neurodevelopmental issues will not present themselves until school entry and beyond, NICU graduates will benefit from parents who recognize and advocate for their child’s needs throughout childhood, adolescence and early adulthood. NICU Brain Sensitive Care Committee/Terrie Lockridge/ 11-2015/Swedish Medical Center – used with permission 21 Neuro-protective Best Practice Guidelines Part 7: Healing Environment Goal is to provide an environment that promotes healing by minimizing the impact of NICU environment on the infant’s developing central nervous system Background: As early as the 19th century, Florence Nightingale recognized the value of a nurturing, healing environment in her patient’s recovery. This remains true two centuries later, and is especially applicable for preterm infants, whose protective intrauterine environment has been replaced by the NICU. The contrast between these two settings is stark. The intrauterine environment allows unrestricted access to mother, and provides unique sensory input that is crucial for normal brain development. The fetus is protected from harsh outside stimulation, and both light and noise are filtered by transmission through fluid and solid media. The predictable nature of intrauterine life supports sleep and the development of normal sleep cycles. Nine months spent within this nurturing intrauterine environment prepares term infants for the variety of sensory experiences that the extrauterine world has to offer. The situation is very different for preterm infants, who are not yet ready for the sensory input that ensues after early delivery. Preterm infants are abruptly separated from their mothers, and exposed to persistent lighting, noise, and noxious odors. Temperature and oxygen levels fluctuate. Handling is random and often dizzying. Most touch is procedural in nature, uncomfortable at best, and painful at worst. Since the preterm is engaged in critical maturation of the central nervous system during the NICU hospitalization, it is our goal to create a healing environment that best mimics fetal life and reduces the impact of an unpredictable extrauterine environment. In utero, the sensory system develops in a precise order that should not be altered. The developing brain is very sensitive to the nature of sensory stimuli that it receives, and sensory interference occurs when immature sensory systems are stimulated out of sequence by unexpected sensory stimuli (for example, exposure to light before the auditory system has completed its pre-programmed development). Preterms are especially vulnerable to Sensory Processing Disorders, which can result in difficulties in the way the brain receives messages from the senses and translates them into appropriate motor and behavioral responses. A healing environment goes beyond the basic components of space, safety, and privacy for infant and family. A healing environment also includes the sensory surroundings and experiences of temperature and touch, position and movement (proprioception), smell and taste, hearing and noise, vision and light. It is important to modulate these sensory exposures as much as possible to avoid enduring alterations in brain development and function. NICU Brain Sensitive Care Committee/Terrie Lockridge/ 11-2015/Swedish Medical Center – used with permission 22 What can we do in the NICU? 7A. Temperature: Supporting appropriate thermoregulation is a priority during the transition from the warm fluid-filled womb to the dry cool extrauterine environment of the NICU. Our goal is to provide a neutral thermal environment in which the infant is able to maintain a normal core temperature with minimum oxygen consumption and calorie expenditure. · Infants who are admitted to pre-warmed warmers for initial stabilization should be transferred to incubators with quiet motors as soon as possible · Humidity should be used for ELBW infants, see SMC Humidification of Incubators · Medically stable infants may be weaned from incubators to open cribs around 1500-1600 grams. See SMC Weaning Preterm Infants from Incubator and SMC Temperature Management of Preterm or Compromised Infant While incubators provide a practical mechanism to support thermoregulation for extended periods, the ideal environment for the preterm infant is skin-to-skin contact with a parent. Thermosynchrony refers to the mother’s ability to increase the temperature of her chest as much as 2⁰ C to warm a cool infant, and decrease by 1⁰ C to cool an overheated infant. See SMC Kangaroo Care (KC) (Skin-to-Skin Holding) for further details. 7B. Touch: Touch is the first of the senses to develop early in fetal life. It is critical for growth and development, communication and learning. An infant’s first emotional bonds are built through touch, which lays the foundation for future emotional and intellectual development. The opportunity to touch and nurture their infant is essential for new parents, just as parental touch and nurturing is critical for the infant’s emotional well-being. Because preterms are exposed to a significant amount of painful “procedural touch” as part of medical therapy, it is vital to offset these negative experiences with positive tactile encounters such as nurturing touch. Parents can provide nurturing touch, reassuring the preterm infant that all touch is not noxious in nature. In the NICU, skin-to-