26  •  2024  •  Developmental Observer

I am from the Children's Hospital of Fudan University where 
I am the deputy director of the nursing department of the 
hospital. I obtained a PhD and now am a doctoral supervi-

sor. I am also the chairman of the Society of Neonatal Nurs-
ing of China Medicine Education Association and have been 
engaged in neonatal nursing for more than 20 years.

Children's Hospital of Fudan University is a “stand alone” 
children's hospital. In 2017, it was approved as a national 
children's medical center. For over a decade, it has consistently 
held the top position in the list of best hospital specialties from 
Fudan University and the best clinical disciplines from Beijing 
University. The hospital serves as a diagnosis and treatment 
facility for difficult and critical pediatric diseases in China 
and as a training ground for top-level medical professionals. 
Additionally, it possesses the ability for clinical research 
transformation in pediatrics. The hospital places great emphasis 
on the development of talents and technology, and highly values 
international exchanges. It maintains close ties with more than 
40 international children's hospitals. The neonatal department 
of the Children's Hospital of Fudan University was established 
in 1953. It has 200 beds, with a daily occupancy rate of over 160 
inpatients. This department is among the first group of national 
clinical key specialties, serving as the specialized department 
for neonatal health care under the National Health and Health 
Commission, an administrative Government organization. It 
also serves as the national training base for neonatal specialists 
and is recognized as a key discipline of medicine in Shanghai. 
Additionally, the department serves as the referral center 
for critically ill newborns in Shanghai. The key laboratories 
of neonatal diseases of the National Health and Health 
Commission, the China Newborn Collaborative Network 
(CHNN), and the Shanghai Clinical Quality Control Center for 
Neonatal Departments are based at the hospital. It is among the 
top neonatal medical centers, talent training centers, academic 
exchange centers, and scientific research bases in China.

In 2022, approximately 10 million babies were born in 
China, with a prematurity rate that amounts to almost 7-8% of all 
newborns. All the babies are born in hospitals and doctors and 
midwives deliver them. The mothers spend two to five days in the 
hospital and receive training on how to breastfeed their babies, 
yet the rate of exclusive breastfeeding for six months remains 
low. Newborn care is categorized as level 1-4 according to the 
international classification of Levels of Care. The average length 

of stay in the NICU varies depending on the institution. For us, 
in our NICU, due to the presence of numerous very premature 
infants, the hospital stay is somewhat lengthy. We are extending 
an invitation to parents to stay with their babies in the unit. An 
increasing number of institutions in China are participating in 
the transformation of the care model. The parents are capable of 
providing hands-on care for their baby. All the nurses possess 
a graduate qualification from a university or college. There 
is, however, no specific discipline for neonatal nursing in the 
university; neonatal nursing belongs to pediatric nursing. 

My NIDCAP journey
In 2003, I started to learn NIDCAP through literature and 
became adept at understanding the impact of the environ-
ment on newborns, especially premature infants, as outlined 
in NIDCAP. We began to cover the incubators and protect the 
newborns in the NICU from light and sound to offer the most 
favorable environment for their growth and development. 
However, I didn't truly comprehend NIDCAP at that time. In 
2007, I became the head nurse of the NICU, and realized that I 
had the responsibility and obligation to lead the nursing team 
in the NICU to provide the best possible care for the infants, 
to maximize their growth and development, to offer appro-
priate stimulation care, and to actively learn new care strate-
gies. Under the recommendation of Professor Cao Yun in the 

Global Perspective on Developmental Care

China
Xiaojing Hu, PhD, Vice Director, NIDCAP Professional
Children’s Hospital of Fudan University in Shanghai

DOI 10.14434/do.v17i1.37081

Xiaojing Hu and Heidelise Als  



2024  •  Developmental Observer •  27  

department, I was fortunate to study NIDCAP with Professor 
Heidelise Als. Professor Heidi came to China many times, and 
each time she taught us how to observe newborns, under-
stand their needs, and provide them with the best support. I 
remember that our NICU environment at that time was still 
very rudimentary, but Heidi's way of treating infants, behavior, 
and love amazed us. Every time she observed the baby, she 
would stay for at least two hours, and although we were much 
younger and slightly tired, we admired her professionalism 
even more.

I have immense respect for Professor Heidi and studied 
NIDCAP with her on and off for a considerable period of time. 
In 2019, I made a special trip to Boston Children's Hospital for 
a few days of study, and subsequently engaged in an intensive 
course on NIDCAP observation and report writing with 
Professor Dorothy Vittner for another few days. After returning 
from the United States, I continued to study NIDCAP online 
with Professor Heidi. I persisted for over a year in this manner 
and eventually obtained the NIDCAP Professional certificate 
from Professor Heidi. I am extremely thrilled that Heidi 
encouraged me to pursue my studies and become a NIDCAP 
Professional. I hope to become a NIDCAP Trainer and am 
following Nikk Conneman and Dorothy Vittner to learn about 
NIDCAP. I am currently sharing some basic knowledge of 
NIDCAP at China's Newborn Nursing Conference and various 
other education programs. I hope to contribute to the future 
development of NIDCAP in China.

The current situation and future expectations for 
NIDCAP in China
Due to the significant number of neonatal patients and the 
shortage of nursing staff, implementing the process of obser-
vation and report writing is challenging. In the NICU of our 
hospital, one nurse takes care of three to five infants every 
shift. I have thoroughly acquired the skill of observation and 
have produced numerous observation reports, yet it remains 
a challenge to carry out standardized observations in the 

current context in China by each bedside nurse. However, 
the act of observation is crucial; hence we opt for an obser-
vation without documentation approach, mandating nurses 
to conduct 20-30-minute observation of each infant during 
their shift. Only through careful observation can we assess the 
developmental level and abilities of the infants and observe the 
response of the caregiver to the infants’ treatment. The caregiv-
er can provide better care for the infants based on these obser-
vations. We acknowledge that it is not feasible for one nurse to 
handle the care of one infant per shift, but we are also working 
on enhancing the specific details of clinical care. 

We are working to involve more families in the care of 
newborns, with more parents engaging in this “kangaroo 
care” technique which helps to stabilize the clinical symptoms 
of infants. I am a postgraduate mentor, and the model of the 
synactive organization of behavioral development theory of 
NIDCAP also supports many studies on enhancing the stability 
of newborns in clinical practice which include family-centered 
care, kangaroo care, strategies to promote early full oral feeding, 
breastfeeding, and other related aspects. These specific measures 
can better contribute to the enhancement of infants' outcomes 
and the formation of stronger bonds between infants and 
their families. Based on the results of clinical research, various 
nursing measures derived from the NIDCAP concept have 
demonstrated remarkable effects on newborns, with a particular 
focus on small premature infants. 

However, we still have a lot to learn from the professionals 
of the NIDCAP Federation (NFI), and we still need to learn 
and communicate with neonatal professionals from various 
international hospitals. Ultimately, we hope to apply what we 
have learned to benefit small babies. Professor Heidi, the board 
of directors of the NFI, and all the NIDCAP trainers have spared 
no effort to improve the prognosis of newborns, especially 
premature infants, worldwide through the NIDCAP method. 
It is the greatest kindness, and we also hope to fully implement 
NIDCAP in China to commemorate Professor Heidi and truly 
carry forward the NIDCAP approach to care..

Kangaroo Care Visit at home