The impact of nesting care on the growth and neurological development of premature infants in neonatal intensive care units

Objective To examine the associations of nesting care with growth, nighttime sleep–wake measures, and early neurodevelopmental outcomes in preterm infants admitted to a neonatal intensive care unit (NICU). Methods This single-center retrospective observational study compared two noncontemporaneous cohorts at the Maternal and Child Health Hospital of Linping District, Hangzhou. Fifty preterm infants receiving nesting care from March 2024 to March 2025 and 50 receiving traditional care from February 2023 to February 2024 were manually selected from the eligible population to achieve approximate baseline comparability. Growth was assessed at birth and 3 months corrected age, sleep–wake activity by actigraphy at baseline and day 7, and neurodevelopment using the Gesell Developmental Schedules at 40 weeks postmenstrual age (PMA) and 3 months corrected age. Longitudinal sleep and Gesell outcomes were analyzed using adjusted change-score regression models with HC3 robust standard errors and Holm correction. Results At 3 months corrected age, the nesting-care group had higher body weight (difference, 195.12 g; 95% CI, 26.00–364.24), greater body length (2.04 cm; 95% CI, 0.68–3.40), and greater head circumference (median difference, 1.00 cm). From baseline to day 7, improvement in total sleep duration was greater in the nesting-care group (adjusted difference in change, 1.09 h; 95% CI, 0.36–1.81; Holm-adjusted P = 0.010), while mean awakening duration decreased more (−0.57 h; 95% CI, −0.70 to −0.45; P < 0.001). For neurodevelopment, adjusted improvements from 40 weeks PMA to 3 months corrected age were greater for fine motor (4.40 points), adaptive (3.95), language (2.18), and personal-social domains (1.60), whereas gross motor change was not statistically significant after adjustment ( P = 0.054). Conclusions In this retrospective comparison of noncontemporaneous cohorts, nesting care was associated with more favorable growth, nighttime actigraphy-derived sleep–wake measures, and several early neurodevelopmental outcomes. These findings should be interpreted cautiously because residual confounding and calendar-period effects cannot be excluded.