Newborn Individualization Developmental Care and Assessment Program (NIDCAP)

 

OVERVIEW

The Newborn Individualization Developmental Care and Assessment Program (NIDCAP) aims to improve brain development of preterm infants through a set of procedures for nurses’ daily interaction with the newborns. Impacts have been found for many behavioral, but not medical measures, of health and development. Positive impacts include improved posture, movement, and emotional regulation.

 

DESCRIPTION OF PROGRAM

Target Population: Preterm infants admitted to a hospital’s newborn intensive care unit

 

The model assumes that the infant is an active participant in his/her environment, and the family is most important caregiver and advocate. The NIDCAP approach has developmental specialists caring for the infants by providing daily touch and care, always slowly and gently. In particular, specialists respond to the infant’s signals indicating either stress or comfort. After the infant’s condition has stabilized, the specialists observe each infant once a week throughout hospitalization. One observation involves a planned medical staff care-giving interaction. The specialist observes the infant for 20 minutes before, during, and after the interaction. Measurements are taken on the infant to tailor caregiving schedules to his or her sleep cycles. Also, observations are used to tailor methods of handling for each infant. If an infant is particularly fussy, limp, or agitated during exams, certain steps (e.g. cradling, bedding in bunting, bedding the infant on his/her side, bathing in deep, warm water, etc) are taken to comfort him or her before, during, or after the interactions. Parents/family are encouraged to personalize the infant’s area and to use reclining chairs to promote handling and prolonged skin-to-skin contact between the infant and family member. Different types of soft cloths and bunting are provided to keep the infant comfortable and warm as well.

 

EVALUATIONS OF PROGRAM

 

Als, H., Duffy, F. H., McAnulty, G. B., Rivkin, M. J., Vajapeyam, S., Mulkern, R. V., et al. (2004). Early experience alters brain function and structure. Pediatrics, 113, 846-857.

 

Evaluated Population: Thirty preterm infants born to mothers at least fourteen years of age and staying in a Boston intensive care unit. Nineteen of the infants were male and 11 were female. Most were white (N=23), with three black, one Hispanic, and one “other race.” All parents were either married or attached in some way.

 

Approach: The specialist measured infant behaviors every two minutes, including breathing, heart rate, color changes, postures, muscle movements, levels of arousal, and clarity and robustness of sleep and awake states.

 

Measurements were reported at two and nine weeks of age on the following: development of the infant’s motor system, self-regulation system; trunk and limb posture; motility; pathological movements; intensity of responses; threshold of responses; Moro response; state stability and total percent of abnormal scores on a scale measuring physical response; movement; posture; development of the autonomic system; state system; attention system; examiner facilitation; motor system tone; crying; length; weight; and head circumference.

 

Total percent of abnormal scores include measurements of trunk and limb posture, motility, pathological movements, motor system tone, intensity of responses, threshold of responses, Moro response, state stability, crying, hemisyndrome, and syndromes abnormal reactivity.

 

The behavior rating scale includes orientation/engagement, emotional regulation, and motor quality. At two weeks, four additional measurements were included: number of days on oxygen, average daily weight gain, number of complications, and number of days in hospital.

 

Several measures mentioned above may require a definition. Self-regulation for infants refers to the challenge of developing a balance among their motor, autonomic, state, and attention systems. Pathological movements simply refer to unusual movements made by an infant that may suggest deeper developmental problems. The Moro response is an involuntary action infants perform when startled. They will stretch out their arms to the sides with their palms up and thumbs flexed. Then they will curl up and relax. State stability and state system refer to the infant’s nervous system arousal, sleeping and drowsiness, awaking and alertness, and fussing and crying. The autonomic system controls the physical functions of our body necessary for survival.

 

The article refers to “corrected age,” which is the age the infant would be if the pregnancy had gone full-term. For example, a four-month-old born one month early would have a corrected age of three months.

 

Results: Significant impacts were found on the development of the infant’s motor system, self-regulation system, trunk and limb posture, motility, pathological movements, intensity of responses, threshold of responses, Moro/startle response, state stability and total percent of abnormal scores. Seventeen percent of experimental group infants at two weeks corrected age had abnormal scores versus the control group’s 30 percent. At nine months corrected age, the experimental group infants scored significantly higher (better) on four measures of mental development, four measures of motor development, and two ratings of behavior (emotional regulation and motor quality), and the behavioral rating scale.

 

No significant impacts were found on medical outcomes at two weeks or nine months corrected age (medical outcomes included length, weight, and head circumference at both ages, and at two weeks it included the following: number of days on oxygen, average daily weight gain, number of complications, and number of days in hospital). At two weeks corrected age, no significant impacts were found on measures of the development of the autonomic system, state system, attention system, examiner facilitation, motor system tone, or crying. At nine months corrected age, there were no significant impacts on a measure of orientation and engagement.

 

SOURCES FOR MORE INFORMATION

 

References:

Als, H., Duffy, F. H., McAnulty, G. B., Rivkin, M. J., Vajapeyam, S., Mulkern, R. V., et al. (2004). Early experience alters brain function and structure. Pediatrics, 113, 846-857.

 

Program categorized in this guide according to the following:

 

Evaluated participant ages: Prenatal, Early Childhood (0-5).

 

Program components: Clinic/provider-based, Parent or family involvement.

 

Measured outcomes: Social and emotional development, Physical health.

 

KEYWORDS: Infants (0-12 months), Males and Females (co-ed), White/Caucasian, Urban, Clinic/Provider-based, Parent/Family Component, Health Status/Conditions.

 

Last Updated on April 12, 2010

 

 

 

 

		© Child Trends 2004