The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants

Abstract

State-of-the-art Newborn Intensive Care Units (NICUs), instrumental in the survival of high-risk and ever-earlier-born preterm infants, often have costly human repercussions. The developmental sequelae of newborn intensive care are largely misunderstood. Developed countries eager to export their technologies must also transfer the knowledge-base that encompasses all high-risk and preterm infants' personhood as well as the neuro-essential importance of their parents. Without such understanding, the best medical care, while assuring survival jeopardizes infants' long-term potential and deprives parents of their critical role. Exchanging the womb for the NICU environment at a time of rapid brain growth compromises preterm infants' early development, which results in long-term physical and mental health problems and developmental disabilities. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) aims to prevent the iatrogenic sequelae of intensive care and to maintain the intimate connection between parent and infant, one expression of which is Kangaroo Mother Care. NIDCAP embeds the infant in the natural parent niche, avoids over-stimulation, stress, pain, and isolation while it supports self-regulation, competence, and goal orientation. Research demonstrates that NIDCAP improves brain development, functional competence, health, and life quality. It is cost effective, humane, and ethical, and promises to become the standard for all NICU care.

Keywords: Kangaroo Mother Care; NICU; NIDCAP; developmental care; premature infant; prematurity.

Fig. (1). Model of Synactive Theory

From: Als H. Toward a synactive theory of development: Promise for the assessment of infant individuality. Inf Mental Health J 1982; 3: 229–243. Fig. (1), p 234. Reprinted with permission.

Fig. (2). Model of Family Focused Care

From: Als, H. (1992). Individualized, family-focused developmental care for the very low birthweight preterm infant in the NICU. In S. L. Friedman & M. D. Sigman (Eds.), Advances in Applied Developmental Psychology (Vol. 6, pp. 341–388). Norwood, NJ: Ablex Publishing Company. Fig. (2), p 358 Reprinted with permission.

Fig. (3). NIDCAP Observation Sheet

From Als, H., Lawhon, G., Brown, E., Gibes, R., Duffy, F. H., McAnulty, G. B., et al. (1986). Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: Neonatal Intensive Care Unit and developmental outcome. Pediatrics, 78, 1123–1132. p. 1125. Reprinted with permission.

Fig. (4)

Tiny intubated infant girl on day 2 sleeping on her mother’s chest in KMC. (Brigham and Women’s Hospital Boston, NCRI, 1991).

Fig. (5)

Father holding his preterm infant daughter skin-to-skin in KMC (Brigham and Women’s Hospital Boston, NCRI, 1992).

Fig. (6)

Preterm infant girl with severe fetal growth restriction sleeping on mother’s chest in KMC (Brigham and Women’s Hospital Boston, FGR Study. H. Als, with permission, 2007).

Fig. (7)

Mother and preterm infant in KMC shown during helicopter transport. (Harzer Kinderklinikum, Wernigerode, Germany; Dieter Sontheimer and Kerstin Buch, with permission, 2010).

Fig. (8)

Mother and preterm infant twins in KMC during ambulance transport. (Harzer Kinderklinikum, Wernigerode, Germany; Dieter Sontheimer and Kerstin Buch, with permission, 2010).