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Lower stress responses after Newborn Individualized Developmental Care and Assessment Program care during eye
Agneta Kleberg1, Inga Warren, Elisabeth Norman
1Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden. a.kleberg@klemed.se
Insights
Newborn Individualized Developmental Care and Assessment Program (NIDCAP) intervention during retinopathy of prematurity exams did not reduce pain but improved infant recovery. NIDCAP care led to faster stress reduction post-examination.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Ophthalmology
Background:
- Retinopathy of prematurity (ROP) screening is painful for preterm infants.
- Minimizing distress during ROP exams is crucial for infant well-being.
Purpose of the Study:
- To evaluate if Newborn Individualized Developmental Care and Assessment Program (NIDCAP) intervention reduces adverse behavioral, pain, and stress responses during ROP examinations compared to standard care.
Main Methods:
- A crossover study design in 36 preterm infants undergoing their first two ROP examinations.
- Infants received either NIDCAP or standard care, with assignment switched for the second exam.
- Assessments included behavioral responses, physiological measures (heart rate, respiration, oxygenation), pain scores, and salivary cortisol levels.
Main Results:
- NIDCAP care was linked to better behavioral scores during the examination.
- No significant differences were observed in heart rate, respiratory rate, oxygenation, or pain scores between the groups.
- Salivary cortisol levels decreased significantly 60 minutes post-examination in the NIDCAP group, indicating faster stress recovery.
Conclusions:
- NIDCAP-based intervention during ROP screening does not decrease immediate pain responses.
- NIDCAP facilitates faster physiological recovery, evidenced by reduced salivary cortisol levels 60 minutes after the examination.
- These findings highlight NIDCAP's role in promoting infant stress recovery despite potential improvements in standard care over time.
Objective:
Screening examination for retinopathy of prematurity is distressing and painful. The aim of the present study was to investigate whether a Newborn Individualized Developmental Care and Assessment Program intervention during a retinopathy of prematurity examination results in less adverse behavioral, pain, and stress responses as compared with standard care.
Methods:
The first 2 eye examinations in 36 preterm infants were evaluated. The infants were randomly assigned at the first eye examination to receive either Newborn Individualized Developmental Care and Assessment Program care or standard care. At the second examination, crossover of subject assignment was performed. The assessments included behavioral responses; recordings of heart rate, respiration, and oxygenation; pain scores (premature infant pain profile); and salivary cortisol at defined time points up to 4 hours after the eye examination. The nursing support given during the eye examinations (intervention score) were scored using predefined criteria.
Results:
Altogether, 68 examinations were evaluated. Newborn Individualized Developmental Care and Assessment Program care was associated with better behavioral scores during the examination but there was no difference in heart rate, respiratory rate, oxygenation, or premature infant pain profile score between the 2 care strategies before or after the eye examination. Salivary cortisol increased from baseline to 30 minutes after the eye examination independent of care strategy and decreased significantly between 30 and 60 minutes when infants were subjected to Newborn Individualized Developmental Care and Assessment Program care but not after standard care. During the study period the intervention score for standard care increased and approached the score for Newborn Individualized Developmental Care and Assessment Program care at the later eye examinations.
Conclusion:
A Newborn Individualized Developmental Care and Assessment Program-based intervention during eye examination does not decrease pain responses but results in faster recovery, as measured by lower salivary cortisol 60 minutes after the examination. The differences were seen despite the influence from the Newborn Individualized Developmental Care and Assessment Program intervention on the standard care treatment that occurred during the study period.
