Newborn Individualised Developmental Care and Assessment Programme (NIDCAP)
What is NIDCAP? The originator of NIDCAP, Professor Als found that assessing the individual infant’s ability to cope with excessive stimulation provided the caregiver with information to modify each infant’s environment and treatment approach. Significant outcome improvements were indicated by
- Fewer days on the ventilator
- Early feeding success
- Shorter hospital stay
- A reduction in the number of complications
- Improved neuro-developmental outcomes during the first eighteen months of life
- Improved parent/infant bonding
Advances in neonatal intensive care have dramatically improved the survival rates of premature infants over the last two decades. However the neonatal intensive care (NICU) environment is a very ‘high tech’ area, which contrasts sharply to the warm, dim, supportive and soothing environment of the womb. Infants receiving care in most NICUs are exposed to bright lights, loud noises, painful procedures, hard surfaces and lack a supportive, confining environment.
Developmentally focused care of the preterm infant is designed to adapt the NICU environment to minimize the stress experienced by premature infants. By using a variety of nursing and medical interventions that manage the environment and individualize the care of the premature infant based on behavioural observations, which aims to promote a stable, well organised infant who can conserve energy for growth and development.
Recognising the non-verbal language of the premature infant Signs of stress:
- Colour changes
- Change in breathing rate and pattern
- Change in heart rate
- Extended limbs or limpness
- Open or gaping mouth
- Looking away
- Frantic, disorganised activity
Signs of Stability:
- Stable colour
- Regular breathing pattern
- Consistent heart rate, flexed position
- Hand on face
- Hand to mouth or in mouth
- Relaxed tone and posture
- Clear sleep states
Developmental Care Interventions include;
- Control of environmental stressors such as noise and light - dim lighting, covering incubators, decreasing noise levels in the room
- Supportive behavioural techniques such as swaddling, handling infant slowly and smoothly, providing boundaries with nesting and non- nutritive sucking
- Scheduling of care giving activities or 'clustering' of care
- Skin to skin contact or 'Kangaroo Care'
- Assimilation of parents in the care of their infant by supporting them to recognise their infant’s cues and teaching them about developmental interventions.
The philosophy of developmentally supportive, family-centered care requires a team approach involving nurses/caregivers, medical staff, parents and other support staff within the NICU.