Individualized Developmental Care for the Very Low-Birth-Weight Preterm Infant: Medical and Neurofunctional Effects

• Published in: JAMA : the journal of the American Medical Association Vol. 272; no. 11; pp. 853 - 858
• Main Authors: Als, Heidelise, Lawhon, Gretchen, Duffy, Frank H, McAnulty, Gloria B, Gibes-Grossman, Rita, Blickman, Johan G
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 21-09-1994
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child Development; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Hospitals, Maternity - standards; Humans; Infant, Low Birth Weight - growth & development; Infant, Newborn; Infant, Premature - growth & development; Infant, Premature, Diseases - nursing; Infant, Premature, Diseases - prevention & control; Intensive care medicine; Intensive Care Units, Neonatal - standards; Intensive Care Units, Neonatal - utilization; Intensive Care, Neonatal - methods; Intensive Care, Neonatal - standards; Male; Massachusetts; Medical sciences; Neonatal Nursing - methods; Neonatal Nursing - standards; Patient Care Planning - standards; Socioeconomic Factors; Treatment Outcome; Massachusetts; Very low birthweight; Premature; Psychomotor development; Intensive care; Treatment efficiency; Resuscitation
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.1994.03520110033025

Objective.—To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants.Design.—Randomized controlled trial.Setting.—Newborn intensive care unit.Patients.—Thirty-eight singleton preterm infants, free of known congenital abnormalities, weighing less than 1250 g, born before 30 weeks' gestation, mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours, randomly assigned to a control or an experimental group.Intervention.—Caregiving by nurses specifically trained in individualized developmental care; observation and documentation of the infants' behavior within 12 hours of admission, and subsequently every 10th day; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists; and the availability of special caregiving accessories.Main Outcome Measures.—Medical outcome, including average daily weight gain; number of days the infant required mechanical ventilation, oxygen, gavage tube feeding, and hospitalization; severity of retinopathy of prematurity, bronchopulmonary dysplasia, pneumothorax, and intraventricular hemorrhage; pediatric complications; age at discharge; and hospital charges. Neurodevelopmental outcome, including Assessment of Preterm Infants' Behavior scale and quantified electroencephalography (2 weeks after due date); and Bayley Scales of Infant Development and Kangaroo Box Paradigm (9 months after due date).Results.—The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support; earlier oral feeding; reduced incidence of intraventricular hemorrhage, pneumothorax, and severe bronchopulmonary dysplasia; improved daily weight gain; shorter hospital stays; younger ages at hospital discharge; and reduced hospital charges compared with the infants in the control group. At 2 weeks after their due dates, these infants also showed improved autonomic regulation, motor system functioning, self-regulatory abilities, and visual evoked potential measures; and at 9 months, they had improved Bayley Mental and Psychomotor Developmental Index scores, as well as Kangaroo Box Paradigm scores.Conclusion.—Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome.(JAMA. 1994;272:853-858)