If premature babies could talk, they’d tell you how stressful it is to come into the world before their time. To help preemies learn to cope better, hospitals are increasingly adding developmental care programs. The movement is transforming the medically-focused intensive care unit into a quieter, more soothing place.
Kamilah Hamilton’s son Khamani was born about two months premature. The first-time mom was shocked when she saw him in the neonatal intensive care unit or NICU.
“He was very small, very skinny, very tiny,” Kamilah said. He had IV's on him. It looked scary to me.”
She quickly learned premature babies don't behave like full term ones. Their system isn’t mature enough to cope with all the outside stimulation.
“They’re supposed to be in the womb in this nice, warm secluded dark place and they’re out in this world where they have no boundaries,” said Developmental Specialist Suzanne Zemaitis, M.S. “It’s light. It’s very bright. It’s very loud."
Developmental care programs try to reduce stimulation by simulating conditions inside the mother's womb.
The preemies are nested in their cribs and fed on their own schedules. Light and noise levels are kept low. The staff avoids unnecessary handling to promote undisturbed sleep and helps parents understand their baby’s cues.
“Initially, we keep reinforcing to watch the baby, look at the color, look at the breathing,” said Neonatal Nurse Sherryl Hazzard, R.N.
Research shows developmental care offers many benefits and has no adverse effects.
“Decreasing the amount of stress for premature babies helped them to develop better, become more organized, feed better and eventually they leave the hospital sooner,” Zemaitis said.
After seven weeks, Khamani is days away from going home and ready to face the world.
The developmental care movement got a boost in the mid 90's when a Harvard study endorsed it. Today hospitals all over the country take steps to eliminate the stress of overstimulation for premature babies.
Premature babies are those that are born before 37 weeks gestation or weighing less than about 5½ pounds. These tiny babies are not as fully developed and can have a number of problems after birth. Many have underdeveloped lungs and are unable to breathe on their own. The babies may not be able to suck or digest formula or breast milk. They often are unable to regulate body temperature and don’t have enough fat reserves to keep their tiny bodies warm. Heart rate irregularities, anemia and jaundice are common. With an immature immune system, they are also unable to fight infections.
According to the March of Dimes, every day, about 1300 premature babies are born in the U.S. Women who are pregnant with two or more babies, patients who have experienced a previous pre-term birth and those with certain uterine or cervical abnormalities are at higher risk of having a premature baby. Some other factors associated with preterm labor and delivery include: premature rupture of the membranes, high blood pressure, diabetes, vaginal or urinary tract infection, clotting disorders, obesity, history of vaginal bleeding and short interval from the previous pregnancy.
Taking Care of Preemies and Sick Newborns
Premature or sick newborns are cared for in a special unit of the hospital called the neonatal intensive care unit (NICU). Modern day NICUs were first established in the 1960s. Today, NICUs are highly specialized care centers with trained nursing staff and high-tech equipment.
The traditional NICU is designed to be a life-sustaining environment for fragile newborns. The room may be filled with lights, alarms, noisy equipment and lots of activity. The environment is a sharp contrast to that of the mother’s womb. Some health experts say the NICU environment may actually be detrimental to the well being and development of its tiny patients. Studies have shown loud noise to be overstimulating to premature infants, who react by crying or with sudden changes in breathing, blood pressure or heart rate.
Some hospitals are taking steps to reduce excessive stimulation for infants in the NICU. At SUNY-Downstate Medical Center, neonatal care experts have taken steps to make the NICU environment more closely resemble that of the womb. The babies are placed in warm isolettes with blanket rolls or “bendy bumpers” to provide a more secure space with closer “walls.” A covering is placed over the isolette to reduce the amount of light on the baby and during established quiet times, talking is kept to a low volume. Tiny, preemie-sized pacifiers are used to further calm the baby. Moms are encouraged to hold or touch the infant and taught how to move the baby. When possible, nurses encourage kangaroo care (skin-to-skin contact with mom). Nurses say, the extra steps to avoid over-stimulation are paying off. The NICU babies appear to be calmer and tend to experience fewer, sudden variations in breathing patterns.