الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
NICU admitted neonates experience multiple painful stimuli in the neonatal intensive care units like (needle breaking, suctioning, endotracheal intubation, heel pricking, exposure to excessive light and noise).
Many studies revealed that frequent pain exposure in NICU may affect neuropsychiatric development of the neonates especially during the period of maximal brain development.
Developmental care measures like (minimizing exposure to noise, light, proper skin to skin contact or kangaroo care, proper positioning, clustering of care and non nutritive suckling) were found to reduce neonatal pain experienced by neonates in the NICU and also reduce the liability of neurodevelopmental impairment in preterms.
In this study our aim was to implement developmental care, assess the relation between it & length of hospital stay, time to achieve full feed, volume of full feed tolerated by the neonates and incidence of IVH, NEC & ROP.
This study involved 80 neonates 20 of them were excluded due to sedative and analgesic intake during study period, no available breast milk & no continuous kangaroo care, major congenital anomalies, exposure to various stressful
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stimuli, hospital stay less than 5 days, rapid improvement & discharge as N.J.
The other 60 neonates were divided into 2 groups developmental care group and care as usual group.
Developmental care measures were applied to the developmental care group and included the following:
Decreasing light exposure.
Decreasing noise.
Parental involvement (as kangaroo mother care).
Non-nutritive suckling.
Swaddling, facilitated tucking and positioning.
Sleep protection.
Developmental care group showed much beneficial effects as follows:
* Significant decrease in N-PASS after implementation of developmental care for the developmental care group (-6 to -3) median -4, compared to N-PASS following application of care
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as usual for the conventional care group (1 to 3) median 3 (P value <0.001).
* Significant reduction in N-PASS score following implementation of developmental care for the developmental care group (7 to 10) median 8, compared to that after implementation of conventional care for the conventional care group 1 (0 to 2) (P value <0.001).
* Significant increase in weight gain (median 220 grams) in developmental care group compared to the conventional care group (median 28 grams) (P value <0.001).
* Convulsions & IVH, it was significantly lower in developmental care group as 2 preterms developed IVH grade I only, compared to conventional care group 8 preterms developed IVH grade I & 1 preterm developed IVH grade IV, so IVH decreased significantly in developmental care group and was with lower grades compared to conventional care group (P value 0.038). *Incidence & grading of NEC, IVH & ROP were significantly less in developmental care group compared to conventional care group, with a P value <0.001, 0.038 & 0.038 respectively, as developmental care group without development of NEC,
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IVH or ROP represented 80%, 93.3% & 93.3% of total cases respectively, while conventional care group without development of NEC, IVH or ROP represented 26.7%, 70% & 80% respectively. *Results of radiological studies in our study, done during admission showed significant difference, with neonates having normal TCU/S, PAUS & plain abdominal X-ray in developmental care group were 93.3%, 90% & 90% of total developmental care group respectively, while in conventional care group 70%, 26.7% & 26.7% respectively, with P value 0.020, <0.001 & <0.001 respectively. *Developmental care group also showed significantly lower incidence of apnea episodes (5 preterms) compared to the conventional care group (14 preterms).
*The duration on oxygen support, CPAP, ventilation or PPV in our study was 0 (0 to 4) days in developmental care group, while in conventional care group 14 (0 to 23) days ( P value 0.001). *Obvious decrease in length of NICU stay & total duration of admission 9.3 (6.0 to 19.0) days in developmental care group compared to 34.0 (21.0 to 51.0) days in conventional care group, P value <0.001.
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* Sepsis incidence was less in the developmental care group (23.3%) compared to the conventional care group 16 (53.3%) (P value 0.017).
All of these encourage spreading developmental care implementation not only in our NICUs but in all NICUs worldwide for better growth and development of all neonates especially