Neonatology[JOURNAL]
Sun
200 papers
Standardised versus individualised fortification of expressed breastmilk for preterm outcomes: a systematic review and meta-analysis.
Bell CM, Cormack BE, Buksh M … +2 more , Bloomfield FH, Lin L
Neonatology · 2026 Jul · PMID 42391159 · Publisher ↗
INTRODUCTION: Although the precise nutrient requirements of preterm infants remain uncertain, routine human milk fortification is standard practice despite limited evidence of long-term benefit. Whether current fortifica...
INTRODUCTION: Although the precise nutrient requirements of preterm infants remain uncertain, routine human milk fortification is standard practice despite limited evidence of long-term benefit. Whether current fortification strategies optimally balance benefits, risks, and resource use remains unclear. This review evaluates whether individualised fortification improves preterm infant outcomes. METHODS: Randomised controlled trials comparing individualised with standardised fortification were included, evaluating outcomes including mortality, neurodevelopment, growth, and neonatal morbidities. Four databases and three trial registries were searched. Screening, data extraction and quality assessment were conducted independently by two reviewers using Cochrane Risk of Bias-1 tool. Certainty of evidence was assessed using GRADE. RESULTS: Twelve studies including 575 participants were included. Evidence is very uncertain about the effect of individualised fortification on mortality [181 infants, relative risk (RR) 0.20, 95% confidence interval (CI) (0.02, 1.66), p=0.14, I²=0%] and necrotising enterocolitis [193 infants, RR 0.29 (0.05,1.72), p=0.17, I²=0%], both very low certainty. Effect on neurodevelopment at 18-months remains very uncertain. Individualised fortification likely increases head circumference [224 infants, mean difference (MD) 1.76 (0.76, 2.76) mm/week, p=0.0005, I²=52%], weight gain [454 infants, MD 2.87 (1.36, 4.39) g/kg/day, p<0.0002, I²=79%], length gain [261 infants, MD 3.20 (1.22, 5.18) mm/week, p=0.002, I²=81%] and fat-free mass [106 infants, MD 121.4 (25.6, 217.2) g, p=0.01, I²=0], all with moderate-certainty. It may increase fat mass [106 infants, MD 68.9 (6.1, 131.8) g, p=0.03, I²=63%] with low-certainty. CONCLUSION: Individualised fortification likely increases growth in preterm infants; however, whether this is beneficial to clinical and long-term functional health is uncertain. Further high-quality trials with long-term follow-up are needed.
Prospective economic evaluation ancillary to a trial of higher versus lower hemoglobin transfusion thresholds for preterm infants.
Zupancic JAF, King BC, Mowitz M … +12 more , Mao W, Dukhovny D, Schmidt B, Tan S, Chaudhary AS, Crawford MM, Bell EF, O'Donnell Auman J, Walsh MC, Higgins RD, Das A, Kirpalani H
Neonatology · 2026 Jun · PMID 42371837 · Publisher ↗
BACKGROUND: The Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants randomized trial compared higher versus lower hemoglobin transfusion thresholds in extremely low birth weight infants. This publicatio...
BACKGROUND: The Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants randomized trial compared higher versus lower hemoglobin transfusion thresholds in extremely low birth weight infants. This publication compares the economic implications of the two strategies. DESIGN/METHODS: We undertook a prospectively-planned economic evaluation, using patient level data from the parent clinical trial. We report costs in 2020 United States dollars, from health sector and modified societal perspectives, with a time horizon through the end of clinical follow-up. We derived costs from hospital finance systems, Medicaid fee schedules, and family questionnaires, and efficacy from trial data. RESULTS: Of the 1824 patients enrolled in the trial in 19 centers, data were available for 1305 for analysis from a health sector perspective, and 752 for analysis from a societal perspective. The mean cost from the health sector perspective was USD 331,186 per patient in the higher hemoglobin transfusion threshold group and USD 351,579 in the lower hemoglobin transfusion threshold group; the difference was not statistically significant after adjustment for study site and birth weight stratum (p=0.085). The mean costs from the societal perspective were also not statistically significant (p=0.094). The incremental cost-effectiveness ratios for adoption of a lower tranfusion threshold from health sector and societal perspectives were USD 6,797,666 and USD 5,596,666 per additional survivor without NDI, respectively. There was substantial uncertainty in these cost-effectiveness estimates. CONCLUSIONS: Similarly to prior results for clinical efficacy, choosing between a lower or higher hemoglobin transfusion threshold for extremely preterm infants has no significant economic advantage.
Mechanisms of Injury From Environmental Exposures in the Neonatal Intensive Care Unit Impacting Neurodevelopmental Outcomes for Neonates.
Kilpatrick R, Chaudhary N, Eze-Njoku C … +2 more , Meharwal N, Singh R
Neonatology · 2026 Jun · PMID 42340929 · Publisher ↗
Technological advancement in neonatal-perinatal care has improved the survival of critically ill neonates with complex medical and surgical conditions. As part of diagnostic and therapeutic management, these vulnerable n...
Technological advancement in neonatal-perinatal care has improved the survival of critically ill neonates with complex medical and surgical conditions. As part of diagnostic and therapeutic management, these vulnerable neonates are exposed to potential harmful and unintended exposures in the NICU, including diagnostic imaging, sensory environments, medications, nutrition, blood products, and devices. The negative effects on multiple organs at cellular levels can not only impact the lifelong growth and neurocognitive outcomes for the neonate but have the potential of being transmitted to future generations through epigenetic changes. Families, nurses, clinicians, and researchers invested in improving neonatal outcomes need to be aware of these negative impacts. Concerted efforts should focus on eliminating known toxic and harmful substances from commercial products used in neonatal care, and alternatives should be made available. Generational population health globally from early neonatal period to adulthood can be improved by allocating resources to research and mitigation strategies.
The Effect of Liberal versus Restrictive Haemoglobin Thresholds on Cerebral Tissue Oxygenation in Preterm Infants: A Systematic Review and Meta-Analysis.
Bailey DN, Noone AN, Crawford TM … +2 more , Andersen CC, Stark MJ
Neonatology · 2026 Jun · PMID 42313692 · Publisher ↗
BACKGROUND: Near infrared spectroscopy (NIRS) is emerging as a promising method of assessing individualised cerebral oxygenation responses to red blood cell (RBC) transfusion. However, the impact of liberal (high) versus...
BACKGROUND: Near infrared spectroscopy (NIRS) is emerging as a promising method of assessing individualised cerebral oxygenation responses to red blood cell (RBC) transfusion. However, the impact of liberal (high) versus restrictive (low) haemoglobin thresholds on transfusion-related changes in cerebral tissue oxygenation (crSO2) remains unclear. This meta-analysis compares cerebral oxygenation changes in preterm neonates following transfusion with liberal compared to restrictive haemoglobin thresholds. METHODS: Data was extracted (PubMed/Medline, Embase, Web of Science, and Cochrane Database of Systematic Reviews) and risk of bias and certainty of evidence reviewed. Included studies reported changes in cerebral oxygenation in preterm infants receiving RBCs in response to reaching either a liberal or restrictive transfusion threshold. A random-effects model was used to determine effect size and 95% confidence for the primary outcome of change in crSO2. RESULTS: Forty-three full text articles were assessed for eligibility with seven studies included for meta-analysis (restrictive threshold: n=357, liberal threshold: n=220). crSO2 increased following transfusion in both the restrictive (6.40% 95% CI [3.85, 8.95], p<0.001) and liberal (2.75% 95% CI [0.35, 5.14], p=0.03) groups. However, the magnitude of change was greater for those transfused at a restrictive threshold (Q=4.19, df=1, p=0.04). The restrictive group also demonstrated a greater transfusion-related decrease in cerebral fractional oxygen extraction than the liberal group (Q=8.30, df=1, p<0.001). CONCLUSION: Greater improvements to cerebral oxygenation occurred in preterm neonates with a restrictive threshold, suggesting enhanced physiological benefit in response to transfusion. However, meaningful clinical conclusions are limited due to low certainty of evidence and considerable inconsistencies across reporting.
Early Total vs Conventional Feeding between 27-32 weeks' gestation: A Randomized Controlled Trial.
Nangia S, Akanksha S, Kumar G … +2 more , Bandyopadhyay T, Anand P
Neonatology · 2026 Jun · PMID 42308132 · Publisher ↗
Introduction To compare the time of attainment of full enteral feeds in sick neonates between 27-32 weeks of gestation receiving early total enteral feeding (ETEF) versus conventional enteral feeding (CEF). Methods In th...
Introduction To compare the time of attainment of full enteral feeds in sick neonates between 27-32 weeks of gestation receiving early total enteral feeding (ETEF) versus conventional enteral feeding (CEF). Methods In this randomized controlled trial, 183 infants were allocated to either the ETEF (n=90) or CEF (n=93) group. In the ETEF group, feeding was initiated as complete enteral feeds, whereas in the CEF group, feeding was initiated as trophic feeding at 20 ml/kg. The rest of the day's requirements for the CEF group were provided as intravenous fluids. Results The ETEF group infants had marginally higher mean birth weight, slightly greater gestational age, fewer infants with SGA at birth, and a lesser need for resuscitation, although these differences were not statistically significant. The neonates in the ETEF group reached full enteral feeds significantly earlier than the CEF group (6.8 ± 1.8 vs. 9.1 ± 4.3 days postnatal age; mean difference -2.3 [-3.2 to -1.3]; p < 0.001). There was a significant reduction in the episodes of feed intolerance and clinical or probable sepsis with significantly higher weight gain at 1 month of age (17.4 vs 15.5 g/kg/d, p 0.001), and a shorter duration of hospital stay (25.9 vs. 38.1 days; p 0.001) in the ETEF as compared to the CEF group. None of the neonates in the ETEF group developed necrotising enterocolitis (NEC). Conclusion Early total enteral feeding in sick neonates between 27-32 weeks' gestation leads to early attainment of full feeds without increasing the incidence of feed intolerance and NEC. This feeding practice also reduces prematurity-associated complications and the duration of hospital stay.
Early Metabolic Alterations are Associated with Intraventricular Hemorrhage and Its Complications in Very Preterm Infants.
Schupper A, Reichman B, Zaslavsky-Paltiel I … +6 more , Almashanu S, Sagiv N, Coster D, Morag I, Lerner-Geva L, Bassan H
Neonatology · 2026 Jun · PMID 42263039 · Publisher ↗
INTRODUCTION: To identify early metabolic alterations associated with intraventricular hemorrhage (IVH) and its complications, periventricular hemorrhagic infarction (PVHI), and Post-hemorrhagic ventricular dilatation (P...
INTRODUCTION: To identify early metabolic alterations associated with intraventricular hemorrhage (IVH) and its complications, periventricular hemorrhagic infarction (PVHI), and Post-hemorrhagic ventricular dilatation (PHVD), in very preterm infants. METHODS: This population-based observational cohort included 7,313 preterm infants born at 24-32 weeks' gestation between 2009 and 2019. Twenty-one analytes were quantified from dried blood samples collected within the first 96 hours of life using tandem mass spectrometry. Multivariable logistic regression models were used to examine the association between analyte concentration quartiles and IVH, including analysis stratified by IVH-related complications. RESULTS: IVH was diagnosed in 882 infants, while 6,431 had normal neurosonography. Compared with infants in the lowest quartile, those in the highest quartile of methionine and proline concentrations had increased odds of IVH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.21-1.86 and OR 1.74, 95% CI 1.40-2.17, respectively). In contrast, infants in the highest quartile of free carnitine concentrations had significantly lower odds of IVH (OR 0.53, 95% CI 0.42-0.67). These associations were more pronounced among infants with PVHI (n=149) and PHVD (n=152) (P<0.001). CONCLUSION: Among very preterm infants, higher methionine and proline concentrations within the first 96 hours of life were associated with increased risks of IVH and its complications, whereas higher free carnitine concentrations were associated with lower risks. Whether these metabolic alterations reflect secondary responses to ischemic-hemorrhagic brain injury or act as modulators of germinal matrix vulnerability warrants further investigation.
Comparative Diagnostic Performance of Early and Term MRI in Preterm Infants: a Diagnostic Test Accuracy Systematic review and Bayesian Meta-analysis.
Bonezzi L, Rocchitelli L, Biagioni T … +8 more , Chorna O, Pannek K, Luke C, Ware RS, Fripp J, Guzzetta A, Fiori S, Boyd RN
Neonatology · 2026 Jun · PMID 42247320 · Publisher ↗
Introduction Early identification of neurodisability and delay after preterm birth is critical for timely intervention. Term-equivalent magnetic resonance imaging (MRI) (36-44 weeks) is widely used for prognostication, e...
Introduction Early identification of neurodisability and delay after preterm birth is critical for timely intervention. Term-equivalent magnetic resonance imaging (MRI) (36-44 weeks) is widely used for prognostication, earlier MRI (<36 weeks) may offer additional value. Methods To provide a comparative diagnostic test accuracy synthesis of early versus term‑equivalent MRI for motor and non‑motor neurodevelopmental outcomes, incorporating advanced imaging modalities including volumetric and diffusion measures, PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched to January 22nd, 2026. PRISMA-DTA guidelines were followed with PROSPERO registration (CRD42024528207). Studies enrolling preterm infants (<37 weeks) undergoing both early and term-equivalent MRI with neurodevelopment assessment between 12-36-months were included. Two reviewers extracted data and assessed bias risk. Meta-analysis used a Bayesian bivariate random-effects model pooling diagnostic metrics for presence of lesion, intraventricular haemorrhage, white matter injury, and cerebellar haemorrhage. Results Of 3,249 records screened, 30 studies met inclusion. Term-equivalent MRI lesion presence (diagnostic odds ratio (DOR)=14.17 vs 2.67; sensitivity 84% vs 76%; specificity 73% vs 45%) and white matter injury (DOR=5.92 vs 2.20; sensitivity 65% vs 52% and specificity 76% vs 67%) demonstrated superior predictivity than Early MRI. White matter injury at term best predicted motor outcomes (DOR=18.43). Volumetric and diffusion measures improved predictive accuracy, especially for cognitive outcomes. Heterogeneity in MRI protocols, biomarker definitions, and outcomes limited comparability and the modest study number reduced precision. Conclusion Term-equivalent MRI offers higher predictivity than Early MRI. Standardised scoring and multimodal integration are needed to optimise early risk stratification in preterm populations.
Neurodevelopmental outcome up to 5 Years after Isolated Mild Non-Cystic White Matter Injury in Very Preterm Infants.
Hofer B, Griesmaier E, Gande N … +4 more , Staudt A, Pupp Peglow U, Kiechl-Kohlendorfer U, Neubauer V
Neonatology · 2026 Jun · PMID 42241372 · Publisher ↗
INTRODUCTION: Mild non-cystic white matter injury (WMI) is commonly detected on MRI in very preterm infants, but its prognostic significance remains uncertain. We assessed neurodevelopmental outcomes up to 5 years in inf...
INTRODUCTION: Mild non-cystic white matter injury (WMI) is commonly detected on MRI in very preterm infants, but its prognostic significance remains uncertain. We assessed neurodevelopmental outcomes up to 5 years in infants with isolated mild non-cystic WMI on term-equivalent MRI compared with those without brain injury. METHODS: In this population-based retrospective cohort study, infants born <32 gestational weeks in Tyrol, Austria (2011-2018) were included. MRI was performed at term-equivalent age. Infants with isolated mild non-cystic WMI (Kidokoro PVL grade 1-2) and those without brain injury were analysed. Neurodevelopmental outcomes were assessed at 12 and 24 months' corrected age using the Bayley Scales, and at 5 years using standardized cognitive tests (WPPSI-III, KABC-II, SON-R) and the MABC-2. RESULTS: Of 363 infants, 35 (9.6%) had isolated mild non-cystic WMI. Median cognitive and motor scores were within the normal range in both groups at all time points, with no significant differences, although cognitive scores were numerically higher in the WMI group at 12 months (p = 0.087). Rates of developmental delay (<85) and impairment (<70) did not differ between groups. All infants with isolated mild non-cystic WMI were born at ≥28 gestational weeks; findings were consistent in this subgroup. CONCLUSION: Isolated mild non-cystic WMI was not associated with adverse neurodevelopmental outcomes up to 5 years. In settings with routine MRI at term-equivalent age, these findings suggest that isolated mild non-cystic WMI may have limited prognostic value and should not be overinterpreted as markers of adverse outcome in clinical counselling.
Oxygen saturation targeting and retinopathy management in very preterm neonates: An international survey.
Darlow BA, Hurrion EM, Battin M … +16 more , Norman M, Adams M, Kowalczykiewicz-Kuta A, Isayama T, Klinger G, San Feliciano L, Biran V, Moroni M, Caldas JPS, Bassler D, Kusuda S, Vento M, Reichman B, Goswami N, Shah PS, Lui K
Neonatology · 2026 May · PMID 42184240 · Publisher ↗
BACKGROUND: Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units might contribute to clinical variability. Objective was to survey current oxygen saturat...
BACKGROUND: Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units might contribute to clinical variability. Objective was to survey current oxygen saturation targets (SpO2), the use of automatic adjustment of inspired oxygen in infants on respiratory support, the criteria for routine retinal examinations for ROP and the use of anti-vascular endothelial growth factor (VEGF) agents to treat ROP in the International Network for Evaluating Outcomes for Neonates (iNeo). METHODS: Online pre-piloted anonymous questionnaires on care practices in 2023 for extremely preterm (<29 weeks) infants were sent to the Directors of 608 NICUs in the iNeo. Four questions concerned ROP management and results were compared with a similar 2015 survey. RESULTS: There were 11 participating networks from 12 high-income countries and one from a middle-income country. The overall NICU response rate was 63% (382 units). Despite variability between NICUs, within networks there was limited change in SpO2 targets between 2015 and 2023. The median upper and lower SpO2 targets were 95% and 89%; in 18% of NICUs the upper target was ≥96%, in 13% the lower target was ≤85%. Automated loop systems for controlled oxygen delivery were used in 24% of NICUs. Most NICUs (78%) used a combination of birthweight and gestation as ROP screening criteria. Intravitreal anti-VEGF agents were used to treat ROP in all networks and by 76% of NICUs. CONCLUSIONS: There was considerable variation in care practices between NICUs and the relationship of this to clinical outcomes should be explored.
Ultrasound-Guided Non-Tunneled Centrally Inserted Central Catheters versus Peripherally Inserted Central Catheters in Neonates Under 1000 grams: A Comparative Cohort Study.
Capasso A, Grasso F, Meliande M … +3 more , Salomè S, Capasso L, Raimondi F
Neonatology · 2026 May · PMID 42176291 · Publisher ↗
INTRODUCTION: Peripherally inserted central catheters (n-PICCs) are standard in neonatal intensive care but carry high complication rates. Ultrasound-guided non-tunneled centrally inserted central catheters (nT-CICCs) of...
INTRODUCTION: Peripherally inserted central catheters (n-PICCs) are standard in neonatal intensive care but carry high complication rates. Ultrasound-guided non-tunneled centrally inserted central catheters (nT-CICCs) offer a potential alternative. This study compared outcomes of nT-CICCs versus n-PICCs in extremely low birth weight (ELBW) neonates. METHODS: Single-center, comparative cohort study (April 2022-October 2025) enrolling neonates <1000g requiring central venous access. A retrospective cohort receiving n-PICCs was compared with a prospective cohort receiving nT-CICCs. The primary outcome was Central Line-Associated Bloodstream Infection (CLABSI) density rate on successfully placed catheters. Secondary outcomes included procedural success, mechanical complications, and risk factors for CLABSI. RESULTS: We analyzed 103 catheter insertions (50 nT-CICCs, 53 n-PICCs). Procedural success was 100% for nT-CICCs and 94% for n-PICCs (3 immediate failures excluded from follow-up). Among 100 indwelling catheters, nT-CICCs showed significantly lower CLABSI rates (1.83 vs 11.09 per 1000 catheter-days; P = .038). Overall complications affected 4% of the nT-CICC group versus 64% of the n-PICC group (P < .001). nT-CICCs enabled therapy completion in 66% of cases compared with 12% for n-PICCs. Catheter type was the sole independent predictor of CLABSI (adjusted HR 7.1, 95% CI 1.01-49.74; P = .048). CONCLUSIONS: Ultrasound-guided nT-CICCs are associated with significantly lower rates of infectious and mechanical complications compared with n-PICCs in ELBW neonates. This approach provides a safer and more durable option for central venous access in this vulnerable population.
2025 American and European Guidelines on Neonatal Resuscitation: Concordance and Differences.
Trevisanuto D, Ramaswamy VV, Nimbalkar S … +1 more , Weiner GM
Neonatology · 2026 May · PMID 42160231 · Publisher ↗
BACKGROUND: Neonatal resuscitation guidelines are periodically updated to reflect advances in evidence and clinical practice. In October 2025, the American Heart Association-American Academy of Pediatrics (AHA-AAP) and t...
BACKGROUND: Neonatal resuscitation guidelines are periodically updated to reflect advances in evidence and clinical practice. In October 2025, the American Heart Association-American Academy of Pediatrics (AHA-AAP) and the European Resuscitation Council (ERC) released updated neonatal resuscitation guidelines, both based on the scientific evaluations of the International Liaison Committee on Resuscitation (ILCOR). Despite this shared foundation, relevant differences remain between the two documents in terms of scope, structure, and specific clinical recommendations. SUMMARY: We reviewed the documents, identified several areas of divergence, and reached a qualitative consensus about their clinical importance. This narrative review compares the 2025 AHA-AAP and ERC guidelines, focusing on algorithm design, initial stabilization, ventilation strategies, and oxygen administration. Both guidelines promote a gentle, physiology-based approach to neonatal transition and emphasize family-centered care. However, they diverge in several areas, including the complexity of resuscitation algorithms, the management of ventilation, and recommendations for initial inspired oxygen concentration. Many of these differences reflect variations in the scope of the documents rather than conflicting interpretations of evidence. KEY MESSAGES: Several recommendations continue to rely on limited data and reflect a consensus of expert opinion. Persistent gaps in knowledge underscore the need for further high-quality research to inform future updates and support greater harmonization of neonatal resuscitation practices.
Trio Whole Genome Sequencing for Diagnosis of Neonates with Multiple Congenital Anomalies.
Kim HH, Chang YS, Park WY … +1 more , Park J
Neonatology · 2026 May · PMID 42139173 · Publisher ↗
BACKGROUND: Genetic disorders are major causes of morbidity and mortality in neonatal intensive care units (NICUs), yet traditional tests like karyotyping and chromosomal microarray (CMA) often fail to provide a diagnosi...
BACKGROUND: Genetic disorders are major causes of morbidity and mortality in neonatal intensive care units (NICUs), yet traditional tests like karyotyping and chromosomal microarray (CMA) often fail to provide a diagnosis, resulting in a "diagnostic odyssey". Trio whole-genome sequencing (WGS) has emerged as a comprehensive tool capable of detecting a wide range of variants beyond protein-coding regions, potentially offering higher diagnostic yields and rapid, actionable results for critical care management. METHODS: This prospective study evaluated 16 neonates with multiple congenital anomalies who had previously received negative results from conventional genetic investigations. Trio WGS was performed using the Illumina NovaSeq 6000 platform, targeting a mean coverage of 30x. A stringent bioinformatics pipeline and a three-step filtering process were applied to prioritize rare functional variants (MAF < 0.1%) and genes specifically curated for NICU-associated conditions. RESULTS: A molecular diagnosis was achieved in 37.5% (6/16) of the cases within the first 6 months of age. Pathogenic or likely pathogenic variants were identified in genes including SCN4A, DLL1, ACTA1, KLHL40, CHD7, and CNTNAP1, covering both autosomal recessive and autosomal dominant inheritance patterns. These findings provided definitive diagnoses for complex conditions such as arthrogryposis, congenital myopathy, and CHARGE syndrome. CONCLUSION: Trio WGS is a highly effective and feasible diagnostic tool for neonates with clinically heterogeneous anomalies, successfully identifying causes where standard-of-care testing fails. Its implementation in the NICU facilitates targeted medical management, informs prognosis, and provides essential data for family planning.
Prolonged low-dose paracetamol prophylaxis accelerates ductal closure in extremely preterm neonates: a randomised trial.
Ukkonen T, Ronkainen E, Laitala A … +3 more , Saarela T, Hallman M, Aikio O
Neonatology · 2026 May · PMID 42133561 · Publisher ↗
INTRODUCTION: Patent ductus arteriosus (PDA) is associated with increased morbidities and mortality in extremely preterm infants. The biological effect of acetaminophen on the closure of ductus has been shown; however, t...
INTRODUCTION: Patent ductus arteriosus (PDA) is associated with increased morbidities and mortality in extremely preterm infants. The biological effect of acetaminophen on the closure of ductus has been shown; however, the effective and safe dosage for early treatment of the most preterm infants remains unknown. METHODS: In a single-centre, randomised, controlled, double-blind, phase II pilot trial, extremely low gestational age (ELGA, <28 wk) and/or birth weight (<1000g) infants were randomized to intravenous paracetamol or 0.45% saline-placebo. The treatment started before 96 hours age, with loading dose of 20mg/kg and maintenance of 7.5mg/kg every six hours for nine days. Ductal patency was assessed prior to trial initiation and monitored daily, using cardiac ultrasound. Primary outcome was the duration of ductal closure. Secondary outcomes included ductal closure rates, treatment of symptomatic PDA, serum paracetamol levels, long-term morbidities, and mortality. RESULTS: After consent, 40 infants were randomly allocated soon after birth. The intention-to-treat analysis included 39 infants; 19 had paracetamol and 20 placebos. The median (IQR) ductal closure time was 3 (10) days in the paracetamol group, vs 14 (20) days in the placebo group (p=0.031). Ductus was closed in 15 (75%) vs 7 (35%) infants, respectively, p=0.016 (number needed to treat, NNT=3). Three infants in the placebo group received post-study treatment for PDA. The numbers of adverse events were similar in both study groups. CONCLUSION: Early, nine-day paracetamol administration, compared to placebo, significantly shortened the ductal closure time without increase in adverse events in ELGA infants. Trial registration EudraCT 2018-000566-11; ClinicalTrials.gov NCT03641209.
Cardiorespiratory Transitioning at Birth During Varying Levels of Resuscitation and The Role of Dry-Electrode ECG (NeoBeat) and Pulse Oximetry in a Low Resource Setting.
Ahn E, Cypriane J, Ngowi E … +2 more , Shayo A, Perlman J
Neonatology · 2026 May · PMID 42126979 · Publisher ↗
INTRODUCTION: Studies on neonatal cardiorespiratory transition are important in guiding resuscitation guidelines. The objectives were to determine the immediate transitional changes of heart rate (HR) and saturation valu...
INTRODUCTION: Studies on neonatal cardiorespiratory transition are important in guiding resuscitation guidelines. The objectives were to determine the immediate transitional changes of heart rate (HR) and saturation values in neonates who received various levels of resuscitation and the level of agreement between NeoBeat and pulse oximetry. METHODS: High risk deliveries (n=63) in a low resource setting were observed using pulse oximetry and NeoBeat in three groups: comfortably breathing receiving no resuscitation, labored breathing receiving oxygen only, and apneic receiving bag mask ventilation (BMV) plus oxygen. Data were analyzed by time of birth and compared for levels of agreement. RESULTS: Comfortably breathing neonates had initial saturation values (86±13%) with relatively high initial HRs (177±19 beats per minute (bpm)). For neonates receiving oxygen only, 43% reached target saturation goals despite an initial HR of 150±21 bpm; while the BMV group had 73% reach target saturation goals with an initial HR of 88±40 bpm. Bland Altman revealed low bias in all groups and progressively wider lines of agreement as neonates required more resuscitation. In the BMV group, pulse oximetry often displayed a lower HR than NeoBeat at lower mean HR values. CONCLUSIONS: Elevated early saturation values and higher HRs in comfortably breathing neonates may be indicative of a seamless cardiorespiratory adaptation. For neonates requiring resuscitation, oxygen alone without positive end expiratory pressure may delay respiratory transitioning as evidenced by low oxygen saturations at 5 minutes whereas neonates receiving effective BMV with oxygen, a higher percentage met target saturation goals.
Evaluation of mothers' recollection of the consistency of information from antenatal consultations with their postnatal experiences.
Babinet C, Gauthier-Moulinier H, Romain-Scelle N … +1 more , Butin M
Neonatology · 2026 May · PMID 42081436 · Publisher ↗
OBJECTIVE: The primary aim of the study was to assess mothers' perception of the consistency of information retained from antenatal consultations relative to their experience of their neonate's hospitalization. Secondary...
OBJECTIVE: The primary aim of the study was to assess mothers' perception of the consistency of information retained from antenatal consultations relative to their experience of their neonate's hospitalization. Secondary aims included evaluating the quality of information delivered on foetal status, management and prognosis, and identifying factors associated with perceived inconsistencies between retained information and experience. METHODS: This questionnaire-based study involved the mothers of neonates treated in a tertiary neonatal intensive care unit (Hôpital Femme-Mère-Enfant, Lyon, France). Mothers were included if they had attended a prenatal diagnosis consultation and gave birth between January 2020 and December 2022 to a newborn admitted to the NICU. The main dependent variable was the perceived consistency of information provided during prenatal consultations compared with mothers' experiences of hospitalization. A descriptive statistical analysis was performed, quantitative variables summarised as medians and qualitative variables as counts and percentages. RESULTS: Of 106 eligible mothers, 64(60%) responded to the questionnaire. Among the latter, 68%(43/63) reported that the information received during antenatal consultations was mostly or fully consistent with their experience of their neonate's hospitalization. Among the 20 mothers who reported disparities (32%), 7(35%) reported inconsistencies with information provided by other specialists and 5(25%) reported not receiving information on their newborn's condition or prognosis. CONCLUSION: This study highlights the need to improve the consistency and clarity of information provided during antenatal consultations, particularly in a multidisciplinary context, and to better convey prognostic uncertainties. Further studies are required on the impact of these interventions on maternal experiences, preferably with a prospective design to limit recall bias.
Surfactant-Budesonide Combination to Prevent Death or Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis.
Kuitunen I, Res G, Räsänen K … +4 more , Vassallo A, Autilio C, Gualano MR, De Luca D
Neonatology · 2026 Apr · PMID 42033736 · Full text
INTRODUCTION: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity. We aimed to assess whether intratracheal administration of budesonide mixed with surfactant reduces mortality and BPD in preterm...
INTRODUCTION: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity. We aimed to assess whether intratracheal administration of budesonide mixed with surfactant reduces mortality and BPD in preterm infants. METHODS: We conducted a systematic review and meta-analysis of randomised and observational studies enrolling preterm neonates. PubMed, Scopus, and Web of Science were searched from inception to October 2025 without language or year restrictions. Studies comparing bolus administration of bovine or porcine surfactant mixed with budesonide versus surfactant alone were included. Random-effects meta-analyses using inverse variance weighting were performed to estimate risk ratios (RRs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using GRADE. RESULTS: Twenty randomised and five observational studies were included. Surfactant-budesonide combination therapy reduced mortality (RR: 0.83, 95% CI: 0.69-0.99; 18 studies, 5,117 infants) and BPD (RR: 0.84, 95% CI: 0.75-0.94; 25 studies, 5,732 infants). Mortality reduction was observed when all studies were pooled, with no significant difference between study designs. Prenatal steroid exposure was associated with greater mortality reduction. Reduction in BPD remained significant when restricted to randomised trials, irrespective of surfactant type. Sensitivity analyses excluding studies at high risk of bias yielded similar results. Certainty of evidence was moderate for both outcomes. CONCLUSION: Surfactant combined with budesonide may reduce mortality and BPD in preterm infants. However, the evidence remains insufficient to recommend the combination as generalised primary treatment for all preterm neonates. Future studies should incorporate pathophysiological phenotyping to identify infants most likely to benefit.
Orthodontic Airway Plate Therapy for Infants with Robin Sequence: Clinical Principles, Current Evidence, and Evolving Innovations.
Lee MS, Guelmann M, Sheller B
Neonatology · 2026 Apr · PMID 42033735 · Full text
BACKGROUND: Robin sequence (RS) is characterized by the triad of mandibular micrognathia, glossoptosis, and upper airway obstruction (UAO), posing significant airway and feeding challenges in affected infants. Although m...
BACKGROUND: Robin sequence (RS) is characterized by the triad of mandibular micrognathia, glossoptosis, and upper airway obstruction (UAO), posing significant airway and feeding challenges in affected infants. Although mandibular distraction osteogenesis is effective in selected cases, less invasive treatment approaches are emerging. The orthodontic airway plate (OAP), including the Tübingen palatal plate and pre-epiglottic baton plate, can be a reliable nonsurgical modality for infants across a broad spectrum of UAO severity, alleviating airway obstruction by anteriorly repositioning the tongue and restoring pharyngeal patency. SUMMARY: This narrative review describes the biomechanical principles, clinical applications, therapeutic outcomes, and recent technological advances in OAP therapy in infants with RS. OAP treatment improves airway stability and promotes coordinated suck-swallow-breathe function, thereby facilitating oral feeding and growth. Clinical studies demonstrate improvements in polysomnographic parameters, oxygenation, feeding efficiency, and weight gain, with most infants avoiding surgical intervention. Emerging evidence also suggests potential functional orthopedic effects of OAP on mandibular development during early growth. Innovations including imaging-guided planning and CAD/CAM fabrication have enhanced treatment precision and reproducibility. However, long-term follow-up data indicate that soft tissue adaptation may remain incomplete, and risks of orthodontic complications and recurrent obstructive sleep apnea persist into childhood. These findings highlight the need for structured long-term surveillance. KEY MESSAGES: OAP therapy represents an effective, reversible, and noninvasive first-line option for infants with UAO associated with RS across a broad spectrum of UAO severity. Integration of digital technologies and multidisciplinary care pathways may further enhance the clinical applicability of OAP.
Automated Brain Segmentation to Establish Reference Ranges for Regional Brain Volumes in Normally Developing Very Preterm Infants at Term-Equivalent Age.
Hammerl M, Biermeier S, Mangesius S … +8 more , Posod A, Birkl C, Krismer F, Griesmaier E, Gizewski ER, Grams AE, Kiechl-Kohlendorfer U, Neubauer V
Neonatology · 2026 Apr · PMID 42033734 · Publisher ↗
INTRODUCTION: Brain volume is an important marker of early brain development in preterm infants. Automated brain segmentation offers a standardized alternative to manual measurements. The aim of this study was to establi...
INTRODUCTION: Brain volume is an important marker of early brain development in preterm infants. Automated brain segmentation offers a standardized alternative to manual measurements. The aim of this study was to establish reference ranges for regional brain volumes in normally developing very preterm infants without brain injury at term-equivalent age (TEA) and to explore associations with key neonatal factors. METHODS: This cross-sectional study included very preterm infants (<32 weeks of gestation) with structurally normal magnetic resonance imaging at TEA and normal neurodevelopmental outcomes up to 2 years. Magnetic resonance imaging scans were acquired on a 3-Tesla system and processed using Infant FreeSurfer, yielding 26 regional brain structures. Only high-quality scans, confirmed by expert consensus, were included. Associations between regional brain volumes, gestational age, head circumference, and sex were assessed using Pearson correlations and Mann-Whitney U tests. RESULTS: The final cohort comprised 55 infants (24 males) with a median gestational age of 29.4 weeks (interquartile range: 27.6-31.0). Reference volumes and sex-stratified centiles are provided. Male infants had significantly larger volumes of the putamen (p = 0.031) and hippocampus (p = 0.003). Gestational age showed weak or no correlations with brain volumes. Head circumference at discharge showed moderate to strong correlations with several brain structures, whereas correlations with head circumference at birth were weaker. CONCLUSION: This study establishes normative data on regional brain volumes in a well-defined cohort of very preterm infants without brain injury at TEA. These data provide a reference for future research and may support studies investigating early deviations from typical brain development.
Rehospitalization in Preterm Infants: Machine Learning Prediction Model and Associated Risk Factors.
Benni D, Ramon-Gonen R, Klinger G … +2 more , Weinstein O, Magnezi R
Neonatology · 2026 Apr · PMID 42030218 · Full text
INTRODUCTION: Preterm birth is a major global health concern, with preterm infants (PIs) at increased risk of morbidity and rehospitalization in the first year after neonatal intensive care unit (NICU) discharge. Few stu...
INTRODUCTION: Preterm birth is a major global health concern, with preterm infants (PIs) at increased risk of morbidity and rehospitalization in the first year after neonatal intensive care unit (NICU) discharge. Few studies have applied predictive modeling in this domain. This study aimed to develop a machine learning model to predict rehospitalization within 1 year of NICU discharge and to identify clinical characteristics associated with increased rehospitalization risk. METHODS: This is a retrospective cohort study of 2,226 PIs born between 2018 and 2023 at a tertiary-care pediatric hospital in Israel. Data were obtained from NICU and inpatient records, including clinical history, laboratory results, and hospitalization outcomes. A machine learning model was developed using the eXtreme Gradient Boosting algorithm (XGBoost) with 20 clinical predictors. RESULTS: Rehospitalization within 1 year occurred in 358 of 2,226 (16.1%) PIs, with one-third occurring within 30 days. The predictive model achieved an AUC of 0.69 (95% CI: 0.59-0.78), sensitivity of 0.38, specificity of 0.87, positive predictive value of 0.38, and negative predictive value of 0.87. Key predictors included early gestational age, lower birth weight, discharge weight >2,000 g, prolonged NICU stay, trisomy, low socioeconomic score, gastrointestinal and neurological conditions, bronchopulmonary dysplasia, surgical interventions, and abnormal laboratory values. CONCLUSIONS: This study introduces one of the first machine learning models for predicting 1-year rehospitalization in PIs, combining predictive modeling with interpretability through the integration of novel parameters. The model provides insight into high-risk profiles and may support early targeted interventions in an underexplored clinical area.
Cerebral Oxygenation during the First 15 Minutes after Birth and Short-Term Outcome Measured by the Motor Optimality Score-Revised in Preterm Infants.
Scheuchenegger A, Wolfsberger CH, Avian A … +6 more , Schwaberger B, Waltner-Romen M, Hammerl M, Kiechl-Kohlendorfer U, Griesmaier E, Pichler G
Neonatology · 2026 Apr · PMID 42030214 · Full text
INTRODUCTION: Monitoring cerebral regional oxygen saturation (crSO₂) using near-infrared spectroscopy (NIRS) during immediate postnatal transition may help detect and mitigate cerebral hypoxia. General movement assessmen...
INTRODUCTION: Monitoring cerebral regional oxygen saturation (crSO₂) using near-infrared spectroscopy (NIRS) during immediate postnatal transition may help detect and mitigate cerebral hypoxia. General movement assessment (GMA), including fidgety movements (FMs) and the Motor Optimality Score-Revised (MOS-R), is widely used to evaluate early motor development. METHODS: The objective was to assess differences in early motor outcome at 6-20 weeks corrected age according to group allocation in the randomized multicenter COSGOD III trial. This was a retrospective ancillary observational study. Preterm infants (<32 weeks' gestation) enrolled in COSGOD III at two Austrian centers (Graz and Inns-bruck) with available GMA video recordings at 6-20 weeks corrected age were included. MOS-R was scored retrospectively from these recordings. In COSGOD III, infants randomized to the NIRS group received continuous crSO₂ monitoring during immediate postnatal transition to guide resuscitation; in the control group, crSO₂ values were not displayed. The main outcome measure was MOS-R (range 5-28) derived from GMA video analysis. RESULTS: A total of 162 infants were included (NIRS: n = 76; control: n=86; median gestational age 29.6 vs. 28.8 weeks; p = 0.357). Normal FMs were present in 95% of infants (96% vs. 94%). However, MOS-R scores were significantly higher in the NIRS group (median [IQR]: 26 [24-28] vs. 24 [22-26]; p = 0.003), with more infants showing an age-adequate motor repertoire (83% vs. 66%; p = 0.003). CONCLUSION: Although FM presence was similar between groups, NIRS-guided management during immediate transition was associated with improved early motor performance, suggesting that targeted cerebral oxygenation may influence early neurodevelopment.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe