Supplementary Table 1. Conventional Care and Individualized Developmental Care A. Components Standard Care Environment NIDCAP Care Frequent Occurrence of: Consistent Provision of: Bright light on infant’s face Protection of infant’s face from all direct light, low light Variable room temperatures levels in care room with individual use of task lights Loud conversations, staff rounds, as indicated and the use of cloth tents over the eyes other infants’ crying, high traffic, frequent alarms, loud telephone conversations near infant High staff traffic in care room Disorganization of equipment in when direct light occurred Stable room temperatures or protection from infant during unstable temperatures Quiet conversations, staff rounds away from bedsides, quiet voices and low quiet and calm traffic in care care room; cluttered room, quick response to silence alarms, low voices appearance of room on telephone Well-organized care room, pleasantly arranged equipment in room Bed Space and Bedding Hospital issue generic incubator Almost fully covered incubators with assurance of visual covers and no covers on open access to infant. Special incubator covers in attractive cribs. light-blocking material and appropriate colors with Commercially available prefabricated. positioning aids Generic hospital clinical décor and bedding Lack of personal items from family at bedside Bright and continuously ribbons instead of Velcro; invitation to parents to individualize the covers with their own over-blankets designs Special canopy covers for when in an open crib, in attractive light-blocking material and infant room appropriate colors with ribbons instead of Velcro Special soft support pillows in support of the infant’s illuminated computer and position and well aligned posture when in the monitor screens dominate bed incubator or crib; special bunting designed for space comfortable leg/foot/toe, arm/hand/finger and Rare availability of chair or recliner, still rarer of two chairs/recliners for parents Maximally two adults permitted at shoulder support and flexion Special, very comfortable and always available at the bedside kangaroo care recliner chairs Soft feeding pillows, support pillows and blankets for the bedside and then for limited the parents and infants when sleeping, feeding or times only relaxing in the Kangaroo chairs Sibling presence not encouraged Lack of privacy screens; if available generic issue Hospital issue, ill-fitting t-shirts and diapers Individualized, skillfully adjusted soft nest/blankets to support comfortable positions and sleep Personalized bed spaces with photos, drawings, decorative name signs, soft stuffed animals, personalized well-fitting soft clothing and soft diapers, and/or soft stretchable buntings, special and sufficient in number, small, finger-shaped pacifiers for the infants when small Computer screens illuminated only when indicated; turned away from infant and family when not in use; blanket covering screen when not in use; reliably available attractive and very comfortable recliners for parent and comfortable chair for second parent; Siblings welcome and included: Foot stools to reach infant easily; appropriate seating for sibling; supervised sibling time available; Encouragement to sibling/parents for involvement in infant’s care Milestone celebratory pictures and certificates, parent/family photos at bedside; individualized developmental care books at the bedside of the infants for the parents/siblings to write in Special spaces at bedside for parent belongings; attractive baskets/tubs for infants’ respectively used and fresh clothing, bedding, mother/father body scent scarf, cloth or other materials Special attractive wood-frame, infant room appropriate privacy screens in soft colors Caregiving Frequently: Consistently: Interactions Determined by the infant’s Guided by the disease process and attending disease process and neonatologist’s orders in interaction with the primary corresponding nursing and nursing team and implemented in collaboration with respiratory protocols the parents and the infant, as adapted to the infant’s implemented on routine basis behavioral profile and cues along the autonomic, as ordered and supervised by motor and state regulation system with the goal to the attending neonatologist support the infant’s calmness, strengths and self Timing of care actions routinely regulation skills and keep stress responses to a determined by infant weight and age and by staff schedule Specialty care adjusted to staff minimum Timing of care actions adjusted to and supportive of the infant’s sleep wake cycles; scheduled care actions schedule and fixed feeding are integrated with awake periods as feasible; when and/or care interval (every 1, 2, a procedure must be performed at a certain time the 3 or 4 hours) nurse caregiver assists the infant in state transition Care components routinized and clustered (See two examples below) and maintenance in order to decrease cost to infant Shift change reports including the infant responsive current schedule adjustments Gavage feeding in incubator Care components in number and sequence horizontal position or slightly individualized to the infant’s current energy level and inclined angle, gravity drip of robustness; frequency of care actions may be feeding, little to no human decreased as indicated contact during feeding Frequent use of fortified mother’s milk, formula; bottle feeding as soon as tolerated. When held burping with back pats During feeding infants held and the gavage reservoirs lowered to decrease or cease flow as indicated by infants’ cues Burping performed very gently, mainly by holding the infant upright against the caregiver’s shoulder and chest, usually making patting unnecessary. And brief period only of holding after feeding; return to incubator and/or crib B. Standard Care and NIDCAP Care Treatment Features Group NIDCAP Professional Standard Care Available on specific consult request only NIDCAP Care Available daily (6/7 or 7/7) in the NICU to experimental group from infant recruitment to discharge (Followed by bi-weekly visits to community transfer nursery and home as indicated, to 42wks PMA) Detailed Behavioral Observations and Reports Available on specific consult request only Report results communicated to Performed weekly throughout hospitalization and beyond to 42wks PMA with detailed report and communication about the results and requesting attending recommendations to attending neonatologist, nursing neonatologist with feedback to team and parents as indicated nurse and parent if so indicated by attending Written copy provided in the infant’s Developmental Book, visible and accessible at the infant’s bedside at Report filed in medical chart all times Excerpts with key recommendations posted in attractive lay-out at bedside Invitation to parents, siblings and staff to write down their observations, thoughts and questions in the Developmental Book and use as diary, communication vehicle, place to add photos and milestone celebration certificates/mementos Support to Care Implementation Lack of development specialist support to care implementation Daily check-in and guided care support, facilitation mentoring, coaching for individual caregiver at bedside as well as to infant’s parents as indicated Daily and continuous availability to infant’s professional caregivers and parents by email and/or telephone, to provide guidance, answer questions, support when worried and concerned and in general provision of emotional support as indicated Practical support in problem solving transportation, housing, babysitting, car seat, discharge, transfer Participation in Family Team meetings; communication of observations, findings and recommendations, and coordination of results with nursing, the attending, social work and physical, occupational and respiratory therapy Support of Parent /Family Inclusion and Collaboration Lack of development specialist support for parent inclusion Consistent and continuous support and problem solving availability for increased inclusion of and collaboration with family members, foremost mother