Developmental Care and Brain Development.

Neonates go through an adaptive phase after birth. During this time they exhibit preferences for their mother and for pleasant vs. unpleasant experiences. The perinatal period is a time when their neuronal networks are prone to disturbance from noxious stimuli.(1) Neonates that suffer repeated pain experiences, sepsis and separation from their mothers have been associated abnormal behavioral tendencies later in life (1) as well as other physical deficits and developmental delays. Micropremies have not reached the same level of development of the synapsi in their brains as term babies. (2) A synapse is the junction that brings two nerve cells together where electrical impulses are transmitted via neurotransmitters. Because of this preemies are much more vulnerable to disruptions in the development of their neuronal networks than term babies. This disruption can have life-long effects on their development. Nursing interventions that relieve pain, developmentally support the neonate and promote parent contact have been associated with improved outcomes including decreased incidence of intraventricular hemorrhage, improved adaptation to stress, better cognitive function and reaching their milestones quicker. (1) Other effects of developmental care include decreased respiratory support, improved weight gain and shorter hospital stays. It is important to note that these interventions are needed when premies and other neonates are at their sickest, not just later after their critical period is passed. (2)

Disorganization.

Witt & Rusk state that organization "reflects the infant's ability to integrate physiologic and behavioral systems in response to the environment without disruption in state or physiologic functions." They describe the physical and behavioral parameters of organization as well as the sensory threshold and signs it has been met.(3) By applying these concepts in their assessments, nurses can determine an infant's readiness for interaction and feeding.

Physical parameters of organization are vital signs, oxygen needs and digestive function. Behavioral parameters of organization are state (level of consciousness) and motor activity. When babies are unable to adjust to the environment they can become disorganized. During disorganization a baby can not coordinate its physical and behavioral functions.

Neonates have a sensory threshold that reflects their level of tolerance for stimulation. When this threshold is reached infants exhibit signs they need a time-out. When signs of overstimulation are noted a "time out" can be provided before the infant becomes completely disorganized and may help the baby back into a quiet alert state. By continuously assessing the infant's state, nurses and parents can determine a baby's ability to interact and avoid prolonged interactions that are likely to cause disorganization and stress the baby out. Gestational age, level of development and physical stability should be taken into consideration with this assessment. Assessing the infant's ability to be organized is particularly important when making such decisions as taking a preemie out of an isolette for holding or whether or not to attempt a nipple feeding. Interventions that create a supportive environment and help the baby transition to a change in their environment can helpt to avoid disorganization.