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Author Disclosure
Dr Westrup did not disclose any relationships relevant to this article.
Objectives
After completing this article, readers should be able to:
Describe the concepts of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).
Review the primary findings of clinical investigations of NIDCAP.
Describe barriers that must be overcome in research studies of NIDCAP.
Introduction
The mortality among infants born preterm has decreased dramatically during the last decade in developed countries. The survival of very low-birthweight (VLBW) infants (<1,500 g) has increased from 50% (1) to more than 85% (2) since the initiation of neonatal intensive care in the early 1970s. However, a concomitant decrease in morbidity has not yet been documented conclusively. Pulmonary morbidity and neurodevelopmental outcome are the two major issues of concern. (3)(4) Employing the 1980 World Health Organization definition of disability, follow-up studies of VLBW infants have reported the incidence of disability to be 15% to 25%. (5)(6) A recent meta-analysis revealed that at school age, cognitive scores of former VLBW infants are approximately 10 points lower than those of matched control children (6) due to difficulties with attention, behavior, visual-motor integration, and language performance. (7)(8)
Important factors related to mortality and morbidity are: gestational age, birthweight, sex, premature rupture of membranes, chorioamnionitis, and brain white matter injury. However, the intensive care environment and family involvement also affect neurodevelopmental outcome.
Development of the Brain
The fundamental objective of developmental care is to support the development of the child. Thus, brain development is one of the key issues. Sensory input affects the wiring of neuronal networks and their mode of functioning as well as the behavior of the newborn. (9)(10)(11)(12) Infants born very prematurely may be overstimulated during a critical period when their brains are developing rapidly (Figure …
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