Nursing Perspectives of Developmental Care in Reducing Opioid Exposure in the Preterm Infant in the NICU

As medical technology advances, so do the number of lives saved, including the lives of extremely low-birth-weight preterm infants. Although these babies are being given the chance at life, the care and procedures they require can have detrimental long-term effects. Many of these procedures are painful, including intubation, mechanical ventilation, obtaining vascular access, and heel sticks. Researchers have demonstrated adverse effects of pain in the preterm infant, including cerebral development and negative neurological outcomes (McPherson et al., 2015). However, limitations exist in the safety profile of the agents used to relieve pain in the preterm infant (McPherson et al., 2015), including the regular use opioids as the main form of pain control, specifically fentanyl and morphine, in newborn intensive care units throughout the country. Evidence has proven that long-term opioid therapy significantly affects brain growth and negatively impacts neurodevelopmental outcomes (McPherson et al, 2015), and therefore alternatives to better pain management in preterm neonates that optimize brain development and functional outcomes are urgently needed. More research regarding the positive effects of NICU developmental care is also necessary. Developmental care is a concept of care practice aimed at promoting improved development and growth of preterm infants (Hendricks-Muñoz et al., 2010). In this project, nurses at the University of Utah NICU were surveyed about their perceptions of developmental care and their attitudes regarding developmental care as a potential alternative to opioid administration, followed by a) a presentation that included discussion of the negative neurodevelopmental outcomes of long-term opioid therapy, the positive effects of NICU developmental care, and exploring ways to implement developmental care as an alternative to opioid therapy; and b) a questionnaire given to the nurses before and after the presentation, with a paired T-test for each question. The three questions that focused on opioid therapy, the negative neurodevelopmental outcomes associated with opioids, and the introduction of developmental care as an alternative to opioids resulted in a P-value of < 0.05, indicating statistical significance. This study identifies that full implementation of developmental care practices continue to be challenging, despite nurses' beliefs regarding its importance. This study provided preliminary evidence that nurses' perceptions of developmental care greatly affect the care the infants receive and ultimately that developmental care could be implemented as a potential alternative to long-term opioid therapy.