Toward the normal growth and development of very low birth weight infants

今日、極低出生体重児のほとんどが救命されるようになりました.一方,その予後,特に1000g未満の超低山生体重児の長期予後調査から.脳性麻痺,精神通勤発達遅延や視力障害以外の問題を抱えている事実もわかってきました.特別な基質的障害を合併しない児の学習障害,注意欠陥多動障害,愛情遮断症候群や被虐胎児症候群などが超低山生体重児に多いことです.この現実から,超低山生体重児の健全な発達を目指すなら,NICUではdevelopmental careとfamily centered careの実践が重要であると認識されてきました.私たちの施設では,早産児へのストレス緩和について検討し,NICU内での「話し声」が保育器内の騒音源であることを認識し,Behavioral Stateの観察から,「明るさ」の制限や「ポジショニング」施行が児の安静を保つことを証明しました.今後さらに「痛み」刺激の緩和,NICUの環境について検討したいと考えています.
Currently, the great majority of VLBW infants can survive. But, from the long-term outcome studies, especially ELBW infants have some problems, for example, cerebral palsy, mental retardation, sensory impairments and blindness. Furthermore, even if an ELBW infant does not develop a major handicap or sensory impairment, he or she may have a higher risk of learning disabilities, attention deficit/hyperactivity disorders, deprivation syndrome and battered child syndrome compared to full-term infants. Consideration of these findings, we must provide developmentally supportive care for VLBW premature infants a t birth in the NICU. In our NICU, we are studying stresses of premature babies. We find lower noise levels, decreased light levels and optimal positioning promote physiologic and behavioral stability of VLBW infants. After this, we will introduce more comfortable NICU environment for normal growth and development of VLBW premature infants.