This article details the conceptual framework, clinical application, and efficacy of a relationship-based developmentally supportive approach to newborn intensive care referred to as NIDCAP (Newborn Individualized Developmental Care and Assessment Program). Outcomes of the approach are reported in regard to infant health and development, reduction of hospital costs, and family adaptation. The approach is guided by a neurodevelopmental framework for understanding preterm infants and depends on the capacities of professionals to collaborate with one another and with families in support of the infants' medical, developmental, and emotional well-being. The primary vehicle for clinical implementation is detailed behavioral observation with subsequent recommendations for individualized caregiving based on the infant's current functioning and apparent developmental goals. A series of essential components of developmentally oriented caregiving are described, including strategies for coordinated discharge planning, and linkage to community services. The voices of individual clinicians highlight the process of change from protocol-based to relationship-based care.