The i-Rainbow: A Flexible, Evidence-based Care Path for Providing Developmental Care in the Neonatal Intensive Care Setting

Approximately 1 in 10 infants are born preterm in the United States annually (cdc.gov). After birth, these infants often develop in the environment of the neonatal intensive care unit (NICU). Evidence demonstrates that clinically indicated, appropriately timed interventions can improve infant outcome and parent infant bonding. Since infants develop at different rates, and with varying degrees of neurologic maturity, relying on gestationally aged-based timelines can be problematic. Therefore, the authors collaborated to design a novel, parent-friendly developmental care path to serve as a guideline for providing evidence-based interventions based on the infant’s clinical status, not gestational age.

The i-Rainbow was designed to 1) be flexible in the NICU setting to easily accommodate fluctuation in infant clinical status and 2) offer a menu of evidence-based developmental activities that are easily understood and used by parents, nurses, and other developmental experts in the NICU. Prior to implementation, the authors 1) collected data on rates of developmental care and 2) surveyed both parents and healthcare professionals in the NICU at Lucile Packard Children’s Hospital Stanford to assess knowledge and comfort level with developmental activities for preterm infants. After implementation, data on developmental care rates were compared to pre-care path rates and feedback on the path was obtained through follow-up nurse and parent survey data. The results from the research and development of this novel, evidence-based developmental pathway will be shared with learners and instruction in the use of this tool will be provided and illustrated through a case.