Early Babies provides essential information for parents and healthcare professionals about the development of preterm babies in neonatal units.

Family and Infant Neurodevelopmental Education (FINE): An innovative, high quality, educational pathway for neonatal healthcare professionals.

Abstract

Family and Infant Neurodevelopmental Education (FINE) is an innovative step-by-step pathway designed to enable neonatal professionals to put the theory and evidence behind infant and family centred, developmentally supportive care into practice. FINE is an international, multidisciplinary programme that makes quality controlled education and training widely accessible and adaptable to many settings. FINE is closely linked to the more advanced NIDCAP training model but aims to support all approaches to early developmental intervention in neonatal care.  The basic principles, core themes, and step by step agenda of FINE are outlined.

Inga Warren, 2017, Infant, 13(5): 200-203

Developmental Care News, September 2017, extracts from Spanish edition.

Para mantenerse al tanto

¿Qué tanto los cuidados centrados en el desarrollo hacen una diferencia? Un nuevo reporte del proyecto italiano NEO-ACQUA evalúa el impacto de los cuidados neuroprotectores (CN) cuando se combinan con diferentes prácticas de cuidados del desarrollo. Se utilizó un cuestionario para calificar dos factores principales: cuidados centrados en el/la bebé y el manejo del dolor en el neonato Los resultados fueron comparados con puntajes altos o bajos para ambos factores. Los puntajes más altos en cuidados centrados en el infante fueron asociados con mejores resultados hasta 60 meses. Los puntajes más altos en manejo del dolor del infante mostraron beneficios al alta de UCIN y a los 18 meses, lo cual varió en comparación con cuidados centrados en el infante. Los autores subrayan la variabilidad en las prácticas de CN y hacen un llamado hacia una transformación cultural y educación a los proveedores de salud para implementar mejores prácticas. Montirosso R, et al. 2017, Promoting neuroprotective care in Neonatal Intensive Care Units and preterm infant development: Insights from the Neonatal Adequate Care for Quality of Life Study, Child Dev Perspec, 11(1):9-15.

 

Entendiendo los mecanismos y consecuencias del dolor neonatal: Esta útil revisión apoya la teoría de que las experiencias dolorosas tempranas tienen efectos a largo plazo y de larga duración en las funciones biológicas, psicológicas y socio-emocionales. La falta de entendimiento de los mecanismos involucrados tanto en tratamientos farmacológicos como no farmacológicos puede en parte explicar la forma variable e inconsistente de manejo de dolor en unidades neonatales. Los autores resumen la evidencia actual para explicar cómo las experiencias dolorosas tempranas pueden alterar la estructura y función del sistema nervioso, cómo esto puede llevar a problemas más adelante en la vida y por qué y cómo las estrategias de manejo de dolor pueden ayudar a prevenir problemas al largo plazo. Young EE, et al. 2017, Neurobiological consequences of early painful experience, J Perinat Neonat Nurs, 31(2):178-185.

Necesitamos saber más sobre por qué los padres abandonan los cuidados piel con piel: Se suele reportar que los padres abandonan los cuidados piel con piel cuando su bebé sale de UCIN. Un estudio retrospectivo de la práctica de piel con piel en una unidad neonatal de Mid-West USA documentó un descenso después de las 30 semanas de gestación. Los datos recabados mostraron que no hubo una tendencia significativa hacia mejores resultados cognitivos con cuidados piel con piel llevados a cabo en etapas tempranas y de forma frecuente, sin embargo los autores apuntan la posible pérdida de potenciales beneficios ya que el descenso ocurrió en etapas significativas del neurodesarrollo.  Gonya J, et al. 2017, Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective study, BMJ Open; 7(3):e012985.

Cercanía y separación, más acerca del grupo SCENE: El grupo SCENE está dedicado a la investigación en el ámbito de cercanía y separación paterno-infantil en UCIN. Un artículo reciente describe el vínculo entre la presencia de los padres y sentimientos de cercanía. Padres de familia en 6 países europeos completaron un récord diario de cuánto tiempo pasaban en UCIN, en contacto piel con piel o cargando a sus bebés durante las primeras dos semanas de hospitalización de su bebé. El factor más importante que apoyó la cercanía paterno-infantil fue la oportunidad de pasar la noche en UCIN. Contrario a las expectativas, tener niños mayores y la distancia entre la casa y el hospital no tuvo un impacto en la cercanía paterno-infantil. Raiskila S, et al. 2017. Parents’ presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within countries, Acta Paediatrica, 106:878-88.

Nueva información sobre resultados en el desarrollo ha sido el resultado de un grande estudio de población en Francia, el cual siguió a recién nacidos de entre 22 y 34 semanas de gestación hasta la edad de 2 años. La sobrevivencia sin discapacidades neuromotoras o sensoriales severas y moderadas mejoró, sin embargo la información recabada en el cuestionario Años y Etapas (Ages and Stages Questionnaire ASQ) mostró que un gran número de niños se encontraron en riesgo de presentar retrasos en el desarrollo; dar seguimiento de forma rutinaria a toda una población utilizando la escala de Bayley puede ser impráctico y costoso; el ASQ parental puede identificar a aquellos niños, entre la mitad y un tercio, dependiendo de su edad gestacional, que pueden requerir una evaluación formal. Pierrat et al, 2017, Neurodevelopmental outcome at 2 years for preterm children born at 22-34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study. BMJ Open 358:j3448.

 

 

 

Developmental Care News, September 2017, extracts

Keeping up ….

How much developmental care makes a difference? A new report from the Italian NEO-ACQUA project evaluates the impact of neuroprotective care (NC) when it combines different developmental care practices. A questionnaire was used to score two main factors: infant-centred care and infant pain management. Outcomes were compared for units with high or low scores for both factors.  Higher infant-centred care scores were associated with better outcomes up to 60 months. Higher infant pain management scores showed benefits at NICU discharge and at 18 months that were different to infant-centred care. The authors highlight the variability of NC practices and make a case for cultural transformation and education of care providers to implement best practice. Montirosso R, et al. 2017, Promoting neuroprotective care in Neonatal Intensive Care Units and preterm infant development: Insights from the Neonatal Adequate Care for Quality of Life Study, Child Dev Perspec, 11(1):9-15.

 

Understanding the mechanisms and consequences of neonatal pain. This useful review supports the theory that early painful experience has long lasting effects on biological, psychological, and socioemotional functions.  Lack of understanding about the mechanisms involved in both pharmacological and non-pharmacological treatments may be partly to blame for variable and inconsistent pain management in neonatal units. The authors summarise current evidence to explain how early painful experience can alter the structure and function of the nervous system, and why and how pain management strategies may help to prevent long term problems. They conclude with a discussion of the implications for neonatal and infant pain management. Young EE, et al. 2017, Neurobiological consequences of early painful experience, J Perinat Neonat Nurs, 31(2):178-185.

We need to know more about why parents give up skin-to-skin. It is often reported that parents give up skin-to-skin when their baby moves out of intensive care. A retrospective study of skin-to-skin practice in a Mid-West USA  neonatal unit  documented a decline after 30 weeks gestation.  The data showed a non-significant trend towards better cognitive outcomes with early and frequent skin- to-skin but the authors point out that potential benefits were missed as the decline occurred at a neurodevelopmentally significant stage.  Gonya J, et al. 2017, Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective study, BMJ Open; 7(3):e012985.

Closeness and separation: More from the SCENE group. The SCENE group is devoted to research on parent-infant closeness and separation in the NICU.  A recent paper describes the link between parents’ presence and feelings of closeness. Parents in 11 units in 6 European countries completed a daily record of time they spent in the NICU, in skin to skin contact or holding their babies during the first two weeks of hospitalisation.  The most important factor supporting parent-infant closeness was the opportunity to stay overnight in the NICU. Contrary to expectations, having other children and the distance from home to the hospital had no impact on parent-infant closeness. Raiskila S, et al. 2017. Parents’ presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within countries, Acta Paediatrica, 106:878-88.

New information on developmental outcomes from a large population study in France following infants born between 22 and 34 weeks gestation to age of 2 years. Survival without severe or moderate neuromotor or sensory disability improved but  data from the Ages and Stages Questionnaire showed  that  a high number were at risk of developmental delay;  Routinely following up whole populations with  Bayley assessment is impractical and costly;  the parental ASQ  can identify those infants, between a half and a third, depending on gestational age, that need more  formal evaluation. Pierrat et al, 2017, Neurodevelopmental outcome at 2 years for preterm children born at 22-34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study. BMJ Open 358:j3448.

How to be  a good (joyful!) leader or manager. Staff retention is often a problem in the emotionally and physically demanding working environment of the neonatal unit. The variable that contributes most to staff retention is management style.  An effective leader is  “… an authentic presence at the front line ..staying focused on mission and what matters, and identifies attention to joy in work as a major component of the leadership role.” The Institute for Health Care Improvement has written a white paper on improving joy (alternatively “engagement”) at work, with helpful suggestions. A good resource for anyone in a leadership role.  Perlo J, et al. 2017. IHI Framework for Improving joy at work, IHI White paper, Cambridge Massachusetts: Institute for Healthcare Improvement

Developmental Care News, May 2017

Extracts from May 2017 DEVELOPMENTAL CARE NEWS

 

Keeping up ….

Eight key principles for patient-centred and family-centred care in the NICU are outlined in brief by Roué and colleagues in the April issue of Archives. Level of evidence is stated with ample referencing. A useful summary for people who don’t quite know what to make of “developmental care”.  Roué  J, et al. Eight principles for newborns in the neonatal intensive care unit. Archives of Disease in Childhood – Fetal and Neonatal Edition  18 April 2017.

Improving family support: The top 10 recommendations for comprehensive family support proposed the National Perinatal Association (USA) working group  on psychosocial support are described by Hall and colleagues in a paper that also  provides a self-assessment tool, and  ideas for quality improvement projects. Hall S, et al. Transforming NICU Care to Provide Comprehensive Family Support. Newborn & Infant Nursing Reviews, 2016; 16: 69-73.

When to give sucrose: Although the convention has been that offering sucrose 2 minutes before a procedure is most effective for reducing  infants’ pain reactivity, this view has been challenged  by Meesters and colleagues . “Waiting 2 minutes after sucrose administration—unnecessary?” Archives of Disease in Childhood – Fetal and Neonatal Edition.  October 2016.

The car seat challenge.  If you are testing babies in car seats before they go home remember that the angle of the seat will be different when it is fixed in the car and the motion of the car will also affect the infant. Arya R, et al. Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Archives of Disease in Childhood – Fetal and Neonatal Edition, 2017;102:F136-F141.

Infant Medical Trauma in the NICU is a conceptual model proposed by D’Agata and colleagues to describe the stressful experience of preterm infants, exposed to many procedures and separated from parents, experiences  potentially linked to adverse long term outcomes.  Unpacking the burden of care for infants in the NICU. Infant Mental Health Journal, February 2017.

Welcome! packs

Some units prepare welcome packs for  families  when their baby is  admitted to the neonatal unit.  We asked you what  would be useful to include — here are your suggestions;

  • A cooler bag for transporting expressed breast milk
  • Muslins to use as wraps or scent exchange cloths—especially if made of soft bamboo fabric
  • A small  washable toy  to grasp
  • A credit card sized mirror for watching the baby during skin-to-skin. This could have information like contact number for the unit printed on the reverse side.
  • A   disposable camera—especially if mobile phones are not permitted on the unit
  • A diary with a pen
  • A map of the hospital, with details of facilities such as food outlets
  • A little book to read to the baby e.g. “Guess how much I love you”,
  • Ink stamp pad for making footprints.
  • Details of “Caring for your Baby on the Neonatal Unit: A Parents’ Handbook”
  • A keepsake bag for saving little things like cord or first hat etc
  • A laundry bag for keeping the baby’s own clothes for washing at home.
  • An expressing pack
  • Stickers for EBM bottles
  • Car parking permit

 

Thanks to the following for sharing their ideas Fiona Kavanagh, Beverley Hicks, Gillian Kennedy, Emily Hills, Cherry Bond, Kayleigh Light, Liba Mason, Jennie Schooling.

 

opening of nidcap centre

second blog

A parents’ handbook
Our first project is a handbook for the parents of premature babies in a newborn intensive care or special care baby unit. It is about the vital part that parents play, right from the start.

Copyright © 2014 - 2018 - Early Babies - All Rights Reserved. London Web Designers - Notting Hill Web Design