We read with great interest the article on Mother-Neonatal Intensive
Care Unit (M-NICU) published in a recent article in Indian Pediatris
. 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.
The Ministry of Health and Family Welfare (MOHFW),
Government of India, through its National Health Mission (NHM), has
demonstrated exemplary leadership in responding and adapting to the
evolving needs of India’s program for small and sick newborns. Recent
inclusion of Family Participatory Care (FPC) as a national health
program innovation in newborn care and launch of a Training Guide and
FPC Operational Guidelines 
are steps in this direction.
Chellani, et al.  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
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.
Feasibility and acceptability of the family-centred
model as a winning strategy for increasing rates of Kangaroo Mother Care
and for facilitating developmentally supportive care, has been
documented in the Indian setting. Data from 38 District Special Newborn
Care Units (SNCUs) have demonstrated that family-centred care is a
feasible model within the Indian public sector health system.
A qualitative study has shown not only a high
degree of acceptability among both parents and service providers but
also that essential newborn care skills acquired by parents during
hospital stay with their sick neonate continues when they return home.
The study also documented an improved patient-staff relations, a highly
needed area in the India health care system.
While family-centred, developmentally supportive care
is the standard model in many high-income countries, India has blazed
the trail  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:
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.
5. India Case Study on Family Participatory care: A
Gateway to Nurturing Care for Small and Sick Newborn Included for Launch
of Nurturing Care framework Launch for Early Childhood Development at
71st World Health Assembly May 2018 at Geneva. Available from:
Accessed January 04, 2019.