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Care procedures


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Care procedures and routine practices can have a big impact, especially on extremely preterm and ill infants. (1) Preterm and ill infants are also at greater risk of infections, water loss, imbalance, thermal instability, and skin injuries. (2) Therefore, this vulnerable group needs to receive appropriate activities of daily living (ADL) providing individualised support and comfort to reduce the risk of short- and long-term consequences. The activities of daily living in the neonatal unit include postural support, feeding, hygiene, nappy change, thermal care, skin and mouth care, sleep protection, weighing, but also medical interventions like inserting and managing feeding tubes, taking blood samples, and support during painful procedures.

All caregivers have to be aware that preterm and ill infants have special needs and appropriate ADL’s have to be chosen. (7,8) To avoid stress, care is carried out by experienced and specially trained healthcare professionals in a developmentally sensitive manner for the infant’s comfort, hygiene, and physiologic and behavioural stability adjusted to infant’s individual needs. (3–6) Techniques are used to minimise skin damage, discomfort, stress and pain, and physiologic instability. (1) Furthermore, sufficient and adequate materials and products adapted to different ages are provided, e.g. for skin cleaning.

Parents are informed and guided by healthcare professionals about the care of their infant and are seen as an active part in the care of their baby, as performing care for their infant encourages parent-infant bonding and also improves parental confidence and competence in supporting their child’s ADL’s. (9–11)

All care procedures should be performed by healthcare professionals trained in the principles of infant- and family-centred developmental care (see Infant- and family-centred developmental care).

The Topic Expert Group on Care procedures has developed standards on topics reflecting the range of care needs of preterm and ill babies and summarises appropriate techniques.

  1. Anand KJ. Clinical importance of pain and stress in preterm neonates. Biol Neonate. 1998;73(1):1–9.
  2. Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women’s Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs JOGNN. 2001 Feb;30(1):41–51.
  3. Comaru T, Miura E. Postural support improves distress and pain during diaper change in preterm infants. J Perinatol Off J Calif Perinat Assoc. 2009 Jul;29(7):504–7.
  4. Lyngstad LT, Tandberg BS, Storm H, Ekeberg BL, Moen A. Does skin-to-skin contact reduce stress during diaper change in preterm infants? Early Hum Dev. 2014 Apr;90(4):169–72.
  5. Levy J, Hassan F, Plegue MA, Sokoloff MD, Kushwaha JS, Chervin RD, et al. Impact of hands-on care on infant sleep in the neonatal intensive care unit. Pediatr Pulmonol. 2017;52(1):84–90.
  6. Visscher MO, Taylor T, Narendran V. Neonatal intensive care practices and the influence on skin condition. J Eur Acad Dermatol Venereol JEADV. 2013 Apr;27(4):486–93.
  7. Coughlin M, Gibbins S, Hoath S. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. J Adv Nurs. 2009 Oct;65(10):2239–48.
  8. Coughlin M. Transformative Nursing in the NICU [Internet]. Springer Publishing. [cited 2018 Jun 20]. Available from: www.springerpub.com/transformative-nursing-in-the-nicu-second-edition-9780826154194.html
  9. Davidson J, Aslakson R, Long A, et. al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017;45(1):103–28.
  10. Bracht M, OʼLeary L, Lee SK, OʼBrien K. Implementing family-integrated care in the NICU: a parent education and support program. Adv Neonatal Care Off J Natl Assoc Neonatal Nurses. 2013 Apr;13(2):115–26.
  11. Als H. A Synactive Model of Neonatal Behavioral Organization: Phys Occup Ther Pediatr. 1986 Jan 1;6(3–4):3–53.

Standards at a glance

  • Download the full set of standards in the field of Care procedures