Neonatal transport plays a crucial role in ensuring newborns receive timely and specialised medical care, yet in Sub-Saharan Africa (SSA), transport systems are often unstructured and inadequate. A recent systematic review by Okai, Fair, and Soltani examines existing neonatal transport practices in SSA and evaluates the impact of low-cost interventions on outcomes. The study highlights significant gaps, including the reliance on informal transport methods and poorly equipped ambulances, which put vulnerable neonates at risk. Importantly, despite its proven benefits, no studies reported the use of Kangaroo Mother Care (KMC) in any transport scenarios. The review underscores the urgent need for structured transport systems, better-equipped ambulances, and the integration of cost-effective, evidence-based interventions to improve survival rates. Strengthening communication between referring and receiving facilities is also essential for continuity of care. Addressing these challenges could greatly enhance neonatal health outcomes across the region.   A recent systematic review titled “Neonatal transport practices and effectiveness of the use of low-cost interventions on outcomes of transported neonates in Sub-Saharan Africa: A systematic review and narrative synthesis” by Emmanuel Okai, Frankie Fair, and Hora Soltani, published in Health Science Reports in 2024, delves into the critical issue of neonatal transport in Sub-Saharan Africa (SSA).   Study Objective The study aimed to assess existing neonatal transport practices within SSA and evaluate the effectiveness of low-cost interventions designed to improve outcomes for transported neonates. This focus is particularly pertinent given that SSA accounts for approximately 43% of global neonatal deaths, with many infants requiring transfer to specialised care facilities after birth.   Methodology Researchers conducted a comprehensive literature search across multiple databases, including CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar, covering publications up to March 2023. The inclusion criteria encompassed peer-reviewed studies detailing neonatal transport processes and outcomes within SSA. The review included 20 studies that met the criteria, involving 11,895 neonates from 10 countries.   Key Findings Transport methods: Caregivers often transported neonates via public means, carrying them in their arms with minimal communication between referring and receiving facilities. This lack of structured transport systems poses significant risks to neonatal health during transit. Ambulance services: Studies highlighted widespread deficiencies in both human resources and essential transport equipment when ambulances were used, undermining the quality and safety of neonatal transfers. Low-cost interventions: Notably, none of the reviewed studies reported the implementation of Kangaroo Mother Care (KMC) during transport. KMC, which involves skin-to-skin contact between the mother and infant, is a proven low-cost intervention that can regulate the infant’s temperature and provide physiological stability.   Implications The findings underscore a critical need for improved planning and resource allocation for neonatal transport in SSA. The prevalent reliance on unregulated public transport and the evident gaps in ambulance services reveal systemic weaknesses that targeted interventions could address. Implementing cost-effective strategies, such as training community health workers and integrating KMC during transport, could significantly enhance neonatal outcomes. Moreover, establishing structured communication protocols between referring and receiving facilities is essential to ensure continuity of care and preparedness upon arrival.   Conclusion This review illuminates the pressing challenges in neonatal transport within Sub-Saharan Africa and advocates for the adoption of low-cost, evidence-based interventions to improve survival and health outcomes for transported neonates. By addressing these gaps, healthcare systems in the region can move closer to achieving equitable and effective neonatal care.   Paper available at: Health Science Reports   Full list of authors: Emmanuel Okai, Frankie Fair, Hora Soltani   DOI: 10.1002/hsr2.1938

© Unsplash/Hush Naidoo The quality of neonatal healthcare varies not only between countries but also between healthcare facilities within the same country. The neonatal mortality rate differs significantly across Europe, highlighting the need for universal care standards to ensure high-quality care everywhere. Moreover, the implementation of good care standards reduces inequalities in access to healthcare. The European Standards of Care for Newborn Health (ESCNH) provide such guidelines, yet their practical implementation remains challenging. Many healthcare providers do not perceive the need for change. Here the development of the new self-assessment tool comes into play. This is where the new self-assessment tool comes into play. As a free and easy-to-use resource for healthcare professionals, it will help identify areas requiring improvement and thereby support the implementation of the ESCNH.   Significant disparities exist across Europe in the quality of healthcare for infants born too soon (<37 weeks of gestation) or too small (<2,500g birth weight). The rates of preterm and low birth weight vary considerably across the continent, reflecting inequalities in access to adequate healthcare. The care of these vulnerable infants is associated with high economic expenses and often has lasting medical and social consequences throughout their lives. However, the quality of care differs not only between countries but also within them. Different clinics and hospitals may provide significantly different quality of neonatal care. Consequently, the place of birth can have a profound impact on lifelong health outcomes.   What are the European Standards of Care for Newborn Health (ESCNH)? One way to address these inequalities is through the establishment and implementation of universal care standards. This is why the European Foundation for the Care of Newborn Infants (EFCNI) initiated the ESCNH. These ninety-six evidence-based care standards cover healthcare from before birth through to follow-up care for preterm and low birth weight neonates. Their objectives are to improve the quality of care, ensure equal access to optimal healthcare, reduce cultural barriers in treatment, and pave the way for national adaptation. Stakeholders from thirty-one different countries and diverse backgrounds contributed to the development of the ESCNH.   How can the ESCNH be implemented? Despite their benefits, the implementation of the ESCNH remains challenging. Healthcare providers may struggle to recognise the need for change or to assess the extent to which they adhere to the standards. Therefore, a self-assessment tool (SAT) is being developed to help healthcare professionals evaluate the level of ESCNH implementation and identify areas requiring improvement. Using the eDelphi method followed by a pilot-testing phase, the SAT will be developed as a free, publicly available resource for all healthcare providers. Experts from various European countries and disciplines participate in its creation. Healthcare institutions are encouraged to publish their SAT results to enhance transparency and improve neonatal care provision. The SAT will function as a simple, easy-to-use checklist that can be integrated into daily clinical routines. The multidisciplinary approach and expert collaboration promise the development of a valuable resource to harmonise high-quality neonatal care across Europe and reduce health-related inequalities for infants and their families.   Paper available at: https://bmjpaedsopen.bmj.com/content/9/1/e003008 Full list of authors: Julia Hoffmann, Sarah Lehmann, Gina Ancora, Helmut Hummler, Nicholas Lack, Dietmar Schlembach, Esther Schouten, Ilaria Simonelli, Ylva Thernström Blomqvist, Eleni Vavouraki, James Webbe, Luc J I Zimmermann, Silke Mader, Isabel Geiger DOI: doi:10.1136/bmjpo-2024-003008

A recent narrative review on thermoregulation strategies for very preterm infants in the delivery room highlights significant advancements in neonatal care. Preterm infants, particularly those born before 32 weeks of gestation, are highly vulnerable to temperatures outside the normal range. Exposure to temperatures above or below normothermia is strongly associated with increased mortality and morbidity. This research stresses the importance of preventing hypothermia while mitigating the risks of hyperthermia, both of which can have serious consequences for neonatal health.    Defining key terms in neonatal thermoregulation  The distinction between thermoregulation and temperature management is important: thermoregulation refers to the body’s natural ability to maintain temperature, while temperature management involves external interventions to support these processes, particularly in preterm infants. Normothermia, defined as 36.5°C to 37.5°C, is the normal body temperature range and is critical for minimising health risks. Hypothermia, below 36.5°C, increases the risk of infection and mortality, while hyperthermia, above 37.5°C, often caused by excessive warming, can result in dehydration, metabolic stress, and neuronal injury.   Modern strategies for thermoregulation in neonatal care  The focus on thermoregulation evolved from basic incubators to contemporary practices such as radiant heat, polyethylene wraps, and exothermic mattresses. The World Health Organization (WHO) and the International Liaison Committee on Resuscitation (ILCOR) currently recommend maintaining a temperature range of 36.5°C to 37.5°C, achieved through a combination of heated, humidified gases, optimised room environments, and external heat sources. However, using these measures during delayed cord clamping, a practice that is becoming more common for its benefits for newborns, remains a difficult task.   Breakthrough insights in newborn thermal management    The review highlights that polyethylene wraps and hats are effective in reducing heat loss through evaporation and conduction, making them important tools in neonatal thermoregulation. Radiant heat systems, exothermic mattresses, and heated, humidified gases are effective but need careful management to avoid the risk of hyperthermia. Emerging practices such as immediate skin-to-skin contact in the delivery room show potential benefits, particularly for fostering parental bonding, but may not fully ensure thermal stability for preterm infants. Therefore, mobile resuscitation trolleys equipped with thermal regulation features are increasingly important. Challenges in thermoregulation include inconsistent definitions of hypothermia and hyperthermia, complicating interventions, and difficulties in maintaining normothermia during delayed cord clamping, particularly in resource-limited settings. A comprehensive approach, combining advanced technologies, staff training, and global standards, is essential, with further research needed to optimise thermal strategies.   Paper available at: https://pubmed.ncbi.nlm.nih.gov/38253875/   Full list of authors: Dunne EA, O’Donnell CPF, Nakstad B, McCarthy LK  DOI: 10.1038/s41390-023-02902-w