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Background

Early discharge to neonatal home care is common practice for preterm infants in Sweden but the evidence base for assessing infant and parent readiness is limited and there are no nationally defined discharge guidelines or criteria. To investigate potential facilitators and barriers in the transition to home, we examined discharge criteria, pre- and post-discharge practices, and staff decision-making.

Methods

All (n = 36) Swedish units participated in this descriptive mixed method study based on semi-structured interviews with one physician and one registered nurse representing each unit.

Results

Discharge criteria and practices varied, both between and within units. Staff were ambivalent about the timing of discharge and postponed giving discharge-related information to parents. The transition process was staff-driven, with limited parental involvement in care planning, and staff discontinuity delayed discharge. Home care combining telemedicine and home visits, adapted to the needs and preference of the family, was considered effective and appraised. Socially vulnerable families or those with limited language proficiency had restricted access to homecare.

Conclusions

There is a need for improved standardization of, and parental involvement in discharge planning for preterm infants. Earlier transfer of care responsibilities to parents should facilitate transition to home and shorten length of hospital stay.

Impact

• Our findings provide insight into facilitators and barriers in preterm infants’ transition from hospital to home.

• Staff were ambivalent about timing of discharge, and criteria and practices varied between and within units depending on local routines and staff preferences.

• The transition process was staff-driven, with limited parental involvement in care planning, and staff discontinuity caused delay.

• Home care models combining telemedicine and home visits, adapted to the needs of the family, was described as effective and appraised.

• Empowering parents by earlier transfer of care responsibilities and involvement in care planning, could facilitate transition to home and reduce length of stay.

Aim

The aim of this study was to describe the routines for handling mother's own milk and donor human milk in Swedish neonatal care units related to national guidelines.

Methods

A web-based survey of 24 of 38 neonatal units and 19 of 28 human milk banks in Sweden.

Results

Despite national guidelines, breast milk handling varied widely. All units offered lactation support and free breast pumps during hospital stays; nine continued post-discharge. Use of mother's milk differed; some prioritised fresh, others mixed or used frozen milk by age. Donor milk was mainly given to infants < 34–35 weeks or post-surgery, though criteria varied. Some also provided it for hypoglycaemia, growth restriction or hypothermia treatment. Fortification routines varied in both target groups and preparation, ranging from bedside at each feed to once daily. Most milk banks tested donor milk before pasteurisation; one tested both before and after. Five units never declined donations, while others did due to storage limits, surplus supply or time constraints.

Conclusion

Substantial variation in practices indicates a need to clarify and update national guidelines and strengthen milk banking, with relevance both nationally and internationally.

Background

Neonatal cardiopulmonary resuscitation (CPR) requires a skilled team including pediatric registered nurses (pRNs) who must manage complex, high-stress situations. This study aimed to describe pRNs' experiences of neonatal CPR and to interpret these in relation to two levels of clinical expertise, novice and expert, using Benner's framework.

Design and methods

A qualitative secondary analysis included two strategically selected novices and two experts from three level III and IV NICUs in Sweden. Data were analyzed using abductive content analysis framed by the Swedish competence description for pRNs and Benner's nursing theory.

Results

Novices relied on guidelines and familiar team members to manage stress and ensure patient safety. Experts demonstrated confidence in team dynamics, anticipatory decision-making, and mentoring behaviors.

Conclusion

The findings highlight differences in how novice and expert pRNs experience neonatal resuscitation and emphasize the importance of mentorship and structured support for professional development.

Background: 

Skin-to-skin contact (SSC) is crucial in neonatal intensive care unit (NICU) care; yet, challenges exist in its implementation. This study addresses a knowledge gap by examining the most effective ways to introduce SSC in the NICU, emphasizing the need to seamlessly integrate this practice for optimal infant and parent care. One way, among many, to implement SSC is to increase staff's knowledge and awareness about SSC.

Objective: 

To describe the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life.

Methods: 

A pre- and postinterventional study design was used to determine the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life.

Results: 

The prevalence of infants receiving SSC during their first 24 hours of life, the number of SSC sessions per day, and the duration of each SSC session increased after the intervention, and these effects persisted over 2 years.

Implications for Practice: 

Our study highlights the impact of staff education and reflective discussions on SSC in the NICU. Integrating these with practical training, parental education, and NICU environment modifications is pivotal for enhancing and sustaining optimal SSC practices, benefiting both infants and parents.

Background

Very preterm born infants face elevated risks of adverse neurodevelopmental outcomes, with prolonged hospitalisation associated with poorer cognitive, motor, and language development. Contributing factors include limited parental presence, insufficient stimulation, and exposure to stressful procedures. In Nordic countries, neonatal home care programmes support early discharge by enabling parents to manage nasogastric tube feeding at home under specialist supervision. However, inconsistent discharge practices delay the transition to home by creating parental uncertainty and making the process more vulnerable to staff discontinuity. This study aimed to co-develop an intervention to support safe and early discharge and evaluate the impact of engaging parents and healthcare professionals as collaborators throughout the research process.

Methods

A descriptive mixed-methods study with an embedded process evaluation was conducted guided by participatory action research methodology. A Steering Committee consisting of two parents, a neonatal nurse, a researcher, and a coordinator managed the process. Five parents and seven healthcare professionals from three Swedish neonatal units representing diverse care models were purposively recruited for creative workshops, ensuring diversity in gender, culture, and professional background. Patient and public involvement (PPI) was evaluated through anonymised impact log surveys, a process log, standardised meeting minutes, semi-structured interviews with Steering Committee members, and a written survey of public contributors. Field notes, post-it notes, mind maps, and audio recordings supported data validation.

Results

The co-development process resulted in an intervention tool designed to visualise the neonatal care journey, discharge criteria, infant development, and parental preparation, including milestones to track progress and strengthen parental roles. More than 90% of stakeholder recommendations were implemented, closely aligning the tool with family needs. Key enablers of meaningful collaboration were a respectful, emotionally safe environment and a shared commitment to collaborative decision-making. Paired reflection supported individual expression. Parents appreciated the opportunity for emotional processing, while professionals valued gaining deeper insight into family perspectives.

Conclusion

This study demonstrates the feasibility and value of PPI in developing a neonatal care intervention. The resulting tool is intended to enhance predictability, standardisation, and timely discharge preparation while strengthening the parental role. A forthcoming feasibility study will assess its potential to improve discharge practices, support parental well-being, and facilitate safe and early transition to home.

Trial registration number

279,523 (Registered 28th of September 2023 in Researchweb, Region of Gävleborg domain).

Studies on pain in preterm infants have usually been confined to observations of painful procedures, and information from extremely preterm infants is limited. Using registry data from a Swedish nationwide cohort, this study explored the epidemiology of pain in very preterm infants, its causes, assessments, and treatment strategies. We included liveborn infants <32 weeks' gestational age (GA) discharged between January 2020 and June 2024. Proportions of infants exposed to potentially painful procedures, experiencing pain, assessed with pain scales, and receiving pharmacological treatment were calculated by each postnatal day. Among 3686 infants (mean birthweight 1176 g, GA 28.2 weeks), 11.6% had a painful condition and 84.1% were exposed to at least 1 potentially painful procedure. In total, 74.6% experienced pain, corresponding to 28,137/185,008 (15.2%) days of neonatal care. For every 2-week increase in GA, significantly lower proportions of infants experienced pain. In infants <28 weeks of GA, proportions with reported pain were approximately half the rate of painful procedures, while in infants born at 28 to 31 weeks, reported pain closely matched exposure to painful procedures. Pain scales were used in 75.0% of the infants. Pharmacological pain treatment was administered to 81.7% of infants, primarily topically or orally. Among infants with pain, proportions treated intravenously were larger at higher GAs. Despite effective analgesia/anesthesia, many very preterm infants experience pain. Visualizing pain epidemiology, procedures, conditions, and treatment by postnatal and gestational age may guide clinical management and generate research hypotheses to reduce short- and long-term adverse effects.

Aim

To investigate specialist nurses’ experiences of caring for full-term infants requiring intensive care and undergoing therapeutic hypothermia in an adult bed.

Methods

Eleven semi-structured interviews were conducted with specialist nurses working in the neonatal intensive care unit at a university hospital in Sweden. These interviews were analysed with thematic content analysis.

Findings

Nurses had a positive attitude towards caring for full-term infants receiving TH in adult beds. They observed benefits for parent-infant bonding, strengthened parental roles, and increased parental involvement. However, they also pointed out challenges, such as ergonomic issues with equipment not designed for this care setting.

Conclusion

Specialist nurses were positive about caring for full-term infants undergoing therapeutic hypothermia in adult beds. It seemed to benefit infant- and family-centred care and could, according to the nurses, contribute to increased parental presence. However, there were workplace-related aspects that could complicate the healthcare staff's work.

Skin-to-skin care (SSC) is essential, can help to prevent separation of parents and the neonate in the NICU, and should be a standard practice. It can safely be integrated into the routine care of preterm neonates, those who require surgery, and those who require all levels of intensive care. Years of experience with the provision of SSC in our NICU influenced our approach to care and resulted in practice guidelines for the safe provision of SSC. In this article, we present our clinical practical guidelines that support SSC and closeness between parents and the neonate to ensure the use of these practices for all neonates in the NICU.

Introduction In Europe, disparities exist in having access to optimal neonatal care. With the European Standards of Care for Newborn Health (ESCNH), evidence-based reference standards are available which provide guidance to improve the care for preterm and ill newborns. To support healthcare professionals (HCPs) and hospital/clinic management in identifying the extent of ESCNH implementation, a feasible assessment tool is required. Such a tool should help identify areas in need of improvement and provide clear recommendations for action. We aim to develop a digital self-assessment tool for HCPs to detect the local level of ESCNH fulfilment and identify areas in need of improvement, and thus provide recommendations for action.

Methods and analysis The self-assessment tool will have the form of a digital questionnaire with condensed ESCNH content. A Project Expert Group provides scientific input. With pretesting among HCPs, a template of a questionnaire section is evaluated and adapted accordingly. The subsequently developed full questionnaire will be appraised within a two-round eDelphi survey by at least 50 invited HCPs. Statements and formulations need to be accepted by at least 80% of participants. The remaining discrepancies will be solved in a final workshop. The resulting digital self-assessment tool (SAT) will be translated into several languages and evaluated in a pilot-testing among at least 20 hospitals/clinics across Europe.

Conclusion With the self-reflection through the SAT, HCPs, hospital/clinic managers, policymakers and other stakeholders will receive feedback on the conformity with the ESCNH and guidance for improvement.

Trial registration number NCT06379828.

Aim: While skin-to-skin care (SSC) early after birth has been demonstrated to promote many benefits in very preterm infants, including thermal stability, less is known about its feasibility in infants born extremely preterm. We aimed to evaluate our practice of initiating SSC in the 1 week of life also in the most immature infants, those born at less than 24 weeks gestation.

Methods: Retrospective chart review of all inborn infants with a gestational age (GA) of 22+0-23+6 weeks, during a 5-year period (2015-2019) at Uppsala University Hospital, Sweden.

Results: Out of 57 infants, 43 infants (GA 23⁺¹±0.5 weeks; birth weight 520±75 g) had their first SSC in the 1 week of life, at a median (IQR) age of 4 (3; 5) days, when most infants were still receiving mechanical ventilation (93%) and had umbilical catheters (63%). SSC duration was 128±74 min. Significant hypothermia (< 36.0°) occurred in 2/43 (5%). 72% survived.

Conclusions: In our practice, skin-to-skin care in the 1 week of life is feasible, and in this retrospective study, few infants (5%) experienced hypothermia. Further improvements in the SSC procedure could be expected to further minimise the risk of hypothermia.