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Klein V, Zores-Koenig C, Dillenseger L, Langlet C, Escande B, Astruc D, Le Ray I, Kuhn P. Changes of Infant- and Family-Centered Care Practices Administered to Extremely Preterm Infants During Implementation of the NIDCAP Program. Front Pediatr 2021; 9:718813. [PMID: 34540769 PMCID: PMC8446645 DOI: 10.3389/fped.2021.718813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Valérie Klein
- Service de Pédiatrie, Centre Hospitalier de Haguenau, Haguenau, France
| | - Claire Zores-Koenig
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Laurence Dillenseger
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Claire Langlet
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Benoît Escande
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Dominique Astruc
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Isabelle Le Ray
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.,Service d'Obstétrique-Gynécologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pierre Kuhn
- Service de Médecine et Réanimation du Nouveau-né, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.,Institut de Neurosciences Cellulaires et Intégratives, CNRS, Université de Strasbourg, Strasbourg, France
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Sannino P, Giannì ML, De Bon G, Fontana C, Picciolini O, Plevani L, Fumagalli M, Consonni D, Mosca F. Support to mothers of premature babies using NIDCAP method: a non-randomized controlled trial. Early Hum Dev 2016; 95:15-20. [PMID: 26900776 DOI: 10.1016/j.earlhumdev.2016.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/26/2015] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The 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. OBJECTIVES To evaluate the effectiveness of NIDCAP program on mother's support and infant development. STUDY DESIGN Non-randomized controlled study, including 43 infants of 32 weeks 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 3 months. The effect of NIDCAP assessment on length of hospital stay and feeding status at discharge were also evaluated. RESULTS Mothers 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 3 months. CONCLUSIONS NIDCAP is an effective program to promote mothers' involvement in infants' care, that, in turn, could endorse infants' neurofunctional development in the short term.
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Affiliation(s)
- Patrizio Sannino
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Milano, Italy.
| | - Maria Lorella Giannì
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Giovanna De Bon
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Camilla Fontana
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Odoardo Picciolini
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Laura Plevani
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Monica Fumagalli
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
| | - Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Epidemiology Unit, Department of Preventive Medicine, Via San Barnaba 8, 20122 Milan, Italy.
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, 20122 Milano, Italy.
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Gallo KP, Hill LC, Hoagwood KE, Olin SCS. A Narrative Synthesis of the Components of and Evidence for Patient- and Family-Centered Care. Clin Pediatr (Phila) 2016; 55:333-46. [PMID: 26116351 PMCID: PMC5555419 DOI: 10.1177/0009922815591883] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A narrative synthesis was conducted to determine typical patient- and family-centered care (PFCC) components and their link to outcomes in pediatric populations. 68 studies with PFCC interventions and experimental designs were included. Study features were synthesized based on 5 core PFCC components (i.e., education from the provider to the patient and/or family, information sharing from the family to the provider, social-emotional support, adapting care to match family background, and/or s decision-making) and 4 outcome categories (health status; the experience, knowledge, and attitudes of the patient/family; patient/family behavior; or provider behavior). The most common PFCC component was education; the least common was adapting care to family background. The presence of social-emotional support alone, as well as educational interventions augmented with shared decision-making, social-emotional support, or adaptations of care based on family background, predicted improvements in families' knowledge, attitudes, and experience. Interventions that targeted the family were associated with positive outcomes.
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Affiliation(s)
- Kaitlin P. Gallo
- The Child Study Center at NYU Langone Medical Center, New York, NY
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Zhang X, Lee SY, Chen J, Liu H. Factors Influencing Implementation of Developmental Care Among NICU Nurses in China. Clin Nurs Res 2014; 25:238-53. [PMID: 25155801 DOI: 10.1177/1054773814547229] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main aim of this article is to describe current developmental care nursing practices among registered nurses (RNs) working in neonatal intensive care units (NICUs) in China and to explore selected personal and unit characteristics related to developmental care implementation. A convenience sample of 207 RNs participated in this descriptive, cross-sectional exploratory study. A tool of Practice Standards for Individualized, Family-Centered Developmental Care was used to collect the data. The findings indicate that Chinese NICU nurses are not implementing developmental care consistently. Higher patient caseloads, fewer work hours per day, higher level of education, and fewer years worked in NICUs are the significant predictors for lower implementation of developmental care. NICU nurses in China currently carry out developmental care based mainly on their accumulated clinical experience rather than their educational experience. More systematic developmental care training for NICU nurses and more support at both unit and hospital levels are necessary in China.
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Affiliation(s)
- Xin Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shih-Yu Lee
- Hungkuang University, Taiwan, Republic of China
| | - Jingli Chen
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huaping Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Kardaş Özdemir F, Güdücü Tüfekci F. The effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants: the effect of mother's scent and flexion position. J Clin Nurs 2013; 23:3036-44. [DOI: 10.1111/jocn.12407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Fatma Güdücü Tüfekci
- Pediatric Nursing Department; Health Science Faculty; Atatürk University; Erzurum Turkey
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Legendre V, Burtner PA, Martinez KL, Crowe TK. The evolving practice of developmental care in the neonatal unit: a systematic review. Phys Occup Ther Pediatr 2011; 31:315-38. [PMID: 21391836 DOI: 10.3109/01942638.2011.556697] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many 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.
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Affiliation(s)
- Valerie Legendre
- Division of Occupational Therapy, University of New Mexico, Albuquerque, New Mexico, USA.
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Abstract
Family-centered developmental care is an essential element of neonatal intensive care. It is of particular importance when the infant is vulnerable and at greater risk for poor outcomes complicated by a family unit that is easily challenged by the unique needs of the infant. Yet, all infants and their families deserve this philosophy of caregiving. Family-centered developmental care must continue to be tested through research to determine which interventions work, what does not work, and which interventions need further refinement. This article provides a brief history of where we have been in neonatal caregiving, provides definitions for family-centered developmental caregiving and offers some "predictions" about where these practices need to be in the next century. Research questions and strategies are also addressed. As we continue to forge ahead integrating this philosophy into the caregiving arena, it is important to remember that there are many unanswered questions.
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Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol 2009; 36:737-62, v. [PMID: 19944833 DOI: 10.1016/j.clp.2009.07.014] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
New discoveries in neonatal imaging, cerebral monitoring, and hemodynamics, and greater understanding of inflammatory and genetic mechanisms involved in intracranial hemorrhage (ICH) in the preterm infant are creating opportunities for innovative early detection and prevention approaches. This article covers the spectrum of ICH in the preterm infant, including germinal matrix intraventricular hemorrhage, its complications, and associated phenomena, such as the emerging role of cerebellar hemorrhage. The overall aim of this article is to review the current knowledge of the mechanisms, diagnosis, outcome, and management of preterm ICH; to revisit the origins from which they develop; and to discuss future expectations.
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Affiliation(s)
- Haim Bassan
- Pediatric Neurology Unit, Neonatal Neurology Service, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel.
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Maguire CM, Walther FJ, Sprij AJ, Le Cessie S, Wit JM, Veen S. Effects of individualized developmental care in a randomized trial of preterm infants <32 weeks. Pediatrics 2009; 124:1021-30. [PMID: 19786441 DOI: 10.1542/peds.2008-1881] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to investigate the effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on days of respiratory support and intensive care, growth, and neuromotor development at term age for infants born at <32 weeks. METHODS Infants were assigned randomly, within 48 hours after birth, to a NIDCAP group or basic developmental care (control) group. The NIDCAP intervention consisted of weekly formal behavioral observations of the infants and caregiving recommendations and support for staff members and parents, as well as incubator covers and positioning aids. The control group infants were given basic developmental care, which consisted of only incubator covers and positioning aids. Outcome measures were respiratory support, intensive care, and weight of <1000 g. Growth parameters were measured weekly or biweekly and at term age. Neuromotor development was assessed at term age. RESULTS A total of 164 infants met the inclusion criteria (NIDCAP: N = 81; control: N = 83). In-hospital mortality rates were 8 (9.9%) of 81 infants in the NIDCAP group and 3 (3.6%) of 83 infants in the control group. No differences in mean days of respiratory support (NIDCAP: 13.9 days; control: 16.3 days) or mean days of intensive care (NIDCAP: 15.2 days; control: 17.0 days) were found. Short-term growth and neuromotor development at term age showed no differences, even with correction for the duration of the intervention. CONCLUSIONS NIDCAP developmental care had no effect on respiratory support, days of intensive care, growth, or neuromotor development at term age.
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Affiliation(s)
- Celeste M Maguire
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
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Wallin L, Eriksson M. Newborn Individual Development Care and Assessment Program (NIDCAP): a systematic review of the literature. Worldviews Evid Based Nurs 2009; 6:54-69. [PMID: 19413582 DOI: 10.1111/j.1741-6787.2009.00150.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Important advancements have been made in the care of preterm infants. Health services have introduced various methods aimed at promoting attachment, breastfeeding, and neurological development. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), developed to stimulate preterm infants at levels adapted to the child's degree of neurological maturity, is increasingly being used. OBJECTIVES The aim was to investigate the impact of NIDCAP on the psychomotor development, neurological status, medical/nursing care outcomes, and parental perceptions. A further aim was to evaluate the cost-related effects of NIDCAP. DATA EXTRACTION AND ANALYSIS A literature search up to September 2007 was performed. The reviewed papers were assessed for methodological quality and only statistically significant findings were extracted. FINDINGS The evidence compiled on the effects of NIDCAP is based on 12 articles from six randomized controlled trials that included approximately 250 children. Each of the studies was assessed as having medium quality. Most of the studies were small and many investigated a huge number of outcome variables, which decreased their scientific strength. On outcome variables in which a significant difference was found between the intervention (NIDCAP) and control groups, most studies showed better results for the NIDCAP group. This was particularly valid for cognitive and psychomotor development. Four studies also showed a reduced need for respiratory support for the NIDCAP group. No studies were identified that weighed the total cost of NIDCAP against its effects. CONCLUSIONS Despite promising findings, primarily on cognitive and motor development, the scientific evidence on the effects of NIDCAP is limited. Shortcomings in design and methods in the reviewed studies hamper far-reaching claims on the effectiveness of the method. Scientific grounds for assessing the effects of NIDCAP would be substantially enhanced by a sufficiently comprehensive study with extended follow-up and a clear focus on a few important outcome variables.
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Affiliation(s)
- Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute and Clinical Research Utilization (CRU), Karolinska University Hospital, Stockholm, Sweden.
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Wielenga JM, Smit BJ, Merkus MP, Wolf MJ, van Sonderen L, Kok JH. Development and growth in very preterm infants in relation to NIDCAP in a Dutch NICU: two years of follow-up. Acta Paediatr 2009; 98:291-7. [PMID: 18793293 DOI: 10.1111/j.1651-2227.2008.01038.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study development and growth in relation to newborn individualized developmental and assessment program (NIDCAP) for infants born with a gestational age of less than 30 weeks. METHODS Developmental outcome of surviving infants, 25 in the NIDCAP group and 24 in the conventional care group, in a prospective phase-lag cohort study performed in a Dutch level III neonatal intensive care unit (NICU) was compared. Main outcome measure was the Bayley scales of infant development-II (BSID-II) at 24 months corrected age. Secondary outcomes were neurobehavioral and developmental outcome and growth at term, 6, 12 and 24 months. RESULTS Accounting for group differences and known outcome predictors no significant differences were seen between both care groups in BSID-II at 24 months. At term age NIDCAP infants scored statistically significant lower on neurobehavioral competence; motor system (median [IQR] 4.8 [2.9-5.0] vs. 5.2 [4.3-5.7], p = 0.021) and autonomic stability (median [IQR] 5.7 [4.8-6.7] vs. 7.0 [6.0-7.7], p = 0.001). No differences were seen in other developmental outcomes. After adjustment for background differences, growth parameters were comparable between groups during the first 24 months of life. CONCLUSION At present, the strength of conclusions to be drawn about the effect of NIDCAP on developmental outcome or growth at 24 months of age is restricted. Further studies employing standardized assessment approaches including choice of measurement instruments and time points are needed.
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Affiliation(s)
- J M Wielenga
- Department of Neonatology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.
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Affiliation(s)
- K J S Anand
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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