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Abstract

A “one health” approach recognises that human health, animal health and planetary health are closely interlinked and that a transdisciplinary approach is required to fully understand and maintain global health. While, by necessity, Neonatal Intensive Care has traditionally focused on the acutely unwell newborn, the avoidance of long-term harm is core to many management decisions. The COVID 19 pandemic and climate crisis have brought into sharp relief the importance of a “one health” approach as part of long-term health promotion in the holistic care of neonates, who may survive to experience the burden of future environmental crises. This narrative review seeks to integrate what we know about “one health” issues in the neonatal intensive care unit, notably antimicrobial resistance and climate change, and suggest “everyday changes” which can be utilised by practitioners to minimise the impact of neonatal intensive care on these global health issues. Many of the changes suggested not only represent important improvements for planetary health but are also core to good neonatal practice.

Conclusions and everyday practice changes

Human activity has had a profound impact on both planetary and animal health. Whilst in the NICU the acuity of our patient workload can sometimes limit our ability to examine global practices is, the fact is our patients will likely carry the burden of the twin threats of climate change and antimicrobial resistance after leaving our care. Table 1 highlights the practical measures individual units can take to try and improve carbon footprints generated in the NICU and reduce antimicrobial resistance in both our patients and in animals.

Table 1 Suggested changes to apply one health principles in the NICU.

Full size table

The “One Health” approach remains an underappreciated area of our care provision and future research should focus on how NICU care can be delivered in a sustainable way. Although some goals should be focused on improving diagnostics, such as diagnosis of sepsis, much can be achieved within current clinical practice. Fortunately, many of these everyday changes not only improve the sustainability of neonatal care but also represent best standard of care for neonatal patients. These changes allow neonatologists not only to meet our patients’ acute needs but also provide for their future beyond the incubator.

SEE: Beyond the incubator: applying a “one health” approach in the NICU | Pediatric Research (nature.com)

https://www.nature.com/articles/s41390-024-03534-4

 Corresponding author

Correspondence to Daniel O’Reilly.