Sensory Rounds

“In the early stages of NICU design as life-and-death treatments were being refined, the impact of light, noise, movement and other sensory stimuli was considered of minor importance. As long-term developmental status has replaced the survival rate as the focal point for evaluation of the quality of  neonatal care, interest in the impact of the physical environment on the developing premature brain has accelerated. (Our care) still views the infant as a solitary individual who sleeps most of the time in a bed. Future NICU design should recognize that the baby must spend most of its time in its mothers arms to get the full benefit of her  sensory environment as experienced throughout our evolution.”

Quote from  Dr Robert White
“Mothers’ arms – the past and future locus of neonatal care?”
Clinics in Perinatology,  June 2004, Vol 31(2)    p293

The newborn’s DNA and brain have an expectation for the maternal environment , the NICU is usually most unlike it. Modern NICU care relies on technology, usually managed by too few staff. The end result is bright lights and loud noises. Yet fairly simple measures can improve the situation, and reduce the experience of stress for the newborn.

At a first pass, this involves sound and light. I bring a decibel meter and can point at various sources of sound and noise that contribute to the physiological instability of newborns. The light meter likewise is relevant both to ambient light and to care in phototherapy. The more detailed theoretical background to this is the content of one of the talks: “Neurologically supportive Labour ward and NICU environments”.

With more time, issues of smell can be discussed … there is very little “hard research evidence”, but smell is probably the most important of all the sensations for the neonate, and least important for adult. Handling, positioning and materials all have sensory implications that can be discussed. The sensory round allows all these to be discussed in relevance context, almost all Units do some thing very well, but not all things!!

I also use a thermal imaging camera (FLIR ONE), which has particular value in the birthing environment, but often has surprising findings in neonatal units also.