Implementing potentially better practices to support the neurodevelopment of infants in the NICU

Abstract

Objective: The purpose of the Vermont Oxford Neonatal Quality Improvement Collaborative 2005 was to explore improvements related to the physical environment of the newborn intensive care unit (NICU) in order to optimize the neurodevelopmental outcome of newborns.Study Design: Five centers were involved in a focus group examining NICU environmental design and its impact on the neurodevelopmental outcome of the neonate. Using an evidence-based approach, the group identified 16 potentially better care practices. This article describes the implementation approaches for some of these practices. The practice areas include tactile stimulation, providing early exposure to mother's scent, minimizing exposure to noxious odors, developing a system for noise assessment of the NICU acoustic environment, minimizing ambient noise in the infants environment, and preservation of sleep.Result: Approaches to implementation were center specific. Optimizing neurodevelopment of the newborn was the desired goal, but this outcome is difficult to measure with a limited number of subjects over a short study period. Many of the changes although intuitively beneficial are difficult to measure. Education of all participants was considered essential to the process of implementation. Conclusion:The process of collaborative quality improvement is useful in identifying ways to optimize the physical environment of the NICU to improve the neurodevelopmental outcome of the neonate.

Hand-disinfectant alcoholic vapors in incubators

“…This work, for the first time, presents actual measurements of alcoholic vapor concentration inside incubators and should therefore be taken into consideration as illustrations of recognized potentially deleterious practices [2].…”

“…Current neonatal unit practices seek to optimize the physical environment of neonates by minimizing potentially noxious stimuli such as aggressive light, noise, and scents [2]. Evaporating alcohol from freshly disinfected hands can be very "smelly" and thus represent a potentially deleterious stimulus to neonates in incubators.…”

The Gustatory and Olfactory Systems During Infancy: Implications for Development of Feeding Behaviors in the High-Risk Neonate

“…However, in the neonatal intensive care unit and normal infant wards in hospitals, infants are also exposed to (and learn about) unpleasant or noxious odors, including disinfectants, antibacterial compounds, and cleaning solutions[101]. The long-term consequences of this altered sensory environment remain unknown.…”

The impact of a noise reduction quality improvement project upon sound levels in the open-unit-design neonatal intensive care unit

“…This was a prospective time series, quasi-experimental design, with ongoing measurement before, during and after intervention cycles. The two participating centers were part of a five-center collaborative ('Senses and Sensibilities:' Physical Environment Group) that worked on the development 28 and implementation 29 of potentially better practices to support neurodevelopment in the NICU, under the auspices of the Vermont Oxford Network sponsored Neonatal Intensive Care Quality Collaborative 2005 (NICQ). All five centers participated in center-specific measurement of sources of noise and equipment, minor design modifications and individual noise reduction initiatives targeting human behavior.…”

“…All five centers participated in center-specific measurement of sources of noise and equipment, minor design modifications and individual noise reduction initiatives targeting human behavior. 29 Noise reduction strategies were developed using insights from this general effort and literature review. The general approach to quality improvement implementation cycles have been described.…”