Aucott Susan, Donohue Pamela K, Atkins Eileen, Allen Marilee C
Eudowood Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-3200, USA.
Ment Retard Dev Disabil Res Rev. 2002;8(4):298-308. doi: 10.1002/mrdd.10040.
Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.
神经发育护理是指为改善神经发育结局而采取的任何新生儿重症监护病房（NICU）干预措施，包括NICU的设计、护理常规、护理计划、疼痛管理、喂养方法，最重要的是鼓励父母参与对其NICU患儿的护理。认识到感觉刺激可能使早产儿不堪重负并增加应激的生理体征，从而促使人们尝试减少感觉输入。最近的方法则谨慎地增加了舒缓的感觉输入（如治疗性触摸、轻柔的音乐）。昼夜明暗周期和身体活动可促进早产儿生长。关注婴儿的体位摆放和护理操作会影响生理变量和关节活动度，即便对功能性运动能力没有影响。一种针对NICU婴儿的高度系统化护理方法是Als的新生儿个体化发育护理与评估计划（NIDCAP）。尽管NIDCAP可能会减少对呼吸支持的需求并缩短住院时间，但对2至3岁时的神经发育结局并无显著影响。疼痛管理包括一些良性干预措施（如非营养性吸吮、口服葡萄糖），但必须权衡长期使用麻醉药品带来的镇静和依赖后果。NICU面临的首要挑战仍然是父母权利的剥夺。袋鼠式护理，即父母与婴儿进行皮肤接触，可促进早产儿生长，减少医院感染，并可能缩短住院时间。需要开展大量工作来确定并证明特定干预措施的有效性，以及那些使NICU更人性化、鼓励父母参与、支持婴儿发育并优化早产儿神经发育结局的改变的有效性。
