Newborn Individualized Developmental Care and Assessment Program (NIDCAP): New frontier for neonatal and perinatal medicine

Article type: Research Article

Authors: Als, Heidelise

Affiliations: Department of Psychiatry, Harvard Medical School and Children's Hospital Boston, Boston, MA, USA

Note: [] Corresponding author: Heidelise Als, Neurobehavioral Infant and Child Studies, Enders Pediatric Research Laboratories, EN -107, Children's Hospital Boston, 320 Longwood Avenue, Boston, MA 02115, USA. Tel.: +1 617 355 8249; Fax: +1 617 730 0224; E-mail: heidelise.als@childrens.harvard.edu

Abstract: The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) derives from the conceptualization of the preterm infant as a goal-oriented fetus outside of the womb in the evolutionarily-unexpected environment of the newborn intensive care nursery or unit (NICU). The NICU may be required for survival, yet violates the displaced brain and infant's neurodevelopmental expectations. Detailed behavioral observations of the infant in the NICU become the professional's guide to provide continuously individually-adapted, developmentally supportive care. The detailed behavioral observations led to the comprehensive dynamic formulation termed the synactive theory of development. It is anchored in sound developmental principles. In turn it provides a framework for the disciplined and systematic study of the infants' behavioral subsystems in their continuous interplay with one another and in turn with the current physical and social environments. Integration of the NIDCAP approach and framework into newborn intensive care reduces the iatrogenic complications of newborn intensive care for infants, parents and staff alike, and in turn enhances the infant's competence, the parents' confidence, and the staff's role satisfaction. The theory-driven and evidence-based NIDCAP model of care involves formal training and education and requires a multidisciplinary commitment to self-definition and growth, as well as systems change within the hospital and the community. Site assessment of the respective nursery and self-assessment of individual professionals initiate the training process and help launch over time a thorough and thoughtful transformation in all aspects of clinical practice and mutual interaction within the NICU. The training consists of a series of individual or paired work sessions with a certified NIDCAP Trainer, made successful by extensive guided independent neurobehavioral practice, study, and observations. Each clinical report based on a detailed infant observation interprets the meaning of the infant's observed behavior within the context of the infant's current and historical medical and developmental course and status, the family's desires, worries, concerns and own development, as well as the NICU staff's care and social interaction skills, and the NICU's physical environment, which all impinge continuously on the infant proximally and distally. The individually adapted care interactions and collaborations with the infant and family, as well as the environment modifications yield significantly enhanced developmental outcomes of newborn intensive care. Survival is only warranted when quality of life and a growing sense of power and effectance make life worthwhile. NIDCAP is a system-anchored relationship-based prevention and intervention model that strives to enhance relationships among the infants, the families and the professionals, who care for them.

Keywords: NIDCAP, preterm infants, newborns, neonatal intensive care, individualized developmental care, NICU environment, staff training, -education and -emotional guidance and support

DOI: 10.3233/NPM-2009-0061

Journal: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 135-147, 2009