This chapter provides an overview of the development of a novel family therapy pilot within a Neonatal Intensive Care Unit (NICU) in the East of England. We discuss how we brought systemic practice into an acute medical environment in a creative way, highlighting how family therapy and systemic approaches can create valuable space for neonatal families to share stories, strengthen bonds, reflect on transitions into becoming a neonatal parent and what they needed from wider systems to continue and survive their neonatal journey. This includes discussing the process of establishing this service, including securing funding, building partnerships across disciplines, and adapting creatively to restrictions, as well as highlighting the distinctive contribution that systemic thinking brings to neonatal care. The chapter concludes by envisioning a future where systemic approaches are fully integrated into neonatal services, helping to empower the delivery of trauma informed care on NICUs through a systematic lens for neonatal families as well as the wider neonatal workforce holding them.