The presence of family members during invasive procedures in neonatal and pediatric intensive care units is limited, despite its emotional benefits. Exploring parents' experiences in these contexts can help us move toward more family-centered models of care. (I) To explore the experiences of parents of pediatric and neonatal patients admitted to intensive care units regarding being present during invasive procedures; (II) Understand the needs, limitations, and suggestions for improvement expressed by parents regarding their presence during invasive procedures. Qualitative phenomenological study based on in-depth interviews with parents of pediatric patients admitted to an intensive care unit. The thematic analysis followed the approach of Braun and Clarke, and the COREQ guidelines were respected. 22 parents participated in the study. Two major themes emerged from the analysis: (1) The influence of family presence during invasive procedures, and (2) Parents' needs. Participants viewed being present as essential to fulfilling their role as caregivers, providing comfort to their children, and strengthening emotional bonds. They endorsed being present, despite the emotional burden entailed. They identified the following key needs: receiving clear information, having emotional support, having the freedom to decide whether to be present, and having a private and safe environment. Parents view being present during procedures as a right and a way of exercising their parental role. It promotes the emotional well-being of the child and strengthens their relationship with professionals. The presence of family members should be encouraged through specific training for staff and support personnel. Safe environments must be created, and teams must foster a sensitive approach toward the active role of parents in caregiving.

To map the current literature on interventions designed to enhance Family Centred Care (FCC) in Neonatal Intensive Care Units (NICUs) and identify gaps in the existing literature. Following Arksey and O'Malley's scoping review framework, a comprehensive search was conducted on November 10th, 2023, and updated on the 20th May 2025. Four databases were searched: Medline via OVID, CINAHL via EBSCO-Host, OVID Embase and PROQUEST. Studies were included if they described interventions targeting FCC in NICUs. Two reviewers independently conducted the screening at both phases with conflicts resolved by a third reviewer. The review identified 31 studies outlining 26 interventions, categorised into four categories: Family centred care bundles; Educational interventions; Communication interventions; and Environmental interventions. Study participants included mothers, fathers, families, and healthcare workers, often restricted to specific languages and cultures. Most outcome measures predominantly reflected the perspectives of mothers and nurses. Many interventions were associated with improvement in family engagement and satisfaction. However, evidence was limited on long-term neonatal and parental outcomes and sustainability of the FCC practices. While some interventions, such as Family Integrated Care (FiCare) and The Close Collaboration Program, have been extensively studied, others have been examined only to a limited extent. This review investigated interventions to enhance FCC in the NICU. The findings highlighted a range of interventions designed to improve family experiences and neonatal outcomes. This review underscores the need for standardised implementation studies on FCC interventions in NICUs. While numerous interventions successfully increased parental involvement and positively influenced staff perspectives, their effectiveness often hinges on the implementation strategies employed, as well as the support from institutions and healthcare providers. Understanding FCC interventions implemented worldwide will broaden the application of FCC within the NICU. Further investigation into these interventions across various NICUs is necessary, involving diverse family members and healthcare professionals in assessing outcomes.

The purpose of our study was to describe the time to full oral enteral feeding for extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU). We conducted a retrospective chart review of ELBW infants born at a regional medical center between July 1, 2021, and December 31, 2022. Infants who died or were transferred before discharge from the NICU were excluded from the study. Fifty four ELBW infants met the inclusion criteria for the study. Survival analysis was conducted using Kaplan-Meier curves to estimate the time to full oral feeds over an observation period of up to 153 days. A total of 25% of all ELBW infants achieved full oral feeding by 94 days of life, and 33.3% achieved full oral feeding before discharge from the NICU. The median time to full oral feeding for ELBW infants born at 27 to 30 weeks gestational age was 82 days. After adjusting for gestational age and birthweight, infants who did not achieve full oral feeds were discharged 12 days later (95% confidence interval: 2-23 days; P = 0.02) than infants who achieved full oral feeds. The majority of ELBW infants did not achieve full oral feeding before NICU discharge. Early discussion of an alternate home feeding plan may shorten the duration of NICU stay.

The importance of the incorporation of the body and the senses, especially touch, in caring for infants in neonatal intensive care units (NICUs) has been widely researched, resulting in practices such as skin-to skin care. This article takes a step back to scrutinise the underlying assumptions of these practices and links the notions of a bodily epistemology and relational ontology to the care of infants in the NICU by means of recent developments in the fields of philosophy and ritual studies. The temporal-spatial context of people involved in caring for hospitalised infants is explored through the lens of the concept of liminality, a concept that stems from the study of rites of passage and thus of people in a state of transition. The relatively new field of carnal hermeneutics is then engaged, first in a general sense with a special emphasis on bodies, flesh and skin as sources of knowledge, and secondly with an emphasis on bodies that are restricted in space, such as infants and their caregivers in NICUs. It is argued that a deeper understanding of the unique kind of liminality that is encountered by people such as mothers and infants in NICUs and of carnal caring emphasises the healing potential inherent in a family-centred care approach and highlights the need for implementation in NICUs. A better understanding of the 'why' of carnal caring is essential for optimising the 'how' of the praxis.

Gender perspectives on experiences of kangaroo mother care for preterm infants in neonatal intensive care unit in China: A qualitative study.

Fathers are prone to suboptimal bonding with their preterm infants, but little is known about the roles that father and infant variables might play in the suboptimal bonding. This gap in knowledge limits the ability of nurses to identify and assist fathers at risk of suboptimal bonding. This study aims to identify (1) the bonding levels of fathers to their preterm infants hospitalized in neonatal intensive care units (NICUs) and (2) the association between father and infant variables and bonding of fathers to their preterm infants hospitalized in (NICUs). This is a secondary data analysis from a parent study in which we recruited 396 fathers using a cross-sectional quantitative design across United States. In the original study, we recruited 396 fathers of preterm infants over 5 months (September 2022 to January 2023). We used self-reported measures to collect data specific to fathers and infant variables and bonding using Paternal Postnatal Attachment Scale. In this sample, 73.12 ± 10.32 represents the average level of bonding for fathers of preterm infants. Additionally, low household income, previous preterm infants, and current multiple-birth infants were significantly associated with low bonding levels for fathers of preterm infants. Results indicate a necessity to further support fathers' needs to bond with preterm infants in the NICU. Specifically, nurses can screen to identify fathers who are at risk for low bonding and provide at-risk fathers with an adequate degree of support like referral to social support.

Despite policy commitments to family-centred care, neonatal services often remain implicitly structured around maternal presence. Fathers, although increasingly acknowledged as vital to early child development, frequently experience feelings of exclusion throughout the neonatal journey, from antenatal care through to the neonatal intensive care unit. This review explores how fathers experience involvement and psychological wellbeing during their infant's admission to a neonatal intensive care unit. A narrative review of qualitative studies was conducted using the SPIDER framework to guide the search strategy. The nine included studies, which met the inclusion criteria were identified via searching the databases CINAHL, PubMed, and PsycINFO. Studies were appraised using the CASP (2018) checklist, and findings were synthesised thematically. Thematic synthesis identified four key themes: ‘Exclusion from the NICU Environment’; ‘ Emotional Suppression and Psychological Strain’; ‘Reclaiming Fatherhood Through Caregiving’ and ‘Coping and Support Mechanisms’. Findings highlight how fathers navigate a system not designed with their needs in mind, often suppressing their own emotions whilst seeking meaningful ways to engage. Fathers often remain peripheral within neonatal care, shaped not only by entrenched gender norms but also by structural barriers that limit their involvement and emotional expression. Without deliberate shifts in practice and policy, fathers risk continued exclusion, with implications for their wellbeing and the wider family dynamic. There is a pressing need for more inclusive and emotionally responsive care practices that recognise fathers as equal partners in neonatal care.

Postnatal outcomes of twins based on chorionicity.

Descriptive cross-sectional analysis of nursing diagnoses, interventions, and outcomes in neonatal intensive care based on Roy's and Swanson's models.

Corrigendum to “Interprofessional collaboration in the neonatal unit: An exploration of dynamics between speech and language therapy and nursing” [J. Neonatal Nurs. (32), Issue 1 (2026), 101768

Adverse perinatal outcomes associated with macrosomia in nulliparous women: A multicenter cohort study.

Descriptive cross-sectional analysis of nursing diagnoses, interventions, and outcomes in neonatal intensive care based on Roy's and Swanson's models

To define standardised outcomes, the Core Outcome Set (COS) for reporting in studies of Intrahepatic Cholestasis of Pregnancy (ICP). e-Delphi survey and consensus process. International. 155 individuals from Asia, Europe, Oceania, North and South America: 31 patients (20%), 121 clinicians (78%), and 3 researchers (2%). Maternal and perinatal outcomes reported in studies of ICP were collated. Stakeholders in ICP research and clinical care scored the importance of each outcome using a 9-point Likert scale over three rounds; short-listed outcomes were ranked during face-to-face consensus meetings. The final COS was agreed by the Study Steering Committee. The study was registered prospectively with Core Outcome Measures in Effectiveness Trials. Ethical approval was granted by the King's College London Research Ethics Committee (KCL MRA-23/24-39574). From 54 manuscripts, 97 individual clinical outcomes were attributed to ICP. Twenty three outcomes were shortlisted by the e-Delphi surveys, the ranking of which enabled selection of 10 core outcomes. Maternal core outcomes comprise: total maternal bile acid (BA) concentration (maximum), gestational age at peak BA concentration, and itch impact on maternal wellbeing. Birth core outcomes comprise: stillbirth, gestational age at birth, and spontaneous preterm birth versus induced preterm birth. Neonatal core outcomes comprise: perinatal death within 7 days of birth, perinatal asphyxia, neonatal unit admission, and mechanical ventilation. Given the heterogeneity of reported outcomes, we have confirmed the need for a COS in ICP, standardising the minimum reported outcomes to reduce outcome reporting bias and research wastage.

Caffeine is the mainstay of treatment for apnea of prematurity, yet the optimal strategy and timing for discontinuation remain undefined. Marked inter-centre variation in the practise of discharging preterm infants home on caffeine therapy has been reported. We aimed to map current practises in Europe concerning discharge of preterm infants on caffeine therapy, including home-monitoring and strategies for discontinuing ambulatory therapy. A web-based three-part questionnaire was sent to 633 neonatal units in 36 European countries (July-October 2025). One response per unit was permitted. The survey collected data on policies and practises regarding discharge on caffeine, criteria for stopping therapy, and post-discharge monitoring. Responses were analysed descriptively. Complete responses were obtained from 125 units in 21, revealing wide variation in practise patterns. Fifty-eight per cent of participating centres reported discharging preterm infants on continued caffeine therapy at least occasionally. Among those units, 58% reported prescribing home-monitoring routinely for infants discharged on caffeine therapy. Overall, significant differences in practise existed between geographical regions but not between high- and low-volume centres. Discharging preterm infants on continued caffeine therapy is a widespread practise among neonatologists in Europe, with considerable variation among regions and differing strategies concerning home-monitoring and discontinuation of treatment.

A fluid bolus is administered to correct hypoperfusion, hypotension, and metabolic acidosis for resuscitation at birth or in the neonatal intensive care unit (NICU). However, there is a lack of evidence-based support for any particular fluid choice. The most used intravenous fluid is 0.9% sodium chloride or "normal saline" (NS). There is a growing body of evidence that NS is associated with hyperchloremic metabolic acidosis and acute kidney injury. Balanced crystalloid solutions such as lactated Ringer's solution and solutions with a more physiological composition similar to plasma may offer some advantages compared to NS based on adult literature. Here we discuss indications and challenges with the use of balanced crystalloids and propose a practical approach to fluid choice in the NICU. Further research is needed to better understand indications for and optimal fluid therapy to correct hypoperfusion and metabolic acidosis in neonates.

To determine if Neonatal Intensive Care Unit (NICU) specific language card use increased infant care activity involvement among Spanish-preferred families. Multisite NICU pilot pre-post intervention (implementation of infant care activity language card) assessing Spanish-preferred family involvement. Chart review was conducted 8 months before and after card implementation (12/2021-11/2023). Outcomes were analyzed using bi-variate analyses and mixed effect models. Of the 989 infants, 5.9% were Spanish-preferred, 91.4% English-preferred, and 2.5% non-English-non-Spanish preferred. Prior to language card implementation, Spanish-preferred families had significantly lower odds of participating in care activities compared to English-preferred families (e.g., overall participation OR 0.64 [95% CI 0.43-0.96]). Following implementation, Spanish-preferred families had significantly higher odds of overall care participation (OR 2.27 [95% CI 1.51-3.41]) and improved odds across all activities. Language cards are associated with increased Spanish-preferred family involvement in infant care activities in the NICU.

Improved quality of care is fundamental for reducing patient mortality and building sustainable health systems. Currently, there is a lack of research on the role of hospital management in improving the quality of care and health outcomes, particularly in low-income settings. We examined associations between hospital management practices and neonatal quality of care in Malawi. We adapted the World Management Survey tool to measure 28 management practices across five domains - delivery of clinical care in the neonatal unit, human resource management, target setting, finances, and governance. In April 2022, we administered the tool to five clinical and administrative managers in each of the 36 central and first-level referral hospitals (n = 180 interviews). Further, we calculated a hospital-level management score (1 - poor, 5 - excellent) and linked these data to records of 20 831 neonatal admissions (February-July 2022). Our primary outcome was in-hospital neonatal mortality, and secondary outcomes included 14 clinical quality indicators. We examined associations between hospital-level management scores and individual-level patient outcomes using a multilevel mixed-effects Poisson regression. The mean hospital-level management score across the 36 hospitals was 3.35 (standard deviation = 0.4). Among 20 831 neonatal admissions, 2590 (12.4%; 95% confidence interval (CI) = 11.9-12.8) died, representing a mortality rate of 27.2 deaths per 1000 person-days. We found no relationship between the management score and in-hospital neonatal mortality (adjusted incidence rate ratio per unit increase in the score = 1.08; 95% CI = 0.81-1.44). Five management domains were not associated with mortality, and we found limited evidence that management practice scores were positively associated with quality of clinical care. This study presents novel, national evidence on the association between hospital management practices and neonatal mortality in a low-income country, with complementary data on quality of clinical care. We found no evidence that hospital management practices were associated with neonatal mortality and limited evidence of an association with the quality of clinical care. Rigorous impact evaluations of targeted management interventions, with embedded process evaluations, could address potential confounders and help understand how and under what circumstances management improvements could translate into better quality of care.

Molecular epidemiological surveillance of carbapenem-resistant Klebsiella pneumoniae (CRKP) in neonates remains limited. This study aimed to investigate the molecular characteristics and transmission patterns of CRKP isolates from neonates. A total of 120 nonduplicate CRKP isolates were consecutively collected between 2018 and 2024 from neonates at West China Second University Hospital, a tertiary-care teaching hospital and national regional medical center for children in Southwest China. The isolates were obtained from routine clinical specimens and targeted surveillance samples. Antimicrobial susceptibility testing was performed using broth microdilution or disk diffusion methods. Whole-genome sequencing was performed for genomic analysis, including sequence types (STs), capsular typing, and resistance/virulence genes. Phylogenetic analyses based on core single-nucleotide polymorphisms were performed. High resistance rates (> 95%) to ceftazidime-avibactam and imipenem-relebactam were observed, while susceptibility to cefiderocol, tigecycline, colistin, and aminoglycosides remained high. blaNDM (95.8%, 115/120) was the most prevalent carbapenemase gene. The major STs were ST789 (45.0%, 54/120) and ST35 (39.2%, 47/120); however, since 2024, ST35 has surpassed ST789 to become the most common ST. Notable differences between ST789 and ST35 were identified: ST789 exhibited a higher aztreonam resistance rate (96.3% vs 14.9%), while ST35 harbored virulence genes kfuABC and mce. Phylogenetic analyses suggested clonal transmission of both STs within the hospital. This study suggests clonal dissemination of CRKP in neonates and documents a shift in the predominant ST from ST789 to ST35. ST35 strains displayed distinct resistance phenotypes and siderophore-linked virulence genes. Given that CRKP represented 73 of 310 (23.5%) neonatal K. pneumoniae isolates during 2018-2024, these data underscore the need for sustained surveillance and strengthened infection control measures in neonatal care units.

The aim of this quality improvement project was to increase preoperative enteral feeding and breastfeeding rates in term neonates with congenital heart disease (CHD). A multidisciplinary team developed and implemented a preoperative feeding protocol for neonates with congenital heart disease. The primary outcome was the presence of preoperative enteral feeding by May 2025. Secondary outcomes included breastfeeding rates and time to first feed. The process measure was the rate of reference to the feeding protocol in provider notes. Our balancing measure was a rule out or diagnosis of necrotizing enterocolitis requiring medical or surgical treatment in the preoperative period. Infants were identified using the Pediatric Cardiac Critical Care Collaborative (PC4). Data was collected from chart review and analyzed with statistical process control charts. The pre-implementation period was from June 2022 to June 2023, the implementation period was from July 2023 to June 2024, and the sustainment period was from July 2024 through May 2025. The number of neonates that met the inclusion criteria was 121. The rate of overall enteral feeding increased significantly from 72% in the pre-implementation phase (June 2022-June 2023) to 93% in the sustainment phase (July 2024-May 2025) (p = 0.026). Additionally, we found an improvement in our secondary outcomes and no change to the balancing measures. This quality improvement initiative, which centered on creating and implementing a clear, standardized, evidence-based feeding protocol while utilizing interdisciplinary collaboration, led to an increase in overall rates of preoperative enteral feeding for newborns with CHD in a level IV intensive care nursery.

Reactive thrombocytosis is defined as an increase in megakaryocyte count and production secondary to inflammation, malignancy, or anemia. Although cases of reactive thrombocytosis are frequently encountered in newborns admitted to the neonatal intensive care unit (NICU), neonatal thrombocytosis has not yet been fully elucidated. This study aimed to evaluate the maternal and neonatal medical characteristics of neonates diagnosed with reactive thrombocytosis in the NICU. This retrospective, cross-sectional study included neonates with thrombocytosis (platelet count >450 × 109/L) who were admitted to our institution's NICU between January 1, 2021, and December 31, 2022. Children with suspected primary thrombocytosis were excluded from the study. Maternal and neonatal medical data were retrospectively analyzed using patient files. The cases were divided into 3 groups: platelet counts >450 and <700 × 109/L, 700 and <900 × 109/L, and 900 and <1000 × 109/L; gestational age was divided into 2 groups: <37 gestational weeks (GH) (preterm) and ≥37 to 42 GH (term); maternal age was divided into 3 groups: 20 years or younger, 20 to 34 years old, and 35 years or older; and birth weight was divided into 3 groups: <2500g, 2500 to 3999g, and ≥4000g. The groups were then compared. Statistical significance was set at P<0.05. A negative correlation was observed between mean platelet volume (MPV) and hemoglobin (Hb) levels at admission, as well as between MPV and platelet counts. The mean platelet count at the time of thrombocytosis was significantly higher in term cases than in preterm cases. Platelet counts were higher in the macrosomic group than in the nonmacrosomic group. Decreased Hb levels and increased C-reactive protein (CRP) levels were associated with severe thrombocytosis. Reactive thrombocytosis resolved spontaneously without complications and did not require any clinical intervention.