Morrison JL, Williams GK, Cho SKS
… +7 more, Meakin AS, Holman SL, Quinn M, Wiese MD, Macgowan CK, Seed M, Darby JRT
Neonatology
· 2026 Apr · PMID 41989957
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INTRODUCTION: Fetal growth restriction (FGR) increases the risk of poor in utero, neonatal, and long-term health outcomes. Tadalafil (TAD) is the current focus of a phase II exploratory trial (TADAFER IIb) to determine i...INTRODUCTION: Fetal growth restriction (FGR) increases the risk of poor in utero, neonatal, and long-term health outcomes. Tadalafil (TAD) is the current focus of a phase II exploratory trial (TADAFER IIb) to determine its efficacy as an intervention for FGR. Herein, we aimed to determine the impact that TAD has on fetal hemodynamics. METHODS: At 116-117 days of gestational age (dGA), pregnant ewes carrying normally grown fetuses (n = 9) underwent fetal catheterization surgery before undergoing MRI scans at 119-123 dGA to measure blood flow and oxygenation within the major vessels of the fetal circulation using phase contrast MRI and T oximetry. Baseline measures were performed after a fetal vehicle infusion and then repeated after a fetal TAD infusion. Fetal TAD concentrations were measured by LC-MS/MS. RESULTS: TAD did not impact right or left ventricular (LV) output but was associated with an increase in pulmonary blood flow with reduced blood flow through both the ductus arteriosus and foramen ovale (FO). The difference in blood oxygenation between the ascending aorta and main pulmonary artery was significantly reduced, but cerebral oxygen delivery was maintained by increased carotid artery blood flow. CONCLUSION: Fetal TAD exposure alters pulmonary hemodynamics and reduces the proportion of the LV preload blood pool that is made up of oxygen-rich blood from the FO. Given fetal exposure to sildenafil increases the rate of persistent pulmonary hypertension after birth and that the TAD exposed fetuses studied herein exhibited similar hemodynamic profiles as those exposed to sildenafil, further studies investigating neonatal outcomes of fetuses exposed to TAD are warranted.
INTRODUCTION: Preterm infants are particularly susceptible to glycemic instability, which has been associated with enhanced risks of morbidity and adverse neurodevelopmental outcomes. Continuous glucose monitoring (CGM)...INTRODUCTION: Preterm infants are particularly susceptible to glycemic instability, which has been associated with enhanced risks of morbidity and adverse neurodevelopmental outcomes. Continuous glucose monitoring (CGM) may offer advantages in minimizing glycemic fluctuations. This study aimed to determine whether real-time CGM improves glycemic control and neurodevelopmental outcomes compared to standard care in preterm infants. METHODS: This single-center, prospective, randomized trial was conducted in our NICU between January 2022 and August 2023. Infants were randomly allocated within 6 h of life to either a real-time CGM group or a control group with blinded CGM. In the intervention group, glycemic management was guided by CGM data; in the control group, it was based on intermittent blood glucose measurements. Primary outcomes included the frequency and duration of hypoglycemic (<47 mg/dL) and hyperglycemic (>180 mg/dL) episodes. Neurodevelopment was assessed at 2 years of corrected age using the Griffiths Scales of Child Development. RESULTS: A total of 53 infants were included (CGM group: n = 26; control group: n = 27). Infants in the real-time CGM group demonstrated significantly fewer episodes of both hypoglycemia and hyperglycemia during the first week of life (hypoglycemia: 339 vs. 934, p = 0.0001; hyperglycemia: 145 vs. 830, p = 0.0001) and at 32 weeks of postmenstrual age (hypoglycemia: 260 vs. 785, p = 0.0001; hyperglycemia: 1 vs. 38, p = 0.0001). No significant differences were observed in neurodevelopmental outcomes. CONCLUSIONS: Use of CGM allows therapeutic metabolic strategies to be employed the enhance glycemic control in preterm during the early neonatal period.
INTRODUCTION: Although interest is increasing, 24-h live-streaming webcams are rare in neonatal intensive care units (NICUs), underscoring the need for evidence to support their use. Therefore, we evaluated the effect of...INTRODUCTION: Although interest is increasing, 24-h live-streaming webcams are rare in neonatal intensive care units (NICUs), underscoring the need for evidence to support their use. Therefore, we evaluated the effect of 24-h webcam access on parental anxiety, bonding, and postpartum depression in a NICU setting and examined the impact on the workflows of healthcare providers. METHODS: This study was conducted from April 2023 to March 2024 in a tertiary NICU in Japan, as a pilot randomized controlled trial designed to assess feasibility and estimate the potential effect size. Parents of infants expected to stay >1 month in the NICU were enrolled. Participants were randomized to receive 24-h webcam access or no webcam access (control). The primary outcome was the Mother-to-Infant Bonding Scale (MIBS) score at 1 month after birth. Secondary outcomes included the State-Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale, salivary oxytocin levels, breastfeeding volume, and staff perceptions assessed birth and at 1 month. RESULTS: Eighty parents of 41 infants were enrolled. MIBS scores did not differ significantly between groups (mothers: 2.4 ± 2.1 vs. 2.3 ± 1.8; fathers: 3.4 ± 2.8 vs. 4.2 ± 2.1). In contrast, STAI scores decreased significantly in the webcam group at 1 month (mothers: 48.0-37.3; fathers: 44.3-35.6; both p < 0.001), with a significant between-group difference (p < 0.05, difference-in-differences analysis). Staff surveys indicated that 92% of nurses supported webcam use, and no adverse events occurred. CONCLUSION: Continuous 24-h webcam access reduced parental anxiety and was well accepted by staff and families. Larger multicenter studies are warranted to validate our findings.
INTRODUCTION: Neonatal coagulation differs quantitatively from adult physiology, and conventional plasma-based tests provide limited functional insight into clot formation in newborns. Rotational thromboelastometry (ROTE...INTRODUCTION: Neonatal coagulation differs quantitatively from adult physiology, and conventional plasma-based tests provide limited functional insight into clot formation in newborns. Rotational thromboelastometry (ROTEM) enables dynamic, whole-blood assessment of clot initiation, propagation, and firmness. This study examined whether mode of delivery is associated with differences in early postnatal ROTEM profiles in term neonates. METHODS: In this single-center cohort study, peripheral venous blood from 60 healthy term neonates (10 elective cesarean section, 24 intrapartum cesarean section, and 26 vaginal deliveries) was analyzed using ROTEM EXTEM and INTEM assays. Evaluated parameters included clotting time (CT), clot formation time (CFT), α-angle, clot amplitudes (A10-A30), maximum clot firmness (MCF), and maximum lysis (ML). Group differences were assessed using nonparametric tests, and independent associations were examined using multivariable regression models adjusting for neonatal and maternal variables. RESULTS: Elective cesarean neonates demonstrated faster clot propagation and greater clot firmness compared with labor-exposed infants, reflected by shorter INTEM CFT, higher INTEM α-angles, and higher EXTEM and INTEM amplitudes. EXTEM MCF increased progressively from vaginal delivery through intrapartum cesarean to elective cesarean section. In contrast, CT and ML did not differ significantly between groups. Mode of delivery remained independently associated with parameters of clot propagation and firmness after multivariable adjustment. CONCLUSIONS: Mode of delivery, particularly exposure to labor, seems to be associated with differences in early postnatal ROTEM profiles in term neonates. These findings underscore the importance of perinatal context when interpreting viscoelastic coagulation testing in newborns and support development of delivery-specific reference intervals.
INTRODUCTION: Surfactant therapy is performed in different ways in respiratory distress syndrome. Surfactant therapy in spontaneously breathing infants <28 weeks' gestation (LIST/MIST) was compared to intubation with dif...INTRODUCTION: Surfactant therapy is performed in different ways in respiratory distress syndrome. Surfactant therapy in spontaneously breathing infants <28 weeks' gestation (LIST/MIST) was compared to intubation with different periods of mechanical ventilation (MV/intubation; INSURE) for efficacy and safety. METHODS: This systematic review and meta-analysis followed PRISMA guidelines with PROSPERO registration (CRD42025630748) using GRADE recommendations. Primary outcomes were BPD at 36 weeks' postmenstrual age, MV in first 72 h; and death before discharge. Secondary outcomes were intraventricular hemorrhage (IVH), necrotizing enterocolitis, retinopathy of prematurity (ROP), periventricular leukomalacia, and pneumothorax. RESULTS: No RCT compared directly LISA/MIST versus INSURE in infants <28 weeks. A total of twenty-six studies were included and 12 studies in quantitative analysis were included. LISA/MIST compared to INSURE was not different in reducing BPD; or death; but reduced MV within 72 h (relative risk [RR], 0.70; 95% confidence interval [CI], 0.55-0.90; events/n = 58/153; INSURE events/n = 82/144). This effect was not detectable when only RCTs were analyzed. Compared to intubation, LISA/MIST reduced BPD (RR, 0.76; 95% CI, 0.59-0.97, n = 6,585), MV (RR, 0.61; 95% CI, 0.45-0.82, n = 6,197), death (RR, 0.63;95% CI, 0.54-0.74, n = 6,597), IVH (RR, 0.62; 95% CI, 0.54-0.73), pneumothorax (RR, 0.58; 95% CI, 0.46-0.73), and ROP (RR, 0.61; 95% CI, 0.50-0.73). Composite outcome analysis BPD/death was not possible due to small numbers. CONCLUSION: LISA/MIST reduced MV, but not BPD, or separately death when compared with INSURE. The findings should be interpreted cautiously due to limited power and competing risk dynamics in extremely preterm infants.
BACKGROUND: The Paris Foundling Hospital was a breeding ground for neonatal medicine, but little is known about its research. During the century preceding the Revolution, admission of newborns rose dramatically, making t...BACKGROUND: The Paris Foundling Hospital was a breeding ground for neonatal medicine, but little is known about its research. During the century preceding the Revolution, admission of newborns rose dramatically, making this institution the largest infant hospital in the world. A total of 3,162 infants were admitted in 1742, of whom 40% died in the hospice and another 20% with the nurses. During the Revolution (1789-1804), monasteries were transformed into jails or hospitals, and the foundling hospital became a teaching institute. Students flocked to the capital, and those believed to qualify for hospital positions were selected through competing publications. SUMMARY: A major research focus was trials of artificial nutrition, motivated by the fear of transmitting venereal disease to wet nurses via breastfeeding. Cows and goats were held on the premises, but milk was kept without refrigeration. A research branch of the foundling hospital was in Vaugirard, directed by François Doublet. In 1781, he treated syphilitic newborns by wet-nursing them from syphilitic nurses treated with mercury. Another approach requiring considerable logistics was sending thousands of infants to the countryside for wet-nursing. In 1769, Joseph Raulin analyzed the mortality at the hospice and found that thrush, diarrhea, marasmus, suffocation, and inflammation were the major causes of death. Foundling hospital surgeon Jean-Abraham Auvity published prize-winning treatises on thrush and sclerema in 1786. He related skin hardening (sclerema) to postnatal hypothermia and developed warming techniques for premature infants. KEY MESSAGES: During the Revolution and Terror, meaningful research was conducted at the foundling hospital but failed to lower mortality.
Isaac Maximo LM, De Carlos GA, Messias Hirano Padrao E
… +6 more, Beshish AG, Gohil S, Rocha Campos L, de Oliveira LGAM, Chiara Carpi G, Garcia RU
Neonatology
· 2026 Mar · PMID 41911150
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INTRODUCTION: Pulmonary hypertension (PH) is associated with adverse outcomes in infants with omphalocele, but existing studies are limited by small sample sizes and single-center designs. This meta-analysis evaluated th...INTRODUCTION: Pulmonary hypertension (PH) is associated with adverse outcomes in infants with omphalocele, but existing studies are limited by small sample sizes and single-center designs. This meta-analysis evaluated the association between PH and mortality, as well as secondary clinical outcomes. METHODS: A systematic search in MEDLINE, EMBASE, and Cochrane CENTRAL identified studies of patients with giant omphalocele stratified by PH status. Eligible studies included nonrandomized cohorts, cross-sectional studies, or case controls assessing mortality in this setting. Exclusions were overlapping populations or incomplete data. Primary outcome was mortality. Secondary outcomes included duration of mechanical ventilation (MV), length of hospital and neonatal intensive care unit stay, parenteral nutrition, tracheostomy, high-frequency ventilation, and home oxygen. The risk of bias was assessed using the Newcastle-Ottawa Scale. The study protocol was registered in PROSPERO (CRD420251025073), and there was no funding for this study. RESULTS: Of 238 studies screened, five retrospective cohorts met criteria, totaling 258 patients (112 [43%] with PH and 146 [57%] without). PH was associated with increased mortality (OR: 6.78, 95% CI: 2.72-16.88, p < 0.001, I2 = 0%) and prolonged MV (mean difference 21.25 days, 95% CI: 13.19-29.31, p < 0.001, I2 = 0%). Limitations included publication bias, incomplete reporting of clinical variables, and the lack of standardized criteria. CONCLUSION: PH in neonates with omphalocele is associated with higher mortality and prolonged MV. Future studies should clarify risk factors and develop targeted management strategies to improve survival and long-term outcomes.
Bergman KA, Rosman AN, Reiss IKM
… +4 more, Semmekrot BA, Matthijsse RP, Kooi EMW, Hulzebos CV
Neonatology
· 2026 Mar · PMID 41911090
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INTRODUCTION: Sudden unexpected postnatal collapse (SUPC) is a rare and potentially life-threatening event with variable reported incidences, mostly derived from in-hospital data. This study investigated the incidence, a...INTRODUCTION: Sudden unexpected postnatal collapse (SUPC) is a rare and potentially life-threatening event with variable reported incidences, mostly derived from in-hospital data. This study investigated the incidence, aetiology, and circumstances of SUPC in the Netherlands and assessed differences between in-hospital and home settings. METHODS: Data concerning SUPC cases were obtained through a web-based registry managed by the Dutch Paediatric Surveillance Unit from April 2019 to April 2022. SUPC was defined as a collapse within 24 h of birth requiring resuscitation with at least positive pressure ventilation in infants born at ≥35 weeks of gestation and with a 5-min Apgar score ≥8. RESULTS: Of 94 registered SUPC cases, 60 met inclusion criteria: 52 cases occurred in hospital and 8 at home. The annual incidence ranged between 7 and 17 per 100,000 live births, with an average of 11 per 100,000. Median time to collapse was 64 min, with over two-thirds occurring within 2 h of birth. Collapses occurring at home occurred significantly later than those in hospital (165 min vs. 60 min; p < 0.05) and were associated with substantially higher mortality rates (37.5% vs. 6%; p < 0.05). Approximately half of all SUPC cases involved possible or definite airway obstruction, which - compared with other aetiologies - was more often related to preventable factors like reduced maternal vigilance and covering of the infant's nose and mouth. CONCLUSIONS: SUPC occurs in hospitals and at home, with later onset and higher mortality outside the hospital. Greater awareness and prevention are needed in both settings.
Kvenshagen LN, Kvenshagen HN, Holte K
… +4 more, Jacobsen AF, Størdal K, Hubin A, Solevåg AL
Neonatology
· 2026 Mar · PMID 41875297
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INTRODUCTION: Regional analgesia is widely used for labour pain relief. The impact on foetal heart rates has been extensively studied, but little is known about its impact on neonatal heart rates. The aim of this study w...INTRODUCTION: Regional analgesia is widely used for labour pain relief. The impact on foetal heart rates has been extensively studied, but little is known about its impact on neonatal heart rates. The aim of this study was to assess whether maternal use of epidural, spinal, or pudendal labour analgesia was associated with differences in neonatal heart rates. METHODS: This Norwegian observational study included 1,281 singleton cephalic term vaginal deliveries from September 1, 2019, to June 30, 2021. Neonatal heart rates were measured using dry electrode technology. Generalised linear models adjusted for covariates related to the mother, neonate, and labour process were used to estimate neonatal heart rates by methods of maternal analgesia at 30 s, 1, 2, and 3 min after birth. The results were compared to a baseline representing heart rates modelled for infants whose mothers received no analgesia. RESULTS: The median heart rate in all groups, including the epidural (n = 439), spinal (n = 34), pudendal (n = 36), and no analgesia (n = 772) groups, ranged from 147 to 175 beats per minute (bpm) at all time points. Infants whose mother received epidural analgesia had slightly higher mean heart rate compared to the baseline at 2 (167 vs. 164 bpm) and 3 (152 vs. 149 bpm) minutes of life (p < 0.05). No significant association was observed between spinal or pudendal analgesia and neonatal heart rates. CONCLUSION: Infants whose mothers received epidural labour analgesia had statistically, but not clinically significant, higher heart rates in the first minutes of life.
Neonatology
· 2026 Mar · PMID 41871223
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BACKGROUND: We know little about how neonatal research changed at the Paris Foundling Hospital following the revolution. SUMMARY: The number of unwanted children rose, and 5,392 infants were admitted in 1826 - a quarter...BACKGROUND: We know little about how neonatal research changed at the Paris Foundling Hospital following the revolution. SUMMARY: The number of unwanted children rose, and 5,392 infants were admitted in 1826 - a quarter of all infants born in Paris; 26% of them died in the infirmary before transport. The infants' appalling mortality was associated with artificial nutrition, and transfer to mercenary nurses in the countryside was organized. In the 1830s sedentary nurses began to run short, and nearly all babies were fed artificially at some time. François Chaussier was director at the Maternity from 1804. He developed instruments to resuscitate newborns: mask-and-bag ventilation, silver endotracheal tubes, and oxygen tanks. He classified congenital malformations and described osteogenesis imperfecta. Marie-Louise Lachappelle trained midwives in forceps deliveries and the use of endotracheal intubation of newborns. Other researchers at the foundling hospital included Antoine Dugès, Jacques-François Baron, Gilbert Breschet, Louis Véron, Johann Heyfelder, Prosper-Sylvain Denis, and Charles Billard. The latter investigated neonatal cry in 1827 and associated expiratory grunting with poor prognosis in prematures. His Treatise on Diseases of the Newborn, based on many autopsies and meticulous clinical records, remained a neonatology standard for a century. It described peritonitis, megacolon, intestinal hemorrhage, pertussis, spina bifida, patent ductus, single ventricle, and various forms of tuberculosis. KEY MESSAGES: Physicians were permanently employed from 1821; their research developed from autopsies. The fusion of medicine and surgery into a single faculty moved obstetrics (and thus newborn care) from the barbers' domain to research-oriented science.
Neonatology
· 2026 Mar · PMID 41871215
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INTRODUCTION: The recent BORN study suggests the incidence of retinopathy of prematurity (ROP) might be significantly reduced by transfusing extremely low gestational age neonates (ELGANs) with red blood cells (RBCs) not...INTRODUCTION: The recent BORN study suggests the incidence of retinopathy of prematurity (ROP) might be significantly reduced by transfusing extremely low gestational age neonates (ELGANs) with red blood cells (RBCs) not from adult donors, but from umbilical cord blood. We are uncertain what proportion of infants with severe ROP had no RBC transfusions and thus would not benefit from changing transfusion practice. METHODS: We created detailed transfusion histories of all infants in our health system (2021-2024) who developed severe ROP. RESULTS: Severe (stage ≥3) ROP was diagnosed in 34 infants; 32 of these had received 1-18 RBC transfusions. Eleven also received 1-16 platelet transfusions. Two received no transfusions. CONCLUSION: A small minority of infants with severe ROP were never transfused, thus changing transfusion practice would not likely prevent all cases. However, the great majority had multiple RBC transfusions and thus might benefit from cord blood RBC transfusions.
The article "Seizure Burden before and after Lidocaine as Add-On Therapy in (Amplitude-Integrated) Electroencephalography-Confirmed Neonatal Seizures" [Neonatology. 2025; https://doi.org/10.1159/000549690] by Rondagh et...The article "Seizure Burden before and after Lidocaine as Add-On Therapy in (Amplitude-Integrated) Electroencephalography-Confirmed Neonatal Seizures" [Neonatology. 2025; https://doi.org/10.1159/000549690] by Rondagh et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been updated.
Neonatology
· 2026 Mar · PMID 41824641
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INTRODUCTION: Persistent pulmonary hypertension of newborn (PPHN) occurs due to the impairment in the expected fall in pulmonary vascular resistance during the fetal to neonatal circulatory transition, with a prevalence...INTRODUCTION: Persistent pulmonary hypertension of newborn (PPHN) occurs due to the impairment in the expected fall in pulmonary vascular resistance during the fetal to neonatal circulatory transition, with a prevalence of 1.9 per 1,000 live births and a significant mortality rate of 4-33%. We aimed to systematically review the genetic variants associated with PPHN in term and late preterm infants without a known genetic syndrome. METHODS: In February 2025, the MEDLINE Ovid, Scopus, and Cochrane databases were searched for eligible studies without publication date restriction. Our review included cohort studies, case-control studies, and case series that examined the association of PPHN and genetic variants in term and late preterm infants. We extracted data regarding the methodology, participant characteristics, and outcome measures. RESULTS: We included nine studies (7 case-control studies and 2 cohort studies) that enrolled 1,494 participants. The risk of bias assessment using the Quality of Genetic Association Studies tool showed that 100% of the studies were of moderate or good quality. Our review found reports of positive associations between specific genetic variants in genes such as CPS1, CRHR1, NOTCH3, EDN1, EPAS1, WWC2, ABCA3, RFX3, EP300, GNA11, PKLR, SLC2A1, BMPR2, and EGLN1. One study reported no association between an ACE gene variant and PPHN. DISCUSSION: Studies of common genetic variants associated with an increased risk of PPHN in term and late preterm infants are limited, based on small cohorts and frequently focused on small sets of candidate genes, yielding inconsistent results across studies.
Westenberg LEH, Been JV, Tintu A
… +11 more, Vis JY, Bouma HA, Nieboer D, Dijk PH, Groen H, Poley MJ, Ista E, Steegers EAP, Reiss IKM, van der Geest BAM, Hulzebos CV
Neonatology
· 2026 Mar · PMID 41811997
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INTRODUCTION: The Bilistick is a handheld point-of-care device for measuring total bilirubin levels in small blood volumes. We assessed its diagnostic accuracy and user convenience in near-term neonates cared for at home...INTRODUCTION: The Bilistick is a handheld point-of-care device for measuring total bilirubin levels in small blood volumes. We assessed its diagnostic accuracy and user convenience in near-term neonates cared for at home. METHODS: A prospective cohort study was conducted in nine Dutch community midwifery practices. Neonates ≥35 weeks' gestation were eligible if they were at home between postnatal days 2-8 and had not received phototherapy. A Bilistick version 2.0 was used in parallel to laboratory-based bilirubin (LBB) quantification when significant visible jaundice was observed or the transcutaneous bilirubin reading was elevated. RESULTS: A total of 2,314 neonates were included in the study, with 423 blood samples analyzed across 13 laboratories. On 203 occasions, the Bilistick was not used. Among the remaining 220 Bilistick readings, 104 failed, and 2 lacked corresponding LBB results. A Bland-Altman plot of 114 paired measurements of Bilistick and LBB showed a mean difference of +9.7 µmol/L (0.57 mg/dL) with corresponding 95% limits of agreement of -179.7 to +199.2 µmol/L (-10.5 to 11.7 mg/dL). The positive predictive value of a Bilistick reading for having a total serum bilirubin level above the phototherapy threshold was 36.4%. The negative predictive value was 90.1%, sensitivity 60%, and specificity 77.6%. Hemolysis (24%) contributed to overestimations by the Bilistick. Community midwives expressed multiple barriers related to user convenience. CONCLUSION: Diagnostic accuracy of the Bilistick when used in the home setting was limited. Its use was further hindered by a significant proportion of failed readings and low user convenience when operated by midwives.
The article "Deferred Cord Clamping in Very Preterm Triplets and Outcomes: A Retrospective Cohort Study" [Neonatology. 2025; https://doi.org/10.1159/000550056] by Shah et al. was published with the wrong open access lice...The article "Deferred Cord Clamping in Very Preterm Triplets and Outcomes: A Retrospective Cohort Study" [Neonatology. 2025; https://doi.org/10.1159/000550056] by Shah et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been corrected.
Klinger G, Shahroor M, Felder D
… +18 more, Lui K, Mori A, Adams M, San Feliciano L, Isayama T, Biran V, Bassler D, Reichman B, Skubisz A, Battin M, Lehtonen L, Helenius K, Vento M, Kusuda S, Norman M, Procianoy RS, Goswami N, Shah PS
Neonatology
· 2026 Mar · PMID 41802141
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INTRODUCTION: Availability and expertise of healthcare professional are essential for the quality care of preterm infants. Objective was to survey different healthcare professionals' availability for management of preter...INTRODUCTION: Availability and expertise of healthcare professional are essential for the quality care of preterm infants. Objective was to survey different healthcare professionals' availability for management of preterm neonates <29 weeks' gestation among neonatal intensive care units (NICUs) of 12 population-based neonatal networks. METHODS: Questionnaires were distributed to 608 NICUs participating in the International Network for Evaluating Outcomes in Neonates (iNeo). Networks included Australia/New Zealand (n = 30), Brazil (n = 20), Canada (n = 32), Finland (n = 5), France (n = 70), Israel (n = 26), Japan (n = 292), Poland (n = 56), Spain (n = 55), Sweden (n = 9), Switzerland (n = 9), and Tuscany (n = 4). Questions focused on availability of physicians, nurses, and additional healthcare professionals in 2023. RESULTS: A total of 382 (63%) NICUs responded. The 24/7 availability of healthcare professionals varied within and between networks and overall was reported to be 66% for neonatologists, 55% for neonatal fellows, 62% for pediatric residents, and 55% for nurse practitioners. Nurse-to-patient ratios were most commonly 1:1 for complex critical care infants (53%) and 1:2 for intensive care infants (48%). Low 24/7 availability was reported for respiratory therapists and pharmacists. CONCLUSIONS: Marked variations exist in healthcare professionals' availability, which might be associated with NICU organization and management of infants <29 weeks' gestation. While majority of NICUs have reported 24/7 availability of neonatologists, the availability of other healthcare professionals was inconsistent. Nurse-to-patient ratio has improved. Further evaluation is needed to understand how these variations are associated with outcomes of extremely preterm infants and to optimize resource utilization.
Sweet DG, Carnielli VP, Greisen G
… +11 more, Hallman M, Klebermass-Schrehof K, Lavizzari A, Ozek E, Te Pas A, Roehr CC, Saugstad OD, Simeoni U, Vento M, Visser GHA, Speer CP
Neonatology
· 2026 Mar · PMID 41802129
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Every year, new evidence emerges about how best to care for tiny babies with respiratory distress. We report the seventh version of "European Guidelines for the Management of RDS" by a panel of European neonatologists an...Every year, new evidence emerges about how best to care for tiny babies with respiratory distress. We report the seventh version of "European Guidelines for the Management of RDS" by a panel of European neonatologists and an expert perinatal obstetrician based on available literature up to mid-2025. Optimising outcome involves close collaboration with obstetricians to predict risk of preterm delivery, consideration of transfer to perinatal centres, and perinatal optimisation including antenatal steroids. Delivery room protocols should include maintenance of normal body temperature while aiming to promote spontaneous breathing before clamping the umbilical cord, using non-invasive respiratory support (NRS) where possible, and considering early use of surfactant delivered by a thin catheter in an attempt to avoid intubation. Ongoing NRS and judicious use of surfactant using techniques that avoid intubation will help improve outcomes. If mechanical ventilation is needed, lung protective strategies should be employed and ventilation continued for the shortest time possible to reduce risk of bronchopulmonary dysplasia. Protocols for general supportive care are also reviewed, with an emphasis on good nutritional care, cardiovascular support and judicious use of antibiotics.