motor containment and quality oral feeding. Neonatal individualised developmental care and assessment programme (NIDCAP) is an individualised approach that integrates a number of interventions and is based on the synactive theory model. NIDCAP has been developed to interact with preterm infants at levels adapted to their degree of neurological maturity. Increase in support to the infant’s behavioural self-regulation has been shown to improve medical, behavioural and developmental outcomes and has a positive impact on neurophysiology and brain structure, likely due to prevention of inappropriate inputs during a highly sensitive period of brain development.54 Improved long-term outcomes in infant cognitive, motor and emotional functioning due to NIDCAP in the NICU have been reported up to school age. Enhanced parent confidence and competence is also well documented.54 Meta-analysis of studies thus far has, however, failed to show significant benefits, likely due to lack of good quality large trials.55 Skin-to-skin contact (SSC) and kangaroo mother care (KMC) (figure 6) are the two most studied, multisensorial parent interventions. A multitude of positive effects have been observed, such as supporting infant physiological stability, preventing pain, strongly promoting infant growth and neurobehavioural development, improving breast feeding, reducing neonatal morbidities, parental anxiety, neonatal stress scores, nosocomial infections, hypothermia and length of stay.56 57 Earlier and longer contact provides greater benefit and studies have alluded to a dose–response relationship.58 SSC and KMC have been shown to confer several benefits to the preterm brain with increased brain maturation,59 improved connectivity,60 improved cerebral blood flow,61 and a positive influence on brain networks and synaptic efficacy up to adolescence.62 KMC is also shown to increase oxytocin levels and decrease cortisol reactivity in term infants.63 Studies allude to a lasting impact on self-regulation skills later in infancy,64 improved executive functioning at 5 and 10 years of life,65 and significant, long-lasting social and behavioural protective effects even after 20 years of the intervention.66 Further longer term effect studies of KMC on cognitive and motor development, socioemotional skills and temperament are needed.64 Exposure to neonatal pain has been linked to impaired brain development in preterm infants,67 neonatal pain experience in animals may lead to physical damage or even death of young neurons in the brain.68 The activation of the hypothalamic–pituitary–adrenal (HPA) axis, in response to stressors during the critical periods of brain development, has been associated with many acute and long-term adverse biobehavioural outcomes. KMC accelerates neurophysiological maturation of premature neonates59 and reduces the HPA axis response to pain and reduced maternal care leading to typical development of the HPA axis and brain with normal cognitive functioning and behavioural outcomes.56 The exact biological mechanism of how KMC results in the large range of beneficial outcomes however remains largely unknown. The relatively limited sample size of studies thus far, heterogeneity in strategies and outcome measures and the potential for confounding variables highlight the need for further trials with clearly defined and similar outcomes. Breast feeding is known to have a range of social, emotional and health benefits for both the term and preterm infant and mother. The cognitive and developmental advantages to breastfed infants have been acknowledged in the literature as early as the 1970s.69 The positive impact of breast feeding on intellectual development has subsequently been established with evidence of a lasting impact through to adulthood.70 Improvement in cognitive development is even greater in preterm and very low birthweight infants.71 Adolescents that were breast fed in infancy have an increase in total WM, subcortical GM and parietal lobe cortical thickness. Studies using evoked potentials suggest delayed or immature myelination of early neural pathways in formula-fed infants as compared with breastfed ones. More recently, imaging studies of preterm infants at term-equivalent age demonstrate an association between higher exposure to breast milk feeding with Figure 6 The preterm infant’s neurosensory experience in three different environments: (A) inside mum’s uterus—feels safe, peaceful and reassured by mum; (B) inside incubator—undergoes several uncomfortable, painful and non-reassuring stimuli; (C) on mum’s chest during skin to skin—most sensations simulate the in-utero experience and the infant feels safe, peaceful and reassured by mum. Adapted from Jill Bergman. I/V, intravenous; NGT, nasogastric tube. Sciences Library. Protected by copyright. on May 17, 2021 at CU Anschutz Strauss Health http://fn.bmj.com/ Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/archdischild-2020-319450 on 10 May 2021. Downloaded from Soni R, et al. Arch Dis Child Fetal Neonatal Ed 2021;0:F1–F8. doi:10.1136/archdischild-2020-319450 F7 Review improved microstructural properties of WM tracts and cerebral structural connectivity. These effects had a dose-dependent relationship with breast milk exposure.72 73 Family-centred care (FCC) interventions are