Advances in Neonatal Care:
Witt, Catherine L. MS, NNP-BC
The author declares no conflict of interest.
Advances in Neonatal Care is delighted to provide this supplemental issue focused on the topic of neuroprotection in the neonatal intensive care unit (NICU). Although we have made great strides in caring for preterm infants, the risk of neurobehavioral disabilities in survivors remains high. The changes in the brain that happen between 23 and 40 weeks gestation are remarkable, and interruption of these changes by preterm birth put our patients at risk of behavioral and social problems, learning disabilities, cerebral palsy, and other adverse outcomes.
Of all our organ systems, the brain is perhaps the most complex. We can treat congenital heart disease, gastrointestinal obstructions and malformations, and premature lung disease. We know what to do for sepsis, renal failure, and liver disease. Although we cannot always fix every problem, we can usually offer treatments that make some difference. The brain is more difficult. We do not have ways of fixing most congenital brain abnormalities. We do not have medications like surfactant, total parenteral nutrition, and human milk fortifier that will help preterm infants compensate while their respective organs mature. However, the more we learn about the brain the more we realize that its complexity provides hope in learning how to treat a variety of developmental, cognitive, and emotional disorders. Research into how the brain works is vital, not just for the preterm infants we care for, but for the large numbers of our population who suffer from learning disabilities, mental health issues, brain injuries and other cognitive issues.
The NICU is by nature a noisy, bright, and busy place. Preterm infants are exposed to excessive noise levels, increased ambient light, and frequent painful procedures.1 They have interrupted sleep-wake cycles and feedings are given routinely, not necessarily in response to hunger.1,2 No matter how careful our nursing care is, preterm infants are exposed to levels of light, noise, and touch that they would normally not experience inside the womb. Other factors, such as hypoxia, intraventricular hemorrhage, and sepsis, add to the risk of long-term developmental problems.
Although we cannot eliminate all of these stressors, the care we give can make a difference. Research is showing how the human brain responds to experiences, both positive and negative.3 This supplement is especially timely as earlier this year, President Barack Obama announced the BRAIN initiative. The initiative allocates funds for Brain Research through Advancing Innovative Neurotechnologies to help us learn about the causes of and treatments for many brain disorders, including autism, epilepsy, schizophrenia, and traumatic brain injury.4 As we learn more about the brain, we undoubtedly will learn more about how to prevent and treat the issues of prematurity.
The articles included in this supplement discuss the types of risk factors that our patients experience, and offer suggestions on how nursing care can make a difference. They also include information that parents of NICU patients need as they care for their infants beyond the NICU. We hope you will take the time to read the articles and incorporate the knowledge into your daily care as we look forward to increased knowledge about our own brains as well as our patients!
1. Peng NH, Bachman J, Jenkins R, Chen CH, Chang YC, Chang YS, Wang TM. Relationships between environmental stressors and stress biobehavioral responses of preterm infants in NICU. J Perinat Neonatal Nurs, 2009;23:363–371.
2. Pickler RH, McGrath JM, Reyna BA, McCain N, Lewis M, Cone S, Wetzel P, Best A. A model of neurodevelopmental risk and protection for preterm infants. J Perinat Neonatal Nurs. 2010;24:356–365.
3. Watson A. Understanding neurodevelopmental outcomes of prematurity. Education priorities for parents. Adv Neonatal Care, 2010;10:188–193.
4. National Institutes of Health. Brain Research through Advancing Innovative Neurotechnologies. 2013. http://www.nih.gov/science/brain
. Accessed August 21, 2013.