To the Editor.
—I question some of the methods and analyses that Dr Als and colleagues1 used in their study of individualized developmental care. The authors state, "Control group status was not revealed to staff"; however, staff would have been aware of which infants were in the experimental group. Many of the medical outcomes could have been influenced by the staffs knowledge of experimental group status. Without set criteria, infants could have been tried off mechanical ventilation or oxygen sooner, been offered a bottle sooner, and been discharged sooner. Data collectors were blinded to group status, but collected all information retrospectively. This may have resulted in less accuracy in the collection of medical variables.Als and colleagues have been pioneers in improving the NICU environment, and many NICUs have incorporated their principles of protecting infants from the constant noise, light, and procedures of this environment. Fewer NICUs are using
Lacy JB. Developmental Care for Very Low-Birth-Weight Infants. JAMA. 1995;273(20):1575-1576. doi:10.1001/jama.1995.03520440027019