Your Presence Is Part of the Treatment

Two 2026 studies on what changes for premature babies when a neonatal unit is built around families rather than around machines

When a hospital in Ukraine changed how its neonatal unit worked — letting parents in around the clock, putting babies skin-to-skin on their parents' chests, protecting sleep, dimming lights and lowering noise — the premature babies cared for afterwards had less infection, less bleeding in the brain, better weight gain and shorter hospital stays than the babies cared for before the change. A second 2026 paper, reviewing 35 studies from around the world, found the same pattern across the wider evidence. Neither study proves the change caused the improvement, but together they make a strong case that how a baby is cared for matters alongside what they are treated with.

Those two papers — one from a hospital in Ternopil, Ukraine [1], and one from a research team in Indonesia reviewing the global literature [2] — were published within six weeks of each other, and they approach the same question from opposite ends. The Ukrainian team asked what happened in one real hospital. The Indonesian team asked what the whole field currently knows. This article explains what each found, and how much weight to put on it.

The Problem That Started All of This

For a long time, the newborn intensive care unit was designed around the equipment and the staff. That was not cruelty; it came from a reasonable belief that a very premature baby was fragile and that the safest thing was to disturb them as little as possible and let the machines do their work. Parents visited briefly. They watched through plastic. They were told, kindly, not to touch too much. Babies survived in growing numbers, and that felt like enough.

In the 1980s an American psychologist named Heidelise Als argued that this had the biology backwards. A premature baby, she pointed out, is not a passive patient. Even at 27 weeks, a baby is constantly signalling — through breathing, colour, muscle tone, movement — whether they are coping or overwhelmed. Care that ignores those signals is not neutral; it costs the baby something. Als built this insight into a formal programme, known as NIDCAP, that trains staff to read those signals and shape care around them [3].

What made doctors take this seriously was not the philosophy but the measurements. Studies of very premature babies given individualised care found differences not just in behaviour but in health and in brain activity [4]. One study in babies who had grown poorly in the womb found differences in how the brain was functioning and how it was structured [5]. That is a striking claim — that how you hold and handle a baby leaves a mark on the developing brain — and it is what turned this from a nursing idea into a medical one.

Two specific practices then built up strong evidence of their own. The first is kangaroo mother care: holding a nappy-clad baby upright against a parent's bare chest. A large review of the evidence found it reduced deaths and infections in low-birthweight babies [6] — an intervention that costs nothing and works. The second is family integrated care, where parents are trained and expected to do much of the day-to-day caregiving themselves. A large international trial found babies gained weight better and parents did better too [7]. A pooled analysis of developmental care studies also found benefits in thinking and movement skills, though the studies varied a lot [8].

The catch is that researchers usually test one practice at a time, while hospitals adopt several at once [9]. And the reason this matters is that the effects of prematurity are not temporary: a large French study following children born early found measurable differences still present at age five [10]. Over the past decade the model has shifted from parents as visitors to parents as partners in care [11] — a change that requires rethinking how a whole unit runs, not buying a new machine.

What the Two Studies Did

The Ukrainian study compared two groups of babies born before 34 weeks at one regional hospital [1]. Ninety-one babies were cared for after the hospital adopted its new approach; 119 had been cared for before it, and their records were reviewed for comparison. Results were reported separately for the most premature babies, born at 24–28 weeks, and for those born at 29–32 weeks.

The new approach was a bundle of changes: parents allowed in at any hour, parents and babies staying together once out of intensive care, sleep protected, pain assessed daily and eased with a sweet glucose solution and a dummy to suck during procedures, breastfeeding actively supported, lights and noise reduced, careful attention to how babies were positioned, and parents doing hands-on care. Skin-to-skin contact was the centrepiece. Before the change, babies were cared for mainly in incubators, parents visited briefly, and formula feeding was the norm.

The second paper was a review [2]. The researchers searched five databases for studies published between 2020 and mid-2025, sifted through 2,500 records, and analysed the 35 that met their standards. They did not combine the numbers statistically, because the studies measured too many different things in too many different ways for that to be meaningful.

What They Found

The clearest finding concerns infection. Serious infections that develop after the first few days of life — a major danger for babies who spend weeks in hospital [12] — dropped substantially. Among the most premature babies, they occurred in about 42 out of every 100 babies after the change, compared with about 76 out of 100 before. Among the 29–32 week babies, the figures were roughly 10 in 100 compared with 22 in 100.

Bleeding into the brain, which is common in premature babies and can affect later development, was less frequent among the 29–32 week group: about 14 in 100 compared with 31 in 100. Serious eye disease of prematurity was less frequent among the most premature babies: about 26 in 100 compared with 62 in 100. Each of these differences appeared in only one of the two age groups, and the groups were small — 19 and 21 babies in the most premature comparison — so these particular numbers should be held loosely.

Growth was the most consistent finding. Babies gained more weight per day in both age groups, left hospital at a healthier weight for their age, and were far less likely to leave hospital undergrown. Babies also went home sooner: a median of 61 days instead of 71 for the most premature, and 31 days instead of 47 for the 29–32 week group. Time on a breathing machine was shorter too, matching earlier findings from hospitals adopting the NIDCAP programme [13]. Among that second group, breastfeeding at discharge rose from about 31 in 100 babies to about 47 in 100, and babies were about twice as likely to still be breastfeeding later — consistent with what kangaroo care studies have found before [14]. Chronic lung disease and serious bowel disease did not differ.

The review found much the same shape [2]. Family integrated care had the most consistent evidence, with benefits still visible at 18–24 months. Kangaroo care improved temperature control, oxygen levels in the brain and stress hormones, and how long a baby spent skin-to-skin appeared to matter — findings echoed in pooled analyses of kangaroo care [15]. Feeding babies according to their own hunger cues, rather than a fixed schedule, helped them reach full feeding sooner. Changes to the physical environment were the least clear-cut: private rooms improved sleep and reduced infection in some studies but raised worries in others that a baby alone in a quiet room might get too little stimulation, particularly for language.

What This Means for Your Family — and What It Does Not

Here is the honest limitation. The Ukrainian study compared babies from two different time periods, not babies randomly assigned to two approaches. Over any few years a hospital gets better at many things at once, and there is no way to separate the new approach from everything else that improved. The study also does not compare how many babies died in each group, which is important missing information. Many results sat close to the line where a difference might have arisen by chance.

There is one point in the study's favour that is easy to miss. The babies cared for under the new approach were, on average, in worse condition at birth — lower Apgar scores, more complicated pregnancies, more breathing trouble. If anything, that should have made their results look worse, not better. So "they just started with healthier babies" does not explain what was found.

What you can reasonably take from all this: the individual pieces — skin-to-skin contact, your presence, your involvement in feeding and comfort — have strong evidence behind them in their own right. When you are invited to hold your baby against your chest, or to be there for a nappy change or a heel prick, you are not being given something to do to pass the time. You are doing something the evidence suggests helps.

It is also worth saying what this does not mean. It does not mean that a parent who cannot be at the bedside constantly — because of other children, work, distance, or their own recovery from birth — is harming their baby. The studies compare hospital systems, not individual parents, and no honest reading of them supports guilt. If the hours you can manage are limited, ask the staff how to make them count.

What Researchers Are Working On Next

The review's main conclusion was a criticism of its own field: studies keep testing one ingredient at a time, measure different things, rarely follow children past discharge, and are overwhelmingly done in wealthy countries even though most premature babies are born elsewhere. The next step researchers are calling for is a trial in which hospitals — not individual babies — are randomly assigned to adopt a defined package at different times, measuring the same outcomes everywhere and following children for years rather than weeks. Until then, the case for developmental care rests on strong evidence for its parts, a sensible explanation for why it should work, and encouraging results from hospitals that have tried it. For a change that costs almost nothing and asks only that families be let in, that is a reasonable place to stand.

References

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  2. Hastuti D, Anggorowati, Zubaidah Z. Developmental care for preterm infants: a scoping review of interventions, outcomes, and implementation contexts. Front Pediatr. 2026;14:1730571. doi:10.3389/fped.2026.1730571 ↩
  3. Als H, McAnulty GB. The newborn individualized developmental care and assessment program (NIDCAP) with kangaroo mother care (KMC): comprehensive care for preterm infants. Curr Womens Health Rev. 2011;7(3):288–301. doi:10.2174/157340411796355216 ↩
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