NIDCAP and Developmental Care: A European Perspective
The systematic review by Ohlsson and Jacobs on the NIDCAP approach concluded that there is no evidence that NIDCAP improves long-term neurodevelopmental or short-term medical outcome.1 Despite their conclusion, “Because NIDCAP was not effective in reducing adverse outcomes, performing cost-effectiveness analyses became redundant,” they report that NIDCAP is associated with a better daily weight gain, a shorter hospitalization, and an increase in Bayley Scale of Infant Development scores at 9 months.
Developmental care and environmental strategies emerged in response to the background of the potential harmful effects of traditional NICU settings. When neonatal intensive care started in the 1960s, the priority was survival, as in adult intensive care. It took some time before the effects on the vulnerable growing preterm brain from the stressful environment and mother–infant separation were recognized. Many NICUs still consider technical aspects of care as a priority and parents as visitors. In Europe most elements of Early Developmental Care (EDC) are routinely applied in Scandinavian countries, but an increasing number of nurseries around Europe are changing their practices.
NIDCAP is difficult to study because it embraces a range of interventions and behavioral changes, and the level of intervention is not standardized. Conventional randomized trial methods are difficult to use with such global intervention strategies, and it is therefore difficult to assess them. There is little need for randomized controlled trials to evaluate the importance of pain and stress management, sleep protection, avoidance of bright light and noise, hemodynamic changes related to handling, proper positioning, skin-to-skin contact, breastfeeding, parental presence, and a supportive patient–caregiver relationship. All these aspects have been studied.2 Furthermore, these are markers of respect for the infant.
There is sufficient scientific evidence of the value of an adequate physical environment, reducing overwhelming sensory stimulation, and increasing sensitive parent caregiving, on the brain development of preterm infants. NIDCAP addresses all these issues and is probably the best-defined and most evaluated method for optimizing care, allowing caregivers to tune in to the infant’s behavioral responses, with parents as the primary caregivers. Rather than discouraging the promotion of NIDCAP and thus EDC, we should focus on the large body of evidence from the neuroscience literature that clearly confirms the deleterious effects of NICU stress and highlights the effects of EDC and parental intervention.4,5 There is a need to engage in high-quality research using techniques learned from the environmental enrichment literature. We academic neonatologists need to offer validated and affordable teaching programs to implement EDC. We have therefore created a European association for developmental care. The parent-initiated European Foundation for the Care of Newborn Infants strongly supports a general implementation of NIDCAP and developmental care. The findings of the article by Ohlsson and Jacobs could dissuade caregivers from devoting all their energies, making this initiative an important step to more neurodevelopmentally driven NICUs and high-quality support for parent–infant interaction.
Conflict of Interest:
- Ohlsson A,
- Jacobs SE
- Haumont D
- Sizun J,
- Westrup B
- Copyright © 2013 by the American Academy of Pediatrics