Immediate skin-to-skin contact after birth ensures stable thermoregulation in very preterm infants in high-resource settings

Aim To investigate the impact of immediate skin-to-skin contact with a parent after birth on thermal regulation in very preterm infants. Methods This clinical trial was conducted in three neonatal intensive care units in Scandinavia from 2018 to 2021. Infants born between 28 + 0 and 32 + 6 weeks and days of gestation were randomised to immediate skin-to-skin contact or conventional care in an incubator during the first 6 postnatal hours. We report on a secondary outcome: serial measurements of axillary temperature. Results Ninety-one infants were randomised to skin-to-skin contact or conventional care. Mean (range) gestational ages were 31 + 2 (28 + 6, 32 + 5) and 31 + 0 (28 + 4, 32 + 6) weeks and days, mean birth weights were 1572 (702, 2352) and 1495 (555, 2440) grams, respectively. Mean (95%CI, p-value) temperatures were within the normal range in both groups, 0.2°C (−0.29, −0.14, p < 0.001) lower in the skin-to-skin contact group. The skin-to-skin contact group had a lower relative risk (95%CI, p-value) of developing events of hyperthermia, RR = 0.70 (0.50, 0.99, p = 0.04). Conclusions Very preterm infants, irrespective of clinical stability, do not develop hypothermia during immediate skin-to-skin contact after birth. Immediate skin-to-skin contact did protect against events of hyperthermia. Concerns about thermal regulation should not limit implementation of immediate skin-to-skin contact in high-resource settings.publishedVersio

Developmentally supportive neonatal care : A study of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) in a Swedish environment

A family-centred, developmentally supportive approach to newborn intensive care, referred to as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has attracted considerable interest in recent years. Studies performed in North America have reported that NIDCAP improves short-term growth, decreases the need for respiratory support, decreases the length and cost of hospitalisation, and improves neurodevelopment. The aim of the present study was to characterise the effects of NIDCAP in Swedish settings. Accordingly, we investigated the effects of NIDCAP on two different Swedish cohorts of infants born prematurely. The first group, the medium-risk cohort (1,11), constituted of infants with a birthweight of less than 1500 grams born at a county hospital with a neonatal intensive care unit. The other group, the high-risk cohort (III,IV,V), was composed of infants from a tertiary intensive care unit born with a gestational age of <32 weeks and with need for ventilatory assistance (CPAP or mechanical ventilation) during the initial 24 hours of life. During the neonatal period, we observed a decreased incidence of pulmonary morbidity among the NIDCAP infants in the high-risk cohort (111). At a postconceptional age of 36 weeks, 40% of the infants in the control group demonstrated radiological findings indicative of moderate to severe bronchopulmonary dysplasia and 70% required supplementary oxygen; whereas, in contrast, none of the infants in the intervention group exhibited such findings or requirement. This difference in pulmonary morbidity was also reflected in a shorter mean duration of CPAP treatment by 17 days in the NIDCAP group. In the high-risk cohort, we examined quiet sleep at the postconceptional ages of 32 and 36 weeks (IV). We could not detect any significant difference in the amount of quiet sleep by the NIDCAP and control infants, but the variation of the percentage of time spent in quiet sleep was significantly reduced in the former group. At one-year follow-up of the high-risk cohort employing the Bayley Scales of Infant Development, overall cognition was found to be significantly better in the NIDCAP group (V). This was in contrast to the three-year follow-up of the medium-risk cohort, which did not reveal any differences in neurodevelopment, as assessed employing the Griffiths' Developmental Scales. Nevertheless, in this latter case there were significant differences in favour of the NIDCAP group with respect to child behaviour and mother-child interaction (II). In connection with follow-up of the high-risk cohort at 5 years of age, we detected a significant impact of NIDCAP only on behavioural parameters, but there were pronounced similar tendencies with regards to general cognitive function and incidence of disability (VI). In order to assess the staff ´s view on the implementation of NIDCAP, we performed a survey at the unit where the study on the medium-risk cohort had been conducted. This staff reported a positive impact on the infants and their families, as well as on their own working conditions (I). In summary, the present study indicates that NIDCAP may have beneficial effects on infants born very prematurely in Sweden. We observed indications of positive impact on short- term pulmonary morbidity, as well as on long-term decreased behavioural problems and mother- infant interaction. Furthermore, Swedish nursing personnel appear to be convinced of the positive effects of NIDCAP and cooperate readily in its implementation

Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Background and Objective: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the 1-year development of infants born with a gestational age of less than 32 weeks. Methods: All surviving infants (11 in the NIDCAP group and 9 in the control group) were assessed employing the Bayley Scales of Infant Development at 1 year of corrected age. Results: The Mental Developmental Index (MDI) of children who had received care according to NIDCAP was higher [88 (72-114)] [median (range)] than the corresponding value for the control children [78 (50-82)] (p = 0.01). The odds ratio for being alive with an MDI > 80 was 14 (95% CI; 1.4-141.5) in favour of the intervention group. However, the Psychomotor Developmental Indices (PDI) were not significantly different [85 (61-108) and 69 (50-114), respectively] (p = 0.23). Conclusion: Our findings indicate that care based on the NIDCAP might have a positive impact on the cognitive development of infants born very prematurely. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents. Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted

No indication of increased quite sleep in infants receiving care based on Newborn Individulized Developmental Care and Assessment Program (NIDCAP)

It has been proposed that the developmentally supportive care of very-low-birthweight (VLBW) infants provided by the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) can improve the infants’ opportunities for rest and sleep. The aim of the present study was to determine whether quiet sleep (QS) in VLBW infants is affected by NIDCAP care. Twenty-two infants with a gestational age of <32 weeks at birth randomly received either NIDCAP (n = 11) or conventional care (n = 11). These two groups were comparable (mean (SD)) with respect to birthweight (1021 (240) vs. 913 (362) g, respectively) and gestational age (27.1 (1.7) vs. 26.4 (1.8) weeks). The infants in the NIDCAP group were cared for in a separate room by a group of specially trained nurses and subjected to weekly NIDCAP observations until they reached a postconceptional age (PCA) of 36 weeks. Quiet sleep (QS) was assessed from 24-h amplitude-integrated EEGs recorded at 32 and 36 weeks of PCA. The percentage of time [mean (SD)] spent in QS at 32 weeks of PCA was 33.5 (2.6) % for the NIDCAP group and 33.3 (6.9) % for the control infants (ns). At 36 wk, the corresponding values were 24.5 (3.2) % and 25.7 (4.7) %, respectively (ns). The number of QS periods/24 h decreased equally in both groups in association with maturation: from 24.6 (3.3) to 16.8 (1.8) and from 25.0 (5.8) to 17.5 (3.3), at 32 weeks, and 36 wk of PCA, respectively (NS). Conclusions: There were no indications of increased QS at 32 or 36 weeks of postconceptional age among VLBW infants who received care based on NIDCAP

Lower cognitive test scores at age 7 in children born with marginally low birth weight

Background: Being born with very low birth weight (&lt;1500 g) is associated with poorer neurocognition later in life. The aim of this study was to explore neurodevelopmental functions in those born with marginally LBW (2000–2500 g). Methods: This was originally a randomized controlled trial investigating the effects of early iron supplementation in 285 marginally LBW children. Herein, we explored the combined marginally LBW group and compared their results to 95 normal birth weight (NBW; 2501–4500 g) controls in an observational design. At 7 years, a pediatric psychologist tested the children using Wechsler Intelligence Scale for Children (WISC IV), Beery–Buktenica developmental test of Visual–Motor Integration (Beery VMI), and Test of Everyday Attention for Children (TEA-Ch). Results: The marginally LBW children had lower verbal comprehension intelligence quotient (IQ) (104 vs. 107, P=0.004), lower VMI scores (96.5 vs. 100, P=0.028), and lower total mean TEA-Ch scores (8.5 vs. 9.7, P=0.006), compared to controls. Also, the marginally LBW children group had a higher proportion of children below −1 SD for VMI and TEA-Ch. Conclusions: Marginally LBW children had lower verbal comprehension IQ, lower visual–motor integration, and lower attention performance than NBW children, suggesting an increased risk of cognitive difficulties in early school ag