To the Editor.
—The study by Dr Als and colleagues1 of the effectiveness of a newborn individualized developmental care and assessment program (NIDCAP) to reduce very low-birth-weight infant morbidity has been published with an accompanying enthusiastic Editorial.2The philosophy behind NIDCAP is attractive and is centered around stress reduction, promotion of infant development, and opportunities for parenting. Unfortunately, as in two previous studies,3,4 the present report leaves the critical reader uncertain with regard to the effectiveness of NIDCAP.It is remarkable that antenatal corticosteroids to prevent neonatal morbidity were given to only 10% of the mothers. Given the size of the authors' unit, it is surprising that it took 21 months to enroll 43 neonates. Randomization occurred within 3 hours after admission to the NICU, but two additional eligibility criteria had to be met by 48 hours' postnatal age. Therefore, one would expect that at least some