Development and Validation of a Nurse-Led Developmental Intervention Package to Improve the Neurodevelopmental Outcomes of Preterm Babies in Neonatal Intensive Care Unit

Abstract

Preterm birth is a major global health concern associated with high morbidity and mortality rates, along with long-term neurodevelopmental impairments. Developmental supportive care (DSC) plays a crucial role in optimizing neurodevelopmental outcomes in these vulnerable neonates. This study aimed to develop, validate, and assess the feasibility of a nurse-led developmental intervention package (NLDIP). A Medical Research Council (MRC) framework was used to develop and validate the NLDIP. The NLDIP was designed based on a comprehensive scoping review, expert consultations, and practical feasibility assessments in a neonatal intensive care unit (NICU). Validation was conducted through single-round Delphi technique with expert reviews from different fields. The content validity index value was 0.9 and a dry run was performed to assess compliance and feasibility. The NLDIP was systematically developed and validated, comprising three key components: standard DSC, age-appropriate multisensory stimulation (MSS) during hospitalization, and continued MSS at home. The findings demonstrate that the NLDIP is a valid, feasible, and well-structured intervention which can be effectively implemented by nurses in an integrated way to enhance the neurodevelopmental outcomes of preterm infants.

Keywords

developmental supportive care (DSC) / neurodevelopment / nurse-led / early intervention / preterm

References

[1] H. Blencowe, S. Cousens, D. Chou, et al., “Born Too Soon: The Global Epidemiology of 15 Million Preterm Births,” supplement, Reproductive Health10, no. S1 (2013): S2.

[2] D. T. Jamison, J. G. Breman, A. R. Measham, et al., Cost-Effective Strategies for the Excess Burden of Disease in Developing Countries (2006), https://www.ncbi.nlm.nih.gov/books/NBK10258/.

[3] S. Jain, P. Patel, N. Pandya, D. Dave, and T. Deshpande, “Neurodevelopmental Outcomes in Preterm Babies: A 12-Month Observational Study,” Cureus15, no. 10 (October 2023): e47775.

[4] R. E. Behrman and A. S. Butler, “ Outcomes I of M (US) C on UPB and AH,” in Mortality and Acute Complications in Preterm Infants (2007), https://www.ncbi.nlm.nih.gov/books/NBK11385/.

[5] R. H. Pickler, J. M. McGrath, B. A. Reyna, et al., “A Model of Neurodevelopmental Risk and Protection for Preterm Infants,” Journal of Perinatal and Neonatal Nursing24, no. 4 (October 2010): 356-365.

[6] G. Radaelli, E. Leal-Conceição, F. K. Neto, et al., “Motor and Cognitive Outcomes of Neonates With Low Birth Weight in Brazil: A Systematic Review and meta-analysis,” Associacao Arquivos de Neuro-Psiquiatria81 (2023): 186-200.

[7] Extremely Low Birth Weight Infant: Overview, Morbidity and Mortality, Thermoregulation and Hypoglycemia, https://emedicine.medscape.com/article/979717-overview?form=fpf.

[8] T. Shrestha, “Developmental Supportive Care for Preterm Infants in Neonatal Intensive Care Units,” Journal of Nursing Education of Nepal13, no. 1 (December 2022): 117-122.

[9] V. Raghu and M. Vatsa, “Early Neurodevelopmental Supportive Care: Approach to Enhance the Neurodevelopmental Outcome in Premature and Low Birth Weight Infant,” Journal of Integrated Health Sciences9, no. 2 (2021): 99-106, https://doi.org/10.4103/jihs.jihs_24_21.

[10] W. Xiao, C. Chan, J. Xiao, C. Wong, and K. Chow, “Development of A Nurse-Led Educational Intervention Program in Managing the Nutrition Impact Symptom Cluster in Patients With Nasopharyngeal Carcinoma Following the Medical Research Council Framework,” Asia-Pacific Journal of Oncology Nursing8, no. 6 (2021): 653-661.

[11] L. Altimier and R. Phillips, “The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-Centered Developmental Care,” Newborn and Infant Nursing Reviews16, no. 4 (December 2016): 230-244.

[12] G. Lawhon and R. E. Hedlund, “Newborn Individualized Developmental Care and Assessment Program Training and Education,” Journal of Perinatal and Neonatal Nursing22, no. 2 (April 2008): 133-144.

[13] M. M. C. Carneiro, S. N. S. Ribeiro, N. A. Menegol, R. Okubo, D. Montemezzo, and L. S. Sanada, “Nest Positioning on Motor Development, Sleep Patterns, Weight Gain in Preterm Infants: Systematic Review,” Pediatric Research96, no. 1 (July 2024): 57-63: Epub 2024 Feb 26. PMID: 38409428, https://doi.org/10.1038/s41390-023-02972-w.

[14] I. Queirós, T. Moreira, R. Pissarra, H. Soares, and H. Guimarães, “Non-Pharmacological Management of Neonatal Pain: A Systematic Review,” Minerva Pediatrica75, no. 2 (April 2023): 282-295: Epub 2022 Jun 21. PMID: 35726765, https://doi.org/10.23736/S2724-5276.22.06871-9.

[15] W. Yue, X. Han, J. Luo, Z. Zeng, and M. Yang, “Effect of Music Therapy on Preterm Infants in Neonatal Intensive Care Unit: Systematic Review and Meta-Analysis of Randomized Controlled Trials,” Journal of Advanced Nursing77, no. 2 (February 2021): 635-652: Epub 2020 Nov 17. PMID: 33200833, https://doi.org/10.1111/jan.14630.

[16] C. Johnston, M. S. Stopiglia, S. N. S. Ribeiro, C. S. N. Baez, and S. A. Pereira, “First Brazilian Recommendation on Physiotherapy With Sensory Motor Stimulation in Newborns and Infants in the Intensive Care Unit,” Revista Brasileira de Terapia Intensiva33, no. 1 (January–March 2021): 12-30: PMID: 33886850; PMCID: PMC8075339, https://doi.org/10.5935/0103-507X.20210002.

[17] M. Aita, G. De Clifford Faugère, A. Lavallée, et al., “Effectiveness of Interventions on Early Neurodevelopment of Preterm Infants: A Systematic Review and Meta-Analysis,” BMC Pediatrics21, no. 1 (April 2021): 210: PMID: 33926417; PMCID: PMC8082967, https://doi.org/10.1186/s12887-021-02559-6.

[18] S. Khurana, A. E. Kane, S. E. Brown, T. Tarver, and S. C. Dusing, “Effect of Neonatal Therapy on the Motor, Cognitive, and Behavioral Development of Infants Born Preterm: A Systematic Review,” Developmental Medicine and Child Neurology62, no. 6 (June 2020): 684-692: Epub 2020 Feb 19. PMID: 32077096; PMCID: PMC7920849, https://doi.org/10.1111/dmcn.14485.

[19] A. Spittle, J. Orton, P. J. Anderson, R. Boyd, and L. W. Doyle, “Early Developmental Intervention Programmes Provided Post Hospital Discharge to Prevent Motor and Cognitive Impairment in Preterm Infants,” Cochrane Database of Systematic Reviews2015, no. 11 (2015): CD005495, https://doi.org/10.1002/14651858.CD005495.pub4.

[20] M. Ochandorena-Acha, M. Terradas-Monllor, L. López Sala, et al., “Early Physiotherapy Intervention Program for Preterm Infants and Parents: A Randomized, Single-Blind Clinical Trial,” Children9, no. 6 (June 2022): 895: PMID: 35740832; PMCID: PMC9222162, https://doi.org/10.3390/children9060895.

[21] Y. Wang, T. Zhao, Y. Zhang, S. Li, and X. Cong, “Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants,” Breastfeeding Medicine16, no. 4 (April 2021): 282-291: Epub 2021 Feb 2. PMID: 33533688, https://doi.org/10.1089/bfm.2020.0358.

[22] J. Fan, J. Wang, X. Zhang, et al., “A Home-Based, Post-Discharge Early Intervention Program Promotes Motor Development and Physical Growth in the Early Preterm Infants: A Prospective, Randomized Controlled Trial,” BMC Pediatrics21, no. 1 (2021): 162, https://doi.org/10.1186/s12887-021-02627-x.

[23] R. Pineda, P. Kellner, C. Ibrahim, and J. Smith, “Supporting and Enhancing NICU Sensory Experiences (SENSE), 2nd Edition: An Update on Developmentally Appropriate Interventions for Preterm Infants,” Children10, no. 6 (May 2023): 961: PMID: 37371193; PMCID: PMC10297666, https://doi.org/10.3390/children10060961.

[24] F. Soleimani, N. Azari, H. Ghiasvand, and S. Fatollahierad, “Effects of Developmental Care on Neurodevelopment of Preterm Infants,” Iranian Journal of Child Neurology14, no. 2 (2020): 7-15.

[25] W. P. Lu, W. H. Tsai, L. Y. Lin, R. B. Hong, and Y. S. Hwang, “The Beneficial Effects of Massage on Motor Development and Sensory Processing in Young Children With Developmental Delay: A Randomized Control Trial Study,” Developmental Neurorehabilitation22, no. 7 (October 2019): 487-495: Epub 2018 Oct 30. PMID: 30376388, https://doi.org/10.1080/17518423.2018.1537317.

[26] M. L. Neel, P. Yoder, P. J. Matusz, et al., “Randomized Controlled Trial Protocol to Improve Multisensory Neural Processing, Language and Motor Outcomes in Preterm Infants,” BMC Pediatrics19, no. 1 (March 2019): 81: PMID: 30890132; PMCID: PMC6423745, https://doi.org/10.1186/s12887-019-1455-1.

[27] K. Mohamed, E. Abdelazeim, F. Elshafey, and N. Nasef, “Neurobehavioral Response to Multisensory Stimulation Programme in High-Risk Neonates,” Bulletin of Faculty of Physical Therapy23, no. 1 (2018): 22-29, https://doi.org/10.4103/bfpt.bfpt_5_18.

[28] P. S. Kanagasabai, D. Mohan, L. E. Lewis, A. Kamath, and B. K. Rao, “Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants,” Indian Journal of Pediatrics80, no. 6 (June 2013): 460-464: Epub 2013 Jan 4. PMID: 23288407, https://doi.org/10.1007/s12098-012-0945-z.

[29] E. J. Lee and S. Y. Lee, “The Effects of Early-Stage Neurodevelopmental Treatment on the Growth of Premature Infants in Neonatal Intensive Care Unit,” Journal of Exercise Rehabilitation14, no. 3 (June 2018): 523-529: PMID: 30018943; PMCID: PMC6028218, https://doi.org/10.12965/jer.1836214.107.

[30] J. J. Liaw, L. Yang, K. W. Katherine Wang, C. M. Chen, Y. C. Chang, and T. Yin, “Non-Nutritive Sucking and Facilitated Tucking Relieve Preterm Infant Pain During Heel-Stick Procedures: A Prospective, Randomised Controlled Crossover Trial,” International Journal of Nursing Studies49, no. 3 (March 2012): 300-309: Epub 2011 Oct 14. PMID: 22001561, https://doi.org/10.1016/j.ijnurstu.2011.09.017.

[31] X. Ding, L. Zhu, R. Zhang, L. Wang, T. T. Wang, and J. M. Latour, “Effects of Family-Centred Care Interventions on Preterm Infants and Parents in Neonatal Intensive Care Units: A Systematic Review and Meta-Analysis of Randomised Controlled Trials,” Australian Critical Care32, no. 1 (January 2019): 63-75: Epub 2018 Dec 13. PMID: 30554939, https://doi.org/10.1016/j.aucc.2018.10.007.

[32] E. J. Lee, “Effect of Neuro-Development Treatment on Motor Development in Preterm Infants,” Journal of Physical Therapy Science29, no. 6 (June 2017): 1095-1097: Epub 2017 Jun 7. PMID: 28626334; PMCID: PMC5468209, https://doi.org/10.1589/jpts.29.1095.

[33] M. K. Nair, R. M. Sunitha, M. L. Leena, B. George, D. Bhaskaran, and P. S. Russell, “CDC Kerala 2: Developmental Intervention Package for Babies < 1,800 g--Outcome at 6 Mo Using DASII,” supplement, Indian Journal of Pediatrics81, no. S2 (December 2014): S73-S79: Epub 2014 Nov 29. PMID: 25429998, https://doi.org/10.1007/s12098-014-1624-z.

[34] R. VA, M. Vatsa, N. Gupta, and T. T. Latha, “‘Effectiveness of a Multimodal Teaching Program on Nurses’ Knowledge Acquisition, Practice, and Perception of Neurodevelopmental Supportive Care in NICU: A Non-randomized Controlled Trial,” Journal of Neonatology (2025): 341-347, https://doi.org/10.1177/09732179251315535.

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