Strategies For Neurodevelopmental Protection And Care For Preterm Neonates

Select one topic from the list below. Choose a broad topic that is of specific interest to you.

1.Critically discuss the nursing care, with rationales, that is provided to the preterm neonate to protect their neurodevelopment.

2.Select a neonatal condition from a topic in this unit (see weekly breakdown - students are invited to select a topic covered in the modules or a condition/disease that is of interest to them) and critically discuss the appropriate nursing care provided to the neonate and their family.

3.Critically discuss the strategies used to facilitate bonding between a newborn and their family in the neonatal environment.

Impact of Preterm Birth on Neurodevelopment

After birth care and nurturing plays a fundamental role in the growth and development of the child as it continues to growth and develop with time. Especially for the preterm babies, the importance of the growth and development focused care holds tremendous value in preserving and protecting their physical and neurological development. Preterm babies are the result of premature birth facilitated by any or a variety of gestational complications which turn the amniotic environment difficult to sustain for the foetus, which in turn requires immediate operation to take the baby out of its mother’s womb (Vinturache et al., 2016). On a more elaborative note, prematurity can be defined as the concept that encompasses the broad category of neonates that are born at less than the 37 weeks of gestational period which is the standard pregnancy to birth period.

It has to be mentioned in this context that the premature babies are not fully developed and their development progress inside the womb stops abruptly when the prematurity occurs. Hence, their overall development especially the neurodevelopmental procedure is left abruptly incomplete which can lead to various complications as the babies continue to grow.  Preterm birth is one of the leading cause of neonatal mortality, sensory and intellectual disabilities; and one of the major contributing factor leading to the anomaly is the lack of adequate care interventions taken for the preterm neonates with respect to their required neurodevelopment (Li, Chen, Jaakkola, Williams  & Guo, 2018). This assignment will attempt to discuss the impact of different care interventions for the preterm neonates and how it can fortify their neurodevelopmental progress along with protecting and nurturing it.

According to the recent statistics it has to be mentioned that among 10 babies born every day one is delivered premature, which indicates that there is around 15 million preterm babies taking birth all across the world.  As mentioned by the Boyle et al. (2015), the advancement in the neonate healthcare services and the enhance accessibility to life saving commodities has resulted into higher survival rate of the preterm neonates.  However, it has to be acknowledged in this context that developmental procedure of the babies that are delivered before the gestational period is complete it is abruptly discontinued which can lead to several developmental incompetence leading to a prematurely develop brain, lungs, cardiovascular system and many other organ system of the body. Exploring this issue further, relationship between the gestational age and the birth weight is inversely proportional, which indicates at the possibility of several developmental anomalies, especially for neurodevelopment.  

Current Care Interventions and Existing Challenges

There is mounting evidence that suggest that extremely preterm and extremely preterm neonates when into school age and early adulthood are reported to show higher rates of motor, cognitive or behavioural impairments when compared to infants born at standard term (Wang & Jiang, 2018).  Most common developmental disorder that has been associated with preterm babies include cerebral palsy (CP), cognitive dysfunction, blindness and impaired vision, hearing loss and disorders of psychological development, behaviour and emotion, all of which are directly or indirectly associated with restricted on incomplete neurological development.  Hence it is crucial for the care services for the preterm neonate to focus entirely on facilitating and accelerating the neurological development process for the neonate along with focusing on the other developmental aspects (Kwon, Vasung, Ment & Huppi, 2014).

As discussed by Baud et al. (2017), that care interventions that has focused on the development of the preterm neonates have been found to focus more on the physical developmental disorders with adequate clinical manifestations rather than focusing on the neurological development which can manifest later as the baby continues to grow.  There is very little to limited knowledge among the neonatal healthcare staff regarding the need for the neurological development oriented so that adequate care interventions can be provided to the preterm neonates to avoid the risk of any possible neurological disorders. There is need for effective and efficient strategies that can be implemented in the care practices that focus entirely on the neurological development of the preterm neonates.

The first care intervention strategy that can be provided to the preterm neonates is focused on improving the diet and growth management of the preterm neonate. The rationale for this care intervention approach is based on the article by the Rose et al. (2014), that states that the proper after-birth weight improvement and BMI increase had been reported to be extremely beneficial for improving and enhancing the neurological development of the preterm neonates. Research has shown the fact that the preterm neonates are generally born with comparatively lesser cortical grey matter than the normal babies. This is one of the fundamental contributing factors leading to flawed brain development and associated clinical manifestations on the behavioural characteristics. Although there is also considerable argument that rejects the ideation of proper weight and BMI increase to directly influence brain development in the preterm neonates.

Another very important strategy that can be implemented to improve the cortical grey matter development of the preterm babies is the emphasis on limiting the exposure of the preterm babies to glucocorticoid. The rationale for this intervention is the fact that for extremely low birth weight preterms, the sustained exposure to the glucocorticoid has been reported to show considerable restriction to the cortical matter development (Carson, Monaghan-Nichols, DeFranco & Rudine, 2016). Hence, care interventions that take into consideration limiting the glucocorticoid exposure even with the critical pharmacological assistance requirement of these preterm neonates can help in fortifying neurological development.

Care Interventions Focused on Neurological Development

The next care interventions should focus on the modifying the physical environment of the preterm neonates which can also help in preventing the chances of sensory loss in the preterm neonates in the latter developmental stages. For instance, bright light can have significant damaging effect on the visual senses of the neonate due to the premature eyelid development and incompletely developed occipital lobe. Hence, the care interventions must focus on limiting the light exposure as well. As suggested by the Pavaine et al. (2016), the ambient lighting, if kept within the limit of 300 Lux, can be optimally effective for the preterm neonates and its visual sensory development.

Similarly, noise also has a significant impact on the sensory hearing abilities of the preterm neonates. Along with that, Almadhoob and Ohlsson (2015), have also suggested that continued exposure to extreme noise has been reported to cause behavioural modifications in the preterm neonates as well. The extreme exposure to noise and chaos has also been reported to cause abnormal brain development in the preterm neonates. Hence it is crucial for the nursing care for the preterm neonates to take into consideration the possible impact of the noise in the brain and sensory development of the neonate. Therefore the recommended nursing intervention strategy should be to limit the ambient noise of the NICU and take extra emphasis to ensure that the ambient noise of the NICU is within the limits of 50 dBs. Along with that, it has been argued there is need for a few precautionary measures involving reducing noise as much as possible in the NICU and close the incubator portholes slowly along with not keeping anything on the top of the incubator to avoid chances of emergencies (Kramari? et al., 2017).

Sleep plays a very important role in developing the synaptic transmission system of the neonates and also promotes overall physical and neurological development of the preterm neonates (Shellhaas et al., 2017). It has been reported in the preterm neonates that sleep disturbances can occur due to slightest of triggers for the preterm neonates which in turn disrupts their growth and developmental progress and enhances the possibility of neurological damage. Hence, care interventions must also incorporate supportive activities for standard sleep-wake cycles of the preterm neonate. Along with that proper sleep-wake cycle documentation is also a very important step to consider for the preterm neonate. The rationale behind this intervention is to improve and accelerate the developmental processes carried on in the body during the sleeping cycle. It has been reported that most of the developmental progress in the body takes place during the sleep cycle, hence any disruption in the sleep cycle can lead to various complication including anomalous brain development. Proper documentation of the sleep cycles of the neonates will help the nurses keep track of the effectiveness of the interventions carried out on ensuring standard sleep-wake cycle of the neonate and the interventions will help support and assist a standard sleep wake cycle required in the preterm neonates for optimal development and growth (Liao et al., 2018).

Diet and Growth Management

It has to be mentioned that the preterm neonates and their neurological development can also be facilitated and nurtured by implementing adequate skin to skin contact. There is mounting evidence that indicates that gentle skin to skin contact is associated with considerable acceleration and protection of the neurological development of the babies, especially the preterm neonates. The skin to skin contact has been found to be the cornerstone that helps support and nurture neurodevelopment and facilitating low birth weight in the preterm neonates. Along with that, as discussed by Carbasse et al. (2013), the skin to skin contact has also been recommended to improve the neurodevelopment of the preterm neonate that are ventilated. Although, there is considerable argument that criticizes the use of skin to skin contact and the chances of infections of the preterm neonates. It has to be mentioned that the preterm neonates have considerably less functional and incompletely developed immune system and they are extreme prone to chronic infections which can easily turn fatal (Aita et al., 2017). Hence, the skin to skin contact is associated with considerable risks and thorough and extensive infection control regimen is needed to be followed to avoid the chances of fatalities.

The last intervention strategy that can be implemented in order to improve the neurodevelopmental procedure in the prematurely developed neonates can be enhanced parental stimulation. Researchers are of the opinion that the implementation of adequate parental involvement during the stay of the preterm neonate in the NICU had been reported to improve the brain development procedure. It has helped in calming the neonates and helping in maintaining a standard sleep wake cycle for the preterm neonates which in turn has been reported to help in improving and enhancing the progress of brain development of the preterm neonates. Similarly, Stefana and Lavelli (2017), have stated that the implementation of parental skin to skin contact has also been reported to improve the developmental pace of the neonates and in turn lead to lesser chances and frequency of neurological or sensory developmental disorders in the preterm neonates. Although, the exact mechanism by which the skin to skin contact and the parental involvement in the NICU care strategies enhance the neurological and other developmental processes of the preterm neonates is still not clearly understood. The statistical results of various research studies have shown promising results, hence both of these interventions can be implemented to improve the neurodevelopmental procedure of the preterm neonates.  

Limiting Glucocorticoid Exposure

Conclusion:

On a concluding note, it has to be acknowledged in here that neurological development is a grave concern for the preterm neonates in the NICU.  There can be various triggers and contributing factors leading to faulty brain development leading to not just various intellectual disabilities and disorders but can also lead to speech, vision,  hearing and other related sensory impairments. The primary purpose of this essay had been explore the need for neurological development assisting care interventions for the preterm neonates to avoid the chances of intellectual or neurological disorders. The essay successfully identified possible care interventions that can be employed in the NICU to enhance the neurological development of the preterm neonates and avoid the chances of any sensory, intellectual or behavioural impairments. However, it has to be mentioned that the available literature on this issue is limited and lacks extensive argument. Hence, there is need for more extensive research to discover the exact triggers and issues to the neurological development of the preterm neonates and discovering patient centred approaches to care interventions to help facilitate better neurological development of the preterm neonates.

References:

Aita, M., Stremler, R., Feeley, N., Lavallée, A., & De Clifford-Faugère, G. (2017). Effectiveness of interventions during NICU hospitalization on the neurodevelopment of preterm infants: a systematic review protocol. Systematic reviews, 6(1), 225. Doi: doi: 10.1186/s13643-017-0613-5.

Almadhoob, A., & Ohlsson, A. (2015). Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database of Systematic Reviews, (1). Retrieved from 10.1002/14651858.CD010333

Baud, O., Trousson, C., Biran, V., Leroy, E., Mohamed, D., & Alberti, C. (2017). Association between early low-dose hydrocortisone therapy in extremely preterm neonates and neurodevelopmental outcomes at 2 years of age. Jama, 317(13), 1329-1337. doi:10.1001/jama.2017.2692

Boyle, E. M., Johnson, S., Manktelow, B., Seaton, S. E., Draper, E. S., Smith, L. K., ... & Field, D. J. (2015). Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Archives of Disease in Childhood-Fetal and Neonatal Edition, fetalneonatal-2014. doi: 10.1136/archdischild-2014-307347

Carbasse, A., Kracher, S., Hausser, M., Langlet, C., Escande, B., Donato, L., ... & Kuhn, P. (2013). Safety and effectiveness of skin-to-skin contact in the NICU to support neurodevelopment in vulnerable preterm infants. The Journal of perinatal & neonatal nursing, 27(3), 255-262. doi: 10.1097/JPN.0b013e31829dc349.

Carson, R., Monaghan-Nichols, A. P., DeFranco, D. B., & Rudine, A. C. (2016). Effects of antenatal glucocorticoids on the developing brain. Steroids, 114, 25-32. doi: 10.1016/j.steroids.2016.05.012

Kramari?, K., Šapina, M., Milas, V., Milas, K., Dorner, S., Varži?, D., ... & Adelson, P. D. (2017). The effect of ambient noise in the NICU on cerebral oxygenation in preterm neonates on high flow oxygen therapy. Signa vitae, 13(3), 52-56. Retrieved from https://www.signavitae.com/wp-content/uploads/2017/06/sv13-s3-52-56.pdf

Kwon, S. H., Vasung, L., Ment, L. R., & Huppi, P. S. (2014). The role of neuroimaging in predicting neurodevelopmental outcomes of preterm neonates. Clinics in perinatology, 41(1), 257-283. doi: 10.1016/j.clp.2013.10.003

Li, S., Chen, G., Jaakkola, J., Williams, G., & Guo, Y. (2018, February). The Impacts of Ambient Temperature on Stillbirth and Preterm Birth: Brisbane, 1994-2013. In ISEE Conference Abstracts. doi: 10.1289/isee.2017.2017-209

Liao, J. H., Hu, R. F., Su, L. J., Wang, S., Xu, Q., Qian, X. F., & He, H. G. (2018). Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review. Worldviews on Evidence?Based Nursing. Doi: 10.1111/wvn.12315

Pavaine, J., Young, J. M., Morgan, B. R., Shroff, M., Raybaud, C., & Taylor, M. J. (2016). Diffusion tensor imaging-based assessment of white matter tracts and visual-motor outcomes in very preterm neonates. Neuroradiology, 58(3), 301-310. doi: 10.1007/s00234-015-1625-2

Rose, J., Vassar, R., Cahill-Rowley, K., Guzman, X. S., Hintz, S. R., Stevenson, D. K., & Barnea-Goraly, N. (2014). Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants. NeuroImage: Clinical, 5, 169-177. doi: 10.1016/j.nicl.2014.05.013

Shellhaas, R. A., Burns, J. W., Hassan, F., Carlson, M. D., Barks, J. D., & Chervin, R. D. (2017). Neonatal sleep–wake analyses predict 18-month neurodevelopmental outcomes. Sleep, 40(11), zsx144. doi: 10.1093/sleep/zsx144

Stefana, A., & Lavelli, M. (2017). Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: protocol of a mixed-method and longitudinal study. BMJ open, 7(2), e013824. doi:  10.1136/bmjopen-2016-013824

Vinturache, A. E., Gyamfi-Bannerman, C., Hwang, J., Mysorekar, I. U., Jacobsson, B., & Collaborative, T. P. B. I. (2016, April). Maternal microbiome–a pathway to preterm birth. In Seminars in Fetal and Neonatal Medicine (Vol. 21, No. 2, pp. 94-99). WB Saunders. doi: 10.1016/j.siny.2016.02.004

Wang, C., & Jiang, Z. D. (2018). Brainstem auditory abnormality in extremely premature babies and the impact of neonatal bronchopulmonary dysplasia. Acta obstetricia et gynecologica Scandinavica, 97(5), 545-551. doi: 10.1111/aogs.13312