Newborn Intensive Care Units (NICUs) emerged in the 1970s with the introduction of new treatment options, especially respiratory support, that led to a dramatic improvement in survival of premature infants. Like the newborn nurseries of the time, they were designed as large, open multibed rooms – of necessity for reasons that included limited space and absence of monitoring abilities that we now take for granted such as transcutaneous oxygen probes and electronic transmission of alarms to remote devices. Parental access was restricted for multiple reasons, including the concern for exposure to infectious agents, limited room at the bedside, and little awareness of the importance of parental presence for optimal infant development. This early NICU environment was, in retrospect, noxious for babies, families, and caregivers alike – brightly-lit, noisy, non-circadian, intense, and highly medicalized.

The current era of NICU care has been driven by recognition of how toxic this environment could be. Facilitated by better technology, better design, and a better understanding of neonatal neurodevelopment, NICUs have become quieter, dimmer, more spacious, and more welcoming. Overstimulation has been replaced by a more “hands-off” approach in an attempt to protect infant sleep and neurodevelopment. Rooms that had been brightly-lit around the clock are now often dim 24/7 or alternatively, incubators are covered to “protect” the babies. Infants are variably offered auditory stimuli such as music or listening to a parent, nurse, or volunteer read to them, but this is often proscribed when the infant appears to be asleep – which can be most of the time or unpredictable in its application. As a result, language exposure for the preterm infant in a NICU is often much lower than would have been the case in fetal life [1, 2] which may impact auditory and language development in later life [3].