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  1. Introduction. The wave of complementary/alternative care sweeping the country has virtually bypassed neonatal intensive care units (NICUs). But if we listen, we find families asking for complements to traditional care in many aspects of medicine. The consciousness that patients wanted around their deathbeds wasn't even on the radar screen of the health-care profession when the hospice movement was developed. Today, we find a similar perception in the freestanding birthing center movement. In the neonatal unit, a new sense of nurturant care is struggling to take shape. Complementary and alternative medical (CAM) therapies may be one adjunct to help soften the high-tech environment of an NICU by imbuing the nurturing elements one would expect to find around newborns.

    Early exposure to the ex utero environment, long before development is capable of handling it, has myriad sequelae. Although we have seen a marked decrease in the mortality in preterm infants this decade, we've seen little or no reduction in the problematic outcomes among the smallest survivors. We know now, too well, the outcomes of living in an NICU. Follow-up studies continue to show that preterm infants have long-term problems with self-regulation, as well as difficulty in concentration and problems with attention.

    CAM therapies may provide balance to support the amazing technological advances we have made in decreasing preterm infant mortality rates. Proponents of complementary therapies believe that physiologic manipulations and brain development are not separate and thus require a simultaneous focus to minimize some of the well-known complications associated with prematurity.

    Preterm infants are fetuses with extremely vulnerable nervous systems developing in extrauterine settings at a time when brain development is more rapid than any other time in their life. During the period from 24 weeks to term, the human cortex is particularly vulnerable as its neurons undergo significant structural and functional transformations. The process of cortical cell migration and cell death that is sculpting the developing cortex is much more dynamic than previously imagined. Taking into consideration what we know about brain development and because this is such a crucial period of cortical development, we must give this stage the focus and support it deserves. CAM therapies give us some options that might help ameliorate some of the routinely expected morbidities.

    Once we appreciate that infants are amazingly responsive organisms, we are faced with the realization that these infants require developmental care equal to their acute and chronic medical care. We also can't escape the realization of how much the environment influences the development of the immature brain.

    This chapter briefly describes some of the most popular and promising CAM therapies, explores how these options are used in the NICU, provides some evidence-based support of CAM therapies, and presents ideas on potential future CAM expansions.

    The four divisions of CAM therapies addressed come from the standard categorization of these modalities from the National Center of Complementary Medicine:

      1. Lifestyle therapies (called "developmental care" in neonatology). Examples included are light and color therapies, sound and music therapies, aromatherapy, kangaroo care, ...

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