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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized
B Westrup1, B Böhm, H Lagercrantz
1Neonatal Programme, Department of Woman and Child Health, Astrid Lindgren Children's Hospital, Karolinska Institute, Stockholm, Sweden. bjorn.westrup@ks.se
Insights
Newborn Individualized Developmental Care and Assessment Program (NIDCAP) care may improve preschool behavior in very premature infants. While cognitive and motor skills showed no significant differences, NIDCAP care showed a trend towards better outcomes, though larger studies are needed.
Area of Science:
- Neonatal developmental care
- Developmental pediatrics
- Premature infant outcomes
Background:
- Newborn Individualized Developmental Care and Assessment Program (NIDCAP) care is hypothesized to benefit prematurely born infants.
- Previous reports suggest positive impacts of NIDCAP on infant development.
Purpose of the Study:
- To evaluate the effect of NIDCAP on preschool-age development in infants born before 32 weeks gestation.
- To assess cognitive, motor, and behavioral outcomes at preschool age.
Main Methods:
- A randomized controlled trial comparing NIDCAP care with conventional care for infants born <32 weeks gestation.
- Preschool-age assessment at approximately 66 months corrected age using WPPSI-R, Movement ABC, and NEPSY subtests.
- Statistical analysis using exact binary logistic regression.
Main Results:
- No significant differences were observed in Full-Scale IQ, Verbal IQ, or Performance IQ between NIDCAP and control groups.
- Higher proportions of infants in the NIDCAP group survived without disability, mental retardation, or attention deficits compared to the control group.
- The odds ratio for surviving with normal behavior was statistically significant after adjusting for covariates, despite overall non-significant group differences.
Conclusions:
- NIDCAP care may have a positive impact on preschool behavior in very prematurely born infants.
- The study's small sample size and low power necessitate caution in interpreting findings.
- Larger, multi-cultural trials are recommended to confirm these preliminary results.
Aim:
Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk.
Methods:
All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed.
Results:
There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents.
Conclusion:
Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted.
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