The clinical stakes are considerable. Umbilical catheters provide direct access to the central circulation of a newborn in the first days of life, a period when peripheral veins are tiny, fragile, and often inadequate for the concentrated nutrition and vasoactive drugs that preterm and critically ill infants require. The umbilical vein offers a route to the inferior vena cava and the right atrium, while the umbilical arteries allow monitoring of blood gases and blood pressure and continuous infusion of medications. But the same anatomical shortcuts that make these devices so useful also make them dangerous when they are misplaced. A venous catheter that stops short of the inferior vena cava can deliver hypertonic fluid directly into the portal circulation of the liver, causing tissue damage, thrombosis, or even hepatic necrosis. An arterial catheter positioned too high or too low can compromise blood flow to the spinal cord, the intestines, or the lower limbs.

The new recommendation emphasizes that the risks are not hypothetical. Recent systematic reviews and meta-analysis cited by the working group document a substantial burden of adverse events associated with umbilical vascular catheters, including bloodstream infections, thrombosis of the portal venous system, hepatic injury from inadvertent infusion of parenteral nutrition into liver parenchyma, and catheter malposition. One retrospective study published in 2025 specifically examined the pursuit of zero central line-associated bloodstream infections in umbilical catheterization, underscoring that these infections are largely preventable with rigorous insertion and maintenance bundles. A risk prediction model developed by Australian researchers further highlights that adverse events are frequent enough, and predictable enough, to warrant systematic prevention strategies rather than case-by-case vigilance.

At the heart of the recommendation is a call for standardized protocols covering three distinct phases of catheter management: assessment before insertion, the insertion procedure itself, and post-insertion evaluation of catheter tip position. The authors argue that each phase contains critical decision points where deviation from best practice compounds risk. Before insertion, clinicians must assess whether an umbilical catheter is truly the most appropriate vascular access device for the infant’s expected needs and duration of therapy, drawing on structured decision-making tools such as the neonatal device-expert algorithm previously developed by members of the same group. The recommendation aligns with the nomenclature established by the Navigate project, a global position statement that created a common vocabulary for vascular access devices, in part because inconsistent terminology has historically made it difficult to compare evidence and practices across centers.

The insertion phase receives particularly detailed attention. The recommendation describes a technique in which the catheter is advanced under controlled conditions with attention to asepsis, pain management, and securement. Procedural pain in neonates is a recognized concern, and the authors point to established guidelines for procedural pain management in newborns as an integral component of any catheterization. Skin antisepsis is another technical focus. The document reviews the evidence comparing aqueous 2 percent chlorhexidine gluconate with 2 percent chlorhexidine gluconate in 70 percent isopropyl alcohol, noting recent studies in moderate and extremely preterm infants suggesting that the alcohol-based preparation is safe after the first week of life and may be associated with a reduced incidence of catheter-related bloodstream infections. A randomized feasibility trial known as the Arctic trial, together with a Cochrane review of antiseptic solutions for central catheter insertion in neonates, informs this guidance, and national surveys of neonatal practice in Italy reveal how rapidly adoption of alcohol-based chlorhexidine has been spreading.

Perhaps the most consequential technical shift endorsed by the recommendation concerns how clinicians confirm that the catheter tip has reached its intended destination. For decades, the default method has been a plain chest and abdominal radiograph obtained after insertion, with the clinician estimating tip position relative to vertebral bodies and cardiac silhouette. The recommendation now champions ultrasound-based tip navigation and tip location, performed in real time during insertion. Structured protocols such as Neo-Echotip, developed for central venous access devices in neonates, allow the operator to watch the catheter advance and to verify the tip position immediately, adjusting depth before securing the device. Recent retrospective data indicate that real-time ultrasound tip location reduces both malposition and radiation exposure during umbilical venous catheter placement, since a correctly placed catheter on the first attempt eliminates the need for repeat radiographs and repositioning procedures.

The evidence base for ultrasound guidance has been accumulating steadily. Prospective studies have used ultrasound to track umbilical venous catheter migration in preterm infants over time, revealing that catheters move as the infant grows and as abdominal pressure changes, a phenomenon with direct implications for how often tip position should be rechecked. Other work has demonstrated that aligning the catheter with the umbilical vein and the ductus venosus under ultrasound guidance improves the likelihood of reaching the ideal central position. Comparative studies of low-lying versus centrally positioned umbilical venous catheters have found higher complication rates when the tip remains in the portal system, reinforcing the argument that precise, verified central placement should be the standard of care rather than an aspiration. An Italian expert consensus on tip location methods for central venous access devices, published in 2026, further consolidates the case for intracavitary electrocardiography and ultrasound as complementary or alternative tools to radiography.

Securement and maintenance form the third pillar of the recommendation. Even a perfectly positioned catheter can migrate, and radiographic assessments of catheter movement over time show that displacement is common in the days following insertion. The recommendation addresses this with guidance on securement techniques, including the use of cyanoacrylate glue, which was evaluated in a randomized controlled trial for umbilical venous catheter securement, and transparent semipermeable dressings, whose moisture vapor transmission properties have been the subject of comparative testing. The authors also draw on infection prevention frameworks, including the Infusion Therapy Standards of Practice, the Epic3 national guidelines from England, and the SHEA neonatal intensive care unit white paper series on preventing central line-associated bloodstream infections, to define how catheters should be handled, accessed, and monitored throughout their dwell time.

For umbilical arterial catheters specifically, the recommendation revisits a long-standing debate about optimal tip position, informed by the Cochrane review originally conducted by Keith Barrington, which compared high-lying catheters positioned above the diaphragm with low-lying catheters below the renal arteries. The working group also acknowledges innovative adaptations, such as the off-label use of peripherally inserted central catheters as umbilical arterial catheters reported in a clinical case series, reflecting the resourcefulness of neonatal teams when conventional devices are unavailable. The broader context for the recommendation is a series of structured insertion bundles developed by the same network, including the SIUVEC protocol for safe insertion of umbilical venous catheters and the SIECC protocol for epicutaneo-cava catheters, both of which were designed to minimize complications during placement and management, and a prospective study of a bundle for central venous catheterization in neonates and children covering more than 700 cases.

The authors, led by Fiammetta Piersigilli of Cliniques Saint Luc and the University of Louvain in Brussels and Robin van der Lee of Radboudumc Amalia Children’s Hospital in Nijmegen, stress that the recommendation is the product of a multidisciplinary consensus spanning neonatologists, nurses, anesthesiologists, and vascular access specialists across Europe, with contributions from the European Foundation for the Care of Newborn Infants and the Global Foundation for the Care of Newborn Infants. The work received no external funding, and the authors declare no competing interests. As the second installment in a ten-part series, the document signals a broader ambition: to bring the same rigor to every vascular access device in the neonatal unit that infection prevention campaigns brought to hand hygiene a generation ago. If the recommendation achieves its stated goals, the routine, verifiable, ultrasound-guided placement of umbilical catheters could become as standard in neonatal care as the devices themselves, turning one of intensive care’s most useful tools into a demonstrably safer one for the smallest patients.

Subject of Research: Standardized management of umbilical venous and arterial catheters in neonatal intensive care

Article Title: Management of umbilical venous and arterial catheter: Neonatal European Vascular Access Team- ESPR Recommendation 2

Article References: Management of umbilical venous and arterial catheter: Neonatal European Vascular Access Team- ESPR Recommendation 2. (n.d.). https://doi.org/10.1038/s41390-026-05465-8

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05465-8

Keywords: umbilical venous catheter, umbilical arterial catheter, neonatal intensive care, NEVAT, ESPR, ultrasound tip location, catheter malposition, central line-associated bloodstream infection, chlorhexidine skin antisepsis, neonate, vascular access, clinical recommendation

The new document, published in the journal Pediatric Research, is the fifth in a series of ten recommendations developed jointly by the Neonatal European Vascular Access Team, known as NEVAT, and the Pediatric and Neonatal Vascular Access Special Interest Group of the European Society for Pediatric Research, or ESPR. Led by Matheus van Rens and Robin van der Lee of Radboud University Medical Center in the Netherlands, together with an international consortium of neonatologists, nurses, anesthetists, and vascular access experts spanning institutions from Brescia to Brussels, London to Sofia, the recommendation tackles a deceptively simple question: how should clinicians manage the humble peripheral intravenous cannula in a newborn? The answer, the authors argue, demands a complete shift in mindset, away from tradition and toward structured, individualized vascular access planning.

The scale of the problem is striking. Vascular access is, as the authors describe it, a pervasive facet of contemporary neonatal practice, yet it lacks standardization, and some common practices simply lack supporting evidence. Peripheral catheters in neonates fail at notoriously high rates, with complications such as infiltration, in which infused fluid leaks into surrounding tissue, and extravasation, in which vesicant medications escape the vein and can cause devastating skin and tissue injury. A multicenter observational study cited in the recommendation documented substantial complication rates in neonatal peripheral cannulation, and retrospective cohort work from the same Dutch group, including the ABBA project, which stands for Assess Better Before Access, has catalogued the device outcomes and modifiable risk factors that drive those failures. Each failed catheter means another painful puncture attempt, another delay in therapy, and another source of stress for fragile infants and their families.

What makes the new recommendation novel is its integration of three pillars: advanced visualization technology, standardized assessment protocols, and modern securement strategies. On the technology front, the authors highlight the growing role of near-infrared light devices, which project an image of subcutaneous veins onto the skin, making otherwise invisible vessels easier to target. Cross-sectional research in a level III neonatal intensive care unit evaluated the efficiency of such systems for peripheral cannulation, and a 2024 meta-analysis of randomized controlled trials examined the effectiveness of near-infrared light devices for venous cannulation in children and adolescents. Ultrasound, too, features prominently, building on prior work that systematically mapped the diameter of deep veins in newborns and on international evidence-based recommendations for ultrasound-guided vascular access. The message is clear: in the smallest patients, seeing the target before you puncture it is no longer a luxury but a standard of care.

Equally important is the recommendation’s embrace of structured pre-procedural assessment. The document incorporates a protocol known as RaSuVA, short for Rapid Superficial Vein Assessment, a systematic pre-procedural evaluation of superficial veins designed to optimize venous catheterization in neonates. Rather than choosing an insertion site on the basis of convenience or habit, clinicians are encouraged to survey the available vasculature deliberately, matching the characteristics of the vein to the intended therapy and the expected duration of treatment. This individualized planning represents a philosophical departure from the one-size-fits-all approach that has historically dominated neonatal units, where the first accessible vein often won by default regardless of whether it was the right vessel for the job.

The recommendation also draws on the broader ERPIUP consensus, a European set of recommendations on the proper indication and use of peripheral venous access devices developed under the WOCOW project, as well as the ninth edition of the Infusion Therapy Standards of Practice, the most widely recognized reference framework in infusion nursing. By anchoring neonatal-specific guidance within these established international standards, the authors ensure that the care of a two-kilogram infant in Rotterdam or Rimini aligns with the same evidence base that governs adult vascular access worldwide, while respecting the unique anatomy, skin fragility, and developmental needs of newborns.

Securement and dressing strategies receive particularly detailed attention, and here the science has moved rapidly in recent years. Tissue adhesive, specifically octyl-butyl-cyanoacrylate glue, has emerged as a sutureless method of anchoring catheters, and retrospective observational studies in neonatal populations have evaluated its use for securing peripheral intravenous catheters. Related work has documented a decade of clinical experience with cyanoacrylate glue for venous access in a large university hospital, demonstrated its safety for securing epicutaneo-caval catheters in neonates, and, crucially, established safe and effective techniques for removing the adhesive without injuring fragile neonatal skin. The recommendation also weighs the properties of transparent semipermeable membranes, including their moisture-vapor transmission characteristics, against the documented risk of medical adhesive-related skin injuries in neonatal departments, a real concern given that the stratum corneum of a premature infant is thinner and more permeable than that of an adult.

Surveillance and early detection of complications form another pillar of the document. The authors cite research on the risks of peripheral intravenous therapy infiltration and extravasation, known by the acronym PIVIE, and on the potential for earlier notification of such events using novel sensor technology in a neonatal population. Complementary work has explored optical detection of infiltration during peripheral infusion in neonates, suggesting a future in which smart dressings and continuous monitoring could alert clinicians to a failing catheter before visible swelling appears. The recommendation also addresses the choice of catheter material and gauge, drawing on studies of how peripheral catheter type and material affect therapy failure in neonates, and considers the emerging role of long peripheral catheters as a middle ground between short peripheral cannulas and epicutaneous-caval central catheters.

Infection prevention and skin antisepsis round out the technical scope. The recommendation situates peripheral access within the broader context of strategies to prevent central line-associated bloodstream infections in acute-care hospitals and practical neonatal intensive care approaches to the same problem, while acknowledging the nuances of antiseptic selection in newborns. Research comparing 2 percent chlorhexidine gluconate in 70 percent isopropyl alcohol for skin disinfection during catheter insertion in premature neonates, alongside a Cochrane systematic review of antiseptic solutions for neonatal central catheter insertion, underscores both the promise and the caution required, since some antiseptic agents carry toxicity concerns in the smallest infants. Even family-centered care makes an appearance: a Dutch case report describes maintaining parent-infant skin-to-skin contact during peripheral catheter insertion, a reminder that technical excellence and developmental care need not be adversaries.

By shifting from habit-driven decisions to individualized vascular access planning, the ESPR and NEVAT consortium has set what its members describe as a new standard for safer, more effective neonatal intravenous therapy. The work was not externally funded, and the authors declare no competing interests, lending weight to its conclusions. For clinicians, the practical takeaways are concrete: assess the veins systematically before every insertion, use visualization technology where available, secure catheters with modern adhesives and dressings chosen for neonatal skin, monitor vigilantly for infiltration, and remove or replace devices based on clinical indication rather than arbitrary routine. For parents, the promise is subtler but no less profound: fewer failed attempts, fewer painful procedures, and a lower risk of the tissue injuries that can scar a child for life. In a field where the patients cannot speak and their veins are measured in fractions of a millimeter, that quiet revolution may prove to be one of the most consequential advances in neonatal care this decade.

Subject of Research: Evidence-based management of peripheral venous access devices in neonatal intensive care

Article Title: Management of Peripheral Venous Access Devices (PVADs): Neonatal European Vascular Access Team – ESPR recommendation 5

Article References: van Rens, M., van der Lee, R., van den Hoogen, A., Rodriguez-Perez, C., Piersigilli, F., Mader, S., Geiger, I., Barone, G., Van Eenoo, S., Hugill, K., on behalf of the Pediatric and Neonatal Vascular Access Special Interest Group (SIG) of the European Society for Pediatric Research (ESPR) and Neonatal European Vascular Access Team (NEVAT), van Rens, M., Van Der Lee, R., van den Hoogen, A., Barone, G., van Eenoo, S., Hugill, K., Breschan, C., Pittiruti, M., … Tuna, M. L. (2026). Management of Peripheral Venous Access Devices (PVADs): Neonatal European Vascular Access Team – ESPR recommendation 5. Pediatric Research. https://doi.org/10.1038/s41390-026-05462-x

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05462-x

Keywords: neonatology, vascular access, peripheral venous catheters, ESPR, NEVAT, near-infrared vein imaging, cyanoacrylate glue, extravasation, RaSuVA, infusion therapy standards, neonatal intensive care, clinical recommendations

The recommendation comes from the Pediatric and Neonatal Vascular Access Special Interest Group of the ESPR, working alongside NEVAT, a European network dedicated to vascular access care. The author group, led by Matheus van Rens and Robin van der Lee of Radboudumc Amalia Children’s Hospital in Nijmegen, the Netherlands, includes neonatologists, nurses and vascular access experts from institutions across the Netherlands, Belgium, Italy, Austria, the United Kingdom, France, Portugal, Spain, Bulgaria and beyond, with international contributors such as Yogen Singh of the University of California Davis Children’s Hospital. Their stated goal is deceptively simple: ensure that the right vascular access device is chosen from the very start of therapy, rather than discovered through a process of trial and error at the patient’s bedside.

The clinical problem the VAMP addresses is well documented in the authors’ own prior work. In the ABBA project, short for Assess Better before Access, a retrospective cohort study of neonatal intravascular device outcomes published in Frontiers in Pediatrics in 2022, the group catalogued how frequently neonatal vascular access devices fail before therapy is complete. Peripheral intravenous catheters in newborns are notoriously short-lived, and repeated replacement attempts mean repeated needle sticks, repeated pain and repeated exposure to complications. Research cited by the group, including a 2023 study in the Journal of Vascular Access examining how catheter type and material affect therapy failure in neonates, underscores that even the physical properties of the device matter in this population, whose veins may be smaller than a millimeter in diameter.

The stakes extend beyond immediate mechanical failure. Neonatal sepsis, which can be triggered by catheter-associated bloodstream infections, has been linked in a 2024 systematic review and meta-analysis in BMC Pediatrics to adverse neurocognitive outcomes later in life. Pain experienced in the first days and weeks of life is likewise not a transient concern; a 2020 review in Frontiers in Pediatrics by Williams and Lascelles summarized clinical and experimental evidence that early neonatal pain can have lasting implications for painful conditions later in life. In other words, every unnecessary needle stick and every preventable catheter infection is not merely an acute event but a potential contributor to long-term developmental burden. This is why the VAMP authors frame vascular access decision-making as a neuroprotective issue, a theme they developed further in a 2025 patient-centered framework based on the 7-Rights concept published in Pediatric Research.

Technically, the VAMP functions as a structured, patient-centered decision pathway, presented by the authors as a flow diagram that guides clinicians through the assessment of an individual newborn’s veins, the expected duration and type of therapy, and the characteristics of available devices before any needle is inserted. The approach draws on a growing body of standardized pre-procedural assessment protocols. Among these is the Rapid Superficial Vein Assessment, or RaSuVa, described by D’Andrea and colleagues in 2024 as a systematic pre-procedural evaluation of superficial veins to optimize venous catheterization in neonates. Similar systematic ultrasound protocols exist for deeper vessels: the Rapid Central Vein Assessment, or RaCeVa, published by Spencer and Pittiruti in 2019, and the Rapid Femoral Vein Assessment, or RaFeVa, described by Brescia and colleagues in 2021, both of which standardize ultrasound evaluation before central catheterization. The VAMP embeds this assessment-first philosophy into routine neonatal practice.

The framework also builds on and harmonizes existing consensus documents rather than replacing them. The authors position VAMP alongside the neonatal DAV-expert algorithm, a GAVeCeLT/GAVePed consensus published in the European Journal of Pediatrics in 2023 for choosing the most appropriate venous access in newborns, and the ERPIUP consensus on the proper indication and use of peripheral venous access devices, a WoCoVA project published in the Journal of Vascular Access. Other reference points include the UK Vessel Health and Preservation framework updated in 2020, the miniMAGIC appropriateness guide for intravenous catheters in pediatrics published in Pediatrics in 2020, the Infusion Therapy Standards of Practice ninth edition from 2024, and the NANN neonatal peripherally inserted central catheter guideline for practice in its fourth edition. By synthesizing these sources into a single European recommendation, the ESPR group aims to reduce the fragmentation that currently produces wide variation in practice between units and countries.

Insertion technique and device maintenance form a second pillar of the plan. The recommendation references novel insertion bundles developed by Italian collaborators, including the SIUVeC protocol for safe insertion of umbilical venous catheters and the SIECC protocol for epicutaneo-cava catheters, both designed to minimize placement and management complications, as well as the SIC seven-step strategy for centrally inserted central catheters. Once a device is in place, the plan emphasizes evidence-based securement and site care, drawing on trials of cyanoacrylate glue as part of bundles to decrease neonatal PICC-related complications and to secure umbilical venous catheters, and on experience with dialkylcarbamoylchloride dressings at catheter exit sites in pediatric and neonatal populations. Care bundles of this kind have already been shown in a 2018 systematic review and meta-analysis in Archives of Disease in Childhood to reduce central line-associated bloodstream infections in neonatal units, and the SHEA NICU white paper series from 2023 offers practical approaches to the same goal.

Two technological themes run through the recommendation with particular force. The first is point-of-care ultrasound, which the authors describe as central to modern neonatal vascular access, from pre-procedural vein mapping to real-time guidance during insertion. A 2024 review in the European Journal of Pediatrics by Pittiruti, Annetta and D’Andrea summarized the role of ultrasound for vascular access in neonates and children, and a 2023 systematic review and meta-analysis in Diagnostics examined the role of ultrasound specifically in epicutaneo-caval catheter insertion. A related narrative review from 2025 weighs intracavitary electrocardiography against real-time ultrasound for tip navigation and tip location of central venous access devices in the neonate, a question also addressed in a 2025 Italian expert consensus on tip location methods. The second theme is standardization itself: the VAMP’s authors contend that a uniform, reproducible method, applied by every clinician on every shift, is what converts scattered best practices into reliable outcomes.

Notably, the recommendation also extends beyond the technical to the human. The framework incorporates family-centered principles, citing recent work on family integrated care in Acta Paediatrica, a 2024 study in Advances in Neonatal Care on family management skills reported by parents of preterm infants, and a 2025 nonrandomized clinical trial in JAMA Network Open on outcomes following close collaboration with parents interventions in neonatal intensive care units. Pain assessment and management in preterm infants, summarized in a 2022 practice update in Children, are likewise woven into the plan, reflecting the view that vascular access decisions should minimize discomfort as well as complications. The involvement of the European Foundation for the Care of Newborn Infants and the Global Foundation for the Care of Newborn Infants, acknowledged by the authors for contributions and critical readings of earlier drafts, signals that parent perspectives were part of the drafting process itself.

The authors state that proper use of the VAMP ensures choosing the right vascular access device from the start of therapy, that the method offers a structured and patient-centered approach, that its implementation ensures more uniform practice regarding vascular access in neonates, and that it has the potential to greatly decrease the number of vascular access-related complications in this population. As the first in what the group describes as a ten-recommendation project, VAMP represents the opening move of a coordinated European effort to professionalize neonatal vascular access in the way that adult vascular access care has been professionalized over the past two decades. If the framework achieves its stated aims, the routine insertion of a cannula in a premature newborn could shift from an improvised procedure, repeated until something works, into a planned, ultrasound-informed, family-aware intervention with fewer sticks, fewer infections and fewer of the long-term consequences that follow them. For the smallest patients in intensive care, that shift could matter for a lifetime.

Subject of Research: A structured European recommendation for vascular access device selection and management in neonatal intensive care

Article Title: Vascular access management plan (VAMP): neonatal European vascular access team—ESPR Recommendation 1

Article References: van Rens, M., Hugill, K., Piersigilli, F., Schwaberger, B., Mader, S., Geiger, I., Singh, Y., Ouwehand, T., van den Hoogen, A., Van Eenoo, S., van der Lee, R., on behalf of the Pediatric and Neonatal Vascular Access Special Interest Group (SIG) of the ESPR and NEVAT, van Rens, M., Van Der Lee, R., van den Hoogen, A., Rodriguez-Perez, C., Barone, G., van Eenoo, S., Hugill, K., … Tuna, M. L. (2026). Vascular access management plan (VAMP): neonatal European vascular access team—ESPR Recommendation 1. Pediatric Research. https://doi.org/10.1038/s41390-026-05467-6

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05467-6

Keywords: neonatology, vascular access, VAMP, ESPR, central venous catheters, PICC, ultrasound, neonatal sepsis, care bundles, point-of-care ultrasound, umbilical venous catheter, family integrated care

The introductory paper, published on 17 September 2026, is the work of Fiammetta Piersigilli of Louvain University’s Saint Luc neonatal intensive care unit in Brussels, together with Kevin Hugill, Robin van der Lee, Matheus F. P. T. van Rens, Giovanni Barone, Tobias Werther, Bernhard Schwaberger and Suzy Van Eenoo, writing on behalf of the Pediatric and Neonatal Vascular Access Special Interest Group of the European Society for Paediatric Research (ESPR) and the vascular access network NEVAT. The group spans institutions across Belgium, the Netherlands, Italy, Austria, Portugal, Bulgaria, France, Spain, the United Kingdom and the United States, reflecting a deliberate effort to build recommendations that transcend local custom and national tradition. The authors state plainly that vascular access is a pervasive facet of contemporary neonatal practice that lacks standardization, and that some long-standing practices have never been supported by solid evidence.

The technical challenge at the heart of neonatal vascular access is scale. A peripheral vein in a premature infant weighing 500 grams may be less than a millimeter in diameter, with a wall thinner than a human hair. Inserting a cannula into such a vessel demands extraordinary precision, and even a successful placement can fail within hours if the device is not secured and managed correctly. Peripheral intravenous cannulation, the most common procedure in neonatal care, carries substantial complication rates. A multicenter observational study cited by the authors reported significant rates of infiltration, phlebitis and inadvertent dislodgement in neonates, and subsequent research has identified both unmodifiable factors, such as gestational age and vein characteristics, and potentially modifiable factors, such as securement technique and dressing choice, that shape how long a device survives and how often it fails.

Beyond the mechanical risks, the series highlights a dimension of neonatal care that has gained increasing scientific attention in recent years: the developmental and neurobiological cost of repeated painful procedures. Neonates undergoing intensive care may experience dozens of invasive procedures during their stay, and systematic reviews have linked early procedural pain exposure to adverse developmental outcomes in children born preterm. Researchers have also framed the cumulative stress of intensive care as a form of toxic stress that can alter infant outcomes, making every avoided cannulation attempt and every extended device dwell time a meaningful gain for the developing brain. In this light, vascular access is not merely a technical task but a determinant of long-term neurodevelopment, which is precisely why the authors argue that objective, evidence-based standardization matters so much.

The ten recommendations that structure the special series cover the full lifecycle of a vascular access device, from the moment a clinician decides that one is needed to the moment it is removed. A central theme is that the decision to place a device should be made deliberately rather than reflexively. The authors point to the Abba Project, whose name stands for Assess Better before Access, a retrospective cohort study of neonatal intravascular device outcomes that encouraged teams to evaluate whether a device was truly necessary and which type was most appropriate before any needle touched the skin. Decision-support tools such as the neonatal DAV-Expert algorithm, developed through an Italian consensus process, guide clinicians toward the most suitable venous access for a given newborn, balancing expected duration of therapy, osmolarity and pH of infusates, and the condition of available vessels.

Assessment of the infant’s veins before insertion is another pillar of the recommendations. The Rapid Superficial Vein Assessment protocol, known as RASUVA, provides a structured pre-procedural evaluation of superficial veins to optimize catheterization, reducing the number of failed attempts. Once a device is in place, the series draws on insertion bundles that have demonstrated measurable reductions in complications. These include the SIUVEC protocol for safe insertion of umbilical venous catheters, the SIECC insertion bundle for epicutaneo-caval catheters, the so-called GAVECELT bundle applied to central venous catheterization in neonates and children in a prospective study of more than 700 cases, and the Neo-Echotip protocol, which uses ultrasound for tip navigation and tip location during placement of central venous access devices. Intracavitary electrocardiography, in which the catheter itself is used as an electrode to confirm tip position, offers an alternative to chest radiography for verifying that a catheter tip sits in the correct position, reducing radiation exposure and delays.

Securement and infection prevention receive equally rigorous treatment. Central line-associated bloodstream infections remain among the most feared complications of neonatal intensive care, and quality improvement work has shown that adopting evidence-based care bundles can drive infection rates toward zero. The recommendations also embrace a material innovation that has rapidly entered neonatal practice: cyanoacrylate glue, the same class of medical adhesive used in tissue bonding. Randomized and observational studies have evaluated octyl-butyl-cyanoacrylate glue for sutureless securement of epicutaneo-caval catheters, umbilical venous catheters and peripheral intravenous catheters in neonates, with results suggesting reduced dislodgement and fewer complications compared with traditional adhesive dressings and sutures. Because glue eliminates puncture sites from sutures and creates a microbial seal at the insertion point, it represents a technically elegant solution to one of the most persistent problems in the field.

Standardization also extends to language. The series incorporates the Navigate Project, a position statement from European vascular access societies establishing a common nomenclature for vascular access devices. The authors argue that inconsistent terminology, in which the same device may be called different things in different countries or even different wards of the same hospital, undermines research, benchmarking and safe communication between teams. A shared vocabulary allows complication rates to be compared meaningfully across units and allows evidence generated in one setting to be translated reliably into another. This effort aligns with broader international frameworks, including the Infusion Therapy Standards of Practice, whose ninth edition provides an overarching reference for infusion-related care, and the ERPIUP consensus on the proper indication and use of peripheral venous access devices in adults, whose methodology the neonatal group adapted to its own population.

What makes the series notable is its candor about the limits of the evidence. The authors emphasize that the recommendations consolidate existing knowledge and consensus rather than presenting definitive trial data, and they explicitly frame the series as a means of highlighting priorities for further research to address gaps in knowledge. Many practices in neonatal vascular access have evolved through apprenticeship and habit rather than randomized evidence, and the ten recommendations are as much a research agenda as a clinical guideline. By naming where the evidence is thin, the group hopes to direct future studies toward the questions that matter most for outcomes, from optimal dwell times to the long-term developmental impact of procedural pain.

For clinicians, the practical message is that objective standardization of neonatal vascular access is achievable now, with tools that already exist. For the smallest patients, whose veins are fragile and whose developing brains are exquisitely sensitive to stress, the stakes of getting this right could hardly be higher. If the series succeeds in bridging practice gaps and supporting evidence-based standardization across neonatal units worldwide, it may quietly transform one of the most routine yet consequential procedures in medicine, turning an area long governed by individual habit into one governed by shared, scrutinized and continually improved evidence.

Subject of Research: Standardization of neonatal vascular access through international expert consensus recommendations

Article Title: Introduction to the special article series to guide neonatal vascular access

Article References: Piersigilli, F., Hugill, K., van der Lee, R., van Rens, M. F. P. T., Barone, G., Werther, T., Schwaberger, B., Van Eenoo, S., on behalf of the Pediatric and Neonatal Vascular Access SIG of the ESPR and NEVAT, Van Der Lee, R., van Rens, M., van Eenoo, S., van den Hoogen, A., Rodriguez-Perez, C., Breschan, C., Pittiruti, M., Oulego-Erroz, I., Ouwehand, T., Debuf, M.-J., … Tuna, M. L. (2026). Introduction to the special article series to guide neonatal vascular access. Pediatric Research. https://doi.org/10.1038/s41390-026-05468-5

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05468-5

Keywords: neonatal vascular access, Pediatric Research, clinical consensus, central venous catheters, peripheral intravenous cannulation, cyanoacrylate glue, ultrasound guidance, catheter-related bloodstream infection, neonatal pain, ESPR, NEVAT, patient safety

Intra-arterial catheters, or IACs, are thin tubes placed directly into peripheral arteries, most commonly the radial artery at the wrist or the posterior tibial artery at the ankle. Once in place, they allow beat-to-beat blood pressure monitoring and painless blood sampling, sparing fragile infants the repeated needle punctures that would otherwise be required. The new recommendation emphasizes that the value of these devices comes with real risks: arterial lines can cause ischemia, infection, bleeding, and injury to delicate neonatal vessels and surrounding nerves. Because premature infants may weigh less than a kilogram and have arteries with internal diameters of well under a millimeter, the technical margin for error is extraordinarily narrow. The authors argue that this combination of high stakes and high variability is precisely why a standardized, evidence-based approach is overdue.

A central technical theme of the recommendation is the use of ultrasound guidance during insertion. Traditional arterial cannulation relies on palpation, feeling the pulse and advancing the needle blindly toward it. In neonates, whose vessels are tiny, mobile, and easily compressed by the palpating finger, this approach frequently fails and can traumatize the vessel. Recent studies cited by the panel, including retrospective observational work on real-time ultrasound-guided peripheral arterial cannulation in infants and case series demonstrating success even in very low birth weight infants who are conventionally considered difficult to cannulate, show that ultrasound dramatically improves first-pass success. A 2023 Cochrane systematic review of ultrasound-guided arterial cannulation in children supports the technique’s advantages, and dedicated protocols such as the Safe Insertion of Arterial Catheters approach have been developed specifically to minimize complications by combining ultrasound imaging with structured technique.

The recommendation also addresses the choice of insertion site, which is far from trivial. The radial artery of the forearm remains the most common target, but the panel reviews the vascular anatomy of the limb in detail, noting that collateral circulation, the backup blood supply that keeps tissue alive if the cannulated artery occludes, must be adequate before a line is placed. The ulnar artery has been proposed as an alternative cannulation site in neonates, and the posterior tibial artery offers another option for lower-limb access. Femoral artery catheterization, by contrast, is treated with considerable caution. Although some cohort studies have reported acceptable outcomes, published cases of limb length shortening associated with femoral arterial lines in the neonatal period highlight the potential for long-term harm when a major vessel supplying a growing leg is compromised. The guidance therefore steers clinicians toward peripheral sites with robust collateral flow whenever clinically feasible.

Catheter selection itself receives technical attention. Ultrasound can be used not only to guide the needle but also to measure the cross-sectional internal diameter of the target artery before cannulation, allowing clinicians to match catheter size to vessel size. Oversized catheters are thought to increase the risk of flow obstruction and ischemic injury, while undersized catheters may kink or fail to transmit accurate pressure waveforms. The recommendation draws on studies of distal radial artery diameter in neonates and infants to support this measurement-based approach, embedding it within the broader vessel health and preservation framework that underpins the whole series: choose the right device, for the right patient, at the right time, and preserve the vasculature for future needs.

Once the catheter is in place, securement becomes the next battleground for standardization. The panel reviews the evidence on transparent semipermeable membranes, including comparative studies of their moisture-vapor transmission properties, and on medical adhesive-related skin injuries, which are a documented hazard in neonatology where the stratum corneum of premature skin is paper-thin. Tissue adhesives such as octyl-butyl-cyanoacrylate glue, already studied for securing peripheral intravenous catheters in neonates, and dialkylcarbamoylchloride-impregnated dressings used at catheter exit sites are discussed as part of a modern securement toolkit. Limb fixation technique is another practical focus: the recommendation describes positioning and splinting methods for both upper and lower limbs that keep the catheter functional without immobilizing the joint so rigidly that circulation or skin integrity is compromised. The goal is a line that stays put, stays patent, and does not injure the skin it crosses.

Perhaps the most striking pharmacological element of the guidance concerns topical nitroglycerin. Arterial spasm is a common reason that cannulation attempts fail and a suspected contributor to ischemic complications after lines are placed. A systematic review and meta-analysis published in Archives of Disease in Childhood found that local nitroglycerin facilitates peripheral arterial cannulation in children, and separate systematic reviews in neonates have examined topical nitroglycerin for treating ischemic injuries, including analyses of nitroglycerin patch application in premature babies with peripheral arterial ischemia. By synthesizing this evidence, the recommendation gives clinicians a rational, evidence-based adjunct: a vasodilator applied to the skin to relax the vessel, improve the odds of a successful first attempt, and potentially rescue compromised perfusion, all while acknowledging the need to monitor for hypotension in infants whose blood pressure is already precarious.

The management phase of an arterial line’s life, from flushing regimens to pressure monitoring to the decision to remove the device, is also covered. Direct arterial pressure measurement differs systematically from indirect cuff-based techniques, and the panel points to comparative studies in pediatric intensive care to remind clinicians that the two are not interchangeable. Infusion therapy standards, most recently the ninth edition of the Infusion Nurses Society standards of practice, provide the backbone for aseptic technique, dressing changes, and surveillance, consistent with national evidence-based guidelines for preventing healthcare-associated infections. The recommendation frames all of this within a patient-centered structure built on the 7-Rights framework and the standardized nomenclature developed through the NAVIGATE project, so that a catheter described in one hospital means the same thing in another, a prerequisite for meaningful quality improvement and research.

What makes this document notable is not a single dramatic discovery but the quiet rigor of consensus built on evidence. The work was not externally funded, the authors declare no competing interests, and the writing team spans neonatologists, nurses, and vascular access specialists from institutions across the Netherlands, France, Austria, Belgium, Italy, the United Kingdom, Bulgaria, Portugal, Spain, and beyond, with input from foundations representing parents of newborn infants. For a field in which some practices, as the authors bluntly state, lack supporting evidence, the recommendation represents a deliberate turn from tradition toward accountability. If the remaining installments in the ten-part series match this one, neonatal units across Europe may soon share a common technical language for the lines that keep their smallest patients alive, and the infants hooked to those lines may face fewer failed attempts, fewer injured vessels, and safer first days of life.

Subject of Research: Evidence-based management of intra-arterial catheters in neonates

Article Title: Management of intra-arterial catheters: neonatal european vascular access team—ESPR recommendation 6

Article References: van der Lee, R., Yousef, N., Schwaberger, B., De Bisschop, B., Piersigilli, F., Ouwehand, T., Van Eenoo, S., Hugill, K., van Rens, M., on behalf of the Pediatric and Neonatal Vascular Access Special Interest Group (SIG) of the European Society for Pediatric Research (ESPR) and Neonatal European Vascular Access Team (NEVAT), Van der Lee, R., De Bisschop, B., Van Eenoo, S., van Rens, M., Debuf, M.-J., Milan, A., Barone, G., Pittiruti, M., Werther, T., … Tuna, M. L. (2026). Management of intra-arterial catheters: neonatal european vascular access team—ESPR recommendation 6. Pediatric Research. https://doi.org/10.1038/s41390-026-05470-x

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05470-x

Keywords: neonatology, intra-arterial catheters, vascular access, ultrasound guidance, radial artery, nitroglycerin, catheter securement, preterm infants, ESPR, NEVAT, blood pressure monitoring, ischemia

The recommendation, developed by the Pediatric and Neonatal Vascular Access Special Interest Group of the European Society for Paediatric Research together with NEVAT, addresses two closely linked procedures: ultrasound-guided cannulation of deep central veins and the tunneling of catheters beneath the skin to secure them in place. Its authors include anesthesiologists, neonatologists, pediatric intensivists, and vascular access nurse specialists from hospitals across Austria, Italy, the Netherlands, Spain, Belgium, and beyond. That breadth of expertise is deliberate. Vascular access in newborns has long been fragmented across specialties, with anesthesiologists, surgeons, and neonatal nurses each bringing different habits, different equipment preferences, and different definitions of success. The new document argues that this variation itself is a patient safety hazard, and that only standardized, protocol-driven practice can close the gap between the best-performing units and the rest.

At the heart of the recommendation is a simple but transformative principle: no needle should enter a neonatal vein without ultrasound guidance, and no catheter should be considered properly placed until its tip position has been verified. The authors emphasize that ultrasound plays an essential role in every phase of insertion and evaluation of both centrally inserted central catheters, often abbreviated CICC, and femorally inserted central catheters, known as FICC. Before any puncture, the operator is expected to perform a systematic ultrasound survey of the candidate veins. For the upper body, this means assessing the internal jugular, subclavian, and brachiocephalic veins; for the lower body, the femoral and iliac vessels. Structured pre-insertion assessment protocols such as the rapid central vein assessment and the rapid femoral vein assessment, both developed by members of the same expert community, provide a repeatable checklist for this survey, documenting vein patency, diameter, compressibility, and surrounding anatomy before a single instrument is opened.

The technical core of the document concerns the supraclavicular approach to the brachiocephalic vein, an access route that has quietly revolutionized neonatal central line placement over the past decade. The brachiocephalic veins are formed by the junction of the internal jugular and subclavian veins and run a short, relatively straight course toward the superior vena cava. In adults they are routinely used for central access, but in neonates they were long considered too small and too deep to target safely. Ultrasound changed that calculus. With a high-frequency linear probe positioned just above the clavicle, an experienced operator can visualize the right brachiocephalic vein in cross-section, advance the needle in real time under the probe, and watch the guidewire enter the vein on screen. The same supraclavicular window then allows the operator to track the catheter tip as it descends toward the cavoatrial junction, providing immediate confirmation of central tip position without a separate radiograph.

The published evidence supporting this approach in the smallest patients is substantial. Case series have documented ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in infants weighing as little as 680 grams, and retrospective analyses have reported hundreds of successful cannulations in neonates and preterm infants with encouraging safety profiles. One study even suggested that the supraclavicular approach may reduce central line-associated bloodstream infections in preterm infants, possibly because the catheter can be tunneled away from the insertion site and secured more effectively. The new recommendation consolidates this experience into formal guidance, complete with illustrated steps for estimating the required intravascular catheter length, trimming the catheter to the correct size, and cannulating the right brachiocephalic vein in a 680-gram neonate. The inclusion of such granular procedural detail reflects a deliberate editorial choice: the authors want the document to function as a practical manual at the bedside, not merely as a statement of principle.

Site selection receives equally rigorous treatment. The recommendation adapts the zone insertion method, originally developed for peripherally inserted central catheters in adult upper arms, to the peculiar geography of the newborn. Extrapolated ZIM zones map out the cervicothoracic and inguinal-femoral regions, identifying which skin insertion points offer the best combination of vessel depth, vein diameter, and a straight catheter trajectory to the desired tip position. The logic is anatomical: a catheter that enters the vein at a shallow angle, travels a straight path, and avoids crossing joints or sharp vessel bends is less likely to cause mechanical complications such as vessel perforation, catheter malposition, or thrombosis. In a neonate, whose veins may grow along with the child over weeks of intensive care, preserving vessel integrity for future access is not a luxury but a necessity.

Tunneling, the second pillar of the recommendation, is presented as a key defense against infection and accidental dislodgement. By creating a subcutaneous tunnel between the venous entry point and a distant skin exit site, the operator increases the distance bacteria must travel to reach the bloodstream and anchors the catheter more securely in fragile, thinly keratinized neonatal skin. The document also addresses modern securement and dressing strategies, including cyanoacrite tissue adhesive, which has emerged in recent neonatal studies as a component of bundles that reduce catheter-related complications, and subcutaneously anchored sutureless fixation devices. These may sound like minor technical refinements, but in a population where a single line failure can mean repeated painful procedures, prolonged hospitalization, and increased infection risk, the cumulative effect of such refinements is clinically significant.

Tip location, the final verification step, receives its own detailed discussion. The recommendation describes structured ultrasound protocols for confirming that the catheter tip sits at the cavoatrial junction, the optimal position where the superior vena cava meets the right atrium. It also reviews the intracavitary electrocardiography method, in which a saline-filled catheter acts as a lead that records the characteristic electrical signature of the atrium, allowing real-time tip confirmation. Recent consensus work and comparative reviews have examined whether intracavitary ECG or real-time ultrasound should be the primary verification tool in neonates, and the new document frames both as complementary techniques within a structured protocol for tip navigation and tip location. The overarching message is that a chest radiograph alone, taken after the fact, is no longer an acceptable standard for confirming neonatal central line position when real-time alternatives exist.

The authors frame the entire package as a bundle, drawing on the seven-step SIC and SIF protocols designed to minimize complications of centrally inserted and femorally inserted central catheters respectively. Each step, from pre-insertion vein assessment through site selection, insertion, tip navigation, tip location, securement, and post-insertion evaluation, is specified in a way that can be audited and taught. The recommendation also aligns with broader international guidance on ultrasound-guided vascular access and with contemporary infusion therapy standards, situating neonatal practice within a coherent evidence framework rather than leaving it as an isolated pediatric exception. The authors acknowledge the contributions of parent organizations, including the European Foundation for the Care of Newborn Infants and the Global Foundation for the Care of Newborn Infants, reflecting a growing recognition that families have a stake in how these procedures are performed and communicated.

What makes this recommendation potentially viral in the world of neonatology is its insistence that excellence in vascular access is not an innate gift of certain surgeons or a matter of institutional tradition, but a learnable, protocolized skill that any well-trained team can deliver. The work was not externally funded, and the authors declare no competing interests, positioning the document as a purely professional consensus. If units across Europe and beyond adopt its standards, the practical consequences could be measured in fewer failed first attempts, fewer misplaced catheters, fewer bloodstream infections, and fewer needle sticks for the smallest and most vulnerable patients in the hospital. For a field where a millimeter of precision can determine whether a 700-gram infant thrives or suffers a preventable complication, the arrival of a unified, ultrasound-first European standard marks a genuine turning point in the care of newborns.

Subject of Research: Ultrasound-guided central venous catheter insertion and tunneling in neonates

Article Title: Ultrasound-guided central vascular access and device tunneling: neonatal European vascular access team—ESPR recommendation 4

Article References: Breschan, C., Pittiruti, M., van der Lee, R., Oulego-Erroz, I., Werther, T., Piersigilli, F., Barone, G., Ouwehand, T., Van Eenoo, S., Hugill, K., van Rens, M., on behalf of the Pediatric and Neonatal Vascular Access SIG of the ESPR and NEVAT, Van Der Lee, R., van Eenoo, S., van Rens, M., Schwaberger, B., Debuf, M.-J., Milan, A., Yousef, N., … Tuna, M. L. (2026). Ultrasound-guided central vascular access and device tunneling: neonatal European vascular access team—ESPR recommendation 4. Pediatric Research. https://doi.org/10.1038/s41390-026-05463-w

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05463-w

Keywords: neonatology, ultrasound, central venous catheter, brachiocephalic vein, ESPR, vascular access, preterm infants, catheter tunneling, tip location, patient safety, supraclavicular approach, Pediatric Research

The document is the eighth recommendation in a series produced by the Pediatric and Neonatal Vascular Access Special Interest Group of the European Society for Paediatric Research, working together with NEVAT, a European network of vascular access specialists. The series is designed to cover the entire process of neonatal vascular access, and this installment focuses squarely on infection prevention. Its central message is that safe catheter care is not a single intervention but a chain of practices that must remain unbroken across insertion, maintenance and discontinuation, and that standardized protocols for assessment, insertion and evaluation are essential if units are to protect their most vulnerable patients.

The stakes could hardly be higher. Central-line-associated bloodstream infections, often abbreviated as CLABSI, remain a significant burden in neonatal intensive care, and Dutch surveillance data cited by the authors show that these infections continue to occur even in well-resourced units. For a premature infant, a bloodstream infection is not merely a temporary setback. Research summarized in the recommendation links neonatal sepsis to impaired neurocognitive outcomes, and studies of extremely preterm children show that late-onset meningitis and Candida infections are associated with worse neurodevelopmental trajectories. In other words, an infection that enters through a catheter can alter the course of a child’s entire life, which is why the authors argue that infection prevention strategies are key to safe neonatal vascular access.

Technically, the recommendation weaves together international guidance with adaptations specific to the neonatal intensive care unit. The authors draw on the ninth edition of the Infusion Therapy Standards of Practice, widely regarded as the reference framework for infusion care, as well as infection control strategies for acute-care hospitals updated in 2022 and a dedicated white paper series offering practical approaches to preventing central-line-associated bloodstream infections in neonatal units. The goal, the team explains, is to reduce the microbial burden around vascular devices by combining evidence-based measures with the practical realities of caring for infants who may weigh less than a kilogram and whose skin, immune system and veins are all uniquely vulnerable.

One of the technical pillars of the recommendation is aseptic technique, and in particular the Aseptic Non Touch Technique, known as ANTT. This practice framework, illustrated in one of the article’s figures, is built on the principle that the key parts of a vascular system, such as catheter hubs, connectors and injection ports, must never come into contact with non-sterile surfaces or hands. Studies from London hospitals and quality improvement projects in other settings have shown that improving compliance with ANTT during intravenous line maintenance can reduce healthcare-associated infections. By embedding this framework in neonatal practice, the European team aims to make the standard of asepsis uniform rather than dependent on the habits of individual clinicians or units.

Skin disinfection is another area where the recommendation engages with rapidly evolving evidence. The choice of antiseptic for central catheter insertion in neonates has long been contested, because chlorhexidine, the workhorse antiseptic in adult care, carries concerns about skin injury in premature infants. The authors reference a Cochrane review of antiseptic solutions for neonatal central catheter insertion and recent clinical trials comparing 2 percent chlorhexidine gluconate in 70 percent isopropyl alcohol with aqueous preparations, including the Arctic randomized feasibility trial. These studies reflect a genuine effort to determine which agent best balances antimicrobial efficacy against the delicate skin of a preterm infant, and the recommendation situates itself within this ongoing debate rather than pretending it is settled.

The recommendation also emphasizes that infection prevention begins before any catheter is inserted, with careful assessment of the infant’s veins and a deliberate choice of the most appropriate device. The authors cite the Assessment Better before Access project, a retrospective cohort study of neonatal intravascular device outcomes, and a pre-procedural systematic evaluation of superficial veins designed to optimize venous catheterization. The logic is straightforward: every failed peripheral attempt creates additional entry points for microorganisms and additional skin trauma, so choosing the right device the first time is itself an infection prevention measure. Consensus algorithms for selecting venous access in newborns, including work from Italian neonatal groups on umbilical venous catheters and epicutaneo-caval catheters, inform this assessment-first philosophy.

Once a line is in place, securement and dressing choices become critical to keeping microbes out. The recommendation discusses cyanoacrylate glue, a medical adhesive that seals the catheter entry site and has been tested in randomized trials for umbilical venous catheters and in observational studies for peripheral and central catheters in neonates, with evidence suggesting it can reduce complications as part of a broader bundle. It also considers subcutaneously anchored securement devices and modern dressing technologies, including dialkylcarbamoylchloride-coated dressings for catheter exit sites and the material properties of transparent semipermeable films. Each of these technologies aims to prevent the micro-movements of the catheter within the tract that allow skin flora to migrate inward, while also protecting the fragile skin from medical adhesive-related injuries, a recognized problem in neonatal units.

Perhaps the most distinctive feature of the recommendation is its attention to the social dimension of neonatal care. The authors highlight evidence that parent-infant skin-to-skin contact can be maintained even during peripheral catheter insertion, and they situate infection prevention within the broader movement toward family integrated care, in which parents are trained partners rather than visitors. Recent clinical trial data on close collaboration with parents in neonatal units and studies of family management skills suggest that involving families does not compromise safety and may enhance it. Hand hygiene, the subject of a Cochrane review on preventing infections in neonates, remains the simplest and most powerful tool available to staff and parents alike, and the recommendation frames it as a shared responsibility across the entire care environment.

Finally, the recommendation addresses the end of the catheter’s life. Timely discontinuation, careful removal technique and ongoing surveillance for bloodstream infection all form part of the lifecycle approach. The authors point to Dutch work on sustainable CLABSI surveillance and consensus toward new criteria, reflecting a European effort to measure these infections consistently so that units can compare performance and improve. Taken together, the document represents a rare attempt to consolidate scattered evidence into a single, practical standard for neonatal vascular access across the continent. For the clinicians who care for the smallest patients, and for the families who trust them, the message is clear: every catheter is a lifeline and a liability at once, and only disciplined, standardized, evidence-based practice from insertion to removal can keep the lifeline from becoming the pathway for harm.

Subject of Research: Infection prevention strategies for neonatal vascular access catheters

Article Title: Infection prevention: neonatal European vascular access team – ESPR recommendation 8

Article References: Infection prevention: neonatal European vascular access team – ESPR recommendation 8. (n.d.). https://doi.org/10.1038/s41390-026-05464-9

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05464-9

Keywords: neonatal intensive care, vascular access, CLABSI, infection prevention, catheter insertion, aseptic non touch technique, chlorhexidine, cyanoacrylate glue, preterm infants, hand hygiene, family integrated care, ESPR

The publication of congress abstracts in a peer-reviewed journal is a well-established practice in academic medicine, but its significance is often underestimated by readers outside the research community. Abstracts are condensed summaries of studies that are typically still in progress or recently completed, and they allow scientists to stake a claim on new findings months or even years before full papers appear in journals. For paediatric research, where patient populations are smaller and studies often take longer to recruit than in adult medicine, the rapid dissemination of preliminary findings through abstract collections can be especially consequential. It allows clinical teams across Europe to see, almost in real time, which questions their colleagues are asking and which approaches are producing results.

The decision by the European Society for Paediatric Research and the European Academy of Paediatrics to merge their meeting calendars into a single congress reflects a broader trend in European medicine toward consolidation. Both organisations have long histories: the society for paediatric research has traditionally focused on the biological and translational science of child health, spanning neonatology, developmental physiology and experimental paediatrics, while the academy has represented a broader clinical constituency, including general paediatrics, subspecialty practice and the training of the next generation of paediatricians. By convening jointly, the two bodies effectively create a single venue where laboratory scientists, neonatologists, hospital paediatricians and primary care researchers can encounter one another’s work without the disciplinary silos that have historically separated them.

Lyon, the host city, is itself a fitting choice for a congress of this scope. The French city sits at the heart of one of Europe’s densest biomedical corridors, with major university hospitals, research institutes and a strong tradition in infectious disease, immunology and clinical research. For the several thousand delegates expected at a congress of this kind, the combination of an accessible European location and a concentrated four-day programme is a practical consideration as much as a symbolic one. Congresses of this scale depend on the ability of clinicians with demanding hospital schedules to attend, and the compressed format of an inaugural joint meeting is designed to maximise scientific exchange per day away from the ward.

What does the publication of the abstract collection actually contain? As is typical for such collections, the document comprises the accepted abstracts for oral presentation, organised by the congress’s scientific tracks. Each abstract represents a study that has passed through a review process conducted by the congress’s scientific committees, which evaluate submissions for originality, methodological rigour and relevance to paediatric practice. The selected oral presentations are, in most congress systems, the highest-ranked subset of a much larger pool of submitted abstracts, with the remainder often presented as posters. Publication in the journal gives these contributions a citable form, which matters for young researchers whose careers depend on documented output, and it preserves a permanent record of what was presented even for work that may never reach full publication.

For the wider readership of Pediatric Research, the collection serves a second function as a barometer of the field. The distribution of abstracts across topics reveals where European paediatric research is concentrating its energy. In recent years, congresses in this space have been dominated by themes such as neonatal brain injury and neuroprotection, the long-term consequences of preterm birth, the rising burden of allergic and inflammatory disease in children, the impact of the microbiome on early development, and the application of genomic diagnostics to critically ill infants. The oral presentation lineup at a joint ESPR and EAP congress would be expected to span the full arc from bench to bedside, reflecting the combined identity of the two parent organisations.

The timing of the publication, roughly a month before the congress opens, is deliberate. Delegates can use the abstract collection to plan which sessions to attend, and research groups can identify potential collaborators whose work dovetails with their own. In an era when much scientific networking happens asynchronously online, the congress abstract book retains a distinctive role: it is a snapshot of an entire community’s priorities at a single moment, unfiltered by the lengthy delays of the journal publication pipeline. For journalists, clinicians and policy makers, it is also one of the few places where the questions being asked at the front line of child health research appear together in one document.

The creation of CEPAS as a standing congress brand also carries implications for how European paediatric science is coordinated. A single annual joint meeting reduces the fragmentation that comes from parallel conferences competing for the same delegates and the same speakers, and it strengthens the negotiating position of European paediatrics in its exchanges with counterpart organisations in North America, Asia and Latin America. The two founding societies have complementary memberships, and a shared congress gives early-career researchers in particular a single, larger stage on which to present, with a correspondingly larger audience for their work. The abstract collection published in the journal is, in this sense, the first public artefact of a new institutional structure.

There are also practical considerations for readers approaching an abstract collection for the first time. Abstracts are by design preliminary: they report findings that have often not yet undergone the full scrutiny of peer review that a complete paper receives, and sample sizes in paediatric studies are frequently modest. The standard caution in the field is that abstract findings should be treated as signals rather than conclusions, to be confirmed or refuted as full manuscripts emerge. At the same time, the review process that selects abstracts for oral presentation is not trivial, and historically many of the most influential ideas in paediatrics, from advances in neonatal respiratory care to new frameworks for developmental screening, circulated as congress presentations long before they appeared in final form in the literature.

As the Lyon congress approaches, the published collection will function as both a programme and a promise: a programme of the oral sessions that will unfold over four days in late October, and a promise of the fuller studies that many of these abstracts are expected to become. For a field in which the health of children often receives a smaller share of research funding and publication attention than adult medicine, the visibility afforded by a joint congress of two major societies, and by a dedicated abstract collection in a leading paediatric journal, is a meaningful step. Whether the inaugural CEPAS meeting establishes a durable new fixture in the European calendar will be judged in Lyon, but the groundwork, in the form of the research its members will present, is already in print.

Subject of Research: Publication of selected abstracts from the inaugural Congress of the European Paediatric Academic Societies (CEPAS 2026)

Article Title: CEPAS abstracts

Article References: CEPAS abstracts. (2026). Pediatric Research. https://doi.org/10.1038/s41390-026-05383-9

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05383-9

Keywords: CEPAS 2026, paediatric research, ESPR, EAP, Pediatric Research, congress abstracts, Lyon, child health, neonatology, academic medicine, oral presentations, European paediatrics

Researchers Prosper Dzidzienyo, Saeed Rahimpour and Luana Dessbesell, writing in Environmental and Sustainability Indicators, have developed what they call a Traceability Degree Score, a systematic framework for grading individual pieces of product data on how reliably they can be captured, verified and exchanged along a supply chain. Rather than asking whether data exists, the framework asks whether each data element can be systematically linked to its point of origin, checked for accuracy and transmitted across supply chain partners in a digitally structured format. That distinction matters, because the authors’ analysis of a full textile lifecycle suggests that most of the data needed for passports currently sits in a grey zone: present in some form, but far from trustworthy or interoperable.

The framework rests on four indicators drawn from maturity-model theory, information quality research and supply chain traceability standards. The first is standardisation, which measures whether data are defined and reported in harmonised formats with persistent identifiers, so that a batch number means the same thing to a pulp mill in Finland and a retailer in Paris. The second is automation, assessing whether information is captured by sensors and enterprise systems rather than typed in by hand. The third is reliability, which captures whether measurements are accurate, consistent and independently verifiable. The fourth, blockchain readiness, is deliberately misnamed in the eyes of no one: it does not assume distributed ledgers are required, but instead evaluates whether data are structured, uniquely identifiable and linked to discrete lifecycle events, properties that any immutable, event-based traceability architecture would demand. Each data element is scored from one to five on every indicator, and the four scores are averaged into a single composite value.

To test the approach, the researchers constructed a detailed case study of a man-made cellulosic textile, a fabric made from 80 percent certified renewable wood and 20 percent recycled textile waste, both sourced in Finland. This hybrid of bio-based and circular material streams was chosen precisely because it mirrors the sourcing complexity that passport regulation is meant to address. Drawing on EU regulatory texts, the CIRPASS project’s passport prototypes, stakeholder consultations and life cycle assessment literature, the team identified 336 individual primary data elements spread across ten lifecycle nodes, from forestry and pulping through fibre, yarn, fabric and garment production to distribution, consumer use and end-of-life.

The results are striking for how unevenly traceability is distributed. Half of all data elements scored at the moderate level, meaning they exist in structured form but lack the full automation, verification or interoperability that seamless passport integration requires. Only 20 percent achieved the highest maturity, being digitally standardised, automatically captured, externally verified and ready for distributed ledger transmission. A quarter showed limited traceability, hampered by manual entry or inconsistent templates, while the remainder were essentially untraceable, concentrated in the consumer-use and end-of-life phases. In other words, the single most important stage for circular decisions — what happens to a garment after the sale — is exactly where the data infrastructure is weakest.

The node-by-node comparison sharpens that picture. Distribution and retail scored highest, with a mean traceability degree of 4.30, closely followed by dissolving pulp production at 4.28 and textile recycling at 4.13. The authors attribute the retail result to the quiet success of existing logistics standards: GS1 identifiers, batch numbering and trade barcodes have been standardised for decades, so the data foundations there are already mature. Manufacturing nodes such as fibre production, fabric making, yarn spinning and garment assembly landed in an intermediate band between 3.78 and 3.89, reflecting partial digitisation within factories but limited data exchange between companies. Raw material sourcing scored 3.55, while consumer use collapsed to 2.00 and end-of-life managed only 3.13. No single node achieved uniformly high scores across all four indicators, a finding the researchers say confirms that traceability maturity cannot be reduced to digitalisation alone.

The study also exposes a structural tension at the heart of the EU’s circular economy agenda. Digital Product Passports are explicitly intended to enable downstream value retention — reuse, repair and recycling — yet the phases where those decisions are made are the ones with the poorest data readiness. Consumer behaviour, device heterogeneity and the absence of standardised reporting at the end of a product’s life mean the data trail simply frays out. The researchers note that harmonised data definitions alone are insufficient: many nodes scored well on standardisation while lagging badly on automation and blockchain readiness, showing that agreeing on what to record is a very different problem from being able to record it reliably at scale.

Methodologically, the framework fills a gap that previous approaches left open. Earlier efforts to prioritise passport data, including ranking systems based on importance, availability and sensitivity, largely captured stakeholder perceptions of what data matters. Industry 4.0 maturity models, meanwhile, assess whole organisations rather than individual data points. By scoring data elements themselves, the new approach converts qualitative regulatory demands — data must be verifiable, data must be machine-readable — into a consistent numerical index that can pinpoint exactly where along a supply chain investment is most needed. The authors stress that the framework is technologically neutral: blockchain readiness measures architectural compatibility, not adoption, and European regulations remain agnostic about implementation technology.

The researchers acknowledge limitations. The case scores were derived from secondary sources reflecting average industrial realities in a Finnish context, and values would shift across regions, technologies and firms; the point of the exercise is to demonstrate a reproducible method rather than to deliver fixed numbers. The assessment is also a snapshot in time, whereas passport requirements and data systems will both evolve rapidly, calling for longitudinal studies and operational pilots. Inter-rater reliability and automated scoring are flagged as priorities for future work, as is validation across other product categories — the framework operates at the level of generic data elements, making it directly applicable to batteries, electronics, construction materials and other sectors that the passport regulation will eventually touch.

Still, the message for industry and policymakers is clear. As passport implementation accelerates, the readiness of product data is not a binary yes or no but a measurable, multi-dimensional capability that currently varies wildly across the lifecycle of even a well-documented textile. With only one in five data elements in the case study achieving full traceability maturity, and with the circular economy’s most critical decision points sitting at the bottom of the maturity curve, the gap between regulatory intent and operational data reality is wide. Diagnostic tools like the Traceability Degree Score offer a way to map that gap precisely — and, the authors argue, a way to close it with targeted investment rather than hopeful assumptions.

Subject of Research: A traceability assessment framework for primary data elements in textile digital product passports

Article Title: A framework for evaluating the traceability of primary data elements for textile digital product passports

Article References: Dzidzienyo, P., Rahimpour, S., & Dessbesell, L. (2026). A framework for evaluating the traceability of primary data elements for textile digital product passports. Environmental and Sustainability Indicators, 32, Article 101514. https://doi.org/10.1016/j.indic.2026.101514

Image Credits: AI Generated

DOI: 10.1016/j.indic.2026.101514

Keywords: digital product passports, textile supply chains, traceability, EU regulation, ESPR, circular economy, data quality, blockchain readiness, standardisation, automation, man-made cellulosic textiles, sustainability indicators