We read with great interest the article on Mother-Neonatal Intensive Care Unit (M-NICU) published in a recent article in Indian Pediatris [1]. This model of care seeks to operationalize two key concepts that are widely accepted as part of optimal care for newborns–integration of maternal and newborn care, and family engagement.

Chellani, et al. [1] have introduced M-NICU as a novel model that tests the feasibility of zero-separation of the mother and newborn, thus taking the FPC model a step further in increasing family engagement. M-NICU is a collaborative effort between the neonatology and obstetrics departments. It positions the mother’s bed in the NICU, providing an opportunity for the mother and her newborn to be together continuously throughout the hospital stay. While this model is a laudable effort in increasing family engagement in the care of small and sick newborns, it raises many questions regarding implementation.

Evidence from India and other countries [3,4] indicate that the family-centred care model does not increase nosocomial infection; does this hold true in the M-NICU model of family-centred care? How is hygiene maintained in a model that widens the circle of family members and health providers who come in contact with the newborn? Are the health staff of the Obstetrics and Neonatology departments trained together in infection prevention and developmentally supportive care? What are the cost implications of a model that requires enhanced infrastructure support and additional space requirements?

The development of a structured, implementable framework for family-centred care in the Indian setting has provided an opportunity for iterative learning for 12 years. From these lessons, we anticipate two major challenges: the attitude of the health care provider (rather than that of the family) and the structural modification that will be required in the NICU space.

While family-centred, developmentally supportive care is the standard model in many high-income countries, India has blazed the trail [5] as the first among low- and middle-income countries to have introduced a national policy to integrate family-centred care in all sick newborn care units. We anticipate many challenges that will need to be overcome in the national rollout of the FPC model, and in the adaptation and integration of the M-NICU model to further deepen FPC in SNCUs at scale.

1. Mother-Neonatal Intensive Care Unit (M-NICU): A novel concept in newborn care. Indian Pediatr. 2018;12:1035-6.

2. Operational Guidelines on Family Participatory Care, July 2017 MOHFW, GOI publication. Available from: http://nhm.gov.in/images/pdf/programmes/child-health/guidelines /Family_Participatory_Care_for_Improving_ Newborn_Health-Operational_ guideline.pdf. Accessed January 04, 2019.

3. Verma A, Maria A, Pandey RM, Hans C, Verma A, Sherwani F. Family-centered care to complement care of sick newborns: A randomized controlled trial. Indian Pediatr. 2017;54:455-9.

4. Ortenstrand A, Westrup B, Broström EB, Sarman I, Åkerström S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: Effects on length of stay and infant morbidity. Pediatrics. 2010;125:278-85.