Multidisciplinary healthcare professionals representing collaboration and NICU teamwork guidelines. © Magnific Conflict between different types of neonatal care providers can affect how consistently a neonatal intensive care unit (NICU) team functions. In turn, this can shape the quality of care infants receive. Clear guidelines and shared expectations can help create a more standardised, collaborative environment. They can also support greater consistency in care and teaching across a unit. A recent paper presents recommendations from a multidisciplinary workgroup of neonatal-perinatal medicine programme directors, fellows, and frontline providers in the United States. The recommendations also draw on a wider survey of neonatology programmes. The paper outlines how NICU teamwork guidelines, self-study frameworks, and structured communication can support more standardised teamwork.   Many neonatal intensive care units rely on different types of providers. These include neonatal-perinatal fellows and frontline providers such as neonatal nurse practitioners, physician assistants, and neonatal hospitalists. When teams do not clearly define expectations and responsibilities, this mix can lead to regular conflict between team members. A previous survey found that most neonatology programme directors reported this kind of conflict happening routinely. More standardised approaches to teamwork could help units address this gap and function more consistently. A multidisciplinary workgroup developed recommendations to address these challenges. The group reviewed common sources of conflict and proposed practical tools for neonatal units. These include a self-study framework that units can use to identify their own specific pressure points.   Why NICU teamwork guidelines support neonatal teams The workgroup recommends that units use a self-study framework to assess strengths, challenges, and opportunities within their own teams. This involves gathering input from both fellows and frontline providers. Methods such as anonymous surveys can encourage honest feedback. The workgroup encourages teams to focus first on shared core values, such as excellent patient care and support for learning. Teams can then create specific action plans. These plans can follow the SMART approach, meaning goals should be specific, measurable, assignable, realistic, and timely. The workgroup particularly highlights clear, standardised guidelines for procedure distribution and role expectations as tools for reducing conflict. Several institutions described in the paper have already developed written guidelines. These specify how team members divide procedures and patient care tasks. The paper notes that guidelines for procedure distribution vary between institutions because local needs and staffing levels differ. Some programmes prioritise newer trainees for procedures early in training. Others adjust priority according to patient acuity or provider experience. Despite these differences, all examples share a common goal: making expectations clear and consistent for everyone involved. The workgroup also recommends simulation training and regular team meetings to support procedural skills and communication across the team.   What this means for parents and health professionals For health professionals, the findings suggest that clearer guidelines around roles, procedures, and communication can help reduce conflict. They may also support a healthier learning environment in the NICU. For parents and families, a more collaborative and consistent care team may translate into steadier, more coordinated care for their infant. The workgroup also identifies psychological safety as an important part of consistent, high-quality care. This means creating an environment where team members feel comfortable speaking up and asking questions. These recommendations offer a starting point for units seeking greater consistency in how their teams work together. The authors encourage health professionals to discuss these approaches with their teams and consider how a self-study framework might apply to their unit.   Paper available at: Journal of Perinatology Full list of authors: Marc-Aurele, K.; Branche, T.; Adams, A.; Feister, J.; Boyle, K.; Scala, M.; Fernández Dyess, N.; Keels, E.; Myers, P.; French, H.; Reber, K.; LaTuga, M.S.; Johnston, L.C.; Odumade, O.A. DOI: 10.1038/s41372-023-01756-8    

Breastfeeding supports nutrition, growth, and bonding in early life. © Ayla Meinberg / Unsplash Growth assessment in preterm infants is an essential part of neonatal care. However, hospitals do not always measure or report growth in the same way. This variation makes it difficult to compare research findings and to understand whether nutritional care truly supports a healthy development. This commentary from researchers at the Liggins Institute, University of Auckland, discusses evidence from a systematic review and meta-analysis of protein intake in preterm infants receiving fortified human milk.   Weight gain is often used to judge whether nutrition is effective because it is easy to measure. However, the authors explain that weight gain does not necessarily reflect healthy growth. This raises an important question for standardised newborn care: are we measuring the outcomes that matter most? Consistent approaches could help ensure that growth is assessed in the same way across neonatal units.   Why growth assessment in preterm infants needs standardisation The commentary discusses findings from a systematic review and meta-analysis that examined whether higher enteral protein intake improves growth in preterm infants receiving fortified human milk. The review found that additional protein was linked with greater weight gain. However, it showed little effect on length growth and no improvement in head circumference growth. The authors also note that studies measured both protein intake and growth in different ways, lacking standardisation. As a result, comparing findings between studies remains difficult. More consistent measurement could strengthen the evidence that guides neonatal care. The authors argue that weight gain alone should not be treated as the main indicator of healthy growth. Instead, researchers should agree on which measures best reflect healthy development and use them consistently. They also recommend including longer term outcomes, such as neurodevelopment, whenever possible to improve understanding of nutritional care.   What this means for parents and health professionals Clear and consistent growth measures can help parents, families and health professionals better understand how nutrition supports healthy development. Having shared standards would also make it easier to compare research findings and improve decisions about future nutritional care for preterm infants. Parents can ask their healthcare team how their infant’s growth is being assessed and what the different measurements mean. As researchers continue to improve standardised growth assessment, families and health professionals will benefit from stronger evidence to guide care.   Paper available at: https://doi.org/10.1038/s41390-025-04270-z Full list of authors: Bloomfield, F; Alexander, T; Cormack, B DOI: 10.1038/s41390-025-04270-z

Parent holding a newborn’s hand during a moment of comfort and care. © Raydedi Martinez / Unsplash Care at the end of a newborn’s life can vary between neonatal intensive care units, even when infants have similar needs. Differences in guidance, staff education, and clinical practice may affect how consistently infants and families receive support. This quality improvement study from a level IV neonatal intensive care unit in the United States explored whether introducing standardised approaches could improve the consistency and quality of end-of-life care. The findings show how shared guidance and multidisciplinary work can strengthen care for infants and their families.   Standardised approaches to neonatal end-of-life care can reduce differences in practice and support more consistent care for infants and their families. However, many neonatal intensive care units do not have clear guidance, and staff may feel uncertain when caring for infants with life-limiting conditions. As a result, symptom management and other aspects of care can vary between settings. The study aimed to assess whether a multidisciplinary quality improvement programme could improve symptom management, staff confidence, and awareness of end-of-life care. The programme introduced clinical guidelines, electronic health record changes, staff education, and practical tools designed to support more consistent care.   Why standardised end-of-life care matters Introducing clear guidelines, staff education, and practical tools helped make end-of-life care more consistent in the neonatal unit. Following these changes, symptom management improved, and staff reported greater confidence, comfort, preparedness, and awareness when caring for infants at the end of life. The unit also introduced standardised vital sign monitoring and used a visual symbol to alert staff when an infant was receiving end-of-life care, helping teams recognise sensitive situations more consistently. Together, these changes supported a more consistent approach to end-of-life care. Specialist palliative care consultations remained common throughout the project, although the increase after the intervention was not statistically significant. The researchers also noted greater differences in opinion between clinical teams about care plans and responded by introducing additional team discussions before speaking with families. As the study was conducted in a single neonatal intensive care unit, further research is needed to understand how these approaches may work in other settings.   What this means for affected parents and health professionals For parents and families, consistent approaches may improve communication and help ensure that care follows clear, shared guidance. For health professionals, the findings highlight how multidisciplinary working, education, and agreed clinical guidance can support more consistent end-of-life care. Parents and families can discuss end-of-life care plans with their healthcare team and ask how care decisions are supported within their unit. Health professionals can use these findings to support ongoing improvements in the quality and consistency of care.   Paper available at: https://doi.org/10.1186/s12904-025-01899-9 Full list of authors: Lofgren, H; Lentin, S; DiMatteo, A; Pasquale, E; Salant, J; Tiwari, P DOI: 10.1186/s12904-025-01899-9