A new study has found that immediate skin-to-skin contact (SSC) between parents and their very preterm infants after birth can significantly enhance the quality of mother-infant interactions at 4 months of age. This groundbreaking research, conducted across neonatal units in Sweden and Norway, offers compelling evidence for the long-term benefits of early physical bonding in premature babies.   Incubator care vs. early skin-to-skin contact in preterm infants The study analysed data from 71 very preterm infants born between 28 and 33 weeks of gestation. Researchers randomly assigned the infants to either standard incubator care or immediate skin-to-skin contact (SSC) with a parent for the first six hours after birth. At 4 months of corrected age, the mother-infant pairs were videotaped during a free-play session. These interactions were then assessed using the Parent-Child Early Relational Assessment (PCERA), a tool designed to measure the quality of parent-infant relationships.   Significant benefits of early skin-to-skin contact on infant development The results were striking. Infants who received immediate SSC after birth showed significantly higher scores in positive affect, communicative skills, and social skills compared to those who received standard care. This improvement was observed even though fathers provided more SSC than mothers in the initial hours after birth. However, the study’s key findings indicate that immediate skin-to-skin contact (SSC) should be encouraged alongside necessary medical care to strengthen the mother-infant relationship after birth. This practice is crucial for enhancing interactions between mothers and their very preterm infants, leading to improved developmental outcomes.   © Pixabay   Implications for neonatal care These results have significant implications for neonatal care practices. They provide strong support for the World Health Organization’s recent guidelines recommending immediate SSC for preterm infants. As survival rates for very preterm infants continue to improve, focusing on developmental outcomes becomes increasingly important. By implement policies that facilitate immediate SSC they may be able to improve long-term developmental outcomes and strengthen the crucial bond between parents and their premature babies.   Paper available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812391 Full list of authors: Siri Lilliesköld, RN, MSc; Karoline Lode-Kolz, MD; Siren Rettedal, MD, PhD; Johanna Lindstedt, MSc; Agnes Linnér, MD, PhD; Hanne Markhus Pike, MD; Sari Ahlqvist-Björkroth, PhD; Ulrika Ådén, MD, PhD; Wibke Jonas, RM, PhD DOI: 10.1001/jamanetworkopen.2023.44469  

Guest article by Stephanie Ernst, Founder of Dutch partner parent organisation “The TAPS Support Foundation”, and Monique Oude Reimers-van Kilsdonk, Senior NIDCAP Trainer at Erasmus MC Hospital, The Netherlands. © TAPS Support Foundation We all know the incredible potential of the European Standards of Care for Newborn Health (ESCNH). These standards have the power to transform care for newborns across Europe, which is why we’re passionate about seeing them implemented—especially because they’re not fully in place yet. But that got us thinking: what about twins and other multiples? Could these standards also benefit them, even though they don’t specifically address the unique challenges of multiple births? This question led us to submit an abstract to the 7th World Congress on Twin Pregnancy and the 19th Congress of the International Society of Twin Studies (ISTS), and we were thrilled when it was accepted as a poster! Our goal was to highlight that while the ESCNH doesn’t have specific guidelines for multiples, these babies and their families can still benefit from the existing standards. Our abstract, titled “Improving Multiple Birth Outcomes: What Role Could the European Standards of Care for Newborn Health Play?”, explores how these standards can help improve outcomes for twins, triplets, and other multiples. Babies from multiple births often face higher risks than singletons—they are more likely to be born preterm, have low birth weight, or experience complications like twin-to-twin transfusion syndrome (TTTS) and growth discordance. In fact, around 60% of twins are born prematurely, and the numbers are even higher for triplets and quadruplets. These babies are also more likely to need neonatal intensive care (NICU) support, which increases the risk of neurodevelopmental challenges as they grow. The ESCNH, developed by the European Foundation for the Care of Newborn Infants (EFCNI), consists of 11 key areas designed to improve outcomes for preterm and high-risk newborns across Europe. However, as our abstract highlights, these guidelines don’t specifically address the unique needs of multiple births—a crucial gap considering the higher risks these babies face. So, what can be done? While the ESCNH doesn’t yet include specific standards for multiples, we believe that several of the existing guidelines could still make a big difference. Two areas in particular stand out: Infant- and family-centered developmental care, and Follow-up and continuing care. The Infant and family-centered developmental care standards focus on involving families in the care of their newborns, which is critical for all infants, but especially for multiples. This standard includes practices like Kangaroo Mother Care (KMC), where parents have skin-to-skin contact with their babies. For twins and triplets in the NICU, KMC can be a game-changer—it helps regulate the babies’ temperatures, encourages breastfeeding, and promotes bonding, all of which are even more crucial when parents are juggling the needs of more than one newborn. The Follow-up and continuing care standards are equally important. Multiples are at a higher risk for developmental delays and health complications, so structured follow-up care is vital after they leave the NICU. This care involves monitoring their growth, feeding, and development, as well as providing mental health support for parents who may face increased emotional and psychological stress. Having a coordinated team of healthcare providers to guide families through this journey ensures that both the babies and their parents get the care and support they need.     Our abstract concludes by emphasising that while the ESCNH is already a strong framework for improving newborn care, there’s a clear opportunity to enhance it further by specifically addressing the needs of multiples. By expanding these guidelines, healthcare providers could be better equipped to manage the unique medical, emotional, and psychological challenges that come with caring for twins, triplets, and higher-order multiples. This would not only reduce health risks but also improve long-term developmental outcomes and provide much-needed support for families. In short, while the ESCNH already makes a big difference, tailoring these standards to the unique needs of multiples could have an even greater impact. By giving healthcare teams the tools to provide targeted care, we can help ensure better, healthier outcomes for both babies and their families—because when it comes to twins, triplets, and beyond, they deserve the very best start in life.

A study conducted at a Neonatal Intensive Care Unit (NICU) in Brazil has demonstrated the effectiveness of simulation-based training in improving compliance with infection prevention practices for central venous catheters. This research highlights the potential of innovative educational interventions to improve patient safety in critical neonatal care settings.   The study, led by researchers from the Federal University of Minas Gerais, Brazil, focused on the use of peripherally inserted central catheters (PICCs) in newborns. These devices, while essential for many preterm infants, carry a risk of central line-associated bloodstream infections (CLABSIs), which can have serious consequences for vulnerable neonates.   Improvements in several critical areas of infection prevention The research team observed 41 nursing professionals before and after the implementation of a simulation-based educational intervention. The results revealed significant improvements in several critical areas of infection prevention, including increased compliance with surgical hand antisepsis, better adherence to skin antisepsis protocols using chlorhexidine, improved waiting times for antiseptic action, and enhanced compliance with sterile technique during catheter insertion. These improvements are crucial in reducing the risk of CLABSIs, a major concern in NICUs worldwide. The study’s findings support global efforts to adopt evidence-based “bundles” of care practices to prevent catheter-related infections.   Innovative training approach The educational intervention utilised clinical simulation which allows nursing staff to practice and refine their skills in a safe, controlled environment. This approach bridges the gap between theoretical knowledge and practical application, addressing a common challenge in healthcare education. Dr. Bruna Figueiredo Manzo, one of the study’s authors, emphasises the importance of ongoing education and that targeted, hands-on training can significantly improve adherence to best practices, which is particularly crucial in high-stakes environments like the NICU.   Implications for neonatal care The study’s findings have important implications for neonatal care units globally. By demonstrating the effectiveness of simulation-based training, it provides a model for other institutions seeking to enhance their infection prevention protocols. Moreover, the research underscores the critical role of nursing professionals in maintaining patient safety. As the primary caregivers responsible for PICC insertion and maintenance, nurses and nursing technicians are at the forefront of infection prevention efforts. However, sustained improvement requires ongoing education and monitoring. The researchers therefore suggest that future research could explore the long-term impact of such interventions on clinical outcomes and patient safety metrics. As healthcare systems worldwide strive to reduce hospital-acquired infections, particularly in vulnerable populations like preterm infants, this study offers valuable insights into effective educational strategies. By investing in innovative training approaches, NICUs can empower their staff to provide safer, higher-quality care to their tiny patients.   Paper available at: SciFlo Brazil Full list of authors: Thayane Gusmão Pires de Oliveira, Juliana de Oliveira Marcatto, Allana dos Reis Corrêa, Luciano Marques dos Santos, Patrícia Kuerten Rocha, Delma Aurélia da Silva Simão, Bruna Figueiredo Manzo DOI: https://doi.org/10.1590/0034-7167-2022-0574