Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1213-1215 (doi:10.1542/peds.2009-1884)

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COMMENTARY

NIDCAP: New Controversial Evidence for Its Effectiveness

Arne Ohlsson, MD, MSc, FRCPC, FAAP

Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Departments of Pediatrics, Obstetrics and Gynecology, and Health, Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

Abbreviations: NIDCAP—Newborn Individualized Developmental Care and Assessment Program • CI—confidence interval • PMA—postmenstrual age

The first 20% of the full text of this article appears below.

In the early 1980s, Als conceptualized the "synactive" theory of child development and established the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).^1,2 This program requires trained caregivers to observe neonatal behaviors before, during, and after caregiving interventions and provide recommendations for care by staff and parents. These recommendations are often generalized to include reductions in noise and light levels, aids to promote flexion and self-regulation, clustering of care, and parental involvement.

Authors who have performed meta-analyses regarding NIDCAP have concluded that the evidence to support NIDCAP as a framework within which to provide developmental care to improve medical and developmental outcomes is inconclusive.^3–6 Incorporating in meta-analyses the results from the trials reported in this issue of Pediatrics by Maguire et al⁷ and Peters et al,⁸ which add 288 infants to the 285 infants previously enrolled in NIDCAP trials,^9–15 will provide more precise effect-size estimates, as would meta-regression to adjust for differences in baseline characteristics between study groups.⁶

Maguire et al conclude that NIDCAP is ineffective for outcomes to term, whereas Peters et al state . . . [Full Text of this Article]

Address correspondence to Arne Ohlsson, MD, MSc, FRCPC, FAAP, 14324 County Rd 29, Warkworth, Ontario, Canada K0K 3K0. E-mail: aohlsson@mtsinai.on.ca

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