ROP

Developmentally supportive care

Welcome to the webinar on Developmentally Supportive Care

In this webinar, you will learn what is Developmental Supportive Care, why we need it and what are the components and methods of DSC

We need to remember that the growth of the preterm brain is occurring mainly outside the uterus.

The brain can be compared to the piano. What keys are pressed determine if the output from the piano is music or noise. Similarly the outcome of the preterm brain development is determined by the experiences of the preterm neonate.

These experiences are provided by the neonatal sensory system. The development of the neonatal sensory system occurs in a particular sequence. The tactile-vestibular sense develops first followed by the gustatory-olfactory. The auditory and visual senses develop last. Stimulation of the early maturing senses has positive influence on the late maturing senses. Untimely stimulation within this sequence disrupts normal maturation. We therefore need to stimulate the senses in the same sequence as its development.

Now, the challenge is to integrate the high technology neonatal care with sensitive individualized approach for optimal neurobehavioral development.

This is DSC – providing a structured care environment which supports, encourages and guides the developmental organization of the premature/critically ill infant. In simple words, DSC is to reduce the stress of NICU and promote womb like growth.

Now let us see the different methods of DSC in relation to the developing senses. For the earliest maturing tactile sense: A balance is sought between stimulating correctly (by prone position, nesting, swaddling, facilitated tuck and massage therapy ) and protection from overstimulation such as pain.

Swaddling and facilitated tuck reduce pain and promote development

Massage therapy promotes neurobehavior, weight gain, sleep, and it reduces pain , stress and hospital stay.

The next important question is… does the newborn esp the preterm experience pain? Yes ! Yes! Yes! A newborn including a preterm feels, responds to and remembers pain. Exposure to repeated pain could affect the developing brain adversely.

You will learn from subsequent videos the recognition of various behavioral and physiological expressions of pain in the neonate. Prevention & minimization of this pain is possible and prevention is better than treatment. Protection from pain is a vital component of DSC and you will more about the methods in videos

After the tactile sense the olfactory-gustatory sense are the next senses to develop. Neonates> 32 weeks not only can smell and taste but discriminate, remember and habituate to them. The breast milk, KMC and non nutritive sucking are best forms of stimulating these senses.

NNS reduces length of hospital stay and improves feeding

The next system to develop is auditory system. As this is a late developing sense, the preterm needs to be protected from noise. Noise affects physiological variables, reduces sleep and increases stress. It is also associated with hearing loss, IVH, PVL and lower intelligence

Music therapy may help in pacification, stabilizing vital signs, promoting feeding and sleep.. Mothers singing in a soft voice to her baby helps to reduce stress and stimulate appropriately.

The last developing sense is vision and the NICU can be harmful for visual development. Exposure to bright light interferes with normal endogenous brain cell activity and results in sleep deprivation. You will see in videos how a healing environment would avoid direct exposure to intense light, use point source of light for procedures and use adjustable light.

A healing environment & Protection of sleep are key components of DSC. Sleep is important to promote normal brain growth. The activity occurring during REM sleep is particularly important. Deprivation of sleep results in neuronal death and reduced brain mass. Promote a womb like environment to promote sleep.

The best form of Developmentally Supportive Care is Kangaroo Mother Care.

Kangaroo Mother Care is exceptional as t it provides an appropriate balance between the under-stimulated tactile-proprioceptive system and the overwhelmed later-developing sensory modalities.

With this background of the developing senses, the 5 core components of DSC are pain management, protected sleep, developmentally Supportive of activities of daily living, family centred care and providing a healing environment.

We need to remember that DSC is a continuous process and not an end. It starts right at birth of the infant The infants are unique and display wide variety of behaviors. DSC has to be individualized for the infant

In conclusion, the Key messages. a- DSC – reduces stress and promotes growth. b- It is based on the principle of Sequential stimulation of the senses. c- KMC is the best form of DSC. d- We should remember the 5 core components of DSC. e- DSC has to be individualized based on infants’ cues. Thank you

Introduction...
1. Learning object...
2. Brain growth - ...
3. Brain-experienc...
4. Neonatal sensor...
5. Challenge...
6. Developmentally...
7. Tactile...
8. Tactile – swa...
9. Tactile - mass...
10. Does the newbo...
11. Protection fro...
12. Smell and tast...
13. Non nutritive ...
14. Auditory...
15. Protection fro...
16. Vision...
17. Protection of ...
18. Kangaroo Mothe...
19. KMC-best devel...
20. 5 Core compone...
21. Developmentall...
22. Key messages...

Introduction

DR. SUMAN RAO
MD, DM (Neonatology)

Professor & Head
Department of Neonatology
St. John's Medical College Hospital
Sarjapur Road, Koramangala, Bangalore

1. Learning objectives

► What is developmentally supportive care?

► Why we need for developmentally supportive care?

► What are the components of developmentally supportive care?

► What are the methods of developmentally supportive care?

2. Brain growth - Ex utero

3. Brain-experience expectant experience dependent

4. Neonatal sensory systems

► Tactile (touch) -> vestibular (posture & balance) ->
gustatory (taste) -> olfactory (smell) -> auditory (hearing) ->
visual (sight)

► Stimulation of early maturing senses has positive influence
on late maturing senses

► Untimely stimulation within this sequence disrupts normal
maturation

5. Challenge

► High technology neonatal care

► Positive sensitive individualized approach

► Optimal neurobehavioral development

6. Developmentally supportive care

► Providing a structured care environment which supports,
encourages and guides the developmental organization of
the premature/ critically ill infant

7. Tactile

8. Tactile – swaddling, facilitated tuck

► Reduce pain

► Promote development

9. Tactile - massage

► Promotes neurobehavior, weight gain and sleep

► Decreases pain, stress and hospital stay

10. Does the newborn experience pain?

► A newborn including a preterm feels, responds to and
remembers pain

11. Protection from pain

► Newborns do experience pain

► They express pain with various behavioural and physiological
indicators

► Prevention/ minimization of pain is possible

► Prevention of pain is more important than treatment of pain

12. Smell and taste

► >32 wks
► Discriminate, remember, habituate

13. Non nutritive sucking

► Length of hospital stay

► Better feeding

14. Auditory

► Noise is harmful

♦ Stress
♦ Reduces sleep
♦ Hearing loss , Intraventricular hemmorhage, Periventricular
leucomalacia
♦ Lower intelligence

15. Protection from noise

► Music therapy
      ♦ Pacification
      ♦ Improves vital signs
      ♦ Feeding
      ♦ Sleep

► Mother singing in a soft voice

16. Vision

► Intense light - Interference with endogenous brain
cell activity
► Sleep deprivation
► Healing environment
► Avoid direct and intense light
► Use point source for procedures
► Adjustable light