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Consider the potential positioning, and postural support strategies to protect and promote the motor development of premature infants.

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The survival rate of premature infants has dramatically improved as a result of increasing technological advances, and developments in newborn and infant care. Consequently, clinical practice needs to adapt to an increased demand for care of very premature babies (BAPM, 2003). Accountability rests health care providers to consider the developmental consequences of this progress, and optimise quality of life for this high-risk group. Under the NMC Code of Professional Conduct (2002) nurses should ensure no act or omission on their part is detrimental to the condition or safety of patients. However, practice experience has highlighted difficulties in balancing the immediate needs of these infants with awareness of their long-term developmental requirements. Therefore, this assignment intends to focus on positioning of the premature infant as a possible intervention, with the aim of considering the consequences of premature birth, specifically its association with motor development. Research regarding positional and postural influences on developmental delay, and postural deformities will be presented and explored. Clinical practice will be evaluated against this research, to consider how these infants are presently being protected from these risks (with regards to positioning strategies), and how nurses might enhance infant development, in partnership with the infant's family. Present influences on practice will be considered, and recommendations with regards to research and practice proposed. Premature infants are considered to be at increased risk for positional and skeletal deformities, atypical postures, motor gaps and developmental delays (Hack and Fanaroff, 2000; Kessenich, 2003). Medical and technological advances strive to prevent or minimise the pathophysiological causes of developmental problems (i.e. extreme prematurity, intraventricular haemorrhage, chronic lung disease). An extensive literature review conducted by Turill (2002; 2002a) identified studies of both short and long term outcomes, acknowledging another aetiology of atypical development as iatrogenic and largely preventable. Traditionally, the focus of care has been on early recognition and treatment of these disorders. A more effective approach would be an intervention to promote normal neuromuscular development and minimise the chances of developing abnormal movement patterns, such as positioning interventions proposed under the philosophy of developmental care (see appendix a). ...read more.


Neonatal nurses need to accustom both infants and their families to supine lying as soon as the infant is medically stable, and well before discharge home (Young, 1996). However, prone positioning has some additional disadvantages, which if unrecognised and untreated may also prove lethal such as delays in recognising upper airway obstruction, sternal and sub costal recession, abdominal distension, and blood leakage from umbilical artery catheters (Cole and Gavey, 2001). Studies indicating certain positions as more favourable for premature infants than others have been translated, in practice, into regimes to seek to place the neonate in standardised flexed postures for promoting muscle tone and midline movement, or to lay the infant prone to support efficient breathing. The studies that underpin such protocols have undeniably shown advantages, but to suggest that their findings have universal application may be stretching the point. Nevertheless, the goals of many positioning protocols in practice appear to almost prescribe a range of correct positions, without considering the infants expressed preferences at any time. Warren (2002) asserts this opposes the philosophy behind developmental care, as interventions are not then provided based on infant cues, and therefore not individualised practice. Positioning is about comfort and functional posture. Static posture fitted into a protocol that expects the infant to remain undisturbed for long periods (due to the minimal handling policies on the neonatal unit - designed to reduce the stresses associated with environment), is not necessarily conductive to developmental progress, or self-regulatory competence. Positioning support that suits individual babies should allow them to: sleep best and when they want, communicate needs and interact with carers when ready, and to be most competent at regulating physiological functions. Neonatal and paediatric nurses can have a major impact in the prevention of the discussed developmental problems, and have the opportunity to influence the shaping and alignment of the newborn infant's muscular-skeletal system during the first year of life when maximum plasticity occurs. ...read more.


Vol.283: pp2135-2142 YOUNG, J. (1996) Developmental Care of the Premature Baby. London: Bailliere Tindall MODULE 8 - Sharing Care with Children and their Families MODULE CODE - CH 30417W/Z Title: This assignment will enable you to focus on a topic of care delivery related to children/young people with complex needs and their families/carers. You are required to identify an aspect of care in relation to children/young people with complex care needs. You must critique and evaluate the relevant literature in relation to your chosen aspect of care. Findings must be critically analysed in relation to observed practice by children/young people, family/carer and members of the multi-professional team. You will be expected to critically evaluate the care given with reference to shared care with children and their families. You must make recommendations for future practice in the light of your discussion. Name: Kim Chappelle-Hedges Student Number - 10277631 Intake - October 2001 Branch - Paediatric Nursing (Degree) SUBMISSION DATE - 9th December 2003 Word Count - 3166 Developmental Care Strategies (Ariagno et al, 1997) Altering the environment by decreasing excess light and noise in the NICU and by using covers over incubators and cots. Use of positioning aids such as boundary supports, nests etc to promote a balance of flexion and extension postures. Modification of direct hands on care-giving to maximise preparation of infants for, tolerance of, and facilitation of recovery from intervention. Promotion of self-regulatory behaviours such as holding-on, grasping, and sucking. Involving parents in the care of their infants as much as possible. Benefits of Developmental Care (Ruiz, 2001) Fewer days spent on a ventilator Earlier enteral feeding Lower incidence of intraventricular haemorrhage Lower incidence of pneumothorax Lower incidence of severe bronchpulmonary dysplasia Increased daily weight gain Shorter hospital stay Younger at discharge Better behavioural organisation Fewer disorganised and jerky movements More flexor movements More flexed posture More alert-wakefulness Better mental and psychomotor indices at 3, 6, 9 months and 9 years Increased autonomic motor system functioning Increased self regulatory abilities 1 ...read more.

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