Abstract
There has been a marked increase in the survival of extremely low birth weight (ELBW) infants, but these babies have a long stay in the NICU. Strategies to decrease their neurodevelopmental impairment become very important. The maximum development of the brain occurs between 29–41 weeks. From the warm, dark, acquatic econiche, where the baby hears pleasant sounds like the mother’s heart beat, the baby suddenly finds itself in the dry, cold, excessively bright, noisy, environment of the NICU. Noise, bright light, painful procedures, and ill-timed caregiving activities, adversely affect the infant’s development. Excessive radiation from X-rays of babies on the ventilator and CT scans also affect the brain. Medications like steroids for chronic lung disease also cause damage to the brain. Aminoglycides and frusemide are known to cause hearing impairment. Hence a developmentally supportive, humanized care will go a long way in enhancing the developmental outcome of these babies.
Article PDF
Similar content being viewed by others
References
Wilson-Costello D, Friedman H, Minich N, Fanaroff A, Hack M. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants. Pediatrics. 2005;115:997–1003.
Gressens P, Rogida A, Pendaveine B, Sola A. The impact of neonatal intensive care practices on the developing brain. J Pediatr. 2002;140:646–52.
Counsell SI, Rutherford MA, Cawan FM, Edwards AD. Magnetic resonance imaging of preterm brain injury. Arch Dis Child Foetal Neonatal Ed. 2003;8:269–74.
EPA, office of noise abatement and control. Information on levels of environmental noise requisite to protect public health and welfare with an adequate margin of safety (report No.5509-74-004). Washington DC, Government Printing Office, 1974.
Lasky RE, Williams AL. Noise and light exposure for extremely low birth weight newborns during their stay in the neonatal intensive care unit. Pediatrics. 2009;123:540–6.
Williams AL, Sanderson M, Lai D, Selwyn BJ, Lasky RE. Intensive care noise and mean arterial blood pressure in extremely low birth-weight neonates. Am J Perinatol. 2009;26:523–9.
Ramesh A, Rao S, Sandeep G, Nagpoornima M, Srilakshmi V, Dominic M. Efficacy of low cost protocol in reducing noise levels in the neonatal intensive care unit. Indian J Pediatr. 2009;76:33–6.
Buckland L, Austin N, Jackson A, Inder T. Excessive exposure of sick neonates to sound during transport. Arch Dis Child Fetal Neonatal Ed. 2003;88:F513–16.
Gibbins S, Steven B, McGrath PJ, Yamada J, Beyene J, Breu J, et al. Comparison of pain responses in infants of different gestational ages. Neonatology. 2008;93:10–8.
Klein VC, Gaspardo CM, Martinez FE, Grunaun RE, Linhares MB. Pain and distress reactivity and recovery as early predictors of temperament in toddlers born preterm. Early Hum Dev. 2009;85:569–76.
Holsti L, Grunau RE, Oberland TF, Whitfield MF. Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU. Early Hum Dev. 2005;81:293–302.
Lai TL, Bearer CF. Iatrogenic environmental hazards in the neonatal intensive care unit. Clin Perinatol. 2008;35:163–81.
Boo NY, Chee SL, Rohana J. Randomized controlled study of the effects of different durations of light exposure on weight gain by preterm infants in a neonatal intensive care unit. Acta Pediatr. 2002;91:674–9.
Rea M. Lighting for caregivers in the neonatal intensive care unit. Clin Perinatol. 2004;31:229–42.
Sehgal A, Stack J. Developmentally supportive care and NIDCAP. Ind J Pediatr. 2006;73:1007–9.
Murphy BP, Inder TE, Huppi PS, Warfield S, Zientara GP. Impaired cerebral cortical gray matter: growth after treatment with dexamethasone for neonatal chronic lung disease. Pediatrics. 2001;107:217–21.
Shinwell ES, Karplus M, Reich D, Weintraub Z, Blazer S. Early postnatal dexamethasone treatment and increased incidence of cerebral palsy. Arch Dis Child Foetal Neonatal Ed. 2000;83:F177–F81.
Rais - Behrami K, Kajd M, Veszelorszky E. Use of furosemide and hearing loss in neonatal intensive care survivors. Am J Perinatol. 2004;21:329–32.
AAP Committee on Drugs. “Inactive” ingredients in pharmaceutical products: update. Pediatrics. 1997;99:268–78.
Als H, Gilkerson L, Duffy H, McAnulty GB, Buehler GB, et al. A three centre randomized, controlled trial of individualized developmental care for very low birth preterm infants: medical neurodevelopmental, parenting and caregiving effects. J Dev Behav Pediatr. 2003;24:399–408.
Prevention and management of pain and stress in the neonate. American Academy of Pediatrics: Committee on fetus and newborn. Committee on Drugs. Section on Anesthesiology. Section on Surgery. Canadian Pediatric Society. Fetus and Newborn Committee. Pediatrics. 2000;105:454–61.
Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G. A systematic review of Lidocaine — Prilocaine cream (EMLA) in the treatment of acute pain in neonates. Pediatrics. 1998;101:e1.
Shah V, Taddio O, Ohlsson A. Randomized controlled trial of neonates. Arch Dis Child. 1998;79:F209–11.
Chatterjee T, Chatterjee D. Practical approach to neonatal analgesia. Indian Pediatr. 2002;39:437–43.
Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2010;1:CD001069.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chaudhari, S. Neonatal intensive care practices harmful to the developing brain. Indian Pediatr 48, 437–440 (2011). https://doi.org/10.1007/s13312-011-0071-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13312-011-0071-4