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Individualized Neurodevelopmental Supportive Care in the NICU

doi: 10.1097/ANC.0000000000000019
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GENERAL PURPOSE: To provide professional nurses with an understanding of interventions including neurodevelopmental supportive care that can minimize neurosensory and neurobehavioral deficits preterm and other critically ill neonates.

TARGET AUDIENCE: Neonatal care registered professional nurses, advanced practice nurses, as well as other health professions who care for high-risk infants in the neonatal intensive care unit (NICU).

LEARNING OBJECTIVES: After completing this supplement, the learner should be able to:

  1. Identify the factors that can negatively and positively affect preterm infant neurological and behavioral development in the intensive care unit setting.
  2. Define neurodevelopmental supportive care.
  3. Identify strategies for implementing neurodevelopmental supportive care interventions in the NICU.

A Model of Neurodevelopmental Risk and Protection for Preterm Infants

  • Which of the following factors can lead to periventricular leukomalacia in preterm infants?
    1. Necrotizing enterocolitis
    2. Retinopathy of prematurity
    3. Intraventricular hemorrhage
    4. Bronchopulmonary dysplasia
  • When compared to full-term infants, preterm infants have a higher incidence of
    1. schizophrenia.
    2. bipolar disorders.
    3. anxiety/social phobia disorders.
    4. attention-deficit/hyperactivity disorder.
  • On what cues are undifferentiated neural systems critically dependent to activate and support the maturation of neural connections for the preterm infant?
    1. Biochemical cues
    2. Environmental cues
    3. Hormonal cues
    4. Respiratory cues
  • For the preterm newborn, nutritive sucking is important for oral feeding skills and achievement of
    1. parental bonding.
    2. hunger sensitivity.
    3. caregiver sensitivity.
    4. developmental milestones.
  • Early intervention strategies seek to take advantage of neural plasticity, which is most sensitive at
    1. 1 week to 6 weeks after term age.
    2. 2 to 15 months after term age.
    3. 24 months to 36 months after term age.
    4. 4 to 5 years after term age.

Relationships Between Environmental Stressors and Stress Biobehavioral Responses of Preterm Infants in NICU

  • After adjustment for environmental stressor effects, the respiratory rate of female infants as compared to males in the NICU was
    1. significantly lower.
    2. significantly higher.
    3. not significant difference.
    4. not able to be compared.
  • Which of the following showed a significantly negative relationship associated with environmental NICU stressors according to study findings?
    1. Heart rate
    2. Hand to mouth
    3. Salute behavior
    4. Oxygen saturation
  • The odds ratio of behaviors such as sucking, yawning, and finger splaying increased in preterm infants in the NICU with higher levels of
    1. nutritional intake.
    2. parent interaction.
    3. environmental stress.
    4. supplemental oxygen.
  • Which change, if any, was found in the balanced muscular tone of the preterm infant in the NICU with a level 5 environmental stress situation?
    1. It decreased
    2. It increased
    3. It did not change
    4. It initially increased, but later decreased
  • Self-regulatory behaviors that were positively related to environmental stress in the NICU included all of the following except
    1. sucking.
    2. holding on.
    3. sitting on air.
    4. hand to mouth.

Understanding Neurodevelopmental Outcomes of Prematurity: Education Priorities for NICU Parents

  • The risk of neurodevelopmental problems is proportional with
    1. maternal age at conception.
    2. maternal age at birth.
    3. maternal weight.
    4. gestational age and birth weight.
  • Premature infants show more developmental problems as which increases?
    1. Age
    2. Physical growth
    3. Communication skills
    4. Complexity of tasks
  • Focusing on which of the following is one way to provide consistent and understandable information to parents of preemies?
    1. Developmental milestones
    2. Neurodevelopmental changes
    3. The concept of self-regulation
    4. The concept of self-maturation
  • Supportive neurodevelopment care includes
    1. kangaroo care.
    2. nutritive sucking.
    3. increased sensory stimulation.
    4. constant care.
  • Premature infants are less able to begin to learn the self-regulation components that are rooted in early
    1. environmental stimulation.
    2. emotional activity.
    3. human social interactions.
    4. attentive abilities.


© 2013 by The National Association of Neonatal Nurses