Effects of individualized developmental care in a randomized trial of preterm infants <32 weeks

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.

Follow-up outcomes at 1 and 2 years of infants born less than 32 weeks after Newborn Individualized Developmental Care and Assessment Program

OBJECTIVE

This was a randomized, controlled trial to investigate the effect of Newborn Individualized Developmental Care and Assessment Program on growth, cognitive, psychomotor, and neuromotor development at 1 and 2 years in infants born at <32 weeks' gestational age.

METHODS

Infants were randomly assigned within 48 hours of birth to the newborn individualized developmental care and assessment program group (intervention) or basic developmental care group (control group [ie, incubator covers and nests]). At 1 and 2 years' corrected age, growth was measured and standardized neurologic examinations were administered. Mental and psychomotor development was assessed by using the Dutch version of the Bayley Scales of Infant Development II. Neurologic outcome, Psychomotor Developmental Index, and Mental Developmental Index scores were combined a total outcome measure.

RESULTS

One hundred sixty-eight infants were recruited (intervention: 84; control: 84). Four infants (newborn intervention: 3; control: 1) were excluded because they were admitted less than or died within the first 5 days, leaving a total of 164 infants who met inclusion criteria. In-hospital mortality was 8 of 81 in the intervention group and 3 of 83 in the control group. At 1 year of age 148 children (intervention: 70; control: 78) and at 2 years of age 146 children (intervention: 68; control: 78) were assessed. There was no significant difference in growth at 1 and 2 years of age. There was no significant difference found in neurologic outcomes or mental and psychomotor development at 1 and 2 years of age. When neurologic outcome, Mental Developmental Index and Psychomotor Developmental Index scores were combined, there still remained no significant difference.

CONCLUSIONS

Newborn individualized developmental care and assessment program developmental care showed no effect on growth or neurologic, mental, or psychomotor development at 1 and 2 years of age in infants born at <32 weeks. Duration of the intervention was not associated with neurologic and developmental outcome.

No change in developmental outcome with incubator covers and nesting for very preterm infants in a randomised controlled trial

OBJECTIVE

To investigate in a randomised controlled trial the effect of basic elements of developmental care (incubator covers and positioning aids) on growth and neurodevelopment in infants born at < 32 weeks.

METHOD

Infants were randomised within 48 h of birth to a developmental care (DC) or standard care (C) group. Outcome measures at 1 and 2 years corrected age were growth, standardised neurological examinations, and mental (MDI) and psychomotor (PDI) development (Dutch version of the Bayley Scales of Infant Development II).

RESULTS

192 infants were recruited (DC = 98; C = 94). Thirteen infants (DC = 7, C = 6) were excluded because they were admitted for <5 days or died within the first 5 days. In total, 179 infants met the inclusion criteria. In-hospital mortality was 12/91 (13.2%) in the DC group and 8/88 (9.1%) in the C group. Assessments were carried out on 147 children (DC = 74, C = 73) at 1 year and 142 children (DC = 72, C = 70) at 2 years. No significant difference in growth, neurological outcomes or MDI was found. A positive trend in PDI at 1 year (p = 0.05) did not continue once the children reached 2 years. There was no difference found when neurological and developmental scores were combined.

CONCLUSIONS

Basic developmental care has no positive effect on neurological and mental development or growth at 1 and 2 years of age in infants born at <32 weeks. A positive effect on psychomotor development at 1 year did not continue at 2 years of age.

Health-related quality of life of very preterm infants at 1 year of age after two developmental care-based interventions

BACKGROUND

In the context of a growing interest in developmental care (DC) this study explores the effect of the basic elements of DC and the additional effect of the individual approach of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on the health-related quality of life (HRQoL) of very preterm infants at 1 year of age. The basic elements of DC in this study were defined as the use of standardized nests and incubator covers whose protective characteristics were hypothesized to have a positive effect on the infant's HRQoL. The individualized approach of the NIDCAP was thought to further increase HRQoL.

METHODS

Very preterm (<or=32 weeks) born infants in a Dutch Neonatal Intensive Care Unit at two locations were included in two consecutive randomized controlled trials (RCT) comparing controls (standard care) with basic DC (standardized nests and covers) in the first RCT and basic DC with NIDCAP in the second RCT. Parents completed a questionnaire (RCT 1, n=136; RCT 2, n=128) regarding their infant's HRQoL (TNO-AZL Preschool Quality of Life Questionnaire) at 1 year of age, corrected for prematurity. Because of multiple testing a P-value of below 0.01 was chosen to indicate significance.

RESULTS

HRQoL scores ranged from good to optimal for most infants. No significant differences were found between basic DC vs. controls and NIDCAP vs. basic DC on the child's HRQoL as reported by parents at 1 year of age.

CONCLUSIONS

These two RCT show that the basic elements of DC and the more individualized NIDCAP do not improve HRQoL of very preterm infants at 1 year of age.

Effects of basic developmental care on neonatal morbidity, neuromotor development, and growth at term age of infants who were born at <32 weeks

OBJECTIVE

The goal of this study was to investigate the effect of basic elements of developmental care (incubator covers and positioning aids) on days of respiratory support and intensive care, growth, and neuromotor development at term age in infants who were born at <32 weeks' gestation.

METHODS

Infants were randomly assigned within 48 hours of birth to the developmental care group or the standard care control group (no covers or nests). The intervention continued until the infant either was transferred to a regional hospital or was discharged from the hospital. Length, weight, and head circumference were measured (bi)weekly and at term age. Neuromotor development was defined as definitely abnormal (presence of a neonatal neurologic syndrome, such as apathy or hyperexcitability, hypotonia or hypertonia, hyporeflexia or hyperreflexia, hypokinesia or hyperkinesia, or a hemisyndrome), mildly abnormal (presence of only part of such a syndrome), or normal.

RESULTS

A total of 192 infants were included (developmental care: 98; control: 94). Thirteen infants (developmental care: 7; control: 6) were excluded according to protocol (admitted for less than or died within the first 5 days: n = 12; taken out at parents' request: n = 1), which left a total of 179 infants who met inclusion criteria. In-hospital mortality was 12 (13.2%) of 91 in the developmental care group and 8 (9.1%) of 88 in the control group. There was no significant difference in the number of days of respiratory support, number of intensive care days, short-term growth, or neuromotor developmental outcome at term age between the developmental care and control groups. Duration of the intervention, whether only during the intensive care period or until hospital discharge, had no significant effect on outcome.

CONCLUSIONS

Providing basic developmental care in the NICU had no effect on short-term physical and neurologic outcomes in infants who were born at <32 weeks' gestation.

Parental experiences during the first period at the neonatal unit after two developmental care interventions

AIM

Developmental care has gained increased attention in the individualized care for preterm infants. This study was designed to explore the effect of a basic form of developmental care and the more extended Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on parental stress, confidence and perceived nursing support.

METHODS

Two consecutive randomized controlled trials (RCT's) comparing (1) standard care versus basic developmental care (standardized nests and incubator covers) (n = 133) and (2) basic developmental care versus NIDCAP, including behavioural observations (n = 150). Parents of infants born <32 weeks gestational age (GA) received questionnaires after the first week of admission in the neonatal unit and on average these 2 weeks after the birth of their infant.

RESULTS

No significant differences were found in confidence, perceived nursing support or parental stress. The difference in parental stress between mother and father was less in the NIDCAP intervention group (p = .03), although not significant.

CONCLUSION

Both basic developmental care and NIDCAP had little effect on parental experiences during the first period at the neonatal unit. As a result of increased paternal stress, the NIDCAP intervention tended to decrease the difference in parental stress levels of fathers and mothers, possibly because of the increased involvement of father during the NIDCAP intervention.

Staff opinions regarding the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

This study explored the opinions of (para)medical and nursing staff in two Dutch Neonatal Intensive Care Units (NICU's). A questionnaire was used that measured: a) the perceived impact of NIDCAP on several NICU conditions, b) attitudes, subjective norm, perceived behavioral control, knowledge and abilities of using the NIDCAP method (based on the Theory of Planned Behavior) and c) training interest, requirements, information sources and the relevance of the NIDCAP method for different groups of NICU patients. Respondents were positive about NIDCAP and felt that using NIDCAP is fulfilling and leads to improvement of the infant's development, health and well-being. However, NIDCAP was also thought to be time-consuming and might worsen job conditions. The nursing staff, compared to the medical staff, had a more positive attitude (p=.004), higher perceived behavioral control (p=.004) and perceived a more positive impact of NIDCAP on NICU conditions (p=.008).

Reading preterm infants' behavioral cues: an intervention study with parents of premature infants born <32 weeks

The effect of a short-term intervention with parents in the Neonatal Intensive Care Unit (NICU) on their knowledge of infant behavioral cues and confidence in caregiving was examined. Ten sets of parents with a total of 22 premature infants born <32 weeks gestational age admitted to a NICU were enrolled in a time-lag control trial over an 8-month period. The intervention group was given 4 sessions of instructions on preterm infant behavior for a period of 2 weeks. The control group did not receive the instructions. All parents completed two subscales of the Mother and Baby Scale (MABS) at weeks 1 and 3 and a short questionnaire concerning nursing support at week 3. Intervention parents completed a pre- and post-test on knowledge of preterm infant behavioral cues at weeks 1 and 3. There was a significant improvement in the post-test scores concerning knowledge of preterm infant behavioral cues and a higher nursing support score for mothers in the intervention group. Intervention mothers showed no significant improvement in confidence in caregiving. Only half of the intervention group fathers participated in the sessions and there were no significant differences in fathers' scores. While the intervention significantly increased maternal knowledge of infant behavioral cues, there was no significant effect on mothers' confidence in caregiving. Very few fathers participated in the entire intervention. A longer, more intensive program with a larger sample size and finding ways of incorporating more participation from fathers is recommended.

Case report: lamivudine therapy for submassive hepatic necrosis due to reactivation of hepatitis B following chemotherapy

This report describes the case of a 53-year-old woman who developed severe hepatitis following chemotherapy for breast carcinoma. The patient was hepatitis B surface antigen positive, e antigen negative and e antibody positive and had high levels of hepatitis B virus-DNA. Liver biopsy revealed submassive hepatic necrosis, consistent with reactivation of hepatitis B. Treatment with lamivudine resulted in rapid loss of hepatitis B virus-DNA, resolution of hepatitis and clinical recovery.

Comparison of [125I]-bolton-hunter substance P binding in young and aged rat spinal cord

Binding of [125I]-labeled Bolton-Hunter substance P ([125I]-BHSP) to NK1 receptors was investigated in the spinal cord of young (3-4 month) and aged (14-16 month) rats. In homogenates of whole spinal cord, the affinity (equilibrium dissociation constant, approximately 210 pM) and maximum density of [125I]-BHSP binding sites ( approximately 0.25 fmol/mg wet weight) were similar for young and aged rats. Autoradiographic studies revealed a similar distribution of [125I]-BHSP sites in both young and old rats at all spinal levels. Intense binding was observed in the superficial dorsal horn (laminae I-III), grey commissure (lamina X) and thoracic intermediolateral cell column (IML) with lower levels of binding in the deeper dorsal horn (laminae IV-VI) and ventral horn (laminae VII-IX). However, the density of [125I]-BHSP sites was significantly (P<0.05) lower in lamina X of lumbar sections of aged rats compared with young controls. These studies suggest that ageing is associated with a selective loss of NK1 receptors in lamina X of the lumbar spinal cord, although the affinity of NK1 receptors in aged rats is unchanged.