Improvement of short- and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial.
OBJECTIVE
Our objective was to determine the impact of Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based care on length of stay of very low birth weight (VLBW) infants. Secondary outcome measures were days of ventilation, incidence of chronic lung disease, and 18-month neurodevelopmental outcomes.


METHODS
This cluster-randomized, controlled trial took place in a large NICU in Canada, with follow-up evaluation at 18 months of age, from September 1999 to September 2004. One hundred VLBW singleton infants and 10 VLBW twin sets were assigned randomly to NIDCAP-based or control care, and 90% participated in follow-up assessments. The intervention was NIDCAP-based care (N = 56), that is, care by NIDCAP-educated staff members and behavioral observations. The control group (N = 55) received standard NICU care. Statistical analyses were adjusted for cluster randomization. Although the intervention was not blinded, the pediatricians making the decisions to discharge the infants were not involved in the study, and the follow-up staff members were blinded with respect to group.


RESULTS
NIDCAP group infants had reduced length of stay (median: NIDCAP: 74 days; control: 84 days; P = .003) and incidence of chronic lung disease (NIDCAP: 29%; control: 49%; odds ratio: 0.42 [95% confidence interval: 0.18-0.95]; P = .035). At 18 months of adjusted age, NIDCAP group infants had less disability, specifically mental delay (NIDCAP: 10%; control: 30%; odds ratio: 0.25 [95% confidence interval: 0.08-0.82]; P = .017).


CONCLUSIONS
NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly.
Faculty of Nursing, Perinatal Clinical Research Centre, University of Alberta, Edmonton, Canada.
Kathrine Leigh
KL
Peters
Rhonda Jean
RJ
Rosychuk
Leonora
L
Hendson
Judith Jean
JJ
Coté
Catherine
C
McPherson
Juzer Mohamed
JM
Tyebkhan
D000367:Age Factors; D000416:Alberta; D002657:Child Development / Q000502:physiology; D016000:Cluster Analysis; D002658:Developmental Disabilities / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods; D007231:Infant, Newborn / Q000254:growth & development*; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019102:Infant, Very Low Birth Weight / Q000254:growth & development* / Q000502:physiology; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D017283:Neonatal Nursing / Q000379:methods; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States