User:Ianbauersfeld/sandbox

Newborn Individualized Developmental Care and Assessment Program (NIDCAP)
Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a model of care adapted for preterm infants in the Neonatal Intensive Care Unit (NICU). Preterm infants are classified as being born prior to 37 weeks gestation, which in turn can lead to a wide range of both physical and cognitive disabilities as the infant develops. The focus of the NIDCAP is to decrease secondary effects on brain development, which include include decreased sensory integration, over active brain stimulation, and lack of appropriate routines. The NIDCAP draws from the Synactive Theory of Newborn Behavioral Organization and Development and an environmental approach to treatment to provide an optimal environment for the infants' development based on their individual developmental stage. Clinicians trained and familiar with NIDCAP assess infant behavior and interactions with parents, as well as staff, and provide alternative approaches to care based off of the observed infant behavior in order to facilitate the infant's developmental process.

Assessment
The NIDCAP monitors behaviors through four systems including: autonomic, motor, state, and self regulation. These systems can be broken down into different responses that are "typical" of infants' developmental process. These responses can be tracked alongside of gestational and chronological age, in order to determine the child's developmental stage. This also allows clinicians to manipulate the infant's environment in order to assist their progression to the next developmental phase. The Assessment portion of the NIDCAP is an observational sheet that consists of ninety-one behaviors representing the four systems. The observation typically occurs with the infant at rest for twenty minutes, during interaction with a family member or clinician, and for twenty minutes post-interaction. This pattern of observation allows the clinician to observe all of the typical infant reactions which are monitored in two minute increments.

Systems

 * Autonomic
 * The autonomic system is looked upon as the physiological functioning of the infant. It includes observing skin color, vitals, visceral signs, sneezing, and yawning.
 * Motor
 * The motor system is observed through the infant's tone, movements, and posture.
 * State- The state system gives insight to the infants overall central nervous system function. It is divided into an infant's "sleep state" and "awake state."  Each state is further subdivided into three domains.
 * Sleep State
 * Deep sleep: The infant demonstrates closed eyes, regular breathing patterns, and has little movement.
 * Light sleep: The infant demonstrates low level activity in the light sleep state. The infant has increased responsiveness to the environment. Rapid eye movement (REM) sleep is also observed.
 * Drowsy: This is a transition state for the infant. Variable activity is often seen as the infant transitions from a sleep state to an awake state or vice versa.
 * Awake State
 * Quiet alert: The infant demonstrates a bright and focused appearance in which they respond appropriately to stimuli. The infant can soothe themselves with minimal motor involvement and can interact with caregivers.
 * Active alert: The infant demonstrates heightened sensitivity to environmental stimuli with increased motor activity.
 * Crying: The infant demonstrates periods of crying and fussiness with increased motor activity. They may be able to self soothe depending on state development.
 * Self Regulation
 * The self regulation system looks at the infant's ability to maintain a balance between the other systems. Self regulation techniques include hand to mouth, sucking, grasping, and changing of position.

Application
After behavior is observed, the observing clinician will typically make recommendations involving noise or light reduction, positioning to promote flexion or self regulation, and general parental involvement. The changes proposed are specifically determined in order to facilitate the infant's comfort.

User:Sharrow96/sandbox

User:Benholmes2209/sandbox