© Pexels Providing the best possible start in life for all newborns is a global challenge, particularly for those requiring intensive hospital care. Traditionally, neonatal care has focused more on medical tasks than on the essential role of parents. To address this gap, a programme called Close Collaboration with Parents was developed in Finland as a staff training initiative to strengthen family-centred care in neonatal intensive care units (NICUs). Involving 26 units, the programme has shown promising outcomes for infants, families, and healthcare staff alike. Most notably, it helped create a care culture where parents are true partners in their infant’s care. These changes have led to improved infant growth, shorter hospital stays, more parent-infant interaction, and a reduction in maternal depressive symptoms.   Changing care culture in neonatal units Newborns in intensive care need more than medical treatment – they need the emotional and physical closeness of their parents. However, many hospitals have traditionally limited parental involvement. This lack of inclusion can increase stress for parents and disrupt bonding with their infant. The Close Collaboration with Parents programme addresses this issue by guiding healthcare teams to adopt a more relationship-based approach, promoting open communication and shared caregiving with parents. To shift care culture, the programme trains all NICU staff in four key phases: observing and understanding infant behaviour, collaborating with parents on care decisions, listening to each family’s unique story, and involving parents in all aspects of care, including discharge planning. Staff practice these skills at the bedside with support from trained mentors, helping them apply what they learn in real-life settings.   Improved connections benefit everyone involved After completing the training, hospitals observed significant improvements. Parents spent more time in the unit and increased skin-to-skin contact with their infants. Fathers especially reported greater involvement in shared decision-making. Staff gained confidence in supporting parents, providing emotional care, and listening actively. Nurses described a shift from being primary caregivers to being facilitators who empower parents to take an active role. In addition to enhanced relationships, measurable medical benefits were observed. Preterm infants in trained units had better weight gain and shorter hospital stays. A long-term follow-up showed that mothers reported fewer depressive symptoms even two years after discharge. These results show that investing in family-centred care has a positive impact on both emotional well-being and clinical outcomes.   From training to transformation The programme ensures that all families – regardless of background or medical condition – can participate fully in their child’s care. This inclusiveness is key to providing equitable support across neonatal units. By involving entire care teams and tailoring implementation to each hospital’s needs, the program fosters sustainable changes that benefit every infant and family. With its emphasis on partnership, empathy, and shared responsibility, the Close Collaboration with Parents programme offers a powerful model for units worldwide. Its success demonstrates that nurturing relationships between staff and families is not just supportive, it is essential.   Paper available at: Close Collaboration with Parents—Implementation and effectiveness – Ahlqvist‐Björkroth – 2025 – Acta Paediatrica – Wiley Online Library Full list of authors: Ahlqvist-Björkroth, S.; Axelin, A.; Lehtonen, L. DOI: https://doi.org/10.1111/apa.17210  

© 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