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Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA The third trimester of gestation is a period of intense growth and development for the fetal central nervous system. Preterm birth disrupts this delicate process and forces fetal development to continue within the potentially noxious extrauterine environment of the NICU. Parents and professional caregivers can work together to minimize the negative impact of the NICU experience, hopefully reducing subsequent impairment and disability. The newborn brain is capable of making both temporary and permanent changes to the strength and number of its synaptic neuronal connections. These adaptations are based upon sensory input from different stimuli, environmental factors and experiences. This is adaptive capacity is known as neuroplasticity and peaks early in life because of the rapid brain growth during that time frame. Neuroplasticity can be positive or negative. Because the brain is actively being “hard wired” throughout the infant’s NICU stay, both functional and dysfunctional synapses are being formed or deleted (“pruned”) based upon the infant’s unique experiences. Neuro-protective interventions are strategies intended to support the developing brain, facilitating normal development and preventing disability. In the case of neuronal injury, neuro-protective interventions are intended to help the brain reduce neuronal cell death and permit healing by fostering functional synaptic connections and pathways. Perhaps the most important neuro-protective intervention is provided not by professional caregivers, but by involved parents. Family is the single “constant” in an infant’s life, providing a unique emotional and nurturing connection that will endure over the course of time. It has been estimated that only about 5% of touch in the NICU is intended to comfort. Parents are in the best position to offer sustained nurturing touch and skin-toskin care to offset some of the negative handling necessary for survival. Neuro-protective care is organized by the seven core measures identified by Altimier & Phillips (2013)*, and their model has been adapted for our use with the permission of the authors: #1 Safeguarding Sleep #5 Nutrition #2 Positioning and Handling #6 Partnering with Families #3 Protecting Skin #7 Healing Environment #4 Minimizing Pain and Stress Neuro-protective care, also known as “brain sensitive care”, can be very challenging. It is inconvenient at times and may not always permit caregiving to be provided in a routine or efficient manner. However, when combined with evidenced based medical and nursing care, neuro-protective care is the best way to promote optimal neurodevelopmental outcomes for our patients. For this reason, neuro-protective care is our standard of care. *Altimier & Phillips. 2013. Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care. Neonatal and Infant Reviews. (13) 9-22 NICU Brain Sensitive Care Committee/Terrie Lockridge/ 11-2015/Swedish Medical Center – used with permission 4 Neuro-protective Best Practice Guidelines Part 1: Safeguarding Sleep Goal is assess infant sleep-wake state before caregiving, and to protect prolonged periods of uninterrupted sleep whenever possible Background: Providing for adequate rest and sleep may be the single most important contribution that NICU caregivers can make to a preterm infant’s long-term outcome. At 32 weeks, the fetus within the protection of the womb will spend 90-95% of the time asleep. By term, sleep requirements decrease slightly in duration (85-90% of the time) but not in importance. Sleep plays a critical role in early neurosensory development, impacts memory and subsequent learning, and preserves brain plasticity. Sleep deprivation reduces both brain size and plasticity, and is associated with enduring consequences for learning, behavior, and function. Like adults, babies have various stages and cycles of sleep. Sleep patterns begin to form in the last months of pregnancy, with predominantly active (rapid eye movement or “REM”) sleep initially, followed by longer periods of quiet (non-REM) sleep. Preterm infants have shorter sleep cycles of 30-40 minutes with 80% of sleep being active/REM sleep. As a preterm infant matures (by approximately 36 weeks) sleep cycles average between 50-60