Neuroprotective and Neuropromotive Care of the High-Risk Infant Beyond the First Week of Life

We must consider how care in the NICU is delivered to improve outcomes for infants and their families. Cultures and practices that support brain maturation, aim to prevent injury, aid in recovery, support the role of the family, and optimize the environment are referred to as developmental, neuroprotective, or neuropromotive care models and are important strategies to optimize the neurodevelopment of vulnerable infants. Neurosupportive care and its full impact on the developing brain has been hard to define due to the range of approaches and confounding factors; therefore, it has been underfunded and underexplored. We review what is known, but there is urgent need for broader recognition of and investment into the many opportunities to improve our care models. We discuss evidence-based care practices that have been shown to impact developmental outcomes, including use of specific care contexts and cultures, a focus on partnerships with families, use of a multidisciplinary team, reduction of pain and stress, and enhancing the sensory environment. Paradigms that adopt an “All Care is Brain Care” approach, center families’ engagement and experience, and employ intentional brain-focused strategies to protect and promote brain development can create a neuroprotective care culture.