Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

Newborn Individualized Developmental Care and Assessment Program

Descriptive Information

1. Title: Newborn Individualized Developmental Care and Assessment Program
2. Edition: N/A
3. Dates of Publication/Revision: Not found
4. Author (s):
   1. Developed by Heidelise Als, PhD and colleagues
5. Source (publisher or distributor, address):
   1. NFI (NIDCAP Federation International)
      1. A non-Profit international professional membership organization that ensures the quality of training and education in the NIDCAP model.
6. Costs (booklets, forms, kit)*
   1. NNCP (NIDCAP Nursery certification process) Application and Review Process for facility
      1. Application Part 1: $1,500
      2. Application Part 2: $9,000
      3. NNCP Site Review Visit: $18,720
      4. Total: $29,220
   2. $1,500 per day for each trainee during training
   3. NFI Membership: $115/year
7. Purpose: (obtained from NFI website)
   1. To provide “developmentally supportive care, and assessment, for preterm and full-term newborns and their families in the hospital, and the transition home.”
   2. Caregivers are educated and trained in developmental observation and assessment in order to interpret an infant’s behavioral cues in order to comfort the infant and reduce stress.
   3. Neurodevelopmentally supportive, individualized, and family-centered framework.
8. Type of Test (eg, screening, evaluative; interview, observation, checklist or inventory)*:
   1. The NIDCAP includes both an observational tool and the APIB. The systematic behavioral observation methodology, known as “NIDCAP observation”, is a tool used to structure the observation of infants within their environments. It helps health care providers interpret infant behavior and reactions to care.
   2. The APIB (Assessment of Preterm Infants’ Behavior) is a neurodevelopmental diagnostic instrument used to assess preterm and fullterm newborns in the nursery setting. It helps to assess the organization of an infant’s subsystems including: autonomic, motor, state, attention, and self-regulation. The APIB also assesses the degree of facilitation needed to support an infant’s reorganization when disorganized, and assesses the integrity of an infant’s sleep organization, movement repertoire, availability and quality of social interaction.
9. Target Population and Ages*
   1. The NIDCAP target population includes preterm and fullterm newborns in the NICU
10. Time Requirements  – Administration and Scoring*
    1. Administration of the NIDCAP is a continuous process once implemented. It takes 5 years to train/implement NIDCAP framework. On average it takes 12 months to train an individual.

Test Administration

1. Administration
   1. All healthcare providers in the NICU administer the NIDCAP and involves the coordination of care delivered by special service providers such as respiratory therapists, occupational and physical therapists, social workers, nutritionists, early intervention professionals, public health nurses, etc.
2. Scoring
   1. The NIDCAP is more of a framework; a “score” is not given.
3. Type of information, resulting from testing (e.g. standard scores, percentile ranks)
   1. Results help to create goals for the infant that will support the infant’s development, allow health care providers to create an appropriate physical environment in the NICU for the infant and family, and provides information for the timing and organization of medical and nursing interventions that are appropriate to the individuality of infant and family
4. Environment for Testing
   1. NICU, special care nursery
   2. Infants are observed in their beds in the nursery before, during, and after caregiving experiences
5. Equipment and Materials Needed (obtained from Promising Practices Network website)
   1. Equipment arranged aesthetically and in close proximity to the infant
   2. Comfortable chairs for parent overnight stays
   3. Families are encouraged to personalize and decorate the infant’s bed space with personal items
   4. Peaceful and quiet area
   5. Darkness during sleep/ low, muted lights when awake
   6. Indirect light on the infant’s face
   7. Supports, blankets, nesting, swaddling for proper positioning
6. Examiner Qualifications (NFI website)
   1. All healthcare providers must have NIDCAP training and APIB certification. In order to be certified as a NIDCAP nursery, a facility must train atleast 2 developmental care specialists, train a multidisciplinary leadership support team and institutional system support, train nursing staff, develop a parent council, and develop a reflective process and continuing education opportunities. It can take 5 years to become an accredited NIDCAP facility.
7. Psychometric Characteristics*
   1. Unable to find research on reliability and validity
8. Standardization/normative data
   1. None provided
9. Evidence of Reliability: (NFI website)
   1. APIB Reliability “requires confidence and expertise in examining infants of a wide range of gestational ages and clinical conditions, and accurately scoring their behavioral repertoires and functioning”. This is gained thought a 2-day reliability session during training.
   2. There was no research found on general NIDCAP reliability
10. Evidence of Validity:
    1. No research found assessing the validity of NIDCAP.
11. Discriminative: unable to find
12. Predictive: unable to find

Summary Comments*

1. Strengths
   1. The NFI claims “research has documented the beneficial effect of NIDCAP in terms of shorter intensive care and overall hospital stay, better weight gain, and improved behavioral outcomes that endure beyond infancy”. NIDCAP “enhances brain structure and function when measured by sophisticated medical techniques such as EEG and MRI”.
   2. Decreases stressful stimuli in the NICU to enhance neurodevelopment in preterm infants.
2. Weaknesses
   1. Unable to find clinical research on reliability and validity
   2. It takes a long time to implement this program and it may be difficult to coordinate between the many different health care providers.
   3. A systematic review that included 627 preterm infants did not find evidence-supporting NIDCAP improving long-term neurodevelopmental or short-term medical outcomes. (Ohlsson)
      1. Concluded that the authors can’t recommend the implementation of NIDCAP as standard care for preterm infants.
3. Clinical Applications
   1. The NIDCAP intervention is a developmental model that can be implemented in the NICU to provide an optimal environment for neonatal development that decreases the stressful stimuli in the NICU.
   2. The goal is to decrease complications and shorten hospital stays.

References

NIDCAP Training Overview. NIDCAPT Federation International website. 2015. Available at: http://nidcap.org/en/programs-and-certifications/nidcap-training/overview-2/

NIDCAP Program Info. Promising Practices Network Website. Last Reviewed July 2009. Available at: http://www.promisingpractices.net/program.asp?programid=103#methods

Ohlsson, A., Jacobs SE. NIDCAP: a systematic review and meta-analyses of randomized control trials. Pediatrics. 2013 Mar; 131 (3) Available at: http://pediatrics.aappublications.org/content/131/3/e881.long

Program Guide. NIDCAP Federation International website. 2014, rev Sep 2014. Available at: http://nidcap.org/wp-content/uploads/2014/09/Program-Guide-Rev-22Sep2014.pdf

 

 Summary of Research Article

McAnulty, GB., Butler, SC., Bernstein, JH., et al. Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data. Clinical Pediatrics. 2010. 49(3) 258-270. Available at: http://cpj.sagepub.com/content/49/3/258.full.pdf+html

This study is a randomized controlled trial that assessed the effectiveness of NIDCAP intervention at infancy, on neuropsychological and neuroelectrophysiological factors at 8 years of age. This study was conducted in response to a meta-analysis of previous NIDCAP RCTs that concluded there was not sufficient evidence to recommend NIDCAP as standard clinical care. One reason for this conclusion was that there were not follow up studies conducted in school age children to assess the long term impact of NIDCAP. An original 2-group RCT study was conducted with 38 high-risk preterm infants born <= 29 weeks postmenstrual age. The current study is a follow up to the original study that was able to recruit 22 of the original 38 participants, at 8 years of age. The experimental group received NIDCAP intervention from admission to the NICU until 2 weeks corrected age. Control group care was described as: primary care nursing, individual staff dependent parent inclusion, standard shielding of incubators with blankets, dressing of infants in T-shirts, use of side and foot rolls, and liberal provision of pacifiers. The participants were assessed using a 12-test neuropsychological battery (WISC-R, K-ABC, K-TEA, EOWPVT, PPVT, TAAS, TAN, VMI, CFRT, ROCFT, SPPI). The assessments were conducted by a blinded psychologist and were videotaped for a reliability check. In addition to the neuropsychological battery, the participants underwent neurophysiological assessment using an EEG spectral coherence measure. The study found that NIDCAP intervention in the NICU enhances neuropsychological and electrophysiological function at 8 years of age in comparison to the control treatment. More specifically, the research suggests better right hemisphere and frontal lobe function in children who received NIDCAP treatment in the NICU in comparison to the control. In addition, it was discovered that neurobehavioral and neurophysiological function at 2 weeks corrected age predicted function at 8 years of age. The authors concluded that NIDCAP intervention can have an effect that last into school age.