We read with great interest the recent article by Shen et al. 1. The authors should be commended for demonstrating how a structured protocol that incorporates breast milk management, sucking stimulation and nest-like interventions can significantly improve physical growth velocities in weight, length and head circumference. Their findings also highlight meaningful enhancements in nutritional markers such as prealbumin and total protein, as well as improved immune function evidenced by higher concentrations of IgA, IgM and IgG. While these results provide a robust foundation for neonatal nursing, we would like to offer several observations regarding the study's limitations and potential avenues for future refinement. A primary consideration in evaluating this intervention lies in the sustainability of family engagement and the substantive depth of behavioural change it fosters. While the study reports a commendable parental satisfaction rate of 95.71% in the observation group, satisfaction is inherently a subjective measure that may not adequately capture long-term caregiving competency or consistent adherence to recommended practices. The current protocol appropriately employs discharge instructions and a nutritional handbook as educational tools, yet it does not include a structured mechanism to assess how well family members actually master the complex skills required for ongoing care. Moreover, the role of fathers, whose involvement is increasingly recognised in child development research including studies such as the ‘EFFECTS’ trial, remains insufficiently examined within this framework 2. To advance this line of inquiry, future research should extend beyond satisfaction metrics by integrating validated, objective family caregiving readiness assessments alongside qualitative approaches, for example, through semi-structured interviews or observational methods. Such a mixed-methods design would allow for a more nuanced evaluation of the family empowerment process, helping to ensure that the essential care behaviours introduced in the NICU are not only acquired but also durably maintained within the home environment over time. Furthermore, while the current bundled intervention demonstrates clear efficacy in the domains of physiological nutrition and physical nursing, its primary focus on these aspects may not fully address the holistic developmental needs of the infant. The authors rightly note that infants born preterm with low birth weight (LBW) are at significantly elevated risk for long-term motor, cognitive, and behavioural challenges. Although the study suggests that combining nutritional support with parenting interventions promotes favourable growth trajectories, the present framework lacks a systematic integration of essential, evidence-based components for early neurodevelopment and family psychosocial well-being. To more comprehensively mitigate the neurodevelopmental vulnerabilities characteristic of this population, future iterations of care should adopt an integrated ‘nutrition-development-psychology’ triad 3. This expanded approach would entail embedding routine maternal mental health screenings, providing structured guidance for parent-child interactive play and communication, and incorporating standardised early developmental assessments directly into the bundled protocol. Such a model would ensure that the notable short-term gains in anthropometric measures are sustained and paralleled by dedicated support for the infant's evolving neurological, cognitive and emotional development, thereby fostering more resilient long-term outcomes. The continuity of care beyond the specialised clinical setting represents another vital area for institutional and systemic advancement. While the study effectively manages the initial hospital-to-home transition, the formal intervention and its structured follow-up conclude at 6 months of corrected age. This endpoint, though pragmatic, may not align with the prolonged and evolving needs of infants born preterm with low birth weight, who often require monitored support well into early childhood. As the original authors note, the 6-month follow-up period represents a limitation of their study, and the single-centre design may further limit the generalisability of the findings. More importantly, there remains a tangible risk of ‘care fragmentation’ once the institutional support recedes 4. If these evidence-based nutritional and developmental strategies are not deliberately integrated with broader community health services, early intervention programmes or primary care systems, the gains achieved in the neonatal period may not be sustained. To bridge this gap, we propose the intentional development and evaluation of a ‘Hospital-Community-Family’ integrated care model 5. This could involve establishing secure, interoperable electronic health record sharing platforms to facilitate seamless information transfer, alongside training community-based nurses or designated care coordinators to provide ongoing guidance and linkage to local resources. Through such a structured continuum, healthcare systems can better ensure that the foundational support initiated in the NICU remains accessible, consistent and responsive as the child grows through the critical toddler years and beyond. Finally, while the accelerated growth velocity observed is impressive, the long-term metabolic and neurodevelopmental implications of rapid ‘catch-up growth’ require careful longitudinal scrutiny. The authors correctly note that sufficient protein and caloric intake supports catch-up growth, and they appropriately acknowledge the need for longer-term follow-up to assess sustained outcomes. However, the ‘Developmental Origins of Health and Disease’ (DOHaD) hypothesis suggests that rapid weight gain in infants with low birth weight (LBW) must be carefully balanced against long-term risks of insulin resistance and altered lipid metabolism. The current study's reliance on short-term indicators over 6 months leaves these metabolic trajectories unmapped. Future research should extend follow-up periods to 2 or 5 years and incorporate standardised neurodevelopmental tools, such as the Bayley Scales, alongside neuroimaging and metabolic biomarkers. Such data are essential to confirm that early clinical gains translate into healthy life-course outcomes without unintended metabolic consequences. Accordingly, refining the current model to incorporate these broader dimensions would represent a meaningful step towards more resilient, long-term support for this vulnerable population. In conclusion, while Shen et al. have provided a valuable framework for improving care standards for infants born preterm with low birth weight (LBW), its long-term impact could be further strengthened by embedding three key dimensions: first, moving beyond subjective satisfaction to objectively assess and sustain family caregiving competence, including paternal involvement; second, integrating early developmental stimulation and psychosocial support to address the infant's holistic neuroemotional needs; and third, establishing a structured Hospital-Community-Family continuity model to ensure consistent nutritional and developmental support beyond the initial follow-up period. These refinements would help translate short-term clinical gains into lasting health and developmental resilience for this vulnerable population. This study was supported by Yibin Hospital Affiliated to Children's Hospital of Chongqing Medical University. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.
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