Developmental Care in North American Pediatric Cardiac Intensive Care Units

Abstract

Background Developmental care practices across pediatric cardiac intensive care units (CICUs) have not previously been described. Purpose To characterize current developmental care practices in North American CICUs. Methods A 47-item online survey of developmental care practices was developed and sent to 35 dedicated pediatric CICUs. Staff members who were knowledgeable about developmental care practices in the CICU completed the survey. Findings/Results Completed surveys were received from 28 CICUs (80% response rate). Eighty-nine percent reported targeted efforts to promote developmental care, but only 50% and 43% reported having a developmental care committee and holding developmental rounds, respectively. Many CICUs provide darkness for sleep (86%) and indirect lighting for alertness (71%), but fewer provide low levels of sound (43%), television restrictions (43%), or designated quiet times (21%). Attempts to cluster care (82%) and support self-soothing during difficult procedures (86%) were commonly reported, but parental involvement in these activities is not consistently encouraged. All CICUs engage in infant holding, but practices vary on the basis of medical status and only 46% have formal holding policies. Implications for Practice Implementation of developmental care in the CICU requires a well-planned process to ensure successful adoption of practice changes, beginning with a strong commitment from leadership and a focus on staff education, family support, value of parents as the primary caregivers, and policies to increase consistency of practice. Implications for Research Future studies should examine the short- and long-term effects of developmental care practices on infants born with congenital heart disease and cared for in a pediatric CICU.

Neurodevelopmental assessment of infants with congenital heart disease in the early postoperative period

“…12,35 Research demonstrates that individualized developmental care and other rehabilitative and developmental therapies initiated early in the hospital stay improve long-term outcomes for hospitalized infants. 12,35 Research demonstrates that individualized developmental care and other rehabilitative and developmental therapies initiated early in the hospital stay improve long-term outcomes for hospitalized infants.…”

“…12,35 Research demonstrates that individualized developmental care and other rehabilitative and developmental therapies initiated early in the hospital stay improve long-term outcomes for hospitalized infants. 12 As reported in this study, our assessment identified areas of developmental vulnerabilities at the time of discharge indicating that delays were already notable and the infants were in need of therapeutic services. 12 As reported in this study, our assessment identified areas of developmental vulnerabilities at the time of discharge indicating that delays were already notable and the infants were in need of therapeutic services.…”

“…In multivariable analyses adjusting for corrected age at as- Days from cardiac operation to assessment 11 [7][8][9][10][11][12][13][14][15][16][17][18][19] Events prior to assessment Any cardiac catheterization b 71 (30) Any preoperative catheterization 47 (20) Any postoperative catheterization 28 (12) Any therapeutic catheterization 41 (17) Cardiac arrest 12 (5) Clinically diagnosed seizure 25 (11) ECMO 11 (5) Any tube feeding (G, GJ, NG, NJ) 33 (14) Age at inpatient assessment, corrected (d) 21 Abbreviations: ECMO, extracorporeal membrane oxygenation; G, gastric; GJ, gastrojejunal; IQR, interquartile range; NG, nasogastric; NJ, nasojejunal; SD, standard deviation. Missing < 4% outcomes except for maternal education (n = 188) and Apgar score at 1 min (n = 212).…”

“…Although mortality rates for children with CHD have significantly declined, the associated neurodevelopmental disabilities require further attention in this increasing population of survivors. [10][11][12] Poor feeding patterns and difficulties including swallowing challenges, abnormal sucking, and decreased oral intake are early indicators of later delays, especially in language, and have been shown to be more prevalent in infants with CHD. [6][7][8] Correspondingly, infants with CHD are often compared to preterm infants in their high risk for cognitive, language, and motor delays, along with regulation difficulties related to state management, feeding, and sleeping.…”

The Pediatric Cardiac Intensive Care Unit Parental Stress Model

“…In the last five years, four papers have emerged in the scientific literature calling for a paradigm shift for PCICUs to strategically incorporate developmental care practices [8, 10, 69, 70]. This study provides further evidence that developmental care would benefit the patient-family experience and improve outcomes, specifically to reduce maternal stress.…”