Developmentally supportive neonatal care : a study of the newborn individualized developmental care and assessment program (NIDCAP) in a Swedish environment

Abstract

A family-centred, developmentally supportive approach to newborn intensive care, referred to as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has attracted considerable interest in recent years. Studies performed in North America have reported that NIDCAP improves short-term growth, decreases the need for respiratory support, decreases the length and cost of hospitalisation, and improves neurodevelopment. The aim of the present study was to characterise the effects of NIDCAP in Swedish settings.

Accordingly, we investigated the effects of NIDCAP on two different Swedish cohorts of infants born prematurely. The first group, the medium-risk cohort (1,11), constituted of infants with a birthweight of less than 1500 grams born at a county hospital with a neonatal intensive care unit. The other group, the high-risk cohort (III,IV,V), was composed of infants from a tertiary intensive care unit born with a gestational age of <32 weeks and with need for ventilatory assistance (CPAP or mechanical ventilation) during the initial 24 hours of life.

During the neonatal period, we observed a decreased incidence of pulmonary morbidity among the NIDCAP infants in the high-risk cohort (111). At a postconceptional age of 36 weeks, 40% of the infants in the control group demonstrated radiological findings indicative of moderate to severe bronchopulmonary dysplasia and 70% required supplementary oxygen; whereas, in contrast, none of the infants in the intervention group exhibited such findings or requirement. This difference in pulmonary morbidity was also reflected in a shorter mean duration of CPAP treatment by 17 days in the NIDCAP group.

In the high-risk cohort, we examined quiet sleep at the postconceptional ages of 32 and 36 weeks (IV). We could not detect any significant difference in the amount of quiet sleep by the NIDCAP and control infants, but the variation of the percentage of time spent in quiet sleep was significantly reduced in the former group.

At one-year follow-up of the high-risk cohort employing the Bayley Scales of Infant Development, overall cognition was found to be significantly better in the NIDCAP group (V). This was in contrast to the three-year follow-up of the medium-risk cohort, which did not reveal any differences in neurodevelopment, as assessed employing the Griffiths' Developmental Scales. Nevertheless, in this latter case there were significant differences in favour of the NIDCAP group with respect to child behaviour and mother-child interaction (II). In connection with follow-up of the high-risk cohort at 5 years of age, we detected a significant impact of NIDCAP only on behavioural parameters, but there were pronounced similar tendencies with regards to general cognitive function and incidence of disability (VI).

In order to assess the staff ´s view on the implementation of NIDCAP, we performed a survey at the unit where the study on the medium-risk cohort had been conducted. This staff reported a positive impact on the infants and their families, as well as on their own working conditions (I).

In summary, the present study indicates that NIDCAP may have beneficial effects on infants born very prematurely in Sweden. We observed indications of positive impact on short- term pulmonary morbidity, as well as on long-term decreased behavioural problems and mother- infant interaction. Furthermore, Swedish nursing personnel appear to be convinced of the positive effects of NIDCAP and cooperate readily in its implementation.