Editorial

The management of premature infants has advanced over the past three decades to the point that infants born as early as 23 weeks' gestation now have a chance of survival in part due to technological advances. With these technological advances, the neonatal intensive care unit environment has become increasingly stressful. From the first moments of life, the premature infant is subjected to excessive noise, bright lights, painful procedures, and excessive handling. The neonate's neurologic system needs to perform at birth. Understanding how we can better support the infant's fragile neurologic system can be the beginning of helping the infant to manage within the extrauterine environment. As we strive to improve our morbidity and mortality rates, we are challenged to enhance the developmental potential of these infants. This will require a focus on developmentally supportive environments in which to care for the fragile preterm infant.

Despite advances in science and technology, premature infants continue to be at high risk for major medical and neurosensory deficits such as intraventricular hemorrhage, learning disabilities, and behavioral problems. The neurologic and sensory systems do not exist as separate entities but are interdependent and comprise the neurobehavioral and neurosensory development of the infant. The sensory systems develop in a specific sequence: tactile, vestibular, gustatory, olfactory, auditory, and visual. Every sensory experience is recorded in the brain, leading to a behavioral response, thereby leading to yet another sensory experience. When an infant is born premature, the still-developing brain and sensory systems are affected by the continuous interplay of interactions in the neonatal intensive care unit. A principle of sensory interference may occur when immature sensory systems are stimulated out of turn or with inappropriate stimuli. In addition, the roles of sleep and sleep cycles have a tremendous impact on the development of the neurosensory and motor systems in the fetus and neonate. Both are essential for creation of memory and long-term memory circuits and are essential for the maintenance of brain plasticity over the lifetime of the individual. Ideally, the early environment of preterm infants should create a situation in which infant maturation can take place with minimal interference.

Doctor Stanley N. Graven is Professor of Maternal & Child Health and Child Development in the College of Public Health at the University of South Florida.

Doctor Joy V. Browne, PhD, CNS-BC, is the Associate Professor of Pediatrics and Psychiatrics in the Department of Pediatrics at the University of Colorado Denver's School of Medicine and the Children's Hospital. The internationally recognized Dr Stanley N. Graven and Dr. Joy V. Brown are the Guest Editors for the December, 2008 NAINR issue, which is dedicated to neonatal brain development. Our hope is that this issue of NAINR will provide knowledge about the neonate's vulnerable neurosensory system and provide practical tips for neonatal nurses to protect each of these systems in our high-tech extrauterine environments.