發展性照護之理論發展與研究趨勢

Theoretical Development and Research Trends in Developmental Care

以統合理論為基礎之個別化發展性照護乃是以嬰兒腦部正常發育為目標，提供早產兒或急重症嬰兒一個支持、促進、引導其發展之環境。基於其重要性，發展性照護之策略及評估內容在臨床上已被廣泛應用，本文透過文獻回顧，探討2000－2013年發展性照護之理論應用與實證依據，提出未來早產兒或急重症嬰兒發展性照護研究之建議。結果顯示多數研究支持發展性照護對早產兒之體重成長、減少氧氣依賴、縮短其住院天數、與2歲內之神經發展成果等成效，然而，在2歲至學齡期之長期發展成效的研究結果並不一致，故須考量各研究介入措施種類、成效指標與測量工具的差異性。此外，發展性照護對臨床照護已有深切影響，這使得研究族群暴露在發展性照護環境等因素皆可能影響研究結果。新生兒照護領域專業人員應進一步思考實施發展性照護對於早產兒及其家庭之核心價值，未來仍需要更多研究驗證發展性照護單一措施與整體照護程序之成效，並檢測發展性照護於健康照護跨領域合作時之共同成效指標，以持續在臨床建構有效的發展性照護方案。

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synactive Theory, is applied to improve brain development in premature and illness infants within a supportive environment. The NIDCAP has been used widely in the clinical setting. The aim of this article was to systematically review research published between 2000 and 2013 that relates to the evidence and application of developmental care. Most studies support the effectiveness of developmental care in terms of facilitating the healthy growth of premature infants, reducing oxygen dependence, reducing hospitalization times, and improving neurodevelopmental outcomes at two years of age. However, research results related to the effects of developmental care on neurodevelopmental outcomes from 2 years old to school age are not consistent. The heterogeneity of interventions, outcome indicators, and measurements in studies may contribute to these mixed results. In addition, as developmental care has been applied for many years, the contamination of participants in the supportive environment should be considered. Based on current evidence, neonatal healthcare professionals must recognize the core value of developmental care in dealing with premature infants and their families. In order to provide effective interventions for infants, further research is needed to assess the comparative effects of the single intervention and the holistic approach in developmental care.