NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction

Abstract

Objective: The effect of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) was examined on the neurobehavioral, electrophysiological and neurostructural development of preterm infants with severe intrauterine growth restriction (IUGR).

Study design: A total of 30 infants, 27-33 weeks gestation, were randomized to control (C; N=17) or NIDCAP/experimental (E; N=13) care. Baseline health and demographics were assessed at intake; electroencephalography (EEG) and magnetic resonance imaging (MRI) at 35 and 42 weeks postmenstrual age; and health, growth and neurobehavior at 42 weeks and 9 months corrected age (9 months).

Results: C and E infants were comparable in health and demographics at baseline. At follow-up, E infants were healthier, showed significantly improved brain development and better neurobehavior. Neurobehavior, EEG and MRI discriminated between C and E infants. Neurobehavior at 42 weeks correlated with EEG and MRI at 42 weeks and neurobehavior at 9 months.

Conclusion: NIDCAP significantly improved IUGR preterm infants' neurobehavior, electrophysiology and brain structure. Longer-term outcome assessment and larger samples are recommended.

Trial registration: ClinicalTrials.gov NCT00914108.

Figure 1

EEG coherence measures at 42 weeks postmenstrual age: C=17; E=13. Head images correspond to coherence factors, top view, scalp left to image left; index electrode and frequencies above head. Color regions: location, magnitude and sign (red=positive; blue=negative) of maximally loading coherence on factor. Color arrows: direction of statistical association/difference (from E-group perspective; red=increased; green=decreased).

Figure 2

MD in corticospinal tract (internal capsule) at 42 weeks postmenstrual age. Control infant on left, experimental infant on right. MD rendered onto trajectories of the corticospinal tract, and color-coded from red (low) to yellow (high). Brighter yellow: higher measure of MD; orange and red: lower measure of MD.