Neonatal care on the way to environmental sustainability – a scoping review

Introduction The health sector contributes approximately 4.5% of global carbon emissions [ 1 ] and up to 8.5% at national levels in some countries [ 2 ]. In light of the climate crisis, hospitals must take action to reduce their carbon emissions and environmental impact to enable a transition towards sustainable health care. As today‘s children will experience the most severe and long-lasting effects of the climate crisis [ 3 ], pediatricians bear a special responsibility for climate protection and adaptation to climate change. This scoping review aims to analyse current research and action to reduce the environmental impact and identify research gaps in paediatric inpatient practice, starting with the highly energy- and resource-consuming area of neonatal intensive care units (NICU). Methods We conducted a scoping review and systematically searched Pubmed and Google Scholar using combinations of terms related to neonatal intensive care and sustainability, including carbon footprint, greenhouse gas emissions, climate change, waste management, energy consumption, and sustainable health care. All results were subsequently screened for relevance and inclusion criteria. Grey literature and additional references were added to achieve a comprehensive overview. The literature research will be extended to Embase, Web of Science and other databases. Results Literature research identified 87 publications addressing climate change in the context of neonatology, of which 40 publications mentioned or investigated interventions to reduce the carbon footprint of neonatal care. They covered energy sourcing and use, waste reduction and segregation, reduction of single-use items, advocacy for breastfeeding, reduction of cesarean section and education of staff and parents. Promising solutions have been developped and investigated in low-resource countries. Although local projects have demonstrated success in reducing waste and energy consumption on neonatal units, no standard practice or guidelines have been established yet. Conclusion While there is an increasing body of evidence investigating the impact of climate change on maternal, neonatal, and child health, primary research on mitigation strategies in neonatal units remains scarce. More evidence on the feasibility, impact and patient safety of sustainable interventions in neonatal care is needed. Future research may focus on life cycle assessments of neonatal treatments, procedures and NICU-specific devices like incubators, feeding modalities and ventilators, as well as medication, procurement and the role of telemedicine. Water and energy use, as well as financial implications and cost savings of sustainable health care pratices need to be further investigated. Publication History Article published online: 10 June 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany