Program

Jan 16, 2013

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.

 

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