6 Nidcap Based Developmental Care Significantly Reduces Apnea of Prematurity (AOP) In Very Low Birth Weight Infants (VLBWI)
Bibliographic record
Abstract
AOP is a significant problem for VLBWI, leading to prolonged hospital stays, ventilator dependence, need for medications, and possibly long-term neurodevelopmental disability. The Neonatal Individualised Developmental Care and Assessment Program (NIDCAP®) has been shown to be beneficial for VLBWI, eg, reduced length of stay. However, its effect on AOP in VLBWI has not been prospectively studied. An RCT to prospectively assess the impact of NIDCAP®-based developmental care on AOP in VLBWI. 120 VLBWI were randomly assigned to one of two groups: control (C) received standard NICU care; intervention (N) received the majority of NICU care by NIDCAP®-educated nurses. Sample size was calculated a priori on a reduction of indicators of AOP by 50%, (alpha=5%; power=0.95). Once randomised, nursing care (standard or NIDCAP®) was assigned according to group for the duration of the infant's stay at the study site. A minimum of 50% appropriate nursing assignment was required. A continuous 72-hour oxycardiorespirograph recording (OCR) was carried out within 24 hours of extubation, or if not intubated, at study entry. Index events were defined as: 1) Bradycardia, B≥30% HR decrease from the level measured over the preceding 2 minutes; 2) Desaturation, D=10% oxygen saturation decrease from the level measured over the previous minute, or saturation <88%; 3) Combined event, BD=concurrent B and D. These are accepted indicators of AOP. All events, reported/hour, were further categorised as short (10–20 sec; S) or long (>20 sec; L). Three experienced research nurses analysed the OCRs; inter-rater reliability was >90%. A p value of <0.01 was required to accommodate multiple testing with Student's non-paired T-test. OCRs were obtained from 57 N and 54 C infants. Groups did not differ significantly in BW; GA; gender; APGAR and SNAP-II(TM) scores; mode of delivery; use of antepartum steroids, inotropes, surfactant; need for ventilation; use of methylxanthines; age at study entry and when OCR was done. Significant event reductions (p<0.00001) were noted between groups in 1) overall S events/h (C=1.32±0.95; N=0.61±0.44); 2) overall L events/h (C=2.41±2.01; N=0.71±0.54), 3) total events/h (C=3.73±2.74; N=1.32±0.89); 4) S D/h (C=0.87±1.04; N=0.21±0.29) and 5) L D/h (C=1.88±2.03; N=0.34±0.47). NIDCAP®-based care significantly reduced indicators of AOP in these VLBWI. Implications for long-term outcomes and on health care resources are expected to be significant, and are under current study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".