dortoms NICU Developmental Care: Interventions

Click on images for printable 8X11 versions of these signs which you are welcome to use.

Environmental Factors.

Develop a culture of quietness! Remind other staff and visitors to keep voices soft or take conversations away from the babies. Expect to be reminded yourself. Use signage as reminders to keep noise minimized. Move small and unstable babies off of radiant warmers and into isolettes as soon as is practical. Remember, however, that an infant in an isolette can still hear noise from outside of the isolette. Open and close isolette doors softly. Avoid exposing babies to drafts and sudden changes in temperatures. Avoid raising the tops of Giraffe isolettes up unnecessarily. Warm the room before taking preemies out of their warmed environments for holding or kangaroo care. Avoid bright lights when possible. Try to establish a pattern of dimmer lights at night to help promote a normal circadian rhythm. As babies get close to coming out of their isolettes remove the isolette cover, particularly in the daytime, to allow them to get used to the light. Discourage people from wearing strong scents and perfumes in the NICU.

Transitioning.

Allowing an infant to transition gradually will help prepare them for caregiving and social interaction without becoming disorganized. Gently alert the infant to upcoming handling. Speak softly to him, and use short statements. Turn the infant gradually. Avoid 'flipping him like a pancake'. Cover eyes before putting lights on. Cover sick babies completely and gently with a blanket or cloth before raising the top of a Giraffe isolette to help dull the sudden change in their environment.

Cluster Care.

Cluster care but also consider the amount of care needed. Avoid repeatedly interrupting your patient's rest repeatedly throughout your shift, however, consider the amount of care you need to provide and her ability to tolerate it all at once. Routine care (i.e. temperature/hands-on vital signs, eye and mouth care, suctioning, diaper change) can usually be tolerated in one caregiving session however if the baby is very unstable or requires a number of additional cares (i.e. OG/NG tube change, IV insertion, dressing changes, etc.), consider giving short recovery times (time-out) in between interventions to avoid stressing her. Optimize long periods of rest between caregiving times.

Positioning.

A healthy term baby will tend to keep itself in a flexed position. Preemies and sick infants will need to be supported in a flexed position. In doing this, avoid hip abduction (maintain proper alignment of legs) and keep the head midline as much as possible (prevents molding and torticolis; avoids increased carotid artery pressure). When positioning the head to the side, alternate sides with care times and decrease the degree the head is turned using sand frogs and small cloth rolls. In very small premies several 4x4s rolled together and tucked under the babies cheek can be helpful (and has the double benefit of catching any drool that may drip). In vented babies the ET tube can be supported using wheels and sandbags to secure tubing and prop up the elbow where the circuit and ET tube join. Make sure the ETT doesn't get pushed inward where it might end up in the baby's right mainstem.

When placing prone (promotes lung expansion) use a gel pad, folded blanket or cloth diaper as a body pillow (avoid arching the back and shoulder extension, and maintain flexion of limbs). On the tiniest of babies I've used a small piece of fleece with several rolled 4x4s under it as a body pillow. To place babies on nasal CPAP in a prone position fold the top of the "body pillow" used under at an angle to avoid pressure of the CPAP tubing on the baby's face. An additional, a small roll may be used above the tubing to help support the baby's head.

Use bendy bumpers or blanket rolls to support positioning and provide boundaries. Use egg crates, sheepskin and gel pads to decrease pressure points. Remove gel pads prior to xrays. Avoid using blankets or quilts with seams under unclothed babies as they can create pressure points and become irritating over time (save them for the top of the isolette). Avoid using diapers for larger babies on small babies (causes hip abduction). If necessary place a larger, open diaper or baby "chuck" pad under the baby to prevent wet linens. Swaddle babies in open cribs. That said, it's good to remember that there may come a time when older babies need some freedom to move their limbs.