Newborn Individualized Developmental Care And Assessment Program Research Articles

NEURODEVELOPMENTAL CARE OF PRETERM BABIES AND ITS KEY ELEMENTS

Over the past few decades, the advancements in the perinatal and neonatal intensive care have led to a significant survival of premature infants. However neurodevelopmental outcome still remains the topical issues of concern. Developmental care is an approach that is aimed to reduce the mismatches between extra- and intra-uterine environments, decrease the stress of preterm newborns in neonative intensive care units, and thus promote optimal neurobehavioral development of the infant.The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) model was developed as a clinical framework for the implementation of developmental care. The model focuses on detailed reading of each individual infant’s behavioral cues. By observing the child during the routine manipulation performance (before, during and after) and a detailed description of his/her behavioral responses, a professional can assess the ability of the infant’s immature nervous system to tolerate the environment and care manipulations. Such evaluation will enable to determine the adequacy of environmental conditions and care manipulations to baby’s opportunities and needs, with their subsequent correction and adaptation. NIDCAP’s aim is to support the child in its increasing tolerance to stimuli and to minimize stressful events and manipulation. With the help of NIDCAP approaches in neonatal care, medical staff study how to read infants’ behavior, hear their voice and understand them.

Longitudinal Responses to Weighing and Bathing Procedures in Preterm Infants.

Knowledge of the effects of nursing-induced stress on short-term outcomes in preterm infants is limited. Effects of 2 standard nursing procedures-weighing and bathing-on autonomic and motor stability of preterm infants were studied during their hospitalization. Outcomes were evaluated during and after the procedures. Eleven preterm infants were observed between 32 and 35 weeks' postmenstrual age (PMA) (postnatal days range: 4-63). Neonatal responses were assessed according to the Synactive Theory of Development and nursing was performed taking into account Newborn Individualized Developmental Care and Assessment Program (NIDCAP) principles. Effects of the studied nursing procedures on infants' stability during and after their execution were evaluated by nonparametric statistics. During monitored procedures, stress responses in autonomic and motor systems were observed at all PMAs. However, after 32 weeks' PMA, preterm infants also showed an autonomic and motor stability recovery 5 minutes after procedure completion. Contrary to our hypothesis, preterm infants showed to be stressed by weighing and bathing procedures up to 35 weeks' PMA. However, if facilitated and supported after nursing conclusion by interventions such as swaddling and nesting, according to NIDCAP principles, they recovered autonomic and motor stability by 5 minutes after ending procedures.

Early Initiation of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduces Length of Stay: A Quality Improvement Project

Infants born at ≤32weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization. Half (50.6%) of the infants admitted to this 84-bed Level IV Neonatal Intensive Care Unit (NICU) with a gestational age of ≤32weeks were referred for NIDCAP. The specific aims of this quality improvement project were to 1) compare the age at discharge for infants meeting inclusion criteria enrolled in NIDCAP with the age at discharge for those eligible infants not enrolled in NIDCAP; and 2) investigate the timing of initiation of NIDCAP (e.g., within six days of admission) on age at discharge. During the 12month period of data collection, infants enrolled in NIDCAP (M=27.85weeks, SD=1.86) were 2.02weeks younger than those not enrolled in NIDCAP (M=29.87weeks, SD=2.49), and were 2.32weeks older at discharge (M=38.28weeks, SD=5.10) than those not enrolled in NIDCAP (M=35.96weeks, SD=5.60). Infants who enrolled within 6days of admission were discharged an average of 25days sooner (p=0.055), and at a younger post-menstrual age (by 3.33weeks on average), than those enrolled later (p=0.027).

Reflective Peer Consultation as an Intervention for Staff Support in the NICU

Professional staff members in a neonatal intensive care unit (NICU) implementing the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) expressed the need for enhancement of their well-being. The Neurorelational Framework (Lillas and Turnbull, 2009) served as a guide for supporting staff education about the science of brain development and function and the provision of trauma-informed care. This paper describes an innovative pilot project implementing a reflective peer consultation group (RPC) facilitated by an infant psychiatrist. The RPC group provided opportunities for education about stress and triggers to stressful responses, and promoted staff reflection as well as strategies to promote stress recovery. Staff reported improved physical and emotional well-being after participating in RPC groups. Additionally, group members implemented changes to their clinical practices with infants and their parents in the NICU to facilitate recovery from stress in intensive care units.

Support to mothers of premature babies using NIDCAP method: a non-randomized controlled trial

BackgroundThe Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is based on preterm infant's observation during hospitalization and considers infant's behavior as the key to evaluate the level of neurobehavioral maturation. ObjectivesTo evaluate the effectiveness of NIDCAP program on mother's support and infant development. Study DesignNon-randomized controlled study, including 43 infants of 32weeks gestation receiving either a Standard Care (SC) or NIDCAP assessment. The Nurse Parent Support Tool (NPST) was given to mothers before discharge to evaluate the support given by NICU staff. Infants' motor, visual and auditory development was investigated by a neurofunctional assessment (NFA) at term and at 3months. The effect of NIDCAP assessment on length of hospital stay and feeding status at discharge were also evaluated. ResultsMothers in the NIDCAP group awarded higher scores in the majority of the NPST items than mothers in the SC group. NFA at term resulted to be normal in a significant higher percentage of infants that underwent NIDCAP, while no difference could be detected at 3months. ConclusionsNIDCAP is an effective program to promote mothers' involvement in infants' care, that, in turn, could endorse infants' neurofunctional development in the short term.

Mothering a Preterm Infant Receiving NIDCAP Care in a Level III Newborn Intensive Care Unit

The purpose of the study is to describe the unique meaning and significance of the essential elements of mothering a preterm infant receiving Newborn Individualized Developmental Care and Assessment Program (NIDCAP) care in a level III NICU. The overall aim was to promote an increased understanding among healthcare practitioners of the experience of this group of women. The authors utilized an existential-phenomenologic method to investigate the experience of 7 mothers of a preterm infant 30weeks gestation or less at birth. Analysis of interview transcripts revealed one overarching theme, parenting with permission, and three essential themes with nine underlying subthemes: choosing to participate (subthemes: managing, settling in, making friends), dealing with people (subthemes: meeting needs, facing judgment, and recognizing not everyone is 'on board,' and coming to feel like a mother (subthemes: overcoming fear, gaining understanding, and feeling empowered). Mothers universally praised NIDCAP for the education and support it provided them. However findings also suggest that great sensitivity and patience is required by professionals to assist mothers to overcome their fear, gain confidence, and participate in NIDCAP without feeling judged. In addition private rooms were found to hold great significance for mothers and should be maintained for the entire hospitalization whenever possible. Finally, ongoing NIDCAP education/support for staff and regular team meetings to discuss and problem-solve concerns are suggested. This might address inconsistent adherence to the NIDCAP care plan by some nurses, which is the greatest source of maternal conflict and frustration.

Theoretical Development and Research Trends in Developmental Care

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synactive Theory, is applied to improve brain development in premature and illness infants within a supportive environment. The NIDCAP has been used widely in the clinical setting. The aim of this article was to systematically review research published between 2000 and 2013 that relates to the evidence and application of developmental care. Most studies support the effectiveness of developmental care in terms of facilitating the healthy growth of premature infants, reducing oxygen dependence, reducing hospitalization times, and improving neurodevelopmental outcomes at two years of age. However, research results related to the effects of developmental care on neurodevelopmental outcomes from 2 years old to school age are not consistent. The heterogeneity of interventions, outcome indicators, and measurements in studies may contribute to these mixed results. In addition, as developmental care has been applied for many years, the contamination of participants in the supportive environment should be considered. Based on current evidence, neonatal healthcare professionals must recognize the core value of developmental care in dealing with premature infants and their families. In order to provide effective interventions for infants, further research is needed to assess the comparative effects of the single intervention and the holistic approach in developmental care.

Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Family-centered developmentally supportive care: The Swedish example

The prematurely born infant is probably the most vulnerable patient in our hospitals due to the immaturity of all organ systems including the brain. Over recent years, the importance of neurodevelopmentally supportive care has been clarified. In addition, to provide the best possible treatment and environmental conditions for the vital functions of the infant to properly develop, we also must support the psychological processes of bonding and attachment between parents and their newborn infant, which is so crucial for long-term health and development. By integrating scientific findings from natural and behavioral science in multidisciplinary developmentally supportive intervention programs, recommendations for redesigning nurseries and integrating families have developed to meet these challenges. It not only is "baby- and family-friendly" but also has economic benefits and improves the long-term development of the child. The basis of family-centered developmentally supportive care interventions is the recognition that the newborn infant is a human being in his or her own right, and letting the caregivers be guided by the current needs of the individual infant and family. In this context, the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is unique since it is the only program designed to be implemented from the moment the infant is born. Different strategies can be used to support the nursing and medical teams to help the family become the primary caregivers of their own infants. Sweden has a long tradition of engaging parents in the actual care and of around-the-clock visiting hours. Nurseries have, or are remodeling to have, the facilities enabling parents to live in the units throughout the entire hospital stay. Skin-to-skin contact is widely implemented. In order to ensure that these strategies are in tune with the individual needs of the infant and the families, all major nurseries have trained NIDCAP professionals. Care and intervention based on the infant's own behavior makes good biological sense and is also ethically attractive.

Impact of a Developmental Care Training Course on the Knowledge and Satisfaction of Health Care Professionals in Neonatal Units: A Multicenter Study

The impact of health-related continuing education courses on knowledge acquisition and clinical practice is infrequently evaluated, despite higher numbers of people enrolling in them. The majority of health care professionals working in neonatal intensive care units (NICUs) have received no training in developmental care (DC). The purpose of this study was to determine whether participation in a theoretical-practical course on DC had an effect on the degree of knowledge possessed by professionals in general terms and with respect to neonatal intensive care. The relationship between course satisfaction and knowledge acquisition was also studied. This was an observational multicenter study conducted in 20 neonatal units in Madrid. A pre- and post-course questionnaire evaluated both knowledge and satisfaction levels regarding the course on DC and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). We carried out a multivariate linear regression analysis to determine whether there was a correlation between knowledge gained and satisfaction level. A total of 566 professionals participated, with a 99% pre-course and a 90% post-course response rate. The mean rate of correct pre-course answers was 65%, while the mean rate of post-course correct answers was 81% (p < 0.001). Results were similar at all levels of neonatal care (Level I: 64% vs 80%; Level II: 64% vs. 83%; and 65% vs. 81%). Scores on a scale of satisfaction from 1 to 5 were high (averages of above 4 for all lectures and workshops). Pre-course knowledge scores, but not satisfaction, significantly influenced post-course knowledge (β 0.499; p < 0.01). Previous DC knowledge among Madrid health care professionals was similar, regardless of the level of neonatal care. Course attendance significantly improved the rate of correct answers. Although course satisfaction was high, there did not seem to be a correlation between knowledge gained and satisfaction.

Le programme NIDCAP (Newborn Individualized Developmental Care and Assessment Program). Principes et théorie

Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a program of care that aims to support the development of preterm infants. This program applies during hospitalisation of the child and his parents in neonatology. This support begins at birth, and it is integrated into medical and nursing care. This personalized care is centered on the premature child and his family. NIDCAP is based on the synactive theory of infant development described by Heidelise Als in 1982. According to this theory, observing the behavior of prematurity based on 5 systems (autonomic, motor, sleep-wake, attentional and self-regulatory) allows to adapt care at skills of the child. Caregiving development used correspond firstly to environmental strategies (control of sound and visual stimulation) and other behavioral strategies (swaddling, non-nutritive sucking, early skin-to-skin…). The role of parents and support breastfeeding are also central on the organization of care. NIDCAP that integrates these techniques and individualized care has shown efficacy in the neonatal period and the development of children up to 2years.

From the Japan Association of Research on Developmental Care

The review article titled “NIDCAP: A Systematic Review and Meta-analyses of Randomized Controlled Trials,” by Arne Ohlsson and Susan E. Jacobs (Pediatrics 131[3], March 2013, e881–e893), encouraged us to pursue our efforts to introduce the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) to Japan, despite their misleading conclusion, because their data show better outcomes in several respects for infants cared for by NIDCAP, without ill effects. Japanese statistics on survival rates and long-term outcomes of premature infants, especially extremely low birth weight infants, are better than those of North America and of European countries. But we are concerned about the high incidence of ADHD, autism, and learning disorders among those who avoid major neurologic handicaps. These disorders are known to be related to high-level brain function impairment and are speculated to result from continuous, excessive stress to these infants during their stay in the NICU. Therefore, we are switching from aggressive medical treatments to save lives and lower major neurologic sequelae to gentle, nurturing care. There are also substantial basic research studies to support this approach, such as increment of apoptosis of neurons in the frontal lobe. We know statistics often obscure the reality behind the clinical data, especially those on multifactorial clinical outcomes. Because their article shows that NIDCAP does not compromise the outcomes of premature infants, we continue to provide gentle care to our most vulnerable infants while improving our modalities and skills.

Necessary resources and barriers perceived by professionals in the implementation of the NIDCAP

BackgroundThe implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires a significant effort from all professionals involved. AimTo determine the necessary requirements and barriers perceived by health professionals in the implementation of the NIDCAP. Study designA questionnaire covering requirements and obstacles perceived in the implementation of the NIDCAP was developed and validated in two Spanish level III neonatal intensive care units. The questionnaire was answered by 305 health professionals (response rate of 85%). ResultsThe requirements identified in the questionnaire were considered by most respondents as necessary to implementing the NIDCAP, especially more time, education, and staff. Nurses, compared to doctors, thought that more staff was necessary (93% vs. 74%; p<.01). The main obstacle identified in the survey was lack of coordination among different professionals (77%), followed by noise level in the unit (35%). Doctors, in comparison to nurses, considered noise level (61% vs. 23%; p<.01) and nursing staff (56% vs. 29%; p=.05) the most relevant obstacles to NIDCAP implementation. The more experienced professionals perceived their own colleagues as an obstacle, particularly among nursing staff. ConclusionsThe implementation of the NIDCAP requires a series of conditions that confirm it is not a trivial process but rather a somewhat laborious one. The lack of coordination among different professionals is often considered the main obstacle.

NIDCAP: A Systematic Review and Meta-analyses of Randomized Controlled Trials

The "synactive" theory of neurobehavioral development forms the basis of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Our objective was to assess the effectiveness of NIDCAP in improving outcomes in preterm infants. Medline, CINAHL, Embase, PsychInfo, The Cochrane Library, Pediatric Academic Societies' Abstracts and Web of Science were searched in July 2010 and February 2012. The studies selected were randomized controlled trials testing the effectiveness of NIDCAP on medical and neurodevelopmental outcomes. The authors abstracted baseline characteristics of infants and outcomes. The risk of bias was assessed by using Cochrane criteria. RevMan 5.1 was used to synthesize data by the use of relative risk and risk difference for dichotomous outcomes and mean or standardized mean difference for continuous outcomes. Eleven primary and 7 secondary studies enrolling 627 neonates were included, with 2 of high quality. The composite primary outcomes of death or major sensorineural disability at 18 months corrected age or later in childhood (3 trials, 302 children; relative risk 0.89 [95% confidence interval 0.61 to 1.29]) and survival free of disability at 18 months corrected age or later in childhood (2 trials, 192 infants; relative risk 0.97 [95% confidence interval 0.69 to 1.35]), were not significantly different between the NIDCAP and control groups. With the sensitivity analysis that excluded the 2 statistically heterogeneous outlying studies, there were no significant differences between groups for short-term medical outcomes. This systematic review including 627 preterm infants did not find any evidence that NIDCAP improves long-term neurodevelopmental or short-term medical outcomes.

Staff perceptions on Newborn Individualized Developmental Care and Assessment Program (NIDCAP) during its implementation in two Spanish neonatal units

BackgroundThe implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires great effort. Few studies evaluating staff perception of NIDCAP exist, especially in Southern Europe, and these few studies usually have a low representation of the medical staff. AimsExploration of staff perception (neonatologists, nurses and nursing assistants) of NIDCAP during its implementation and their attitude towards it and intention to put it into practice. Study designThis study is a descriptive survey measuring staff perceptions of NIDCAP and its effects on their work in two Spanish neonatal level III intensive care units (NICUs). Validated questionnaires were distributed to neonatologists, nurses and nursing assistants of which 305 were completed (response rate: 85%). ResultVirtually all the items which assess the infant's well being and the parents' role received a positive evaluation. However, three items got slightly negative evaluations: NIDCAP was more time consuming and nurses' working conditions and lighting in the unit were less optimal than in earlier practices. The professionals also had a positive attitude and a willingness to use the NIDCAP. Neonatologists perceived NIDCAP more positively than the nursing staff with statistically significant differences. ConclusionThe neonatal unit staff in two Spanish NICUs perceived NIDCAP positively. This assessment is more positive for neonatologists than for nurses.

NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction.

Objective:The effect of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) was examined on the neurobehavioral, electrophysiological and neurostructural development of preterm infants with severe intrauterine growth restriction (IUGR).Study Design:A total of 30 infants, 27–33 weeks gestation, were randomized to control (C; N=17) or NIDCAP/experimental (E; N=13) care. Baseline health and demographics were assessed at intake; electroencephalography (EEG) and magnetic resonance imaging (MRI) at 35 and 42 weeks postmenstrual age; and health, growth and neurobehavior at 42 weeks and 9 months corrected age (9 months).Results:C and E infants were comparable in health and demographics at baseline. At follow-up, E infants were healthier, showed significantly improved brain development and better neurobehavior. Neurobehavior, EEG and MRI discriminated between C and E infants. Neurobehavior at 42 weeks correlated with EEG and MRI at 42 weeks and neurobehavior at 9 months.Conclusion:NIDCAP significantly improved IUGR preterm infants' neurobehavior, electrophysiology and brain structure. Longer-term outcome assessment and larger samples are recommended.

School age effects of the Newborn Individualized Developmental Care and Assessment Program for medically low-risk preterm infants: Preliminary findings

Background:By school-age, even low-risk moderately preterm-born children show more neuro-cognitive deficits, motor impairments, academic underachievement, behavioral problems, and poor social adaptation than full-term peers.Aim:To evaluate the outcomes at school-age for moderately preterm-born children (29-33 weeks gestational age), appropriate in growth for gestational age (AGA) and medically at low-risk, randomized to Newborn Individualized Developmental Care and Assessment Program (NIDCAP) or standard care in the Newborn Intensive Care Unit. At school-age, the experimental (E) group will show better neuropsychological and neuro-electrophysiological function, as well as improved brain structure than the control (C) group.Materials and Methods:The original sample consisted of 30 moderately preterm-born infants (29 to 33 weeks), 23 (8C and 15E) of them were evaluated at 8 years of age, corrected-for-prematurity with neuropsychological, EEG spectral coherence, and diffusion tensor magnetic resonance imaging (DT-MRI) measures.Results:E-performed significantly better than C-group children on the Kaufman Assessment Battery for Children-Second Edition (KABC-II) and trended towards better scores on the Rey-Osterrieth Complex Figure Test. They also showed more mature frontal and parietal brain connectivities, and more mature fiber tracts involving the internal capsule and the cingulum. Neurobehavioral results in the newborn period successfully predicted neuropsychological functioning at 8 years corrected age.Conclusion:Moderately preterm infants cared for with the NIDCAP intervention showed improved neuropsychological and neuro-electrophysiological function as well as improved brain structure at school-age.

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants.

State-of-the-art Newborn Intensive Care Units (NICUs), instrumental in the survival of high-risk and ever-earlier-born preterm infants, often have costly human repercussions. The developmental sequelae of newborn intensive care are largely misunderstood. Developed countries eager to export their technologies must also transfer the knowledge-base that encompasses all high-risk and preterm infants' personhood as well as the neuro-essential importance of their parents. Without such understanding, the best medical care, while assuring survival jeopardizes infants' long-term potential and deprives parents of their critical role. Exchanging the womb for the NICU environment at a time of rapid brain growth compromises preterm infants' early development, which results in long-term physical and mental health problems and developmental disabilities. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) aims to prevent the iatrogenic sequelae of intensive care and to maintain the intimate connection between parent and infant, one expression of which is Kangaroo Mother Care. NIDCAP embeds the infant in the natural parent niche, avoids over-stimulation, stress, pain, and isolation while it supports self-regulation, competence, and goal orientation. Research demonstrates that NIDCAP improves brain development, functional competence, health, and life quality. It is cost effective, humane, and ethical, and promises to become the standard for all NICU care.

The Evolving Practice of Developmental Care in the Neonatal Unit: A Systematic Review

ABSTRACTMany neonatal intensive care units (NICUs) are experiencing changes in their approaches to preterm infant care as they consider and incorporate the philosophy of individualized developmental care. The aim of this systematic review is to research current literature documenting the short-term effects of developmental care and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). The following databases were reviewed: PubMED, CINAHL, and PsychINFO by using the keywords developmental care, individualized care, preterm infant, early intervention, and NIDCAP. Fifty-four articles were found with a total of 15 matching the selection criteria. All 15 articles were assessed using a research design developed by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM). Twelve of the 15 articles contained strong Levels of Evidence (I or II). Our findings suggest evidence supporting developmental care and NIDCAP, however, further research documenting outcomes for preterm infants receiving developmental care and/or NIDCAP is needed.

Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction?

This study investigates the effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on neurobehavioral and electrophysiological functioning of preterm infants with severe intrauterine growth restriction (IUGR). Thirty IUGR infants, 28 to 33 weeks gestational age, randomized to standard care (control/C=18), or NIDCAP (experimental/E=12), were assessed at 2 weeks corrected age (2wCA) and 9 months corrected age (9mCA) in regard to health, anthropometrics, and neurobehavior, and additionally at 2wCA in regard to electrophysiology (EEG). The two groups were comparable in health and anthropometrics at 2wCA and 9mCA. The E-group at 2wCA showed significantly better autonomic, motor, and self-regulation functioning, improved motility, intensity and response thresholds, and reduced EEG connectivity among several adjacent brain regions. At 9mCA, the E-group showed significantly better mental performance. This is the first study to show NIDCAP effectiveness for IUGR preterm infants.