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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., Competing Interests: Competing interests: The authors have no competing interests. Ethics approval and consent to participate: Ethical approval was provided by the Swedish Ethical Review Authority (Dnr: 2020-05500) and written consent was collected by all participants. Patient consent was not required., (© 2024. The Author(s).)

Aim: We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units., Methods: Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments., Results: We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay., Conclusion: Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge., (© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized., (© 2023. The Author(s).)

Background: Involving parents in decisions about the care of their infant is common practice in most neonatal intensive care units. However, involvement is less common in neonatal research and a gap appears to exist in understanding the process of patient and public involvement. The aim of this study was to explore parents and researchers' experiences of patient and public involvement in a neonatal research project. Methods: A qualitative design was employed, consisting of two focus group interviews, one dyadic interview, and four individual interviews with parents and researchers. The interviews followed a semi-structured guide specific to both parents and researchers. Data were analysed using content analysis as described by Graneheim and Lundman. Results: A total of nine parents and four researchers participated in the study. Seven themes were consolidated into three core concepts: Embracing the ethos and pathos of patient and public involvement, Finding the path to maximise meaningful involvement, and Becoming skilled in engaging patients and the public in research. The core concepts highlighted both similarities and differences, as well as challenges and facilitators, of the experiences of the patient and public involvement process. Conclusion: Patient and public involvement in research was a mutually beneficial process, facilitating learning and reflective opportunities for parents and researchers. However, there were challenges that emphasised the need for rapport building between parents and researchers, valuing everyone's unique perspective and expertise, with clear communication and well-defined roles and goals. These insights offer a contribution for future patient and public involvement in health research. Plain English summary: It is usual practice to involve parents in decisions about their babies care in neonatal intensive care units, but their involvement in research is less common. Although patient and public involvement in research is increasing, there is a lack of strategies to ensure meaningful involvement. This qualitative study used interviews, to explore how parents and researchers experienced patient and public involvement in a research project about couplet care in a neonatal intensive care unit. Nine parents and four researchers participated and the analysis revealed several themes that describes their experiences. These themes were consolidated into three main concepts: (1) Embracing the ethos and pathos of patient and public involvement, which focuses on the emotional and ethical aspects of involvement, (2) Finding the path to maximize meaningful involvement, which addresses the strategies and methods to ensure effective involvement, and (3) Becoming skilled in engaging patient and the public in research, which emphasizes the need for developing skills and knowledge for better involvement practices. These core concepts provide a comprehensive understanding of how to enhance involvement, not only in the neonatal setting, but research in general. [ABSTRACT FROM AUTHOR]

Background/Objectives: Long hospitalisation has been recognized as an independent risk factor for poor neurodevelopmental outcomes of preterm infants. Systematic training and early inclusion of parents in their preterm infant's care is a strategy to shorten the length of hospital stay. We implemented an enhanced stepwise family-centred care program and assessed its effects on postmenstrual age (PMA) at discharge and parental satisfaction. Methods: This prospective single-centre longitudinal cohort study was carried out in a German level III neonatal unit from October 2020 to May 2023. Five consecutive 6-month cohorts (1 baseline and 4 intervention cohorts, 169 infants and their caregivers) were analysed. Results: Mean PMA at discharge did not change in the total cohort but declined significantly in patients without neonatal morbidities from baseline to cohort 4 (37.2 ± 1.4 to 36.1 ± 1.6 weeks; p = 0.036). Concomitantly, discharge with tube feeding raised from 2.4% to 74.1% (p < 0.001) and discharge with home monitoring raised from 9.8% to 74.1% (p < 0.001), while unplanned readmissions remained unchanged (p = 0.44). Parental satisfaction with time point of discharge increased non-significantly from baseline to cohort 4 (75.8% vs. 95.7%; Chi2 0.22). Conclusions: Discharge of preterm infants at a significantly lower PMA is feasible through enhancement of family-centred care and is very well accepted by parents. [ABSTRACT FROM AUTHOR]

Background: In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every “small and sick” newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28  days. New perspectives: The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be “normal” (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is “normal,” keeping newborns with their mothers is the infant’s physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC. Actionable recommendations: This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units. Discussion: The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of couplet care on parent-infant closeness among preterm infants., Methods: A comparison study in a Level III neonatal intensive care unit (NICU) before and after the introduction of couplet care, including stabilising infants in the delivery unit for early skin-to-skin contact, providing mothers' postpartum care in the infant's room and providing the father's bed in the infant's room. The study included parents of preterm infants born below 35 weeks., Results: Parents of 40 and 66 infants were included before and after couplet care was introduced, respectively. In the linear regression model, the first skin-to-skin contact happened significantly earlier after the introduction than before: mean 4.0 vs. 24.0 h after birth and mean difference -18.5 (95% confidence interval -34.8 to -2.1). A larger proportion of infants received their first skin-to-skin contact within 2 h after birth after the introduction than before (45.5% vs. 8.6%; odds ratio 13.8 [3.6-62.8]). At least one parent was present in the infant's NICU room longer after the introduction than before (mean 21.2 vs. 10.8 h per day; mean difference 10.8 [9.1-12.4])., Conclusion: Couplet care significantly increased parent-infant closeness during the first weeks of life., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: The aim of this study is to evaluate an early discharge programme with video consultations for preterm infants., Methods: A homecare programme for preterm infants was developed. Prospective data on readmissions, length of stay, growth, breastfeeding rates, and parent self-reports about satisfaction were collected from April 2021 to August 2023. Additionally, retrospective data were collected from the Norwegian Neonatal Network Central Database from 2020., Results: Preterm infants, 72 and parents, 128 were included. The infants were discharged from the hospital at a median of 35 + 6 (34 + 0-42 + 4) weeks postmenstrual age. The median length of stay in the program was 18 days (3-37). There were four readmissions. The Z-score of infant weight slightly increased during the follow up, with a mean of 0.16. By discharge, 75% of the infants were exclusively breastfed. Growth and breastfeeding rates were in line with retrospective data (85 infants). The response rate of the parents to the survey was 61 (52%). Overall, the parents (n = 54) were highly satisfied (96%). The video consultations contributed to ensuring parents to feel safe in caring for their infant at home., Conclusion: Follow up by video consultations is a viable healthcare service for preterm infants, the infants' growth is sufficient, breastfeeding rates are maintained, and parents feel safe and satisfied., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

This article from Acta Paediatrica highlights several important topics in pediatric healthcare. The first topic discusses the wide variations in discharge practices for very preterm infants in the Nordic countries. A survey found that there were differences in the preparations and criteria for discharging these infants, both between and within countries. However, most physicians favored early discharge, believing that the home environment was best for growth, breastfeeding, and empowering parents. Another topic addresses the issue of clinicians missing critical congenital heart defects in newborn infants. A Norwegian study found that while most infants with severe congenital heart diseases were identified before discharge, some were still sent home undiagnosed. The study suggests ways to improve screening for these conditions. The article also explores the potential role of paracetamol in a recent outbreak of pediatric severe acute hepatitis. The authors suggest that paracetamol, when used during infections, may have put patients at a higher risk of hepatotoxicity. Finally, the article discusses a study that found Taiwanese mothers used a wider range of words and talked more to their children when reading books compared to playing with toys. This study also found that diverse maternal vocabulary positively influenced the number of different words the children used at 18 months of age. The article concludes with a case report on unexplained hypernatraemia and the need for assessment tools and a registry of cases covering salt poisoning in children. [Extracted from the article]