The document discusses developmental supportive care (DSC) for preterm infants in the neonatal intensive care unit (NICU). DSC aims to minimize stress and provide developmentally appropriate care by replicating aspects of the womb environment. This includes controlling light, sound, and temperature exposure; providing skin-to-skin contact; assessing infant cues and needs; and clustering care activities to allow for protected sleep. DSC has been shown to reduce stress, support brain development, and improve short- and long-term health, growth, and neurodevelopmental outcomes for preterm infants.

1. Developmental Supportive Care
CNE , Ramesh Hospital Guntur
Prof.(Dr.) Smriti Arora
Principal, College of Nursing, AIIMS Rishikesh

2. Introduction
• Newborn infants are the most susceptible population worldwide.
• It is estimated that 15 million infants are born preterm (before 37
completed weeks of gestation), and this number is rising.
• Globally, prematurity is the leading cause among the deaths in children
under the age of five.
• Almost one million children die each year due to complications of preterm
birth.
• Many survivors face lot of problems- learning disabilities, visual and
hearing problems.
• Stress is one of the main complications among preterm infants admitted to
a neonatal unit, which has short- and long-term effects on health status,
growth and development

3. • The artificial environment of bright light, loud sound, unpleasant
taste, noxious smell disorganizes baby at the prime time of
brain development
• Neonatal team can minimize the amount of stress in preterm
infants by monitoring stress levels and intervening when
necessary.
• A structured environment similar to womb must be provided.
• Neuromuscular developmental and clinical outcomes can be
improved by providing a developmentally appropriate sensory
milieu

4. Developmental Supportive Care (DSC)
“Practices implemented by neonatal nurses to reduce
stressful external stimuli such as noise and light levels,
and to provide secure boundaries by containing preterm
infants in a flexed position that optimises postural
development”
(Symington and Pinelli, 2004).
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5. Why DSC?
• Important development occurs in the foetus throughout the final
weeks of pregnancy (-a period of rapid brain growth)
• For infants born before 35 weeks gestation, this development
occurs in the newborn intensive care unit (NICU) where they are
handled frequently and undergo invasive, stressful procedures
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6. Impacts of stress on later development
• Stress increases pressure in the brain causing fragile blood vessels in
the brain to burst leads to IVH- resulting neurodevelopmental
problems in the future
• Oral motor sensitivity and oral motor muscle problems – effect
speech and language development
6

7. Contd…
• Inability to walk
• Very low cognitive ability
• Blindness
• Deafness
• Language disability
• Fine and gross motor poor coordination
• ADHD
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8. Virtues of womb
• Cushioned aquatic abode
with flexion
• Thermal comfort
• Zero insensible loss
• Shielded from light, sound
• Oxygenation
• Nutrition

9. DSC
• Stimulation of the early developing senses tactile, olfactory-gustatory
and protecting the later developing senses auditory and visual is the
core principle of DSC

11. Supports autonomic stability, normal motor, sensory, neurological dev and promotes
behavioural state organization. Refers to the ability of the infant to maintain a
balance between the five subsystems:
1. Autonomic/physiologic
2. Motor
3. State organisation
4. Attention / interaction
5. Self-regulation (Strategies used by an infant to return to a calm, balanced state.)
Reduces length of stay, improves weight gain and shortens time to full enteral feeds
Benefits of DSC

13. Goals of DSC
• Identifying stress responses and self regulation behaviors
• reduce stress
• conserve energy and enhance recovery
• promote growth and well being
• support emerging behaviours at each stage of neurodevelopmental
maturation
13

14. Contd…
• Improve state organisation.
• Reduce oxygen needs, improve respiratory patterns.
• Reduce apnoea and bradycardia.
• Improve thermal regulation.
• Enhance parent infant bonding and a parental sense of competence.
• Enhance cognitive and motor development.
14

15. Core measures
of DSC

16. How to provide DSC ?
• Assess
• Stress behaviours
• Self regulatory behaviour- Strategies used by an infant to return to a calm,
balanced state.
• Sleep state
• Attend to the observable cues
• Position and Handling
• Manage pain stress
• Adjust environment

18. Motor Stress Behaviour

19. Motor Stress Behaviour

20. Motor Stress behaviour

21. Motor Stress Behaviour

22. Attention/interaction stress behaviour

24. Self Regulatory Behaviours

25. Self Regulatory behaviours

26. Self Regulatory behaviours

27. Protected sleep
• Undisturbed sleep state- energy
conservation, weight gain and optimal brain
growth
• Essential for brain growth and development
• Sleep pattern – 28 weeks
• Sleep deprivation- loss of brain plasticity and
effects long term behaviour

28. Protected Sleep Protocol

29. Protect Sleep : Cluster Care

30. Stress and pain management
• Newborns do feel pain
• Prevention of pain is better than management of pain
• Neonatal pain can be measured – behavioural and physiological
indicators

31. Stress and Pain management

32. Facilitated Tuck (Containment)

34. Swaddling

38. Position and handling
promotes proper joint alignment and
symmetry, supports neuromuscular
development, and promotes self-
soothing and behavioral organization

40. Positioning check

45. Back to Sleep- prevent SIDS

46. Infant Positioning Assessment Tool (IPAT)

47. IPAT scores

49. ADLs
• Dressing
• Diaper change
• Feeding
• Skin integrity- bathing, massage
• Clustered care, monitor for stressful cues and intervene
• FCC

50. https://www.physio-
pedia.com/Rooting_Reflex

51. Setting the scene for feeding
• Plan stressful procedures away from feeding
• Assess color, HR, RR and effort, muscle tone and behavioural state
• Limit excessive sound and light
• Feed on demand
• Consider swaddling during sucking and swallowing

52. Skin integrity

54. Standards for NICU thermal
environment specify 72–76 °F (22–
26 °C) as acceptable range for
air temperature and relative
humidity at 30–60%

55. Skin integrity

57. Healing environment

58. Touch
• Slow, firm yet gentle touch
• Avoid over stimulating touch
• Massage (coconut oil)
Smell
• Keep cotton ball dipped in mothers milk,
KMC
• Keep strong odourous objects/ chemicals
away from baby
Taste
• Breastmilk , breastmilk gauze lollipop
• NNS for gustatory stimulation

59. Healing environment- Sound

60. Healing environment- Sound

61. Potential effects of excessive sound levels on
hearing

62. • The adverse effects of the acoustic environment in the
NICU include
• behavioral disturbances and increases in infant muscle
tension.
• Changes in infant vital signs including heart rate,
respiratory rate, O2 saturation, blood pressure, and
intracranial pressure.

63. NICU Noise control protocol

64. Noise reduction tips
Implement interventions to reduce noise:
 Turn radio volume down or off.
 Have designated quiet times during the day (keep to
limits at all times).
 Close incubator portholes quietly.
 Encourage staff and visitors to talk quietly, and avoid
talking over the infant in an open cot
 Avoid banging bin lids
 Mute monitor alarms, prefer to have visual alarms
where possible
 Monitor noise levels periodically to identify times and
causes of high levels
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67. Light

68. • Cycled lighting is the practice of
exposing baby to indirect light
during the day, or for 12 hours,
from 7AM to 7PM and providing
dim lighting during the evening and
night hours, from 7PM to 7AM.

69. Family Centred Care

70. Nursing implications
• Provide opportunities for undisturbed rest.
• Cluster cares but avoid completing a number of potentially
distressing interventions at the same time.
• If an infant indicates signs of stress during handling - stop and
provide ‘time out’ for the infant to recoup from that
intervention.
• Interventions should ideally take place with consideration of
infant cues.
• Slow controlled gentle handling.
• Abrupt/fast changes in position are poorly tolerated.
9/9/2022 Jeena Pradeep KSCH New Delhi 70

71. Summary
The basic physical, and sensory, needs of preterm infants can be
achieved by
(1) promoting physical design changes that are healing in nature,
(2) selecting developmentally-sensitive equipment
(3) incorporating developmental care concepts and
neuroprotective interventions into all policies, procedures,
protocols and guidelines
(4) ensuring that all NICU staff are educated and trained on
concepts of developmental care.

72. Summary
• Griffiths et al. recommended nine guidelines including
1. minimizing infant-parent separation,
2. protecting sleep,
3. feeding,
4. providing skin-to-skin care,
5. providing pain and stress management,
6. fostering caregiving interactions,
7. positioning,
8. continuity in caregiving, and
9. staff education and training.

74. References
• https://www.youtube.com/watch?v=UD3VhbD8TQ0
• https://www.youtube.com/watch?v=6WHAfsVPdPI

75. THANK YOU