Dear colleague,Together with a group of neonatologists, I developed a survey on procedural sedation and analgesia in neonates. Procedures like intubations, LISA/MIST, catheter placements and chest drain insertions are amongst the painful procedures performed in NICUs. Currently, there are no clear international guidelines for sedation and analgesia for neonates undergoing these procedures. The aim of this study to get insights in current practices of procedural sedation and analgesia across Europe.We would like to reach neonatologists (in training) working in European hospitals and kindly ask them to complete this survey. Responses from multiple neonatologists within the same NICU are encouraged, as clinical practices may vary between individual neonatologists.The survey takes approximately 10-15 minutes to complete and can be accessed through the following link: https://esurvey.erasmusmc.nl/servicebedrijf/ls/index.php?r=survey/index&sid=797838&lang=enWe would greatly appreciate your valuable participation. If you have any questions or comments, please contact v.blok@erasmusmc.nlYours sincerely,Veerle Blok, Medical student, Erasmus University Rotterdam - Erasmus MC, The Netherlands.Judith ten Barge, PhD, Erasmus MC – Sophia Children’s Hospital, The Netherlands.Gerbrich van den Bosch, MD, PhD, Erasmus MC – Sophia Children’s Hospital, The Netherlands.Sinno Simons, MD, PhD, Erasmus MC – Sophia Children’s Hospital, The Netherlands.Procedural sedation and analgesia in neonates poster.pdf

Dear Colleagues, As co-editor I'm pleased to invite you to contribute to our Research Topic in Frontiers in Pediatrics: "Optimizing enteral nutrition in the NICU: early feeding strategies, fortification approaches, and long-term growth outcomes in preterm and high-risk infants."We welcome Original Research, Reviews, Clinical Trials, Perspectives, and Case Reports that advance understanding of early nutrition’s impact on survival, growth, and neurodevelopment in preterm infants worldwide. The collection is peer-reviewed, and if we reach 10 published articles, a free Open Access eBook will be compiled.Key date: Manuscript deadline: 12 Feb 2027.Fees: Open Access publication fees apply. Institutional agreements, national consortia, and fee support options may be available. Eligibility and availability of financial support may vary. Fees are due only after acceptance.For the full scope and to submit, please visit: https://www.frontiersin.org/research-topics/84340/optimizing-enteral-nutrition-in-the-nicu-early-feeding-strategies-fortification-approaches-and-long-term-growth-outcomes-in-preterm-and-high-risk-infantsCarlos A. Delgado, MD, PhD. Pediatrician Neonatologist.Professor of Pediatrics. Universidad Nacional Mayor de San Marcos. Lima, PeruCo-Editor, Research Topic "Optimizing Enteral Nutrition in the NICU"

Sepsis doesn't wait for a convenient hour, so neither will we. This Friday, 30 October, 08:00–09:00, the Newborn Sepsis Society launches in Europe at CEPAS 2026 in Lyon. Yes, it's early. We promise it's worth the alarm.📍 Room: St Clair 2New society, same goal: fewer newborns harmed by sepsis, and more of us working on it together. What to expect:🔹 Why a new society? Eleanor Molloy, Johan Gyllensvärd and Joanna Seliga-Siwecka (short answer: because babies deserve better, long answer: come and see)🔹 The problem: where are we in 2026? Joseph Ting🔹 The future: diagnostics and therapies. Eric Giannoni (evidence included, crystal ball optional)🔹 Open discussion: where do we go from here? You, with the microphoneFamilies have a seat at our table from day one, not as an afterthought. Mandy Daly will open the session with a message from our parent and public involvement committee.Already more than 100 members, and we've saved you a chair.💻 Can't make it to Lyon? Join us at newbornsepsissociety.orgSee you at 8:00 sharp (coffee optional, curiosity required).

Gandhi is universally admired and respected across the world as one the most inspirational political figures campaigning for independence and civil rights in both South Africa and India; lands that were colonised and ‘stolen from’ for centuries by British rule.By chance I am in India today, on Gandhi’s birthday (Jayanti). I’ve been privileged to present at workshops and give lectures at conferences and NICUs, and been invited to join ward rounds and discuss various aspects of neonatal nutrition. A common challenge is ensuring adequate growth, sufficient electrolyte intakes and maintaining serum concentrations especially those <1000g. Promotion, and use of, Mother’s Own Milk (MOM) is universal across India, and many NICUs in privately run facilities also now operate their own donated human milk banks. Some NICUs are also being approached by mother’s experiencing baby loss, to offer their milk in memory of their baby who died (Lactation after Loss), the topic of one of my workshops.The Salt March of 1930, led by Mahatma Gandhi, is one of the most transformative events in India’s struggle for independence. Gandhi and followers undertook a 240-mile march to the Gujarat coast on the Arabian/Indian sea. Salt is an essential nutrient, especially in hot climates where losses through sweat are high. It had been traded for centuries before the British imposed the Salt Laws, which made it illegal to collect or sell salt which was heavily taxed and controlled. Gandhi recognised that taxing an essential biological nutrient was an extreme act of colonial oppression affecting every Indian. Raising this issue was a masterstroke of political strategy that crossed societal boundaries. Salt taxes disproportionately penalised the poorest and highlighted the moral bankruptcy of colonial rule.Salt & evolutionEverything in biology is explained by evolution. Hundreds of millions of years ago, life originated in the primordial oceans and the first single celled and early multicellular organisms developed in a highly saline environment, from which all cellular processes depended on the surrounding sea water. When animals migrated out of the sea, they couldn’t leave the ocean behind and developed complex renal and hormonal metabolism to enclose that ancient ocean.Salt is essential for human survival, regulates fluid balance, nerve transmission and muscle function. It is one of the most critical nutrients for preterm infants, who are born prior to the 3rd trimester when sodium is accumulated as ‘osmotically inactive’ sodium reserves in bone, skin and other tissues. This may help compensate for the relatively low [Na] in MOM. However, most people on the NICU are far more interested in ‘sexier’ nutrients like protein, DHA, zinc etc. and salt needs are rather under-appreciated.Preterm infants have a high requirements for sodium due to several factors including:limited body storeshigh growth ratesrenal tubular immaturitylow sodium concentration in human milkSodium potassium pumps in every cell maintain the electrical charge across cell membranes enabling nerve transmission and muscle function, and help maintain osmotic balance and blood volume. Term-born infants only receive/need around 1-2mmol/kg/d sodium in MOM, but preterm infants require much higher intakes because of rapid growth and urinary losses. Fractional excretion of sodium (FeNa) is typically high.Salt concentration of early milk and colostrum is higher, but most preterm infants only receive small volumes. There have also been concerns that adding too much sodium to PN in the first 1-2 days may provoke fluid retention and worsen later BPD. High [Na] in the first 2-3 days are also common and may represent excess trans-epidermal water loss, prompting many to believe that additional sodium is not needed.Serum sodium - common mistakesBlood/serum [Na] measures the concentration of sodium and not the total mass, as most sodium is extravascular in the interstitial tissues and also bone. A normal serum sodium can mask massive sodium depletion. Once the baby is total body sodium deficient it can be very hard ever to catch up, and all of us have witnessed infants where we keep prescribing i.v. corrections to no avail. When we updated the ESPGHAN guidelines in 2022 we noted that many very preterm babies need more than than 3-5mmol/kg/d previously recommended, and suggested intakes up to 8mmol/kg (or occasionally higher) might be needed.Clinical practiceBecause sodium is vital for both nerve function and growth, it makes sense to provide recommended intakes in the first few days rather than wait for [Na] to drop. It’s analogous to meeting macronutrient intakes with fortifier or formula before waiting for the baby to experience growth faltering. ‘Prophylaxis’ is the key.Do higher salt intakes improve outcomes?Whilst there are no well powered large RCTs, the accumulating evidence suggest sodium intakes are important for growth and perhaps brain development. There is little point giving optimal intakes of protein and calories, if there isn’t sufficient sodium to accrete into lean tissue.Conclusions and recommendations from ESPGHAN are summarised below.

Fabian J. S. van der Velden and Prakash Kannan Loganathan from James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK, review the article "Djordjevich CJ, Magers J, Cantey JB, Prusakov P, Sánchez PJ, Duration of Antibiotic Therapy for Gram-Negative Bloodstream Infections in the Neonatal Intensive Care Unit, The Journal of Pediatrics (2026), doi: https://doi.org/10.1016/j.jpeds.2026.114993. PMID: 41554433" for for ebneo.org.READ HERE!ACTA PAEDIATRICA COMMENTARY:Acta Paediatrica - 2026 - Velden - EBNEO Commentary Duration of Antibiotic Therapy for Gram‐Negative Bloodstream.pdf"Gram-negative bloodstream infections (GNBSIs) are an important cause of morbidity and mortality in neonates(1, 2). Recognition and early instigation of appropriate antibiotic treatment is paramount to improve outcomes. The optimal duration of treatment for GNBSI remains uncertain, and prolonged courses may not be necessary for all infants. The aim should be to use the shortest effective course, balancing clinical recovery with the risks of antimicrobial resistance and the potential longer-term harms of unnecessary antibiotic exposure. Prolonged courses of antibiotics have been associated with increased risk of necrotising enterocolitis in premature neonates(3), an increased risk for allergic disease, and inflammatory bowel disease later in life(4). In parallel, antimicrobial resistance remains a growing concern, with reported resistance among neonatal E. coli isolates reaching 50–75% for amoxicillin, 15–30% for gentamicin, and 46% for cefotaxime(1, 5). Although defined as ≤8 versus ≥9 days, the effective comparison was approximately 7 versus 14 days (short: median 7 days, 67% at 7 days; long: median 14 days; only 9 and 1 infant at the 8- and 9-day boundary). Within this contrast outcomes were broadly similar; treatment failure (same-organism recurrence within 14 days; 5% vs 0%) and subsequent multidrug-resistant gram-negative (MDRO) infection occurred only in the longer-course group. The design cannot recover a dose-response or inform intermediate durations. An important limitation is confounding by indication. Infants in the longer-course group appeared clinically more complex, with higher central venous catheter use (68% vs 38%), all cases with multiple positive blood cultures (19% vs 0%), and greater exposure to broader-spectrum monotherapy such as cefepime or piperacillin-tazobactam (49% vs 10%), whereas gentamicin monotherapy was more common in the shorter-course group (36% vs 11%). These findings suggest that clinicians were already tailoring both antibiotic duration and spectrum according to perceived illness severity or complexity. Therefore, the higher MDRO rate in the longer-course group may reflect broader-spectrum exposure and underlying case mix rather than duration alone. This is reinforced by the MDRO definition itself—any-site detection within 90 days—with events occurring 10–82 days later and predominantly new E. coli ESBL isolates that are plausibly independent acquisitions.Blood culture volume, sampling technique, and repeat-culture practice were not reported, and the methods do not explain how metastatic foci (bone, abscess) were excluded. Because lumbar puncture was not always performed at presentation, post-antibiotic or traumatic CSF sampling may have under-recognised meningitis. The study is underpowered, with no multivariable or propensity adjustment and no confidence intervals. Survivorship bias is also a concern: the 27 of 67 excluded infants who died before day 7 could not experience the outcome, and reaching ≥9 days itself required survival, favouring the longer-duration group on mortality. Importantly, the 7 NICUs sit within only 2 healthcare systems under shared stewardship, so this reflects closer to two practice cultures than seven independent centres; gentamicin monotherapy was viable only because local E. coli and Klebsiella susceptibility was 92–95%, against the 15–30% resistance cited in the literature, and centres with higher resistance could replicate neither strategy—narrowing external validity. Taken together, these data support a hypothesis-generating comparison of approximately 7 versus 14 days in a selected, lower-acuity, vasopressor-excluded population managed within two health systems. Given the small sample, methodological limitations, and risk of bias, the findings justify a prospective trial rather than a change in practice, consistent with the authors’ own conclusion.Artificial intelligence disclosure: ChatGPT (OpenAI; GPT-5.4 Thinking) was used to support drafting, language editing, and improvement of clarity in this commentary. The authors independently reviewed, critically appraised, revised, and approved the final content, and take full responsibility for the accuracy and interpretation of the work."