August 2022, new and old challenges for humanity, but the neonatal world keeps turning and the quality of care must be sustained and, where possible, improved

And so, as another summer draws to a close, at least here in the northern hemisphere, we continue to hear distressing news. There is less reported about COVID-19 - but do we need to worry about monkeypox? Although COVID-19 was not a disease that specifically targeted neonates, the pandemic profoundly affected their care. Furthermore, the whole of the neonatal community has been distressed by the images of mothers and babies, including sick neonates, suffering as a result of the war in the Ukraine. Our thought and best wishes are with those babies, their families and the community of healthcare professionals trying to care for them. Throughout the world, neonatal nurses are confronted by war, oppression, poverty and multiple other challenges. We stand with all those caring for neonates, whether in a professional of lay capacity throughout the world. We hope that you will find peace to nurture them. We can only offer to share knowledge to underpin your care, but knowledge can be a powerful weapon in itself.

We start at the highest point in the hierarchy of evidence with no less than four review articles. Zeinab Hemati, and a group of Iranian colleagues, ask the ever-relevant question - in our attempt to help the babies could we be doing lasting harm? Their systematic review and meta-analysis suggests that there may be an association between phototherapy and the risk of developing all childhood cancers; and more specifically leukemia. More evidence would be needed to make us question our practice, as neonatal jaundice can be dangerous in itself, but this is an extremely interesting article. Equally interesting, and by Leila Seiiedi-Biarag and another Iranian group, there is weak evidence that massage can enhance the quality of the time spent awake in premature babies. By the authors admission this is based on a small number of studies that could have been better conducted. More research is needed in this area. Both these systematic reviews have successfully combined evidence to answer important clinical questions and we thank the authors for their work.

Like the USA, where Sarah C. Rhoads and Aksana Waskosky carried out their literature review, many countries are seeing a worrying increase in the prevalence of Neonatal Opioid Withdrawal Syndrome, or Neonatal Abstinence Syndrome as it is sometimes called. They show that using a system called “Eat, Sleep, Console, as opposed to more traditional scoring systems, reduced the use of opioids in this vulnerable group. It is an area where quality improvement work is always welcome. The final review, by Ella Holden and a UK based team compliments an article by the same team in British Dentistry Journal (DeSeta et al., 2022) and certainly clarified some facts about neonatal teeth for me.

Staying in Iran, Naimeh Abbasi and colleagues describe a relatively high prevalence of Retinopathy of Prematurity (RoP). It is interesting in that they call for more comprehensive RoP screening, as early diagnosis allows for earlier, and more effective, treatment. It would also be interesting to see the prevalence in of RoP in specific units, as it has long been known that the prevalence can be reduced with good neonatal care (Chow et al., 2003). There are quality improvement projects which could be put in place to prevent as well as cure this worrying disease. Staying with epidemiology, Belete Fenta and a team in Ethiopia, looked at the exposures associated with respiratory distress in their neonatal unit. Although their results are unsurprising, it is always worth looking again at these as patterns can change over time, giving the opportunity to initiate care early.

On a really positive note, and also in Ethiopia, Dejen Getaneh Feleke and colleagues describe a very high proportion of mothers initiating breastfeeding. The most significant factor involved seems to be encouragement from the fathers. They may have much to teach the world where the neonatal community is always striving to improve the rate and quality of breastfeeding.

Sarah K. Edney and a UK based team remind us that about a third of babies have feeding difficulties following brain injury, and that the more severe the brain injury the more likely they are to have feeding difficulties. This is good information to have to hand when counselling families at a very difficult time.

Ameerah Fakher Khudhair and team found that Iranian neonatal nurses were accurate in making nursing diagnoses of the problems associated with neonatal jaundice. Zohour Ibrahim Rashwan, working in Egypt, used a quasi-experimental design to show that carefully measuring the depth of the catheter used reduced mucosal injury when suctioning neonates. Rakhshaneh Goodarzi and another Iranian team, in a randomized controlled trial, failed to show that probiotics could reduce the need for phototherapy, or convincingly show an association with earlier discharge, in hospitised near term babies. They was weak evidence that the babies who received probiotics were more likely to be discharged on day three.

In letters to the editor, Raquel Almeida and her Portuguese colleagues remind us of the positive lessons learned through COVID-19, while Lesieli Leota asks if an exacting English language requirement is stopping well qualified overseas nurses for registering to practice in New Zealand. In this difficult and changing world, the improvement in neonatal care worldwide is evident in falling mortality rates, still neonatal nurses and other healthcare professionals continue to strive to improve the care offered to the smallest and sickest of babies. Measures as simple as hand hygiene initiatives and care bundles related to the care of central lines have been shown to be effective (El-Atawi et al., 2019). Neonatal nurses are in a strong position to introduce quality improvement initiatives (Purdy et al., 2017). A multidisciplinary approach can be even stronger (Bixby et al., 2016). Please share your quality improvement ideas and successes with us so that the standard of neonatal care will continue to improve worldwide.