Climate change threatens human health, particularly vulnerable populations like pregnant individuals, children, and infants. This article examines the multifaceted impacts of climate change on pregnancy and neonatal health. Therefore, we discuss climate vulnerability as a social determinant of health and advocate for integrating climate change screening and counseling into routine perinatal care. As a result, climate health education is critical for both healthcare providers and families, and there is a need for climate-resilient healthcare systems. Furthermore, climate change education is necessary in the NICU, and we advocate for a comprehensive curriculum to equip healthcare professionals with the knowledge and skills to address the unique challenges posed by climate change to this vulnerable population.

Pediatric residency and pediatric subspecialty fellowship programs have seen reduced growth in the number of applicants relative to the increased number of positions over the last 6 years. There are concerns this will lead to a future pediatrician workforce unable to meet the needs of an expanding population of children with highly complex medical conditions. This review will describe the current landscape of the pediatric subspecialty workforce, the factors contributing to pediatric subspecialty applicant shortages, and the potential impacts of these shortfalls on the future of pediatric complex care. Strategies are described to address the insufficient numbers of pediatric subspecialty applicants. Future research is needed to better delineate etiologies and address gaps in the pediatric workforce thus ensuring favorable health outcomes for children.

Multichannel electroencephalography (EEG) is a well-established tool for detecting neonatal seizures and for the assessment of global brain function. Numerous classification and grading schemes for neonatal EEG in full term neonates have been proposed but no universally accepted framework exists, hindering international multicentre research and complicating clinical interpretation. This review summarises widely used classification schemes, compares their key features and argues for a consensus-based classification system.

South Asian and Sub-Saharan African countries, disproportionately overrepresented in the World Bank's low- and middle-income categories, bear a high burden of small and/or sick newborns. It is important to acknowledge that, in addition to reducing mortality, creating opportunities to enhance their health and well-being, thereby improving quality of life, is an essential metric for evaluating neonatal care success. With increased survival rates for small and/or sick newborns in most high-burden, resource-constrained settings, developing and strengthening specialized, structured neonatal follow-up programs to provide high-quality post-hospital care is imperative for optimizing outcomes and quality of life. This paper proposes a Systems Framework for Neonatal Follow-Up of small and/or sick newborns. While this framework applies to all settings, it is particularly pertinent in low-resource, high-burden countries, considering their unique contextual settings. This framework will provide a significant opportunity to foster meaningful engagement and partnership with a wide range of relevant local stakeholders, including families with small and/or sick newborns, as well as to identify areas for increased strategic investment. Furthermore, a multidimensional checklist aligned with the proposed framework provides a comprehensive tool for assessing neonatal follow-up readiness in health systems. The goal is to accelerate progress by transforming the delivery and accessibility of neonatal follow-up for small and/or sick newborns, thus improving the prospects for favorable long-term outcomes in this highly vulnerable population.

Medication, equipment, and formula shortages have become commonplace in the neonatal intensive care unit (NICU). These shortages challenge clinicians to provide optimal care despite suboptimal resources. The effects of these shortages can impact morbidity and mortality and may extend beyond the NICU admission with consequences for the patient's growth and development. We will review the causes of medication, equipment, and formula shortages and discuss ethical approaches to allocating scarce resources.

Significant portions of the U.S. population face barriers to maternity care, contributing to rising rates of maternal and infant morbidity and mortality, particularly among rural and historically marginalized communities. Over 35 % of U.S. counties are designated as "maternity care deserts", lacking obstetric clinicians and birthing facilities. These counties are home to more than 2.3 million reproductive-aged women and account for over 150,000 births annually. Limited access to maternity care is associated with delayed prenatal care, increased preterm birth rates, and higher maternal mortality. Contributing factors include hospital closures, clinician shortages, restrictive policies, and gaps in insurance coverage, disproportionately affecting Medicaid recipients and communities of color. Addressing this crisis requires multifaceted policy solutions. Expanding Medicaid coverage and increasing payment rates can incentivize provider participation and reduce financial barriers to care. Integrating midwifery care offers safe, patient-centered options for low-risk births, yet restrictive state policies and limited training opportunities hinder growth in this workforce. Telehealth presents a promising approach to extending access, particularly in rural areas, by enabling remote consultations, monitoring, and perinatal education. Additionally, fostering regionalized perinatal care networks and investing in workforce development are critical to strengthening the maternity care system. Action is needed to close persistent gaps in maternity care access and ensure equitable, high-quality care for all birthing people. Policymakers, clinicians, and advocates must implement evidence-based solutions to mitigate disparities and improve maternal and infant health outcomes across the U.S.

Stress exposure in the neonatal intensive care unit (NICU) is ubiquitous and affects long-term outcomes for preterm infants. The NICU hospitalization occurs during a critical period of experience-dependent and experience-expectant development when the immature brain is particularly sensitive to environmental exposures, but the experiences of preterm infants are often poorly matched to their neurologic expectations. The mismatch between preterm infants' experiences and neurologic expectations may cause abnormal brain development and programming of the stress response systems. Routine nursing care and parental separation are two neurologically unexpected experiences that, while often overlooked, may be amenable to interventions, including system-level changes. To guide the development and implementation of effective interventions, it is necessary to understand how nurse caregiving practices and parental separation specifically contribute to the preterm infant's stress burden. The purpose of this paper is to provide an overview of the effects of routine nursing care and parental separation, two persistent NICU stressors, and offer recommendations for interventions that nurses and other care providers can use to mitigate the negative effects of these exposures.

Quality improvement collaborative (QIC) networks have been instrumental in improving care and outcomes across various populations, demonstrating a consistent track record of success, particularly within neonatal intensive care units on both national and international levels. Successful networks require many structural factors to be in place at both the collaborative and local level. Engagement and investment in QICs promote equitable care by decreasing variation and driving practice improvements. This review provides an overview of the historical context and a successful methodology in neonatology.

Traditional measures of neurodevelopmental outcomes in preterm children are deficit focused and not informed by parent and family perspectives. Parents care less about medical classification of severity of disability and more about the child's ability to function and participate. Positive health encompasses a broad and dynamic perspective on health that goes beyond the absence of disease and focuses on physical, mental, and social well-being, life-satisfaction, and goal attainment. Measuring positive health as an outcome in children at high risk of disability is challenging but possible. Further exploration of positive health as an outcome may meet the needs of both families and researchers.

In this era of rapid digital transformation, media has become an essential tool for education, communication, collaboration, and advocacy in neonatal-perinatal care. This article explores the evolving media ecosystem within the neonatal intensive care unit (NICU), highlighting how healthcare professionals are using traditional media, video content, blogs, podcasts, and social media to connect with one another, share the latest research, educate peers and families, improve clinical practice, and amplify public health messaging. Drawing on diverse examples and expert commentary, the authors argue that strategic engagement in media enhances family-centered care, bridges the gap between research and bedside application, and fosters a connected, informed, and empowered neonatal community. The article presents a framework for assessing media engagement and invites clinicians to consider how media integration can shape their professional identity and expand their impact beyond their units.

Neonatal follow-up programs are critical in monitoring the long-term outcomes of infants born preterm. The current focus is on neurodevelopmental impairment (NDI). However, such deficit-based outcomes often exclude parental perspectives, failing to capture what matters the most to families: function and quality of life over diagnoses. This paper explores the integration of new family-important outcomes (FIO) measures into neonatal follow-up using patient-reported outcome measures. FIO measures are patient-completed questionnaires that assess a range of health outcomes such as health status, functional ability, and quality of life. We discuss the importance and ethical imperative of integrating FIO measures into neonatal follow-up programs to better align care with family priorities and challenges in bringing practice changes. We propose using an implementation science approach to successfully embed FIO measures into practice and research, enhancing the relevance, equity, and quality of neonatal follow-up care.

As survival rates of extremely preterm (EPT) infants continue to improve, focus has shifted to reduce morbidity and complications in these vulnerable patients. Management of EPT infants presents significant clinical, logistical, and sometimes ethical challenges. Outcomes across centers are highly variable and strongly influenced by the care provided in the early neonatal period. Standardized guidelines, based on published literature and center-specific experiences, play an important role in improving outcomes for EPT infants. Multidisciplinary guidelines provide a framework for clinical management and support a consistent care approach. Guidelines can improve care throughout the entire neonatal intensive care unit (NICU) course, beginning prior to delivery during antenatal counseling, delivery room management, golden hour, and throughout the NICU stay as infants' needs evolve based on physiologic changes.

The diagnosis, management and differentiating of gastroesophageal reflux (GER) and pathologic gastroesophageal reflux disease (GERD) in infants remains a clinical challenge. There is significant clinical and economic burden attributed to GERD in the NICU leading to longer length of stays, higher financial costs, and overuse of medications.

Cesarean delivery (CD), performed in nearly one in three U.S. births, is the most common surgical procedure. As utilization has increased, advances in surgical technique and perioperative management, guided by landmark trials, have refined the procedure and improved outcomes. Some of the most significant trials have focused on antibiotic prophylaxis, prevention of postpartum hemorrhage, and standardization of surgical techniques. For example, pre-incision prophylactic cefazolin has reduced the risk of postoperative infectious morbidity up to 60% compared to administration at the time of cord clamping. Additionally, the introduction of TXA to the treatment of obstetric hemorrhage has been shown to reduce maternal mortality related to hemorrhage. Future research should prioritize continuing reduction of maternal morbidity as CD still incurs increased risk of infectious and bleeding morbidity. Another important focus in the era of increased CD rates is research into the optimal closure of the hysterotomy. Identification of patients at risk of uterine rupture in future pregnancies can improve the safety of trial of labor after cesarean delivery (TOLAC); further investigation into how hysterotomy closure may contribute to the development of placenta accreta spectrum can significantly decrease maternal morbidity from an increasingly common and life-threatening placental disorder.

Both apnea and gastroesophageal reflux are nearly universal in premature infants delivered before 32 weeks gestational age. Apnea of prematurity is multifactorial, secondary to immaturity of several different aspects of respiratory control. Amongst these is the laryngeal chemoreflex, when stimulated in newborns results in central and obstructive apnea as opposed to a cough reflex in older infants, an observation leading to a hypothesis that reflux and apnea may be linked. The current evidence for a role of reflux as a causative factor for apnea of prematurity is poor despite multiple studies seeking to prove a relationship. The studies have been hampered by poor design, inadequate measurement techniques and differing endpoints as well as heterogeneous patient populations. Whether subsets of premature infants can be identified in whom GER plays a larger role in disorders of respiratory control will require careful identification of specific patient populations to be studied, accurate measurement of acidic and non-acidic reflux events, and strict definitions of cardiorespiratory endpoints.

Despite widespread use, electronic fetal monitoring (EFM) has not demonstrably reduced perinatal morbidity or mortality, and likely contributed to the rise in cesarean delivery. To improve its utility, a number of adjunctive approaches have been introduced over the past three decades, including fetal pulse oximetry, ST segment analysis (STAN), and maternal oxygen supplementation. Each intervention was supported by strong physiologic rationale, yet none achieved widespread clinical adoption due to inconsistent evidence of benefit and, in some cases, potential harm. This review critically evaluates landmark studies on EFM adjuncts, highlights the limitations that have impeded progress, and outlines emerging innovations, including artificial intelligence and multimodal surveillance. The persistent challenges in intrapartum fetal assessment underscore the need for high-quality evidence, rigorous implementation strategies, and a patient-centered reframing of EFM goals.

Bronchopulmonary dysplasia (BPD) is among the most common and serious complications of prematurity. The pathobiology of BPD and BPD associated pulmonary arterial hypertension (BPD-PH) is multifactorial and not yet fully defined. Gastroesophageal reflux (GER), a physiologic process that occurs in most preterm infants and is typically benign, has been proposed as a potential contributor to the development or worsening of BPD and BPD-PH. Infants who develop BPD compared to those who do not are more frequently diagnosed with symptomatic GER and undergo therapeutic interventions to treat GER. However, current evidence does not support a direct causal relationship between GER and the onset or progression of BPD or BPD-PH in preterm infants. While GER may contribute to respiratory morbidity in individual cases, population-level data do not implicate it as a major driver of BPD pathogenesis. Moreover, the limited available data from clinical trials and observational studies does not consistently demonstrate improved outcomes in patients with BPD who are treated for GER. This narrative review summarizes the current literature evaluating the relationship between GER, BPD, and BPD-PH.

Gastroesophageal reflux disease (GERD) is common in neonates, and a wide variety of symptoms have been attributed to reflux in this age group, including regurgitation, fussiness, and respiratory symptoms. Though the natural history of GERD is one of resolution in most infants, treatment may be needed when symptoms are particularly bothersome or associated with concerning medical complications. An array of management options exists for neonatal GERD, including both medical and surgical treatments. The goal of this review is to present an overview of nonpharmacologic, pharmacologic, and surgical GERD treatments and to review the available evidence on these treatments with a focus on research completed in the neonatal population.