Developmental Supportive Care For Newborns in NICU by Dr Lathiesh Kumar Kambham

A developmental supportive care unit for newborns in NICU aims at creating a supportive environment for premature babies to grow and survive. A NICU provides medical support for premature babies, the staff in the NICU are trained to handle such babies and respond to the issues quickly, without wasting any time.

Despite being in the NICU under constant observation, some preemies might need a better or more conducive environment to support their development. Their surroundings such as the noise in the ward, the positioning of the lights around their bed and the sleep pattern may all need more delicate handling to help the baby develop well.

By changing the light position, reducing the exposure to noise and handling the baby more carefully, the DSC can help reduce the infant’s stress and let them relax like they would in the womb. When normal neurological developments happen as per the expected timeline, it reduces the morbidity rate in preemies.

Why is Developmental Supportive Care For Neonates Important?

In a regular NICU, the focus is on mortality. The doctors and the medical professionals around focus on saving the baby’s life from the regular dangers of preterm birth. Despite these facilities, the rate of morbidity, i.e. the rate of infections or diseases that affect premature babies is high.

Developmental supportive care aims to reduce this morbidity. Over time, with close observation, it is understood that if a baby is allowed to develop fully as per the expected timeline, their bodies and immune system can protect them as they grow up. When such an important development is hindered due to premature birth, it puts the baby at a higher risk of contracting diseases and infections, which can have a lasting impact.

[Read : Common Health Issues of Premature Babies]

Which Babies Need DSC in NICU?

Premature babies are generally born a few weeks before their delivery dates. During these last few weeks, their brain undergoes a lot of crucial development. Preterm birth stops this development and results in many neurosensory impairments which are not evident until the child is older.

In many cases, the parents start noticing the differences and delays only when the child is in pre-school or older when they start interacting with their environment. You cannot rectify some of these cognitive and behavioral problems as the critical developmental phase is over.

So, if a baby is born pre-term and is very immature, the neonatal environment could be very stressful and affect the baby’s development. Such babies need a better environment to help them develop neurologically. Babies who are at a higher risk of morbidity need DSC in NICU.

What is Included in Developmental Supportive Care For Neonates in NICU?

Developmental supportive care for neonates in NICU mainly involves modifying the baby’s environment. DSC modifies a neonate’s environment in the following ways:

1. Adjusting Lights

NICU will have constant lighting, which can affect the baby and lead to overstimulation. Different countries have different recommendations for the optimal light setting for neonates.

2. Adjusting Noise

A newborn’s threshold for cochlear damage is very low and the constant noise in the NICU can be very disturbing for them. It can sound louder than it actually is, to those tiny underdeveloped ears. Background noise and the general noise in the NICU will be reduced to the recommended limits in the DSC.

3. Position Right

Position the baby with the help of cushions to aid their musculoskeletal development. They will change the baby’s position in alignment with their sleep and wake cycles to optimize the development.

4. Involve Parents

The parents are educated about the various procedures and the care offered to the baby. This will help them understand the reason behind the various changes being made around the baby. This will also help them read the baby’s cues and support them in the best way possible to aid development.

5. Assess Baby

The neonate will be monitored and assessed for their cues and responses. Their response to their modified environment will help make more changes as and when necessary. Such assessments and changes ensure there is no hindrance to the baby’s development in any way.

6. Sleep Protection

Understanding the infant’s sleep and wakeup cycles to ensure they get sufficient sleep, which in turn can aid development. Sleep deprivation due to the noise and lights around can have a detrimental effect on the infant’s health.

7. Reduce Painful Procedures 

Babies experience pain in different ways and exhibit them through their behavior and responses. Newborns also remember the pain they experience, which can have a lasting impact on them. DSC will try to minimize the baby’s pain by changing the position, swaddling, rocking, non-nutritive sucking, and more. In case of severe pain, anesthesia can also be given.

8. Family – Centered Care

The family is involved in the developmental supportive care given to neonates. This type of care offers parents unrestricted access to their baby and also allows them to be present during invasive procedures. Hearing the mother’s voice and feeling her touch is something the baby has until birth. A premature baby loses out on this bonding and the DSC aims to provide that to the best extent possible.

How to Implement Developmental Supportive Care For Newborns

Taking special care of an infant who cannot communicate is complicated. Here are some tips to help implement developmental supportive care for newborns.

• Observe the baby and take note of a change in cues or responses. Alter the treatment or care according to the changes.
• Understand each baby is different with a different set of needs. What suits one baby need not suit another. One baby may need more or less care than the other. Individualized care is the most important part of DSC.
• Change the cluster of care as the baby develops and grows. They have different needs at different stages and these should be given at the appropriate times.
• Use slow and deliberate moves to swaddle a baby. Securely tuck the baby’s limbs inside when you start.
• Moving the infant has to be as slow as possible, without losing body contact.
• Avoid strong fragrances and smells from other medicines, and alcohol swabs
• Monitor and adjust the environment as per the baby’s cues.

Benefits of Providing DSC For NICU Babies

DSC may seem completely unnecessary for a neonate who is already under close supervision in the NICU. However, your neonate can benefit in the following ways

1. Shorter Stay

DSC can help reduce your baby’s stay in the hospital. Developmental Supportive Care enables your baby to develop on their own. As a result, their body can reach the required milestones, and get them ready to go out into the world. They need not stay in the hospital for months, to ensure they don’t contract any disease or infections.

2. Fewer Complications

Preterm babies are prone to many complications. Some of these become visible only after the baby is a few years old. DSC reduces the risk of such complications by supporting the baby’s development.

3. Improved Weight Gain

Neonates are prone to be underweight. The main reason being their birth happens before the major developments happen in the last few weeks of pregnancy. When the baby is nurtured in the right environment, the weight gain can be good, thus making them stronger and bigger much earlier than expected for a preemie.

4. Better Feeding

The baby and the mother get better support for breastfeeding. They learn about the alternatives too. DSC aims to follow the neonate’s cues and pace the feeds according to the baby’s needs and ability to suck, feed and swallow.

[Read : Breastfeeding A Premature Baby]

5. Enhance Bonding

DSC is more of infant-driven care. The care given depends on the baby’s cues and needs. When parents are aware of these from the beginning, they learn to respond better to cues. They can offer similar care even after going home and be in tune with their baby’s needs.

6. Regulating Sleep Cycles

It includes changing the light settings to mimic the day or night lights, to help the baby get into a good sleeping cycle/ rhythm. Quality sleep without the disturbance of noise or light can help accelerate the baby’s neurological development.

Are There Any Risks to DSC For Neonates?

When developmental supportive care is well administered by well-trained staff in a well-facilitated hospital, there are not many risks to the baby. Some of the possible risks could be due to negligence or unawareness, such as

a. Lack of Individual Care

Not giving individualized care. Each baby is different and their needs will vary too. Though there are set recommendations for noise and light levels, and how to swaddle or handle, one cannot give the same care to all the neonates in the DSC. The care needs alterations according to the baby’s age, size, needs, cues, etc.

b. Incorrect Massaging Techniques

Massaging the right way with the right pressure will stimulate growth and development. Using a little more or less pressure can overstimulate the child, which can be detrimental to the purpose of offering developmental supportive care.

[Read : Overstimulation in Babies]

c. Overstimulation

If babies and their families don’t get separate rooms, the noise from other babies or their families, and the noise or disturbance of handling other babies can contribute to a baby’s stress. Stimulating the baby and aiding its development can hinder the normal maturation of the body and brain.

d. Infections

These babies are highly prone to infections and hospitals are the thriving hub for such infections. Sometimes, despite all the care and precautions, infections can spread.

These are just the possible risks associated with DSC. If your baby is in a well-equipped hospital under the care and supervision of experienced doctors who are not new to DSC, you need not worry. Let the professionals do their work so that your baby can benefit from it.

Taking care of a newborn, especially a neonate is not easy. Offering them specialized care requires not only well-trained professionals and a fully functional NICU, but it requires the parents and family to hop on board as well. The family needs to believe in this care and offer the same to the baby, to see the best possible results.

Read Also: Caring For Your Baby in NICU by Dr Lathiesh Kumar Kambham