Considerations for Nurses and Families
- Minimize handling and stimulation from light and noise throughout the admission process to avoid potentiating persistent pulmonary hypertension (PPHN)
- Encourage input and help with care from the infant's parents, as they are a partner in every aspect of the infant's care
- Provide all care using a Two-Person Care Method
- Consider three-person care for high-risk procedures. If three-person care is not possible, consider swaddling for high-risk procedures
- Never place infants diagnosed with congenital diaphragmatic hernia with their unaffected lung down, unless indicated by the clinical team. If atelectasis or airway collapse occurs in the unaffected lung, this may result in severe decompensation.
- For visitors, the goal is to keep the babies asleep. Please be mindful to use gentle touches and soft voices (low, conversational tones) to promote a positive sleeping/healing environment
- Visitation may be dependent upon census or impacted by the viral season
- Be mindful that if you are having flu-like symptoms, it may be beneficial to ask for permission to visit and wear a protective face covering
Two-Person Care Method
Encourages the provision of physical support with slow, purposeful movements in synchrony with the infant’s responses to promote comfort and protection during care and improve tolerance of activities.
- Containment should include flexion support, keeping the infant’s hands in midline, legs flexed, and foot bracing likened in utero
- Provide all care using a two-person care method based on the infant's cues. The second caregiver could be a parent, nurse, respiratory therapist, neonatal nurse practitioner, physician, etc.
- Before handling the infant and beginning care, both caregivers should define roles and prioritize what needs to be completed with the interaction
- Utilize slow movements, especially with turning and position changes, to help the infant gain and maintain organization
- Provide consistent, relaxed touch during care
- One person should have at least one hand on the infant, providing containment
- One person should talk gently to the infant as an introduction to care and support and contain the infant to mimic the uterine walls, while the other provides care
- Provide frequent breaks and do not rush to complete care
- Follow infant time-out cues of when to pause and when to resume care, ensuring the infant has time to recover
References
Altimier, L., Kenner, C., & Damus, K. (2015). The Wee Care Neuroprotective NICU Program (Wee Care): The effect of a comprehensive developmental care training program on seven neuroprotective core measures for family-centered developmental care of premature neonates. Newborn & Infant Nursing Review, 15(1), 6-16. https://doi.org/10.1053/j.nainr.2015.01.006
Phillips, R., Solomon, J., & Altimier, L. (2023). Neuroprotective infant and family-centered development care for the tiniest babies: Perspectives from key members of the Neonatal Intensive Care Unit Small Baby Team. Critical Care Nursing Clinics of North America, 36(2), 167-184. https://doi.org/10.1016/j.cnc.2023.11.003
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.