Search

Supportive sensory environment

Authors 

Kuhn P, Westrup B, Bertoncelli N, Filippa M, Hüppi, P, Warren I

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

The hospital sensory environment is adjusted to the infants’ sensory expectancies and perceptual competences.

Rationale

The hospital environment may be challenging for the infant and their parents. Developmental neurosciences and psychology have enlightened the complex relationships between the environment and brain development. (1) Sensory systems develop progressively and continuously from fetal to neonatal life, with a timeline specific to each sensory modality (2,3); even extremely preterm infants are sufficiently mature to react to their environment. (4) Early brain development is genetically driven, but as early as the third trimester of pregnancy it becomes also sensory driven. Thus the period of hospitalisation is critical, since the sensory experiences can impact neurodevelopment, through many factors including synaptogenesis, synapses elimination, and epigenetic factors. (1,5–8) The harmful role of stressful/painful (over)stimulations and their long-term potential impact have been described. (9–11) As maternal stimuli are particularly salient for newborn infants, the hospital environment poses also a risk of sensory deprivation of biologically meaningful inputs for the infant. (12) Early and prolonged separation from their family can alter the bonding process and later mutual interactions. (13)

Both basic and medical research support the provision of a sensory nurturing environment. It is essential to protect infants from deleterious environmental stimuli and to support their access to positive sensory stimulations from their parents and other caregivers. Sensory interventions in the NICU, adjusted to the infants’ needs and responses, attuned to their current developmental stage, are at best implemented through individualised programmes. Skin-to-skin contact is the best strategy to restore some of the sensory discontinuity associated with preterm birth.

Benefits

Enhanced, natural and direct exposure of the hospitalised infant to hedonically positive and/or biologically meaningful stimuli is provided during social interactions mainly through intimate contact between the mother (partner) and the infant, and minimising exposure to environmental stressors (see TEG NICU design). These enhanced sensory experiences are mainly delivered through skin-to-skin care, early vocal contact (direct talking and singing), exposure to maternal/paternal scents, access to breast milk taste and smell, eye contact, touch, and massage. Benefits may also come from other sensory interventions which are individually attuned to the behavioral state of the newborn infant: hedonically positive tastes, postural support, oral stimulation, and music-based intervention.

Short-term benefits

  • Increased physiological and behavioural stability (14–19)
  • Increased feeding competences (14,20–22)
  • Improved weight gain (14,23–27)
  • Supported sleep (15,28,29)
  • Improved social interaction and recognition (30,31)
  • Reduced pain behaviour (32–38)
  • Enhanced infant vocalisations (38)
  • Reduced length of hospital stay (14,23,25,26)
  • Enhanced maternal attachment (39,40)
  • Improved interaction with the infant (39,40)
  • Improved adaptation to the infants’ behavioural and social cues (41–44)
  • Decreased parental stress/anxiety (41,45–47)

Long-term benefits

  • Improved neurodevelopment for the infant (28,39,48–53)
  • Improved language and cognitive outcome for the infant (54–57)
  • Increased quality of life during childhood (58,59)
  • Improved social interactions (57)
  • Improved parental mental health (25)

 

Components of the standard

Component Grading of evidence Indicator of meeting the standard
For parents and family    
1. Parents are guided by healthcare professionals to respond to the infant’s behaviour and sensory needs through attuned vocal, visual, olfactory, tactile interactions with their infant. (12,25,51,60) A (Moderate quality)
B (Moderate quality)
Guideline, parent feedback, patient information sheet
       
2. Parents are supported by healthcare professionals to be continually present and involved in the care of their infant. (61,62) A (Moderate quality)
B (Moderate quality)
C (High quality)
Guideline, parent feedback
       
3. Parents are supported by healthcare professionals to provide as much skin-to-skin contact as they are comfortable with. (14) A (High quality)
B (Moderate quality)
Guideline, parent feedback
       
For healthcare professionals    
4. A unit guideline to facilitate a supportive sensory environment and infant- and family-centred developmental care is adhered to by all healthcare professionals. B (High quality) Guideline
       
5. Training on care adapted to a supportive sensory environment and infant- and family-centred developmental care is attended by all responsible healthcare professionals. B (High quality) Training documentation
       
6. Environmental noise and excessive light exposure are minimised according to guidelines. (63–66) A (High quality)
B (Moderate quality)
Guideline, parent feedback
       
7. Exposure to deleterious hospital odours is reduced. (67–69) A (Moderate quality)
B (Low quality
Guideline
       
8. Exposure to painful, stressful stimuli related to care are minimised. (70) A (High quality)
B (High quality)
Guideline, parent feedback
       
9. Parental knowledge about infant’s behaviour and parental involvement during caring procedures to support the well-being and self-regulation of the infant are supported. (25) A (High quality)
B (Moderate quality)
Guideline, parent feedback
       
10. Care is taken to provide appropriate multisensory input during initiation of breastfeeding. (71) A (High quality)
B (High quality)
Guideline, parent feedback
       
11. Intimacy, quietness and speech privacy are preserved and supported. (64,66,72) A (Moderate quality)
B (Low quality
Guideline
       
12. Early meaningful interactions between parents and infants, in particular through skin-to-skin and vocal contacts according to the condition and status of each infant are supported. (14,15,60) A (High quality)
B (Moderate quality)
Guideline, parent feedback
       
For neonatal unit    
13. A unit guideline on care adapted to a supportive sensory environment and infant- and family-centred developmental care is available and regularly updated. B (High quality) Guideline
       
14. Noise reduction and light adjustment protocols are available. (64,66,72) A (High quality)
B (Moderate quality)
Guideline
       
15. Facilities to welcome parents continuously in the unit are provided. (61) A (Moderate quality)
B (Moderate quality)
Parent feedback
       
For hospital    
16. Training on care adapted to a supportive sensory environment and infant- and family-centred developmental care is ensured. B (Moderate quality) Training documentation
       
17. A noise management team is established. B (Moderate quality) Audit report
       
18. During the commissioning of new medical devices an assessment of the environmental and noise impact on the infant is included. B (Moderate quality) Audit report
       
For health service    
19. A national guideline on a sensory supportive environment is available and regularly updated. (73,74) A (Moderate quality)
B (High quality)
Guideline
       

Where to go

Further development Grading of evidence
For parents and family  
  • Parents are supported by healthcare professionals to be the essential providers of sensory stimulations attuned to their infant.
B (High quality)
  • Other family members are involved as a source of sensory stimulation attuned to the infant when the parents are not available.
B (Moderate quality)
For healthcare professionals and neonatal units  
  • Develop and evaluate innovative ways to support parent-infant interactions and synchrony.
A (Low quality)
  • Strengthen the information given to parents about the sensory competencies and needs of their infant (educational course).
B (Moderate quality)
For hospital  
  • Provide coherent perinatal support for skin-to-skin care and implement couplet care organisation optimising the sensory experience of the infant.
B (Moderate quality)
For health service  
  • Develop sustainable collaboration with parental organisations to support the provision by parents of a nurturing sensory environment.
B (Moderate quality)
  • Support, with specific funding, research in the field of sensory system development and in the population of preterm infants.
B (Moderate quality)
   

Getting started

Initial steps
For parents and family
  • Parents are verbally informed by healthcare professionals about the development of sensory competencies of preterm infants and about their sensory expectancies.
  • Provide skin-to-skin, vocal and touch contacts as early as possible.
  • Participate in the feeding of the infant as early as possible.
For healthcare professionals
  • Attend training on the development of sensory competencies of preterm infants and about their sensory expectancies.
  • Protect infants from excessive sound and bright light.
  • Evaluate, respect and support the infant’s behavioural state.
  • Support breastfeeding.
  • Support safe skin-to-skin contact by parents as early as possible.
For neonatal unit
  • Develop and implement a unit guideline on care adapted to a supportive sensory environment and infant- and family-centred developmental care.
  • Develop information material about the development of sensory competencies of preterm infants and their sensory expectancies.
For hospital
  • Support healthcare professionals to participate in training about the development of sensory competencies of preterm infants and their sensory expectancies.
  • Provide accommodation for parents as continuously as possible in the hospital.
For health service
  • Develop and implement a national guideline on care adapted to a supportive sensory environment and infant- and family-centred developmental care.
 

Description

Sensory environment and brain development
Although many clinical factors may lead to a higher risk of neurodevelopmental sequelae in very preterm infants, environmental factors during critical periods of brain development also contribute. (1) Epigenetic factors contribute to this “environmental shaping of the developing brain”, as synaptogenesis and selective elimination of synapses during early stages of brain development. (5) The adaptation of the sensory experiences of a preterm infant in the NICU to its sensory expectations and capabilities is the cornerstone of early interventions in infant- and family-centred developmental care. (12) The postnatal environment differs markedly from the environment it should have continued to encounter in utero. (3,68,75,76) This exposes the infant to excessive sensory inputs, as well as to sensory deprivation, that can alter well-being and may interfere with brain development and growth. (77,78) For example, the number of painful/stressful procedures during neonatal life impacts brain growth and function (10), and at seven years of age correlates negatively with IQ, is associated with altered brain microstructure (9) and impacts stress sensitive behaviours. (79) Moreover, early sensory experience may have later effects, for example, brief exposure of newborn infants during the early postnatal period to artificial odours while breastfeeding can influence subsequent olfactory preferences until toddlerhood. (80)

Sensory sensitivity to the hospital environment
The provision of a sensory supportive environment is based on knowledge about sensory system development in very preterm infants and its sensitivity to and expectancies derived from the sensory environment. This knowledge guides the implementation of evidence-based and biologically meaningful strategies/interventions for sensory nurturing. The responses of a preterm infant to environmental stimuli can be recorded at physiological, behavioural and cerebral levels. Even an infant born extremely preterm, is sensitive to pain and can integrate at a cortical level a painful heel lance stimulus in pain processing areas from 25 weeks’ post-menstrual age. (81) On the other hand, an infant displays fine manual tactile perceptual capacities from 28 weeks of gestation. (82) The chemosensory sensitivity of a preterm infant has been demonstrated through its behavioural responses to odours and tastes. (69,83,84) The cortical responses of preterm infants to nosocomial odours has been recorded as early as 30 weeks post-menstrual age. (67) The developing brain, only few days after birth, can process new artificial odorants in similar cortical areas to those in adults. (85) This provides evidence that human olfaction at birth relies on brain functions that involve all levels of the cortical olfactory system. A very preterm infant is able to react to moderate changes in the artificial auditory environment that can affect its well-being, and its cerebral oxygen saturation. (86,87) They are also particularly sensitive to human voices (15,60,88) and can integrate at a cortical level subtle language differences from 29 weeks post-menstrual age (89), indicating that the immature cortical circuits might process speech even at a stage where cortical organisation in layers is not completed. Finally, although the visual system is the last to develop, a very preterm infant has the capabilities to detect small light level changes in its environment. (90)

Modulation of the hospital environment to support neurodevelopment
Understanding that the environment impacts the experience-dependent brain organisation and realising that the NICU is not the expected and optimal environment for infant development, many strategies have been developed and shown efficient to minimise the exposure to deleterious stimuli coming from the hospital: painful procedures (70), noise (64,72,74), odour from health care products (68), exposure to continuous bright light. (63) A series of recommendations and criteria have been drawn to reduce the impact of the deleterious aspects of the NICU environment (65) and a number of organisations advocate for less invasive practices. (66,73)

Moreover, other strategies support also the access to biologically meaningful stimuli. Experiences of early skin-to-skin contact and of “couplet care” with continuous access and non-separation between the infant and the mother, aim to sustain the ongoing contact between parents and preterm infants, sustaining consistent, and predictable multisensory communication, resulting in more optimal medical and developmental outcomes. Most of these strategies are included in well evaluated and validated developmental care programmes as the NIDCAP programme (12,24,52), Family Nurture Intervention (51,91,92), the COPE (25,47). Other programmes develop similar approaches and scientific evaluations are expected in the near future (93), e.g., for Family Integrated Care and the Close Collaboration with Parents. (94)

Finally, specific sensory interventions may be beneficial but have also an inherent risk of overstimulation, especially if delivered without an individualised approach adjusted to the infant’s behaviour. However, this risk could be decreased if the interventions are applied by parents (95), and/or with support of evidenced based developmental care programmes. Their long-term benefits remain to be evaluated. (18,96)

Sources

  1. Lagercrantz H. The newborn brain: neuroscience and clinical applications. 2nd ed. Cambridge ; New York: Cambridge University Press; 2010. 412 S.
  2. Lecanuet JP, Schaal B. Fetal sensory competencies. Eur J Obstet Gynecol Reprod Biol. September 1996;68(1–2):1–23.
  3. Kuhn P, Zores C, Astruc D, Dufour A, Casper C. [Sensory system development and the physical environment of infants born very preterm]. Arch Pediatr Organe Off Soc Francaise Pediatr. Juli 2011;18 Suppl 2:S92-102.
  4. Lagercrantz H, Changeux J-P. Basic consciousness of the newborn. Semin Perinatol. Juni 2010;34(3):201–6.
  5. Knudsen EI. Sensitive periods in the development of the brain and behavior. J Cogn Neurosci. Oktober 2004;16(8):1412–25.
  6. Kappeler L, Meaney MJ. Epigenetics and parental effects. BioEssays News Rev Mol Cell Dev Biol. September 2010;32(9):818–27.
  7. Montirosso R, Provenzi L. Implications of epigenetics and stress regulation on research and developmental care of preterm infants. J Obstet Gynecol Neonatal Nurs JOGNN. April 2015;44(2):174–82.
  8. Dubois J, Dehaene-Lambertz G, Kulikova S, Poupon C, Hüppi PS, Hertz-Pannier L. The early development of brain white matter: a review of imaging studies in fetuses, newborns and infants. Neuroscience. 12. September 2014;276:48–71.
  9. Vinall J, Miller SP, Bjornson BH, Fitzpatrick KPV, Poskitt KJ, Brant R, u. a. Invasive procedures in preterm children: brain and cognitive development at school age. Pediatrics. März 2014;133(3):412–21.
  10. Smith GC, Gutovich J, Smyser C, Pineda R, Newnham C, Tjoeng TH, u. a. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol. Oktober 2011;70(4):541–9.
  11. Brummelte S, Grunau RE, Chau V, Poskitt KJ, Brant R, Vinall J, u. a. Procedural pain and brain development in premature newborns. Ann Neurol. März 2012;71(3):385–96.
  12. Als H, Duffy FH, McAnulty GB, Rivkin MJ, Vajapeyam S, Mulkern RV, u. a. Early experience alters brain function and structure. Pediatrics. April 2004;113(4):846–57.
  13. Korja R, Latva R, Lehtonen L. The effects of preterm birth on mother-infant interaction and attachment during the infant’s first two years. Acta Obstet Gynecol Scand. Februar 2012;91(2):164–73.
  14. Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 16. März 2011;(3):CD002771.
  15. Filippa M, Devouche E, Arioni C, Imberty M, Gratier M. Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatr Oslo Nor 1992. Oktober 2013;102(10):1017–20.
  16. Doheny L, Morey JA, Ringer SA, Lahav A. Reduced frequency of apnea and bradycardia episodes caused by exposure to biological maternal sounds. Pediatr Int Off J Jpn Pediatr Soc. April 2012;54(2):e1-3.
  17. Varendi H, Christensson K, Porter RH, Winberg J. Soothing effect of amniotic fluid smell in newborn infants. Early Hum Dev. 17. April 1998;51(1):47–55.
  18. Bieleninik Ł, Ghetti C, Gold C. Music Therapy for Preterm Infants and Their Parents: A Meta-analysis. Pediatrics. September 2016;138(3).
  19. van der Heijden MJE, Oliai Araghi S, Jeekel J, Reiss IKM, Hunink MGM, van Dijk M. Do Hospitalized Premature Infants Benefit from Music Interventions? A Systematic Review of Randomized Controlled Trials. PloS One. 2016;11(9):e0161848.
  20. Raimbault C, Saliba E, Porter RH. The effect of the odour of mother’s milk on breastfeeding behaviour of premature neonates. Acta Paediatr Oslo Nor 1992. März 2007;96(3):368–71.
  21. Fucile S, Gisel EG, McFarland DH, Lau C. Oral and non-oral sensorimotor interventions enhance oral feeding performance in preterm infants. Dev Med Child Neurol. September 2011;53(9):829–35.
  22. Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. J Pediatr. August 2002;141(2):230–6.
  23. Kardaş Özdemir F, Güdücü Tüfekci F. The effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants: the effect of mother’s scent and flexion position. J Clin Nurs. November 2014;23(21–22):3036–44.
  24. Ohlsson A, Jacobs SE. NIDCAP: a systematic review and meta-analyses of randomized controlled trials. Pediatrics. März 2013;131(3):e881-893.
  25. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, u. a. Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. November 2006;118(5):e1414-1427.
  26. Álvarez MJ, Fernández D, Gómez-Salgado J, Rodríguez-González D, Rosón M, Lapeña S. The effects of massage therapy in hospitalized preterm neonates: A systematic review. Int J Nurs Stud. April 2017;69:119–36.
  27. Loewy J, Stewart K, Dassler A-M, Telsey A, Homel P. The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants. PEDIATRICS. 1. Mai 2013;131(5):902–18.
  28. Feldman R, Eidelman AI. Skin-to-skin contact (Kangaroo Care) accelerates autonomic and neurobehavioural maturation in preterm infants. Dev Med Child Neurol. April 2003;45(4):274–81.
  29. Scher MS, Ludington-Hoe S, Kaffashi F, Johnson MW, Holditch-Davis D, Loparo KA. Neurophysiologic assessment of brain maturation after an 8-week trial of skin-to-skin contact on preterm infants. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. Oktober 2009;120(10):1812–8.
  30. Varendi H, Porter RH. Breast odour as the only maternal stimulus elicits crawling towards the odour source. Acta Paediatr Oslo Nor 1992. April 2001;90(4):372–5.
  31. Varendi H, Porter RH, Winberg J. Does the newborn baby find the nipple by smell? Lancet Lond Engl. 8. Oktober 1994;344(8928):989–90.
  32. Nishitani S, Miyamura T, Tagawa M, Sumi M, Takase R, Doi H, u. a. The calming effect of a maternal breast milk odor on the human newborn infant. Neurosci Res. Januar 2009;63(1):66–71.
  33. Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev. 23. Januar 2014;(1):CD008435.
  34. Jebreili M, Neshat H, Seyyedrasouli A, Ghojazade M, Hosseini MB, Hamishehkar H. Comparison of Breastmilk Odor and Vanilla Odor on Mitigating Premature Infants’ Response to Pain During and After Venipuncture. Breastfeed Med Off J Acad Breastfeed Med. September 2015;10(7):362–5.
  35. Harrison D, Reszel J, Bueno M, Sampson M, Shah VS, Taddio A, u. a. Breastfeeding for procedural pain in infants beyond the neonatal period. Cochrane Database Syst Rev. 28. Oktober 2016;10:CD011248.
  36. Stevens B, Yamada J, Lee GY, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 31. Januar 2013;(1):CD001069.
  37. Bellieni CV, Cordelli DM, Marchi S, Ceccarelli S, Perrone S, Maffei M, u. a. Sensorial saturation for neonatal analgesia. Clin J Pain. April 2007;23(3):219–21.
  38. Caskey M, Stephens B, Tucker R, Vohr B. Importance of parent talk on the development of preterm infant vocalizations. Pediatrics. November 2011;128(5):910–6.
  39. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry. 1. Januar 2014;75(1):56–64.
  40. Feldman R, Weller A, Sirota L, Eidelman AI. Testing a family intervention hypothesis: the contribution of mother-infant skin-to-skin contact (kangaroo care) to family interaction, proximity, and touch. J Fam Psychol JFP J Div Fam Psychol Am Psychol Assoc Div 43. März 2003;17(1):94–107.
  41. Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of Skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development. PEDIATRICS. 1. Juli 2002;110(1):16–26.
  42. Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev. Januar 2015;91(1):63–70.
  43. Mörelius E, Theodorsson E, Nelson N. Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care. Pediatrics. November 2005;116(5):1105–13.
  44. Milgrom J, Newnham C, Martin PR, Anderson PJ, Doyle LW, Hunt RW, u. a. Early communication in preterm infants following intervention in the NICU. Early Hum Dev. September 2013;89(9):755–62.
  45. Welch MG, Halperin MS, Austin J, Stark RI, Hofer MA, Hane AA, u. a. Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU. Arch Womens Ment Health. Februar 2016;19(1):51–61.
  46. Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB. A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics. Juli 2006;118(1):e9-19.
  47. Melnyk BM, Crean HF, Feinstein NF, Fairbanks E. Maternal anxiety and depression after a premature infant’s discharge from the neonatal intensive care unit: explanatory effects of the creating opportunities for parent empowerment program. Nurs Res. Dezember 2008;57(6):383–94.
  48. Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, u. a. Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics. Januar 2017;139(1).
  49. Nordhov SM, Rønning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics. November 2010;126(5):e1088-1094.
  50. Nordhov SM, Rønning JA, Ulvund SE, Dahl LB, Kaaresen PI. Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial. Pediatrics. Januar 2012;129(1):e9–16.
  51. Welch MG, Firestein MR, Austin J, Hane AA, Stark RI, Hofer MA, u. a. Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry. November 2015;56(11):1202–11.
  52. Peters KL, Rosychuk RJ, Hendson L, Coté JJ, McPherson C, Tyebkhan JM. Improvement of short- and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial. Pediatrics. Oktober 2009;124(4):1009–20.
  53. Westrup B, Böhm B, Lagercrantz H, Stjernqvist K. Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Acta Paediatr Oslo Nor 1992. April 2004;93(4):498–507.
  54. Caskey M, Stephens B, Tucker R, Vohr B. Adult Talk in the NICU With Preterm Infants and Developmental Outcomes. PEDIATRICS. 1. März 2014;133(3):e578–84.
  55. Lester BM, Salisbury AL, Hawes K, Dansereau LM, Bigsby R, Laptook A, u. a. 18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit. J Pediatr. Oktober 2016;177:84–9.
  56. Vohr B, McGowan E, McKinley L, Tucker R, Keszler L, Alksninis B. Differential Effects of the Single-Family Room Neonatal Intensive Care Unit on 18- to 24-Month Bayley Scores of Preterm Infants. J Pediatr. Juni 2017;185:42-48.e1.
  57. Kleberg A, Westrup B, Stjernqvist K. Developmental outcome, child behaviour and mother-child interaction at 3 years of age following Newborn Individualized Developmental Care and Intervention Program (NIDCAP) intervention. Early Hum Dev. Dezember 2000;60(2):123–35.
  58. Landsem IP, Handegård BH, Ulvund SE, Kaaresen PI, Rønning JA. Early intervention influences positively quality of life as reported by prematurely born children at age nine and their parents; a randomized clinical trial. Health Qual Life Outcomes. 22. Februar 2015;13:25.
  59. Montirosso R, Giusti L, Del Prete A, Zanini R, Bellù R, Borgatti R. Does quality of developmental care in NICUs affect health-related quality of life in 5-y-old children born preterm? Pediatr Res. 2016;80(6):824–8.
  60. Filippa M, Panza C, Ferrari F, Frassoldati R, Kuhn P, Balduzzi S, u. a. Systematic review of maternal voice interventions demonstrates increased stability in preterm infants. Acta Paediatr Oslo Nor 1992. August 2017;106(8):1220–9.
  61. Ortenstrand A, Westrup B, Broström EB, Sarman I, Akerström S, Brune T, u. a. The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity. Pediatrics. Februar 2010;125(2):e278-285.
  62. UNICEF. The United Nations Convention on the Rights of the Child [Internet]. 1990. Verfügbar unter: https://downloads.unicef.org.uk/wp-content/uploads/2010/05/UNCRC_united_nations_convention_on_the_rights_of_the_child.
    pdf?_ga=2.163550268.1218459234.1527076484-403558301.1527076484
  63. Morag I, Ohlsson A. Cycled light in the intensive care unit for preterm and low birth weight infants. Cochrane Database Syst Rev. 19. Januar 2011;(1):CD006982.
  64. Philbin MK, Robertson A, Hall JW. Recommended permissible noise criteria for occupied, newly constructed or renovated hospital nurseries. The Sound Study Group of the National Resource Center. J Perinatol Off J Calif Perinat Assoc. Dezember 1999;19(8 Pt 1):559–63.
  65. Roué J-M, Kuhn P, Lopez Maestro M, Maastrup RA, Mitanchez D, Westrup B, u. a. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. Juli 2017;102(4):F364–8.
  66. White RD. Recommended NICU design standards and the physical environment of the NICU. J Perinatol Off J Calif Perinat Assoc. April 2013;33 Suppl 1:S1.
  67. Frie J, Bartocci M, Lagercrantz H, Kuhn P. Cortical Responses to Alien Odors in Newborns: An fNIRS Study. Cereb Cortex N Y N 1991. 1. August 2017;1–12.
  68. Kuhn P, Astruc D, Messer J, Marlier L. Exploring the olfactory environment of premature newborns: a French survey of health care and cleaning products used in neonatal units. Acta Paediatr Oslo Nor 1992. März 2011;100(3):334–9.
  69. Schaal B, Hummel T, Soussignan R. Olfaction in the fetal and premature infant: functional status and clinical implications. Clin Perinatol. Juni 2004;31(2):261–85, vi–vii.
  70. COMMITTEE ON FETUS AND NEWBORN and SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE. Prevention and Management of Procedural Pain in the Neonate: An Update. PEDIATRICS. 1. Februar 2016;137(2):e20154271–e20154271.
  71. Rozé J-C, Darmaun D, Boquien C-Y, Flamant C, Picaud J-C, Savagner C, u. a. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open. 2012;2(2):e000834.
  72. Graven SN. Sound and the developing infant in the NICU: conclusions and recommendations for care. J Perinatol Off J Calif Perinat Assoc. Dezember 2000;20(8 Pt 2):S88-93.
  73. White RD, Smith JA, Shepley MM, Committee to Establish Recommended Standards for Newborn ICU Design. Recommended standards for newborn ICU design, eighth edition. J Perinatol Off J Calif Perinat Assoc. April 2013;33 Suppl 1:S2-16.
  74. Committee on Environmental Health. Noise: A Hazard for the Fetus and Newborn. PEDIATRICS. 1. Oktober 1997;100(4):724–7.
  75. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, u. a. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2. Juli 2008;300(1):60–70.
  76. Lickliter R. Atypical perinatal sensory stimulation and early perceptual development: insights from developmental psychobiology. J Perinatol Off J Calif Perinat Assoc. Dezember 2000;20(8 Pt 2):S45-54.
  77. Anand KJ, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biol Neonate. Februar 2000;77(2):69–82.
  78. Philbin MK, Lickliter R, Graven SN. Sensory experience and the developing organism: a history of ideas and view to the future. J Perinatol Off J Calif Perinat Assoc. Dezember 2000;20(8 Pt 2):S2-5.
  79. Ranger M, Synnes AR, Vinall J, Grunau RE. Internalizing behaviours in school-age children born very preterm are predicted by neonatal pain and morphine exposure. Eur J Pain Lond Engl. Juli 2014;18(6):844–52.
  80. Delaunay-El Allam M, Soussignan R, Patris B, Marlier L, Schaal B. Long-lasting memory for an odor acquired at the mother’s breast. Dev Sci. November 2010;13(6):849–63.
  81. Slater R, Cantarella A, Gallella S, Worley A, Boyd S, Meek J, u. a. Cortical pain responses in human infants. J Neurosci Off J Soc Neurosci. 5. April 2006;26(14):3662–6.
  82. Marcus L, Lejeune F, Berne-Audéoud F, Gentaz E, Debillon T. Tactile sensory capacity of the preterm infant: manual perception of shape from 28 gestational weeks. Pediatrics. Juli 2012;130(1):e88-94.
  83. Marlier L, Gaugler C, Astruc D, Messer J. La sensibilité olfactive du nouveau-né prématuré. Arch Pédiatrie. Januar 2007;14(1):45–53.
  84. Lipchock SV, Reed DR, Mennella JA. The gustatory and olfactory systems during infancy: implications for development of feeding behaviors in the high-risk neonate. Clin Perinatol. Dezember 2011;38(4):627–41.
  85. Adam-Darque A, Grouiller F, Vasung L, Ha-Vinh Leuchter R, Pollien P, Lazeyras F, u. a. fMRI-based Neuronal Response to New Odorants in the Newborn Brain. Cereb Cortex N Y N 1991. 6. Juli 2017;1–7.
  86. Kuhn P, Zores C, Langlet C, Escande B, Astruc D, Dufour A. Moderate acoustic changes can disrupt the sleep of very preterm infants in their incubators. Acta Paediatr Oslo Nor 1992. Oktober 2013;102(10):949–54.
  87. Kuhn P, Zores C, Pebayle T, Hoeft A, Langlet C, Escande B, u. a. Infants born very preterm react to variations of the acoustic environment in their incubator from a minimum signal-to-noise ratio threshold of 5 to 10 dBA. Pediatr Res. April 2012;71(4 Pt 1):386–92.
  88. Saliba S, Esseily R, Filippa M, Kuhn P, Gratier M. Exposure to human voices has beneficial effects on preterm infants in the neonatal intensive care unit. Acta Paediatr Oslo Nor 1992. Juli 2018;107(7):1122–30.
  89. Mahmoudzadeh M, Dehaene-Lambertz G, Fournier M, Kongolo G, Goudjil S, Dubois J, u. a. Syllabic discrimination in premature human infants prior to complete formation of cortical layers. Proc Natl Acad Sci. 19. März 2013;110(12):4846–51.
  90. Zores C, Dufour A, Pebayle T, Langlet C, Astruc D, Kuhn P. Very preterm infants can detect small variations in light levels in incubators. Acta Paediatr Oslo Nor 1992. Oktober 2015;104(10):1005–11.
  91. Welch MG, Hofer MA, Stark RI, Andrews HF, Austin J, Glickstein SB, u. a. Randomized controlled trial of Family Nurture Intervention in the NICU: assessments of length of stay, feasibility and safety. BMC Pediatr. 24. September 2013;13:148.
  92. Welch MG, Myers MM, Grieve PG, Isler JR, Fifer WP, Sahni R, u. a. Electroencephalographic activity of preterm infants is increased by Family Nurture Intervention: a randomized controlled trial in the NICU. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. April 2014;125(4):675–84.
  93. O’Brien K, Bracht M, Robson K, Ye XY, Mirea L, Cruz M, u. a. Evaluation of the Family Integrated Care model of neonatal intensive care: a cluster randomized controlled trial in Canada and Australia. BMC Pediatr. 15. Dezember 2015;15:210.
  94. Ahlqvist-Björkroth S, Boukydis Z, Axelin AM, Lehtonen L. Close Collaboration with ParentsTM intervention to improve parents’ psychological well-being and child development: Description of the intervention and study protocol. Behav Brain Res. 15 2017;325(Pt B):303–10.
  95. Lai MM, D’Acunto G, Guzzetta A, Boyd RN, Rose SE, Fripp J, u. a. PREMM: preterm early massage by the mother: protocol of a randomised controlled trial of massage therapy in very preterm infants. BMC Pediatr [Internet]. Dezember 2016 [zitiert 29. Juni 2018];16(1). Verfügbar unter: http://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-016-0678-7
  96. Haslbeck FB, Bucher H-U, Bassler D, Hagmann C. Creative music therapy to promote brain structure, function, and neurobehavioral outcomes in preterm infants: a randomized controlled pilot trial protocol. Pilot Feasibility Stud. 2017;3:36.

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Kuhn P, Westrup B et al., European Standards of Care for Newborn Health: Supportive sensory environment. 2018.

For the purpose of evaluation, we would be grateful if you could send us details on your profession and country. This information is optional, anonymous and the data processed will exclusively be used for the aforementioned purpose, in line with Article 6, Para. 1 lit. a GDPR (General Data Protection Regulation).

Thank you for your support!