Aditya Hemendra Bhatt

Background: Alarm fatigue in neonatal intensive care units (NICUs) may affect patient safety, staff well-being, and the developmental care environment. NICU alarm-management interventions have been reported across quality improvement (QI), before-after, randomized crossover, implementation, and observational designs, but outcome definitions, denominators, and safety measures remain heterogeneous. Objective: To map NICU alarm-management interventions and related implementation studies, emphasizing intervention components, outcome metrics, alarm-burden outcomes, clinical safety measures, and implementation lessons. Methods: This scoping review followed PRISMA-ScR guidance. PubMed/MEDLINE, Embase, CINAHL, and Cochrane Library were searched, with an updated search through June 2026. Eligible reports involved neonatal or newborn intensive care settings and addressed alarm fatigue, clinical alarm management, alarm burden, alarm thresholds, alarm delays, alarm routing, or related QI or implementation approaches. Two reviewers screened records and charted data. A protocol was predefined before screening but was not prospectively registered. Full database-specific search strategies are provided in Supplementary Appendix A. Owing to heterogeneity in designs, denominators, and outcome definitions, findings were synthesized descriptively and were not pooled. Results: Sixteen studies/reports met inclusion criteria. The PRISMA-ScR flow diagram shows 20 records identified, 0 duplicates removed, 20 records screened, 3 excluded at title/abstract screening, 17 full texts assessed, 1 full text excluded, and 16 studies included. Included studies addressed alarm-threshold or parameter optimization, oxygen-saturation alarm strategies, staff education, protocol standardization, PDSA-based QI, alarm delay/filtering, handheld-device routing, and single-room NICU alarm workflows. Reported alarm reductions were directionally favorable in many studies, but denominators differed substantially, including total alarms, SpO ₂ alarms, false alarms, non-actionable alarms, and alarms transmitted to handheld devices. Conclusions: The NICU alarm-management literature describes cautiously favorable alarm-burden trends after carefully implemented, patient-tailored, multidisciplinary approaches, while reported monitored safety outcomes were generally maintained in published studies. However, most evidence is observational, before-after, or QI in design; therefore, conclusions should remain descriptive and cautious. Limitations include heterogeneous outcome definitions, English-language full-text restriction, and limited long-term and economic data. The evidence does not support ranking intervention combinations or making causal comparative-effectiveness claims. Future work should use standardized NICU-specific alarm outcomes, predefined balancing safety measures, long-term sustainability assessment, and economic evaluation.

This scoping review maps and compares evidence on enhanced or modified Family‐Centered Care (FCC) models—including Family Integrated Care (FICare) and related variants—against standard FCC/usual neonatal intensive care unit (NICU) care for preterm infants. We aimed to summarize the comparative effects on neonatal growth and development, feeding and hospital utilization metrics, parental engagement, and parental psychosocial outcomes, and to describe program characteristics and contextual factors reported alongside variation in results across settings. We included diverse study designs conducted in NICUs across multiple regions. Growth‐related outcomes were the most commonly reported domain: 30 studies assessed weight gain, growth velocity, feeding progression, discharge weight, or breastfeeding, and 15 studies explicitly reported better growth or feeding‐related outcomes with enhanced FCC/FICare than with standard FCC/usual care. Developmental outcomes were reported in 12 studies, parental psychosocial outcomes in 25 studies, hospital utilization metrics in 28 studies, and parental engagement measures in 22 studies. Benefits were most often described in programs that combined structured parent education with active bedside caregiving, participation in rounds, mentoring, or other implementation supports, although findings varied by program intensity, unit context, and implementation fidelity. Overall, the evidence supports enhanced FCC/FICare as a promising strategy for improving infant–family outcomes in NICUs, while highlighting the need for clearer component definitions, standardized outcome reporting, and longer‐term follow‐up to support scalable, sustainable implementation.

This study aims to map ethical, legal, social, professional, and implementation issues associated with artificial intelligence (AI) in neonatal intensive care units (NICUs). A JBI-informed scoping review using the population-concept-context framework was reported according to PRISMA-ScR. Peer-reviewed English-language articles published from 1 January 2016 to 31 May 2026 were eligible. Because the original exports and screening log were unavailable, a documented updated rerun was completed on 13 July 2026 using public PubMed-indexed bibliographic searching, supplementary publisher and bibliographic web searching, and backward and forward citation chaining. Exact strategies and record-level decisions are provided as online resources. The retrieval log contained 78 record captures. After removal of 21 duplicates, 57 unique records were screened; 45 full texts were assessed, 14 were excluded with documented reasons, and 31 sources were included. Eight recurring domains were identified: data governance; bias and fairness; transparency and explainability; human oversight; accountability and surveillance; parental engagement; professional readiness and workflow; and equitable implementation. Empirical evidence was concentrated on parent and nurse perceptions, pain assessment, counseling, and explainability, whereas consent processes, subgroup fairness, liability, and post-deployment safety remained under-studied. Conclusion: Ethically responsible NICU AI requires secure governance, local and subgroup validation, understandable communication, active clinician oversight, defined accountability, staff and family engagement, and prospective monitoring. Generative AI should remain supervised and should not replace clinician-family communication. What is known: • Artificial intelligence is increasingly being developed for neonatal outcome prediction, monitoring, pain assessment, clinical decision support, documentation, and family communication, but relatively few systems have progressed to validated routine NICU use. • The use of AI in neonatal care raises concerns regarding privacy, algorithmic bias, explainability, accountability, human oversight, parental trust, and equitable access. What is New: • This scoping review identifies eight recurring ethical and implementation domains for NICU AI: data governance, fairness, transparency, human oversight, accountability, parental engagement, professional readiness, and equitable implementation. • Current empirical evidence is concentrated on stakeholder perceptions, pain assessment, counseling, and explainability, while consent processes, subgroup fairness, legal responsibility, and post-deployment safety monitoring remain insufficiently studied.

Background: Climate change is increasing the frequency and intensity of heatwaves globally, with potential implications for maternal and neonatal health. While associations between heat exposure and preterm birth (PTB) and low birth weight (LBW) have been documented, the broader spectrum of neonatal morbidities remains incompletely characterized. This scoping review systematically maps the evidence on heatwaves and neonatal outcomes beyond PTB and LBW. Objectives: To identify and synthesize evidence on (1) which neonatal morbidities beyond PTB and LBW are studied in relation to heat exposure; (2) exposure windows examined (preconception, trimester-specific, peripartum); and (3) heat metrics employed in the literature. Methods: Following PRISMA-ScR guidelines and the JBI Population-Concept-Context (PCC) framework, we searched PubMed, Embase, Web of Science, and Scopus for peer-reviewed studies examining maternal heat exposure during pregnancy and neonatal outcomes in the first 28 days of life other than PTB and LBW. Because this was a scoping review of a heterogeneous literature, we retained variation in study design, exposure metrics, and outcome definitions rather than attempting quantitative pooling. Two reviewers independently screened titles, abstracts, and full texts. Data were extracted on study characteristics, neonatal outcomes, exposure windows, and heat metrics. Risk of bias was assessed using design-appropriate tools. Results: From 165 initial records, 15 records informed the review. The evidence base was heterogeneous in design, exposure assessment, and outcome definition, and represented 62,986,500 participants across nine countries (primary study publication period: 2012-2020). Eight neonatal outcome categories were identified: mortality (n = 7 evidence sources), NICU admissions (n = 5), thermoregulation disorders (n = 4), metabolic complications (n = 4), respiratory morbidity (n = 3), clinical assessment/Apgar scores (n = 3), congenital anomalies (n = 3), and infectious complications (n = 2). Third-trimester exposure was most frequently studied (n = 9), followed by peripartum (n = 3), second trimester (n = 2), and first trimester (n = 2). Heat metrics included maximum temperature (n = 5), heat index (n = 4), heatwave definitions (n = 4), mean temperature (n = 4), apparent temperature (n = 2), humidex (n = 1), and WBGT (n = 1). Seven studies (47%) were rated as low risk of bias. Across outcome groups, the literature generally suggested adverse associations with heat exposure, but the magnitude, statistical significance, and certainty varied across designs and metrics. Conclusions: This scoping review reveals a growing, yet heterogeneous, body of evidence linking heat exposure to diverse neonatal morbidities beyond PTB and LBW. Third-trimester and peripartum exposures appear especially relevant, but conclusions should remain cautious because the included evidence varies in design, exposure metrics, outcome definitions, and confounder control. Standardization of heat metrics and exposure assessment is needed. Gaps include limited research on preconception and first-trimester exposures, metabolic and infectious complications, and research from low- and middle-income countries. Future research should employ consistent methodologies and examine vulnerable populations to inform climate adaptation strategies for maternal-neonatal health.

Background: Water pollution is an increasingly important but underintegrated determinant of maternal and newborn health. Drinking‐water contaminants such as heavy metals, nitrates, disinfection by‐products, pesticides, per‐ and polyfluoroalkyl substances (PFAS), and industrial pollutants have been linked with adverse perinatal and neonatal outcomes, but the evidence is dispersed across pollutant classes, outcomes and regions. We aimed to map the scope and nature of the published evidence on water pollution and perinatal or neonatal outcomes. Methods: We conducted a scoping review using Joanna Briggs Institute methodology and reported the review in line with PRISMA‐ScR guidance. PubMed, Embase and Scopus were searched through December 2024, with supplementary hand‐searching of reference lists. Eligible studies evaluated exposure to water pollutants through drinking water or water supply systems and reported perinatal or neonatal outcomes. Two reviewers independently screened records and extracted data using a standardised form. Findings were synthesised descriptively. Results: Of 138 records identified, 95 remained after duplicate removal, 65 underwent full‐text review and 42 studies were included. The evidence came from 26 countries across six continents. Prospective cohort, cross‐sectional and case–control designs accounted for most studies. Heavy metals dominated the literature, especially arsenic and lead, while PFAS was the most prominent emerging contaminant group. Preterm birth, low birth weight and congenital anomalies were the most frequently examined outcomes. Across studies, higher exposure levels were repeatedly associated with adverse outcomes, with signals strongest for arsenic, lead, PFAS, cadmium, mercury, nitrates and mixed‐pollutant exposure. Conclusions: The available evidence consistently suggests that water pollution is relevant to perinatal and neonatal risk. The literature is strongest for growth restriction, prematurity, birth defects and mortality‐related outcomes, but important gaps remain in exposure standardisation, mixture analysis, neonatal phenotyping and intervention research. Water quality should be considered part of routine maternal‐child health protection, especially in high‐burden settings.

Neonatal parenteral nutrition (PN) remains a cornerstone of care for preterm infants and for selected term infants when enteral feeding is not possible or is clearly insufficient. In day-to-day neonatal practice, decisions about when to initiate PN, how quickly to advance macronutrient delivery, which lipid emulsion to use, and how closely to monitor biochemical tolerance are guided by several major documents rather than by a single universally adopted standard. This expert narrative review compares the principal recommendations from ASPEN, NICE, and the ESPGHAN/ESPEN/ESPR/CSPEN pediatric PN guideline series, and interprets them alongside contemporary trials, systematic reviews, meta-analyses, and clinically relevant safety guidance. Across these sources, there is broad agreement on the essentials: start PN early when clearly indicated, introduce amino acids and lipids without unnecessary delay, individualize glucose delivery according to tolerance, provide vitamins and trace elements early, and monitor closely for electrolyte disturbances and catheter- or liver-related complications. The remaining areas of disagreement are narrower but important at the bedside, particularly the upper limits of amino acid provision, timing of PN in critically ill term infants, routine use of standardized versus individualized formulations, interpretation of triglyceride concentrations, and the clinical role of mixed-oil or fish-oil-containing lipid emulsions. A practical reading of the literature suggests that the most workable neonatal PN pathway borrows the operational detail of NICE, the physiologic and subgroup-specific framework of the European guidance, and the evidentiary caution emphasized by ASPEN.

To increase the proportion of preterm infants achieving acceptable positioning [Infant Positioning Assessment Tool (IPAT) Score ≥8] from baseline 6% to ≥75% within 6-9 mo. A quality improvement initiative was conducted in a tertiary teaching hospital's Neonatal Intensive Care Unit (NICU). Preterm infants (<37 wk) cared under radiant warmers/incubators were assessed daily using the validated IPAT Scoring (0-12) across six body domains. IPAT scoring was undertaken across shifts by trained "positioning champions" (senior residents and experienced nurses). Sequential PDSA cycles introduced staff training by Positioning Champions, IPAT cards, thicker nesting, a low-cost "Nest-in-Nest" bedsheet technique, onboard training, and supportive supervision. Of 210 infants [mean (SD) gestational age 32.78 (2.44) wk; mean (SD) birth weight 1.69 (0.55) kg], 1051 IPAT observations were collected. Acceptable positioning improved from 12/201 (6.0%) at baseline [median (IQR) IPAT 4 (2, 5)] to 88/302 (29.1%) after PDSA-1 [median (IQR) 6 (5, 8)], 194/301 (64.5%) after PDSA-2 [median (IQR) 8 (7, 9)], 56/71 (78.9%) after PDSA-3 [median (IQR) 9 (8, 10)], and 156/176 (88.6%) in the sustenance phase [median (IQR) 9 (9, 10)]. A stepwise, team-led package that pairs hands-on training with simple, locally made positioning support and continuous feedback can improve and sustain acceptable positioning in a resource-constrained NICU.

Background: Bronchopulmonary dysplasia (BPD) remains a major complication of extreme prematurity, but diagnosis and severity classification have become increasingly challenging in contemporary neonatal respiratory care. Changing respiratory support practices and survival patterns have exposed limitations in older oxygen‐centric definitions, while prognostic tools have emerged to estimate BPD severity or BPD or death risk earlier in the clinical course. Objective: To map post‐2016 evidence on BPD definitions, severity classifications, and severity/risk prediction tools in preterm infants, and to summarise differences in construction, classifiability, healthcare‐context transportability, and prediction of clinically relevant outcomes. Methods: This scoping review followed PRISMA‐ScR reporting guidance and the JBI Population‐Concept‐Context framework. PubMed/MEDLINE, Embase, Web of Science, and Google Scholar were searched from January 1, 2017 to February 28, 2026, with citation chaining of eligible articles. No language restriction was planned at search level, but only English full‐text articles were included because of feasibility. Two reviewers independently screened titles/abstracts and full texts; disagreements were resolved by consensus with a third author. Data were charted using a standardised framework and synthesised descriptively. Formal risk‐of‐bias appraisal was not performed because this was a scoping review. The review protocol was not registered, and no external funding was received. Results: Eighteen studies met inclusion criteria after screening. Evidence clustered into conceptual revision of BPD definitions, comparative validation studies of newer definitions against short‐ and long‐term outcomes, and severity/risk prediction tools including online estimators, machine‐learning adaptations, and nomogram‐based models. Newer support‐mode‐based definitions generally improved classifiability compared with oxygen‐centric definitions and showed outcome gradients in representative cohorts; for example, one NRN definition correctly predicted death or serious respiratory morbidity in 81% of infants, while estimator performance varied by timing and cohort, with reported C‐statistic/AUC values ranging from approximately 0.67 to 0.91 in key prediction‐tool studies. Conclusions: Post‐2016 BPD research shows a shift from oxygen‐centred criteria toward contemporary support‐based classification and dynamic risk estimation. Current evidence supports careful use‐case‐specific selection of definitions and cautious local validation of prognostic tools rather than a universal single best definition or estimator. Future work should harmonise outcome targets, strengthen external validation and calibration, and develop multidimensional, phenotype‐informed classification systems.