All neonatal care is brain care—every interaction matters!

WHY I care so strongly about this topic…

The neonatal intensive care unit (NICU) is a place of immense care and hope, where fragile lives are nurtured with dedication and expertise. For infants in the NICU, every interaction, every touch, and every moment are crucial for their developing brains.

Neonatal Brain Development

The brain of a baby in the NICU is actively growing and changing. While 90% of NICU babies eventually discharge from the NICU, their success is more than just surviving their NICU stay. Longitudinal studies tell us that more than 50% of NICU graduates will have learning disabilities, and over 25% will require intensive help. These babies are more likely to be diagnosed with autism, present with lower IQs and struggle with ADHD and depression.

Trauma in the NICU

The NICU environment, though necessary for medical care, is not conducive to a baby’s natural development. Babies in the NICU experience trauma from being separated from their parents, life threatening illnesses, pain and stress, and the sensory overstimulation of the NICU environment, but this is not widely recognized or understood. Most people don’t correlate the trauma experienced by these babies in the NICU with the lasting effects on their neonatal brain development. It is essential to provide a safe, secure, and loving environment for these infants, despite the challenges.

Neuroprotective Care

Neonatal caregivers play a crucial role in shaping the brains of these infants during a very sensitive time in their development. Neuroprotective care and strategies, which essentially is anything that protects the brain and supports healing after an insult is essential (because the time that a baby is admitted into the NICU is a very sensitive time). The gestational age between 26-40 weeks, which is the typical times that a baby could be admitted in the NICU, is the time that the thinking cells in the cerebellum are developing and migrating…40,000 connections/minute.

You read that correctly, 40,000 connections/minute.

We know that what fires together wires together in the brain. It’s how the brain organizes itself. The principle of “use it or lose it” applies, where pathways that receive continuous stimulation thrive, while those that don’t are pruned.

The body doesn’t forget the NICU.

How could it when a baby typically experiences at least 15-20 painful or stressful events/day. So, we MUST balance the negative stimuli of the NICU with positive stimuli, and the easiest and most effective way to do that is by incorporating the family. Treat the entire family as a family unit.

Advocating for Quality Care

Every interaction in the NICU matters when it comes to neonatal brain development. Quality developmental care not only predicts better outcomes for the infant but also includes support for their family. Advocating for quality care can be challenging, but it is essential for the well-being of NICU babies.

Wondering about how to advocate for your little one in the NICU? Check out my article “Empowering NICU Parents: Your Guide to Effective NICU Advocacy.”

Here are a few of my faves to advocate for:

• Family-centered care: fight to be included in decision making for your child
• Kangaroo Care: you want to be skin-to-skin with your baby early on, as often as possible and as long as baby can tolerate.
• Talk & read to baby: your baby will love it and it will make the parenting role feel more normal

Small interactions have big results in neonatal brain development.

The care provided in the NICU has a profound impact on the developing brains of infants. Every interaction, no matter how small, can shape the future of these babies. By understanding the importance of developmental care and advocating for quality care, we can make a difference in the lives of NICU babies and their families.

 

Sources:

• Lean RE, Rogers CE, Paul RA, Gerstein ED. NICU Hospitalization: Long-Term Implications on Parenting and Child Behaviors. Curr Treat Options Pediatr. 2018 Mar;4(1):49-69. Epub 2018 Jan 24. PMID: 29881666; PMCID: PMC5986282.
• Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg. 2015 Jun;120(6):1337-51. doi: 10.1213/ANE.0000000000000705. PMID: 25988638; PMCID: PMC4438860.
• Colvin M, McGuire W, Fowlie PW. Neurodevelopmental outcomes after preterm birth. BMJ. 2004;329(7479):1390-1393. doi:10.1136/bmj.329.7479.1390
• Coughlin, M. E. (2014). Transformative Nursing in the NICU: Trauma-Informed, Age-Appropriate Care. Springer Publisher Company.
• Als, Heidelise. (2009). A Synactive Model of Neonatal Behavioral Organization:Framework for the Assessment of Neurobehavioral Development in the Premature Infant and for Support of Infants and Parents in the Neonatal Intensive Care Environment. Physical and Occupational Therapy in Pediatrics. 6. 3-53. 10.1080/J006v06n03_02.