The influence of neonatal intensive care unit caregiving practices on motor functioning of preterm infants.

OBJECTIVES Experimental design intervention studies have demonstrated that a model of individualized developmental care based on specific behavioral observation improves medical and behavioral outcome for very small preterm infants. It is proposed that infants who were not directly involved in an experimental intervention study per se, but were patients in a neonatal intensive care unit (NICU) where such studies took place and the model was adopted as the standard of care, demonstrate some of the same benefits as the infants in the experimental study. METHOD The study was a retrospective descriptive analysis of an existing data set. The functioning of two cohorts of infants, comparable medically and demographically and cared for in an NICU where developmental care research was conducted and subsequently adopted as the standard of care, was measured after discharge with the Assessment of Preterm Infants' Behavior (APIB). Cohort I was cared for before the first study of individualized developmental care in the NICU; Cohort II was cared for after the individualized developmental care approach was adopted as the standard of care for the NICU. RESULTS Cohort II infants demonstrated better scores than Cohort I infants on 8 out of 23 summary variables, 6 of which reflect improved motor functioning. They also showed significantly better scores on 7 of the 17 specific motor variables of the APIB. CONCLUSION Infants cared for in an NICU with an individualized developmental care approach showed improved motor system functioning compared to infants cared for in the same NICU before the approach was adopted. It is speculated that the individualized developmental approach to care based in the synactive theory of development contributed to the documented improvements. This finding would indicate that functioning of preterm infants, particularly in terms of their motor systems, can be influenced by modification in caregiving.