Clearly, the great majority of premature infants currently survive their neonatal course in the hospital. The major challenge facing neonatal health care providers is to combine the necessary technologic intensive care for the newborn with a sensitive and individualized approach to facilitate neurobehavioral development while acknowledging and supporting the parents of these infants in their role as primary advocates and long-term caregivers. This challenge has been met in a variety of ways over time, and a new history of providing developmentally supportive care is being created. A multidisciplinary collaborative approach based on the synactive theory of newborn development incorporates both environmental and caregiving modifications to enhance infant and family outcomes. The article reviews the history of this approach to care, the current state of the art and practice, and the current challenges for future implementation.