Mothers’ perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared to conventional care

https://doi.org/10.1016/j.earlhumdev.2006.05.024Get rights and content

Abstract

Background

Family-centred care according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to positively influence family function. The aim was to examine if NIDCAP affects the views of prematurely born infants’ mothers regarding maternal role, perception of the infant and the neonatal care.

Method

Preterm infants with gestational age < 32 weeks were randomly assigned to receive either care based on NIDCAP (n = 12) or conventional neonatal care (n = 13), forming two comparable groups with respect to gestational age, birth weight, female/male ratio, and initial illness severity. A questionnaire was designed to evaluate various aspects of the mothers’ attitudes and apprehension of their maternal role, perception of their infant and the neonatal care. The questionnaire was validated and given to the mothers when the infants reached 36 weeks postmenstrual age (PMA).

Results

Ten mothers in each group replied to the questionnaire. The mothers in the NIDCAP-group perceived more closeness to their infants than did the control mothers (p = 0.022) and this feeling demonstrated no significant correlation to the infant’s gestational age, weight at birth or severity of illness. Furthermore, the mothers in the NIDCAP-group tended to rate the staff’s ability to support them in their role as a mother somewhat higher (p = 0.066), but at the same time they expressed more anxiety than did the control mothers (p = 0.033).

Conclusion

Early intervention according to NIDCAP seems to facilitate a feeling of closeness between the mother and her premature infant regardless of the infant’s birth weight or health status. The higher level of anxiety in the mothers in the NIDCAP-group, may mirror that the mothers in the NIDCAP-group had already bonded to their infants during the hospital stay.

Introduction

During the course of a normal pregnancy, the pregnant woman continuously becomes more psychologically prepared to become a mother and to attach to her newborn infant. The healthy, full-term infant is capable of interacting with its environment and to make eye contact. The awake infant can cope with different impressions simultaneously, and is able to attain an alert state of wakefulness, including listening to and turning towards its parents [1]. The full-term infants’ evident communication guides the parents into new interactions.

In contrast, the prematurely born infant is not sufficiently mature to interact and deal with external stimuli, and as a result the infant is hypersensitive and may overreact with e.g. increased or decreased motor action, irregular breathing or apnoea [2], [3], [4]. A probable explanation for this is that the cerebral cortex and the rich subcortical networks are not fully matured. Organization of the neurons in the frontal lobe, the site of intelligence and personality, occurs at a late stage of gestation. Consequently, in order not to disturb the development of the premature infant during this highly sensitive phase, interactions must be adjusted to the child’s degree of maturation [5].

For the preterm infant, the neonatal intensive care period often involves painful stimuli and discomfort, and the preterm infant’s energy may become devoted to reacting to these and other environmental stimuli, resulting in less energy for parental interaction. The parents may be anxious about their infant’s survival and possibility of surviving without handicap.

Furthermore, the neonatal staff with experience of preterm infants may convey an impression to the parents that they know and understand the infant better than the parents. Under such circumstances the parents must begin to get acquainted with, and bond to their child. Several investigations have revealed that mothers experience premature birth, and the neonatal intensive care environment as very traumatic and stressful, and they often express feelings of anxiety, fear, guilt, anger and helplessness [6], [7], [8]. Such feelings may influence the process of bonding negatively, and may be further enhanced by the premature infant’s weaker signals and lower alertness and responsiveness [9], [10], [11], [12], sometimes to such a degree that the mother feels that her infant avoids contact.

The Newborn Individualized Developmental Care and Assessment Program, NIDCAP, was designed to create a relationship-based developmentally supported care environment for the premature infant and its family [13], [14]. The NIDCAP is based on structured observations of the infants’ behaviour and response during a care procedure. The timing and nature of care is subsequently adapted to suit the infants’ present state and behaviour. The parents are encouraged to learn how to interpret their infant’s signs and to participate in the care as early as possible. Moreover, the infant is considered to be an active communicator and participant in its own development [15], [16].

The aim of the present study was to investigate whether care according to NIDCAP, as compared to conventional care, affects how mothers of preterm infants experience their feelings of closeness to their infant, their role as a mother, and how they perceive the neonatal staff and the neonatal care. Several validated questionnaires evaluating parental stress in the NICU are available for term and preterm infants [17], [18], [19], [20]. The reason for constructing the current questionnaire was that we, in the perspective of the randomized NIDCAP-intervention, wanted to evaluate not only negative stress factors but also positive factors related to early bonding between mother and infant.

Section snippets

Patients and methods

The study group consisted of 20 mothers of preterm infants who were enrolled in a randomized controlled trial evaluating the medical effects of care based on NIDCAP, versus standard neonatal care, at the level III Neonatal Intensive Care Unit (NICU) Karolinska Hospital, Stockholm, Sweden. The infants were inborn, singleton infants with gestational age below 32 weeks, who needed ventilatory support with continuous positive airway pressure (CPAP) or mechanical ventilation during the first 24 h of

Differences between the NIDCAP and the conventional care groups

The mothers in the NIDCAP group gave “the feeling of closeness between her and her infant” a significantly higher score than mothers of infants treated with conventional care, median (range) 4 (3–4) versus 3.5 (2–4), p = 0.022. Of the 5 statements included in this subscale, there was a significant difference in the mothers’ attitudes towards the importance of eye contact, 4 (3–4) for the NIDCAP group versus 3 (2–4) for the conventional care group, p = 0.05 (see Table 6). In order to investigate

Discussion

The major finding of the present investigation was that mothers of prematurely born infants receiving care according to NIDCAP felt closer to their infants, but also experienced a higher level of anxiety than the mothers whose children received conventional neonatal care.

Closer examination of the subscale “feeling of closeness to her infant” revealed that the mothers in the NIDCAP group more frequently said that they had eye contact with their infants, which is well known to be an important

Conclusions

The mothers of premature infants receiving care according to NIDCAP felt closer to their infants, perceived more eye contact, experienced more anxiety, who might be interpreted as a sign of early bonding, and tended to experience more support from the staff in taking over the care of their infants than did the mothers given conventional care. This finding indicates that early NIDCAP intervention may facilitate participation of the mother in care-giving on a neonatal intensive unit, as well as

Acknowledgements

We thank Björn Westrup, Hugo Lagercrantz, Karin Stjernqvist and Kristina von Eichwald for their support in this study. Statistical analyses were performed by Jan Ifver. The study was financially supported by The Dalarna Research Institute, First of May Annual Flower Campaign, Södra Sveriges Sjuksköterskehem Foundation, Solstickan Foundation, Sven Jerring Foundation, Smedby Foundation, the Swedish Association of Paediatric Nurses, Lund University Funds, and the Federation of County Councils and

References (39)

  • H. Als et al.

    Early experience alters brain function and structure

    Pediatrics

    (2004)
  • D.M. Buehler et al.

    Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence

    Pediatrics

    (1995)
  • D. Affonso et al.

    Stressors reported by mothers of hospitalized premature infants

    Neonatal Netw

    (1992)
  • J. Wereszezak et al.

    Maternal recall of the neonatal intensive care unit

    Neonatal Netw

    (1997)
  • M.E. Redshaw et al.

    Maternal perception of neonatal care

    Acta Paediatr

    (1995)
  • K. Stjernqvist et al.

    Neurobehavioural development at term of extremely low-birthweight infants (less than 901 g)

    Dev Med Child Neurol

    (1990)
  • K. Minde et al.

    Effect of neonatal complications in premature infants on early parent–infant interactions

    Dev Med Child Neurol

    (1983)
  • H. Als

    A Synactive model of neonatal behavioral organization: framework for the assessment of neurobehavioral development in the premature infant and for support of infants and parents in the neonatal intensive care environment

    Phys Occup Ther Pediatr

    (1986)
  • H. Als

    Reading the premature infant

  • Cited by (40)

    • A Collaborative Learning Assessment of Developmental Care Practices for Infants in the Cardiac Intensive Care Unit

      2020, Journal of Pediatrics
      Citation Excerpt :

      Ideally, the next step would be to provide formal individualized developmental care training and then study the impact of improving developmental care on longer term outcomes. Individualized developmental care improves neurodevelopment and psychosocial outcomes for preterm infants and their families and it is felt to be best practice for vulnerable high-risk infants.9,10,19-25,29-32 The intervention of developmental care is designed to minimize the mismatch between the fragile brain's expectations and the experiences of stress and pain inherent in an ICU environment.

    • The efficacy of interventions aimed at improving post-partum bonding: A review of interventions addressing parent-infant bonding in healthy and at risk populations

      2019, Journal of Neonatal Nursing
      Citation Excerpt :

      The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) is a developmentally-focused intervention that targets mothers of preterm children. In particular, it aims to train mothers to detect and interpret their early-preterm babies' (i.e., born prior to 32 weeks' gestation) reactions to their care and to the environment in the care is given (Kleberg et al., 2007). An RCT, involving 20 mothers of preterm infants (singleton infants with gestational age below 32 weeks), was conducted, to test the effectiveness of NIDCAP, specifically, by evaluating the effects of care provided on the basis of NIDCAP guidance, relative to standard neonatal care, using a specific questionnaire comparing mothers' attitudes toward various styles of neonatal care in terms of a mother's perceived feelings of closeness to her infant (each answer was scored on a 4- point scale).

    • Mothers' perceptions of family centred care in neonatal intensive care units

      2014, Sexual and Reproductive Healthcare
      Citation Excerpt :

      Within neonatology, FCC has evolved into an extensive spectrum of services and activities incorporating a range of environmental, educational, psycho-social and behavioral characteristics all of which seek to place the family at the heart of care planning [3–5]. In the last two decades, FCC based interventions have been developed to support the parent–child attachment relationship [6–9]. There is convincing evidence about the positive effects of Kangaroo Mother Care [9–11], but studies suggest there are huge differences in the provision of facilities to enable skin-to-skin care and parental involvement [12,13].

    View all citing articles on Scopus
    View full text