The power of developmental care – exploring the mechanisms to shorten Neonatal Intensive Care Unit (NICU) hospitalisation

Developmental care is an approach to improve the care of infants hospitalised in a NICU. It includes measures to adapt the NICU environment to be more patient-friendly, foster parental involvement in care, increase oral immune therapy and exclusive breastfeeding. A new study conducted in 14 hospitals in China and including more than 1,300 low birth weight infants highlights the promising outcomes of developmental care. Most significantly, the length of hospitalisation was markedly shorter when the newborns received developmental care. In addition, the interventions promoted increased skin-to-skin care, exclusive breastfeeding, and a more suitable NICU environment.

The length of stay in a NICU is a commonly used indicator to evaluate the quality of healthcare. Preterm or very low birth weight infants often have to stay longer in hospital requiring complex treatment due to the higher risk of morbidity and neurodevelopment sequalae. As a result, they are separated from their parents very early, which may impact their development and academic performance. In addition, the infants’ sensory abilities are exposed to atypical stimuli in the NICU. A more appropriate NICU environment and better care enable infants may mitigate some of these factors and lead to better health outcomes, thus allowing parents to take their newborns home sooner.

A Chinese study investigated the extent to which developmental care can potentially reduce the length of a NICU stay. Developmental care includes the promotion of family-centred care practices such as skin-to-skin contact, parental involvement, exclusive breastfeeding, and oral immune therapy. Moreover, the environment was adapted to be more patient-friendly, with light and noise adaptions and sensory stimulating interventions included.

Developmental care significantly reduces the duration of hospitalisation

The study included 14 NICUs in China with a total of 575 very low birth weight infants receiving developmental care and 758 infants in the control group. A team from each NICU involved in the study attended a training workshop to implement the pillars of developmental care. Strategies to improve developmental care in the ward included creating a spacious, patient-friendly zone, dimmed light and noise, daily parental involvement and skin-to-skin care and more time observing the infant’s behaviour and better understand their development.

The comparison of both groups revealed that newborns receiving developmental care were discharged significantly earlier than those not receiving the care. The developmental interventions reduced the time spent in the NICU by 35%. It can be concluded that developmental care has the potential to improve functioning in behavioural systems of infants and subsequently reduce hospitalisation and hospital costs.

The success of developmental care may be attributed to the increased skin-to-skin care provided in the developmental interventions. These interventions were introduced earlier, performed longer, and applied more frequently. This might also improve parent-infant bonding. Additionally, infants in the developmental care group were breastfed more often and received exclusive breast milk more frequently. Further successes associated with developmental care included enhanced NICU environmental management. The average light intensity was much lower, benefiting the sensitive infants.

Gaps to further develop developmental care

However, developmental care failed to improve parental involvement, as no difference was reported between the group receiving developmental interventions and the group receiving standard care. Developmental care is a complex intervention; enhancing parental involvement remains a challenge. Additionally, mortality and morbidity rates remained similar in both groups meaning more research is needed on the exact effects of neonatal care interventions.

The rate of oral immune therapy could not be increased by developmental care measures. Colostrum is the first form of breastmilk released and may provide the newborn with immune components that contribute to a more diverse microbiome. However, preterm infants are separated early, making it challenging to obtain the mother’s colostrum. Developmental care could bridge this separation as a strategy to facilitate the delivery of early colostrum. Overall, the influence of developmental care has significant potential to increase family-centred care and decrease the duration of hospitalisation for neonates.

Paper available at: https://www.sciencedirect.com/science/article/pii/S0020748924000968?via%3Dihub

Ful list of authors: TianChan Lyu, Ruming Ye, Li Ling Li, Li Li Zhang, Juan Xiao, Yue Lan Ma, Fang Li, Hui Rong, Dan Liuf, Hua Wang, Yan Wang, Wei Wei Gu, Yan Xuan, XiaoChun Chen, Qiao Ling Fan, Yun Fei Tang, Xiang Hui Huang, An Qin, Yi Li Zhang, Yalan Dou, Xiao Jing Hu

DOI: https://doi.org/10.1016/j.ijnurstu.2024.104784

Find out more about infant- and family centred developmental care here