Authors: E Zana-Taïeb, M Bigard, C Lopez (avril 2015)
Developmental care is a set of environmental and behavioral non-pharmaceutical techniques intended to preserve the comfort of a hospitalized newborn, premature or not (1).
These techniques can be used in isolation or in combination in integrated program such as NIDCAP. This program created in the United States by Heideliese Als, arrived in France in the 1990s. It is a philosophy of care based on repeated and formalized observation of the child’s behavior in response to stimulation and/or during rest. Observations provide hints as to how to improve the child’s wellbeing and reduce stress signs by responding to his or her specific needs in collaboration with the family. In NIDCAP, the child is a full player in his or her own development, supported with the help of the family.
Major points of NIDCAP
A child’s behavior is observed in 5 aeras: the automatic nervous system (particularly cardio-respiratory regulation), motor system, sleep-wake, self-regulation and attention-interaction. The child’s efforts are observed through approach and withdrawal behaviors.
Environmental strategies
The child’s environment is redesigned with suitable facilities. The parents are welcome and visits 24/7 with unlimited visiting hours are encouraged. There are rooms dedicated to rest for the parents and others to encourage breastfeeding, rooms for eating, relaxing, or for the siblings.
Excessive noise levels can negatively impact cardio-respiratory stability and have long-term negative developmental effects. Care units has been redesigned to create single room units, using noise-absorbing materials (2).
Flexible light control is used to ensure that babies are exposed to light level compatible with their stage of development and with the time of day.
Apart from the ambient light intensity, special care should be taken to protect babies’ retinas by avoiding shining light directly into their eyes, even when closed.
Behavioral strategies
Non-nutritive sucking is triggered by teat use, sucrose administration, or the smell of breast milk. Its calming effect has been clearly demonstrated whether used alone or with sugar solution (3,4). Swaddling with a blanket or hand restraint is used to delimit the child’s immediate environment as to promote self-regulation and mitigate physiological and behavioral stress due to acute pain (3).
Apart from care, cocoons or nests facilitate the tuck position to promote bending and self-regulation (hands to face or mouth) and to prevent the acquisition of fixed postures (5). This set of behavioral techniques is useful to reduce pain, generated by routine care such as diaper changing or weighing (6,7).
Skin-to-skin contact is strongly encouraged in developmental care and is another example of techniques that combine postural support and swaddling, family involvement, multi-modal sensory stimulation, and nutritive and non-nutritive sucking. It has a positive impact, demonstrated many times, on cardio-respiratory and temperature stability, sleep, mother-infant attachment and breast-feeding (8).
More about developmental care and NIDCAP
«The child’s timeframe »: thinking about life rhythms
With NICAP, ways are sought to reduce handling and to combine care interventions or conversely to separate them, because some very immature children do not tolerate lenghty interventions. Respect of the child’s sleep-wake cycle is strongly encouraged.
Family-centered care
Family-centered care is integral to NIDCAP and goes well beyond the daily patient-caregiver relationship. NIDCAP mothers report that they feel closer to their babies, whatever the baby’s weight or health status, and that the care team better help them more in their role as mother.
Breastfeeding is strongly encouraged through family-centered care and a better understanding of the newborn baby’s individual needs. Breast milk is indispensable in the feeding of extreme preterm newborns and has many beneficial effects, including on the child’s neurological development of the child till the age of 5 years (9).
- Browne JV. Developmental care for high-risk newborns: emerging science, clinical application, and continuity from newborn intensive care unit to community. Clinics in perinatology. 2011;38(4):719-29.
- Jacques Sizun BG, Charlotte Casper, Gérard Thiriez, Pierre Kuhn Soins de développement en période néonatale. De la recherche à la pratique. 2014. 329 p.
- Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, et al. Non-pharmacological management of infant and young child procedural pain. The Cochrane database of systematic reviews. 2011(10):CD006275.
- Pinelli J, Symington A. Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. The Cochrane database of systematic reviews. 2005(4):CD001071.
- Vaivre-Douret L, Ennouri K, Jrad I, Garrec C, Papiernik E. Effect of positioning on the incidence of abnormalities of muscle tone in low-risk, preterm infants. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society. 2004;8(1):21-34.
- Sizun J, Ansquer H, Browne J, Tordjman S, Morin JF. Developmental care decreases physiologic and behavioral pain expression in preterm neonates. The journal of pain : official journal of the American Pain Society. 2002;3(6):446-50.
- 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. The journal of pain : official journal of the American Pain Society. 2005;6(12):791-7.
- Conde-Agudelo A, Diaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. The Cochrane database of systematic reviews. 2014;4:CD002771.
- Roze JC, Darmaun D, Boquien CY, Flamant C, Picaud JC, Savagner C, et al. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ open. 2012;2(2):e000834.
To read more : website of NIDCAP Federation International