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).     

Newborn Individualized Developmental Care and Assessment Program (NIDCAP) - family-centered developmentally supportive care

The theoretical framework behind family-centered, developmentally supportive care (NIDCAP) is endorsed by research from several scientific fields, including neuroscience, developmental and family psychology, medicine and nursing. However, the introduction of NIDCAP involves a considerable investment at all levels of the organization. NIDCAP requires some physical changes in the NICU as well as substantial educational efforts and changes in the practice of care. The findings of the presented NIDCAP studies have been encouraging, and NIDCAP has been very well received by nursing staff, neonatologists and parents. It also is attractive from an ethical point of view. It appears reasonable to recommend that nurseries implement NIDCAP and investigate developmentally supportive care in different cultural contexts and with diversified, randomized multicenter trials.     

Mothers' perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared to conventional care

BACKGROUND: Family-centred care according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to positively influence family function. The aim was to examine if NIDCAP affects the views of prematurely born infants' mothers regarding maternal role, perception of the infant and the neonatal care. METHOD: Preterm infants with gestational age <32 weeks were randomly assigned to receive either care based on NIDCAP (n=12) or conventional neonatal care (n=13), forming two comparable groups with respect to gestational age, birth weight, female/male ratio, and initial illness severity. A questionnaire was designed to evaluate various aspects of the mothers' attitudes and apprehension of their maternal role, perception of their infant and the neonatal care. The questionnaire was validated and given to the mothers when the infants reached 36 weeks postmenstrual age (PMA). RESULTS: Ten mothers in each group replied to the questionnaire. The mothers in the NIDCAP-group perceived more closeness to their infants than did the control mothers (p=0.022) and this feeling demonstrated no significant correlation to the infant's gestational age, weight at birth or severity of illness. Furthermore, the mothers in the NIDCAP-group tended to rate the staff's ability to support them in their role as a mother somewhat higher (p=0.066), but at the same time they expressed more anxiety than did the control mothers (p=0.033). CONCLUSION: Early intervention according to NIDCAP seems to facilitate a feeling of closeness between the mother and her premature infant regardless of the infant's birth weight or health status. The higher level of anxiety in the mothers in the NIDCAP-group, may mirror that the mothers in the NIDCAP-group had already bonded to their infants during the hospital stay.     

Necessary resources and barriers perceived by professionals in the implementation of the NIDCAP

Background

The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires a significant effort from all professionals involved.

Aim

To determine the necessary requirements and barriers perceived by health professionals in the implementation of the NIDCAP.

Study design

A questionnaire covering requirements and obstacles perceived in the implementation of the NIDCAP was developed and validated in two Spanish level III neonatal intensive care units. The questionnaire was answered by 305 health professionals (response rate of 85%).

Results

The requirements identified in the questionnaire were considered by most respondents as necessary to implementing the NIDCAP, especially more time, education, and staff. Nurses, compared to doctors, thought that more staff was necessary (93% vs. 74%; p < .01). The main obstacle identified in the survey was lack of coordination among different professionals (77%), followed by noise level in the unit (35%). Doctors, in comparison to nurses, considered noise level (61% vs. 23%; p < .01) and nursing staff (56% vs. 29%; p = .05) the most relevant obstacles to NIDCAP implementation. The more experienced professionals perceived their own colleagues as an obstacle, particularly among nursing staff.

Conclusions

The implementation of the NIDCAP requires a series of conditions that confirm it is not a trivial process but rather a somewhat laborious one. The lack of coordination among different professionals is often considered the main obstacle.     

Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents.

Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted.     

Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

BACKGROUND AND OBJECTIVE: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the 1-year development of infants born with a gestational age of less than 32 weeks. METHODS: All surviving infants (11 in the NIDCAP group and 9 in the control group) were assessed employing the Bayley Scales of Infant Development at 1 year of corrected age. RESULTS: The Mental Developmental Index (MDI) of children who had received care according to NIDCAP was higher [88 (72-114)] [median (range)] than the corresponding value for the control children [78 (50-82)] (p=0.01). The odds ratio for being alive with an MDI>80 was 14 (95% CI; 1.4-141.5) in favour of the intervention group. However, the Psychomotor Developmental Indices (PDI) were not significantly different [85 (61-108) and 69 (50-114), respectively] (p=0.23). CONCLUSION: Our findings indicate that care based on the NIDCAP might have a positive impact on the cognitive development of infants born very prematurely.     

The Evidence-based Practice for Improving Quality method has greater impact on improvement of outcomes than dissemination of practice change guidelines and quality improvement training in neonatal intensive care units

OBJECTIVES:To determine whether outcome improvements achieved by neonatal intensive care units (NICUs) in the Evidence-based Practice for Improving Quality (EPIQ) trial could be reproduced in other NICUs by providing quality improvement (QI) training and practice change guidelines developed during the EPIQ trial; and to examine whether the results of the EPIQ trial were sustained.METHODS:The present prospective before-after study included 5812 infants born at ≤32 weeks’ gestation and admitted to 19 level 3 NICUs in the Canadian Neonatal Network between October 1, 2005 and December 31, 2007. During a three-month baseline period, multi-disciplinary teams received general training in QI techniques at a two-day workshop, and practice change guidelines targeting nosocomial infection (NI) and bronchopulmonary dysplasia (BPD) developed during the EPIQ trial were provided to all participants. Outcome data collected during the intervention period were compared with data from the baseline period and reported quarterly.RESULTS:In NICUs that had not previously participated in the EPIQ trial (non-EPIQ NICUs), there were no significant changes in the incidence trends of NI or BPD. However, within NICUs that had previously participated in the EPIQ trial (EPIQ NICUs) there was a continued reduction in the incidence trend of NI and BPD among EPIQ NICUs randomized during the trial to reduce NI and BPD, respectively.CONCLUSIONS:Providing NICUs with QI training and practice change guidelines developed during a successful QI initiative in other units is not effective. The authors speculate that successful practice change involves organizational culture and behaviour change, and should be driven by context-specific evidence.     

高浓度氧对新生大鼠肺血管内皮生长因子及其受体表达的影响

目的:研究持续吸入75%氧对新生大鼠肺血管内皮生长因子（vascular endothelial growth factor,VEGF）及其受体（VEGFR1和VEGFR2）表达的影响,探讨较高浓度吸氧对肺血管发育的影响及与支气管肺发育不良（bronchopulmonary dysplasia,BPD）的关系。方法:新生足月Sprague-Dawley大鼠48只,随机分为对照组和实验组。实验组生后12 h开始持续吸入75%氧气。分别于实验开始后的7 d、14 d和21 d处死留取肺组织标本,苏木精-伊红染色观察病理改变,免疫组化检测VEGF及其受体蛋白表达,RT-PCR检测其mRNA表达。结果实验组大鼠肺组织结构发生类似“新型”BPD的病理改变。75％氧暴露21 d时,VEGF（10.9±2.7 vs 30.8±6.4）、VEGFR1（5.4±1.4 vs 15.6±3.4）和VEGFR2（11.3±2.6 vs 21.7±4.5）的蛋白表达均较对照组减少（P<0.05）;VEGF（1.6 vs 3.3）、VEGFR1（0.4 vs 6.6）及VEGFR2（0.5 vs 4.9）的mRNA表达均较对照组减少（P<0.05）。结论:在新生大鼠中,长时间吸入较高浓度氧可能通过抑制肺血管发育导致BPD的发生。［中国当代儿科杂志,2009,11（11）：927-930］     

高浓度氧对新生大鼠肺血管内皮生长因子及其受体表达的影响

目的研究持续吸入75%氧对新生大鼠肺血管内皮生长因子(vascular endothelial growth factor,VEGF)及其受体(VEGFR1和VEGFR2)表达的影响,探讨较高浓度吸氧对肺血管发育的影响及与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的关系。方法新生足月Sprague-Dawley大鼠48只,随机分为对照组和实验组。实验组生后12h开始持续吸入75%氧气。分别于实验开始后的7d、14d和21d处死留取肺组织标本,苏木精-伊红染色观察病理改变,免疫组化检测VEGF及其受体蛋白表达,RT-PCR检测其mRNA表达。结果实验组大鼠肺组织结构发生类似"新型"BPD的病理改变。75%氧暴露21d时,VEGF(10.9±2.7vs30.8±6.4)、VEGFR1(5.4±1.4vs15.6±3.4)和VEGFR2(11.3±2.6vs21.7±4.5)的蛋白表达均较对照组减少(P<0.05);VEGF(1.6vs3.3)、VEGFR1(0.4vs6.6)及VEGFR2(0.5vs4.9)的mRNA表达均较对照组减少(P<0.05)。结论在新生大鼠中,长时间吸入较高浓度氧可能通过抑制肺血管发育导致BPD的发生。     

The Convention on the Rights of the Child (UNCRC) and its implementation in paediatric clinical research

The amount of research being performed in children, in particular pharmacological research, is lower than in adults, which is in direct contrast to the aims of the UN Convention on the Rights of the Child. A Pediatric Clinical Research Center (PCRC) has been established at Sahlgrenska University Hospital with the aim of supporting clinical research in children and adolescents. The number of inquiries and initiated clinical studies at PCRC has increased since the start in 2016. In addition, there is a need for regional and national infrastructures for paediatric clinical research and a national network for paediatric clinical studies.

Conclusion

Sahlgrenska University Hospital has established an infrastructure to support paediatric research and to work with national networks and infrastructures.