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). CONCLUSION: NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly.
