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A Three-Center, Randomized, Controlled Trial of Individualized Developmental Care for Very Low Birth Weight Preterm Infants: Medical, Neurodevelopmental, Parenting, and Caregiving Effects

ALS, HEIDELISE Ph.D.; GILKERSON, LINDA Ph.D.; DUFFY, FRANK H. M.D.; MCANULTY, GLORIA B. Ph.D.; BUEHLER, DEBORAH M. Ph.D.; VANDENBERG, KATHLEEN M.A.; SWEET, NANCY M.A.; SELL, ELSA M.D.; PARAD, RICHARD B. M.D., M.P.H.; RINGER, STEVEN A. M.D., Ph.D.; BUTLER, SAMANTHA C. Ph.D.; BLICKMAN, JOHAN G. M.D., Ph.D., FACR; JONES, KENNETH J. Ed.D.

Journal of Developmental & Behavioral Pediatrics: December 2003 - Volume 24 - Issue 6 - p 399-408
ORIGINAL ARTICLES
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ABSTRACT. Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospialization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

Department of Psychiatry, Harvard Medical School, Boston

Irving B. Harris Infant Studies Program, Erikson Institute, Chicago, Illinois

Department of Neurology, Harvard Medical School, Boston

Department of Psychiatry, Harvard Medical School, Boston

Department of Education, Mills College, Oakland, California

Division of Developmental-Behavioral Pediatrics, Children’s Hospital Oakland, Oakland, California

Department of Pediatrics, College of Medicine, University of Arizona, Tucson, Arizona

Department of Pediatrics, Harvard Medical School, Boston

Department of Psychiatry, Harvard Medical School, Boston

Department of Radiology, UMC Nijmegen, Nijmegen, The Netherlands

Florence Heller School for Advanced Studies in Social Welfare, Brandeis University, Boston, Massachusetts

Received August 2002; accepted September 2003.

Address for reprints: Heidelise Als, Ph.D., Enders Pediatric Research Laboratories, EN-107, Children’s Hospital, 320 Longwood Avenue, Boston, MA 02115; e-mail: heidelise.als@tch.harvard.edu.

© 2003 Lippincott Williams & Wilkins, Inc.