Newborn ICU (NICU) design has changed dramatically in the past 25 years, perhaps more than any other area of the hospital. Research and experience have demonstrated the pervasive effect of the physical environment not only on the developing newborn brain, but also on the families and caregivers who spend many hours a day in the NICU.

The Recommended Standards for Newborn ICU Design have been the primary vehicle for translating this growing evidence base into guidelines that can be used by individuals and teams planning new NICU designs, as well as by the American Academy of Pediatrics, the Facilities Guidelines Institute and by similar organizations worldwide.

In one sense, we are reaching a mature state in which hospitals are willing to dedicate similar space and resources to the care of ill newborns as has previously been granted to older children and adults, so the Recommended Standards do not change dramatically from one iteration to the next. On the other hand, we are just now beginning to appreciate the true complexity of the human brain, so we may look forward to continued need for change in the future. To this end, the two accompanying articles in this supplement ask us to look more closely at the environment we create for babies within incubators and the environment we ask our night shift staff to work in. It is clear that much work remains to be done in order to build and operate NICUs in which the health of all those who enter is facilitated by the physical environment.