Hospital-acquired infections (HAIs) are among the leading causes of morbidity and mortality in the NICU. Adhering to proper hand hygiene compliance and technique is one of the most effective ways to minimize HAIs and create a safer environment for patients, their families, and staff. This quality improvement (QI) initiative aimed to audit hand washing quality in the NICU and ensure consistent adherence to proper techniques by all staff to reduce the incidence of HAIs. An increase in unit infections and high staff turnover prompted the project. This project was carried out over two Plan-Do-Study-Act (PDSA) cycles to evaluate the effectiveness of hand washing. All health care professionals entering the NICU applied glow lotion to their hands before washing. A glow light illuminated any missed areas, and an auditor collected data on each instance of participation. The material from the audit focused on : (a) the percentage of people who had glowing areas after hand washing (indicating missed germs) and no glowing areas after hand washing (indicating quality hand washing, eliminating germs); and (b) the number of missed hand washing areas and locations. At the end of this project, the proportion of participants with no glowing areas increased from 19.7 to 37%. Similarly, improvements were also seen in the number of glowing areas. The proportion of those with more than two missed areas decreased from 39.6 to 20.7%, again indicating that health care professionals were performing hand hygiene more effectively. It was noted that, although improvements were made, some staff still had one glowing area after hand washing, indicating that ongoing intermittent auditing of hand hygiene quality is pivotal. This back-to-basics activity demonstrates how health care professionals can improve the quality of their hand washing, thereby reducing the spread of infections in health care settings. It should be everyone's responsibility to ensure effective hand washing to protect those most vulnerable. Continued multidisciplinary education and audits are necessary to monitor compliance.

Surgical neonates represent one of the most vulnerable populations in the NICU due to physiologic immaturity, limited compensatory reserves, and exposure to perioperative stress. Although advances in neonatal surgery, anesthesia, and intensive care have improved survival, outcomes remain closely linked to the quality and consistency of nursing care. Nurses play a critical role in physiologic stabilization, prevention of complications, early recognition of deterioration, and delivery of family-centered care throughout the perioperative course. This narrative review synthesizes current evidence on the nursing care of surgical neonates, focusing on essential domains including monitoring and documentation, thermoregulation, respiratory and nutritional support, infection prevention, pain assessment, parental counseling, nurse-led education, and nursing leadership. The review also examines the influence of nurse-to-bed ratios on patient safety, particularly in low- and middle-income countries where workforce shortages remain common. Strengthening nursing capacity, leadership, and structured communication with families is essential to improving safety and outcomes for surgical neonates.

Perinatal mood and anxiety disorders (PMADs) are the most common complications of pregnancy and the postpartum period, affecting approximately one in five women in the United States. Perinatal mood and anxiety disorders encompass postpartum depression, perinatal anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar spectrum disorder, and perinatal psychosis. Despite their prevalence, PMADs remain significantly underdiagnosed and undertreated, with up to 75% of affected women not receiving adequate care. Untreated PMADs carry substantial consequences for maternal health, infant development, and family well-being, with an estimated annual economic burden of $14.2 billion. NICU admission compounds parental risk due to heightened stress, trauma, and uncertainty. Fathers and nonbirthing parents are also affected but remain largely unscreened. This article reviews the epidemiology, pathophysiology, key symptoms, screening, and treatment considerations for each PMAD, with case studies illustrating clinical implications for neonatal nursing practice.

For a family in the NICU, this is literally the worst time in their lives. Most new parents feel that they are protective of their newborn, but being a parent of a NICU baby is 20 times more challenging. NICU nurses have the power to make a difference by building resilience at the same time they are providing patient education. Celebrations, respectfulness, and supportiveness toward the family are key. For parents, the actions of nurses can profoundly affect the NICU stay and persist after discharge. Confidence and resilience go a long way toward creating advocates as they take their child out into the world.

The Textbook of Neonatal Resuscitation is the leading educational resource on neonatal resuscitation, and the ninth edition was released in October 2025, updating the standard of care for newborn resuscitation. The changes in this new edition of NRP are sweeping, with twice as many changes as the previous edition, and include two new highly requested chapters on resuscitation of infants with congenital heart disease and resuscitation of postnatal infants convalescing in the NICU. This narrative review provides in-depth coverage of the changes and discusses the evidence supporting them, enabling clinicians to incorporate them into their everyday practice. With such sweeping changes, individual centers must adapt their approach to resuscitation to their unique circumstances, given their available resources.

Neonatal conjunctivitis is a common condition that can develop and progress at any stage of infancy, depending on the causative agent, including in otherwise healthy term infants outside of the NICU. Despite its frequency, there is no single, readily accessible reference that concisely integrates causative pathogens, presentation timing, and evidence-based treatment strategies. Given the multiple etiologies, each with distinct pathophysiology and management considerations, accurate identification is essential to prevent complications. This article highlights the most common causes of neonatal conjunctivitis, reviews the pathophysiology and clinical presentation, and provides recommendations for both pharmacologic and nonpharmacologic treatments. In addition, nursing implications for prevention, early recognition, and bedside management are discussed. A case study is included to enable readers to apply these concepts in a real-world context.

Infant colic or colic is a disorder of brain-gut interactions in infants less than 5 months of age. An infant with colic has bouts of prolonged crying without organic or environmental cause. Simethicone is an over-the-counter medication often prescribed in the outpatient setting as well as the NICU. This column provides an overview of colic, describes the Rome Criteria for colic in practice and research, discusses the gut-brain axis in neonatal development, reviews the pharmacology of simethicone, and reviews the evidence around the use of simethicone for colic.

A female infant born at 23 0/7 weeks' gestation with a birth weight of 570 g was admitted to the NICU due to extreme prematurity, extremely low birth weight, and respiratory distress syndrome. At approximately 2 weeks of life, she underwent an evaluation for late-onset sepsis because of escalating respiratory support requirements. Empiric antibiotics were initiated while awaiting culture results. Sequential broadening of antibiotic coverage occurred in response to worsening clinical status. Despite maximal medical therapy, the infant continued to deteriorate and ultimately died following an acute bradycardic/desaturation event requiring CPR. Blood culture results returned after her death revealed Gram-negative bacteremia. This case emphasizes the treatment challenges of late-onset sepsis in periviable infants, in whom rapid decompensation from infection can occur even with aggressive antimicrobial therapy.

This is a descriptive cross-sectional study that aimed to determine the factors that affect suboptimal breastfeeding practices among mothers, assess the nutritional status of infants 1-6 months of age, and determine the association between suboptimal breastfeeding practices and the nutritional status of infants. The study was done at various pediatric wards and outpatient departments of the All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. A total of 258 mother-child dyads participated in this study. Suboptimal breastfeeding practices (which means delayed initiation of breastfeeding, discarding colostrum, giving prelacteal feeding, or nonexclusive breastfeeding) and their associated factors (maternal, socioeconomic, environmental, and infant characteristics) were assessed, as well as the nutritional status of infants and its association with suboptimal breastfeeding. The prevalence of suboptimal breastfeeding was 45.7%. Significant factors included outborn delivery (prevalence ratio [PR] = 1.50, p = 0.003), cesarean delivery (PR = 1.38, p = 0.03), preterm birth (PR = 1.47, p = 0.01), and lack of postnatal breastfeeding assistance (PR = 1.56, p = 0.02). Finally, suboptimal breastfeeding practices were associated with being underweight (p = 0.04) and with stunting (p = 0.01).

In 2023, 53% of 300 patients in our NICU developed diaper dermatitis during their hospital stay. Literature indicates that providing effective skin care to patients can help prevent diaper dermatitis. The purpose of this project was to answer the following clinical question: Does application of Cavilon No Sting Barrier with reapplication every 3 days to high-risk newborns, either experiencing neonatal withdrawal due to maternal drug use or who were under observation for suspected infections and were noted to have blanchable redness on their buttocks on admission, prevent diaper dermatitis? This is an evidence-based project using a pre- and post-approach to reducing diaper dermatitis in a Level III NICU unit in Central Texas. Since the project started, there has been no more than a 10% rate of development of diaper dermatitis during the stay of patients who met the inclusion criteria. The recommendation is that every patient admitted to the NICU receives Cavilon applied on admission and with reapplication every 72 hours and/or after bath.

Multiple imaging modalities are used to diagnose, care for, and manage infants in the NICU. Each modality provides unique benefits; however, radiography remains the most common. This article aims to highlight the use of x-rays by reviewing indications, applications, and a systematic interpretation-guiding process. Evaluation, common pathologies, and considerations are discussed to bridge the gap between fundamental concepts and clinical practice, thereby enhancing neonatal care. This article is designed as an educational resource for all neonatal providers and trainees. Finally, a case study allows readers to practice applying concepts in a real-world, clinically relevant context.

Social and community context, the final domain in the Centers for Disease Control and Prevention's determinants of health framework, influences the health and well-being of neonates and their families in many ways that may not always have been considered in neonatal intensive care settings. Building on previous columns, here the impacts of social and community context are described, focusing on community cohesion, justice-related issues, and discrimination and stigma. In this column, we encourage neonatal nurses to consider how the social environment impacts neonates and families during their NICU stay and after discharge. Actions that nurses can take within the NICU setting and externally are described and resources are provided.