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Heather Hendry, RN, tends to a newborn.

Forrest General Hospital is the only hospital in the state to offer NIDCAP — the Newborn Individualized Developmental Care and Assessment Program.

"I'm very proud of this program," said Forrest General developmental care coordinator Felicia Browning. "I've been a neonatal nurse since 1981 and feel nothing has impacted the outcomes of our babies like this program in a very long while."

Visitors to an NICU (newborn intensive care unit) know that changing a diaper on undeniably vulnerable babies becomes a highly sensitive and critical task, one that must be monitored closely.

Here's where NIDCAP specialists come in. They observe the infants closely to monitor their heart rate, respiratory rate, blood pressure, movement, and body position. At each evaluation, striving to alleviate overstimulation and distress, the specialists observe the baby at strategic intervals to determine the infant's most desired position. They work closely with the nurses, and together they collaborate to see that the babies are "tucked in" properly and sleeping. Yes, sleeping.

"The babies must remain comfortable 24 hours a day," explained Browning. "If left uncomfortable, this will cause them to flail or wiggle around. If they wiggle around, they're not sleeping and therefore don't gain weight. This begins a vicious cycle, making them more prone to infection and a host of other complications."

Developed by Heidelise Als, PhD, director of neurobehavioral infant and child studies at Children's Hospital Boston and associate professor of psychology at Harvard Medical School, and her colleagues, NIDCAP works with doctors, nurses and families to optimize the treatment provided for premature babies. In the words of the NIDCAP Federation International, their vision is "that all newborn infants in intensive and special care nurseries receive individualized, developmentally supportive, family-centered care so that they may realize optimal health and developmental outcome."

The emphasis on developmental health is significant. As neonatal care has advanced over the years so that babies' survival rates have increased significantly, caregivers are now able to focus more on implementing strategies to help newborns make up for developmental "lost ground" as they spend so much of their formative first weeks in hospital units that are, of necessity, quite different from the nurseries their parents have longingly prepared for them at home.

Browning, for one, certainly appreciates this emphasis. "It usually takes a premature baby about a year to catch up with other year-old children; some take longer, depending on what issues the baby encountered early on," she said. "We now have four- and five-year-old children who are developmentally well adjusted, performing well in preschool and kindergarten because of the care received."

When working with hospitals, NIDCAP practitioners encourage them to craft a strategic five-year plan for implementing this truly comprehensive approach throughout the nursery facilities. For their part, professionals wanting to be certified as NIDCAP specialists typically undergo 12 months of intensive training. At this time, of the four certified NIDCAP practitioners in Mississippi, all are affiliated with Forrest General.

"Most states have programs of early intervention beginning around age two or three," said Browning. "Our program, in conjunction with the university, begins at birth, giving our children a head start and the best outcome possible."

Forrest General has long focused on newborns. In 1992, Dr. Clinton White became the first neonatologist to begin practicing in the hospital's NICU. Then, in 1993, Dr. Vinay Kumar performed neonatal surgery on a two-pound infant.

All of these milestones add to the dynamic atmosphere in the Women and Children Center of Excellence at Forrest General. The intermediate care nursery, the labor and delivery unit, NICU — all are up for renovation. As well, the women's unit, the postpartum unit, and the well-baby nursery will all be relocated.

Forrest General is also making room to help families better contribute to their babies' recovery and health. The hospital trains the parents of NICU babies in CPR and closely monitors the babies for two years through their follow-up clinic. NIDCAP, then, is but a part of the whole neonatal service package for infants and their families.

"NIDCAP is an important aspect of family-centered care in the intensive care unit," said Dr. Randy Henderson, a neonatology specialist at the hospital. "Participating in the program gives parents confidence and allows them to prepare for discharge by becoming a caretaker while the infant is still in the NICU."

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