Robert White, MD
From its inception in the early days of NICU care, the Gravens Conference has focused on the human component needed to achieve excellent neonatal care and optimal outcomes. Over the nearly 40 years of this meeting, compelling evidence has emerged to show that to achieve optimal outcomes; we must address not only the physiological challenges of ill newborns but also their developmental needs. These needs are not easily evaluated by looking at a lab test or treated by writing an order, nor are they achieved only by protecting babies from noxious stimuli; we must also consistently provide nurturing stimuli, which has been more challenging.
At the recently concluded 2023 Gravens Conference, several formal programs were designed to assure that each newborn is given the development support often lacking, even in NICUs offering the most advanced medical and surgical treatments. The evidence basis for these programs is now more than sufficient to affirm that using such a structured program should be considered the standard of care for NICU care going forward.
When a decision has been reached to adopt a formal program of developmental support that incorporates staff and family, the next step is to choose a system that best fits the personnel and resources of a given NICU. To this end, the 2023 Gravens Conference presentations will be reviewed in Neonatology Today articles in the upcoming months. Hopefully, all those who provide care in the NICU will consider these carefully and find one they can embrace.
We are at the end of the era where developmental care was considered turning down the lights, reducing noise, eliminating unnecessary painful procedures, and leaving babies undisturbed except for a few minutes each time vital signs and feedings were due. Developmental care involves comprehensive nurturing of human interactions, even in the sickest or most premature infants, and NICUs now have several choices of evidence-based programs that can be adopted. Going forward, what should not be an option is retaining the disproven notion that babies’ brains will optimally develop if we protect them from harm and watch them grow.
Disclosure: The author has no conflicts of interest