Promoting preterm infants' development and mother child interaction : newborn individualized developmental care and assessment program

Family-centred care according to Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been increasingly introduced in Europe since the 1990's. The NIDCAP model provides a tool for observation and interpretation of preterm infant's behavioural cues, and includes guidelines on how to support the preterm infant's development and family.

The overall aim of the thesis was to investigate effects of NIDCAP as compared to conventional neonatal care on short and long-term outcomes of the preterm infant, on mother-child interaction, and on mothers' experiences of the different care regimes. The thesis also aimed to test if a structured intervention based on NIDCAP reduces pain and distress during eye xamination for retinopathy of prematurity.

Study 1 was performed at a county hospital in Sweden, and evaluated outcome at 3 years of age of two cohorts of infants with BW 500 gram.who were subjected either to conventional care or to NIDCAP in a phase lag study design. Studies 11, 111 and IV report outcomes from a randomized controlled trial performed at the level 111 NICU Karolinska University Hospital in Stockholm. Preterm inborn infants, with GA <32 weeks and need for ventilatory support at 24 hours of age were included. Study V was performed as a randomised cross-over study evaluating two eye examinations, one with a NIDCAPintervention and one with conventional care. The study was performed at two level-III NICU's, St Mary's Hospital (London, UK) and University Hospital (Lund, Sweden).

The main short-term effects from NIDCAP care (paper 11) was lower respiratory morbidity, including fewer days with CPAP and additional oxygen. At 36 weeks PMA, none of the 11 infants in the NIDCAP group displayed bronchopulmonary dysplasia in comparison to 8/11 infants in the control group. At 36 weeks PMA (paper 111), when the infants were still in hospital, the mothers of the infants in the NIDCAP group perceived more feelings of closeness and eye contact with their infants. Furthermore, they tended to rate the staff's ability to support them in their role as a mother somewhat higher, but at the same time they expressed more anxiety than did the mothers of the infants in the control group. At one year of age (paper IV), cognitive development was significantly higher for the children in the NIDCAP intervention group.

At three years of age (paper 1) there were no significant differences in overall cognitive development between the two groups in the phase lag study. However, the NIDCAP-intervention group demonstrated significantly better language skills and higher scores for mother-child interaction. The mothers' in the NIDCAP group also displayed more physical and visual contact with their children. In addition, the children cared for according to NIDCAP also demonstrated fewer behavioural problems and less internalizing problems, i.e. were more open and expressed their feelings more readily. The NIDCAP-intervention was clearly associated with a quicker recovery of the infants, as measured by lower salivary cortisol levels one hour after the eye examination (paper V). Furthermore, after the first examination when infants were 1-2 weeks younger than at the second examination, significantly fewer infants needed additional oxygen after the NIDCAP intervention.

The studies reported in this thesis show different aspects on how a behaviourally sensitive, developmentally oriented, family-centred humane care supports and promotes short-term and long-term outcomes for preterm infants and their families, as well as reduces stress in connection with a painful procedure.

List of scientific papers

I. Kleberg A, Westrup B, Stjernqvist K (2000). Developmental outcome, child behaviour and mother-child interaction at 3 years of age following Newborn Individualized Developmental Care and Intervention Program (NIDCAP) intervention. Early Hum Dev. 60(2): 123-35.
https://doi.org/10.1016/S0378-3782(00)00114-6

II. Westrup B, Kleberg A, von Eichwald K, Stjernqvist K, Lagercrantz H (2000). A randomized, controlled trial to evaluate the effects of the newborn individualized developmental care and assessment program in a Swedish setting. Pediatrics. 105(1 Pt 1): 66-72.
https://doi.org/10.1542/peds.105.1.66

III. Kleberg A, Hallstrom-Vestas L, Widstrom A-M, (2006). Mothers' perception of Newborn Individualized Developmental care and Assessment Program (NIDCAP) as compared to conventional care. Early human development. [Accepted]
https://doi.org/10.1016/j.earlhumdev.2006.05.024

IV. Kleberg A, Westrup B, Stjernqvist K, Lagercrantz H (2002). Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Early Hum Dev. 68(2): 83-91.
https://doi.org/10.1016/S0378-3782(02)00014-2

V. (2006). Lower stress response after developmental care intervention during eye examination for retinopathy of prematurity, a randomized study. [Submitted]