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Filling a significant gap in the cardiac ICU: implementation of individualised developmental care

Published online by Cambridge University Press:  07 August 2017

Samantha C. Butler ,
Kate Huyler ,
Aditya Kaza  and
Chris Rachwal
Samantha C. Butler*
Affiliation:
Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts, United States of America
Kate Huyler
Affiliation:
Department of Child Life, Boston Children’s Hospital, Boston, Massachusetts, United States of America
Aditya Kaza
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
Chris Rachwal
Affiliation:
Department of Cardiovascular and Critical Care Programs, Boston Children’s Hospital, Boston, Massachusetts, United States of America
*
Correspondence to: S. Butler, PhD, Boston Children’s Hospital, Enders Research Building Room 107, 300 Longwood Ave, Boston, MA 02115, United States of America. Tel: 617 355 7483; Fax: 617-730-0224; E-mail: [email protected]
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Abstract

Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child’s behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child’s survival but also optimising development through individualised developmental care in the cardiac ICU.

Keywords

developmental carecardiac intensive careNewborn Individualized Developmental Care and Assessment Program (NIDCAP)neurodevelopmentinfancy
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1797 - 1806
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Copyright
© Cambridge University Press 2017 

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