Neonatal Individualized Developmental Care And Assessment Program Research Articles

Changes of Infant- and Family-Centered Care Practices Administered to Extremely Preterm Infants During Implementation of the NIDCAP Program.

Introduction: Many studies have evaluated the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP), but few studies have assessed changes in infant- and family-centered developmental care (IFCDC) practices during its implementation.Objectives: The primary objective of this single center study was to investigate the impact of the implementation of the NIDCAP program on IFCDC practices used for management of extremely preterm infants (EPIs). The secondary objective was to determine during implementation the impact of this program on the short-term medical outcomes of all EPIs hospitalized at our center.Methods: All EPIs (<28 weeks gestational age) who were hospitalized at Strasbourg University Hospital from 2007 to 2014 were initially included. Outborn infants were excluded. The data of EPIs were compared for three time periods: 2007 to 2008 (pre-NIDCAP), 2010 to 2011, and 2013 to 2014 (during-NIDCAP implementation) using appropriate statistical tests. The clinical and caring procedures used during the first 14 days of life were analyzed, with a focus on components of individualized developmental care (NIDCAP observations), infant pain management (number of painful procedures, clinical pain assessment), skin-to-skin contact (SSC; frequency, day of initiation, and duration), and family access and involvement in the care of their children (duration of parental presence, parental participation in care). The short-term mortality and morbidity at discharge were evaluated.Results: We examined 228 EPIs who received care during the three time periods. Over time, painful procedures decreased, but pain evaluations, parental involvement in care, individualized observations, and SSC increased (all p < 0.01). In addition, the first SSC was performed earlier (p = 0.03) and lasted longer (p < 0.01). There were no differences in mortality and morbidity, but there were reductions in the duration of mechanical ventilation (p = 0.02) and the time from birth to first extubation (p = 0.02), and an increase of weight gain at discharge (p = 0.02).Conclusion: NIDCAP implementation was accompanied by progressive, measurable, and significant changes in IFCDC strategies. There were, concomitantly, moderate but statistically significant improvements in multiple important outcome measures of all hospitalized EPI.

Healthcare professional perceptions of family-centred rounds in French NICUs: a cross-sectional study

ObjectiveTo assess the perceptions of healthcare professionals (HCPs) regarding parental presence at medical rounds in French neonatal intensive care units (NICUs). We hypothesised that HCPs would perceive barriers against allowing...

The importance of parents in the neonatal intensive care units

The premature birth and the hospitalization in a neonatal intensive care unit (NICU) are potential risk factors for the development and behavior of the newborn, as has been shown in recent studies. Premature birth of an infant is a distressing event for the family. Several feelings are experienced by parents during hospitalization of their baby in the NICU. Feelings of guilt, rejection, stress and anxiety are common. Also the attachment processes have the potential to be disrupted or delayed as a result of the initial separation of the premature newborn and the mother after the admission to the NICU. Added to these difficulties, there is the distortion of infant’s “ideal image”, created by the family, in contrast with the real image of the preterm. This relationship-based family-centered approach, the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP), promotes the idea that infants and their families are collaborators in developing an individualized program to maximize physical, mental, and emotional growth and health and to improve long-term outcomes for the high risk newborns. The presence of parents in NICUs and their involvement caring their babies, in a family centered care philosophy, is vital to improve the outcome of their infants and the relationships within each family. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)

How can we evaluate developmental care practices prior to their implementation in a neonatal intensive care unit?

Developmental care is designed to allow optimal neurobehavioral development of the preterm infant. The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) associates various strategies and focuses on individualized, family-oriented care. Scientific evaluation of developmental care is needed. Randomized controlled trials are the basis for medical evaluation, but present some limitations for developmental care studies. Qualitative research and benchmarking could be of interest in this field of neonatal medicine.

Neurodevelopmental care in the NICU.

Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.

Implanter un programme individualisé de soutien du développement en réanimation néonatale: pourquoi, comment?

The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) is based upon a behavioral observation of the premature newborn. The information is used for suggesting individualized caregiving and environmental changes. The role of the parents in supporting the development is reinforced. This program appears to reduce ventilation, artificial feeding and hospitalization stay length, and is also found to improve neurobehavioral maturation. Its setting in a neonatal intensive care unit implies a collective reflective process and staff education.

Developmental care teams in the neonatal intensive care unit: survey on current status.

Developmental Care Teams (DCT) have evolved in Neonatal Intensive Care Units (NICUs) in response to mounting evidence that developmental care is cost-effective and improves outcomes of critically ill newborns. Lack of national practice guidelines and standardized roles for DCT members prompted formulation and distribution of a questionnaire to obtain information regarding staff membership of DCTs, budgeting for DCTs, utilization of developmental care in practice, and education and developmental training of NICU staff. Questionnaires were sent to 50 NICUs in 30 states, with a return rate of 62% (31 of 50), representing 18 different states. Of those who responded, 64% had a DCT, and an additional 24% were in various phases of starting a team. Forty-three percent of the teams meeting on a regular basis did so monthly. Only 30% of those with a DCT had a dedicated budget to cover operating costs of their developmental program. Fifty-two percent of respondents had Neonatal Individualized Developmental Care and Assessment Program (NIDCAP)-certified staff at their institutions; however, nine other types of developmental specialists were also listed. Only four respondents indicated utilization of set criteria for initiation of a DCT consult, and 74% of those with DCTs initiated consults "when the need arises." NIDCAP assessments were used for parent teaching (54%), care plans (69%), care recommendations (46%), and at caregiver "discretion" (39%). The results of the survey validated an intense interest in developmental care. Approach to developmental care is variable between NICUs and implementation as outlined by NIDCAP is unusual. Practical guidelines for utilization and funding of DCTs are needed.

The effect of developmental care on preterm infant outcome

Using a retrospective comparative design, the investigators evaluated the effects of training 10% of a nursing staff in the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) on preterm infant outcomes. A convenience sample of 25 preterm infants (< 1500 grams) cared for during the NIDCAP implementation and training period were matched by birth weight and gestational age to infants born before NIDCAP implementation. Outcome measures collected through chart review showed NIDCAP infants had significantly fewer and less severe intraventricular hemorrhages, fewer days of ventilatory support, shorter hospitalizations, and greater rate of weight gain. Findings suggest that benefits of developmental care are achievable with only a portion of the staff being NIDCAP trained.

INDIVIDUALIZED DEVELOPMENTAL CARE FOR VERY LOW BIRTH WEIGHT (VLBW) PREMATURE INFANTS: IMPROVED “STATE SYSTEM CONTROL” WITHOUT ADVANCED DEVELOPMENT IN SLEEP MEASURES USING THE MOTILITY MONITORING SYSTEM (MMS).

Objective: We hypothesized that individualized developmental care for the VLBW Neonatal Intensive Care Unit (NICU) infant would result in advanced sleep development (measured by the MMS). Population: We conducted sleep studies using the MMS on 28 preterm infants who were part of a larger group enrolled in the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) at Stanford. Enrollment criteria for this program included birth wt. ≤1250g and mechanical ventilation for more than 24h during the first 48h of life. Infants were randomly assigned to Intervention(INT, n=14) or Control (C, n=14) groups. Groups were similar for severity of illness. Researchers recording and scoring the sleep data were blinded. Care plans were devised and implemented for the INT infants, as described (Als et al. JAMA. 1994). C infants received routine NICU nursing care. Both INT and C infants were evaluated at 42 weeks post-conceptional age (PCA) by a blinded examiner using the Assessment of Premature Infant Behavior (APIB) tool. The APIB assesses an infant's behavior in five areas or systems including“state system control” (evaluation of sleep and wake states for maturity). Methods: MMS technique used a pressure sensitive pad, amplifier, and recorder. Studies were conducted for 48 continuous hours at 36 wks PCA and at 3 mos corrected age (CA). Data were scored for states, state transitions, and out of crib time. Results: INT infants showed better sleep and wake “state system control” than C infants as measured by the APIB (p=.03). However, there was no significant difference between the two groups at either age on any MMS sleep measure. There were significant maturation effects in both groups between 36 wks PCA and 3 mos CA(% Quiet Sleep/Total Sleep Time increase: INT=11, C=6 and% Active Sleep/Total Sleep Time decrease: INT=11, C=6 all p's <0.006). Conclusion: Improved medical outcome measured by shorter time on mechanical ventilation, fewer days to full enteral feeds and decrease in length of hospitalization reported in infants who have had developmental care implemented does not appear to be associated with improvement in sleep development or in the amount of sleep. Improvement in “state system control” occurs without neurodevelopmental maturation in sleep as measured by the MMS.

Natural course of behavioral organization in premature infants

This experiment describes a method of scoring naturalistic behavioral observations made on 84 premature infants who received nursing care in the traditional medical model. The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) was used for making the observations, and the systems component of the Assessment of Preterm Infant Behavior (APIB) was used for scoring. We found that (a) behavior was best where the infant was at rest and undisturbed prior to care (i.e., baseline); (b) behavioral disorganization increased with care; (c) behavioral recovery after care was limited; and (d) baseline behavioral disorganization increased with age. Gestational age, level of pulmonary support, and bronchopulmonary dysplasia had effects on certain aspects of behavior. These systematic observations suggest that nursing care necessary for medical management is quite demanding for premature infants and that repeating such experiences over time may inadvertently produce behavioral disorganization. If these findings can be replicated in other intensive care nurseries, then there will be additional support to recommend the nursing approach to care be expanded to incorporate attention to the infant's response to, and tolerance of, care.