NEWBORN INDIVIDUALIZED DEVELOPMENT CARE & ASSESSMENT

POORNA SHAH

All NICU experience affects the Brain Development. All NICU care is brain care. -Heidelise Als

Synactive Model of Development Care

Infant

Caregiver

Environment

Caregiver is the instrument to life

The infants response to the environment is our only insight to whether the environment is supportive and appropriate for the infant.

http://www.nidcap.org/

History
The Newborn Individualized Developmental Care and Assessment Program is a research based, systems based, education and consultation program Brigham and Women's Hospital, Harvard Medical School and Children's Hospital, Boston Dr. Heidelise Als and her colleagues.

Goals of NIDCAP
Child: omfort C voidance of pain A lustering C nalgesia A void overstimulation A

Goals of NIDCAP
Parent : upport S Interaction kin-to-skin S eading signs R evelopmental clues D

NIDCAP observations
Infant behavior : At rest Stability" and/or Stress" signals communicated by the infant in relation to the following: Autonomic nervous system Motor system State" organization system Attention/interaction system Self-regulatory system

NIDCAP observations
Interaction with the care giver Returning to rest On 24 hrs. ongoing basis

NIDCAP observations
Environment would be the : Community and setting Path to the infant Care area Bed space and spacing Infants immediate contact ecology.

Intervention
Equipment the infant parents

Comfortable chairs

Personalize and decorate their infant's bed space with personal items parents

Intervention
A peaceful and quiet care area maintained for the infant. Darkness Night Muted light levels Alertness All light that falls on the infant's face is indirect In timing caregiving, the infant's sleepwake cycle :alertness, medical needs, and feeding ability are considered.

Intervention
The infant supported and facilitated physiologically in well-aligned positions. Prone or side. Blankets, nesting, and swaddling help assure proper positioning. Supports used to build on the infant's ability to support him or herself. Use of supports diminished as stability increased.

Intervention
Parents: The parents are supported from the beginning of the feeding. Feedings are timed to be supportive of the infant's sleep-wake cycles so that the infant may learn to recognize feelings of hunger and satiation. Parents are supported to breastfeed

Report
Written report for caregivers, including the following narrative sections: Summary of medical history current medical condition Observation Current Goals Recommendations : Environment Specific caregiving suggestions

Cornerstones of NIDCAP:

Individualization Modification of caregiving Interaction based on infants development Promotion of family centered care

 Newborn Individualized Developmental Care and Assessment \

NIDCAP is a system-anchored relationship-based prevention and intervention model that strives to enhance relationships among the infants, the families and the professionals, who care for them.

Program (NIDCAP): New frontier for neonatal and perinatal medicine. Heidelise Als Department of Psychiatry, Harvard Medical School and Childrens Hospital Boston, Boston, MA, USA

 Parents expressed positive experiences with NIDCAP and reported positive influences on the comfort and wellbeing of their infant during their stay in the NICU. Clinical lessons for NICU personnel on infant behavior are based on the NIDCAP observational tool and the synactive theory of infant development.

Parental stress and child behavior and temperament in the first year after the newborn individualized developmental care and assessment program. Pal S, Maguire C , Cessie S, et al; Journal of Early Intervention March 2008 30: 102-115.

 How satisfied are

Parents were significantly more satisfied with care given according to NIDCAP principles than they were with the traditional care for their premature born babies. The value of measuring parents' satisfaction in regard to NIDCAP introduction is increasingly important and necessary to document quality improvement Three major themes are involved with this shift would be to acknowledge the central role of the parent in the care of the infant, to foster the parent as a competent caregiver, and integrating the roles of coach, teacher, and facilitator into the existing technically expert nurse role
NIDCAP Model of Care for Their Preterm Infant, Wielenga JM, Smit BJ, Unk LK. Journal of Nursing and Care Quality 2006 Jan-Mar; 21(1):41-8.

 30 IUGR infants, 28 to 33 weeks gestational age, were randomly put into standard care or NIDCAP and were assessed at 2 weeks corrected age and 9 months corrected age in regard to health, anthropometrics, and neurobehavioral, and additionally at 2 WCa in regard to electrophysiology. The two groups were comparable in health, anthropometrics, and neurobehavior, and additionally at 2 wCA and 9 mCA. NIDCAP is effective on the neurophysiological functioning of preterm infants with severe intrauterine growth restrictions.
Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction? Als H, F Duffy, McAnulty G B , Fischer C B, et al; Journal of perinatology official journal of the California Perinatal Association (2011) Volume: 31, Issue: 2, 130-136.

Controversy
NIDCAP has received a "proven" rating.
Several controlled experiments, including two with reasonable sample sizes have shown the program to be effective at improving outcomes for low- and very low-birthweight babies.

Effective in various sites throughout the country, and several studies indicated that low- and very low-birthweight babies who participated in NIDCAP showed gains similar to those of full-term babies.

Controversy
Not proved beyond first months of life. Several studies examining outcomes at one year of age and beyond found no significant effect of the program.
NIDCAP as a standard of clinical care ?? Randomized controlled trials all involve small sample sizes, but moreover they lacked follow-up into school age

Training Eligibility: a) Application Process Site assessment, a financial plan and a training time line as well as the selfassessments of the intended trainees done.

Individual Requirements Professionals- Newborn Intensive Care and/or Special Care Nursery- approved for training by the applicant nursery. http://www.nidcap.org/pdf/Application-andReview-Flow-Charts-July-2011.pdf

Training sessions, consultation, and education applicant nursery site

Starting a center: five years People involved: 15 Cost for 1 trainee: $1500/ day approx. At site, varied expenses.

 Variety of settings as well and a variety of personnel. Observations only Wealth of information on the infants reaction to internal and external stimuli. Observations intervention Excellent teaching tools regarding the behaviors of infants.

Drawbacks:

Lengthy to administer. Majority of items on observation sheet are subjective. Depending on the infant, we may not observe the variety of behaviors infant uses, thus may require multiple observations to develop comprehensive plans.

References
Program (NIDCAP): New frontier for neonatal and perinatal medicine. Heidelise Als Department of Psychiatry, Harvard Medical School and Childrens Hospital Boston, Boston, MA, USA Parental stress and child behavior and temperament in the first year after the newborn individualized developmental care and assessment program. Pal S, Maguire C , Cessie S, et al; Journal of Early Intervention March 2008 30: 102-115. NIDCAP Model of Care for Their Preterm Infant, Wielenga JM, Smit BJ,UnkLK. Journal of Nursing and Care Quality 2006 Jan-Mar; 21(1):41-8 Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction? Als H, F Duffy, McAnulty G B , Fischer C B, et al; Journal of perinatology official journal of the California Perinatal Association (2011) Volume: 31, Issue: 2, 130-136. http://www.nidcap.org/ http://www.nidcap.org/pdf/Application-and-Review-Flow-Charts-July2011.pdf