Environmental Modifications and More

As noted in the 'special problems for preterm infants' section, premature infants are surrounded in most NICUs by loud noises, high light intensities, and many uncomfortable positions and situations. As research over the last several years have shown, there are several ways to alleviate some of the stressful situations in NICUs while providing the same level of medical care, which can improve the health and development of infants.

Special Cradles
One study by Gatts et al. (1995) with healthy newborn infants, which used a special cradle that incorporated smooth motion, low sound, tactile containment, and low light, (all intra-uterine features) was used to test the difference between a normal cradle and its special cradles . Infants with special cradles spent more time in the cradle (see graph below), with 55.4 hours more nighttime rest over the 16 week period. In addition, infants with special cradles spent less time crying than normal cradle infants. They also slept through the night sooner than normal cradle infants. Infants in special cradles also had higher mean scores on three of the seven Brazelton Neonatal Behavioral Assessment Scale factors; orientation, regulation of state, and interaction (see infant massage for more info on the BNBAS).

Adapted from Gatts et al. 1995

Adapted from Gatts et al. 1995

Adapted from Gatts et al. 1995

These results are important because an increase in sleep leads to less time crying and more time conserving energy (especially if they are in quiet sleep). Crying is dangerous for premature infants, because it increases intracranial pressure,destabilizes breathing, lowers oxygen concentration in the blood, increases blood pressure, blood flow from the heart decreases, and it lowers lung capacity. Crying can lead to hypoxemia, which is associated with apnea (cessation of breathing) and their association can lead to neonatal morbidity. (Marasco & Barger, Davis 1999)

Waterbeds

Adapted from Korner 1999

Beyond changing the cradle, Korner et al (1999) has tested vestibular stimulation by adding water beds with head to foot oscillations with rhythms much like a mothers biological rhythm. Infants placed on the waterbeds for 9 days had significantly less apnea (as shown in graph below), while no detrimental effects were found. Apnea can cause brain damage, thus a reduction in apnea is very important. Korner replicated her results in several succeeding experiments and also found that quiet sleep increased and crying decreased while infants were on the waterbeds.

Developmental Care
In addition to modifying the environment, many researchers, like Als et al. (1994) have created what they call developmental care of premature infants. This method includes not only attention to the infants environment, but also paying close attention to infant cues and trying to follow infant sleep/wake cycles for feeding. After two weeks of developmental care, experimental infants had positive results as compared to their controls (see graphs). Bronchopulmonary Dysplasia is also known as chronic lung disease and requires infants to be on oxygen for long periods of time (while at the same time is caused by oxygen therapy). Intraventricular Hemorrhage (bleeding in the ventricles of the brain), especially grade IV hemorrhage, can cause hydrocephalus and other serious disorders, including permanent brain damage (Children's Hospital of Boston 2001).

Adapted from Als et al. (1994)

Intraventricular Hemorrhage: Grade I -bleeding in a small area of ventricles Grade II-bleeding also occurs inside ventricles Grade III-Ventricles enlarged by blood Grade IV-bleeding into brain tissues surrounding ventricles (Parents of Preemies 2001)

The combination of creating more intrauterine like environmental factors and paying close attention to infant cues clearly benefits premature infants physiologically. Adding kangaroo care too benefits infants. In a study done by Buehler et al (1995)., in 41/70 electrophysiological features had significant differences between developmental care infants and control infants. In 32/41 of the significant features premature developmental care infants were comparable to full-term infants. The 41 significant regions included the frontal lobe (18), temporal region (12), and the last 11 were the central, occipital and parietal regions. The frontal lobe is associated with state organization and attention. The neuronal organization of the frontal lobe occurs relatively late in development and studies of premature infants have indicated its vulnerability (Als et al., 1994). The developmental intervention may support a more full-term like development of the frontal lobe while at the same time supporting state and attention organization outside of the womb (Als et al., 1994)

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