Vascular access is the circulatory lifeline of neonatal intensive care. Premature and critically ill infants depend on intravenous lines for nutrition, medications, and fluids, often for weeks at a time. Yet the devices that deliver these therapies fail frequently. Peripheral intravenous catheters in neonates are prone to infiltration, dislodgement, phlebitis, and occlusion, and each failure means another painful insertion attempt in an infant whose veins may be barely visible. Previous work by the same research group, including retrospective cohort studies such as the ABBA project, documented the scale of device-related complications and the factors associated with them. What remained poorly understood was the human and organizational side of the problem: how nurses actually decide when to insert, monitor, escalate, or abandon a line.

To answer that question, Matheus van Rens of Radboud University Medical Center and colleagues conducted semi-structured interviews with twelve neonatal nurses involved in vascular access and infusion therapy across three tertiary neonatal intensive care units in the Netherlands. The team analyzed the transcripts using reflexive thematic analysis, a method that treats the researcher’s perspective as an active ingredient in interpretation rather than a bias to be eliminated. Sample adequacy was guided by the concept of information power, an approach that determines whether enough interviews have been conducted based on the richness of the data and the specificity of the study aims, rather than by a fixed numerical target.

Four themes emerged from the analysis, and together they sketch a system that consistently rewards reaction over anticipation. The dominant finding was that vascular access care was characterized by reactive decision-making, with escalation to more secure or more appropriate devices typically occurring only after a complication had already appeared. Nurses described delayed escalation, repeated peripheral intravenous attempts, and inconsistent monitoring practices across all three centers. In other words, a catheter often had to fail before the team reconsidered whether a different strategy was needed from the start.

Behind this reactive pattern, the interviews revealed a web of interacting pressures. Organizational factors, including workload, staffing constraints, and the absence of structured decision-support embedded in daily workflows, shaped how much attention vascular access received at any given moment. Knowledge varied between individual nurses, and so did the implementation of existing guidelines, producing inconsistency both within and between units. The researchers also identified relational factors: parents were largely left out of decisions about vascular access, despite growing evidence from family integrated care research that involving parents in neonatal care improves outcomes for infants and families alike.

Perhaps the most striking theme was a persistent gap between risk awareness and clinical action. The nurses interviewed clearly understood which infants were at high risk of catheter failure and could articulate the consequences of repeated attempts. Knowing, however, did not translate into doing. This disconnection echoes classic patient safety literature, including James Reason’s models of human error, which emphasize that accidents rarely stem from individual carelessness alone but from systems that allow known risks to go unaddressed. The study’s authors frame their findings in exactly this spirit, pointing to organizational and behavioral factors that reinforce reactive practice regardless of individual competence or good intentions.

The technical literature has long documented the consequences of this gap. Studies of peripheral intravenous catheter failure in adult and pediatric populations have described the problem as accepted but unacceptable, a phrase coined by researchers reviewing the burden of device failure in hospitals. In neonates, multicenter observational studies have reported substantial complication rates for peripheral cannulation, and consensus tools such as the neonatal DAV-expert algorithm developed by European vascular access groups now exist to guide the selection of the most appropriate venous access for each newborn. The Dutch study suggests that the bottleneck is not a lack of technical knowledge or decision tools, but the absence of structures that trigger their use at the right moment.

The authors argue that the way forward lies in structured, anticipatory approaches integrated directly into clinical workflows. Rather than relying on individual nurses to remember to reassess a line or to escalate concerns through informal channels, units could build anticipatory planning into routine care, ensuring that the choice of device, the monitoring plan, and the escalation pathway are considered together at the moment of insertion and revisited systematically thereafter. The team has previously proposed a patient-centered framework based on the 7-Rights of vascular access, and the new findings support the idea that such frameworks must be embedded in practice rather than left as optional guidance.

The implications extend beyond the neonatal unit. Catheter-related bloodstream infections in intensive care were dramatically reduced in landmark studies when checklists and standardized bundles transformed culture and behavior, demonstrating that structured interventions can convert awareness into consistent action. The Dutch researchers point to similar potential in neonatal vascular access: if the reactive cycle of failure and rescue can be interrupted by anticipatory planning, the payoff could include fewer painful procedures, fewer infections, shorter stays, and more consistent care across centers. Practice variation in neonatal care is well documented, and standardizing the behavioral and organizational dimensions of vascular access may be as important as standardizing the technical ones.

The study also carries a methodological lesson for patient safety research. By listening to nurses rather than measuring devices, the investigators surfaced factors that retrospective audits of complication rates could never capture: the hesitation to escalate, the uneven distribution of knowledge, the silence of parents at the bedside. The authors acknowledge the limitations inherent in qualitative work, including the interpretive nature of thematic analysis and the potential identifiability of interview data, which is why the underlying datasets are available only on reasonable request. Yet the consistency of the four themes across three separate tertiary centers lends weight to the central conclusion. Vascular access care in neonatal intensive care, the nurses suggest, is shaped by interacting organizational, behavioral, knowledge-related, and relational forces that quietly reinforce reaction over prevention. Recognizing those forces, the researchers argue, is the first step toward designing workflows in which the smallest patients receive lines that are planned, monitored, and escalated with the same rigor that the technology itself deserves.

Subject of Research: Nurses' decision-making and reactive versus proactive practice in neonatal vascular access care

Article Title: Reactive rather than proactive: nurses’ perspectives on decision-making in neonatal vascular access

Article References: van Rens, M. F., Huis, A., Hugill, K., van der Lee, R., & de Boode, W. P. (2026). Reactive rather than proactive: nurses’ perspectives on decision-making in neonatal vascular access. Pediatric Research. https://doi.org/10.1038/s41390-026-05570-8

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05570-8

Keywords: neonatal intensive care, vascular access, nursing decision-making, peripheral intravenous catheters, patient safety, qualitative research, thematic analysis, catheter failure, escalation delays, family integrated care, clinical workflows, Pediatric Research

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 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: van Delft, B., Romitti, M. G., van Rens, M., van den Hoogen, A., Van Eenoo, S., Piersigilli, F., van der Lee, R., Ouwehand, T., Hugill, K., on behalf of the Pediatric and Neonatal Vascular Access SIG of the ESPR and NEVAT, Van Delft, B., van Rens, M., van den Hoogen, A., van Eenoo, S., Van Der Lee, R., Barone, G., Werther, T., Schwaberger, B., Rodriguez-Perez, C., … Tuna, M. L. (2026). Infection prevention: neonatal European vascular access team – ESPR recommendation 8. Pediatric Research. 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 recommendations come from the Pediatric and Neonatal Vascular Access Special Interest Group of the European Society for Paediatric Research, working together with NEVAT, a multidisciplinary vascular access network. Led by first author Tobias Werther of the Medical University of Vienna and corresponding author Robin van der Lee of Radboud University Medical Center in the Netherlands, the group spans institutions across Europe and beyond, from Lisbon and Treviso to Brussels, Sofia, and London. Their motivation is blunt: vascular access is a pervasive facet of contemporary neonatal practice, yet it lacks standardization, and some common practices lack supporting evidence. In other words, the procedures are universal, but the way clinicians prepare babies for them varies enormously from unit to unit, and not always in ways supported by data.

The scientific case for taking neonatal pain seriously has grown dramatically over the past two decades. Preterm infants in intensive care are exposed to a remarkable number of painful procedures during their hospital stay, and repeated early-life pain is no longer regarded as a transient inconvenience. Recent research cited by the group links cumulative early pain exposure in premature infants to atypical cerebellar development and later neurodevelopmental deficits, suggesting that unmanaged procedural pain may leave lasting traces in the developing brain. The developing nervous system of a newborn, and especially that of a very preterm infant, processes nociceptive signals with heightened sensitivity, and immature descending inhibitory pathways mean that pain signals arrive essentially unfiltered. The long-standing assumption that newborns barely feel pain, or that any distress is quickly forgotten, has been thoroughly dismantled by modern neuroscience.

A central pillar of the new recommendations is the principle of assessing pain before attempting to treat it. Because preverbal infants cannot report their experiences, clinicians must rely on validated behavioral and physiological indicators: facial expression, body movement, crying, changes in heart rate, and oxygen saturation. The authors emphasize the use of structured pain and sedation scales designed specifically for neonatal and pediatric patients in preverbal stages of development, noting that systematic reviews have evaluated the validity and reliability of such instruments, including for preterm infants. Without consistent measurement, the group argues, pain management becomes arbitrary, and the effectiveness of any intervention, whether pharmacological or non-pharmacological, cannot be judged. Assessment is framed not as a bureaucratic step but as the foundation on which every subsequent decision rests.

On the pharmacological side, the recommendations draw on a substantial evidence base. For minor procedures, oral sucrose has become one of the most widely studied analgesic interventions in neonatology, with Cochrane reviews confirming its effectiveness for procedural pain relief in newborns undergoing painful procedures, and subsequent trials working to identify the minimally effective dose. Sucrose appears to activate endogenous opioid pathways, and its effect can be amplified when combined with non-nutritive sucking, such as a pacifier. Breastfeeding and expressed breast milk also carry evidence for procedural pain relief, offering a natural alternative that combines analgesia with nutrition and maternal contact. Topical anesthetics such as lidocaine-prilocaine cream have been evaluated for needle-related pain, although the evidence in neonates remains more limited than in older children.

For more invasive procedures, particularly the ultrasound-guided placement of central venous catheters, the recommendations acknowledge that simple sweet-tasting solutions are not enough. Here the group points to analgosedation protocols, the deliberate combination of analgesic and sedative agents to keep infants comfortable and still during longer procedures. Randomized controlled trials have examined remifentanil for percutaneous intravenous central catheter placement in preterm infants, and more recent prospective studies have tested structured analgosedation protocols for ultrasound-guided catheterization in the neonatal intensive care unit, including combinations such as ketamine with fentanyl. Population pharmacokinetic studies have clarified how fentanyl exposure in preterm and term newborns depends on pre- and postnatal maturation, underscoring that dosing in this population is a precision exercise rather than a simple weight-based calculation. Intranasal routes for analgosedation have also been systematically reviewed as a practical option for infants in intensive care, while the evidence for intravenous midazolam infusion as a sedative in this population has been critically appraised by Cochrane reviewers.

Perhaps the most striking technical shift reflected in the recommendations is the rise of ultrasound as a routine tool in neonatal vascular access. Structured pre-procedural ultrasound assessment protocols, with acronyms such as Rasuva for superficial veins, Raceva for central veins before catheterization, and Rafeva for the femoral veins of the lower limb, allow clinicians to map vessel anatomy, diameter, and patency before the first needle stick. Structured protocols for ultrasound-based tip navigation and tip location during central venous access device placement further reduce the guesswork. The logic connecting this technology to pain relief is straightforward: every failed insertion attempt is an additional painful procedure, so improving first-attempt success through better planning directly reduces the cumulative pain burden. This philosophy was crystallized in the Abba Project, Assess Better before Access, a retrospective cohort study of neonatal intravascular device outcomes that demonstrated the value of careful pre-procedural assessment.

Alongside drugs and devices, the recommendations give prominent weight to non-pharmacological and family-centered strategies. Systematic reviews and meta-analyses have found that non-pharmacological methods reduce neonatal pain, and the group highlights interventions such as swaddling, facilitated tucking, and skin-to-skin care, for which Cochrane evidence supports a role in procedural pain relief. Notably, one reported practice involves maintaining parent-infant skin-to-skin contact even during peripheral intravenous catheter insertion, a departure from the traditional separation of baby and parent for any sterile procedure. Family integrated care models, in which parents are trained and empowered as partners in their infant’s care rather than visitors, are supported by emerging clinical trial evidence, including nonrandomized trials of close collaboration with parents interventions in neonatal intensive care units. The involvement of the European Foundation for the Care of Newborn Infants and the Global Foundation for the Care of Newborn Infants in the drafting process signals that parent perspectives were built into the recommendations from the start, not appended afterward.

The recommendations also confront an uncomfortable implementation gap. National guidelines for procedural pain in newborns have existed for years, for example in Italy, where audits of their implementation revealed uneven adherence across units. The American Academy of Pediatrics issued an update on the prevention and management of procedural pain in the neonate nearly a decade ago, and pediatric clinical practice guidelines for acute procedural pain have been systematically reviewed, yet translation into bedside practice remains inconsistent. By focusing specifically on vascular access, the procedures that generate much of the procedural pain burden in neonatal care, the new document aims to close the distance between guideline and practice with concrete, procedure-specific recommendations rather than general exhortations.

For clinicians, the practical message is a sequence: assess the infant’s pain and distress with validated tools, plan the vascular access strategy with ultrasound before touching the patient, choose the appropriate combination of non-pharmacological comfort measures and pharmacological analgesia or analgosedation for the specific procedure, involve parents wherever possible, and reassess afterward to confirm that the strategy worked. For parents, the message is that their presence, touch, and breast milk are not sentimental extras but measurable components of pain care. The authors declare no competing interests and note that the work received no external funding, positioning it as a consensus effort by a community of specialists who see, daily, what unrelieved pain does to the smallest patients. As neonatal intensive care continues to push survival boundaries earlier and earlier, the group’s recommendations make the case that how these babies are treated matters as much as whether they survive, and that a needle inserted with skill, preparation, and compassion is a fundamentally different experience from one inserted without them.

Subject of Research: Management of pain and distress in neonates during vascular access device placement

Article Title: Neonatal vascular access: management of pain and distress during vascular access device placement

Article References: Werther, T., Marçal, M., Tuna, M. L., Salazar, A., van der Lee, R., Lago, P., Mader, S., Piersigilli, F., 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., Yousef, N., Schwaberger, B., De Bisschop, B., Ouwehand, T., … Van Delft, B. (2026). Neonatal vascular access: management of pain and distress during vascular access device placement. Pediatric Research. https://doi.org/10.1038/s41390-026-05482-7

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05482-7

Keywords: neonatal pain, vascular access, preterm infants, neonatal intensive care, analgesia, sucrose analgesia, ultrasound-guided catheterization, analgosedation, skin-to-skin care, family integrated care, pain assessment scales, central venous catheters

The traditional framework of neonatal care has often created a divide between parents and the healthcare team. Historically, parents have been relegated to the role of passive observers, frequently feeling detached from the complex medical processes that their infants endure. However, the introduction of family integrated care shifts this paradigm, emphasizing parental involvement in the care of their newborns. This new model empowers families, allowing them to take on active roles in their children’s medical journey, resulting in enhanced emotional and psychological well-being.

Research has consistently shown that when parents are involved in their infants’ care—engaging with the medical staff, participating in caregiving tasks, and being present during key medical interventions—there is a significant improvement in the infants’ health outcomes. Preterm infants who receive care from their parents in conjunction with healthcare professionals tend to experience shorter hospital stays, reduced incidences of chronic health issues, and lower rates of hospital readmissions, establishing a clear link between parental involvement and better clinical results.

The findings of the systematic review underscore the various ways in which family integrated care contributes to enhanced evidence-based practices in NICUs. Engaged parents are more likely to understand and implement recommendations related to feeding, hygiene, and other aspects of care. The emotional bonds forged between parents and infants through this interactive approach further create a nurturing environment that is critical for the development of preterm infants, who often face significant health challenges due to their underdeveloped systems at birth.

Moreover, the meta-analysis highlights the necessity of training healthcare professionals in effective communication and partnership-building techniques with families. Healthcare teams need to prioritize education and support for parents who may initially feel overwhelmed by the unfamiliar and intimidating environment of the NICU. By equipping medical staff with the skills to facilitate family integration, institutions can create a culture of collaboration that eases the anxiety felt by families and promotes a more holistic approach to neonatal care.

Despite the clear advantages of family integrated care, the transition to incorporating this model has posed challenges in several settings. The study emphasizes that healthcare systems must be adaptive, creating supportive policies that encourage parent engagement and remove barriers to participation. Factors such as staff shortages, high patient-to-nurse ratios, and limited parental resources can impede the implementation of FIC practices. Therefore, addressing these barriers is essential to ensure consistent and effective application of the family integrated care model across various NICUs.

In addition, the review explores the psychological implications of FIC on both infants and their parents. The emotional stability provided by consistent and meaningful parental involvement has been shown to reduce stress levels in preterm infants, thereby aiding their overall development. For parents, being involved in their children’s care significantly mitigates feelings of helplessness and anxiety, fostering a sense of agency that can lead to better mental health outcomes during the neonatal period and beyond.

The authors of the study also acknowledge the need for further research to understand the long-term outcomes associated with family integrated care. The goal is to expand upon current knowledge regarding the benefits of this model and explore how it can be adapted to meet the needs of diverse populations within different healthcare settings. Such insights are vital for refining FIC practices and ensuring that they are accessible to all families, regardless of their circumstances.

As healthcare continues to evolve, the implications of the findings from this meta-analysis are profound. The adoption of family integrated care is not merely a trend but rather a necessity in the contemporary healthcare landscape. By embracing a familial approach to neonatal care, healthcare systems have the potential to make significant strides in improving both clinical outcomes and parental satisfaction, ultimately fostering the well-being of one of society’s most vulnerable populations—preterm infants.

The study provides critical insights into the systemic changes needed to implement family integrated care widely. Stakeholders in the healthcare system, including policymakers, administrators, and practitioners, must work collaboratively to advocate for and facilitate these changes. Increased funding, targeted training, and the development of supportive infrastructures are essential to transition towards a more family-centric model of care in NICUs.

In conclusion, the systematic review by Zhang et al. represents a pivotal moment in the evaluation of neonatal care practices. Their findings advocate for a shift from traditional, paternalistic approaches to one that embraces partnership with families. The evidence presented makes a strong case for family integrated care as a fundamental component of neonatal intensive care. As such, it is imperative that healthcare institutions worldwide reassess their approaches to infant care, ensuring that families are at the forefront of this vital aspect of healthcare delivery.

This transformative shift in care philosophy is not without its proponents and adversaries. However, as data continues to mount in favor of family integrated care, it is increasingly evident that inclusive practices not only positively influence infants’ health outcomes but also serve to empower and support families during one of the most challenging times of their lives.

By prioritizing family integrated care, NICUs stand to enhance the developmental trajectories of preterm infants while simultaneously fostering resilience and well-being within their families. As this research continues to gain traction, it will undoubtedly influence how neonatal care is perceived and delivered, marking a significant advancement in the ongoing quest to provide the highest quality care to our most vulnerable populations.

The call to action is clear: for the sake of our future generations, we must embrace the concept of family integrated care within neonatal settings, fostering an environment where families are seen as integral partners in the health and nurturing of premature infants.

Subject of Research: Family integrated care in the neonatal intensive care unit

Article Title: Family integrated care to improve evidence-based practices for preterm infants in the neonatal intensive care unit: a meta-analysis and systematic review

Article References: Zhang, Y., Wang, S., He, W. et al. Family integrated care to improve evidence-based practices for preterm infants in the neonatal intensive care unit: a meta-analysis and systematic review. BMC Nurs (2026). https://doi.org/10.1186/s12912-026-04309-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-04309-4

Keywords: Family integrated care, neonatal intensive care unit, preterm infants, evidence-based practices, systematic review, meta-analysis.

Parental stress during the care of preterm infants can have ripple effects extending beyond immediate emotional well-being, affecting infant recovery trajectories and family dynamics. The traditional NICU environment, often characterized by strict clinical protocols and limited parental involvement, can inadvertently augment feelings of helplessness and anxiety. The FICare model ambitiously redefines this paradigm by actively integrating parents into the caregiving team, fostering collaboration with healthcare professionals and empowering parents in both decision making and practical care tasks.

This latest study critically evaluates whether embedding Family-Centered Rounds — multidisciplinary meetings where care plans are discussed with both medical staff and families — within the FICare framework measurably reduces parental stress. Utilizing a stepped-wedge cluster-randomized trial allowed researchers to sequentially introduce the intervention across multiple NICU sites, enabling robust comparison while controlling for temporal and institutional variability. This design is particularly suited to evaluating complex interventions in real-world healthcare settings, ensuring that findings reflect practical applicability.

The results of the study reveal compelling insights. While FICare combined with Family-Centered Rounds significantly reduced stress levels among parents of preterm infants who had been transferred between hospitals, this psychological benefit did not uniformly extend to all participating families. Such heterogeneity underscores that the intervention’s efficacy may hinge on family-specific factors including prior NICU experience, social support structures, and individual coping mechanisms. Consequently, the research advocates for tailored implementation strategies that adapt the FICare model to accommodate diverse family needs.

Delving deeper, the study employed validated psychometric tools to quantify parental stress, leveraging longitudinal data to track fluctuations throughout the infant’s NICU stay and subsequent transfer phases. This approach illuminated patterns indicating that stress reduction was particularly pronounced in parents encountering the added complexities of inter-institutional transfers, where continuity of care and communication can be compromised. Thus, FICare’s emphasis on parental integration appears instrumental in bridging informational gaps that exacerbate uncertainty during transfers.

The integration of Family-Centered Rounds further reinforced these benefits by systematically involving parents in daily medical discussions. This practice fosters transparency, demystifies clinical decision-making processes, and nurtures a sense of agency and partnership. Importantly, the study highlights that such engagement is not merely symbolic but translates into measurable psychological relief, reinforcing the critical role of transparent communication in neonatal care frameworks.

Nonetheless, the study’s nuanced findings caution against a one-size-fits-all application of FICare. Certain families did not exhibit significant stress reduction, suggesting that barriers such as linguistic challenges, socioeconomic constraints, or pre-existing mental health conditions may attenuate the intervention’s effectiveness. This insight beckons further research to identify mediating variables and to customize support mechanisms enabling broader inclusivity and impact.

From a healthcare systems perspective, the implications of this research are multifaceted. Incorporating FICare with Family-Centered Rounds represents a paradigm shift towards family empowerment and collaborative caregiving, aligning with contemporary patient- and family-centered care principles. Yet, operationalizing such models demands investment in staff training, workflow restructuring, and cultural change within NICUs to embrace parental partnership as essential rather than ancillary.

Moreover, the psychological benefits observed align with growing evidence that parental emotional well-being tangibly influences infant health outcomes. Stress reduction not only improves parents’ quality of life but can enhance their ability to participate actively and consistently in infant care, potentially promoting neurodevelopmental gains and reducing NICU length of stay. Hence, FICare emerges not just as a compassionate approach but as a strategic clinical intervention with systemic value.

The trial’s stepped-wedge design also exemplifies methodological rigor in health services research, balancing ethical considerations—since all sites eventually received the intervention—with statistical robustness. Such designs are increasingly pivotal in complex care environments where randomized controlled trials confront logistical and ethical constraints, ensuring that innovations can be evaluated without denying beneficial care components to control groups.

The study’s authors advocate for ongoing exploration of how FICare interventions can be refined to optimize inclusivity, recommending integration of culturally sensitive communication strategies and psychosocial support tailored to vulnerable populations. Additionally, future research directions include leveraging digital health tools to augment parental education and engagement, particularly amidst social distancing imperatives that challenge traditional in-person interactions.

In conclusion, this landmark study delivers critical evidence substantiating the psychological benefits of combining Family Integrated Care with Family-Centered Rounds for parents of preterm infants, while elucidating the nuanced boundaries of such benefits across diverse family contexts. It invites neonatal care providers and policymakers alike to reimagine NICU environments as collaborative ecosystems that honor parental agency as a pillar of infant health and family resilience. As scientific understanding evolves, the challenge remains to translate these insights into universally accessible models that uplift every family navigating the fragile beginnings of life.

Subject of Research: Whether Family Integrated Care (FICare) model including Family-Centered Rounds (FCR) reduces parental stress in neonatal wards.

Article Title: Family integrated care reduces stress in transferred parents of preterm infants, but not across all families: a stepped-wedge cluster-randomized trial.

Article References:
Alferink, M.T., Hoeben, H., Jonkman, N.H. et al. Family integrated care reduces stress in transferred parents of preterm infants, but not across all families: a stepped-wedge cluster-randomized trial. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02318-w

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41372-025-02318-w