Conclusion : Positive clinical ly meaningful effects ( > 5 points ) are seen to an age of 36 months , but are no longer present at 5 years
Objective : To determine in a systematic review , whether interventions for infant development that involve parents , improve neurodevelopment at 12 months corrected age or older .
Developmental care does not alter sleep and development of premature infants.
OBJECTIVE The Neonatal Individualized Developmental Care Program ( NIDCAP ) for very low birth weight ( VLBW ) preterm infants has been suggested by Als et al to improve several medical outcome variables such as time on ventilator , time to nipple feed , the duration of hospital stay , better behavioral performance on Assessment of Preterm Infants ' Behavior ( APIB ) , and improved neurodevelopmental outcomes . We have tested the hypothesis of whether the infants who had received NIDCAP would show advanced sleep-wake pattern , behavioral , and neurodevelopmental outcome . METHODS Thirty-five VLBW infants were r and omly assigned to receive NIDCAP  or routine infant care . The goals for NIDCAP intervention were to enhance comfort and stability and to reduce stress and agitation for the preterm infants by : a ) altering the environment by decreasing excess light and noise in the neonatal intensive care unit ( NICU ) and by using covers over the incubators and cribs ; b ) use of positioning aids such as boundary supports , nests , and buntings to promote a balance of flexion and extension postures ; c ) modification of direct h and s-on caregiving to maximize preparation of infants for , tolerance of , and facilitation of recovery from interventions ; d ) promotion of self-regulatory behaviors such as holding on , grasping , and sucking ; e ) attention to the readiness for and the ability to take oral feedings ; and f ) involving parents in the care of their infants as much as possible . The infants ' sleep was recorded at 36 weeks postconceptional age ( PCA ) and at 3 months corrected age ( CA ) using the Motility Monitoring System ( MMS ) , an automated , nonintrusive procedure for determining sleep state from movement and respiration patterns . Behavioral and developmental outcome was assessed by the Neurobehavioral Assessment of the Preterm Infant ( NAPI ) at 36 weeks PCA , the APIB at 42 weeks PCA , and by the Bayley Scales of Infant Development ( BSID ) at 4 , 12 , and 24 months CA . RESULTS Sleep developmental measures at 3 months CA showed a clear developmental change compared with 36 weeks PCA . These include : increased amount of quiet sleep , reduced active sleep and indeterminate sleep , decreased arousal , and transitions during sleep . Longest sleep period at night showed a clear developmental effect ( increased ) when comparing nighttime sleep pattern of infants at 3 months with those at 36 weeks of age . Day-night rhythm of sleep-wake increased significantly from 36 weeks PCA to 3 months CA . However , neither of these sleep developmental changes showed any significant effects of NIDCAP intervention . Although all APIB measures showed better organized behavior in NIDCAP patients , neither NAPI nor Bayley showed any developmental advantages for the intervention group . The neurodevelopmental outcome measured by the Bayley at 4 , 12 , and 24 months CA showed 64 % of the NIDCAP intervention group at the lowest possible score compared with 33 % of the control group . These findings could not be explained by the occurrence of intraventricular hemorrhage or the socioeconomic status of the parents , which showed no significant group effect . CONCLUSION The results of this study , including measures of sleep maturation and neurodevelopmental outcome up to 2 years of age did not demonstrate that the NIDCAP intervention results in increased maturity or development . Buehler et al ( Pediatrics . 1995;96:923 - 932 ) have reported that premature infants ( N = 12 ; mean gestational age 32 weeks , mean birth weight 1700 g ) who received developmental care compared with a similar group of infants who received routine care showed better organized behavioral performance on an APIB assessment at 42 weeks PCA . None of the medical outcome measures were significantly different in this study . Although our APIB results are in agreement , the results of the NAPI , the Bayley and sleep measures do not show an increase in neurodevelopmental maturation . In the earlier report by Als et al ( Journal of the American Medical
Conclusion : Positive clinical ly meaningful effects ( > 5 points ) are seen to an age of 36 months , but are no longer present at 5 years
Objective : To determine in a systematic review , whether interventions for infant development that involve parents , improve neurodevelopment at 12 months corrected age or older .