Heidelise Als, whose research revolutionized the care of premature babies, dies at 81

Keenly observant and determined to improve the prospects for premature babies, Dr. Als pioneered new approaches for their care that have spread across the country and around the world.

Via Zoom, she was still teaching medical personnel in places as distant as Africa when she suffered a ruptured cerebral aneurysm while in her Tunbridge, Vt., home and died Aug. 18 in Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

At 81, Dr. Als was director of Neurobehavioral Infant and Child Studies at Boston Children’s Hospital and an emerita professor of psychology at Harvard Medical School.

In the 1980s, she founded the Newborn Individualized Developmental Care and Assessment Program, or NIDCAP — a system through which nurses and medical professionals could be trained to incorporate her findings into day-to-day care.

At an age when many are long retired, Dr. Als was vigorously involved in running the nonprofit NIDCAP Federation International, which she had founded to spread her research far from the hospital where she pioneered a more comprehensive understanding of premature newborns.

“She was very clear about what she wanted her impact to be,” said Gloria McAnulty, an assistant professor of psychiatry at Harvard Medical School and a board member of the nonprofit. “She wanted to be the voice of the newborn, and to teach other people how to interpret that voice and respond to it.”

The foundation of Dr. Als’s work was professional and personal. While she was a graduate student in psychology, and married to her first husband, she gave birth to her son Christopher, who suffered brain injuries during the delivery process that led to significant developmental challenges, including a seizure disorder.

Nurturing Christopher was an education in how adults needed to listen to how babies communicate their needs.

“I learned from him to observe him and believe what he’s telling me,” Dr. Als told the Globe in 2019. “I learned that he influences me in many ways more than I influence him.”

That led her to create what she called the synactive theory of development, which became a cornerstone of the Newborn Individualized Developmental Care and Assessment Program.

By focusing on developmental care of premature babies, Dr. Als essentially changed the field.

“Heidi was brilliant,” Deborah Buehler, who is president of NIDCAP Federation International’s Board of Directors, wrote in a draft tribute she plans to present at the organization’s annual trainers meeting in October.

“And in every way, Heidi had an extraordinary capacity for being completely present. Present in conversing, observing, assessing, training, mentoring, writing,” wrote Buehler, who is a developmental psychologist. “Whatever Heidi was doing, she did it with her full attention, with heart, with skill, and with conviction. And within each of these moments, she created change.”

One of three siblings, Heidelise Als was born in Krumbach, Germany, on Nov. 8, 1940. Her parents were Elizabeth Broicher Als, who raised the children, and Heinrich Als, a lawyer and a senior judge.

The fragility of her own childhood amid and after World War II “prompted me to question how people developed their emotions and their character,” she said in 2019.

Graduating in 1963 with a bachelor’s degree in education from the University of Würzburg in Germany, she was an elementary school teacher when she realized she wanted to return to school.

“I’ve always been fascinated by the differences between children,” she said in 2008. “How did they get there? Why is life a challenge for some people while other people thrive?”

Marriage to an American brought her to Philadelphia, where she did graduate work at the University of Pennsylvania and had Christopher, who now lives in Copake, N.Y., in the respected Camphill Village community for adults with developmental disabilities.

Dr. Als, whose first marriage ended in divorce, graduated in 1968 with a master’s in education, and in 1975 a doctorate in developmental and educational psychology.

Postdoctoral studies and research work with renowned pediatrician Dr. T. Berry Brazelton brought her to Boston Children’s Hospital.

It was there that she met Dr. Frank H. Duffy, a neurologist. She borrowed a piece of equipment from him one day and then accidentally spilled coffee on him when they were in line at a coffee machine.

A burgeoning friendship led them to work together professionally. “We began collaborating,” he said, “and collaboration turned to marriage.”

They divided their time between Boston and Tunbridge, where she tended a flower garden and became an accomplished horse rider.

“I’ve come to realize how much Heidi did — not just for the world or for babies, but for me,” Duffy said.

“She extended her view of behavior and development and human action to everyone in her life,” he said. “But she focused on babies because they were the most deserving and they were the most needy.”

Still, “as she was to children, so she was to her colleagues,” Duffy said, “and she has many people who adore her.”

Watching Dr. Als observe other people was a lesson in how to pay close attention — how to let small details speak volumes, her friends said.

“She saw everything, actually,” McAnulty said. “You would walk into an elevator with Heidi and a mother holding a baby, and by the time we got off the elevator Heidi knew everything about that person.”

Dr. Als “noticed every detail,” McAnulty said. “She could see if they hadn’t tied their shoes. She would see if they looked a little pale. She would notice if they were smiling, if they were holding the hand of their child. She would notice if they met her gaze.”

That kind of careful observation led Dr. Als to change her profession’s approach to caring for premature babies by dimming lights, softening the sounds in the room, allowing infants to move, and encouraging physical contact between parents and babies.

“I observed her compassionate, reassuring, and thoughtful interactions with families,” Buehler wrote.

“Parents knew that she saw their child, really saw them, and that they felt understood as well,” Buehler added. “Heidi’s conversations with parents always acknowledged life and parenting realities and challenges.”

Dr. Als “focused on strengths, supports, and next steps,” Buehler wrote. “This is the same life-affirming, life-changing approach that we have felt as her trainees and her mentees.”

A service has been held for Dr. Als, who in addition to her husband and son leaves three stepchildren, Victoria Duffy Hopper of New York City and Lisa Duffy and Stephen Duffy, both of Florida; a brother, Heinzpeter of Germany; a sister, Urselmarie of Montreal; two grandchildren; and a great-grandchild.

Learning to listen to premature babies and their parents “often doesn’t take much,” Dr. Als said in 2019.

“It takes standing next to someone and bringing down the stress, so the hands are soft and the baby relaxes, and the mother blossoms,” she said. “It’s wonderful to see when it happens.”

And that, she added, is “what you’re really in the field for.”

Bryan Marquard can be reached at [email protected].