This document discusses developmental care in the NICU, which recognizes infant and family vulnerabilities and focuses on minimizing complications from hospitalization. Developmental care provides an environment that supports premature infant development through practices like cluster care, protecting sleep, and involving parents. For infants receiving respiratory support, developmental care is especially important and has been shown to lead to earlier extubation and reduced oxygen needs. Developmental care humanizes medical treatment and allows stronger emotional attachment between caregivers, parents and infants.

1. Developmentally
Supportive Care and
Respiratory Support in
the NICU

2. Developmental Care
 Recognizes the physical, psychological and emotional
vulnerabilities of infants and their families.
 Focused on minimizing potential short and long-term
complications associated with the hospital experience.
(Coughlin, Gibbins, & Hoath, 2009)

3. Developmental Care
(continue)
 The concept combines developing infant, his family and
the environment where he exist. The goal is to provide
care environment, which supports and encourages the
developmental organization of the premature and/or
critically ill infant.
 For example:
Cluster care in the NICU can improve infant’s outcomes.
By protecting his sleep we encourage natural heeling and
promote development of his brain.

4. Developmental Care
(examples continue)
Supporting the infant during painful procedures by containing him or
giving a soother can improve outcomes and his perception of pain
Changing positions will stimulate different parts of the body and brain
and will help with muscular and neural development
Teaching and involving parents in their child’s care will help them to
develop confidence, and support the partnership between the care
provider and the family
Being receptive and sensitive to infant’s cues will help the care
provider to get “to know” him and apply individualized care
(Gardner, Carter, Enzman-Hines, & Hernandez, 2011)

5. The core measures include: protected sleep, pain and stress assessment, and
management, daily living activities(positioning, feeding and skin care), family-centered
care and the healing environment (Coughlin et al., 2009)

6. Respiratory support and
developmental care
Although initiating respiratory care is essential and
life saving, it conceals many risks factors and challenges.
Ventilated infant and his family become far more vulnerable
and require special treatment that include holistic and
sensitive care.
Parent involvement in these cases is important, as
they are the ideal planers and providers of developmentally
appropriate care.
Anticipation and careful planning is crucial to avoid
unnecessary handling and procedures.

7. Respiratory support and
developmental care
(continue)
 Respiratory support can interfere with the ability of the infant
to communicate his needs
 Take control over the environment from the infant and
increase his vulnerability
 Jeopardize infant’s development of self and trust by
noncontingent stimulation
 May lead to overstimulation and disruption of essential
heeling processes
 Can prevent the family from initiating contact and delay
bonding

8. Effect of DSC on Infant
Receiving Respiratory
Support
Developmental support important to every infant in the
NICU, however infants receiving respiratory support are the
most vulnerable and will benefit the most.
 Consistency of care providers will allow the caregiver to get
familiar with behavior functioning of an infant.
 Procedures like suctioning should be done only on PRN
basis, while providing physical support
 Quiet environment and dim lights will enhance rest and
sleep.

9. Effect of DSC on Infant
Receiving Respiratory Support
 Uninterrupted sleep have been associated with increased
weight gain and improved state organization
 Containing the infant’s limbs will reduce random
movement and help to conserve energy for growing
Research showed that infants that were treated
according to developmentally supportive care were
extubated earlier and required less oxygen therapy (Becker,
Grunwald, Moorman, & Stuhr, 1991)

10. Description of Learning
With increasing technology and the variety of
medical treatment options, the infant became a patient
that we treat. DSC remind us that the newborn has its
own personality, his own path and can communicate his
needs. Based on observation of behavior cues we can
“tailor” the treatment to a specific baby and his family.
The DSC model “humanized” the medical care that
we were giving, and I can’t agree more with it. I believe it
allows parents and caregivers to have a better emotional
attachment, to see a baby rather than a patient.
Promoting DSC can play a big role in shaping the future
on neonatal care.

11. Reference
Becker, P., Grunwald, P., Moorman, J., & Stuhr, S. (1991). Outcomes of Developmentally Supportive Nursing Care for
Very Low Birth Weight Infants. Nursing Research. Retrieved from
http://journals.lww.com/nursingresearchonline/Abstract/1991/05000/Outcomes_of_Developmentally_Supportive_Nursing.6.aspx
Coughlin, M., Gibbins, S., & Hoath, S. (2009). Core measures for developmentally supportive care in neonatal intensive
care units: theory, precedence and practice. Journal of Advanced Nursing, 65(10), 2239–48. doi:10.1111/j.1365-2648.2009.05052.x
Gardner, S. L., Carter, B. S., Enzman-Hines, M., & Hernandez, J. A. (2011). Merenstein & Gardner’s Handbook of
Neonatal Intensive Care (7th ed.). St. Louis: Mosby.
Lawhon, G. (1997). Providing developmentally supportive care in the newborn intensive care unit: an evolving challenge.
The Journal of Perinatal & Neonatal Nursing, 10(4), 48–61.