The newborn individualized developmental care and assessment program is not supported by meta-analyses of the data

doi:10.1067/mpd.2002.123667

The Journal of Pediatrics

Volume 140, Issue 6, June 2002, Pages 699-706

https://doi.org/10.1067/mpd.2002.123667 Get rights and content

Abstract

Objectives: To systematically review the effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared with conventional care to improve long-term neurodevelopmental outcomes or short-term medical and neurodevelopmental outcomes in preterm and/or low birth weight infants. Study design: With the use of standard systematic review methodology, all randomized, controlled trials (RCTs) and prospective cohort studies evaluating in-hospital developmental care based on the framework of NIDCAP in preterm and/or low birth weight infants were identified. The quality of the RCTs was assessed. Meta-analyses were performed by using relative risk and risk difference for dichotomous data and weighted mean difference for continuous data with 95% confidence intervals. Results: Five RCTs (n = 136) and 3 phase-lag cohort studies (n = 185) met inclusion criteria. School-age neurodevelopmental outcomes after NIDCAP have not been reported. Meta-analyses of medical outcomes showed a statistically significant benefit of NIDCAP on requirement for supplemental oxygen. Neurodevelopmental outcome was improved at 9 or 12 months but not at 2 years. Conclusions: There is insufficient evidence to support the NIDCAP to improve medical and neurodevelopmental outcomes of preterm infants. (J Pediatr 2002;140:699-706)

Section snippets

Methods

The systematic review followed the Cochrane Collaboration methodology according to guidelines of the Neonatal Review Group, with three modifications.¹⁹ Information from prospective cohort studies was included, an additional validated instrument was used to assess the quality of randomized controlled trials,²⁰ and the random effects model was applied when significant between study heterogeneity existed. Randomized and quasi-randomized controlled trials (RCTs) as well as prospective cohort

Results

Preterm infants of <37 weeks' gestation and <2500 g at birth at risk of neurodevelopmental sequelae (n = 136) have been enrolled in 5 RCTs to evaluate the effects of developmental care on short-term medical and long-term neurodevelopmental outcomes.14, 15, 25, 26, 27, 30 An additional 185 infants have been observed in 3 prospective phase-lag cohort studies.13, 16, 28, 29 One study was undertaken in Canada,16, 29 one in Sweden,²⁷ and the remainder in the United States. Three studies were

Discussion

There is no published evidence of the effects of NIDCAP on school-age neurodevelopmental outcomes in preterm infants. In addition, there is no available evidence from high-quality RCTs on the effect of NIDCAP on short-term neurodevelopment or medical outcomes in preterm and/or low birth weight infants.

Meta-analyses of poor quality RCTs and prospective cohort studies suggest that NIDCAP may have some early but unsustained effect on neurodevelopment as well as on respiratory status (duration of

Acknowledgements

We thank all the authors of the included studies, particularly Heidelise Als, Barry Fleisher, Björn Westrup, Patricia Becker, and Bonnie Stevens, who clarified existing data and provided us with additional information.

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^☆: Reprint requests: Arne Ohlsson, MD Evidence Based Neonatal Care and Outcomes Research, Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Rm 775A, 600 University Ave, Toronto, Ontario, Canada M5G 1X5.

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Original ArticlesThe newborn individualized developmental care and assessment program is not supported by meta-analyses of the data☆

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Am J Obstet Gynecol

Appl Nurs Res

Control Clin Trials

J Pediatr

J Pediatr

School-age outcomes in infants with birth weights under 750g

N Engl J Med

Neonatal follow-up of very low birth weight/extremely low birth weight infants to school age: a critical overview

Acta Paediatr Scand

Neural plasticity: a new frontier for infant development

Structural and neurobehavioral delay in postnatal brain development of preterm infants

Pediatr Res

Toward a synactive theory of development: promise for the assessment and support of infant individuality

Infant Mental Health J

A synactive model of neonatal behavioral organization: framework for the assessment of neurobehavioral development in the preterm infant and for support of infants and parents in the neonatal intensive care environment

Program guide: newborn individualized developmental care and assessment program (NIDCAP): an education and training program for health care professionals

Developmental care in the newborn intensive care unit

Curr Opin Pediatr

Infant and family-centered developmental care guidelines

The principles for family-centered neonatal care

Pediatrics

Individualized behavioral and environmental care for very the low birth weight preterm infant at high risk for bronchopulmonary dysplasia: neonatal intensive care and developmental outcome

Pediatrics

Individualized developmental care for the very low-birth-weight preterm infant: medical and neurofunctional effects

JAMA

Original Articles
The newborn individualized developmental care and assessment program is not supported by meta-analyses of the data☆