Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects.
OBJECTIVE
To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants.


METHODS
Randomized controlled trial.


METHODS
Newborn intensive care unit.


METHODS
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Als
H
H
Department of Psychiatry, Harvard Medical School, Boston, MA.
Lawhon
G
G
Duffy
F H
FH
McAnulty
G B
GB
Gibes-Grossman
R
R
Blickman
J G
JG
D002657:Child Development; D005260:Female; D006771:Hospitals, Maternity / Q000592:standards; D006801:Humans; D007230:Infant, Low Birth Weight / Q000254:growth & development; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D007235:Infant, Premature, Diseases / Q000451:nursing / Q000517:prevention & control*; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D008297:Male; D008404:Massachusetts; D017283:Neonatal Nursing / Q000379:methods / Q000592:standards; D010347:Patient Care Planning / Q000592:standards*; D012959:Socioeconomic Factors; D016896:Treatment Outcome