Lars Wallin1, Mats Eriksson. 1. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute and Clinical Research Utilization (CRU), Karolinska University Hospital, Stockholm, Sweden. lars.wallin@karolinska.se
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.
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.