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“ Providing Individualized Developmental, Family- Centered care in the Neonatal Intensive Care Unit” Bonni Moyer, MSPT, Developmental Coordinator, NIDCAP.

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Presentation on theme: "“ Providing Individualized Developmental, Family- Centered care in the Neonatal Intensive Care Unit” Bonni Moyer, MSPT, Developmental Coordinator, NIDCAP."— Presentation transcript:

1 “ Providing Individualized Developmental, Family- Centered care in the Neonatal Intensive Care Unit” Bonni Moyer, MSPT, Developmental Coordinator, NIDCAP Trainer St. Joseph’s Hospital and Medical Center St. Joseph’s NIDCAP Training Center

2 Babies are such a nice way to start people Don Herald

3 Objectives Trainees with become familiar with concepts involving: Brain development Sensory-Motor development Infant behavior-both full-term and preterm Developmental Care and Evidence-based Practice Relationship Based Caregiving and Implications

4 “One brain for life” Als

5 Incidence of Prematurity- U.S.A. 12.7 % 12.7 % 1/8 infants 1/8 infants African American - 18% of all live births African American - 18% of all live births 4 million live births/year, 520,000 premature 4 million live births/year, 520,000

6 Incidence of Prematurity-Arizona Premature infants born each week in AZ: 243 < 37 weeks 128 < 2500 grams 13.2 % of live births (1 in 8) is preterm

7 Outcomes of Prematurity: Developmental outcomes Poor school performance Lower IQ scores Behavioral problems (ADHD, affective disorders) Hack,M Adult Outcomes of Preterm Children; J Dev Behav Pediatr; 30:460-470, 2009

8 Outcomes of Prematurity: Neurosensory outcomes Cerebral palsy is the most common major neurological diagnosis seen in LBW children (5-8% for VLBW AND 12-13% IN ELBW) Increased incidence of diagnoses: CP, hydrocephalus, microcephaly, blindness, deafness, seizures (4% for births 23-27 weeks) M. Hack (2002)

9 Neurodevelopmental Outcomes: “They survive and make the best of it… yet at what cost?” Als Most premies survive, but nearly ½ will have difficulties later in life. They are bright, but they can’t hold their own in the second grade…they may have trouble with… Paying attention Prioritizing Planning Imposing structure Learning

10 Factors effecting long-term developmental outcomes social and environmental factors (maternal education, race, social class) Biological factors are important influences on the outcomes social risk factors have a greater effect on the long- term cognitive outcomes than do biological risk factors Smith, Butler, Als; 2008 In: R. Martin,AA. Fanaroff, MC Walsh, Fanaroff and Martin’s Neonatal-Perinalat Medicine; Vol. Two, Diseases of the Fetus and Infance (8 th edition). Pp 1051-1068

11 Why is Developmental Care Important?

12 Development in the extrauterine environment leads to different and potentially maladaptive developmental trajectories. Als H.1982. Toward a synactive theory of development: Promise For the assessment of infant individuality. Inf Mental Health J 3:229-243

13 How do we ensure the infant's smooth and balanced functioning now outside the womb? Als, 2006

14 Why developmental care? shown to improve preterm infants’ outcomes and have positive effects hospitalized outcomes and on their overall development improved overall physiology function improved feeding behavior, weight gain decreased length of hospitalization improved neuro-physiological outcome with improved brain structure Als H et al: A three-center randomized controlled trial of individualized developmental care for very low birth weight preterm infants: Medical, neuordevelopmental, parenting and caregiving effects. J Dev Behav Pediatr 24: 399,2003

15 Implications Our responsibility is to improve quality of life Ensuring survival is not enough


17 Sensory development-sequence of the sensory systems 1.Touch: Somatosensory,touch, pain, position and temperature 2.Vestibular: motion and balance 3.Smell 4.Taste (gustatory) 5.Hearing 6.Vision Graven,S The Relationship between Physical Environment and Patient Medical Outcomes Journal of Healthcare Design, vol IX;15-19

18 SENSORY MOTOR INTEGRATION The relationship between the nerves (sensory system) and the muscles ( motor system) The process by which these two systems work together and coordinate the overall outcome of movement Develops from birth to approximately 7 years old

19 Three parts of sensory integration 1.The sense organ receives a stimulus 2.The nerves carry the information to the brain where the information is interpreted 3. The brain decides what response should be made and relays this information to the appropriate group of muscles needed to perform this task

20 Sensory Motor Development The skills of motor integration can effect a child’s learning in areas such as: 1. balance 2. left/right development 3. knowing where their body is in space 4. self confidence of being in control of the body

21 Signs of immature sensory motor integration avoids writing tasks difficulty with hand-eye coordination clumsy confuses right and left difficulty getting dressed no development of dominant right or left hand difficulty balancing difficulty crossing midline

22 Motor Control The process of the brain and spinal cord that coordinates one’s posture and movement

23 Motor Development Process of change in motor behavior that occurs over relatively extended periods of time. Results from internal and external influences: -maturation, growth and learning -can be affected by environmental influences

24 Factors effecting motor development The development and quality of a child’s motor skills are influenced by many factors including: 1. Tone 2. Strength 3. Endurance 4. Motor planning 5. Sensory Integration

25 Motor Learning A set of processes associated with practice or experience that leads to a relatively permanent change in skilled motor behavior Isaac S.Michael WB: Handbook on Research and Evaluation

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