Als devised a highly organized comprehensive system for providing neurodevelopmental support in a NICU (Als, 1998). This system, commonly known as NIDCAP, has generated much interest and is often equated with NICU developmental care (Ashbaugh et al., 1999). Its systematic implementation requires development of NICU developmental care teams with dedicated staff trained and certified in NIDCAP, the systematic observation of the behavior of the infants, the coordination of care, and careful monitoring of the infant's physiological responses. An individual developmental care plan is designed for each infant, with efforts to decrease adverse elements in the NICU environment.
Although some studies, including randomized clinical trials, have demonstrated the beneficial effects of NIDCAP on short-term growth, the duration of ventilation, the need for tube feedings, hospital stays, and cognitive abilities, many of these studies have been criticized for their small sample sizes or because they lacked masked outcome evaluators (Symington and Pinelli, 2003). In addition, for every positive effect reported, other studies have provided conflicting results. Because NIDCAP includes multiple interventions, it has been difficult to determine the efficacy of any single intervention. A recent paper found differences in brain structure and behavior at 8 months of age for infants who were part of NIDCAP, but further research is needed to assess longer-term outcomes (Als et al., 2004).
Cost has been cited as a reason for the lack of full implementation of NIDCAP, but no studies have addressed the economic impact of NIDCAP implementation (Symington and Pinelli, 2003). Only 30 percent of responders to a nursing survey published in 1999 worked in a NICU with a dedicated developmental care team and budget, although most reported the incorporation of aspects of NIDCAP care into their practices. The Cochrane Review concludes, "Before a clear direction for practice can be supported, evidence demonstrating more consistent effects of developmental care interventions on important short- and long-term clinical outcomes is needed. The economic impact of the implementation and maintenance of developmental care practices should be considered by individual institutions" (Symington and Pinelli, 2003, p.).
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