Navigation path

Additional tools

  • Print version
  • Decrease text
  • Increase text

Newborn Individualized Developmental Care and Assessment Programme

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Supporting Parenting and Assisting with Childcare, Helping Vulnerable Children

Recommendation Pillars

Improve the responsiveness of health systems to address the needs of disadvantaged children

Countries that have implemented practice

Belgium, Netherlands, Sweden, United Kingdom

Age Groups

Young Children (age 0 to 5)

Target Groups

Parents, Fathers

Years in Operation

1980  - still operating

Practice Overview

The Newborn Individualized Developmental Care and Assessment Programme (NIDCAP) offers an individualized and nurturing approach to the care of infants in neonatal intensive care unit (NICU) and special care nurseries (SCN). It is a relationship-based, family-centered approach that promotes the idea that infants and their families are collaborators in developing an individualized program of support to maximize physical, mental, and emotional growth and health and to improve long-term outcomes for preterm and high medical risk newborns.

Enduring Impact

Two studies have assessed the long terms effects of NIDCAP in European populations (Maguire et al., 2009 and van der Pal et al., 2008). Among a sample of 164 infants born with a gestational age of less than thirty-two weeks in the Netherlands randomized to receive NIDCAP or standard care, Maguire et al. (2009) found no effects of NIDCAP on neurologic, mental, psychomotor, or physical development at one-year (using the infants’ corrected ages). Similarly, van der Pal et al., (2008) found no effect of NIDCAP on health-related quality of life at one-year after birth among a sample of 168 infants born with a gestational age of less than 32 weeks in the Netherlands randomized to NIDCAP or standard developmental care.

Transferability

NIDCAP has been successfully implemented in the United States and found to be successful by several studies (Als et al., 1994, Als et al., 2003, Als et al., 2004, Becker et al, 1991, Buehler et al., 1995, Fleisher et al, 1995, McAnulty et al., 2009, and Resnick et al., 1987). In addition to having been implemented in Sweden and the United Kingdom, NIDCAP has also been implemented in at least five other EU countries (see Contact Information below).

Evidence of Effectiveness

Thirty-six infants with a gestational-age less than 32 weeks and who were receiving care at either St. Mary’s hospital (London, UK) or the University Hospital of Lund (Lund, Sweden) participated in this study. The infants were randomized to the intervention (NIDCAP) and control (standard care) groups prior to receipt of an eye exam. Prior to a second eye exam, the groups were switched such that infants who were in the control group prior to the first eye exam received the intervention and vice versa. Infants were assessed before, during, and after the eye exams (Kleberg et al., 2008).

 

Outcome

Eye exam with NIDCAP

Eye exam with standard treatment

Outcomes improved (statistically significant)*

During Eye Exam

Behavioral score (higher is better)2.252.00

After Eye Exam (60 min)

Oxygen saturation9296

Outcomes with no effect

Before Eye Exam

Behavioral score

2.50

2.50

Pain assessment (lower is better)

7

8

Heart rate

157

160

Respiratory rate

61

60

Oxygen saturation

95

96

During Eye Exam

Pain assessment

13

13.5

After Eye Exam (30 min)

Behavioral score

2.5

2.25

Heart rate

154

152

Respiratory rate6260
Oxygen saturation9595
After Eye Exam (60 min)
Pain assessment2.292.25
Heart rate160155
Respiratory rate6260
After eye exam (4 hours)
Behavioral score2.52.5
Heart rate156162
Respiratory rate6067
Oxygen saturation9595

Outcomes improved had to demonstrate effects that were statistically significant at least at the 0.05 level.

Issues to consider

NIDCAP was shown to be effective among a sample of infants born at less than 32 weeks in Sweden and the United Kingdom. Infants in this evaluation were randomized to NIDCAP care or standard care prior to an eye exam given shortly after birth. NIDCAP has not been shown to have sustained effects among infants born at less than 32 weeks in Europe. Two samples of infants born in the Netherlands and receiving NIDCAP care at birth showed no differences in health-related quality of life, or mental, neurologic, psychomotor, or physical development at one-year corrected age compared to infants receiving standard care at birth (Maguire et al., 2009 and van der Pal et al, 2008).

Contact Information

Name

Ann-Sofi Gustafsson, RN, BSN

Title

 

Organization

Neonatal Unit, Astrid Lindgren Children's Hospital

at Karolinska University Hospital,

Karolinska NIDCAP Training Center, Sweden

Address

SE-171 76 Stockholm, Sweden

Phone

+46-8-5177 9426

Email

nidcap@karolinska.se

 

Name

Nathalie Ratynski, MD

Title

 

Organization

Department of Pediatrics and Medical Genetics,
University Hospital

Address

29609 Brest Cedex, France

Phone

+33 298 22 36 66

Email

nathalie.ratynski@chu-brest.fr

 

Name

Monique Oude Reimer, RN

Organization

Sophia NIDCAP Training Center,

ErasmusMC-Sophia, Childrens Hospital

Address

Dr. Molenwaterplein 60
Room Sb 2607
P.O. Box 2060
3000 CB Rotterdam, The Netherlands

Phone

+31 104 637 181

Email

nidcap@erasmusmc.nl

 

Name

Inga Warren, Dip COT, MSc

Title

 

Organization

UK NIDCAP Training Centre at St. Mary's,Winnicott Baby Unit
St. Mary's Hospital, Imperial College Healthcare NHS Trust

Address

Praed Street
London W2 1NY, UK

Phone

+ 44 (0)207 886 1283/6773/2172

Email

inga.warren@imperial.nhs.uk

Websitewww.winnicott.org.uk

 

Name

Delphine Druart, RN

Title

 

Organization

Department of Neonatology, Saint-Pierre University Hospital

Address

Rue Haute, 322, B 1000 Brussels, Belgium

Phone

+32 2 5354226

Email

delphine_druart@stpierre-bru.be

Website

 

Name

Liv Ellen Helseth, RN and Unni Tomren, RN

Title

 

Organization

NIDCAP Norway, Aalesund Training Center,

Department of Neonatology, Aalesund Hospital

Address

Helse More og Romsdal HF, 6026 Aalesund, Norway

Phone

+47 701 67 649

Email

nidcap@helse-mr.noe

Website

 

Name

Josep Perapoch, MD, PhD

Title

 

Organization

The Barcelona-Vall d’Hebron NIDCAP Training Center,

Department of Neonatology, Hospital Universitari Vall d’Hebron

Address

Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain

Phone

+34 934 893 127

Email

jperapoc@vhebron.net

Website

 

Name

María López Maestro, MD

Title

 

Organization

Hospital Universitario 12 de Octubre NIDCAP Training Center
Department of Neonatology

Address

Av de Andalucía sn. 28041 Madrid Spain

Phone

+34 913908272/0034682157072

Email

nidcap.hdoc@salud.madrid.org ; mariamaestro@gmail.com

Website

Available Resources

NIDCAP website (available in English, French, and Spanish): http://www.nidcap.org/default.aspx

Training centers are available throughout Europe. The contact information for these centers is provided in the Contact Information section.

Evaluation Details

NIDCAP was evaluated at two hospitals, one in London, UK and one in Lund, Sweden (Kelberg et al., 2008). Thirty-six infants with a gestational-age less than 32 weeks and who were receiving care at either St. Mary’s hospital (London, UK) or the University Hospital of Lund (Lund, Sweden) participated in this study. The infants were randomized to the intervention (NIDCAP) and control (standard care) groups prior to receipt of an eye exam. Prior to a second eye exam, the groups were switched such that infants who were in the control group prior to the first eye exam received the intervention and vice versa. Infants were assessed before, during, and after (30 minutes, 60 minutes, and four hours) the eye exams. Assessments included color, breathing, muscle tone, state (e.g, sleeping), state regulation, position, heart rate, breathing rate, and oxygen saturation. In the Lund sample, 65% of infants were male, the median gestational age was 27 weeks, and the median birth weight was 930 grams. In the London sample, 63% of the infants were male, the median gestational age was 26 weeks, and the median birth weight was 823 grams.

The following outcomes improved significantly when NIDCAP care was provided:

  • Behavioral score during the eye exam (NIDCAP care: 2.25, Standard care: 2.00; higher scores are better)
  • Oxygen saturation at 60 minutes post eye exam (NIDCAP care: 92, Standard care: 96)

There were no significant differences between when NIDCAP care was provided compared to standard care provision for behavioral score, pain assessment, heart rate, respiratory rate, or oxygen saturation before the eye exam. There were also no differences on the pain assessment during the eye exam. At thirty minutes after the eye exam, there were no differences on behavior score, heart rate, respiratory rate, or oxygen saturation. At sixty minutes after the eye exam, there were no differences on behavioral score, heart rate, or respiratory rate. At four hours after the eye exam, there were no differences on behavioral score, pain assessment, heart rate, respiratory rate, or oxygen saturation.

Bibliography

 

Als, H., Manual for the Naturalistic Observation of the Newborn (Preterm and Fullterm), Boston, Mass.: Children's Hospital, 3rd revision, 1981, rev. 1995.

Als, H., F. H. Duffy, G. B. McAnulty, M. J. Rivkin, S. Vajapeyam, R. V. Mulkern, et al., "Early Experience Alters Brain Function and Structure," Pediatrics, Vol. 113, 2004, pp. 846-857.

Als, H., G. Lawhon, F. H. Duffy, G. B. McAnulty, R. Gibes-Grossman, and J. G. Blickman, "Individualized Developmental Care for the Very Low Birthweight Preterm Infant: Medical and Neurofunctional Effects", Journal of the American Medical Association, Vol. 272, 1994, pp. 853-858.

Als, H., L. Gilkerson, F. H. Duffy, G. B. McAnulty, D. M. Buehler, K. A. VandenBerg, et al., "A Three-Center Randomized Controlled Trial of Individualized Developmental Care for Very Low Birth Weight Preterm Infants: Medical, Neurodevelopmental, Parenting and Caregiving Effects", Journal of Developmental & Behavioral Pediatrics, Vol. 24, 2003, pp. 399-408.

Becker, P. T., P. C. Grunwald, J. Moorman, and S. Stuhr, "Outcomes of Developmentally Supportive Nursing Care for Very Low Birthweight Infants," Nursing Research, Vol. 10, 1991, pp. 150-155.

Buehler, D. M., H. Als, F. H. Duffy, G. B. McAnulty, and J. Liederman, "Effectiveness of Individualized Developmental Care for Low-Risk Preterm Infants: Behavioral and Electrophysiological Evidence," Pediatrics, Vol. 96, 1995, pp. 923-932.

Fleisher, B. F., K. A. VandenBerg, J. Constantinou, et al., "Individualized Developmental Care for Very-Low-Birthweight Premature Infants," Clinical Pediatrics, Vol. 34, 1995, pp. 523-529.

Kleberg, A., I. Warren, E. Norman, E. Mörelius, A. Berg, E. Mat-Ali, K. Holm, A. Fielder, N. Nelson, and L. Hellström-Westas, "Lower Stress Responses After Newborn Individualized Developmental Care and Assessment Program Care During Eye Screening Examinations for Retinopathy of Prematurity: A Randomized Study," Pediatrics, Vol. 121, No. 5, May 2008, pp. e1267-e1278.

Maguire, C. M., Frans J. Walther, Paul H. T. van Zwieten, Saskia Le Cessie, Jan M. Wit, and Sylvia Veen, on behalf of the Leiden Developmental Care Project, "Follow-Up Outcomes at 1 and 2 Years of Infants Born Less Than 32 Weeks After Newborn Individualized Developmental Care and Assessment Program," Pediatrics, Vol. 123, No. 4, 2009, pp. 1081-1087.

McAnulty, G. B., F. H. Duffy, S. C. Butler, J. H. Bernstein, D. Zurakowski, and H. Als, "Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data," Clinical Pediatrics, May 15, 2009.

Resnick, M., F. Eyler, R. Nelson, et al., "Developmental Intervention for Low Birth Weight Infants: Improved Early Developmental Outcomes," Pediatrics, Vol. 80, No. 1, 1987, pp. 68-74.

van der Pal, S. M., C. M. Maguire, J. Bruil, S. Le Cessie, J. M. Wit, F. J. Walther, and S. Veen, "Health-Related Quality of Life of Very Preterm Infants at 1 Year of Age After Two Developmental Care-Based Interventions," Child Care Health Development, Vol. 34, No. 5, September 2008, pp. 619-625.

Last Updated

September 2012

Programme details

The therapeutic framework and method of NIDCAP provides early developmental support and preventive intervention, beginning immediately with birth. Numerous premature infants are born during or before the last trimester of gestation (beginning around 24 weeks), which is an exceedingly critical period for brain development. The infant's sensory experience in the environment of the NICU and SCN, including exposure to bright lights, high sound levels, frequent stressful and painful interventions, and diminished positive experiences, presents unexpected challenges to the immature brain during this sensitive period.

The goal of the NIDCAP approach is to minimize the mismatch between the immature brain's expectations and the over-stimulating environment. In turn, NIDCAP seeks to improve brain development and long-term outcomes. The NIDCAP approach uses methods of detailed documentation of an infant's ongoing communication to teach parents and caregivers skills in observing an individual infant's behavioral signals. These sometimes subtle signals provide the basis for interpreting what the infant is trying to communicate and can be used to guide parents and caregivers to adapt all interaction and care to be supportive of the infant's behavior. Suggestions for care are made in support of the infant's self-regulation, calmness, well-being, and strengths and the infant's sense of competence and effectiveness. Such suggestions begin with support, nurturance, and respect for the infant's parents and family, who are the primary co-regulators of the infant's development; and the suggestions extend to the atmosphere and ambiance of nursery space, the organization and layout of the infant's care space, and the structuring and delivery of specific medical and nursing care procedures and specialty care. These practices ensure that a developmental perspective and an infant's environment are incorporated into the infant's care (see Als, 1995).