© Pexels   A recent study from the Medical University of Graz, Austria, has revealed that regular interprofessional in situ simulation training can significantly reduce latent safety threats (LSTs) in neonatal emergencies. Conducted over nearly eight years, this research underscores the importance of immersive, on-site training in improving patient safety by identifying and addressing previously unrecognised risks.    Study overview  The study involved 13 simulation training sessions at the Department of Gynaecology and Obstetrics at the Medical University of Graz, Austria. The training targeted a range of healthcare professionals, including anaesthesiologists, obstetricians, and nurses, focusing on identifying LSTs, i.e.system-based threats to patient safety. A total of 67 LSTs were identified, primarily related to equipment (62.7%), followed by resource/system (20.9%) and medication (16.4%). Remarkably, 91% of these threats were rectified by the next training session. The study found a significant negative correlation between the number of training sessions and the frequency of identified LSTs, indicating a sustained decrease in safety threats over time.    Impact on patient safety  The findings underscore the positive impact of simulation training on patient safety. By simulating real-life scenarios, healthcare teams can practice critical skills such as airway management and emergency drug administration, leading to improved teamwork and communication. Given the high stakes in neonatal care, the ability to quickly identify and address safety threats is crucial. The training sessions effectively prepared healthcare teams for emergencies, enhancing their readiness and response capabilities.    Challenges and future directions  While the study demonstrated significant improvements, it acknowledged limitations, such as not assessing the direct impact of training on clinical outcomes. Future research could focus on evaluating patient-related parameters to provide a more comprehensive understanding of the benefits of simulation training.   The study highlights the effectiveness of regular in situ simulation training in neonatal care. By fostering a culture of continuous improvement, healthcare teams can significantly reduce safety threats and enhance patient outcomes, paving the way for safer healthcare practices.      Paper available at: BMJ Open Quality Full list of authors: Lukas Peter Mileder,Bernhard Schwaberger, Nariae Baik-Schneditz, Mirjam Ribitsch, Jasmin Pansy, Wolfgang Raith, Angelika Rohrleitner, Günter Mesaric, Berndt Urlesberger DOI: 10.1136/ bmjoq-2023-002567  

© Shutterstock Preterm birth significantly increases risks for infants, leading to immediate health issues and long-term developmental challenges. Effective growth monitoring in neonatal intensive care units (NICUs) is essential for improving outcomes, as it enables the identification of infants at risk for conditions like extrauterine growth restriction (EUGR). However, the choice of growth chart is vital for accurate assessments. A recent study highlights the challenges in monitoring extremely and very preterm neonates, revealing discrepancies between growth charts. It emphasises the need for standardised growth monitoring practices in NICUs to better support preterm infants and improve their long-term health outcomes.   Prevalence of growth restrictions A retrospective study of 462 preterm infants born before 32 weeks of gestation at the University General Hospital of Heraklion in Greece (2008-2022) examined the impact of early feeding practices on growth outcomes. Utilising the Fenton 2013 and INTERGROWTH-21st growth charts, the study assessed how different feeding strategies influenced rates of Extrauterine Growth Restriction (EUGR).   Significant discrepancies in growth chart assessments for preterm infants The findings revealed considerable discrepancies in the classification of SGA and EUGR depending on the growth chart used. According to the Fenton2013 growth curves, 6.3% of the neonates were classified as small for gestational age (SGA) at birth, whereas the INTERGROWTH-21st curves identified 9.3% as SGA. This discrepancy was even more pronounced at discharge, with 45.9% of neonates being classified as having EUGR based on the Fenton2013 weight curves, compared to only 29.2% with the INTERGROWTH-21st curves. These findings highlight significant differences in growth restriction prevalence depending on the growth reference used. These differences were observed through the calculation of z-scores for birth weight and weight, length, and head circumference at discharge and highlight the urgent need for scientific clarity on the most effective methods for measuring growth and making predictions.   Nutritional and clinical factors  The study also assessed the impact of nutritional practices on growth outcomes. It revealed that the timing of enteral feeding initiation and the duration of parenteral nutrition were associated with EUGR in both growth curves. Specifically, the study observed that an earlier initiation of enteral feeding and a shorter duration of parenteral nutrition were linked to better growth outcomes, reducing the prevalence of EUGR. of detailed and individualised nutritional management in the care of preterm infants.   Implications for neonatal care  The findings indicate a need for further evaluation of growth charts to determine the most appropriate tools for monitoring the growth of preterm infants in neonatal intensive care units. Choosing the right growth reference is crucial because an inaccurate growth chart can lead to some cases of EUGR being missed or identified too late, affecting clinical decisions and long-term health outcomes. By refining feeding plans and monitoring growth closely, healthcare providers can better manage their patients’ nutrition plans and improve their long-term health and well-being. In summary, this research highlights the urgent need for personalised growth monitoring for preterm babies, as it is crucial for accurately tracking their development and improving care, which has important implications for how NICUs around the world manage their patients.   Paper available at: The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association with Clinical and Nutritional Factors (nih.gov) Full list of authors: Kakatsaki I, Papanikolaou S, Roumeliotaki T, Anagnostatou NH, Lygerou I, Hatzidaki E. DOI: 10.3390/nu15153290

Introduction and importance of perinatal palliative care St. Josef Hospital in Vienna delivers comprehensive medical care with a particular emphasis on obstetrics. Our perinatal palliative care (PPC) programme is designed to support families during the challenging period surrounding the birth of a child with life-limiting conditions.   Services and offerings at St. Josef Hospital Interdisciplinary team We have formed a dedicated interdisciplinary team comprising gynaecologists, midwives, neonatologists, nurses, psychologists, and chaplains. This team collaborates closely to provide holistic care tailored to the unique needs of each family. Before birth Our support begins well before birth with thorough counselling sessions. We elucidate the diagnosis to the parents and its implications for their child. Many parents feel helpless and frightened in this situation, making our support and the provision of ample time for decision-making crucial. Often, parents face a difficult journey marked by a loss of control and external pressures. Our PPC programme aims to help them experience a self-determined birth and make the time with their child as meaningful as possible. In preparation, we work closely with the parents and our interdisciplinary team to develop a comprehensive birth plan and a neonatal care plan. These plans consider the parents’ wishes and the child’s medical needs, detailing actions for various scenarios to ensure optimal support and care for both the child and the parents. Advanced Care Planning (ACP) is integral to this process. Whenever possible, the same professionals remain with the family throughout the course of care, fostering a trustful relationship. During birth During birth, we strive to create a stress-free and dignified environment for the family. For deliveries involving palliative care, we provide a dedicated midwife. This one-on-one support is crucial for intensive and personalised care. The dedicated midwife remains continuously present, offering emotional support, monitoring the birth process, and adapting care to the evolving needs of the family. © iStock After birth Post-birth, our primary focus shifts to palliative care, which can extend from a few hours to several weeks, depending on the child’s condition. We ensure that all medical needs, including pain relief, are met to provide maximum comfort. Parents receive ongoing emotional support from our psychologists and chaplains, who assist them in coping with their emotions and processing their grief. We also aid families with administrative tasks and coordination with other institutions to ensure access to necessary resources and services. Additionally, we help families create cherished memories through photographs, hand and footprints, or special farewell rituals, which are vital in the grieving process. If the child lives longer, we facilitate seamless integration with external care facilities, including outpatient services, specialised children’s hospices, and other relevant organisations. After discharge from the hospital, families can opt for outpatient follow-up sessions, if needed. These conversations offer an essential opportunity for continued emotional and psychological support. Conducted by the same psychologists who cared for the families during their hospital stay, these sessions ensure continuity and trust. Implementation The implementation of our PPC programme naturally brought with it challenges, but these were largely related to specific structures of the hospital. Thus, these challenges were very individual, and in the end all initial problems were solved well thanks to an incredibly committed and interdisciplinary team. Conclusion Our PPC programme at St. Josef Hospital Vienna offers a comprehensive and compassionate service that transcends traditional medical care. We provide families in challenging life situations with unwavering support and comfort. The holistic and individualised care provided by our specialised team enables affected families to say goodbye and experience the loss of their child with dignity.