Closness and sepration in neonatal ICU

1. ‫طه‬:114

2. Closeness and Separation in
Neonatal Intensive Care
Unit
Asmaa Abd El Wakeel Ibrahim
Lecturer of pediatric

4. Brain Development and Long-
term outcomes of The Infant
Closeness and separation in NICU

5. Closeness and separation in NICU
 The human brain is an amazing organ made up of over
100 billion brain cells that each connect to over 7000 other
brain cells. In fact it’s most complicated object in the
known universe. (Flacking et al., 2012).

6. Closeness and separation in NICU
 The most important stage for brain development is the
beginning of life, starting in utero and then the first year
of life. By the age of three, a child’s brain has reached
almost 90% of its adult (Raiskila et al., 2017).

7.  The brain of a newborn infant specially preterm one is
immature and vulnerable, therefore, newborn is at a risk
for abnormal brain development and later developmental
problems. (Raiskila et al., 2017).

8.  However, they also have large brain plasticity and
potential for injury compensation. This rapid brain
growth and circuitry have been estimated at an
astounding rate of 700–1000 synapse connections per
second in this period. (Ogra et al., 2006).
Closeness and separation in NICU

9.  There’s evidence in both humans and animals suggests
that brain development and later development may be
influenced by the quality of care given to newborn infants
including physical ,emotional closeness and parent
empowerment. (Winstona and Chicot, 2016).

10.  Repeated interactions and communication lead to
pathways being laid down that help memories and
relationships form and enable millions and millions of
new connections in the brain to be made. (Linsell et al.,
2018)
Closeness and separation in NICU

11. ‘use it or lose it’
principle
 If positive experiences do not
happen, the pathways needed
for normal human
experiences may be lost.
 This is often referred to as the
‘use it or lose it’ principle.
(Linsell et al., 2018)

12.  Mother–infant interaction in early postnatal life, or lack
of it in case of separation, can mediate variations in
offspring phenotype, including emotional and cognitive
development, with long-term health consequences.
 Environmental factors can influence gene expression
through epigenetic mechanisms to provide the ‘plasticity’
necessary to respond to variations in environment.
(Stefana and Lavelli, 2017)
Closeness and separation in NICU

13.  Immediately after birth the natural environment for a
newborn is to be close to their caregiver (parents).
 Physical closeness is defined as parent and infant being
spatially close, while emotional closeness refers to
feelings of an emotional connection to the infant such as
feelings of love, warmth and affection.
(Stefana and Lavelli, 2017)
Closeness and separation in NICU

14. Benefit of closeness to infant
and parent
Closeness and separation in NICU

15. Closeness and separation in NICU
Evidence suggests that after birth, physical closeness between
parent and newborn may contribute to the:
 Development of attachment.
 Supports the biological and behavioral needs of the
newborn.
 Contribute to differences in infant development.

16. SCloseness and separation in NICU
Physical closeness between parent and newborn may contribute to the:
 Somatosensory stimulation between infant and parents can
enhance parenting behavior and care.
 Establishment of the parent-infant relationship and also
stimulate neurological systems that support parental well-
being.
 Parents’ neurological system becomes interconnected with the
newborn’s immature nervous system resulting in symbiotic
regulation .

17. Closeness and separation in NICU
 Recent evidence shows that both the brain and body of
mothers undergo changes to support the development and
maintenance of caregiving behaviors as:
 Imaging studies of mothers and fathers reveal that specific
regions of the brain, hypothesized to be involved in parenting
behavior, are activated in response to exposure to infant-
related auditory or visual stimuli such as cries.

18. Forms of parent- newborn
contact
Closeness and separation in NICU

19. Various forms of contact such as
 Single room NICU.
 Visitation.
 Holding.
 Parent talk even told the baby with any story.
 Skin to skin contact.
Closeness and separation in NICU

20. Closeness and separation in NICU

21. Mother’s voice
Closeness and separation in NICU

22. Mother’s voice
 NICU infants receiving added exposure to
recordings of their mothers’ voice show lower heart
rate , better feeding outcomes , greater auditory
cortex growth , better visual attention and
neurofunction.
Closeness and separation in NICU

23. ‘use it or lose it’
principle
 Skin-to-skin care, in which an
infant lies on a parent’s bare
chest, is an important form of
physical closeness now
promoted in NICU care, and is
associated with benefits for
infants, parents and their
relationship.

24. Skin to skin benefits
 It accelerates the development of infant’s sleep structure
and brain maturation.
 Lowers stress reactivity .
 Associated with decreased mortality.
 Lower risk of sepsis, and readmission to hospital .
 Shorter NICU stay.
Closeness and separation in NICU

25.  Longer duration of breastfeeding.
 Decreased parental cortisol.
 Improved parent well-being and decreased anxiety.
 Optimal parent-infant interaction.
 Improved maternal attachment behavior and greater
parental competence after discharge .
Closeness and separation in NICU

26.  Finally some studies as Teicher et al. 2000 has
reported the following pathology in children who
suffered neglect (an extreme form of insecure
attachment) in their early years.
Closeness and separation in NICU

27.  Reduced growth in the left hemisphere which may
 Lead to associated increased the risk for depression.
 Increased sensitivity in the limbic system which can lead to
anxiety disorders.
 Reduced growth in the hippocampus that could cntribute to
learning and memory impairments.
Closeness and separation in NICU