Family-Centered Developmentally Supportive Care of the High-Risk Infant and Family: Comments on Als, Westrup, and Mallik and Spiker

During the period from 1970 to 1990, there was a dramatic improvement in survival and impairment rates for high-risk newborns thanks to major advances in neonatal physiology, technology and the organization of regionalized neonatal intensive care. The primary focus of intensive care remained medical and physiological, with patients subjected to prolonged periods of repeated medically necessary treatment-related adverse stimuli in an environment very different from that of the womb. Als, one of the strongest proponents of the introduction of babyand family-centered care, 1 developed a theory-based approach to refocus the pattern of interactions in neonatal care firmly on the needs of baby and family. Her Newborn Individualized Developmental Care and Assessment Program (NIDCAP), 2 currently the most widely used neonatal developmental care intervention, involves training staff and parents in the neonatal intensive care unit (NICU) to be aware of, and respond appropriately to, their baby’s behavioural and developmental cues. This approach has the appeal of being caring, compassionate and humane, and by reducing stress and promoting mother-infant interactions where both mother and baby are successfully reading and responding to each other’s cues (“dyadic interactions”), could be expected to lead to better outcomes. However, at the present time, neonatal specialists hold starkly contrasting views of the evidence for efficacy and cost-effectiveness of NIDCAP, resulting in differing levels of adoption in different parts of the world.