Neonatal Behavioral Development and Protection
The fetal neurologic system is in a highly active stage of development
during the third trimester of gestation. With volumes of research
documenting long-term disabilities in prematurely born children,
understanding how we can better support the preterm infant's fragile
neurologic system can pave the way to decreasing the negative effects of
fetal development occurring within the extrauterine environment of the
NICU and help to minimize these impairments.13–15
Support must begin with the adoption of a conceptual framework
and philosophy of neuroprotective family-centered, developmental
care. The pioneering work by Sameroff, Brazelton, and Als16 found
that assessing the individual infant's ability to cope with excessive
stimulation provides the caregiver with information to modify each
infant's environment and treatment strategies. When preterm infants
were assessed and provided with developmentally supportive
individualized care, Als17 saw significantly improved outcomes
including fewer days on the ventilator, earlier feeding success, shorter
hospital stay, a marked reduction in the number of complications, and
improved neurodevelopmental outcomes during the first 18 months
of life, findings that were sustained to 8 years of age.18
Neuroprotection has been defined as strategies capable of preventing
neuronal cell death.19 Neuroplasticity refers to the ability of the
brain to make short- or long-term modifications to the strength and
number of its synaptic neuronal connections in response to incoming
stimuli associated with activity and experience. Neuroplasticity is a
lifelong property of the human brain, although it is most prominent
from birth until late childhood. It is thought that neuroplasticity peaks
during early life because it is a period of rapid brain growth with the