"One of the most complex issues in healthcare is the care of sick or premature infants and those with multiple, severe congenital anomalies. Despite advanced technology and knowledge, preterm delivery continues to be a significant problem in the United States. Maternal risk factors have changed over the past decade. For example, more women with congenital heart anomalies and chronic illnesses, such as diabetes or sickle cell anemia, are giving birth to infants with consequent health problems. The rise of in vitro fertilization has resulted in increased multiple births and prematurity. Many infants in neonatal intensive care units (NICUs) have been exposed to substances or are born to mothers with other risk factors such as delayed childbearing or childhood cancers