A Three-Center, Randomized, Controlled Trial of Individualized Developmental Care for Very Low Birth Weight Preterm Infants: Medical, Neurodevelopmental, Parenting, and Caregiving Effects

Abstract

Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospitalization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

The Assessment of Preterm Infants' Behavior (APIB): Furthering the understanding and measurement of neurodevelopmental competence in preterm and full‐term infants

“…The authors concluded that in contrast to most other newborn neurobehavioral assessments available, the APIB measures not only task performance but also quality of performance. The APIB also showed consistently high sensitivity in identifying neurobehavioral differences associated with gestational ages at birth [Als et al, 1988b;; as well as with documentation of the effects of individualized behavioral intervention (NIDCAP) in the NICU Als et al, 1994Als et al, , 2003Als et al, , 2004Buehler et al, 1995;Fleisher et al, 1995]. No such sensitivity has been identified for any of the other newborn behavioral assessments available.…”

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

“…[15][16][17] They promote self-regulation of the infant and provide oro-tactile, oro-gustatory, and tactile stimulation, capable of reducing infants' pain responses during most painful procedures. 15,[18][19][20][21] Sucrose is recommended extensively for pain relief in preterm infants [22][23][24] and has shown to be highly effective and safe for single procedures by Stevens et al 17 Sweet taste solutions seem to trigger endogenous opioid and nonopioid pathways. 25,26 FT is described as holding the infant by placing a hand on his or her hands and feet and by positioning the infant in a flexed midline position while in either a side-lying, supine, or prone position.…”

The development of potentially better practices to support the neurodevelopment of infants in the NICU

“…Although the participating centers did not implement this approach, there is a shared belief that reduction of infant stressors, and facilitation of the infant's own ability to self-regulate within his environment is supportive of normal brain development. Individualized developmental care has been shown to decrease ventilator days, with improved weight gain and decreased length of stay, 393,431 and improved behavioral performance. 432 It was not found to improve developmental outcomes nor alter sleep at 2 years of age, 394 nor, in one meta-analysis, was existing evidence strong enough to warrant recommendation for treatment.…”

“…433 However, a more recent randomized, three-center clinical trial of individualized developmental care for infants less than 1250 g did demonstrate more rapid transition to full enteral feeds, shorter length of stay with improved weight gain and enhanced self-regulatory functioning. 434 Of interest is that there were no differences in relative measurements of light and sound between treatment and control groups, although the study was not designed to look specifically at these factors. The potentially beneficial effects of diminished stress during critical periods of development may reflect multiple strategies with overlapping beneficial pathways.…”