Abstract
The arrival of a newborn is a highly anticipated occasion. But for families with preterm and ill babies, the associated health challenges and psychological burden can make the occasion a stressful one. Each year in Europe, an estimated 500 000 babies—roughly 10% of all livebirths—are born before 37 weeks of gestation.
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Although much progress has been made to improve survival and outcomes in the past 40 years, premature birth remains a major cause of under-5 mortality and lifelong morbidities. Regrettably, the highly variable quality of maternal and infant care in Europe means that vast outcome disparities exist both between and within countries. Published on Nov 28, the European Standards of Care for Newborn Health aim to define and harmonise “the care and treatment that shall be provided by a neonatal service”. Recognising that improving newborn health is a truly collaborative effort, the project was conceptualised and coordinated by the parent organisation European Foundation for the Care of Newborn Infants, which brought together around 220 experts across disciplines from 31 countries to work with parent representatives. The resulting standards cover 11 key topics—starting from antenatal and perinatal care, to transition to home, ethical decision making, palliative care, and long-term follow-up. At the heart of the standards is infant-and-family-centred developmental care. While detailed clinical guidance is given on relevant issues such as preventing bronchopulmonary dysplasia and early-onset neonatal sepsis, a large proportion is devoted to empowering parents in taking up their roles as primary caregivers. When given individualised support, parents' participation in daily care procedures in the neonatal intensive care unit (NICU) such as nappy changes, bathing, and weighing can reduce stress, increase care-giving competency, and strengthen parent–child bonding. The standards also advocate 24 h access for parents to the NICU and recommend provision of a supportive sensory environment that minimises exposure to excessive light, noise, and other stressful stimuli. Where painful medical procedures are necessary, parents are encouraged to recognise their baby's discomfort signals and to provide non-analgesic pain relief—for example, by breastfeeding and having skin-to-skin contact with the infant. To ensure continuity of care after hospital discharge, the standards recommend providing families with a comprehensive plan that includes tailored education, training, and ongoing psychosocial support for parents. Assessment of the infant's neurological status, cognitive, motor, and language development, as well as respiratory, cardiometabolic, and other health outcomes should be included in continuing care. Such long-term follow-up is essential to enable early identification of any concerns and rapid intervention, so that these children can continue to thrive at school age and beyond. Although these recommendations are already part of routine practice in some countries, the establishment of a harmonised set of standards represents an important step towards equitable outcomes for premature and ill infants across Europe. Each standard is broken down into components for parents and families, health-care professionals, neonatal units, hospitals, and health services—exemplifying the concept that close collaboration at all levels of the health system is essential. Evidence-based clinical practice needs to be implemented with the infant and their family in mind, respecting that each family has different needs and requires individualised support to achieve the best outcome for their child. Importantly, although some recommendations require substantial investments, initial steps are proposed so that immediate actions can be taken. Some simple steps include putting up a folding screen to guarantee privacy, carefully explaining medical conditions and management plans to parents, and providing information about available professional and peer-to-peer support services. We call on national health systems to review their protocols in light of these standards, identify priority areas for change, and establish strategies for implementation. To monitor progress and enhance accountability, clear indicators for meeting the standards have been proposed, although challenges remain in the systematic collection of data that can be compared across countries. Decades of research have refined our knowledge of neonatal health and improved survival of preterm and ill infants. It is now time to translate the evidence into the best quality of care for patients and their families, no matter where they live. And it all starts with respecting the rights and dignity of the infant and their family, and recognising these early weeks as a pivotal stage in the pathway from fetal life to adulthood.
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