to work on other initiatives that target bedside care providers and encourage family involvement including:
- A book cart where parents can obtain books for themselves, their other children and their hospitalized infant.
- A sensory book for each room with pictures and lullaby words so parents can read and sing to their infant.
- Adult coloring books for reducing stress.
- Ongoing and regular education with staff, including reminder cards with a summary of important “take home” points from the latest education, review of recent journal articles and monthly educational topics that have both been converted to virtual sessions during the coronavirus pandemic.
In 2019, the multidisciplinary team expanded to include audiologists and rehabilitation medicine as well as NICU physicians, nurse practitioners and bedside nurses, and began holding regular NICU neurodevelopmental rounds. “During weekly rounds, each patient is systematically discussed,” Black said, “including their current medical and neurodevelopmental care plan, specific short- and long-term goals as well as long-term overall prognosis.”
The discussions may lead to changes in the care plan, such as starting physical therapy earlier. “It’s helpful to have a team-based approach to developing the neurodevelopmental goals, discussing parents’ expectations and providing the space for an open forum to discuss each patient’s long-term medical prognosis,” she said.
This team encourages parents and other caregivers to be involved with their infant’s therapy, working alongside the rehabilitation physicians they will see in the outpatient setting. “Involving the rehab medicine team early in the course helps ease the transition once our patients are discharged home,” Black said. “I think the frequent discussion, early engagement and involvement of the multidisciplinary team and care providers will help us accomplish the ultimate goal of improving the overall neurodevelopmental care and outcomes for our patients.”
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