Neurodevelopment of Preterm Neonate: Care Interventions for Optimal Growth and Development

This assignment will attempt to discuss the impact of different care interventions for the preterm neonates and how it can fortify their neurodevelopmental progress along with protecting and nurturing it. The essay successfully identified possible care interventions that can be employed in the NICU to enhance the neurological development of the preterm neonates and avoid the chances of any sensory, intellectual or behavioural impairments.

Running head: NEURODEVELOPMENT OF PRETERM NEONATE
Neurodevelopment of preterm neonate
Name of the student:
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NEURODEVELOPMENT OF PRETERM NEONATE
Introduction:
After birth care and nurturing plays a fundamental role in the growth and
development of the child as it continues to growth and develop with time. Especially for the
preterm babies, the importance of the growth and development focused care holds
tremendous value in preserving and protecting their physical and neurological development.
Preterm babies are the result of premature birth facilitated by any or a variety of gestational
complications which turn the amniotic environment difficult to sustain for the foetus, which
in turn requires immediate operation to take the baby out of its mother’s womb (Vinturache et
al., 2016). On a more elaborative note, prematurity can be defined as the concept that
encompasses the broad category of neonates that are born at less than the 37 weeks of
gestational period which is the standard pregnancy to birth period.
It has to be mentioned in this context that the premature babies are not fully
developed and their development progress inside the womb stops abruptly when the
prematurity occurs. Hence, their overall development especially the neurodevelopmental
procedure is left abruptly incomplete which can lead to various complications as the babies
continue to grow. Preterm birth is one of the leading cause of neonatal mortality, sensory and
intellectual disabilities; and one of the major contributing factor leading to the anomaly is the
lack of adequate care interventions taken for the preterm neonates with respect to their
required neurodevelopment (Li, Chen, Jaakkola, Williams & Guo, 2018). This assignment
will attempt to discuss the impact of different care interventions for the preterm neonates and
how it can fortify their neurodevelopmental progress along with protecting and nurturing it.

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Neurodevelopment of preterm neonate:
According to the recent statistics it has to be mentioned that among 10 babies born
every day one is delivered premature, which indicates that there is around 15 million preterm
babies taking birth all across the world. As mentioned by the Boyle et al. (2015), the
advancement in the neonate healthcare services and the enhance accessibility to life saving
commodities has resulted into higher survival rate of the preterm neonates. However, it has
to be acknowledged in this context that developmental procedure of the babies that are
delivered before the gestational period is complete it is abruptly discontinued which can lead
to several developmental incompetence leading to a prematurely develop brain, lungs,
cardiovascular system and many other organ system of the body. Exploring this issue further,
relationship between the gestational age and the birth weight is inversely proportional, which
indicates at the possibility of several developmental anomalies, especially for
neurodevelopment.
There is mounting evidence that suggest that extremely preterm and extremely
preterm neonates when into school age and early adulthood are reported to show higher rates
of motor, cognitive or behavioural impairments when compared to infants born at standard
term (Wang & Jiang, 2018). Most common developmental disorder that has been associated
with preterm babies include cerebral palsy (CP), cognitive dysfunction, blindness and
impaired vision, hearing loss and disorders of psychological development, behaviour and
emotion, all of which are directly or indirectly associated with restricted on incomplete
neurological development. Hence it is crucial for the care services for the preterm neonate to
focus entirely on facilitating and accelerating the neurological development process for the

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neonate along with focusing on the other developmental aspects (Kwon, Vasung, Ment &
Huppi, 2014).
Care interventions:
As discussed by Baud et al. (2017), that care interventions that has focused on the
development of the preterm neonates have been found to focus more on the physical
developmental disorders with adequate clinical manifestations rather than focusing on the
neurological development which can manifest later as the baby continues to grow. There is
very little to limited knowledge among the neonatal healthcare staff regarding the need for
the neurological development oriented so that adequate care interventions can be provided to
the preterm neonates to avoid the risk of any possible neurological disorders. There is need
for effective and efficient strategies that can be implemented in the care practices that focus
entirely on the neurological development of the preterm neonates.
The first care intervention strategy that can be provided to the preterm neonates is
focused on improving the diet and growth management of the preterm neonate. The rationale
for this care intervention approach is based on the article by the Rose et al. (2014), that states
that the proper after-birth weight improvement and BMI increase had been reported to be
extremely beneficial for improving and enhancing the neurological development of the
preterm neonates. Research has shown the fact that the preterm neonates are generally born
with comparatively lesser cortical grey matter than the normal babies. This is one of the
fundamental contributing factors leading to flawed brain development and associated clinical
manifestations on the behavioural characteristics. Although there is also considerable
argument that rejects the ideation of proper weight and BMI increase to directly influence
brain development in the preterm neonates.

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Another very important strategy that can be implemented to improve the cortical grey
matter development of the preterm babies is the emphasis on limiting the exposure of the
preterm babies to glucocorticoid. The rationale for this intervention is the fact that for
extremely low birth weight preterms, the sustained exposure to the glucocorticoid has been
reported to show considerable restriction to the cortical matter development (Carson,
Monaghan-Nichols, DeFranco & Rudine, 2016). Hence, care interventions that take into
consideration limiting the glucocorticoid exposure even with the critical pharmacological
assistance requirement of these preterm neonates can help in fortifying neurological
development.
The next care interventions should focus on the modifying the physical environment
of the preterm neonates which can also help in preventing the chances of sensory loss in the
preterm neonates in the latter developmental stages. For instance, bright light can have
significant damaging effect on the visual senses of the neonate due to the premature eyelid
development and incompletely developed occipital lobe. Hence, the care interventions must
focus on limiting the light exposure as well. As suggested by the Pavaine et al. (2016), the
ambient lighting, if kept within the limit of 300 Lux, can be optimally effective for the
preterm neonates and its visual sensory development.
Similarly, noise also has a significant impact on the sensory hearing abilities of the
preterm neonates. Along with that, Almadhoob and Ohlsson (2015), have also suggested that
continued exposure to extreme noise has been reported to cause behavioural modifications in
the preterm neonates as well. The extreme exposure to noise and chaos has also been reported
to cause abnormal brain development in the preterm neonates. Hence it is crucial for the
nursing care for the preterm neonates to take into consideration the possible impact of the
noise in the brain and sensory development of the neonate. Therefore the recommended

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nursing intervention strategy should be to limit the ambient noise of the NICU and take extra
emphasis to ensure that the ambient noise of the NICU is within the limits of 50 dBs. Along
with that, it has been argued there is need for a few precautionary measures involving
reducing noise as much as possible in the NICU and close the incubator portholes slowly
along with not keeping anything on the top of the incubator to avoid chances of emergencies
(Kramarić et al., 2017).
Sleep plays a very important role in developing the synaptic transmission system of
the neonates and also promotes overall physical and neurological development of the preterm
neonates (Shellhaas et al., 2017). It has been reported in the preterm neonates that sleep
disturbances can occur due to slightest of triggers for the preterm neonates which in turn
disrupts their growth and developmental progress and enhances the possibility of
neurological damage. Hence, care interventions must also incorporate supportive activities
for standard sleep-wake cycles of the preterm neonate. Along with that proper sleep-wake
cycle documentation is also a very important step to consider for the preterm neonate. The
rationale behind this intervention is to improve and accelerate the developmental processes
carried on in the body during the sleeping cycle. It has been reported that most of the
developmental progress in the body takes place during the sleep cycle, hence any disruption
in the sleep cycle can lead to various complication including anomalous brain development.
Proper documentation of the sleep cycles of the neonates will help the nurses keep track of
the effectiveness of the interventions carried out on ensuring standard sleep-wake cycle of the
neonate and the interventions will help support and assist a standard sleep wake cycle
required in the preterm neonates for optimal development and growth (Liao et al., 2018).
It has to be mentioned that the preterm neonates and their neurological development
can also be facilitated and nurtured by implementing adequate skin to skin contact. There is
mounting evidence that indicates that gentle skin to skin contact is associated with

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considerable acceleration and protection of the neurological development of the babies,
especially the preterm neonates. The skin to skin contact has been found to be the cornerstone
that helps support and nurture neurodevelopment and facilitating low birth weight in the
preterm neonates. Along with that, as discussed by Carbasse et al. (2013), the skin to skin
contact has also been recommended to improve the neurodevelopment of the preterm neonate
that are ventilated. Although, there is considerable argument that criticizes the use of skin to
skin contact and the chances of infections of the preterm neonates. It has to be mentioned that
the preterm neonates have considerably less functional and incompletely developed immune
system and they are extreme prone to chronic infections which can easily turn fatal (Aita et
al., 2017). Hence, the skin to skin contact is associated with considerable risks and thorough
and extensive infection control regimen is needed to be followed to avoid the chances of
fatalities.
The last intervention strategy that can be implemented in order to improve the
neurodevelopmental procedure in the prematurely developed neonates can be enhanced
parental stimulation. Researchers are of the opinion that the implementation of adequate
parental involvement during the stay of the preterm neonate in the NICU had been reported to
improve the brain development procedure. It has helped in calming the neonates and helping
in maintaining a standard sleep wake cycle for the preterm neonates which in turn has been
reported to help in improving and enhancing the progress of brain development of the
preterm neonates. Similarly, Stefana and Lavelli (2017), have stated that the implementation
of parental skin to skin contact has also been reported to improve the developmental pace of
the neonates and in turn lead to lesser chances and frequency of neurological or sensory
developmental disorders in the preterm neonates. Although, the exact mechanism by which
the skin to skin contact and the parental involvement in the NICU care strategies enhance the
neurological and other developmental processes of the preterm neonates is still not clearly

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understood. The statistical results of various research studies have shown promising results,
hence both of these interventions can be implemented to improve the neurodevelopmental
procedure of the preterm neonates.
Conclusion:
On a concluding note, it has to be acknowledged in here that neurological
development is a grave concern for the preterm neonates in the NICU. There can be various
triggers and contributing factors leading to faulty brain development leading to not just
various intellectual disabilities and disorders but can also lead to speech, vision, hearing and
other related sensory impairments. The primary purpose of this essay had been explore the
need for neurological development assisting care interventions for the preterm neonates to
avoid the chances of intellectual or neurological disorders. The essay successfully identified
possible care interventions that can be employed in the NICU to enhance the neurological
development of the preterm neonates and avoid the chances of any sensory, intellectual or
behavioural impairments. However, it has to be mentioned that the available literature on this
issue is limited and lacks extensive argument. Hence, there is need for more extensive
research to discover the exact triggers and issues to the neurological development of the
preterm neonates and discovering patient centred approaches to care interventions to help
facilitate better neurological development of the preterm neonates.

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