Care of Extremely Low-Birth-Weight Infants and Timing of Discharge. Information and Psychosocial Intervention in Neonatology
The welcoming and assistance services of birth have evolved in the last decades. In western countries, birth at hospital went from a medical-sanitary assistance, aimed to guarantee the best security in hospital with more and more advanced and meticulous procedures and protocols, to a more humanitarian vision of the birth issue.
Prevention procedures have been established to promote attachment and bonding from the delivery room until discharge: the respect and promotion of birth physiology, the early and prolonged contact with the infant through the “skin to skin” technique immediately after birth, and the promotion of rooming-in practice, which is essential for the beginning of breastfeeding and bonding.
It has ever more clearly emerged the role of the emotional and psychological support of motherhood and the need to provide psychological services in the obstetric wards, in nurseries, and in all those “risky” contexts such as Neonatal Intensive Care Units (NICU), for extremely low birth weight infants (ELBW).
In fact ELBW infants are at high-risk for mortality, morbidities, and long-term complications. Optimizing perinatal and postnatal care is essential to improve their outcome and a better understanding of pathophysiological mechanisms involved in respiratory, cardiac, and cerebral injury is crucial to implement new preventive strategies.
Nevertheless an active and early involvement of parents in the infant’s care is also greatly advisable. Specific guidelines to support the parents in these critical areas were created, in order to limit the traumatic effects connected to prematurity and pathologic births. NICU wards have increasingly promoted the early contact and involvement of parents, which allow the bonding not to be totally compromised by long separation, prolonged medicalization, and parental experiences.
Time of home discharge has to be carefully planned together with parents since ELBW infants are often discharged with some unresolved medical problems so an individualized, close, home-care plan has to be developed for these babies.
Long-term sequelae are mainly represented by neurodevelopmental disorders, neurosensory deficits, growth failure, and bronchopulmonary dysplasia. Long-term follow-up programs are recommended in order to early identify those babies who may benefit from intervention programs.
After hospital discharge, specific intervention models have been designed to support parenthood and to promote the parent’s ability to take care of his own and his child’s health.
In addition to psychological therapy, new types of services have been created as mutual self-help groups of parents and home visits service.
The diffusion of these intervention models has generated a significant improvement in the protection of parenthood and ELBW development.
KeywordsNeonatology Prematurity ELBW Care Home Discharge Psychosocial Intervention NICU Motherhood Bonding
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