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Background Enhanced Recovery After Surgery (ERAS ® ) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS ® Society guidelines. We created an ERAS ® guideline designed to enhance quality of care in neonatal intestinal resection surgery. Methods A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. Results Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. Discussion We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.

Background Trainees aiming to specialize in Neonatal Perinatal Medicine (NPM), must be competent in a wide range of procedural skills as per the Royal College of Canada. While common neonatal procedures are frequent in daily clinical practice with opportunity to acquire competence, there are substantial gaps in the acquisition of advanced neonatal procedural skills. With the advent of competency by design into NPM training, simulation offers a unique opportunity to acquire, practice and teach potentially life-saving procedural skills. Little is known on the effect of simulation training on different areas of competence, and on skill decay. Methods We designed a unique simulation-based 4-h workshop covering 6 advanced procedures chosen because of their rarity yet life-saving effect: chest tube insertion, defibrillation, exchange transfusion, intra-osseus (IO) access, ultrasound-guided paracentesis and pericardiocentesis. Direct observation of procedural skills (DOPS), self-perceived competence, comfort level and cognitive knowledge were measured before (1), directly after (2), for the same participants after 9–12 months (skill decay, 3), and directly after a second workshop (4) in a group of NPM and senior general pediatric volunteers. Results The DOPS for all six procedures combined for 23 participants increased from 3.83 to 4.59. Steepest DOPS increase pre versus post first workshop were seen for Defibrillation and chest tube insertion. Skill decay was evident for all procedures with largest decrease for Exchange Transfusion, followed by Pericardiocentesis, Defibrillation and Chest Tube. Self-perceived competence, comfort and cognitive knowledge increased for all six procedures over the four time points. Exchange Transfusion stood out without DOPS increase, largest skill decay and minimal impact on self-assessed competence and comfort. All skills were judged as better by the preceptor, compared to self-assessments. Conclusions The simulation-based intervention advanced procedural skills day increased preceptor-assessed directly observed procedural skills for all skills examined, except exchange transfusion. Skill decay affected these skills after 9–12 months. Chest tube insertions and Defibrillations may benefit from reminder sessions, Pericardiocentesis may suffice by teaching once. Trainees’ observed skills were better than their own assessment. The effect of a booster session was less than the first intervention, but the final scores were higher than pre-intervention. Trial Registration Not applicable, not a health care intervention.

Background: Complexity of care, adequate staffing levels, and workflow are key factors affecting nurses’ workloads. There remain notable gaps in the current evidence regarding clinical complexity classification and related staffing adjustment, limiting the capacity for optimal staffing practices. This study aimed to adapt and validate the Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool (WANNNT-SC) for an Italian context to allow the assessment of newborns admitted to NICUs. Methods: This was a validation study. Results: To evaluate the reliability of the tool among different professionals, a correlation test was performed using Pearson’s correlation, which revealed a strong correlation (r = 0.967, p = 0.01). In the test–retest phase, there was a significant correlation (r = 0.910 and p = 0.01). Using an analysis of variance, we found that the higher the I-WANNNT-SC score was, the higher the predicted death rate (F = 13.05 and p < 0.001). Conclusions: The Italian Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool represents the first tool available for an Italian context that aims to measure the nursing workload in neonatal intensive care. It could allow adjustments in nursing staffing based on NICU activities and patient needs. This study was prospectively approved by the local Ethics Committee “Palermo 1” (Protocol CI-NICU-00).

Background Parents endure significant stress when their newborns require surgery while in the neonatal intensive care unit (NICU). Our study aims to explore the surgical NICU experience from the parents’ perspective and identify areas that may improve this experience. A secondary objective was to integrate their feedback to refine the implementation strategy of the neonatal enhanced recovery after surgery (ERAS ® ) guideline. Methods In December 2019, five surgical NICU parents participated in a focus group. Conversation surrounded parents’ perspectives and experiences of the surgical NICU. Inductive analysis was performed to identify data, themes, and concepts that emerged from the discussion. Results Participants identified four major interrelated themes that impacted the surgical parents’ NICU experience. These themes include (1) parental state, both physical and emotional, (2) the altered parental caregiver role which necessitates identifying alternative meaningful parental experiences, (3) the care team dynamic, incorporating consistency and effective communication, and (4) the discharge process which may be significantly eased through graduated, hands-on training. Conclusion Key elements of the neonatal ERAS ® guideline address major themes and stressors identified by parents. The parental perspective may help clinicians appreciate the parent surgical NICU experience and assist in improving family-centered care to surgical infants and their families.

ObjectiveTo determine the relationship between number of attempts and adverse events during neonatal intubation.Study designA retrospective study of prospectively collected data of intubations in the delivery room and NICU from the National Emergency Airway Registry for Neonates (NEAR4NEOS) in 17 academic centers from 1/2016 to 12/2019. We examined the association between tracheal intubation attempts [1, 2, and ≥3 (multiple attempts)] and clinical adverse outcomes (any tracheal intubation associated events (TIAE), severe TIAE, and severe oxygen desaturation).ResultsOf 7708 intubations, 1474 (22%) required ≥3 attempts. Patient, provider, and practice factors were associated with higher TI attempts. Increasing intubation attempts was independently associated with a higher risk for TIAE. The adjusted odds ratio for TIAE and severe oxygen desaturation were significantly higher in TIs with 2 and ≥3 attempts than with one attempt.ConclusionThe risk of adverse safety events during intubation increases with the number of intubation attempts.

ObjectiveTo evaluate the effectiveness in reducing pain by giving oral sucrose and non-pharmacological comfort measures prior to topical administration of mydriatic eye drops on premature infants undergoing retinopathy of prematurity (ROP) screening eye exams in a neonatal intensive care unit (NICU).Study designA prospective quality improvement study was conducted in the NICU where infants were given oral sucrose prior to administration of mydriatic eye drops while a second person performed facilitated tucking and containment. Premature Infant Pain Profile (PIPP) scores were recorded during eye drop administration and compared to a group that did not receive any comfort measures.ResultSixty-eight infants were enrolled. Mean PIPP scores increased an average of 1.5 (SD = 1.5) during administration of mydriatic drops without comfort measures compared to 0.6 (SD = 0.8) when comfort measures were used. This difference was statistically significant (p < 0.001).ConclusionsOral sucrose and simple comfort measures can be effective in reducing pain associated with mydriatic eye drops.

Background Idiopathic infantile arterial calcification (IIAC) is a rare autosomal recessive disorder, characterized by wide spread calcifications in arterial walls, leading to vaso-occlusive ischaemia of multiple organs. Mortality is high, and there is no definitive treatment. Case presentation A male neonate, 36 +5 weeks gestation, 2.81 kg, was admitted to NICU for respiratory distress. At one hour of age, he was noted to be pale, hypoperfused, with weak pulses, a hyperdynamic precordium and a grade IV/VI pansystolic murmur. The rest of his examination was normal. A chest X-ray showed massive cardiomegaly and pulmonary oedema. An echocardiogram (ECHO) indicated moderate persistent pulmonary hypertension (PPHN) of unclear etiology. A diagnosis of Idiopathic infantile arterial calcification was made and a trial of Editronate therapy was given without success. Conclusion IIAC is a rare disorder, it should be considered whenever a neonate presents with unexplainable cardiac failure, PPHN, echogenic vessels on X-ray/ultrasound and, or concentric hypertrophic ventricles on ECHO. Serial antenatal ultrasound findings of echogenic cardiac foci should raise the suspicion of IIAC. Further studies to determine the long term effects of Editronate on vascular calcifications, disease outcome, and other treatment options are needed.

Hospitals face challenges in long-term intensive care unit (ICU) capacity planning under uncertain demand. Admission rates fluctuate over time, and LOS distributions vary with patient heterogeneity, hospital location, case mix, and clinical practice. Common approaches rely on steady-state queueing models or heuristic rules with fixed parameters, which often fail to capture real occupancy dynamics. The widely used 85% occupancy rule, for example, recommends keeping average utilization below this level to preserve responsiveness, yet it is grounded in stationary assumptions and may lack resilience in time-varying systems. Our analysis shows that even when long-run utilization targets are satisfied, daily occupancy often exceeds 100% capacity. We propose a data-driven framework to estimate ICU bed occupancy using an \\(M_t/G_t/ınfty\\) queueing model with time-varying arrival rates and empirically fitted LOS distributions. The approach combines statistical decomposition and parametric fitting to capture temporal patterns in admissions and LOS, and is applied to multi-year data from neonatal ICUs (NICUs) in Calgary. We evaluate capacity scenarios including average-based thresholds and Poisson-based surge estimates. Results show that static heuristics are inadequate under fluctuating demand and underscore the importance of modeling LOS variability when estimating bed needs. Although the case study focuses on NICUs, the framework has potential applicability to other ICU settings and provides interpretable, data-informed support for systems facing rising demand and constrained capacity.

Hospitals struggle to make effective long-term capacity planning decisions for intensive care units (ICUs) under uncertainty in future demand. Admission rates fluctuate over time due to temporal factors, and length of stay (LOS) distributions vary with patient heterogeneity, hospital location, case mix, and clinical practices. Common planning approaches rely on steady-state queueing models or heuristic rules that assume fixed parameters, but these methods often fall short in capturing real-world occupancy dynamics. One widely used example is the 85\\% occupancy rule, which recommends maintaining average utilization below this level to ensure responsiveness; however, this rule is based on stationary assumptions and may be unreliable when applied to time-varying systems. Our analysis shows that even when long-run utilization targets are met, day-to-day occupancy frequently exceeds 100\\% capacity. We propose a data-driven framework for estimating ICU bed occupancy using an \\(M_t/G_t/ınfty\\) queueing model, which incorporates time-varying arrival rates and empirically estimated LOS distributions. The framework combines statistical decomposition and parametric distribution fitting to capture temporal patterns in ICU admissions and LOS. We apply it to multi-year data from neonatal ICUs (NICUs) in Calgary as a case study. Several capacity planning scenarios are evaluated, including average-based thresholds and surge estimates from Poisson overflow approximations. Results demonstrate the inadequacy of static heuristics in environments with fluctuating demand and highlight the importance of modeling LOS variability when estimating bed needs. Although the case study focuses on NICUs, the methodology generalizes to other ICU settings and provides interpretable, data-informed support for healthcare systems facing rising demand and limited capacity.