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  

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