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Developmentally Supportive Care & NIDCAP

Health Factors: Education
Decision Makers: Community Organizations, Government - State, Healthcare Organizations, Schools
Evidence Rating: Some Evidence
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Developmental care interventions are designed to minimize the stress of the neonatal intensive care unit (NICU) environment. Such interventions may include: controlling external stimuli, clustering nursery care activities, and positioning or swaddling preterm infants (Cochrane-Symington 2006).

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a family-centered developmental care program that includes family training in NICUs and home visits aimed at avoiding developmental delays and impairment for premature and low birth weight infants (Rand-Karoly 2005).

Expected Beneficial Outcomes

Increased mental indices
Increased reflexes
Increased weight gain
Reduced developmental delay
Reduced hospital stays
Reduced need for respiratory support
Improved cognitive and psychomotor develoment (for age)

Evidence of Effectiveness

A number of reviews and studies indicate that NIDCAP is a promising approach to supporting growth and development of premature infants and assisting their families. Most of these studies also note a need for continued research into the long-term impacts of this program.

• RAND-Karoly 2005 considers DSC/NIDCAP a program with a promising evidence base, finding numerous statistically significant shorter-term benefits, such as: improvements in children's mental indices, reflexes, and weight gain, and reduced developmental delays and hospital stays. Long-term program outcomes are needed to consider NIDCAP a proven program.

• Westrup 2007 reports improved hospital outcomes (e.g., days on ventilator, incidence of chronic lung disease, hospitalization etc.) from four randomly controlled trials of NIDCAP.  It also notes that the program has been very well received by nursing staff, neonatologists, and parents.

• Wallin 2009 finds NIDCAP to be safe with no complications or undesired effects on infants.  Despite promising findings on cognitive and motor development, this study notes a need for more comprehensive study with extended follow-up.

• Cochrane-Symington 2006 review of trials suggests that interventions such as NIDCAP may have some benefit to the outcomes of preterm infants.  The review notes conflicting evidence among studies and a need for evidence demonstrating more consistent effects of developmental care.  

Implementation Examples

United States

Developmentally Supportive Care (DSC) and the Newborn Individualized Developmental Care & Assessment Program (NIDCAP) are in place around the country.

Implementation Resources

NIDCAP - NIDCAP Federation International. NIDCAP program guide. Accessed on June 20, 2012
Webpage: http://www.nidcap.org/

Citations - Evidence

Cochrane-Symington 2006* - Symington A, Pinelli J. Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database of Systematic Reviews. 2006;(2):CD001814. Accessed on March 23, 2013
Webpage: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001814/frame.html
RAND-Karoly 2005 - Karoly LA, Kilburn MR, Cannon JS. Early childhood interventions: Proven results, future promise. Santa Monica: RAND Corporation; 2005: Monograph Report. Accessed on March 23, 2013
Webpage: http://www.rand.org/pubs/monographs/MG341.html
Wallin 2009 - Wallin L, Eriksson M. Newborn Individual development care and assessment program (NIDCAP): A systematic review of the literature. Worldviews on Evidence-Based Nursing. 2009;6(2):54-69. Accessed on June 19, 2012
Webpage: http://onlinelibrary.wiley.com/doi/10.1111/j.1741-6787.2009.00150.x/pdf
Westrup 2007* - Westrup B. Newborn individualized developmental care and assessment program (NIDCAP) - Family-centered developmentally supportive care. Early Human Development. 2007;83(7):443-9. Accessed on June 23, 2012
Webpage: http://www.sciencedirect.com/science/article/pii/S0378378207000540

* Journal subscription may be required for access.

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Evidence Rating

Level of effectiveness based on a scan of academic literature and key recommendations of leading organizations.

  • Scientifically Supported Numerous studies or systematic review(s) with positive results
  • Some Evidence Research suggests positive impacts; further study may be warranted
  • Expert Opinion Recommended by credible groups*; research evidence limited
  • Insufficient Evidence Evidence limited or unavailable; further study warranted
  • Mixed Evidence Evidence mixed; further study warranted
  • Evidence of Ineffectiveness Research consistently shows program is detrimental or has no effect

Although many policies and programs are recommended by credible groups, we apply the rating ‘expert opinion’ only when policies are recommended but limited scientific evidence of effectiveness is available.

* The American Heritage Dictionary defines credible as 'capable of being believed; plausible.' and 'worthy of confidence; reliable.' To be considered an 'expert recommendation,' policies and programs must be recommended by one or more organizations that are recognized for their impartial expertise in the area of interest and have limited evidence available.

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Impact on Health Disparities

Likely impact of a given policy or program on racial/ethnic, socioeconomic, geographic or other disparities in Wisconsin based on its characteristics (e.g., target audience, mode of delivery, etc.) and best available evidence related to disparities.

  • Likely to decrease disparities
  • No impact on disparities likely
  • Likely to increase disparities