Very preterm infant wrapped in towels as part of thermal management after birth. © Janko Ferlic / Unsplash Very preterm newborns can lose heat quickly after birth, yet hospitals do not always use the same thermal care practices. Consistent approaches to thermal management matter because both low and high body temperatures can affect newborn outcomes. This multicentre randomised clinical trial from Italy examined whether drying very preterm infants before plastic wrapping could improve temperature control after birth. The study involved 354 very preterm infants cared for in 21 tertiary hospitals. The findings showed that drying before wrapping did not improve normothermia (body temperature within the recommended range) at admission to the neonatal intensive care unit (NICU). They also do not support changing current standardised care practices.   Very preterm infants face a high risk of heat loss immediately after birth because their bodies lose heat rapidly through evaporation. Current international guidelines recommend placing these infants directly into plastic wrapping without drying first. However, many newborns still arrive at the neonatal intensive care unit with temperatures outside the recommended range. This ongoing challenge highlights the need for standardised newborn care that supports consistent thermal management across settings. It also shows why thermal care in very preterm infants remains an important focus in neonatal care.   Why standardised thermal care in very preterm infants matters The researchers compared two approaches to thermal care in very preterm infants. One group received drying with a prewarmed towel before plastic wrapping, while the other group received immediate wrapping without drying. All participating hospitals followed current neonatal resuscitation guidance, including warm delivery rooms, radiant warmers, caps, and transport incubators. The study aimed to determine whether adding drying to the existing thermal care bundle could improve normothermia at NICU admission. Results showed similar rates of normothermia in both groups. Around half of all infants remained outside the normal temperature range. The authors suggested that drying may delay immediate wrapping or may not further reduce evaporative heat loss compared with direct plastic wrapping. This could explain the similar rates of normothermia in both groups. The study also examined other health outcomes linked to thermal care quality. Rates of hypothermia, respiratory distress syndrome, bronchopulmonary dysplasia, and late-onset sepsis were similar between the two groups. However, mortality was higher among infants who were dried before wrapping, especially among the most extremely preterm infants. The researchers could not identify a direct physiological explanation for this difference. They noted that many deaths were linked to the infants’ severe clinical conditions.   What thermal care in very preterm infants means for parents and health professionals The findings support current guidance that recommends immediate plastic wrapping without drying for very preterm newborns. They also show the importance of consistent thermal care bundles that combine several evidence-based interventions. Although most hospitals consistently used plastic wrapping and radiant warmers, they used heated humidified gases and warming mattresses less often. Guidelines recommend both as part of thermal care. Wider use of these approaches may help improve temperature control after birth. Parents and healthcare professionals can discuss with their care teams how thermal management practices are applied during stabilisation after birth. Further research may help refine standardised newborn care strategies and improve temperature control for very preterm infants in neonatal settings.   Paper available at: JAMA Network Open article Full list of authors: Cavallin, F; Doglioni, N; Risso, F M; Monari, C B; Aversa, S; Troiani, S; Battajon, N; Moschella, S; Villani, P E; Vedovato, S; Maiorca, D; Frezza, S; Lista, G; Laforgia, N; Mondello, I; Sibona, I; Staffler, A; Pratesi, S; Paviotti, G; De Bernardo, G; Lama, S; Miselli, F; Bua, J; Gitto, E; Pesce, S; Baraldi, E; Trevisanuto, D DOI: 10.1001/jamanetworkopen.2025.56902

Healthcare professional demonstrating a quiet gesture to support communication in care settings. © Pexels / Olly Care in the neonatal intensive care unit can vary widely in how much sound, speech, and silence a preterm infant experiences. Consistent, standardised care matters because the auditory environment supports brain and behavioural development during a very sensitive period. This prospective observational study followed 64 infants born at or before 28 weeks of gestation in a Level IV NICU and measured sound exposure at four points during hospitalisation. The study showed that higher adult word exposure was linked with lower infant stress, while louder sound levels were linked with less favourable neurobehaviour near term age.   Preterm infants often spend many weeks in the NICU while the brain and auditory system are still developing. During this time, they may hear staff voices, family speech, alarms, equipment noise, music, and long periods of silence. The study highlights why standardised newborn care should include attention to the sound environment, not only medical treatment. It also shows that different sound exposures do not appear to relate to infant outcomes in the same way. The researchers aimed to examine whether language and sound exposure during NICU hospitalisation related to infant neurobehaviour near discharge. They used repeated 16-hour recordings to measure adult words, silence, electronic sounds, and sound levels. They then assessed neurobehaviour between 35 and 41 weeks postmenstrual age. This approach allowed the team to compare different types of auditory exposure across the NICU stay.   Why standardised care for sound exposure matters The main findings suggest that both too much harsh sound and too little positive sound may matter. Higher average decibel levels were associated with lower orientation scores, and higher peak decibel levels were associated with greater hypertonia. More silence was also associated with greater hypertonia. At the same time, higher adult word counts were linked with lower infant stress. The paper also reports that more electronic sound exposure was associated with less hypotonia, but the authors caution that this finding is difficult to interpret. The recording device could not distinguish between potentially helpful sounds, such as music, and potentially disruptive sounds, such as alarms. The authors therefore do not suggest that electronic noise is beneficial. Instead, they argue for careful attention to the type, timing, and intensity of auditory input in the NICU.   What this means for parents and healthcare professionals For parents, families, and healthcare professionals, the findings suggest that clearer standards around NICU sound may support more consistent, high-quality care. Care teams may need to reduce loud and unnatural noise. They also need to avoid an overly silent environment and make room for meaningful speech around the infant. The authors note that more research is needed, but this study supports practical discussion about how sound is managed in the NICU. Parents and professionals can ask how the unit supports a developmentally appropriate auditory environment. They can also use this evidence to encourage care practices that combine neuroprotection with responsive human interaction.   Paper available at: Journal of Perinatology Full list of authors: Pineda, R; Woodward, LJ; Vesoulis, ZA; Smyser, CD; Inder, TE; Mathur, AM; Schlaggar, BL DOI: 10.1038/s41372-026-02623-y

Child engaged in drawing activity, reflecting early cognitive development. © Pexels / Olly Children born preterm have an increased risk of cognitive and language difficulties. In this context, researchers identify maternal sensitivity as an important and potentially modifiable early-life factor influencing long-term development. This international individual participant data meta-analysis combined data from seven birth cohorts in five countries and included 2,560 children. Overall, the study found that higher maternal sensitivity relates to better cognitive and language outcomes. Notably, the strongest associations occurred in children born at lower gestational ages. Together, these findings inform newborn care practices and long-term follow-up for preterm children.   Children born preterm often score lower on cognitive and language tests than those born at term. Therefore, identifying modifiable protective factors remains an important goal in newborn care. Maternal sensitivity describes well-attuned and emotionally warm responses to an infant’s cues. In this study, the researchers examined how maternal sensitivity and gestational age relate to later cognitive and receptive language outcomes. To address this question, the researchers conducted a one-stage individual participant data meta-analysis using harmonised data from seven longitudinal birth cohorts in Europe and Oceania. They assessed maternal sensitivity through standardised observations. They then measured cognition and receptive language using validated tests. Finally, the analyses adjusted for relevant child and family characteristics.   Why maternal sensitivity in preterm children is important for newborn care Across cohorts, higher maternal sensitivity related to better cognitive and receptive language scores. Specifically, each standard deviation increase in maternal sensitivity corresponded to higher cognitive and language outcomes. In addition, gestational age independently predicted both outcomes. Importantly, the link between maternal sensitivity and cognition was stronger in children born at lower gestational ages. This pattern suggests a potential protective effect in those born most preterm. Moreover, the association remained after adjustment for neurodevelopmental impairment. In contrast, for receptive language, maternal sensitivity and gestational age showed additive effects. However, the analysis found no significant interaction. As expected, children born extremely or very preterm scored lower on cognitive and language measures than those born at term. Nevertheless, maternal sensitivity continued to show a positive association with cognitive outcomes. Overall, results remained consistent across cohorts despite differences in sampling and timing of assessments.   What this means for parents and health professionals Taken together, the findings show that maternal sensitivity in preterm children relates to improved cognitive and language outcomes across the full range of gestational ages. For health professionals, this supports including approaches that promote sensitive parent–infant interactions in standardised newborn care and follow-up services. Likewise, for parents and families, the results underline the importance of responsive and emotionally warm interactions in everyday care. In addition, the study provides a basis for discussions between parents and health professionals about how follow-up services support sensitive interactions. Ultimately, greater awareness of evidence-based standards may strengthen consistency in care across settings.   Paper available at: https://pubmed.ncbi.nlm.nih.gov/41655627/ Full list of authors: Jaekel, J; Wolke, D; Esser, G; Woodward, LJ; Spittle, A; Cheong, J; van Baar, AL; Verhoeven, M; Gueron-Sela, N; Atzaba-Poria, N; Anderson, PJ; Treyvaud, K DOI: 10.1016/j.jpeds.2026.115024