The review article titled “NIDCAP: A Systematic Review and Meta-analyses of Randomized Controlled Trials,” by Arne Ohlsson and Susan E. Jacobs (Pediatrics 131, March 2013, e881–e893), encouraged us to pursue our efforts to introduce the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) to Japan, despite their misleading conclusion, because their data show better outcomes in several respects for infants cared for by NIDCAP, without ill effects. Japanese statistics on survival rates and long-term outcomes of premature infants, especially extremely low birth weight infants, are better than those of North America and of European countries. But we are concerned about the high incidence of ADHD, autism, and learning disorders among those who avoid major neurologic handicaps. These disorders are known to be related to high-level brain function impairment and are speculated to result from continuous, excessive stress to these infants during their stay in the NICU. Therefore, we are switching from aggressive medical treatments to save lives and lower major neurologic sequelae to gentle, nurturing care. There are also substantial basic research studies to support this approach, such as increment of apoptosis of neurons in the frontal lobe. We know statistics often obscure the reality behind the clinical data, especially those on multifactorial clinical outcomes. Because their article shows that NIDCAP does not compromise the outcomes of premature infants, we continue to provide gentle care to our most vulnerable infants while improving our modalities and skills.
Conflict of Interest:
- Copyright © 2013 by the American Academy of Pediatrics