Behavioral state organization of very low birth weight infants: Effects of developmental handling during caregiving

Handling infants for nursing care in the neonatal intensive care unit has been associated with physiological and behavioral distress. The purpose of this study was to determine whether an individualized approach to nursing care designed to reduce stressors and support behavioral organization would positively affect behavioral state organization during caregiving. The developmental approach was contrasted with a traditional approach in 38 infants (< 1700 g, 53% female, 85% white) at 28, 30, and 32 weeks postconceptional age. Subjects served as their own controls in a cross-over design, with assessment of four caregiving sessions at each age. Results showed that with developmental caregiving, time spent in sleep and drowsy wakefulness was higher, and time in alert and non-alert wakefulness and fuss/cry was lower than with traditional caregiving. Results demonstrate a positive effect of developmental handling for behavioral state organization. However, the findings for the alert state were unexpected and require further exploration of how alertness may be promoted without the physiological and behavioral costs of disorganized arousal.