Intervention Review

Developmental care for promoting development and preventing morbidity in preterm infants

  1. Amanda J Symington1,*,
  2. Janet Pinelli2

Editorial Group: Cochrane Neonatal Group

Published Online: 19 APR 2006

Assessed as up-to-date: 30 DEC 2005

DOI: 10.1002/14651858.CD001814.pub2


How to Cite

Symington AJ, Pinelli J. Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD001814. DOI: 10.1002/14651858.CD001814.pub2.

Author Information

  1. 1

    Hamilton Health Sciences, The Children's Hospital, Hamilton, Ontario, Hamilton-Wentworth, Canada

  2. 2

    McMaster University, School of Nursing, Hamilton, Ontario, Canada

*Amanda J Symington, The Children's Hospital, Hamilton Health Sciences, Children's Hospital Neonatal Unit - MUMC 4G, 1200 Main St. West, Hamilton, Ontario, Hamilton-Wentworth, L8N 3Z5, Canada. symington@hhsc.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Preterm infants experience a range of morbidity related to the immaturity of their organ systems and to concurrent disease states. There is concern that an unfavourable environment in the neonatal intensive care unit (NICU) may compound this morbidity. Modification of the environment could minimize the iatrogenic effects. Developmental care is a broad category of interventions designed to minimize the stress of the NICU environment. These interventions may include elements such as control of external stimuli (vestibular, auditory, visual, tactile), clustering of nursery care activities, and positioning or swaddling of the preterm infant. Individual strategies have also been combined to form programs, such as the 'Newborn Individualized Developmental Care and Assessment Program' (NIDCAP) (Als 1986).

Objectives

In preterm infants, do developmental care interventions reduce neurodevelopmental delay, poor weight gain, length of hospital stay, length of mechanical ventilation, physiological stress and other clinically relevant adverse outcomes?

Search methods

The Neonatal Review Group search strategy was utilized. Searches were made of MEDLINE from 1966 to June, 2005 and of CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005), and conference and symposia proceedings in the English language from 1990 to June, 2005. A search of EMBASE was also made from 2003 to June 2005. A list of all relevant articles was sent to two experts in the field to identify any omissions or additional unpublished studies.

Selection criteria

Randomized trials in which elements of developmental care are compared to routine nursery care for infants < 37 weeks gestation and that measured clinically relevant outcomes. Reports were in English or a language for which a translator was available.

Computerized searches were conducted and all potentially relevant titles and abstracts were extracted. Retrieved articles were assessed for relevance independently by two reviewers, based on predetermined criteria. Articles that met all criteria for relevance were assessed for methodological quality based on predetermined criteria. Articles judged to have the appropriate quality by both reviewers were included in the analysis.

Data collection and analysis

Data were extracted independently by the two authors. Meta-analyses were conducted for each intervention where the same outcome measures and/or instruments were used within comparable time points.

Main results

This review detected 36 eligible randomized controlled trials involving four major groups of developmental care interventions, 19 sub-groups and multiple clinical outcomes. In addition, the long-term outcomes of a previously included trial were added to the review.

The results of the review indicate that developmental care interventions demonstrate limited benefit to preterm infants with respect to: decreased moderate-severe chronic lung disease, decreased incidence of necrotizing enterocolitis and improved family outcome. Conversely, an increase in mild lung disease and an increase in the length of stay were demonstrated in infants receiving developmental care compared to controls. There is also very limited evidence of the long-term positive effect of NIDCAP on behavior and movement at 5 years corrected age but no effect on cognition. Other individualized developmental care interventions have also demonstrated some effect in enhancing neurodevelopmental outcome. Although a limited number of other benefits were demonstrated, those results were from single studies with small sample sizes. The lack of blinding of the assessors was a significant methodological flaw in half of the studies. The cost of the interventions and personnel was not considered in any of the studies.

Authors' conclusions

Because of the inclusion of multiple interventions in most studies, the determination of the effect of any single intervention is difficult. Although there is evidence of limited benefit of developmental care interventions overall, and no major harmful effects reported, there were a large number of outcomes for which no or conflicting effects were demonstrated. The single trials that did show a significant effect of an intervention on a major clinical outcome were based on small sample sizes, and the findings were often not supported in other small trials.

Before a clear direction for practice can be supported, evidence demonstrating more consistent effects of developmental care interventions on important short- and long-term clinical outcomes is needed. The economic impact of the implementation and maintenance of developmental care practices should be considered by individual institutions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Developmental care for promoting development and preventing morbidity in preterm infants

Developmental care interventions may help preterm infants cope better with the environment of the Neonatal Intensive Care Unit (NICU). Preterm infants (babies born before 37 weeks) can develop a range of problems because their organs are not mature. There is concern that an unfavourable environment in the NICU can add to these problems and negatively affect the infant's growth, with the brain being particularly vulnerable. Developmental care refers to a range of strategies designed to reduce the stresses of the NICU. These include reducing noise and light, minimal handling and giving longer rest periods. The review of trials suggests that these interventions may have some benefit to the outcomes of preterm infants; however, there continues to be conflicting evidence among the multiple studies. Before a clear direction for practice can be supported, evidence demonstrating more consistent effects of developmental care interventions on important short- and long-term clinical outcomes is needed. The economic impact of the implementation and maintenance of developmental care practices should be considered by individual institutions.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

發展性照顧可以促進早產兒發育和預防疾病

早產兒患有一系列疾病,這與他們的器官系統不成熟和同時存在的疾病狀態有關。人們擔心新生兒加護病房(NICU)的不利環境可加重這一疾病。改進環境可以使醫源性的不利作用降低到最低限定。發展性照顧是一廣範的介入,目的在於最大限度減少NICU環境的壓力。這些介入包括諸如外部刺激(前庭、聽覺、視覺、觸覺)的控制,集中護理照顧以及早產兒的姿勢調整或襁褓包裹在內的各種姿勢。結合多個單獨策略形成一計劃,如“新生兒個體化發展性照顧和評估規程”(NIDCAP)(Als 1986)。

目標

發展性照顧的介入能減少早產兒神經發育遲緩、體重增加不足、住院時間、機械通氣時間、生理壓力和其它臨床相關不良癒後。

搜尋策略

使用新生兒評價組檢索方法。檢索內容包括MEDLINE(1966年-2005年6月)和CINAHL, Cochrane對照試驗中心註冊資料庫(CENTRAL,Cochrane圖書館,2005年第1期),1990年-2005年6月間召開的會議和研討會英語論文集。還對EMBASE從2003年-2005年6月進行了檢索。將一份所有相關文章的目錄送給該領域的兩位專家以確認是否有任何遺漏或另外的未發表研究。

選擇標準

對小於37週早產兒將進行發展性照顧與該齡早產兒常規育嬰室護理進行比較,並測定臨床相關結局的隨機試驗。用英語或有翻譯人員的語言撰寫報告。進行電腦檢索,收集所有可能有關的題目及摘要,委託相關領域的兩位專家,根據事先擬定的標準獨自評估,根據事先擬定好的標準,將所有有關的文獻進行方法學質量的評估,同時也將兩位專家對這些文獻的評等也列入分析中。

資料收集與分析

由兩位評價作者獨立提取數據。對在可比較時間點內使用相同癒後指標和/或工具每種介入進行Meta分析。

主要結論

本評價發現36項符合要求的隨機對照試驗,涉及發展性照顧干預的四個大組,19個亞組和多個臨床癒後。此外,還將以往納入試驗中的長期癒後增加到本回顧中。 本回顧的結果顯示,發展性照顧的介入對降低早產兒的中、重度慢性肺病變,壞死性腸炎的發生率,以及促進在家癒後的進展效果有限。相反地,與對照組比起來,接受發展性照顧的早產兒有較多的輕度肺疾患,較長的住院時間。另一篇也有報告顯示在矯正年齡5歲時,NIDCAP(發展性照顧)組在長期癒後上,在行為與動作有非常有限的正面效應,認知方面則否。其它個人化發展性照顧也顯示對神經發展癒後有某些效果。雖也有其它有限的益處,但是這些來自於一篇文獻,且樣本數少。一半以上的研究文獻有方法學上的缺失,因評估者並非盲端。介入的花費及人員則沒有一篇研究有提到。

作者結論

由於多數研究採取的是多種介入,因而要確定任何單項介入的效果很困難。儘管有證據表明,發展性照顧介入在總體上有有限的好處,且未報告有重要有害影響,但還有大量癒後被證明無效或相互矛盾; 顯示介入對重要臨床癒後有顯著影響的單項試驗是小樣本試驗,其結果常常在其它小樣本試驗中得不到支持。在臨床獲得明顯實施指引之支持前,發展性照顧必須在長、短期的癒後方面顯示更多的正向證據來獲得支持。單一機構還必須要考量植入及維持發展性照顧所花費的費用衝擊。

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

發展性照顧可能有助早產兒更好地應對新生兒重症監護病房(NICU)環境。早產兒(出生於前37週的嬰兒)可產生出一系列問題,因為他們的器官並不成熟。人們擔心,在不利的環境如NICU可添加到這些問題和不利嬰兒的生長,尤其是特別脆弱的腦部。發展性照顧指的是一系列策略,旨在減少NICU的壓力。這些措施包括減少噪音和亮度,並給予較長的休息時間。這次試驗回顧表明,這些措施可能會有利於早產兒未來發展,但在多研究中仍然是有相互之間矛盾存在。在臨床獲得明顯實施指引之支持前,發展性照顧必須在長、短期的癒後方面顯示更多的正向證據來獲得支持。單一機構還必須要考量植入及維持發展性照顧所花費的費用沖擊。