The validity and reliability of the EValuation of INtervention Scale: preliminary report.

AIM: Pain management is a priority for infants receiving neonatal care as they undergo many necessary painful and stressful interventions, which are associated with negative short- or long-term consequences. This study aims to validate the content, and test the reliability, of the EValuation of INtervention Scale (EVIN), which is designed to evaluate the use of widely recommended nonpharmacological strategies to reduce neonatal pain and stress during procedures. METHODS: The content of the EVIN was validated with multidisciplinary participation (N = 80), and consistency was established via observations on preterm infants (N = 12, at 31-34 weeks' gestation) during interventions in a neonatal unit. A revised scale was tested for inter-rater reliability with observations of invasive (blood sampling, N = 16) and noninvasive (nappy change, N = 18) interventions. The intraclass correlation coefficient (ICC) was used to determine inter-rater reliability. SPSS (PASW Statistics) version 18 was used for analysis. RESULTS: Very good intraclass correlation coefficients (>0.8) for both invasive (0.962) and noninvasive procedures (0.970) were achieved. CONCLUSION: These results indicate that the EVIN is suitable for the evaluation of nonpharmacological support during painful or stressful interventions.

Development and psychometric properties of the Swedish ALPS-Neo pain and stress assessment scale for newborn infants.

AIM: To validate and evaluate the psychometric properties of the ALPS-Neo, a new pain assessment scale created for the continuous evaluation of pain and stress in preterm and sick term infants. METHODS: A unidimensional scale for continuous pain, Astrid Lindgren Children's Hospital Pain Scale (ALPS 1), was developed further to assess continuous pain and stress in infants treated in the neonatal intensive care unit (NICU). The pain scale includes observations of five behaviours. A manual was created, clarifying the scoring criteria. An internal and an external panel assessed face validity. Psychometric properties were evaluated in three different steps. Inter-rater reliability was estimated from video-based assessments (n = 625) using weighted kappa statistics (test I). Inter-rater reliability was further evaluated in test II (n = 125) and test III (n = 96) by real-time assessments using the intraclass correlation coefficient (ICC) and Cronbach's alpha. RESULTS: The final inter-rater reliability (test III) was assessed as good with ICC 0.91 for the total score and 0.62-0.81 for the five items. Cronbach's alpha showed 0.95 for the total score. CONCLUSION: ALPS-Neo is a new assessment tool for optimising the management of pain and stress in newborn infants in the NICU. It has proved easy to implement and user-friendly, permitting fast, reliable observations with high inter-rater reliability.

Lower stress responses after Newborn Individualized Developmental Care and Assessment Program care during eye screening examinations for retinopathy of prematurity: a randomized study.

OBJECTIVE: Screening examination for retinopathy of prematurity is distressing and painful. The aim of the present study was to investigate whether a Newborn Individualized Developmental Care and Assessment Program intervention during a retinopathy of prematurity examination results in less adverse behavioral, pain, and stress responses as compared with standard care. METHODS: The first 2 eye examinations in 36 preterm infants were evaluated. The infants were randomly assigned at the first eye examination to receive either Newborn Individualized Developmental Care and Assessment Program care or standard care. At the second examination, crossover of subject assignment was performed. The assessments included behavioral responses; recordings of heart rate, respiration, and oxygenation; pain scores (premature infant pain profile); and salivary cortisol at defined time points up to 4 hours after the eye examination. The nursing support given during the eye examinations (intervention score) were scored using predefined criteria. RESULTS: Altogether, 68 examinations were evaluated. Newborn Individualized Developmental Care and Assessment Program care was associated with better behavioral scores during the examination but there was no difference in heart rate, respiratory rate, oxygenation, or premature infant pain profile score between the 2 care strategies before or after the eye examination. Salivary cortisol increased from baseline to 30 minutes after the eye examination independent of care strategy and decreased significantly between 30 and 60 minutes when infants were subjected to Newborn Individualized Developmental Care and Assessment Program care but not after standard care. During the study period the intervention score for standard care increased and approached the score for Newborn Individualized Developmental Care and Assessment Program care at the later eye examinations. CONCLUSION: A Newborn Individualized Developmental Care and Assessment Program-based intervention during eye examination does not decrease pain responses but results in faster recovery, as measured by lower salivary cortisol 60 minutes after the examination. The differences were seen despite the influence from the Newborn Individualized Developmental Care and Assessment Program intervention on the standard care treatment that occurred during the study period.

Mothers' perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared to conventional care.

BACKGROUND: Family-centred care according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to positively influence family function. The aim was to examine if NIDCAP affects the views of prematurely born infants' mothers regarding maternal role, perception of the infant and the neonatal care. METHOD: Preterm infants with gestational age <32 weeks were randomly assigned to receive either care based on NIDCAP (n=12) or conventional neonatal care (n=13), forming two comparable groups with respect to gestational age, birth weight, female/male ratio, and initial illness severity. A questionnaire was designed to evaluate various aspects of the mothers' attitudes and apprehension of their maternal role, perception of their infant and the neonatal care. The questionnaire was validated and given to the mothers when the infants reached 36 weeks postmenstrual age (PMA). RESULTS: Ten mothers in each group replied to the questionnaire. The mothers in the NIDCAP-group perceived more closeness to their infants than did the control mothers (p=0.022) and this feeling demonstrated no significant correlation to the infant's gestational age, weight at birth or severity of illness. Furthermore, the mothers in the NIDCAP-group tended to rate the staff's ability to support them in their role as a mother somewhat higher (p=0.066), but at the same time they expressed more anxiety than did the control mothers (p=0.033). CONCLUSION: Early intervention according to NIDCAP seems to facilitate a feeling of closeness between the mother and her premature infant regardless of the infant's birth weight or health status. The higher level of anxiety in the mothers in the NIDCAP-group, may mirror that the mothers in the NIDCAP-group had already bonded to their infants during the hospital stay.

Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

BACKGROUND AND OBJECTIVE: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the 1-year development of infants born with a gestational age of less than 32 weeks. METHODS: All surviving infants (11 in the NIDCAP group and 9 in the control group) were assessed employing the Bayley Scales of Infant Development at 1 year of corrected age. RESULTS: The Mental Developmental Index (MDI) of children who had received care according to NIDCAP was higher [88 (72-114)] [median (range)] than the corresponding value for the control children [78 (50-82)] (p=0.01). The odds ratio for being alive with an MDI>80 was 14 (95% CI; 1.4-141.5) in favour of the intervention group. However, the Psychomotor Developmental Indices (PDI) were not significantly different [85 (61-108) and 69 (50-114), respectively] (p=0.23). CONCLUSION: Our findings indicate that care based on the NIDCAP might have a positive impact on the cognitive development of infants born very prematurely.

Neonatal individualized care in practice: a Swedish experience.

A family-centred, developmentally supportive approach to newborn intensive care referred to as NIDCAP (Newborn Individualized Developmental Care and Assessment Programme) has caught considerable interest during recent years. In this paper we review the scientific context behind its conceptual framework and summarize our experience from 10 years of training, implementation and research. We present the short- and long-term medical and developmental outcome of our Swedish NIDCAP studies as well as attitudes of nursing staff and neonatologists. Furthermore, ethical issues and scientific obstacles concerning this concept of care are discussed.