© Pexels Providing optimal nutrition for preterm and low-birth-weight newborns remains one of the greatest challenges in neonatal care. While clinical guidelines exist, actual practices often vary widely depending on local resources and policies. To identify areas where improvements are needed, a descriptive study was conducted in a level 3 neonatal intensive care unit in Portugal, focusing on infants born before 34 weeks of gestation or weighing less than 1500 grams. This study, involving 85 infants, evaluated when and how feeding was initiated and developed over time. It found that although most infants received nutrition early, significant differences existed based on birth weight. The study concluded that access to donor milk and standardised feeding protocols could greatly improve adherence to recommended practices and ultimately support better outcomes for all newborns. In many parts of the world, nutrition for preterm and low-birth-weight infants is inconsistent, posing risks to their growth and development. While some hospitals follow international standards, others lack the resources, such as human milk banks, to fully implement best practices. This discrepancy affects the timely initiation of feeding and the progression to full nutrition, especially for the most vulnerable infants. The study looked at how nutrition was managed from birth to hospital discharge in a Portuguese neonatal intensive care unit. All participating infants received parenteral nutrition, with most starting it on the first day of life. However, only 21.5% began enteral (trophic) feeding that early, and 74.7% had started by the third day. Importantly, the type of milk first received was often not human milk due to limited availability, only three infants received donor milk at the start. The study clearly shows how birth weight influenced the timing and progression of feeding.   Weight matters: Feeding milestones differ greatly for preterm infants Infants with higher birth weights (≥1500 g) consistently began and completed enteral feeding much sooner than those with lower weights. They also had fewer interruptions in feeding and reached breastfeeding and oral feeding milestones earlier. For example, infants weighing less than 1000 g typically began full oral feeding 48 days later than the highest-weight group. Feeding interruptions, often due to diet intolerance or medical complications, delayed progress significantly, particularly for the smallest infants. Additionally, while most infants (96.5%) received their mother’s breast milk at some point, only a small percentage received pasteurised donor milk, mainly because the hospital’s human milk bank had only recently opened. This lack of donor milk availability led to delays in initiating enteral feeds, especially for extremely low-birth-weight infants. Notably, infants who did receive consistent feeding without interruption reached full enteral nutrition 7 days earlier than those who experienced breaks in their diet.   What this means for parents and hospitals The findings have direct implications for how neonatal units can improve care. Providing donor milk through human milk banks ensures that preterm infants can begin enteral feeding sooner, reducing complications and supporting growth. Hospitals with access to donor milk can also better follow international feeding guidelines, particularly when mothers’ milk is not immediately available. This study reinforces the need for standardised feeding protocols and the establishment of human milk banks in every neonatal unit. For parents and caregivers, these improvements translate to better support for breastfeeding, quicker recovery, and earlier discharge from hospital. By implementing consistent standards and ensuring donor milk availability, healthcare systems can take a significant step forward in protecting and nurturing our most vulnerable newborns.   Paper available at: Wiley Online Library Full list of authors: de Paula, L.; Silva, D.; Dias, C. C.; Moita, R.; Pissarra, S. DOI: https://doi.org/10.1002/jpen.2770

As artificial intelligence (AI) rapidly enters neonatal care, it brings both promise and concern. New technologies offer the chance to better predict and monitor health outcomes for newborns, especially for those born preterm. However, this progress also raises deep ethical questions about fairness, transparency, and informed decision-making. A recent review explored how AI impacts four core principles of medical ethics – beneficence, non-maleficence, autonomy, and justice – in the context of neonatology. This study emphasises that without proper safeguards, AI may unintentionally reinforce existing health disparities or hinder parental involvement in decisions. To ensure ethical and equitable care for all newborns, clear guidelines and collaboration across disciplines are essential.   Across the world, there is a growing need to ensure every newborn receives fair, high-quality care. In neonatal units, where the smallest and most vulnerable lives are supported, artificial intelligence is beginning to influence decision-making. From monitoring vital signs to predicting complications like bronchopulmonary dysplasia (BPD), AI can help identify health risks earlier and support faster intervention. But because these decisions affect infants who cannot speak for themselves, the stakes are especially high. The reviewed study examines how AI must align with four ethical principles to support – not compromise – neonatal health. These are: doing good (beneficence), avoiding harm (non-maleficence), ensuring fairness (justice), and respecting families’ rights to make decisions (autonomy). When implemented thoughtfully, AI can improve care. But if systems are not transparent or based on biased data, they may risk doing harm instead of good.   Ethics cannot be an afterthought in neonatal AI Beneficence demands that AI systems bring real benefit to newborns. When trained with accurate, diverse data, AI can help personalise care and reduce medical errors. For instance, some algorithms use early-life data to predict a child’s risk of developing BPD, enabling earlier interventions. However, non-maleficence highlights the risks when algorithms are not fully understood or validated. Many AI systems are “black boxes,” meaning even clinicians can’t explain how decisions are made. This lack of clarity can lead to confusion or incorrect care, especially if AI models are used in different settings without adjustment. Adding to this, AI can unintentionally reflect and even worsen existing healthcare inequalities. This is especially concerning in neonatology, where past disparities in care have affected children from different backgrounds. The study stresses that AI tools must be trained on data from varied populations to ensure they work fairly. Otherwise, decisions might benefit some groups more than others – a direct violation of justice in healthcare.   Putting families first in a digital era Autonomy, or the right to make informed decisions, is particularly complex in neonatal care. Since infants cannot speak for themselves, parents and clinicians must decide together what’s best. When AI systems are too complex to explain, or when recommendations come from algorithms instead of people, this shared decision-making can suffer. Families deserve to know when AI is influencing care and to fully understand its role. Ultimately, AI must support – not replace – the human relationships that are vital in neonatal care. The study urges ongoing collaboration among healthcare providers, parents, ethicists, and data scientists to make sure AI tools are safe, clear, and fair. By focusing on ethical standards, we can harness AI’s potential while protecting the rights and futures of every newborn.   Paper available at: Preserving medical ethics in the era of artificial intelligence: Challenges and opportunities in neonatology Full list of authors: Arora, T.; Muhammad-Kamal, H.; Beam, K. DOI: https://doi.org/10.1016/j.semperi.2025.152100

© Pexels For women living with HIV, the decision to breastfeed comes with medical, emotional, and legal complexity. Although effective antiretroviral therapy (ART) significantly reduces the risk of HIV transmission, breastfeeding remains a debated issue, especially in countries with access to safe alternatives. A new European survey study, coordinated by WAVE under the European AIDS Clinical Society, looked at how national guidelines vary, how many women breastfeed, and what support is offered across 25 countries. The study revealed wide variations in policies—yet also a growing number of women living with HIV who choose to breastfeed. In many parts of the world, breastfeeding is both a cultural norm and a medical recommendation. For mothers living with HIV, however, this everyday choice becomes much more complicated. While the World Health Organization (WHO) supports breastfeeding alongside ART, most national guidelines in high-income settings continue to advise against it. These conflicting messages often leave women feeling unsupported or judged, especially when they wish to make informed, personal choices. This European survey explored national practices, trends, and laws regarding breastfeeding in women living with HIV. It gathered input from 25 countries, asking about guideline recommendations, current practices, and research activities. The aim was to understand how policies align with women’s real-life experiences—and to identify opportunities for better support.   A divided landscape with growing numbers of breastfeeding mothers Nearly half of the surveyed countries reported an increase in breastfeeding among women living with HIV. However, recommendations were split: 52% of countries advise against breastfeeding, while 48% allow it under strict conditions, such as undetectable maternal viral load. Notably, no country currently recommends breastfeeding as a routine option for all women living with HIV. In practice, however, some healthcare providers support women who choose to breastfeed, even when national guidelines discourage it. The study also found that maternal viral load monitoring, infant post-exposure prophylaxis, and education around breastfeeding vary widely between countries. Less than one-third of countries have dedicated staff to counsel women on this topic, and only a few provide clear patient information resources.   What this means for families and care providers For families navigating this decision, support depends heavily on where they live and which healthcare professionals they encounter. The study underscores the need for open, respectful conversations between providers and parents, acknowledging the emotional importance of breastfeeding while also addressing medical risks. A collaborative, informed approach can empower women to make safe, supported choices. This European-wide initiative will now help form a collaborative network focused on data sharing, research, and policy development. The goal is not only to fill knowledge gaps but to ensure that women living with HIV receive consistent, respectful care—no matter where they live.     Paper available at: Guidelines and practice of breastfeeding in women living with HIV—Results from the European INSURE survey – Keane – 2024 – HIV Medicine – Wiley Online Library Full list of authors: Keane, A.; Lyons, F.; Aebi-Popp, K.; Feiterna-Sperling, C.; Lyall, H.; Martínez Hoffart, A.; Scherpbier, H.; Thorne, C.; Albayrak Ucak, H.; Haberl, A. DOI: 10.1111/hiv.13583