Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle

Abstract

Advances in neonatal–perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.

Management and outcomes of extreme preterm birth

“…Approaches to early developmental care, such as the Newborn Individualized Developmental Care and Assessment Program 39 are increasingly used because of concerns about potential long term effects of the intensive care environment. 40 Challenges for children and their families Many children born extremely preterm have happy fulfilling lives, but they have an increased risk of a wide range of health, learning, and social difficulties compared with those born at higher gestational ages. 41 Specialist follow-up with appropriate multidisciplinary input enables potential problems to be identified early and thus mitigates risks.…”

“…Approaches to early developmental care, such as the Newborn Individualized Developmental Care and Assessment Program 39 are increasingly used because of concerns about potential long term effects of the intensive care environment. 40 …”

Early Skin-to-Skin Contact in Preterm Infants: Is It Safe? An Italian Experience

“…The key message of neuroscience is zero separation in the mother–infant dyad and the increase in immediate SSC. The nurturescience approach is therefore extremely important for preterm infants admitted to the NICU, because it promotes the implementation of immediate and early SSC, and can potentially reduce the risks of neurodevelopmental problems [ 24 , 25 , 26 ].…”

Nursing care of infants born extremely preterm

“…It is well described that preterm birth and/or the subsequent hospital stay [10] as well as the physical separation from the infant evoke stress and anxiety in parents, and experimental data indicates that the separation per se is stressful also for the infant [11].…”