Supplementary Table 1. Conventional Care and Individualized Developmental Care
A. Components
Standard Care
Environment
NIDCAP Care
Frequent Occurrence of:
Consistent Provision of:
Bright light on infant’s face
Protection of infant’s face from all direct light, low light
Variable room temperatures
levels in care room with individual use of task lights
Loud conversations, staff rounds,
as indicated and the use of cloth tents over the eyes
other infants’ crying, high traffic,
frequent alarms, loud telephone
conversations near infant
High staff traffic in care room
Disorganization of equipment in
when direct light occurred
Stable room temperatures or protection from infant
during unstable temperatures
Quiet conversations, staff rounds away from bedsides,
quiet voices and low quiet and calm traffic in care
care room; cluttered
room, quick response to silence alarms, low voices
appearance of room
on telephone
Well-organized care room, pleasantly arranged
equipment in room
Bed Space and
Bedding
Hospital issue generic incubator
Almost fully covered incubators with assurance of visual
covers and no covers on open
access to infant. Special incubator covers in attractive
cribs.
light-blocking material and appropriate colors with
Commercially available prefabricated. positioning aids
Generic hospital clinical décor
and bedding
Lack of personal items from family
at bedside
Bright and continuously
ribbons instead of Velcro; invitation to parents to
individualize the covers with their own over-blankets
designs
Special canopy covers for when in an open crib, in
attractive light-blocking material and infant room
appropriate colors with ribbons instead of Velcro
Special soft support pillows in support of the infant’s
illuminated computer and
position and well aligned posture when in the
monitor screens dominate bed
incubator or crib; special bunting designed for
space
comfortable leg/foot/toe, arm/hand/finger and
Rare availability of chair or
recliner, still rarer of two
chairs/recliners for parents
Maximally two adults permitted at
shoulder support and flexion
Special, very comfortable and always available at the
bedside kangaroo care recliner chairs
Soft feeding pillows, support pillows and blankets for
the bedside and then for limited
the parents and infants when sleeping, feeding or
times only
relaxing in the Kangaroo chairs
Sibling presence not encouraged
Lack of privacy screens; if
available generic issue
Hospital issue, ill-fitting t-shirts
and diapers
Individualized, skillfully adjusted soft nest/blankets to
support comfortable positions and sleep
Personalized bed spaces with photos, drawings,
decorative name signs, soft stuffed animals,
personalized well-fitting soft clothing and soft diapers,
and/or soft stretchable buntings, special and
sufficient in number, small, finger-shaped pacifiers for
the infants when small
Computer screens illuminated only when indicated;
turned away from infant and family when not in use;
blanket covering screen when not in use; reliably
available attractive and very comfortable recliners for
parent and comfortable chair for second parent;
Siblings welcome and included: Foot stools to reach
infant easily; appropriate seating for sibling;
supervised sibling time available; Encouragement to
sibling/parents for involvement in infant’s care
Milestone celebratory pictures and certificates,
parent/family photos at bedside; individualized
developmental care books at the bedside of the
infants for the parents/siblings to write in
Special spaces at bedside for parent belongings;
attractive baskets/tubs for infants’ respectively used
and fresh clothing, bedding, mother/father body scent
scarf, cloth or other materials
Special attractive wood-frame, infant room appropriate
privacy screens in soft colors
Caregiving
Frequently:
Consistently:
Interactions
Determined by the infant’s
Guided by the disease process and attending
disease process and
neonatologist’s orders in interaction with the primary
corresponding nursing and
nursing team and implemented in collaboration with
respiratory protocols
the parents and the infant, as adapted to the infant’s
implemented on routine basis
behavioral profile and cues along the autonomic,
as ordered and supervised by
motor and state regulation system with the goal to
the attending neonatologist
support the infant’s calmness, strengths and self
Timing of care actions routinely
regulation skills and keep stress responses to a
determined by infant weight
and age and by staff schedule
Specialty care adjusted to staff
minimum
Timing of care actions adjusted to and supportive of the
infant’s sleep wake cycles; scheduled care actions
schedule and fixed feeding
are integrated with awake periods as feasible; when
and/or care interval (every 1, 2,
a procedure must be performed at a certain time the
3 or 4 hours)
nurse caregiver assists the infant in state transition
Care components routinized and
clustered
(See two examples below)
and maintenance in order to decrease cost to infant
Shift change reports including the infant responsive
current schedule adjustments
Gavage feeding in incubator
Care components in number and sequence
horizontal position or slightly
individualized to the infant’s current energy level and
inclined angle, gravity drip of
robustness; frequency of care actions may be
feeding, little to no human
decreased as indicated
contact during feeding
Frequent use of fortified mother’s
milk, formula; bottle feeding as
soon as tolerated.
When held burping with back
pats
During feeding infants held and the gavage reservoirs
lowered to decrease or cease flow as indicated by
infants’ cues
Burping performed very gently, mainly by holding the
infant upright against the caregiver’s shoulder and
chest, usually making patting unnecessary.
And brief period only of holding
after feeding; return to
incubator and/or crib
B. Standard Care and NIDCAP Care Treatment Features
Group
NIDCAP
Professional
Standard Care
Available on specific consult
request only
NIDCAP Care
Available daily (6/7 or 7/7) in the NICU to experimental
group from infant recruitment to discharge
(Followed by bi-weekly visits to community transfer
nursery and home as indicated, to 42wks PMA)
Detailed
Behavioral
Observations
and Reports
Available on specific consult
request only
Report results communicated to
Performed weekly throughout hospitalization and
beyond to 42wks PMA with detailed report and
communication about the results and
requesting attending
recommendations to attending neonatologist, nursing
neonatologist with feedback to
team and parents as indicated
nurse and parent if so
indicated by attending
Written copy provided in the infant’s Developmental
Book, visible and accessible at the infant’s bedside at
Report filed in medical chart
all times
Excerpts with key recommendations posted in attractive
lay-out at bedside
Invitation to parents, siblings and staff to write down
their observations, thoughts and questions in the
Developmental Book and use as diary,
communication vehicle, place to add photos and
milestone celebration certificates/mementos
Support to Care
Implementation
Lack of development specialist
support to care implementation
Daily check-in and guided care support, facilitation
mentoring, coaching for individual caregiver at
bedside as well as to infant’s parents as indicated
Daily and continuous availability to infant’s professional
caregivers and parents by email and/or telephone, to
provide guidance, answer questions, support when
worried and concerned and in general provision of
emotional support as indicated
Practical support in problem solving transportation,
housing, babysitting, car seat, discharge, transfer
Participation in Family Team meetings; communication
of observations, findings and recommendations, and
coordination of results with nursing, the attending,
social work and physical, occupational and
respiratory therapy
Support of Parent
/Family Inclusion
and Collaboration
Lack of development specialist
support for parent inclusion
Consistent and continuous support and problem solving
availability for increased inclusion of and
collaboration with family members, foremost mother