This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (252)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Medical and Neurofunctional Effects

Heidelise Als, PhD; Gretchen Lawhon, RN, PhD; Frank H. Duffy, MD; Gloria B. McAnulty, PhD; Rita Gibes-Grossman, RN, MS; Johan G. Blickman, MD

JAMA. 1994;272(11):853-858.

Abstract
Objective.
—To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants.

Design.
—Randomized controlled trial.

Setting.
—Newborn intensive care unit.

Patients.
—Thirty-eight singleton preterm infants, free of known congenital abnormalities, weighing less than 1250 g, born before 30 weeks' gestation, mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours, randomly assigned to a control or an experimental group.

Intervention.
—Caregiving by nurses specifically trained in individualized developmental care; observation and documentation of the infants' behavior within 12 hours of admission, and subsequently every 10th day; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists; and the availability of special caregiving accessories.

Main Outcome Measures.
—Medical outcome, including average daily weight gain; number of days the infant required mechanical ventilation, oxygen, gavage tube feeding, and hospitalization; severity of retinopathy of prematurity, bronchopulmonary dysplasia, pneumothorax, and intraventricular hemorrhage; pediatric complications; age at discharge; and hospital charges. Neurodevelopmental outcome, including Assessment of Preterm Infants' Behavior scale and quantified electroencephalography (2 weeks after due date); and Bayley Scales of Infant Development and Kangaroo Box Paradigm (9 months after due date).

Results.
—The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support; earlier oral feeding; reduced incidence of intraventricular hemorrhage, pneumothorax, and severe bronchopulmonary dysplasia; improved daily weight gain; shorter hospital stays; younger ages at hospital discharge; and reduced hospital charges compared with the infants in the control group. At 2 weeks after their due dates, these infants also showed improved autonomic regulation, motor system functioning, self-regulatory abilities, and visual evoked potential measures; and at 9 months, they had improved Bayley Mental and Psychomotor Developmental Index scores, as well as Kangaroo Box Paradigm scores.

Conclusion.
—Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome.

(JAMA. 1994;272:853-858)

Author Affiliations
From the Department of Psychiatry (Dr Als), Department of Neurology (Drs Duffy and McAnulty), and Department of Radiology (Dr Blickman), Harvard Medical School and the Department of Nursing, Brigham and Women's Hospital (Dr Lawhon and Ms Gibes-Grossman), Boston, Mass.

Footnotes
Dr Als holds a patent for the bunting, one of the special caregiving accessories available for the infants in the experimental group. She has a royalty arrangement with the manufacturer and a contract with the coninventor for profit sharing.

Reprint requests to Enders Pediatric Research Laboratories, EN-029, Children's Hospital, 320 Longwood Ave, Boston, MA 02115 (Dr Als).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effects of Individualized Developmental Care in a Randomized Trial of Preterm Infants <32 Weeks
Maguire et al.
Pediatrics 2009;124:1021-1030.
ABSTRACT | FULL TEXT  

Improvement of Short- and Long-Term Outcomes for Very Low Birth Weight Infants: Edmonton NIDCAP Trial
Peters et al.
Pediatrics 2009;124:1009-1020.
ABSTRACT | FULL TEXT  

NIDCAP: Testing the Effectiveness of a Relationship-Based Comprehensive Intervention
Als
Pediatrics 2009;124:1208-1210.
FULL TEXT  

NIDCAP: New Controversial Evidence for Its Effectiveness
Ohlsson
Pediatrics 2009;124:1213-1215.
FULL TEXT  

Massage Accelerates Brain Development and the Maturation of Visual Function
Guzzetta et al.
J. Neurosci. 2009;29:6042-6051.
ABSTRACT | FULL TEXT  

Follow-up Outcomes at 1 and 2 Years of Infants Born Less Than 32 Weeks After Newborn Individualized Developmental Care and Assessment Program
Maguire et al.
Pediatrics 2009;123:1081-1087.
ABSTRACT | FULL TEXT  

No change in developmental outcome with incubator covers and nesting for very preterm infants in a randomised controlled trial
Maguire et al.
Arch. Dis. Child. Fetal Neonatal Ed. 2009;94:F92-F97.
ABSTRACT | FULL TEXT  

Individualized Developmental Care in the Neonatal Intensive Care Nursery
VandenBerg and Ross
Swallowing and Swallowing Disorders (Dysphagia) 2008;17:84-93.
ABSTRACT | FULL TEXT  

Developmental care: does it make a difference?
Bustani
Arch. Dis. Child. Fetal Neonatal Ed. 2008;93:F317-F321.
ABSTRACT | FULL TEXT  

Lower Stress Responses After Newborn Individualized Developmental Care and Assessment Program Care During Eye Screening Examinations for Retinopathy of Prematurity: A Randomized Study
Kleberg et al.
Pediatrics 2008;121:e1267-e1278.
ABSTRACT | FULL TEXT  

Love, Pain, and Intensive Care
Anand and Hall
Pediatrics 2008;121:825-827.
FULL TEXT  

Open-Bay and Single-Family Room Neonatal Intensive Care Units: Caregiver Satisfaction and Stress
Shepley et al.
Environment and Behavior 2008;40:249-268.
ABSTRACT  

Parental Stress and Child Behavior and Temperament in the First Year After the Newborn Individualized Developmental Care and Assessment Program
van der Pal et al.
Journal of Early Intervention 2008;30:102-115.
ABSTRACT  

Effects of Basic Developmental Care on Neonatal Morbidity, Neuromotor Development, and Growth at Term Age of Infants Who Were Born at <32 Weeks
Maguire et al.
Pediatrics 2008;121:e239-e245.
ABSTRACT | FULL TEXT  

Cobedding Twins and Higher-Order Multiples in a Hospital Setting
Tomashek et al.
Pediatrics 2007;120:1359-1366.
FULL TEXT  

Posture and movement in healthy preterm infants in supine position in and outside the nest
Ferrari et al.
Arch. Dis. Child. Fetal Neonatal Ed. 2007;92:F386-F390.
ABSTRACT | FULL TEXT  

Fetal Adrenal Development: Implications For Lung Development and Postnatal Disease
Watterberg
NeoReviews 2006;7:e135-e142.
FULL TEXT  

Does a Mother Singing to her Premature Baby Affect Feeding in the Neonatal Intensive Care Unit?
Blumenfeld and Eisenfeld
CLIN PEDIATR 2006;45:65-70.
ABSTRACT  

Family-Based Intervention to Enhance Infant-Parent Relationships in the Neonatal Intensive Care Unit
Browne and Talmi
J Pediatr Psychol 2005;30:667-677.
ABSTRACT | FULL TEXT  

Challenging Designs of Neonatal Intensive Care Units
Floyd
Crit Care Nurse 2005;25:59-66.
FULL TEXT  

Evaluation of a developmental care training programme for neonatal nurses
Milette et al.
J Child Health Care 2005;9:94-109.
ABSTRACT  

Newborn Individualized Developmental Care and Assessment Program (NIDCAP): Family-centered Developmentally Supportive Care
Westrup
NeoReviews 2005;6:e115-e122.
FULL TEXT  

Early Intervention in Preterm Infants After Discharge From Hospital: In Reply
Als
Pediatrics 2004;114:1739-1739.
FULL TEXT  

Early developmental care for preterm neonates: a call for more research
Sizun and Westrup
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89:F384-F388.
ABSTRACT | FULL TEXT  

Rest-Activity Patterns of Premature Infants Are Regulated by Cycled Lighting
Rivkees et al.
Pediatrics 2004;113:833-839.
ABSTRACT | FULL TEXT  

Early Experience Alters Brain Function and Structure
Als et al.
Pediatrics 2004;113:846-857.
ABSTRACT | FULL TEXT  

The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial
Ferber and Makhoul
Pediatrics 2004;113:858-865.
ABSTRACT | FULL TEXT  

Relationship Between Spontaneous Kicking and Age of Walking Attainment in Preterm Infants With Very Low Birth Weight and Full-Term Infants
Jeng et al.
ptjournal 2004;84:159-172.
ABSTRACT | FULL TEXT  

What's New in the Management of Pain in Children
Zempsky and Schechter
Pediatr. Rev. 2003;24:337-348.
FULL TEXT  

Family-Centered Care and the Pediatrician's Role
Committee on Hospital Care
Pediatrics 2003;112:691-696.
ABSTRACT | FULL TEXT  

Developing Circadian Rhythmicity in Infants
Rivkees
Pediatrics 2003;112:373-381.
ABSTRACT | FULL TEXT  

Evaluation and Development of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants
Carteaux et al.
Pediatrics 2003;111:e489-496.
ABSTRACT | FULL TEXT  

Analgesics for the Treatment of Pain in Children
Berde and Sethna
NEJM 2002;347:1094-1103.
FULL TEXT  

Comparison of Skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development
Feldman et al.
Pediatrics 2002;110:16-26.
ABSTRACT | FULL TEXT  

Factors Associated with Vagal Tone Responses in Preterm Infants
Harrison et al.
West J Nurs Res 2000;22:776-795.
ABSTRACT  

A Randomized, Controlled Trial to Evaluate the Effects of the Newborn Individualized Developmental Care and Assessment Program in a Swedish Setting
Westrup et al.
Pediatrics 2000;105:66-72.
ABSTRACT | FULL TEXT  

Developmental Care Does Not Alter Sleep and Development of Premature Infants
Tyebkhan et al.
Pediatrics 1999;104:1169a-1170.
FULL TEXT  

Analgesia and Sedation in Preterm Neonates Who Require Ventilatory Support: Results From the NOPAIN Trial
Anand et al.
Arch Pediatr Adolesc Med 1999;153:331-338.
ABSTRACT | FULL TEXT  

Reflections on measuring pain in infants: dissociation in responsive systems and "honest signalling"
Barr
Arch. Dis. Child. Fetal Neonatal Ed. 1998;79:152F-156.
FULL TEXT  

A Comparison of Outcomes in Demand Versus Schedule Formula-Fed premature Infants
Waber et al.
Nutr Clin Pract 1998;13:132-135.
ABSTRACT  

Medical Complications of the Critically III Newborn: A Review for Early Intervention Professionals
McNab and Blackman
Topics in Early Childhood Special Education 1998;18:197-205.
ABSTRACT  

Bonding: Recent Observations That Alter Perinatal Care
Kennell and Klaus
Pediatr. Rev. 1998;19:4-12.
FULL TEXT  

Developmental Care Does Not Alter Sleep and Development of Premature Infants
Ariagno et al.
Pediatrics 1997;100:e9-e9.
ABSTRACT | FULL TEXT  

Retinopathy of prematurity screening, stress related responses, the role of nesting
Slevin et al.
Br J Ophthalmol 1997;81:762-764.
ABSTRACT | FULL TEXT  

Nurses' Experience with Implementing Developmental Care in NICUs
Premji and Chapman
West J Nurs Res 1997;19:97-109.
ABSTRACT  

Supporting A Preterm Infant's Behaviour During Breastfeeding: A Case Report
Nyqvist et al.
J Hum Lact 1996;12:221-228.
ABSTRACT  

Individualized Developmental Care for Very-Low-Birth-Weight Premature Infants
Fleisher et al.
CLIN PEDIATR 1995;34:523-529.
ABSTRACT  

Developmental Care for Very Low-Birth-Weight Infants
Garland
JAMA 1995;273:1575-1575.
ABSTRACT  

Developmental Care for Very Low-Birth-Weight Infants
Ohisson
JAMA 1995;273:1576-1576.
ABSTRACT  

Developmental Care for Very Low-Birth-Weight Infants
Sepkowitz
JAMA 1995;273:1577-1577.
ABSTRACT  

Developmental Care for Very Low-Birth-Weight Infants
Lacy
JAMA 1995;273:1575-1576.
ABSTRACT  

Developmental Care for Very Low-Birth-Weight Infants
Saigal and Streiner
JAMA 1995;273:1576-1577.
ABSTRACT  

TAILORED SUPPORTIVE CARE FOR VERY-LOW-BIRTH-WEIGHT INFANTS
JWatch General 1994;1994:5-5.
FULL TEXT  

Individualized Developmental Care: An Emerging New Standard for Neonatal Intensive Care Units?
Merenstein
JAMA 1994;272:890-891.
ABSTRACT