Developmental care of low birth weight infants.

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.