Then vs. Now in the NICU: How Advances Have Transformed Care

The NICU is a young specialty—only about 60 years old. That makes it one of the fastest-growing areas of medicine, with change driven by research, collaboration, and the relentless pursuit of better outcomes for babies and families. For NICU Awareness Month, I want to take a step back and reflect on how much has changed in just a few decades. The babies we care for today benefit from progress that previous generations could never have imagined.

This isn’t just history—it’s a reminder that our practice as nurses continues to evolve. Let’s look at some of the biggest shifts in neonatal care and what they mean for our daily work.

Nutrition: From Delay to Early Intervention

Nutrition may be one of the clearest examples of “then vs. now.” Years ago, tiny preemies were often kept NPO (nothing by mouth) for fear of NEC, and IV fluids were little more than sugar water. Today, early feeding and optimal protein delivery are cornerstones of care.

• Donor breast milk has replaced formula as the standard supplement when mother’s milk isn’t available, reducing NEC risk and supporting gut health.

• Oral colostrum care uses every drop of a mother’s milk—even if her baby can’t yet eat by mouth—to prime the immune system.

• Fortified and earlier feeds allow babies to grow and develop without waiting weeks to start.

• Protein in starter fluids helps protect brain and body growth from the very beginning.

For nurses, this shift means rethinking old routines. Instead of being cautious to the point of withholding, we now support the gut early and often—because we know the outcomes are better.

Breathing Easier: Advances in Respiratory Care

Mechanical ventilation used to be the mainstay of support, but it often came at a cost—chronic lung disease. Over time, research proved that less can be more.

• Surfactant therapy in the 1980s dramatically reduced deaths from RDS.

• Gentler ventilation strategies like CPAP, NIPPV, and less invasive surfactant administration now help avoid ventilator-induced lung injury.

• High-frequency ventilation offers options for the sickest lungs with less trauma.

The “then vs. now” here is striking: where once survival meant long-term lung complications, today’s strategies give babies a chance at healthier lungs for life.

Preventing Infections: From Acceptance to Zero Tolerance

In the early NICUs, infections were common and often expected. Central lines were placed and cared for with variable technique, and CLABSI rates were high.

Today, infection prevention is non-negotiable. Standardized bundles, sterile protocols, and checklists have proven we can lower infection rates dramatically. The shift is cultural as much as clinical—nurses now lead the charge in holding each other accountable for safety.

Medications That Changed the Game

Some advances in the NICU came not from equipment or protocols, but from medications that reshaped survival:

• Surfactant turned RDS from a frequent killer into a treatable condition.

• PDA closure medications (indomethacin, ibuprofen, acetaminophen) reduced the need for surgery.

• Recognition of neonatal pain shifted us from withholding analgesia to actively managing pain during procedures and surgery.

Each medication milestone has changed not just outcomes, but also the ethical landscape of how we treat our smallest patients.

Families at the Center: From Visitors to Partners

Perhaps the most profound change isn’t medical at all—it’s cultural. In early NICUs, parents were restricted, sometimes allowed to visit only briefly. Babies were cared for in isolation, with families watching from the outside.

Now, family presence is central to NICU care. Parents are encouraged in kangaroo care, invited on rounds, and treated as partners in decision-making. This has been shown to improve not only bonding, but also infant outcomes like growth and stability.

As nurses, this change challenges us to shift from “doing for” families to “doing with” them—coaching, supporting, and empowering them in their baby’s journey.

Why This Matters for Nursing Practice

Looking back reminds us that NICU care is never static. Practices we take for granted today—like donor milk, kangaroo care, or CPAP—were once controversial, unproven, or unavailable. It’s a powerful reminder to stay open-minded about new evidence and to engage families when practice evolves.

Our role as nurses is not only to deliver evidence-based care, but also to explain it to parents, reassure them through change, and advocate for what research shows is best.

Final Thoughts

The NICU has come a long way in a short time. From survival-focused beginnings to today’s nuanced, family-centered, evidence-driven care, each advance reflects the persistence of researchers, clinicians, and parents who refused to accept “good enough.”

For those of us working at the bedside, these changes are a reminder of why staying curious, adaptable, and compassionate matters. Every shift we embrace today may be the “then vs. now” that someone looks back on decades from now—with gratitude for how it shaped their baby’s future.