To the Editor.
—Although it is laudable that Dr Als and colleagues1 have evaluated a difficult issue such as developmental care in very low-birth-weight infants in a randomized controlled trial, we would like to point out certain methodological concerns. First, considering the large size of the unit, the 43 subjects enrolled over a 21-month period may represent a small and highly select group of the overall admissions, thus diminishing the generalizability of the study. Further concern of a possible selection bias stems from the surprising lack of any reported exclusions because of death or other causes following randomization at age 3 hours. Second, we find it difficult to imagine how 91 behaviors could be collected every 2 minutes for 20 minutes each, before, during, and after a clinical maneuver, even if some of these are automated. We wonder if such complexity is warranted if the intention of the investigators
Saigal S, Streiner D. Developmental Care for Very Low-Birth-Weight Infants. JAMA. 1995;273(20):1576-1577. doi:10.1001/jama.1995.03520440027021