Authors: E Zana-Ta\u00efeb, M Bigard, C Lopez (avril 2015)<\/p>\n\n\n\n
Developmental care is a set of environmental and behavioral non-pharmaceutical techniques intended to preserve the comfort of a hospitalized newborn, premature or not (1).<\/p>\n\n\n\n
These techniques can be used in isolation or in combination in integrated program such as NIDCAP. This program created in the United States by Heideliese Als, arrived in France in the 1990s. It is a philosophy of care based on repeated and formalized observation of the child\u2019s behavior in response to stimulation and\/or during rest. Observations provide hints as to how to improve the child\u2019s wellbeing and reduce stress signs by responding to his or her specific needs in collaboration with the family. In NIDCAP, the child is a full player in his or her own development, supported with the help of the family.<\/p>\n\n\n\n
A child\u2019s behavior is observed in 5 aeras: the automatic nervous system (particularly cardio-respiratory regulation), motor system, sleep-wake, self-regulation and attention-interaction. The child\u2019s efforts are observed through approach and withdrawal behaviors.<\/p>\n\n\n\n
The child’s environment is redesigned with suitable facilities. The parents are welcome and visits 24\/7 with unlimited visiting hours are encouraged. There are rooms dedicated to rest for the parents and others to encourage breastfeeding, rooms for eating, relaxing, or for the siblings.<\/p>\n\n\n\n
Excessive noise levels can negatively impact cardio-respiratory stability and have long-term negative developmental effects. Care units has been redesigned to create single room units, using noise-absorbing materials (2). <\/p>\n\n\n\n
Flexible light control is used to ensure that babies are exposed to light level compatible with their stage of development and with the time of day. <\/p>\n\n\n\n
Apart from the ambient light intensity, special care should be taken to protect babies\u2019 retinas by avoiding shining light directly into their eyes, even when closed.<\/p>\n\n\n\n
Non-nutritive sucking is triggered by teat use, sucrose administration, or the smell of breast milk. Its calming effect has been clearly demonstrated whether used alone or with sugar solution (3,4). Swaddling with a blanket or hand restraint is used to delimit the child’s immediate environment as to promote self-regulation and mitigate physiological and behavioral stress due to acute pain (3).<\/p>\n\n\n\n
Apart from care, cocoons or nests facilitate the tuck position to promote bending and self-regulation (hands to face or mouth) and to prevent the acquisition of fixed postures (5). This set of behavioral techniques is useful to reduce pain, generated by routine care such as diaper changing or weighing (6,7).<\/p>\n\n\n\n
Skin-to-skin contact is strongly encouraged in developmental care and is another example of techniques that combine postural support and swaddling, family involvement, multi-modal sensory stimulation, and nutritive and non-nutritive sucking. It has a positive impact, demonstrated many times, on cardio-respiratory and temperature stability, sleep, mother-infant attachment and breast-feeding (8).\u00a0<\/p>\n\n\n\n
With NICAP, ways are sought to reduce handling and to combine care interventions or conversely to separate them, because some very immature children do not tolerate lenghty interventions. Respect of the child\u2019s sleep-wake cycle is strongly encouraged.<\/p>\n\n\n\n
Family-centered care is integral to NIDCAP and goes well beyond the daily patient-caregiver relationship. NIDCAP mothers report that they feel closer to their babies, whatever the baby\u2019s weight or health status, and that the care team better help them more in their role as mother.<\/p>\n\n\n\n
Breastfeeding is strongly encouraged through family-centered care and a better understanding of the newborn baby’s individual needs. Breast milk is indispensable in the feeding of extreme preterm newborns and has many beneficial effects, including on the child’s neurological development of the child till the age of 5 years (9).<\/p>\n\n\n\n