Environment and early developmental care

Abstract

The spectacular development of neonatal intensive care since the 1960s has allowed a drop in neonatal mortality of verylow- birth-weight (VLBW) infants from 50% to less than 15% in the last decade [1]. However 15 to 25% of the VLBW infants will present neurodevelopment impairment in the following fields: motor function, vision, auditory function, cognition, behavior, attention deficit and hyperactivity disorders, visual-motor integration and language [2, 3]. Compared to their term pairs there is substantial scientific evidence of altered early brain development [4]. These infants spend weeks and sometimes months in the neonatal intensive care unit (NICU), which is a quite different environment compared to what they would experience in utero. At this young age brain growth and development is particularly critical. The configuration of neurons is genetically predetermined, but the further organization and wiring of the neural circuits will depend on endogenous and exogenous stimulation. The existing evidence of interaction between environment and brain development has been extensively reviewed and better practices encouraged [5]. It is against the background of the potential harmful effects of the traditional NICU that developmental care and environmental strategies have gained more and more attention.