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Family-centered developmental supportive care: a holistic and humane approach to reduce stress and pain in neonates

Journal of Perinatology volume 27, pages S12–S18 (2007)Cite this article

Abstract

The theoretical framework behind family-centered developmentally supportive care is endorsed by research from several scientific fields such as neuroscience, developmental and family psychology, medicine and nursing. The most developed and well-studied form of developmental care is the newborn individualized care and assessment program (NIDCAP). This program has been shown to reduce stress and pain behaviors, physiologic stress response and decrease the use of sedatives and opioids. In addition, NIDCAP has positive effects on pulmonary morbidity, brain lesions and costs in the newborn period. In the longer term, the program is also reported to improve cognitive outcome and behavior in former very low-birth weight infants. The introduction of NIDCAP is not a trivial process but involves a considerable investment at all levels of the organization. NIDCAP requires some physical changes in the neonatal intensive care unit as well as substantial educational efforts and changes in the practice of care. The findings of the presented NIDCAP studies are encouraging and, equally important, is attractive from an ethical and humane perspective.

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References

  1. Stewart AL, Reynolds EO, Lipscomb AP . Outcome for infants of very low birthweight: survey of world literature. Lancet 1981; 1: 1038–1040.

    Article  CAS  PubMed  Google Scholar 

  2. Horbar JD, Badger GJ, Lewit EM, Rogowski J, Shiono PH . Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network. Pediatrics 1997; 99(2): 149–156.

    Article  CAS  PubMed  Google Scholar 

  3. Vaucher YE . Bronchopulmonary dysplasia: an enduring challenge. Pediatr Rev 2002; 23: 349–358.

    Article  PubMed  Google Scholar 

  4. Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS . Cognitive and behavioral outcomes fo school-aged children who were born preterm. JAMA 2002; 288: 728–737.

    Article  PubMed  Google Scholar 

  5. Bartocci M, Bergqvist LL, Lagercrantz H, Anand KJ . Pain activates cortical areas in the preterm newborn brain. Pain 2006; 122(1–2): 109–117.

    Article  PubMed  Google Scholar 

  6. Bellù R, de Waal KA, Zanini R . Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev 2005, Issue 1. Art. No.: CD004212. doi:10.1002/14651858.CD004212.pub2.

  7. Shah PS, Aliwalas LL, Shah V . Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database of Syst Rev 2006, Issue 3. Art. No.: CD004950. doi:10.1002/14651858.CD004950.pub2.

  8. Johnston CC, Filion F, Snider L, Majnemer A, Limperopoulos C, Walker CD et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks' postconceptional age. Pediatrics 2002; 110: 523–528.

    Article  PubMed  Google Scholar 

  9. Wiesel TN, Hubel DH . Comparison of the effects of unilateral and bilateral eye closure on cortical unit responses in kittens. J Neurophysiol 1965; 28(6): 1029–1040.

    Article  CAS  PubMed  Google Scholar 

  10. Philbin MK, Ballweg DD, Gray L . The effect of an intensive care unit sound environment on the development of habituation in healthy avian neonates. Dev Psychobiol 1994; 27(1): 11–21.

    Article  CAS  PubMed  Google Scholar 

  11. Modney BK, Hatton GI . Maternal behaviors: evidence that they feed back to alter brain morphology and function. (Review). Acta Paediatr 1994; (Suppl. 397): 29–32.

  12. Rosenblum LA, Andrews MW . Influences of environmental demand on maternal behavior and infant development. [Review]. Acta Paediatr 1994; (Suppl. 397): 57–63.

  13. Evrard P, Marret S, Gressens P . Environmental and genetic determinants of neural migration and postmigratory survival. Acta Paediatr Suppl 1997; 422: 20–26.

    Article  CAS  PubMed  Google Scholar 

  14. Rabinowicz T, de Courten-Myers GM, Petetot JM, Xi G, de los Reyes E . Human cortex development: estimates of neuronal numbers indicate major loss late during gestation. J Neuropathol Exp Neurol 1996; 55(3): 320–328.

    Article  CAS  PubMed  Google Scholar 

  15. Huppi PS, Warfield S, Kikinis R, Barnes PD, Zientara GP, Jolesz FA et al. Quantitative magnetic resonance imaging of brain development in premature and mature newborns. Ann Neurol 1998; 43(2): 224–235.

    Article  CAS  PubMed  Google Scholar 

  16. Bourgeois JP . Synaptogenesis, heterochrony and epigenesis in the mammalian neocortex. Acta Paediatr Suppl 1997; 422: 27–33.

    Article  CAS  PubMed  Google Scholar 

  17. Penn AA, Shatz CJ . Brain waves and brain wiring: the role of endogenous and sensory-driven neural activity in development. Pediatr Res 1999; 45(4 Pt 1): 447–458.

    Article  CAS  PubMed  Google Scholar 

  18. Peterson BS, Vohr B, Staib LH, Cannistraci CJ, Dolberg A, Schneider KC et al. Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. JAMA 2000; 284(15): 1939–1947.

    Article  CAS  PubMed  Google Scholar 

  19. Murdock D . Handling during neonatal intensive care. Arch Dis Child 1984; 59: 957–961.

    Article  Google Scholar 

  20. Long JG, Lucey JF, Philip AG . Noise and hypoxemia in the intensive care nursery. Pediatrics 1980; 65(1): 143–145.

    CAS  PubMed  Google Scholar 

  21. Lagercrantz H, Nilsson E, Redham I, Hjelmdahl P . Plasma catecholamines following nursing procedures in a neonatal ward. Early Hum Dev 1986; 14: 61–65.

    Article  CAS  PubMed  Google Scholar 

  22. Liu D, Caldji C, Sharma S, Plotsky PM, Meaney MJ . Influence of neonatal rearing conditions on stress-induced adrenocorticotropin responses and norepinepherine release in the hypothalamic paraventricular nucleus. J Neuroendocrinol 2000; 12(1): 5–12.

    Article  PubMed  Google Scholar 

  23. Ruda MA, Ling QD, Hohmann AG, Peng YB, Tachibana T . Altered nociceptive neuronal circuits after neonatal peripheral inflammation. Science 2000; 289(5479): 628–631.

    Article  CAS  PubMed  Google Scholar 

  24. Anand KJ, Coskun V, Thrivikraman KV, Nemeroff CB, Plotsky PM . Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiol Behav 1999; 66(4): 627–637.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Liu D, Diorio J, Day JC, Francis DD, Meaney MJ . Maternal care, hippocampal synaptogenesis and cognitive development in rats. Neuroscience 2000; 3(8): 799–806.

    CAS  PubMed  Google Scholar 

  26. Francis DD, Young LJ, Meaney MJ, Insel TR . Naturally occurring differences in maternal care are associated with the expresson of oxytocin and vasopressin (V1a) receptors: gender differences. J Neuroendocrinol 2002; 14: 349–353.

    Article  CAS  PubMed  Google Scholar 

  27. Klaus MH, Kennell JH . Parent-Infant Bonding. CV Mosby Company, St Louis, MO, 1982.

    Google Scholar 

  28. Harrison H . The principles for family-centered neonatal care. Pediatrics 1993; 92: 643–650.

    CAS  PubMed  Google Scholar 

  29. Minde K, Whitelaw A, Brown J, Fitzhardinge P . Effect of neonatal complications in premature infants on early parent–infant interactions. Dev Med Child Neurol 1983; 25: 763–777.

    Article  CAS  PubMed  Google Scholar 

  30. Whitelaw A . Clinical implications of basic research in the neurobiology of infant–parent interaction in the newborn period. Acta Paediatr 1994; 83(8): 874–876.

    Article  CAS  PubMed  Google Scholar 

  31. Als H, McAnulty GB . Behavioral differences between preterm and full-term newborns as measured with the APIB system scores:I. Infant Behav Dev 1988; 11: 305–318.

    Article  Google Scholar 

  32. Stjernqvist K, Svenningsen NW . Neurobhavioural development at term of extremely low-birthweight infants (less than 901 g). Dev Med Child Neurol 1990; 32: 679–688.

    Article  CAS  PubMed  Google Scholar 

  33. Eckerman CO, Oehler JM, Medvin MB, Hannan TE . Premature newborns as social partners before term age. Infant Behav Dev 1994; 17: 55–70.

    Article  Google Scholar 

  34. Als H, Lawhon G, Brown E, Gibes R, Duffy FH, McAnulty G et al. Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: neonatal intensive care unit and developmental outcome. Pediatrics 1986; 78(6): 1123–1132.

    CAS  PubMed  Google Scholar 

  35. Als H . A synactive model of neonatal behavioral organization. Phys Occup Ther Pediatr 1986; 6: 3–55.

    Google Scholar 

  36. Holsti L, Grunau RE, Oberlander TF, Whitfield MF . Specific newborn individualized developmental care and assessment program movements are associated with acute pain in preterm infants in the neonatal intensive care unit. Pediatrics 2004; 114(1): 65–72.

    Article  PubMed  Google Scholar 

  37. Als H, Lawhon G, Duffy FH, McAnulty GB, Gibes-Grossman R, Blickman JG . Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects [see comments]. JAMA 1994; 272(11): 853–858.

    Article  CAS  PubMed  Google Scholar 

  38. Fleisher BE, VandenBerg K, Constantinou J, Heller C, Benitz WE, Johnson A et al. Individualized developmental care for very low birthweight premature infants improves medical and neurodevelpmental outcome in the neonatal intensive care unit. Clin Pediatr 1995; October: 523–529.

    Article  Google Scholar 

  39. Westrup B, Böhm B, Lagercrantz H, Stjernqvist K . Preschool outcome in children born very preterm and cared according to the Newborn Individualized Care and Assessment Program (NIDCAP). Acta Paediatr 2004; 93: 1–10.

    Article  Google Scholar 

  40. Als H, Gilkerson L, Duffy FH, McAnulty GB, Buehler DM, Vandenberg K et al. A three-center, randomized, controlled trial of individualized developmentally supportive care for very low birth weight preterm infants: medical, neurodevelopmental, parenting and caregiving effects. J Dev Behav Pediatr 2003; 24: 399–408.

    Article  PubMed  Google Scholar 

  41. Jacobs SE, Sokol J, Ohlsson A . The newborn individualized developmental care and assessment program is not supported by meta-analyses of the data. J Pediatr 2002; 140(6): 699–706.

    Article  PubMed  Google Scholar 

  42. Symington A, Pinelli J . Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database of Syst Rev 2006, Issue 2. Art. No.: CD001814. doi:10.1002/14651858.CD001814.pub2.

  43. Ariagno RL . Developmental care does not alter sleep and development in premature infants. Pediatrics 1997; 100(6): E9.

    Article  CAS  PubMed  Google Scholar 

  44. Buehler DM, Als H, Duffy FH, McAnulty GB, Liederman J . Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence. Pediatrics 1995; 96(5 Pt 1): 923–932.

    CAS  PubMed  Google Scholar 

  45. Als A, Duffy FH, McAnulty G, Rivkin MJ, Vajapeyam S, Mulkern RV et al. Early experience alters brain function and structure. Pediatrics 2004; 113(4): 846–857.

    Article  PubMed  Google Scholar 

  46. Peters K, Tyebkhan J, Hendson L et al. The Edmonton RCT of NIDCAP. SPR San Francisco Pediatric Res 2004; 55: 505A.

    Google Scholar 

  47. Sizun J, Ansquer H, Browne J, Tordjman S, Morin JF . Developmental care decreases physiologic and behavioral expression in preterm neonates. J Pain 2002; 3: 446–450.

    Article  PubMed  Google Scholar 

  48. Catelin C, Tordjman S, Morin V, Oger E, Sizun J . Clinical, physiologic, and biologic impact of environmental and behavioral interventions in neonates during a routine nursing procedure. J Pain. 2005; 6(12): 791–797.

    Article  PubMed  Google Scholar 

  49. Bertelle V, Mabin D, Adrien J, Sizun J . Sleep of preterm neonates under developmental care or regular environmental conditions. Early Hum Dev 2005; 81: 595–600.

    Article  PubMed  Google Scholar 

  50. Heller C, Constantinou JC, VandenBerg K, Benitz W, Fleisher BE . Sedation administered to very low birth weight premature infants. J Perinatol 1997; 17(2): 107–112.

    CAS  PubMed  Google Scholar 

  51. Westrup B, Kleberg A, von Eichwald K, Stjernqvist K, Lagercrantz H . A randomized controlled trial to evaluate the effects of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) in a Swedish setting. Pediatrics 2000; 105: 66–72.

    Article  CAS  PubMed  Google Scholar 

  52. Becker PT, Grunwald PC, Moorman J, Stuhr S . Outcomes of developmentally supportive nursing care for very low birth weight infants. Nurs Res 1991; 40(3): 150–155.

    Article  CAS  PubMed  Google Scholar 

  53. Petryshen P, Stevens B, Hawkins J, Stewart M . Comparing nursing costs for preterm infants receiving conventional vs. developmental care. Nurs Econ 1997; 15: 138–145 150.

    CAS  PubMed  Google Scholar 

  54. Brown LD, Heermann JA . The effect of developmental care on preterm infant outcome. Appl Nurs Res 1997; 10: 190–197.

    Article  CAS  PubMed  Google Scholar 

  55. Westrup B, Kleberg A, Wallin L, Lagercrantz H, Wikblad K, Stjernqvist K . Evaluation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) in a Swedish setting. Prenat Neonat Med 1997; 2: 366–375.

    Google Scholar 

  56. Stevens B, Petryshen P, Hawkins J, Smith B, Taylor P . Developmental versus conventional care: A comparison of clinical outcomes for very low birth weight infants. Can J Nurs Res 1996; 28: 97–113.

    CAS  PubMed  Google Scholar 

  57. Als H, Gilkerson L . The role of relationship-based developmentally supportive newborn intensive care in strengthening outcome of preterm infants. Semin Perinatol 1997; 21: 178–189.

    Article  CAS  PubMed  Google Scholar 

  58. Levin A . Humane neonatal care initiative. Acta Paediatr 1999; 88(4): 353–355.

    Article  CAS  PubMed  Google Scholar 

  59. Kennell JH . The humane neonatal care initiative. Acta Paediatr 1999; 88: 367–370.

    Article  CAS  PubMed  Google Scholar 

  60. Sizun J, Ratynski N, Boussard C . Humane neonatal care initiative, the NIDCAP and the family-centered neonatal intensive care. Acta Paediatr 1999; 88: 1172.

    Article  CAS  PubMed  Google Scholar 

  61. Westrup B, Kleberg A, Stjernqvist K . The humane neonatal care initiative and family-centred developmentally supportive care. Acta Paediatr 1999; 88: 1051–1052.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Jacques Sizun is supported by the CNP Foundation and French Ministry of Health PHRC grants.

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Authors and Affiliations

  1. Neonatal Unit, Astrid Lindgren Children's Hospital, Karolinska Institute, Stockholm, Sweden

    B Westrup & H Lagercrantz

  2. Department of Pediatrics, Brest University Hospital, Brest, France

    J Sizun

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  1. B Westrup
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Correspondence to B Westrup.

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Westrup, B., Sizun, J. & Lagercrantz, H. Family-centered developmental supportive care: a holistic and humane approach to reduce stress and pain in neonates. J Perinatol 27 (Suppl 1), S12–S18 (2007). https://doi.org/10.1038/sj.jp.7211724

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