Oehler J M
Division of Medical Psychology, Duke University Medical Center, Durham, NC 27710.
Nurs Clin North Am. 1993 Jun;28(2):289-301.
Nurses are the key to the implementation of developmentally focused care for LBW infants. There seems to be a sufficient research base to support reduced lighting in the hospital setting and consideration of cycled lighting. Face-to-face visual stimulation would seem sufficient for infants less than 40 weeks old until further research is done. In regard to sound, it seems clear that failure to reduce noise created by personnel, faculty equipment, radios, and so on represents negligence. Talking to infants who are in states other than sleep is to be encouraged, and planned interventions such as taped music and vocal selections need continued exploration. There seems to be a sufficient research base to support handling and caretaking that considers the state of the infant and aims to disrupt sleep as little as possible. Similarly, there appears to be ample support for placing infants in ways that promote a balance of flexion and extension or in the prone position whenever possible. NNS should be used during feeding and to reduce stress. Attention to reducing pain should be as much a part of the care of LBW infants as it is for adults. The potential negative effects of drugs on the developing brain must be considered and studied. Finally, the family, including siblings, should be encouraged to participate in the infant's plan of care as much as possible and prepared for discharge well in advance of the actual date. A note of caution should be entertained for stimulation programs not based on sufficient research. It is possible, perhaps even probable, that excessive sensory input at critical times can do harm. Interventions may be recommended with great enthusiasm but without research support. Thus, until the relative merits and possible adverse effects of various interventions are known, they should be approached with caution. Perhaps remembering that the first consideration in giving care is to "Do not harm" should facilitate our care of LBW infants.
护士是对低体重儿实施以发育为重点护理的关键。似乎有足够的研究依据支持在医院环境中减少照明并考虑采用循环照明。在进一步研究之前，对于40周以下的婴儿，面对面的视觉刺激似乎就足够了。关于声音，很明显，未能减少人员、医疗设备、收音机等产生的噪音属于疏忽行为。应鼓励与非睡眠状态的婴儿交谈，诸如录制音乐和语音选择等有计划的干预措施需要继续探索。似乎有足够的研究依据支持在处理和照顾婴儿时考虑其状态并尽量减少对睡眠的干扰。同样，有充分的依据支持尽可能以促进屈伸平衡的方式放置婴儿或让其俯卧。喂养期间应使用非营养性吸吮以减轻压力。对减轻疼痛的关注应成为护理低体重儿与护理成年人同样重要的一部分。必须考虑并研究药物对发育中大脑的潜在负面影响。最后，应鼓励包括兄弟姐妹在内的家庭尽可能参与婴儿的护理计划，并在实际出院日期之前提前做好准备。对于缺乏充分研究依据的刺激方案应持谨慎态度。在关键时期过多的感官输入可能会造成伤害，这是有可能甚至很可能发生的。干预措施可能会在没有研究支持的情况下被大力推荐。因此，在了解各种干预措施的相对优缺点和可能的不良影响之前，应谨慎对待。也许记住护理的首要考虑是“不伤害”将有助于我们对低体重儿的护理。
