Guest article by Stephanie Ernst, Founder of Dutch partner parent organisation “The TAPS Support Foundation”, and Monique Oude Reimers-van Kilsdonk, Senior NIDCAP Trainer at Erasmus MC Hospital, The Netherlands. © TAPS Support Foundation We all know the incredible potential of the European Standards of Care for Newborn Health (ESCNH). These standards have the power to transform care for newborns across Europe, which is why we’re passionate about seeing them implemented—especially because they’re not fully in place yet. But that got us thinking: what about twins and other multiples? Could these standards also benefit them, even though they don’t specifically address the unique challenges of multiple births? This question led us to submit an abstract to the 7th World Congress on Twin Pregnancy and the 19th Congress of the International Society of Twin Studies (ISTS), and we were thrilled when it was accepted as a poster! Our goal was to highlight that while the ESCNH doesn’t have specific guidelines for multiples, these babies and their families can still benefit from the existing standards. Our abstract, titled “Improving Multiple Birth Outcomes: What Role Could the European Standards of Care for Newborn Health Play?”, explores how these standards can help improve outcomes for twins, triplets, and other multiples. Babies from multiple births often face higher risks than singletons—they are more likely to be born preterm, have low birth weight, or experience complications like twin-to-twin transfusion syndrome (TTTS) and growth discordance. In fact, around 60% of twins are born prematurely, and the numbers are even higher for triplets and quadruplets. These babies are also more likely to need neonatal intensive care (NICU) support, which increases the risk of neurodevelopmental challenges as they grow. The ESCNH, developed by the European Foundation for the Care of Newborn Infants (EFCNI), consists of 11 key areas designed to improve outcomes for preterm and high-risk newborns across Europe. However, as our abstract highlights, these guidelines don’t specifically address the unique needs of multiple births—a crucial gap considering the higher risks these babies face. So, what can be done? While the ESCNH doesn’t yet include specific standards for multiples, we believe that several of the existing guidelines could still make a big difference. Two areas in particular stand out: Infant- and family-centered developmental care, and Follow-up and continuing care. The Infant and family-centered developmental care standards focus on involving families in the care of their newborns, which is critical for all infants, but especially for multiples. This standard includes practices like Kangaroo Mother Care (KMC), where parents have skin-to-skin contact with their babies. For twins and triplets in the NICU, KMC can be a game-changer—it helps regulate the babies’ temperatures, encourages breastfeeding, and promotes bonding, all of which are even more crucial when parents are juggling the needs of more than one newborn. The Follow-up and continuing care standards are equally important. Multiples are at a higher risk for developmental delays and health complications, so structured follow-up care is vital after they leave the NICU. This care involves monitoring their growth, feeding, and development, as well as providing mental health support for parents who may face increased emotional and psychological stress. Having a coordinated team of healthcare providers to guide families through this journey ensures that both the babies and their parents get the care and support they need.     Our abstract concludes by emphasising that while the ESCNH is already a strong framework for improving newborn care, there’s a clear opportunity to enhance it further by specifically addressing the needs of multiples. By expanding these guidelines, healthcare providers could be better equipped to manage the unique medical, emotional, and psychological challenges that come with caring for twins, triplets, and higher-order multiples. This would not only reduce health risks but also improve long-term developmental outcomes and provide much-needed support for families. In short, while the ESCNH already makes a big difference, tailoring these standards to the unique needs of multiples could have an even greater impact. By giving healthcare teams the tools to provide targeted care, we can help ensure better, healthier outcomes for both babies and their families—because when it comes to twins, triplets, and beyond, they deserve the very best start in life.

A study conducted at a Neonatal Intensive Care Unit (NICU) in Brazil has demonstrated the effectiveness of simulation-based training in improving compliance with infection prevention practices for central venous catheters. This research highlights the potential of innovative educational interventions to improve patient safety in critical neonatal care settings.   The study, led by researchers from the Federal University of Minas Gerais, Brazil, focused on the use of peripherally inserted central catheters (PICCs) in newborns. These devices, while essential for many preterm infants, carry a risk of central line-associated bloodstream infections (CLABSIs), which can have serious consequences for vulnerable neonates.   Improvements in several critical areas of infection prevention The research team observed 41 nursing professionals before and after the implementation of a simulation-based educational intervention. The results revealed significant improvements in several critical areas of infection prevention, including increased compliance with surgical hand antisepsis, better adherence to skin antisepsis protocols using chlorhexidine, improved waiting times for antiseptic action, and enhanced compliance with sterile technique during catheter insertion. These improvements are crucial in reducing the risk of CLABSIs, a major concern in NICUs worldwide. The study’s findings support global efforts to adopt evidence-based “bundles” of care practices to prevent catheter-related infections.   Innovative training approach The educational intervention utilised clinical simulation which allows nursing staff to practice and refine their skills in a safe, controlled environment. This approach bridges the gap between theoretical knowledge and practical application, addressing a common challenge in healthcare education. Dr. Bruna Figueiredo Manzo, one of the study’s authors, emphasises the importance of ongoing education and that targeted, hands-on training can significantly improve adherence to best practices, which is particularly crucial in high-stakes environments like the NICU.   Implications for neonatal care The study’s findings have important implications for neonatal care units globally. By demonstrating the effectiveness of simulation-based training, it provides a model for other institutions seeking to enhance their infection prevention protocols. Moreover, the research underscores the critical role of nursing professionals in maintaining patient safety. As the primary caregivers responsible for PICC insertion and maintenance, nurses and nursing technicians are at the forefront of infection prevention efforts. However, sustained improvement requires ongoing education and monitoring. The researchers therefore suggest that future research could explore the long-term impact of such interventions on clinical outcomes and patient safety metrics. As healthcare systems worldwide strive to reduce hospital-acquired infections, particularly in vulnerable populations like preterm infants, this study offers valuable insights into effective educational strategies. By investing in innovative training approaches, NICUs can empower their staff to provide safer, higher-quality care to their tiny patients.   Paper available at: SciFlo Brazil Full list of authors: Thayane Gusmão Pires de Oliveira, Juliana de Oliveira Marcatto, Allana dos Reis Corrêa, Luciano Marques dos Santos, Patrícia Kuerten Rocha, Delma Aurélia da Silva Simão, Bruna Figueiredo Manzo DOI: https://doi.org/10.1590/0034-7167-2022-0574  

A guest article by Pani Pantelides* *Pani Pantelides is a NIDCAP professional, Neonatal Physiotherapist and Early Intervention Specialist, Senior Faculty of the Family and Infant Neurodevelopmental Education (FINE) programme, and Ambassador of the European Standards of Care for Newborn Health © Preemie Success Programme (PSP) After attending the last EFCNI conference, we were amazed by Prof. Dr Dieter Wolke’s research from the University of Warwick (UK) on the “Long term development after very preterm/VLBW birth” and potential resiliency factors. What surprised us most was the finding that the ability of very preterm or Very Low Birth Weight (VLBW) children to succeed in life tasks as adults—such as health, wealth, and relationships—is not only determined by their health/level of disability. Rather, it is influenced by the quality of parenting they receive, followed by their academic achievements, which are also shaped by the quality of that parenting. Consequently, Prof. Dr Dieter Wolke emphasises the importance of monitoring preterm children until school age, recommending that assessments and interventions focus not only on motor and language development but also on parent-child interactions, the child’s social life, support during the transition into school, and academic assistance. Based on Prof. Dr Wolke’s findings, the Scientific Committee of Thermokoitida Agapis has designed a developmental follow-up service. The “Preemie Success Programme (PSP) – A choice to thrive!” is a developmental follow-up, prevention, and intervention programme for preterm-born infants and children. It aims to prevent learning difficulties and optimise academic potential by empowering early parent-infant interaction from the moment of discharge from the NICU. PSP is a new initiative in Cyprus aimed at evaluating, preventing, and providing early intervention for preterm-born children, with a focus on optimising their school readiness. The ultimate goal is to facilitate a smoother transition into kindergarten while also predicting their future academic trajectory. Our programme is also based on the European Standards of Care for Newborn Health (ESCNH), particularly those under the umbrella of the Topic Follow-up & continuing care. Who is it for? It is designed for all preterm-born children (those born between 24 and 36+6 weeks gestation) and their parents, starting from the day of discharge from the NICU until preschool age, specifically from 0 months to 4 years old. Statement of the Preemie Success Programme – A choice to thrive! Research shows that all preterm children have an increased risk of poor academic performance, learning difficulties and special educational needs. Other than the quality of early mother-child interaction, the developmental sequelae of prematurity that can impact a child’s ability to learn, as well as their social and emotional skills, include: motor coordination disorders, deficits in executive functions (such as inadequate attention span, inhibitory control, and cognitive flexibility), slower processing speed, difficulties with fine motor skills and visual-motor integration, deficits in executive function (such as working memory, organisation of thought and behaviour), general cognitive weaknesses, language problems, and difficulties with sensory processing. Those developmental skills that determine a preterm child’s school readiness and academic trajectory are not established just before school entry; rather, they begin forming and have their neural foundations in the neonatal period, evolving throughout the child’s developmental journey. For this reason, we have designed the “Preemie Success Programme – A choice to thrive!”, which begins as soon as the infant is discharged from the NICU and follows their development until preschool age.     © Preemie Success Programme (PSP)   The PSP has two main pillars: The first pillar concerns the developmental follow-up of preterm infants and children. The second pillar concerns prevention and therapeutic intervention programmes. The developmental follow-up of preterm infants and children in the PSP is carried out using specific assessment tools for all areas of their development: Following the basic algorithm proposed by ICHOM, ensuring that Cyprus has comparable results with other countries. Additionally, this algorithm is enriched with other assessment tools to cover the developmental needs of the first year and toddler period as well as sensory development. The prevention or/and intervention programmes follow the principles of infant and family-centred developmental care, supported by the ESCNH.   Possible benefits of the “Preemie Success Programme – A choice to thrive!” for the child and the family:   Short-term benefits Monitoring/evaluation of the infant’s development at all levels, from the first day after discharge from the NICU and individualised support for parents to ensure a smooth transition from NICU to home. Prevention and intervention practices to help the infant or child achieve the developmental milestones of their age, through individualised meetings or/and parent-child groups or/and parent groups. Mutual support between parents through parent-groups of preterm children. Long-term benefits Early identification of children at increased risk of learning difficulties. Timely implementation of prevention and intervention strategies to optimise developmental outcomes. Timely development of an individualised educational plan and initiation of intervention for children with developmental problems or low school readiness. Improved educational outcomes and better life prospects. Improved quality of life for preterm children and their families. Improvement of the child’s socialisation and emotional regulation skills at school. Parental counselling. Improved communication between parents, teachers, and healthcare professionals (with parental consent). National benefits over time Documentation of preterm children who needed support for school. Creation of a national preterm registry for school readiness. Development of policies to support preterm children in school. Comparison of national results for the school readiness of preterm children with other countries. The scientific team of the “Preemie Success Programme – A choice to thrive!” (in alphabetical order) Klearchos Demiris (Paediatric Neurologist) Giannis Lemonis (NBO professional, Occupational Therapist for neonates and children) Anastasios Mokas (Speech and Language Therapist, Special Educator) Pani Pantelides* The PSP is funded (partially or fully) by Thermokoitida Agapis, based on income criteria of the families which will participate.