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Gepubliceerd in:

01-08-2008

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

Auteurs: S. M. van der Pal, F. J. Walther

Gepubliceerd in: Tijdschrift voor Kindergeneeskunde | Uitgave 4/2008

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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.
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Metagegevens
Titel
Ervaringen met ontwikkelingsgerichte zorg voor te vroeg geboren kinderen in een Nederlandse setting
Auteurs
S. M. van der Pal
F. J. Walther
Publicatiedatum
01-08-2008
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Kindergeneeskunde / Uitgave 4/2008
Print ISSN: 0376-7442
Elektronisch ISSN: 1875-6840
DOI
https://doi.org/10.1007/BF03078199