Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects

JAMA. 1994 Sep 21;272(11):853-8.


Objective: To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants.

Design: Randomized controlled trial.

Setting: Newborn intensive care unit.

Patients: Thirty-eight singleton preterm infants, free of known congenital abnormalities, weighing less than 1250 g, born before 30 weeks' gestation, mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours, randomly assigned to a control or an experimental group.

Intervention: Caregiving by nurses specifically trained in individualized developmental care; observation and documentation of the infants' behavior within 12 hours of admission, and subsequently every 10th day; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists; and the availability of special caregiving accessories.

Main outcome measures: Medical outcome, including average daily weight gain; number of days the infant required mechanical ventilation, oxygen, gavage tube feeding, and hospitalization; severity of retinopathy of prematurity, bronchopulmonary dysplasia, pneumothorax, and intraventricular hemorrhage; pediatric complications; age at discharge; and hospital charges. Neurodevelopmental outcome, including Assessment of Preterm Infants' Behavior scale and quantified electroencephalography (2 weeks after due date); and Bayley Scales of Infant Development and Kangaroo Box Paradigm (9 months after due date).

Results: The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support; earlier oral feeding; reduced incidence of intraventricular hemorrhage, pneumothorax, and severe bronchopulmonary dysplasia; improved daily weight gain; shorter hospital stays; younger ages at hospital discharge; and reduced hospital charges compared with the infants in the control group. At 2 weeks after their due dates, these infants also showed improved autonomic regulation, motor system functioning, self-regulatory abilities, and visual evoked potential measures; and at 9 months, they had improved Bayley Mental and Psychomotor Developmental Index scores, as well as Kangaroo Box Paradigm scores.

Conclusion: Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child Development
  • Female
  • Hospitals, Maternity / standards
  • Humans
  • Infant, Low Birth Weight* / growth & development
  • Infant, Newborn
  • Infant, Premature* / growth & development
  • Infant, Premature, Diseases / nursing
  • Infant, Premature, Diseases / prevention & control*
  • Intensive Care Units, Neonatal / standards*
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Intensive Care, Neonatal / methods*
  • Intensive Care, Neonatal / standards
  • Male
  • Massachusetts
  • Neonatal Nursing / methods
  • Neonatal Nursing / standards
  • Patient Care Planning / standards*
  • Socioeconomic Factors
  • Treatment Outcome