April 23, 1999

In the MGH's Neonatal Intensive Care Unit (NICU), lighting is low and nurses speak in hushed voices as they rock the tiniest of babies in their arms. This softened environment is vital for infants born prematurely to continue developing hearing, sight and other basic functions.

Now nurses in the NICU are doing something more: taking many of their cues from the infants themselves. Rather than sticking to a schedule for feeding or bathing, the nurses let the babies tell them when they're too stressed or tired to be disturbed. If a baby cries, yawns, hiccups or stretches its arms in protest, the baby may be giving signals that it needs rest more than anything else. So a nurse may wait until the next day to give the baby a bath or draw blood for routine testing. Nurses also help keep the babies calm by bringing their hands together or surrounding them with cushions so the babies don't flail and become exhausted. This specialized care was developed by Heidelise Als, PhD, director of the Neurobehavioral Infant and Child Studies Laboratory at Children's Hospital, who visited the NICU March 31. Her approach of heeding signals from babies, which she has advocated for years, was the focus of a documentary filmed at the MGH by the Canadian Broadcasting Company.

Als' philosophy is part of a comprehensive program at the MGH, called Homeward Bound, which will include home visits by nurses and more involvement by parents in their baby's care.

"Some people feel this approach is controversial, but it makes sense," says Mark Ogino, MD, director of the MGH's NICU. "When you follow the patterns of the baby, the complications should decrease with time." Ogino says clinicians are already seeing benefits: The babies need less oxygen, and they're being weaned from ventilators sooner.

Nurses seem to have embraced the new way of caring for babies. "They are excited about it. They say it makes sense," says Anne Armstrong, RN, MSN, clinical nurse specialist for the NICU and special care nurseries.

Terry MacDonald, RN, has worked in the NICU for 20 years. She sees a difference in this new type of care. A decade ago, nurses believed that parents shouldn't touch their babies much, as it would tire them out and possibly impair their development. Today, that philosophy has changed. MacDonald now lets parents take the lead.

She recalls a time when a mother wanted to breastfeed her premature baby and MacDonald questioned whether it was a good idea. When the mother tried it, MacDonald saw the baby bond with the mother. Parents now are encouraged to hold and care for their babies to further their development.

"The parents tell me how they want their visit to go. It works unbelievably well," MacDonald says.

Adrienne Sacco-Maguire, RN, of the NICU, cares for premature twins Samantha and Madeline Baptiste.