Development-Focused Care (DFC) involves a series of measures implemented in Neonatal Intensive Care Units (NICUs) aimed at reducing stress in newborns and encouraging parents to actively participate in their care in order to promote their development.
Due to the anatomical and functional immaturity of their organs and senses, premature newborns, have a limited capacity to adapt to their environment. They are very vulnerable and sensitive to stimuli, like light, sound/noise, handling, pain, and gravity, that they were either not exposed to in the womb, or cushioned from.
In this sense, it is currently thought that the environmental factors these patients are exposed to in the NICU are a decisive aspect in their long-term evolution.
Implementing DFC entails a change in working methods, as the personalisation of each patient's needs and those of their family becomes the focus, as opposed to strict routines.
Measures for reducing the impact of stressors
Sound. The sound that the foetus receives in the womb is muffled and between 20 and 50 dB. For this reason, intense noise can cause newborns a great deal of stress and even lead to hearing loss. It must be borne in mind that hearing is very important for the development of language, attention, and environmental perception.
The American Academy of Paediatrics (AAP) recommends that the level of noise in a neonatal unit is below 45 dB (between 10 and 55 dB), with a maximum of 60 dB during the day and 35 dB at night.
Environmental control measures should be adopted, such as not playing loud music, decreasing the volume of telephones and alarms or, failing that, turning them off quickly, using sound level meters to warn of increasing decibels, avoiding closing incubator windows abruptly, using incubator covers that muffle sound, speaking quietly when working to allow the newborns to rest and facilitate their slow transition to alertness.
Light. Up to 37 weeks, light is not necessary for visual development. All excess light is an important sensorial stress for newborns.
It is recommended that preterm babies are not exposed to more than 60 lux (depending on gestational age), that they are not exposed to higher light intensities during examinations/handling, and that indirect light, natural light, and incubator covers are used, in addition to specific eye protection when it is necessary to utilise more intense light.
Minimum handling. Any examinations and care that must be performed on a newborn should be grouped together and adapted to when it is awake or sleeping.
Postural care. After birth, the premature newborn is subjected to the significant influence of gravity, and it loses the spatial limits and containment it had in the womb. For this reason, it is possible to observe the appearance of jerky movements. In this sense it is recommendable to:
simulate the intrauterine position: with the body bent and drawn up together, simulating the foetal position. Providing the newborn with limits and containment is fundamental for its global stability and musculoskeletal development.
maintain containment and the correct position. To avoid the stress triggered by loss of containment, “nests” are used that simulate the mother's womb. Any necessary handling of these patients should be grouped whenever possible, and be performed carefully between two people. Signs of stress in the patient must be observed to adapt to their tolerance.
Containment and postural control increase the security and tranquillity of the patient, they improve tolerance to handling, and diminish the perception of pain and stress. In addition, they favour respiration, gastrointestinal tolerance, and sleep; they stimulate sensorial and motor development, and prevent musculoskeletal deformities and skin lesions.