Crawford Long provides
special care for special babies

Four years ago at Crawford Long Hospital, the neonatal team launched a new philosophy in caring for premature babies. Today, the Developmentally Supportive Care Program is among the nation's best, and hospitals throughout the state want to duplicate the program and its results.

Developmentally supportive care holds great promise for the improvement of preterm, low-birthweight babies. According to Ann Critz, chief of Crawford Long's neonatology service, babies who have undergone these types of programs have significant weight gains and an increase in both head circumference and height. Preterm babies who are small, but basically healthy, show significant improvement in motor and cognitive development. The benefits extend beyond good physical results: Crawford Long is experiencing a significant reduction in neonatal intensive care unit and overall hospital stays and costs.

The program attempts to provide a quiet, gentle environment that gives preterm and critically ill newborns the best opportunity to develop normally. Because rapid brain growth occurs between 24 and 40 weeks gestation, the brains of premature infants must be protected. These babies are developing their senses at that time as well, so any developmental approach must take physical surroundings, direct care and family participation into account.

Longtime team member and neonatal nurse Susan Mason, who teaches the program to other hospitals, recalled the program's origin. "We began by modifying our environment in the NICU. We reduced the light and put blankets over the incubators to keep them dark, like the womb. We realized that the bright lights of the nursery were stressful because of the thin eyelids of a preemie and their inability to have long periods of sleep that promote growth.

"We also reduced the noise level of the nursery, even to the point of installing a stop signal that measures decibels. When the light turns yellow, it cautions us that it's getting too loud for the babies' sensitive hearing, and red tells us immediately to tone it down," Mason explained.

They then decided to place the babies in a flexed, natural position, not sprawled. "We began putting some boundaries around the babies, nestling them naturally in the incubator. The babies began improving, were less irritable and were able to use their limited energy to grow," she added.

Expanding the concept
Soon, the medical professionals at Crawford Long were looking at developmental care from a broader perspective. The NICU team wanted to study everything they were doing that had an effect on the babies. "We were determined to provide a quiet, soothing, trusting environment that promoted stability. That meant we had to make some changes in our thinking," Mason said.

Hospital administrators created a committee, with representatives from nursing, physician, respiratory care, occupational therapy/physical therapy and social work staff-every department that comes in contact with premature newborns. The group sets standards of care for preterm and sick newborns, starting in the delivery room.

"Our team is at the mother's side during delivery of the high-risk baby, prepared to move immediately to stabilize a child as young as 24 weeks gestation," Critz explained. The care team first opens the baby's airway after birth, dries the eyes and nestles the child quickly, trying to prevent heat loss as well as blood pressure and oxygen level fluctuations. "These babies are so fragile that every touch, every procedure and every medication is delivered with care," Critz emphasized.

Touch is crucial
Because premature infants are sensitive, parents are encouraged to bond with their babies with skin-to-skin contact, a technique called "kangarooing." "A baby thrives on touch and nurturing from the parents," Critz said. "Even a premature baby knows its mother's voice, smell and touch."

Rosa Diaz of Atlanta was one such mother in 1992. Her son Alexander thrived under the developmentally supportive care team after his December birth. Today, he is a healthy boy, fluent in both English and Spanish.

In a recent letter to the hospital medical team, Diaz wrote, "Please let everyone know how well my son is doing, and that everything you are doing developmentally really makes a difference. I thank God every day that Alexander was born at Crawford Long."

To find out more about Crawford Long's Developmentally Supportive Care Program, call Emory HealthConnection at (404) 778-7777.

-Kaye Cagle

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