Sotiropoulos JX, Manley BJ, Libesman S
… +10 more, Ambalavanan N, Das A, Mckinlay CJD, Panigrahy N, Cruz M, Nguyen D, Williams J, Davis P, Hunter KE, Seidler AL
INTRODUCTION: Bronchopulmonary dysplasia (BPD) is a leading cause of morbidity and mortality in preterm infants. Combining surfactant with budesonide has been proposed to prevent BPD, but results from existing randomised...INTRODUCTION: Bronchopulmonary dysplasia (BPD) is a leading cause of morbidity and mortality in preterm infants. Combining surfactant with budesonide has been proposed to prevent BPD, but results from existing randomised controlled trials (RCTs) are conflicting. Individual participant data meta-analysis (IPD-MA) synthesises raw trial data, increasing precision, improving assessment of data quality and enabling subgroup analyses. This IPD-MA aims to examine the effect of surfactant plus budesonide versus surfactant alone. METHODS: We will systematically search medical databases and trial registers for RCTs enrolling preterm infants born at < 32 weeks' gestation randomised to intratracheal surfactant alone or surfactant plus budesonide. Studies with major quality concerns will be excluded. Risk of bias will be assessed using Cochrane's RoB 2 tool. Two-stage fixed-effects IPD-MA will be performed with co-primary outcomes of all-cause mortality at hospital discharge and BPD at 36 weeks' postmenstrual age. Subgroups will be examined using treatment-covariate interactions. Certainty of evidence will be assessed using GRADE. A nested prospective meta-analysis will also be conducted. The study is preregistered on PROSPERO (CRD42023456941). CONCLUSION: If effective, surfactant plus corticosteroid would be a low-cost addition to standard care to reduce BPD and increase survival. IPD-MA will allow further insight into treatment effects.
AIM: Obesity is a stigmatised disease, and weight-related bullying is the most common form of victimisation. This study aimed to provide a nuanced understanding of adolescents' experiences of such victimisation and relat...AIM: Obesity is a stigmatised disease, and weight-related bullying is the most common form of victimisation. This study aimed to provide a nuanced understanding of adolescents' experiences of such victimisation and related interventions. METHODS: Data were collected between April and October 2025 through semi-structured interviews and analysed using reflexive thematic analysis. Participants were Swedish adolescents aged 12-19 years, primarily recruited from obesity units. RESULTS: The analysis generated three main themes. My body is the problem reflects how weight-related bullying is experienced in everyday contexts and how adolescents encounter pervasive messages devaluing their bodies and self-worth. When the school turns a blind eye illustrates how the school fails to protect and at times becomes part of the problem. I'm ruined for life captures how bullying erodes trust, self-confidence, and optimism about the future. CONCLUSION: Adolescents report that weight-related bullying has substantial negative effects on both their current and future well-being. They also perceive that schools do not take such bullying seriously enough. Healthcare providers should routinely assess whether adolescents with obesity experience weight-related bullying and respond appropriately. Schools must recognise weight-related bullying as a pervasive issue and implement strategies that do not place responsibility on the victim.
AIM: We examined how lower limb muscle tone was related to age, sex, Gross Motor Function Classification System (GMFCS) level, and the cerebral palsy (CP) subtype in Swedish children with CP. METHODS: This registry-based...AIM: We examined how lower limb muscle tone was related to age, sex, Gross Motor Function Classification System (GMFCS) level, and the cerebral palsy (CP) subtype in Swedish children with CP. METHODS: This registry-based cohort study from 2023 to 2024 used data on all 3 216 children aged 1-15 from the Swedish follow-up program and national CP Registry. Muscle tone was assessed with the Ashworth Scale in the gastrocsoleus, hamstring, and adductor muscles. Associations between muscle tone and age, GMFCS level, sex, and CP subtype were analysed using descriptive statistics and logistic regression. RESULTS: Hypertonia, defined as Ashworth grade ≥ 1, was present in the gastrocsoleus in 84% of the children, in the hamstrings in 52%, and in the adductors in 34%. Prevalence increased with higher GMFCS levels and varied across age and muscle groups. Gastrocsoleus hypertonia peaked at 7-9 years and then declined. Hamstring hypertonia increased steadily up to 13-15 years. Adductor hypertonia showed a U-shaped pattern across age groups. Children with bilateral spastic or dyskinetic CP had the highest hypertonia levels in all muscle groups. CONCLUSION: Muscle hypertonia in children with CP varied by age, GMFCS level, CP subtype, and muscle group. This should be considered when planning treatment strategies.
de Almeida MF, Guinsburg R, Helenius K
… +18 more, Vento M, Biran V, Szczapa T, Battin M, Kusuda S, Norman M, Pratesi S, Adams M, Bassler D, Lui K, SanFeliciano L, Lehtonen L, Klinger G, Isayama T, Reichman B, Beltempo M, Shah PS, iNeo Investigators
AIM: Neonatal resuscitation follows national or regional guidelines, but uptake varies in clinical practice. This study aimed to examine variations in reported delivery room practices for infants < 29 weeks' gestation ac...AIM: Neonatal resuscitation follows national or regional guidelines, but uptake varies in clinical practice. This study aimed to examine variations in reported delivery room practices for infants < 29 weeks' gestation across neonatal units in 12 networks of the International Network for Evaluating Outcomes in Neonates. METHODS: An online pre-piloted survey was sent to 608 neonatal units across 12 networks. Responses, based on 2022-2023 practices, were categorized as very frequent (90%-100%), often (50%-89%), sometimes (10%-49%), rarely (1%-9%), and never, and summarized as frequency of units per network. RESULTS: Overall, 382 units (63%) responded (37%-100% within network). Active resuscitation at 22, 23 and 24 weeks was reported as 'very frequent/often' by 22%, 53% and 76% of units, with variation. Delayed cord clamping, cord milking, and resuscitation with intact cord were 'very frequent/often' in 47%, 27% and 7% of units. Japan reported 75% cord milking. For initial respiratory support, 86% reported oxygen concentration < 40%. Intubation at birth for infants 27-28 weeks was uncommon except in Japan. Surfactant delivery room use was reported by 24% of units. CONCLUSIONS: Delivery room management of very preterm infants varies across networks. Future studies should analyse the impact of reported delivery room practices on neonatal outcomes.
AIM: Antenatal information is essential for families facing the possibility of an extremely preterm (EPT) birth. Their information needs are not always clear and communication can be challenging during this stressful, un...AIM: Antenatal information is essential for families facing the possibility of an extremely preterm (EPT) birth. Their information needs are not always clear and communication can be challenging during this stressful, uncertain time. We explored parental perceptions about antenatal information provided during perinatal counselling about EPT births. METHODS: This Spanish qualitative study comprised parents of infants born between 23 + 0 and 26 + 6 weeks of gestation in 2023-2024, who received antenatal counselling in a tertiary setting. Semi-structured interviews were conducted with 15 families after their infants were discharged from the neonatal intensive care unit. These were analysed using inductive thematic analysis, in which themes and subthemes were identified. RESULTS: Four main themes emerged. These were: making sense of complex antenatal information, the key roles of context and communication style, emotional journeys around extreme prematurity and supporting better perinatal care. Satisfaction with counselling was generally high, but parents wanted more practical, empathic approaches that respected their individual values and supported their emotional needs. There were wide variations in the level of detail required. CONCLUSION: Effective antenatal counselling about EPT births should empower parents by respecting their values, supporting their emotional needs and providing resources for informed decision-making.
AIM: To assess prospective associations between media parenting practices and screen time and problematic screen use in early adolescents. METHODS: We used data from the Adolescent Brain Cognitive Development Study, a pr...AIM: To assess prospective associations between media parenting practices and screen time and problematic screen use in early adolescents. METHODS: We used data from the Adolescent Brain Cognitive Development Study, a prospective cohort of 7947 adolescents [M 12.9 years]. Media parenting practices from Year 3 (2019-2021) and adolescent-reported screen time, app-reported smartphone time (subsample N = 840), and problematic screen use from Year 4 were analyzed using linear regression models adjusted for potential confounders. RESULTS: Use of screens to control behaviour (e.g., as a reward or punishment) and adolescent bedroom screen use were associated with greater screen and smartphone time. Parental screen time modelling and family mealtime screen use were associated with greater screen time. Parental monitoring and limiting of screen time were associated with lower adolescent screen time. Parental monitoring was also associated with lower smartphone time. Parental screen time modelling and use of screens to control behaviour were associated with problematic social media use, while family mealtime screen use, adolescent bedroom screen use, and use of screens to control behaviour were associated with problematic mobile phone use. CONCLUSION: These findings suggest that counselling families on specific media parenting practices may help reduce adolescent screen exposure and problematic screen use.
AIM: High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are options for respiratory support in infants with bronchiolitis. The aim of this study was to evaluate the use of HFNC and CPAP in infa...AIM: High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are options for respiratory support in infants with bronchiolitis. The aim of this study was to evaluate the use of HFNC and CPAP in infants with bronchiolitis at five hospitals in Norway to study time trends over seasons and differences in use between hospitals. METHODS: In this multicentre retrospective study, we compared data from 1186 infants < 12 months of age hospitalized for bronchiolitis at five Norwegian hospitals during the winter seasons 2017-2018, 2018-2019, and 2021-2022. RESULTS: Over the three seasons, HFNC was provided to 29%-33% and CPAP to 8%-18% of all infants, but with a substantial difference between hospitals for both modalities. The change between seasons was less prominent but also differed between hospitals. The length of stay was longer, and the age and weight were lower in those receiving any non-invasive respiratory support, but this did not differ between infants treated with HFNC or CPAP. CONCLUSION: In Norwegian hospitals there was a substantial variation in the use of HFNC and CPAP for infants with bronchiolitis. This calls for unified and evidence-based guidelines for the use of non-invasive respiratory support for this patient group.
AIM: The aim was to investigate the incidence of sepsis and use of antibiotics among extremely preterm infants, given the limited number of population-based studies examining this. METHODS: This retrospective study in Ea...AIM: The aim was to investigate the incidence of sepsis and use of antibiotics among extremely preterm infants, given the limited number of population-based studies examining this. METHODS: This retrospective study in Eastern Denmark included all liveborn infants from 23 + 0 weeks/days to 27 + 6 weeks/days of gestation from 2019 to 21. Data on dispensed intravenous antibiotics were obtained from the regional joint electronic health platform. Early-onset sepsis was defined as occurring within the first 72 h of life and late-onset sepsis from 3 to 90 days. Positive blood culture episodes were classified as proven sepsis. RESULTS: Within the first six months of life, 187 of the 232 (81%) infants received intravenous antibiotics. Empirical treatment was initiated for early-onset sepsis in 164 of the 232 infants (71%) and late-onset sepsis in 118 (51%). Late-onset sepsis accounted for 90% of proven sepsis, predominantly caused by Staphylococcus aureus and Coagulase-negative Staphylococcus. Antibiotic use for late-onset sepsis was three-fold higher than for early-onset sepsis (9902 versus 3413 days per 1000 live births). Sepsis caused two deaths (9 per 1000 live births infants). CONCLUSION: Suspected early-onset sepsis was the most common indication for antibiotic initiation, but late-onset accounted for most proven sepsis episodes and antibiotic exposure in extremely preterm infants.
AIM: Most infants with a low cord pH have reassuring 5-min Apgar scores of 7-10, but their long-term outcomes have been poorly studied. We examined whether cord pH predicted later special educational needs (SEN). METHOD:...AIM: Most infants with a low cord pH have reassuring 5-min Apgar scores of 7-10, but their long-term outcomes have been poorly studied. We examined whether cord pH predicted later special educational needs (SEN). METHOD: This nationwide register-based study was conducted in Denmark, which provides universal cord pH screening. It comprised singletons born after 35 weeks of gestation from 2006 to 2013, with 5-min Apgar scores of 7-10 and cord pH values of < 7.0, 7.0-7.09, and ≥ 7.1. Information on SEN was obtained from national registers until June 3, 2020, when the children were 6.5-14.5 years of age. Associations between cord pH and SEN were analysed using multivariable Cox regression, and eight-year cumulative incidence estimates were calculated. RESULTS: We found that 1121 of the 318 486 (0.4%) infants had cord pH values of < 7.0 and 8582 (2.7%) had 7.0-7.09. The adjusted hazard ratio for SEN was 0.95 (p = 0.73) for a cord pH of < 7.0 and 0.98 (p = 0.72) for 7.0-7.09, compared with a pH of ≥ 7.1. The eight-year cumulative incidence of SEN was similar in the groups. CONCLUSIONS: Cord pH was not associated with later SEN in children born after 35 weeks of gestation who had reassuring 5-min Apgar scores.
AIMS AND METHODS: Advances in neonatal care have extended borderline survival to 22-24 post-conceptional weeks. Present review discusses approaches for prolonging short pregnancies and prevention of serious morbidities i...AIMS AND METHODS: Advances in neonatal care have extended borderline survival to 22-24 post-conceptional weeks. Present review discusses approaches for prolonging short pregnancies and prevention of serious morbidities in extremely premature infants born before 28 weeks of pregnancy. RESULTS: Spontaneous extremely premature delivery and foetal alveolar differentiation are induced by inflammatory signals. They either coexist in chorioamnionitis or first premature birth triggers functional differentiation of immature pulmonary alveoli. Infections, other acquired or genetic factors predispose to extremely premature births. Non-steroidal anti-inflammatory agents are effective in tocolysis. However, they are toxic to very premature newborns. In recent animal studies, inhibitors of inflammatory receptors or augmentation of deficient intrauterine anti-inflammatory defences have prevented inflammation-induced preterm deliveries. Antenatal glucocorticoid advances foetal maturity, but glucocorticoid excess interferes with growth and neurodevelopment. Optimizing indications and dosage of glucocorticoid is needed. Despite increasing survival, acute and chronic pulmonary, somatic and particularly neurosensory diseases have barely decreased. Practices of ventilation and multiple other therapies need to be refined for this extremely high-risk population. CONCLUSION: Aiming to medical treatments that safely prolong extremely premature pregnancies and promote the management and safety of extremely premature infants would increase the healthy life years. These goals require persistent multidisciplinary research.
AIM: It is unclear how early childhood obesity treatment affects metabolic risk. This study assessed long-term metabolic health in children with obesity aged 4-6 years and examined associations with weight status. METHOD...AIM: It is unclear how early childhood obesity treatment affects metabolic risk. This study assessed long-term metabolic health in children with obesity aged 4-6 years and examined associations with weight status. METHODS: This prospective cohort study pooled data from the Sweden-based More and Less randomized controlled trial, which compared a parent support program with standard care in 2012-2016. Children met the International Obesity Task Force (IOTF) criteria for obesity. Anthropometrics and metabolic risk factors were collected at baseline, 12 and 48 months. Associations between metabolic markers and weight status were examined using linear mixed models. RESULTS: Data from 106/177 (60%) children, mean age at baseline 5.3 years, were analysed. At baseline, 33/90 (36.6%) had elevated metabolic risk markers. At 48 months, one unit of body mass index standard deviation score (BMI SDS) was associated with higher glycosylated haemoglobin (HbA1c IFCC) (0.99 mmol/mol), higher fasting insulin (2.72 mIU/L) and lower high-density lipoprotein (HDL) (-0.16 mmol/L or -6.2 mg/dL). A BMI SDS reduction ≥ 0.25 was associated with lower HbA1c and triglycerides at 12 months, and a reduction ≥ 0.5 with lower total cholesterol at 48 months. CONCLUSION: Improved weight status may reverse metabolic disturbances present in early childhood.