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Improvement of short- and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial
Kathrine Leigh Peters1, Rhonda Jean Rosychuk, Leonora Hendson
1Faculty of Nursing, Perinatal Clinical Research Centre, University of Alberta, Edmonton, Canada.
Insights
Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based care significantly reduced hospital stays and chronic lung disease in very low birth weight (VLBW) infants. This approach also improved long-term neurodevelopmental outcomes at 18 months.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Evidence-Based Healthcare
Background:
- Very low birth weight (VLBW) infants require specialized care to optimize outcomes.
- The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a developmental care approach designed to support infants in the NICU.
- The impact of NIDCAP-based care on VLBW infant outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of NIDCAP-based care on the length of hospital stay for VLBW infants.
- To assess secondary outcomes including ventilation duration, chronic lung disease incidence, and neurodevelopmental status at 18 months.
- To determine the overall impact of NIDCAP on short- and long-term outcomes in VLBW infants.
Main Methods:
- A cluster-randomized controlled trial was conducted in a Canadian NICU from 1999 to 2004.
- VLBW infants (N=100 singletons, 10 twin sets) were randomized to NIDCAP-based care (N=56) or standard NICU care (N=55).
- Follow-up assessments were performed at 18 months of adjusted age, with 90% participation.
Main Results:
- NIDCAP group infants experienced a significantly shorter length of stay (median 74 days vs. 84 days, P = .003).
- The incidence of chronic lung disease was lower in the NIDCAP group (29% vs. 49%, OR 0.42, P = .035).
- At 18 months, NIDCAP infants showed less disability, specifically reduced mental delay (10% vs. 30%, OR 0.25, P = .017).
Conclusions:
- NIDCAP-based care significantly improves short-term outcomes, including reduced length of stay and chronic lung disease, for VLBW infants.
- NIDCAP-based care leads to significantly better long-term neurodevelopmental outcomes at 18 months of age.
- NIDCAP represents an effective intervention for enhancing the overall well-being of VLBW infants in the NICU.
Objective:
Our objective was to determine the impact of Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based care on length of stay of very low birth weight (VLBW) infants. Secondary outcome measures were days of ventilation, incidence of chronic lung disease, and 18-month neurodevelopmental outcomes.
Methods:
This cluster-randomized, controlled trial took place in a large NICU in Canada, with follow-up evaluation at 18 months of age, from September 1999 to September 2004. One hundred VLBW singleton infants and 10 VLBW twin sets were assigned randomly to NIDCAP-based or control care, and 90% participated in follow-up assessments. The intervention was NIDCAP-based care (N = 56), that is, care by NIDCAP-educated staff members and behavioral observations. The control group (N = 55) received standard NICU care. Statistical analyses were adjusted for cluster randomization. Although the intervention was not blinded, the pediatricians making the decisions to discharge the infants were not involved in the study, and the follow-up staff members were blinded with respect to group.
Results:
NIDCAP group infants had reduced length of stay (median: NIDCAP: 74 days; control: 84 days; P = .003) and incidence of chronic lung disease (NIDCAP: 29%; control: 49%; odds ratio: 0.42 [95% confidence interval: 0.18-0.95]; P = .035). At 18 months of adjusted age, NIDCAP group infants had less disability, specifically mental delay (NIDCAP: 10%; control: 30%; odds ratio: 0.25 [95% confidence interval: 0.08-0.82]; P = .017).
Conclusion:
NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly.
