Newborn Individualized Developmental Care And Assessment Program Research Articles

Caring for hearts and minds: a quality improvement approach to individualized developmental care in the cardiac intensive care unit.

Infants with congenital heart disease (CHD) are at high risk for developmental differences which can be explained by the cumulative effect of medical complications along with sequelae related to the hospital and environmental challenges. The intervention of individualized developmental care (IDC) minimizes the mismatch between the fragile newborn brain's expectations and the experiences of stress and pain inherent in the intensive care unit (ICU) environment. A multidisciplinary group of experts was assembled to implement quality improvement (QI) to increase the amount of IDC provided, using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), to newborn infants in the cardiac ICU. A Key Driver Diagram was created, PDSA cycles were implemented, baseline and ongoing measurements of IDC were collected, and interventions were provided. We collected 357 NIDCAP audits of bedside IDC. Improvement over time was noted in the amount of IDC including use of appropriate lighting, sound management, and developmentally supportive infant bedding and clothing, as well as in promoting self-regulation, therapeutic positioning, and caregiving facilitation. The area of family participation and holding of infants in the CICU was the hardest to support change over time, especially with the most ill infants. Infants with increased medical complexity were less likely to receive IDC. This multidisciplinary, evidence-based QI intervention demonstrated that the implementation of IDC in the NIDCAP model improved over time using bedside auditing of IDC.

Preterm infant cues during breastfeeding and its measurement: A scoping review.

Preterm infants display certain behaviors to communicate their needs, known as preterm infant cues. However, the existing research on preterm infant cues primarily draws from studies conducted on bottle-fed infants rather than breastfed infants. This study aimed to investigate the concept of preterm infant cues during breastfeeding and its appropriate instruments. A scoping review. The articles published up to January 2022 were searched from multiple sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and E-Journals. The articles retrieved for this review were screened using PICO (Population, Intervention, Comparison, and Outcomes) format. Preferred Reporting Items for Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs Institute Critical Appraisal was utilized by two independent authors to assess the articles' quality. A descriptive method was used to analyze the data. The initial review stage found 183 potential articles, but only four satisfied the criteria. The notion of preterm infant cues during breastfeeding is centered on the actions of preterm infants while positioned on their mother's chest. These feeding cues are identifiable before, during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation, approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm Breastfeeding Behavior Scale (PIBBS) can be utilized. The study findings highlight the importance of recognizing preterm infant cues during breastfeeding to facilitate proper feeding and developmental care. Observational studies have proven to be an effective means of observing these cues during breastfeeding. By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP, and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal care settings of all levels. This, in turn, can aid in developing care plans that promote better feeding ability outcomes.

Parents' Experience in an Italian NICU Implementing NIDCAP-Based Care: A Qualitative Study.

Background: The birth of a preterm infant and his/her immediate admittance to the Neonatal Intensive Care Unit (NICU) are sudden, unexpected, stressful and painful events for parents. In the last decade, in response to the increased awareness of the stressful experiences of parents, much attention has been paid to Family-Centered Care (FCC) and the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). According to the NIDCAP model, the infant-parents' dyad is the core of the care provided by the NICU professionals to reduce the stress experienced by parents. So far, the literature does not show a clear correlation between parental experiences and the NICU practices according NIDCAP principles. Aims: To explore how parents of preterm infants experienced the NIDCAP-based care from admission to discharge, in particular, their relationships with NICU professionals and with other parents, and the organization of the couple's daily activities during this process. Design: Qualitative exploratory study. Methods: Twelve parents of preterm infants born between January 2018 and December 2020 at the NICU of Modena, with a gestational age at birth of less than 30 weeks and/or a birth weight of less than 1250 g, were recruited. Three couples had twins, and the total number of infants was 15. All infants were followed for up to 24 months post-term age (PTA) for neurological outcomes. Each couple was given a semi-structured online interview about their experience during their infant's hospitalization in the NICU up to discharge. The interview was developed around three time points: birth, hospitalization and discharge. The data analysis was conducted according to the template analysis method. Results: The admission to the NICU was unexpected and extraordinary, and its impact was contained by the skilled staff who were capable of welcoming the parents and making them feel they were involved and active collaborators in the care of their infant. The emotional experience was compared to being in a blender; they were overwhelmed by changing emotions, ranging from terrible fear to extreme joy. The couple's activities of daily life were reorganized after the infant's birth and admission to the NICU. Fathers felt unbalanced and alone in taking care of their partners and their children. Conclusions: This is the first study in Italy to explore parental experience in an NICU implementing NIDCAP-based care. The NIDCAP approach in the NICU of Modena helps parents to be involved early, to develop parental skills, and to be prepared for the transition home; and it also facilitates and enhances the relationship between parents and NICU staff.

Care with child development and André Bullinger's special look at prematurity.

Objective:To assess different ways of caring for preterm infants’ development and for their families in neonatal units, with emphasis on the studies by André Bullinger.Data source:A review of the literature in the databases PubMed, SciELO, and the Cairn.info portal, which publishes reviews in human sciences in French. Also, the books and articles of André Bullinger, available only in French, were reviewed.Data synthesis:This review includes the Kangaroo Method, which is based on skin to skin contact and the encouragement of breastfeeding; the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synaptic Developmental Theory and aiming to positively change the neonatal environment, having the preterm newborn as the actor of their own development and the mother as a regulator; and the Bullinger Approach, which uses a sensory-motor perspective to approach child development, including preterm infants’ development.Conclusions:The Kangaroo Method has changed child developmental care in countries with limited financial resources. NIDCAP was shown to be efficient, although only a few long-term studies have been conducted on the subject. The Bullinger Approach is well diffused in European neonatal units, with promising results for the prevention of neurodevelopmental disabilities, especially those related to orality

Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation.

AimTo assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).DesignProspective observational study.MethodsTwelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme.ResultsDespite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.

Effect of Nesting on Extensor Motor Behaviors in Preterm Infants: A Randomized Clinical Trial

Background: The aim of this study was to investigate the effect of bedding preterm infants in nests on their motor behaviors in a neonatal intensive care unit (NICU) in Iran.Methods: In this randomized controlled trial, 44 clinically stable preterm infants, admitted to the NICU, were recruited and randomly divided into two groups of control and intervention. The routine of the unit was to take care of infants on a flat mattress. The intervention was a U-shaped cloth nest in which the intervention group was bedded for 7 days. The control group consisted of infants who were normally cared without any boundaries. All infants were videotaped before and on the last day of the intervention. The motor behaviors, as defined in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) sheet, were analyzed in each of the films.Results: To compare the number of total extensor motor behaviors between the two groups, the change score in each group was calculated and compared between the two groups. The mean change scores in the intervention and control groups were -21.36±13.5 and 2.32±7.9, respectively. Accordingly, nesting significantly reduced the occurrence of unstable behaviors in the intervention group, compared to that in the control group (P<0.001).Conclusion: According to the findings, supporting the preterm infant body even by accessible materials could enhance their neurodevelopmental strengths and motor behavior stabilities.

Implementing NIDCAP training in a low-middle-income country: Comparing nurses and physicians' attitudes

BackgroundThe Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides developmentally supportive environment for preterm infants and their families. Few studies evaluated staff perceptions about NIDCAP implementation and its effect on infant and parents and working conditions. AimsTo assess the perception and experience of NICU staff during the NIDCAP implementation. Study designCross-sectional anonymous online survey. Subjects57 NICU staff (29 nurses and 28 doctors) who were present at least one year prior to and during the implementation of NIDCAP training in a tertiary care center. Outcome measuresA standard questionnaire addressing attitude, perceived behavioral control, subjective norm, intention, behavior and NIDCAP impact related to NICU conditions was used after initiating developmental care activities and NIDCAP training in the unit from June 2014 to May 2018. ResultsForty-six doctors and nurses filled the questionnaire; they scored ≥3 out of 5 on all the questionnaire items. Nurses scored significantly higher than doctors (mean 4.00 ± 036) versus (3.57 ± 0.30) (p < 0.001) on the overall NIDCAP score. Specifically, nurses scores were significantly higher for attitude (p < 0.001), perceived behavioral control (p = 0.029); subjective norm (p = 0.011), intention (p = 0.024) and behavior (p < 0.001) questions. ConclusionThe implementation of NIDCAP in a low-middle income country was perceived as a positive experience for both nurses and doctors: It was thought to have improved infant care and wellbeing as well as the staff relationship with parents, however working conditions remained a challenge. More studies are needed to address areas of improvement for implementation.

Using Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Philosophy and Principles in the Implementation of a NICU Book Sharing Program

Using Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Philosophy and Principles in the Implementation of a NICU Book Sharing Program

Filling a Significant Gap in the Cardiac Intensive Care Unit (CICU): Quality Improvement Using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Approach

Filling a Significant Gap in the Cardiac Intensive Care Unit (CICU): Quality Improvement Using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Approach

Barriers to Provision of NIDCAP in the Neonatal Intensive Care Unit of Nursing viewpoints

Introdution: Newborn individualized developmental care and assessment program (NIDCAP) is emphasized. This study aimed to determining the barriers to implementation of NIDCAP from nurses' perspectives in neonatal intensive care units in Shahid Sadoughi Hospital in Yazd.&#x0D; Methods: This descriptive study was conducted using a census sampling method. The samples were54 nurses working in the intensive care unit of Shahid Sadoughi and Afshar Hospitals in Yazd. Data were gathered using two questionnaires,( demographic and barrier assessment questionnaires) . Data analysis was performed in SPSS version 24 using descriptive statistics, Chi-square, independent t-test and fisher test.&#x0D; Results: Results showed that in terms of mean and standard deviation, in the area barriers of sleep care, lack of skill (3.08± 1.28 ), In the area of pain and stress assessment management, lack of skill (2.86. ±1.31), in the area of activities of daily living and family-centered care, lack of effective communication with parents respectively (2.83 ± 1.39) and ( 2.86± 1.32), in the area of provision of healing environment, lack of standard light and sound in unit (2.76 ± 1.81) and in the area of organizational barriers, the disproportionate number of nurses to the patients (3.47±0.84) were identified as the most important barriers&#x0D; Conclusion: Based on the findings, lack of skill, lack of effective communication with parents, lack of standard environment and disproportionate number of nurses and patients are the most important barriers to the implementation of NIDCAP in NICUs that managers need to plan appropriate design for addressing them.

Online Video-based Supplement for Assessment of Preterm Infant Behavior (APIB) and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Education

In response to repeated requests for enhanced educational mate-rials for NIDCAP and APIB training, NIDCAP Federation In-ternational (NFI) members were asked in October 2016 to share photos and videos for the creation of a photographic library.

Evaluation of “CLE” an Intermediate Family Centered Developmental Care Program Based on the Theoretical Concept of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

The Belgian government has always been very supportive con-cerning the implementation of individualized family-centered developmental care in newborn units. Since 2012 the implemen-tation of NIDCAP has been subsidized by the government. This project evolution demonstrated the benefit of NIDCAP on care practices1 and revealed the need for intermediate NIDCAP-based programs.2,3 This requires facilitation of NIDCAP implementation in Newborn Intensive Care Units (NICUs) on the one hand, and development of programs adapted to the reality of Intermediate Newborn Care Units on the other hand. These findings matched the observations of the Brussels NIDCAP training center.

Global Perspectives of Developmental Care – Belize

Of all the advances in neonatology in the past several decades, developmentally supportive, family-centered care is arguably one of the most powerful tools for improving outcomes in countries with limited economic resources. Developmental care does not require expensive technology, and rather it is based on sensitive observation, responsive hands-on care, and strengthening relationships among infants, families and caregivers. While some aspects of the highest quality, Newborn Individualized Developmental Care and Assessment Program (NIDCAP) based developmental care can be relatively costly (for example, single-room NICU design including family accommodations), resourceful and adaptive planners in developing countries are no strangers to finding creative solutions to such challenges. We have only to look at the history of kangaroo care to see strong proof of this concept, as countries as diverse as Colombia, South Africa and Argentina have led the way in developing and implementing this critical strategy.

Early Initiation of a Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduced Length of Stay

Early Initiation of a Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduced Length of Stay

Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran

PurposeThe Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU. Design & methodsA purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004). ResultsSix themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver. ConclusionsThe findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers. Practice implicationsHealth care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.

Neonatal Intensive Care Unit Nurses' Perceptions and Knowledge of Newborn Individualized Developmental Care and Assessment Program: A Multicenter Study.

Background:The newborn individualized developmental care and assessment program (NIDCAP) is a new multifaceted approach, which is developmentally and functionally supportive of health especially in premature newborns at the neonatal intensive care unit (NICU). This study is designed for assessing the knowledge and perception of nurses as the most important members of the multidisciplinary team of NIDCAP about this program.Materials and Methods:This cross-sectional study was conducted on 120 nurses working in the NICUs of Alzahra, Taleghani, and Children hospitals affiliated to the educational and treatment centers of Tabriz University of Medical Sciences as well as 29 Bahman Hospital affiliated to Tabriz Social Security Organization in 2016 using census sampling method. Three questionnaires were employed to collect demographic data and to explore the nurses' perceptions and knowledge of the NIDCAP program.Results:Findings of the study indicated that the mean (SD) nurses' knowledge and perception scores for NIDCAP were 71.83 (1.64) and 76.80 (0.79), respectively. In the terms of knowledge, significant differences were found with regard to being married (t = -2.39, p < 0.019), having an MSc degree (t = -2.14, p = 0.034), and employment experience (t = -3.38, p = 0.001). However, there was no significant relationship between perception and demographic variables (p > 0.05), nor was there any significant relationship between perception and knowledge (p = 0.275).Conclusions:The results of this study showed that the majority of nurses participating in the study had high knowledge about NIDCAP.

Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review.

Nonpharmacological interventions are often used to promote sleep among preterm infants in the neonatal intensive care unit (NICU). However, there is a lack of synthesis in the evidence of their effectiveness. To synthesize the evidence on the effectiveness of nonpharmacological interventions on NICU preterm infants' sleep during hospital stay. Seven databases were searched, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Wan-fang database, China National Knowledge Infrastructure, China Biological Medicine Database, and VIP Journal Integration Platform from their inceptions to August 2017. Randomized controlled trials examining the effects of nonpharmacological interventions on preterm infants' sleep were included. This review included 36 studies. Nonpharmacological interventions included the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), music, non-nutritive sucking, touch, cycled light, cobedding, rocking, oral sucrose, remolding mattresses, and family nurturing. The meta-analysis results showed that 1. the NIDCAP had no significant effect on total sleep time efficiency (TST%; p=.34); 2. mattress interventions had significant effects on TST% (p<.001); and active sleep efficiency (AS%; p=.006) but no significant effect on quiet sleep efficiency (QS%; p=.75); 3. cycled light increased TST (p=.02); and 4. cobedding had no significant effects on QS% and AS% (p=.63 and p=.88, respectively). Remolding mattresses and cycled light had significant effects on sleep promotion in preterm infants, but the quality of the evidence was very low. Further high-quality studies are needed to strengthen this evidence.

Less is More: Modern Neonatology.

Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that “less is more.” In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21–0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous non-invasive monitoring not only of the O2 but also of CO2 is warranted. “Kangaroo care” and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether “less is more,” or not enough, is to be seen in future studies.

Remifentanil versus Fentanyl for pain control during elective endotracheal intubation for surfactant administration in preterm infants

Introduction: Today, the reality of pain in neonates is an undisputed fact, but pain management in clinical practice remains a challenging issue. All neonatal units should have a pain management protocol. The aim of this study was to compare the effectiveness of Remifentanil versus Fentanyl in pain control during elective endotracheal intubation for surfactant administration in preterm infants. Materials and methods: Preterm infants with gestational age between 28 weeks and 34 weeks + 6 days with Respiratory Distress Syndrome (RDS) who needed surfactant administration were divided into two groups using a random sampling method. Neonates in the first group received 2 μg/kg intravenous Fentanyl infusion and neonates in group 2 received 1 μg/kg intravenous Remifentanil before elective endotracheal intubation for surfactant therapy. The vital signs, including heart rate, oxygen saturation, mean arterial blood pressure and change in facial grimace were documented in an unnamed Premature Infant Pain Profile-Revised (PIPP-R) scoring sheet individually. Video recording was performed in both groups before, during and after the endotracheal intubation. All videos and data were interpreted and scored by two Newborn Individualized Developmental Care and Assessment Program (NIDCAP) professionals. Results: The mean PIPP-R score in the Fentanyl-treated group was 13.06 ± 3.55 and in the Remifentanil-treated group was 10.75 ± 2.93, with no statistically significant difference (p = 0.054). There was less need for Naloxone use in the Remifentanil group (p < 0.001). Incidence of apnea, severe drop in oxygen saturation, Intra-Ventricular Hemorrhage (IVH) and chest rigidity were not significantly different between the two groups. Conclusion: Although the difference was not statistically significant, Remifentanil reduced the pain score more than Fentanyl during elective endotracheal intubation in preterm infants. We recommend conducting further studies with larger study populations to determine the better drug and the optimal dosage of these drugs in neonates.

Developmental Care for Preemies and their Families: One Neonatologist’s Journey toward NIDCAP Practice

Over the course of a 40+ year career in pediatrics and neonatology, I moved slowly toward the sort of developmentally sensitive practice with infants and families exemplified by the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). I was somewhat misled by early neurologic teachings, but was put on the right track during pediatric and fellowship training. Finding guidance from mentors in NIDCAP, I learned to “read” my patients’ reactions and messages, and to tailor my care to their individual capabilities and expectations. Sharing these insights with other caregivers and parents allowed me to support the infants’ neurodevelopment, to avoid negative impacts on their developing nervous systems and to discharge a more intact graduate sooner, and at less expense. NIDCAP makes for better neonatology and it is worthy, both inherently and scientifically, of your consideration.