formula. Higher IQ’s, larger brain volumes, and improved neurodevelopmental outcomes have been reported in preterm infants fed breast milk. Because of the clear advantages, it is essential to support mothers in establishing and maintaining an adequate milk supply. Utilize lactation consults as needed. Oral feeding is a complex undertaking for preterm infants, especially since only about 53% of cortical volume is present at 34 weeks GA when such feedings are often introduced. Care must be taken to provide a safe, functional, nurturing, and developmentally appropriate feeding experience. The use of an infant driven feeding approach and appropriate feeding techniques are vital to provide for a successful experience and to avoid oral aversion. Pediatric therapy consults should be utilized as necessary to support oral feeding. What can we do in the NICU? · Refer to SMC Infant-driven Feeding Pathway for detailed information · Minimize negative perioral experiences such as suctioning, vigorous oral care, and saline for oral care · Use colostrum for gentle oral care (see SMC, Colostrum: Oral Administration) · Promote nonnutritive sucking (NNS) at mother’s pumped breast during gavage feeds · Provide the taste and smell of breast milk during gavage feedings (binky dips) · Focus on quality of feeding rather than quantity of feeding · Glucose should be infusing within 30-60 minutes after birth NICU Brain Sensitive Care Committee/Terrie Lockridge/ 11-2015/Swedish Medical Center – used with permission 19 Background: Pregnancy, birth, and parenthood have traditionally been viewed as life crises for parents. The upheaval, change, and vulnerability triggered by these developmental crises are greatly intensified when associated with premature birth or admission to an NICU. Professional caregivers are called upon to offer support as parents work through their shock, anger, and grief over the loss of a normal pregnancy and childbirth experience. Because a sick or preterm infant is focused upon the physiologic demands needed for survival, engagement with parents or caretakers often occurs at the expense of physiologic stability. Let parents know that as the infant’s clinical status stabilizes, there will be more energy to direct towards social interaction. Neurobehavioral organization is the product of CNS function and maturation, and improves over the first year of life. Assure parents that infant’s disorganization with handling is due to an immature CNS, and “not their fault”. What can we do in the NICU? · Discuss infant’s clinical condition and needs in a culturally appropriate, clear manner · Use active, empathetic listening with parents as they express their concerns and fears · Acknowledge and support where parents are in terms of the stages of grief and loss · Assist parents in accessing resources such as the March of Dimes Family Support Program, The Lytle Center, or further counseling · Create a welcoming environment where parents know that they are valued · Allow parents to join in infant’s care to the extent they choose, whenever they desire · Encourage containment (“hand hugs”) both during and after caregiving · If able to do so without awakening, allow parents to provide containment during sleep · Parents may hold “between” cares as tolerated, but stress the critical need for infant to sleep as much as possible · Encourage parents to read to infant when awake to support language development · Promote skin-to-skin as soon as possible, as often as possible, for as long as possible · Empower parents to recognize and respond to infant cues appropriately · Explain that when dealing with infants, “the infant leads and the adult follows” · Help parents become competent in infant care, building confidence towards discharge · Support parents as they evolve into their roles as expert and advocate for their child. Neuro-protective Best Practice Guidelines Part 6: Parent Partnerships Goal is to support parents in their role as the most importance caregivers for their infant, and to promote secure attachment NICU Brain Sensitive Care Committee/Terrie Lockridge/ 11-2015/Swedish Medical Center – used with permission 20 Why is this important? Successful partnerships between families and professionals have been shown to reduce length of stay, increase parent and staff satisfaction, and improve neurodevelopmental outcomes. Encouraging initial attachment between infant and parents, and actively involving them in the care of their infant supports the most important relationship of that child’s life, setting the tone for all subsequent emotional connections. Because of this special bond, involved parents are known to play the most important role in their child’s eventual neurodevelopmental outcomes. Because long term developmental outcomes are so significantly influenced by family involvement, professional caregivers must actively engage families early on in their infant’s care. Educating families about neuro-protective strategies empowers them to become “experts” at interpreting and responding to their infant’s cues and needs. This sets the stage for parents to foster their infant’s growth and development after discharge from the NICU. Prematurely born children are at higher risk for a wide range of motor impairments, cognitive deficits, poor academic achievement, behavioral issues, and emotional disorders. Since many