Judith Meek, consultant neonatologist and Gillian Kennedy, consultant speech and language therapist and NIDCAP Trainer, explore how the UCLH Charity Neonatal Fund supports developmental care for neonates.
Pictures show a newborn at UCLH, during and after care from the neonatal unit
Neonatal Intensive Care Units are instrumental for survival of preterm babies as they provide the immediate and ongoing care that babies who have been born early require.
Infants born early are unprepared for life outside the womb and their immature development means they are vulnerable to an array of complications - including breathing, gut and brain development.
Vulnerable babies are cared for in incubators so that their temperature can be controlled and other immediate complications can be cared for e.g. in the instance of Respiratory Distress Syndrome (RDS) caused by immaturity of the lungs, a ventilator can help them breathe and maintain adequate oxygen levels in their blood.
But what about long term development? Could it be that the best medical care, whilst ensuring immediate survival, could jeopardise the infant’s long- term development? Judith Meek, along with Gillian Kennedy says yes, and this is why they practise The Newborn Individualised Developmental Care and Assessment Programme (NIDCAP) which is supported by the UCLH Charity Neonatal Care Fund.
“NIDCAP is about working collaboratively with the baby and acknowledging that parents are the most important caregivers in their baby’s lives”, says Judith. She explains that when babies are born prematurely, they are unprepared for the experiences of the ward and the harsh sounds and light, discomfort, painful procedures and 2D surfaces which make a sharp contrast to the warm envelopment of the womb.
Judith adds, “These intense stimuli at a time of rapid brain growth may compromise normal development and affect the baby’s later ability to interact, organise movement or make sense of the world”.
The NIDCAP approach aims to avoid over-stimulation or stress by reading behavioural cues of strength and sensitivity to understand what the baby is communicating, and to shape subsequent intervention and interaction. Isolation can also impact brain development so the NIDCAP programme supports an intimate connection between the parent and infant. One expression of this is Kangaroo Mother Care.
Gillian is a member of the Neonatal team and one of two national NIDCAP trainers in the UK. She points out that on one side of the neonatal ward lies the smallest infant that was born at just 23 weeks and weighs 500 grams. The baby is in the foetal position wrapped up comfortably with a towel and another towel covers the incubator to block out the bright lights of the ward. During my time on the ward, I’m also told to whisper and to avoid shutting the doors loudly to prevent any unnecessary noise.
On the other side of the ward one mother holds her baby snuggly to her chest and this is the practice of Kangaroo Mother Care. Gillian explains that skin to skin contact is beneficial for many reasons. It is the best way to keep the infant warm and regulate their temperature. It empowers the parent as the most important care giver and the close intimacy offers an opportunity for the parent and infant to bond.
“Even hearing the rumbles of the mother’s stomach and her heart beating is comforting for the baby psychologically as it replicates the sounds heard in the womb”, comments Judith. She says that this relationship-based approach improves lives and enables an individualised, developmentally supportive model of care.
To practice NIDCAP and carry out the detailed observations which inform care and therefore support the baby’s individual neuro-development, nurses, therapists and doctors have to undertake extensive training over a minimum period of two years. UCLH currently has three members of the multi-professional team that are fully qualified in NIDCAP. “To put a neonatal professional through the course costs £10-12K and the UCLH Charity Fund helps to pay for this. We also hope to expand the programme giving NIDCAP professionals protected time for the observations and sharing these with families and carers. This will require a backfilling of staff which the fund will also subsidise”, says Gillian.
Research demonstrates that NIDCAP can improve brain development, functional competence, health, and quality of life. It also has short term positive outcomes such as shorter overall hospital stay (including time in intensive care), better weight gain and improved behavioural outcomes. “This is a whole new standard of neonatal care which enhances development to positively influence the infant’s potential. It’s a truly beautiful practice which I’m glad UCLH has taken on board, with thanks to the UCLH Charity Neonatal Fund.”
To donate to the fund visit the UCLH Charity Just Giving page, making sure you quote the Neonatal Fund (reference 0063).