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Tijdschrift voor Kindergeneeskunde

, Volume 76, Issue 4, pp 165–171 | Cite as

Ervaringen met ontwikkelingsgerichte zorg voor te vroeg geboren kinderen in een Nederlandse setting

  • S. M. van der Pal
  • F. J. Walther
Article
  • 305 Downloads

Samenvatting

Doel. Bij het Leidse Ontwikkelingsgerichte Zorg Project is gedurende twee opeenvolgende gerandomiseerde onderzoekstrials gekeken naar de effecten van enkele basiselementen van ontwikkelingsgerichte zorg (OGZ: het gebruik van couveusehoezen en nestjes) en het Newborn Individualized Developmental Care and Assessment Program (NIDCAP) met individuele gedragsobservaties voor te vroeg geboren kinderen met een zwangerschapsduur onder de 32 weken.

Opzet. Twee opeenvolgende gerandomiseerde onderzoeken in twee Nederlandse neonatale intensivecareafdelingen: standaardzorg vs. OGZ en OGZ vs. NIDCAP-zorg.

Methode. Door de ouders werden vragenlijsten ingevuld tijdens opname (ouderlijke stress en zelfvertrouwen en de door ouders ervaren steun) en vervolgonderzoek op de gecorrigeerde leeftijd van 1 jaar (ouderlijke stress, gedrag en kwaliteit van leven van de kinderen) en door het personeel op de afdelingen na implementatie van het NIDCAP.

Resultaten. Kwaliteit van leven en ouderlijke stress verschilden niet tussen de interventies tijdens opname en op 1-jarige leeftijd.Wel werden er beperkte effecten gevonden op het competentiegedrag van de kinderen: kinderen uit de OGZ-groep lieten op 1-jarige leeftijd meer prestatiemotivatie (nieuwsgierigheid, doorzettingsvermogen en gehoorzaamheid) zien. Bij een langere interventieduur hadden de individuele NIDCAP-gedragsobservaties een toegevoegd positief effect op het sociaal gedrag, aangezien de kinderen op 1-jarige leeftijd meer sociale verbondenheid toonden. Ouders, verplegend en (para)medisch personeel op de neonatologieafdelingen gaven bij vragenlijstonderzoek aan een positief effect van de NIDCAP-verzorging waar te nemen op het comfort en welbevinden van de kinderen tijdens de opname.

Conclusie. Hoewel alleen kleine effecten op de uitkomsten werden gevonden, waren ouders en personeel op de neonatologieafdelingen positief over de effecten van de interventies op het comfort en welzijn van de kinderen. Een volledige kosten-batenanalyse is van belang vanwege de hoge trainingskosten van het officiële NIDCAP-programma. Bij toekomstig onderzoek zijn een langere interventieduur, comfort- of pijnmeetinstrumenten en een kwalitatieve evaluatie door ouders en verzorgend personeel van belang.

Summary

Objective and design. The Leiden Developmental Care Project explored the effects of the basic elements of developmental care (DC: the use of incubator covers and nests) and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with individual behavior observations for very premature infants less than 32 weeks of gestation.

Design. Two consecutive randomized trials in two Dutch neonatal intensive care units: standard care versus DC and DC versus NIDCAP care.

Method. Questionnaires completed by parents during admission (parental stress and confidence and social support) and follow-up at 1 year of corrected age (parental stress, behavior and healthrelated quality of life of the children) and by caregivers after implementation of the NIDCAP.

Results. Quality of life and parental stress were not influenced by either type of intervention. Limited effects were found on competence child behavior at 1 year of age, when children who had received DC showed more mastery motivation (curiosity, persistence and obedience). When the intervention duration was longer, the behavioral observations had a positive effect on the social relatedness behavior of the children at 1 year. Parents, nursing and (para)medical personnel in the neonatal unit reported a positive effect of NIDCAP care on comfort and wellbeing of the children during admission to the neonatal unit. Conclusion. Although only limited effects on outcome were found, parents and personnel in the neonatal units were positive about the effects of the interventions on comfort and well-being of the very premature infants. A complete cost-benefit analysis in the Dutch setting is important because of the high training costs of the NIDCAP. Future research should consider a longer intervention duration, use of comfort or pain measures and a qualitative evaluation by parents and caregiving personnel.

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Copyright information

© Bohn Stafleu van Loghum 2008

Authors and Affiliations

  • S. M. van der Pal
    • 1
  • F. J. Walther
  1. 1.

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