A randomized, controlled trial to evaluate the effects of the newborn individualized developmental care and assessment program in a Swedish setting

Background and Objective. Family-centered developmentally supportive care o f very low birth weight infants, provided by the Newborn Individualized Dev elopmental Care and Assessment Program (NIDCAP) has been reported to have p ositive medical and economic impacts. Our aim was to investigate its effect on need of ventilatory assistance, growth, and hospitalization in a Swedis h setting. Methods. Preterm infants born between September 1994 and April 1997 with a gestational age <32 weeks and with a need of ventilatory assistance at 24 h ours were randomly assigned to either NIDCAP (n = 12) or conventional care (n = 13). The 2 groups were comparable (median [range]) with respect to bir th weight (1083 [630-1411] vs 840[ 636-1939 g]), head circumference (24.0 [ 22.3-26.5] vs 24.0 [21.1-30.0 cm]), gestational age (27.6 [24.0-28.7] vs 26 .1 [23.9-30.3] weeks), female/male ratio (3/9 vs 9/8) and Clinical Risk Ind ex for Babies (4.0 [0-11] vs 6.0 [2-15]). The infants in the intervention g roup were cared for in a separate room by a group of specially trained nurs es. Formal weekly observations of these infants starting within 3 days afte r birth and continuing until 36 weeks postconception were used to develop i ndividualized care plans. These plans provided recommendations as to how ca re might be attuned to the current developmental stage of the infant and ho w the family might be supported and stimulated to participate in this care. The treatment of the 2 groups was in all other respects identical. Results. The duration of mechanical ventilation (median [range] was 2.8 [0- 36.7] days in the intervention group vs 4.8 [.1-29.8] days; not significant [NS]) among the controls and continuous positive airway pressure was appli ed for 26.1 (6.9-52.0) vs 43.9 (5.0-65.1) days. Supplementary oxygen was wi thdrawn at 33.0 (29.3-35.7) vs 38.1 (33.1-44.9) weeks of postconceptional a ge (PCA). The weight gain up to 35 weeks of PCA was 13.0 (6.7-21.0) vs 9.8 (6.8-16.6) g/day (NS). The head growth up to 35 weeks of PCA was .73 (.56-1 .3) vs .63 (.56-.77) cm/week (NS). The age of the infant at discharge was 3 8.3 (36.1-57.7) vs 41.0 (36.9-48.4) weeks of PCA (NS). Conclusions. NIDCAP does not seem to have detrimental effects on Swedish ve ry low birth weight infants in comparison with conventional care. Indeed, N IDCAP might even be advantageous.