Neonatology[JOURNAL]
Sun
200 papers
Cord Clamping Time and Residual Placental Blood Volume in Elective and Emergency Caesarean Sections: An Observational Multicenter Study.
Claréus A, Maler S, Sand A … +5 more , Strandvik V, Hetting E, Linden K, Andersson O, Svedenkrans J
Neonatology · 2026 Feb · PMID 41758735 · Full text
INTRODUCTION: Placental transfusion at caesarean sections (CSs) is affected by different factors, such as cord clamping (CC) time and the cardiopulmonary transition of the infant. Measuring residual placental blood volum...
INTRODUCTION: Placental transfusion at caesarean sections (CSs) is affected by different factors, such as cord clamping (CC) time and the cardiopulmonary transition of the infant. Measuring residual placental blood volume (RPBV) is one method to assess the magnitude of placental transfusion. The aim of this study was to evaluate the association between CC time and RPBV in elective and emergency CS, and to evaluate the association with other potential factors that may influence placental transfusion. METHODS: An observational multicenter study was conducted. Data were collected at elective and emergency CS at gestational ages ≥35+0 weeks, by direct observation and measurement of RPBV. RESULTS: A total of 185 subjects with CS were included (78 emergency CS). Birth weight was significantly associated to RPBV with a 13.0 mL increase of RPBV per kg birth weight. RPBV decreased by 4.7 mL/kg/min of deferred CC. Significant variables in the final adjusted model included CC time, indication for CS with a higher RPBV in emergency CS, and time to placental emptying. Non-significant variables included sex, form of anesthesia, cord gas blood sampling, and position of infant. CONCLUSION: RPBV, used as an inverse proxy for placental transfusion, was found to be associated with CC time at CS. The finding remained when adjusting for other variables that may influence RPBV and was particularly pronounced for emergency CS.
Intermittent Hypoxemia and Brain Injury Biomarker S100B in Preterm Infants.
Abu Jawdeh EG, Van Eldik LJ, Stevenson J … +5 more , Patwardhan A, Westgate PM, Chalak L, Martin RJ, Bada HS
Neonatology · 2026 Feb · PMID 41758727 · Full text
INTRODUCTION: Intermittent hypoxemia (IH) is common in preterm infants and linked to brain injury. S100B is a glial-derived protein that rises early after neural injury and can be measured noninvasively in urine. We eval...
INTRODUCTION: Intermittent hypoxemia (IH) is common in preterm infants and linked to brain injury. S100B is a glial-derived protein that rises early after neural injury and can be measured noninvasively in urine. We evaluated the relationship between IH burden and urinary S100B in preterm infants of ≤32 weeks' gestation. METHODS: Preterm infants of ≤32 weeks' gestation were prospectively enrolled. Oxygen saturation was continuously monitored, and IH profiles were quantified using validated algorithms. Urine S100B was measured by ultrasensitive immunoassay and normalized for urinary creatinine. Infants with severe intraventricular hemorrhage were excluded. Weighted Spearman correlations examined associations between IH metrics and urinary S100B, overall and by gestational age subgroups. RESULTS: Twenty-one infants contributed 53 urine samples. Higher urinary S100B correlated with greater IH frequency, percent time in hypoxemia, longer event duration, and lower nadir saturations (all p < 0.05). Short events showed the strongest correlations for frequency (ρ = 0.49) and percent time (ρ = 0.51), while longer events correlated most strongly with nadir (ρ = -0.69). Extremely preterm infants demonstrated stronger associations for nadir and duration; very preterm infants only for event severity. S100B increased stepwise across IH burden tertiles. CONCLUSIONS: Urinary S100B increases with IH burden, with patterns varying by gestational age and event duration. Urinary S100B may provide an early, noninvasive biomarker of IH-related brain injury in preterm infants.
Maternal Ureaplasma Species Colonization and Neonatal Outcomes: A Large Cohort Study on Preterm Birth and Vertical Transmission.
Li Q, Mei X, Cai Y … +1 more , Weng K
Neonatology · 2026 Feb · PMID 41739725 · Publisher ↗
INTRODUCTION: The impact of maternal Ureaplasma colonization on vertical transmission and its contribution to acute neonatal morbidity remains unclear. METHODS: In this retrospective cohort of 1,647 mother-neonate dyads...
INTRODUCTION: The impact of maternal Ureaplasma colonization on vertical transmission and its contribution to acute neonatal morbidity remains unclear. METHODS: In this retrospective cohort of 1,647 mother-neonate dyads from a Chinese tertiary center (2020-2025), maternal vaginal and neonatal respiratory Ureaplasma colonization was detected via quantitative real-time polymerase chain reaction. We analyzed associations between maternal colonization and perinatal outcomes and assessed determinants of vertical transmission and whether neonatal colonization independently predicted severe morbidity in Ureaplasma-positive mothers. RESULTS: Maternal Ureaplasma colonization (prevalence 65.9%) significantly increased risks of very preterm birth (16.2% vs. 8.7%), term premature rupture of membranes (9.3% vs. 5.3%), very low birth weight (11.4% vs. 6.9%), neonatal intensive care unit (NICU) admission (58.6% vs. 52.0%), and respiratory distress syndrome (RDS) (10.6% vs. 7.3%). In Ureaplasma-positive mothers, vertical transmission occurred in 20.7% of exposed neonates, was strongly associated with vaginal delivery (25.4% vs. 15.8% for cesarean), and was inversely correlated with gestational age (43.7% at <28 weeks vs. 6.4% at term). Colonized neonates had significantly higher rates of NICU admission (86.7% vs. 51.3%), RDS (16.4% vs. 9.1%), and intrauterine infection/sepsis (35.6% vs. 25.8%). After confounder adjustment, neonatal colonization remained an independent risk factor for severe illness (adjusted odds ratio 3.06, 95% confidence interval 1.55-6.06). CONCLUSION: Maternal Ureaplasma colonization predisposes to preterm birth and neonatal morbidity. Vertical transmission varies by delivery mode and is the highest with extreme prematurity. Neonatal Ureaplasma colonization independently predicts severe acute morbidity, underscoring the need for targeted risk stratification and intervention in high-risk dyads.
Clinically Silent Seizures in Neonates with Tuberous Sclerosis: An International Case Series.
Curcio AM, Moavero R, Boada Cuellar JL … +3 more , Starc TJ, Cilio MR, Sands TT
Neonatology · 2026 Feb · PMID 41712515 · Publisher ↗
INTRODUCTION: In patients with tuberous sclerosis complex (TSC), seizure onset can be as early as in the neonatal period. Recent studies showed that earlier treatment of TSC positively improves epilepsy and neurodevelopm...
INTRODUCTION: In patients with tuberous sclerosis complex (TSC), seizure onset can be as early as in the neonatal period. Recent studies showed that earlier treatment of TSC positively improves epilepsy and neurodevelopmental outcomes. METHODS: This is an international retrospective study on neonates with TSC monitored with long-term video-EEG. RESULTS: Six of ten neonates with a perinatal diagnosis of TSC were found to have electrographic-only seizures within the first 10 days of life on long-term video-EEG. All patients in this series were found to have TSC2 variants and, except for 1 patient, had difficult-to-treat seizures requiring multiple anti-seizure medications. CONCLUSION: Our study suggests that early video-EEG for electrographic-only seizures may be valuable in neonates with TSC who otherwise would go untreated.
Contemporary Challenges in Thermal Homeostasis: Time for a Rethink?
Andersen CC, Crawford TM, Bailey DN … +1 more , Stark MJ
Neonatology · 2026 Feb · PMID 41678435 · Full text
BACKGROUND: Thermal homeostasis remains a fundamental aspect of neonatal intensive care, yet modern practice differs significantly from earlier studies. Contemporary cohorts include infants at the edge of viability, char...
BACKGROUND: Thermal homeostasis remains a fundamental aspect of neonatal intensive care, yet modern practice differs significantly from earlier studies. Contemporary cohorts include infants at the edge of viability, characterised by immature skin, limited thermogenic capacity, and extended ventilatory support. Simultaneously, incubator design has evolved from basic normothermic chambers to servo-controlled, high-humidity environments. Additionally, infants often require weeks of support with heated respiratory circuits. These developments introduce complex, interacting thermal inputs that were not present in earlier physiology, yet current protocols remain largely empirical. SUMMARY: Evaporative heat loss, caused by transepidermal water loss (TEWL), mainly influences the thermal balance of very preterm infants. TEWL can be equal to or greater than metabolic heat production, especially in the early postnatal period. Its magnitude is determined by gestation, vapour pressure gradients, and environmental dew point. High relative humidity reduces evaporative stress but narrows the safety margin, increasing the risk of condensation and subsequent cooling. Additional instability comes from convective and conductive losses during handling, as well as the thermal effects of ventilator circuits. KEY MESSAGES: We suggest reframing neonatal thermal care as actively managing thermal and vapour gradients, rather than simply maintaining core normothermia. Evidence-based strategies include maintaining high relative humidity soon after birth, minimising isolette openings, pre-warming contact surfaces, and recognising dew point thresholds. Research priorities include defining optimal humidity protocols, measuring the circuit thermal load, and validating monitoring systems that integrate oxygen consumption with environmental factors. Tackling these gaps may reduce metabolic stress, enhance survival, and optimise outcomes for the most vulnerable infants.
Red Blood Cell Transfusion and Risk of Iron Overload in Preterm Infants: A Prospective Study on Serum Ferritin and Hepcidin.
Yang H, Yang K, Deng F … +5 more , Zhong X, Feng J, Ying J, Wang H, Jiang J
Neonatology · 2026 · PMID 41671199 · Full text
UNLABELLED: <p>Introduction: The aims of this study were to evaluate iron metabolism changes and overload risk in preterm infants after red blood cell transfusion (RBCT) and to assess hepcidin's diagnostic value. METHODS...
UNLABELLED: <p>Introduction: The aims of this study were to evaluate iron metabolism changes and overload risk in preterm infants after red blood cell transfusion (RBCT) and to assess hepcidin's diagnostic value. METHODS: This prospective study analyzed 72 preterm infants (mean GA: 30.1 weeks; BW: 1,356 g) at Shenzhen Children's Hospital (2023). Groups were stratified by the volume of RBCT (>40 mL/kg vs. ≤40 mL/kg). Serum ferritin (SF) and hepcidin levels were measured alongside clinical parameters. RESULTS: The >40 mL/kg RBCT group had significantly lower GA (p = 0.039) and BW (p = 0.013). SF and hepcidin levels were elevated in the >40 mL/kg RBCT group (p < 0.001), with higher risks of iron overload (RR = 1.6, 95% CI: 1.3-2.3) and severe overload (RR = 4.5, 95% CI: 1.8-12.4). The volume of RBCT was an independent risk factor (p = 0.034). Hepcidin showed predictive value (area under the curve = 0.731, sensitivity: 92%, cutoff: 45.08 ng/mL). CONCLUSIONS: High-volume of RBCT (>40 mL/kg) significantly increase iron overload risk in preterm infants. Hepcidin demonstrates potential as a predictive biomarker. </p>.
Home-Based Transcutaneous Bilirubin Screening and Telemedicine Reduce Neonatal Referrals.
Nissimov S, Haas N, Habib S … +6 more , Madjar B, Zimmerman DR, Hazan A, Daniel S, Berkovitch M, Kohn E
Neonatology · 2026 Feb · PMID 41662349 · Full text
INTRODUCTION: Neonatal jaundice is a leading cause of early post-discharge referrals. Community follow-up commonly relies on visual assessment and clinic-based evaluation, generating avoidable visits. Scalable home pathw...
INTRODUCTION: Neonatal jaundice is a leading cause of early post-discharge referrals. Community follow-up commonly relies on visual assessment and clinic-based evaluation, generating avoidable visits. Scalable home pathways that maintain safety are needed. We evaluated a nurse-led home pathway that integrates transcutaneous bilirubin (TcB) screening with targeted pediatric teleconsultation. METHODS: A prospective before-after study was conducted within routine nurse-led home visits for eligible infants (firstborn or preterm) ≥35 weeks of gestation. A 3-month pre-intervention phase (usual visual assessment) was compared with a 9-month intervention using TcB-guided thresholds and teleconsultation via a secure digital platform. The primary analysis targeted infants who, under usual care, would be referred ("baseline-eligible"), estimating the absolute difference in referral at the home visit. Secondary outcomes were agreement between clinical cues and TcB, teleconsultation utilization, and phototherapy requirement. RESULTS: A total of 1,236 infants were enrolled (157 pre-intervention; 1,079 intervention). Among baseline-eligible infants (n = 840), 152 (18.1%) were referred; thus, 688/840 (81.9%) potential referrals were avoided (absolute reduction 81.9%; 95% CI 79.2-84.4; NNR 1.22, 95% CI 1.19-1.26). TcB identified all infants requiring phototherapy (4/1,079; 0.4%) within 14 days. Agreement between clinical cues and TcB-defined need for follow-up was slight (weighted κ = 0.075; 95% CI 0.059-0.091). The reduction in referrals corresponded to an absolute decrease of 0.67 visits per infant. CONCLUSIONS: A nurse-led, digitally supported home pathway that integrates TcB screening and targeted teleconsultation substantially reduces unnecessary neonatal referrals, with no missed cases requiring phototherapy. This pragmatic precision-triage model is implementable within existing community services and can relieve post-discharge system burden while preserving safety.
Strengthening Neonatology in Ethiopia: From Survey Data to System Improvement.
Moretti C, Gizzi C, Trevisanuto D … +12 more , Lista G, Carnielli V, Saugstad OD, Gagliardi L, Vertecchi G, Jira LA, Demtse A, Metaferia G, Gatta L, Manenti F, Carraro D, Bogale W
Neonatology · 2026 · PMID 41662338 · Publisher ↗
INTRODUCTION: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal condition...
INTRODUCTION: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions. METHODS: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation "Train the Trainers" course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites. RESULTS: The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas. CONCLUSIONS: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.
Interventions to Prevent Intraventricular Haemorrhage in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-Analyses.
Bhanushali M, Balasubramanian H, Sharma H … +5 more , Ananthan A, Anne RP, Choubey R, Dash SK, Kabra NS
Neonatology · 2026 · PMID 41642734 · Publisher ↗
INTRODUCTION: Intraventricular haemorrhage (IVH) leads to significant morbidity among preterm infants. We conducted an overview of systematic reviews of RCTs assessing the effects of perinatal/neonatal interventions in r...
INTRODUCTION: Intraventricular haemorrhage (IVH) leads to significant morbidity among preterm infants. We conducted an overview of systematic reviews of RCTs assessing the effects of perinatal/neonatal interventions in reducing IVH among preterm infants. METHODS: PubMed, Embase, Cochrane database for systematic reviews, and systematic review repositories were searched for meta-analyses of RCTs involving preterm infants or women at high risk of preterm birth and reporting on IVH. Metaumbrella package of R software was used to pool outcome data for each intervention. Quality of the systematic reviews was assessed using AMSTAR 2 tool. Certainty of evidence (COE) was reported using GRADE recommendations. RESULTS: A total of 148 systematic reviews (110 Cochrane vs. 38 non-Cochrane) were included. Postnatal interventions were reported in 118 reviews. Severe IVH was reported in 100/148 reviews that included 39,483 infants and 20,400 antenatal women. In total, 78% (n = 116) of the reviews were rated high or moderate quality on AMSTAR-2 assessment. Antenatal corticosteroids and magnesium sulphate for imminent preterm birth, volume-targeted ventilation, early rescue surfactant administration through thin catheter, prophylactic indomethacin significantly reduced the rates of severe IVH (moderate COE). Use of respiratory function monitors and heated humidified respiratory gases in the delivery room and early prophylactic erythropoietin supplementation for preterm infants may reduce the rates of severe IVH (very low COE). DISCUSSION: Antenatal steroids and magnesium sulphate administration and early neonatal lung protective strategies reduce the rates of IVH in preterm neonates. Adequately powered RCTs evaluating IVH care bundles with long-term follow-up are required.
Family Integrated Care in Single Family Rooms and Neonatal Outcomes in Preterm Infants: A Multicenter Cohort Study.
Hoeben H, van Veenendaal NR, van Laerhoven H … +5 more , van den Heuvel MEN, De Groof F, van Kempen AAMW, Van Goudoever JB, van der Schoor SRD
Neonatology · 2026 · PMID 41637244 · Full text
UNLABELLED: <p>Introduction: We aimed to evaluate the effect of Family Integrated Care (FICare) in single family rooms (SFR) on infant outcomes, compared with standard neonatal care (SNC) in open bay units (OBU). METHODS...
UNLABELLED: <p>Introduction: We aimed to evaluate the effect of Family Integrated Care (FICare) in single family rooms (SFR) on infant outcomes, compared with standard neonatal care (SNC) in open bay units (OBU). METHODS: A prospective cohort study was conducted in three Dutch level II neonatal units. Preterm infants hospitalized ≥7 days were included between 2017 and 2020. The intervention site provided FICare in SFR; control sites provided SNC in OBU. Predefined secondary outcomes included length of stay (LOS), breastfeeding, growth, late-onset sepsis, days with tube feeding (TF), respiratory support and intravenous access, discharge with TF, and readmissions. Linear mixed models accounting for multiple births, and exploratory mediation analyses, were used. RESULTS: A total of 358 infants were included (169 FICare; 189 SNC; median gestational age 33+3 weeks [interquartile range 30+5-35+0]). FICare was associated with a 9% reduction in LOS (adjusted mean ratio [aMR] 0.91 ≈ 2 days, 95% CI 0.84-0.99). Infants in the FICare group were more likely to be discharged with TF (adjusted odds ratio 5.77, 95% CI 2.25-14.79) and had fewer days with TF in hospital (aMR 0.79, 95% CI 0.66-0.94) and intravenous access (adjusted incidence rate ratio 0.55, 95% CI 0.39-0.76), while maintaining similar growth and readmission rates. Days with TF and intravenous access fully mediated the effect on LOS (adjusted total indirect effect 0.91, 95% CI 0.85-0.97). Other outcomes did not differ. CONCLUSIONS: FICare in SFR was associated with decreased LOS, mediated by acquiring feeding skills. Further research should include robust study designs, including diverse parental populations. </p>.
Maternal Neighborhood Characteristics Are Associated with Left Heart Disease, Extracorporeal Membrane Oxygenation, and Mortality in Congenital Diaphragmatic Hernia.
Avitabile CM, Jones AL, Faig W … +7 more , Wild KT, Tam V, Diaz EM, Gebb JS, Khalek N, Gaynor JW, Hedrick HL
Neonatology · 2026 · PMID 41615871 · Publisher ↗
INTRODUCTION: In congenital diaphragmatic hernia (CDH), infants with left heart disease are at the highest risk of extracorporeal membrane oxygenation (ECMO) and mortality, but the association between maternal-fetal envi...
INTRODUCTION: In congenital diaphragmatic hernia (CDH), infants with left heart disease are at the highest risk of extracorporeal membrane oxygenation (ECMO) and mortality, but the association between maternal-fetal environmental characteristics and these adverse postnatal outcomes is unknown. METHODS: Maternal-fetal dyads with CDH who were enrolled in a single-center birth defects biorepository and also in comprehensive postnatal echocardiographic studies from 2019 to 2023 were included in a retrospective analysis. Geocoded census tract was used to generate maternal neighborhood characteristics from conception to birth from the American Community Survey (ACS), Child Opportunity Index, Air Quality Index (AQI), and Food and Drug Administration percent food insecurity. Infant characteristics including ECMO and survival were abstracted from the biorepository. Quantification of left heart hypoplasia and/or left ventricular (LV) dysfunction was performed on postnatal echocardiograms. Disease-specific and neighborhood characteristics were compared by ECMO/mortality status and by the presence of left heart disease. RESULTS: Seventy-seven patients (58% male, 82% left CDH, 68% liver herniation) were included. Twenty-four (31%) patients required ECMO, 61 (77%) had left heart hypoplasia or LV dysfunction, and 19 (25%) received pulmonary vasodilators. ECMO utilization was higher in patients with left heart disease. Worse neighborhood air quality by AQI was identified in patients who required ECMO and/or died and in patients with left heart disease. A higher percentage of female-headed households was seen in patients who required ECMO and/or died. CONCLUSION: Maternal neighborhood characteristics may impact outcomes in CDH. Future study of these environmental factors may inform individualized treatment strategies.
Desaturations with or without Bradycardia Are Associated with Cerebral and Abdominal Hypoxemia: Secondary Analysis of a Randomized Clinical Trial.
Travers CP, Nakhmani A, Aban I … +5 more , Laney D, Shukla VV, Gentle SJ, Carlo WA, Ambalavanan N
Neonatology · 2026 · PMID 41615858 · Full text
UNLABELLED: <p>Introduction: The aim of this study was to determine if episodes of desaturation, either with or without bradycardia, are associated with cerebral and abdominal hypoxemia in preterm infants. METHODS: Secon...
UNLABELLED: <p>Introduction: The aim of this study was to determine if episodes of desaturation, either with or without bradycardia, are associated with cerebral and abdominal hypoxemia in preterm infants. METHODS: Secondary analysis of a single-center pilot randomized clinical trial including preterm infants <29 weeks of gestation on positive pressure respiratory support. Rates of cerebral hypoxemia (<55% for ≥10 s) and abdominal hypoxemia (<40% for ≥10 s) on near-infrared spectroscopy corresponding with episodes of desaturation (oxygen saturations <85% for ≥10 s) either with or without bradycardia (<100 bpm for ≥10 s) were compared using a generalized estimating equation to address repeated events from the same subject. RESULTS: Twenty-five infants with a gestational age (mean + SD) of 24 weeks 6 days ± 11 days and birth weight 645 ± 142 grams were included. Desaturations with and without bradycardia were both associated with cerebral hypoxemia and abdominal hypoxemia (all p < 0.05). Cerebral hypoxemia was more strongly associated with desaturations with bradycardia compared to episodes without bradycardia (adjusted odds ratio [aOR], 95% confidence intervals [CI]: 0.34, 0.25-0.47; p < 0.001). There were also more episodes of abdominal hypoxemia during desaturations with bradycardia versus desaturations with no bradycardia (aOR, 95% CI: 0.35, 0.26-0.46; p < 0.001). The rate of concurrent cerebral and abdominal hypoxemia was also higher during desaturations with bradycardia. DISCUSSION: Desaturations, whether occurring with or without bradycardia, are associated with cerebral and abdominal hypoxemia in very preterm infants. Cerebral and abdominal hypoxemia are more likely during episodes of desaturation with bradycardia than during episodes without bradycardia. </p>.
Reply to the Letter by Ramakrishnan et al.: "Methodological Considerations in the Comparison of INSURE and LISA in Very Preterm Infants".
Cho H, Lee J
Neonatology · 2026 · PMID 41610076 · Full text
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American Academy of Pediatrics 2022 Phototherapy Thresholds Reduce the Hospitalizations and the Associated Costs.
De Luca D, Cortina I
Neonatology · 2026 · PMID 41591975 · Publisher ↗
INTRODUCTION: The latest American Academy of Pediatrics guidelines for managing jaundice in late preterm and term neonates have increased the bilirubin thresholds to start phototherapy. This was considered safe based on...
INTRODUCTION: The latest American Academy of Pediatrics guidelines for managing jaundice in late preterm and term neonates have increased the bilirubin thresholds to start phototherapy. This was considered safe based on expert consensus, but its cost-effectiveness has not yet been evaluated. METHODS: This was a before-and-after, quality improvement and pharmaco-economical evaluation of hospital financial data from a perinatal academic referral centre. RESULTS: Implementing the new guidelines decreased hospitalizations due to phototherapy by 68.7%, 70.2%, and 60% for the total population and the late preterm and term subgroups, respectively (p < 0.001 for the three analyses). The hospitalization costs were decreased from EUR 1,289,040 to EUR 423,120 (i.e., an absolute saving of EUR 865,920, or ≈68%, for the entire population composed by late preterm and term neonates). Implementing the new treatment threshold nationwide would entail an estimated cost reduction of EUR 191,964,324. CONCLUSIONS: The new jaundice guidelines significantly decreased the use of phototherapy and associated healthcare costs.
Effect of Changing NAVA Levels on Tidal Ventilation in Extremely Preterm Infants Supported with NIV-NAVA.
Lefevere J, Cools W, Cools F
Neonatology · 2026 · PMID 41591972 · Publisher ↗
INTRODUCTION: Noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is used in preterm infants as a synchronized and proportional mode of noninvasive ventilation. Finding the ideal NAVA level to support preterm inf...
INTRODUCTION: Noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is used in preterm infants as a synchronized and proportional mode of noninvasive ventilation. Finding the ideal NAVA level to support preterm infants remains challenging. METHODS: A single-center prospective interventional study was conducted to study the effect of increasing NAVA levels on tidal ventilation measured with electrical impedance tomography (EIT). Preterm infants supported with NIV-NAVA were included. After a baseline registration and following a predefined titration protocol, NAVA levels were progressively increased by 0.5 cmHO/µV up to a NAVA level of 3 cmHO/µV. Before and during the titration procedure, the evolution of EIT parameters (end-expiratory lung impedance, end-inspiratory lung impedance, silent spaces, and center of ventilation) and respiratory parameters (electrical diaphragm activity [Edi] peak and minimum [Edi min] and peak inspiratory pressure [PIP]) were measured. RESULTS: Sixteen patients with a mean (standard deviation) gestational age (GA) at birth of 26.7 (1.2) weeks and birth weight of 838 (205) g were included for analysis. EIT parameters did not change significantly with titration of NAVA levels. PIP increased significantly with each increase in NAVA level and Edi peak decreased significantly from NAVA level 1 tot 1.5 cmHO/µV. Edi min and transcutaneous CO (TcCO) remained constant during the titration procedure. CONCLUSION: There was no effect of increasing NAVA levels on regional ventilation parameters. PIP increased with each increase in NAVA level, whereas Edi peak largely remained stable.
Identifying Infants <32 Weeks' Gestation at Low Risk of Early-Onset Sepsis: A 10-Year Retrospective Study from Western Australia.
Mackay CA, Nathan EA, Shrestha D … +1 more , Strunk T
Neonatology · 2026 · PMID 41569955 · Full text
UNLABELLED: <p>Introduction: Preterm infants are commonly treated with antibiotics on admission to the neonatal unit as part of routine care. We aimed to identify infants <32 weeks' gestation at low risk of early-onset s...
UNLABELLED: <p>Introduction: Preterm infants are commonly treated with antibiotics on admission to the neonatal unit as part of routine care. We aimed to identify infants <32 weeks' gestation at low risk of early-onset sepsis (EOS) in whom antibiotics could be safely withheld. METHODS: This retrospective cohort study included infants <32 weeks' gestation admitted between January 2012 and June 2022. Data were extracted from electronic databases. Low risk for EOS (LR) was defined as caesarean section delivery, rupture of membranes <1 h prior to birth, no preterm labour and no features of maternal chorioamnionitis. Maternal and neonatal characteristics and neonatal outcomes were compared between LR and not low risk (NLR) infants. IBM SPSS Statistics (Version 29) was used for data analysis. RESULTS: There were 3,285 infants included in the analysis of which 1,035 (31.5%) were LR and 2,250 (68.5%) NLR. No LR infants had culture-confirmed EOS compared with 35 (1.6%) NLR infants. Antibiotics were commenced in the first 48 h of life in 794 (76.7%) LR and 2,159 (96.0%) NLR infants (p < 0.001) and continued for ≥5 days in 226/782 (28.8%) LR and 603/2,107 (28.6%) NLR infants, despite negative blood cultures. There was no difference in mortality or late-onset sepsis between LR and NLR infants. CONCLUSION: Simple clinical parameters available at birth can be used to identify very preterm infants at lower risk of EOS in whom withholding empiric antibiotics could be considered. </p>.
Patterns of Neonatal and Neurodevelopmental Comorbidities in Neonates of <29 Weeks' Gestation.
Shah PS, Luu TM, Beltempo M … +4 more , Zwicker JG, Afifi J, Soraisham AS, Shivananda S
Neonatology · 2026 · PMID 41569950 · Full text
UNLABELLED: <p>Introduction: Multi-morbidity is a known cause of adverse outcomes and resource utilization in adults. Our objective was to describe the co-occurrence of neonatal morbidities and their association with neu...
UNLABELLED: <p>Introduction: Multi-morbidity is a known cause of adverse outcomes and resource utilization in adults. Our objective was to describe the co-occurrence of neonatal morbidities and their association with neurodevelopmental outcomes in preterm neonates. METHODS: We included 17,438 preterm neonates of <29 weeks' gestation admitted to Canadian neonatal intensive care units between 2010 and 2020, of whom 7,943 children had neurodevelopmental information. Neonatal outcomes were mortality, late-onset sepsis, necrotizing enterocolitis, and severe neurological injury. The outcomes were neurodevelopmental impairments, with significant impairment defined as any of: Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) score of <70, cerebral palsy with Gross Motor Function Classification System (GMFCS) of ≥3, hearing amplification, or bilateral visual impairment; and severe impairment defined as any of: Bayley-III score of <55, cerebral palsy with GMFCS of 4-5, or bilateral blindness. RESULTS: The mean (standard deviation) gestational age was 26.1 (1.6) weeks and 54.5% were male. Any neonatal mortality/morbidity occurred in 40.1% of children. Among survivors, 16.3% had significant neurodevelopmental impairment and 5.8% had severe neurodevelopmental impairment. However, 51% of children with significant impairment and 43% with severe neurodevelopmental impairment had no neonatal morbidities. Late-onset sepsis (aOR 1.60, 95% CI: 1.36, 1.88), necrotizing enterocolitis (aOR 1.91, 95% CI: 1.36, 2.69), and severe neurological injury (aOR 3.54, 95% CI: 2.85, 4.38) were associated with significant neurodevelopmental impairment among survivors. An increase in the count of neonatal morbidities correlated with a rise in the count of neurodevelopmental impairments. CONCLUSIONS: Sixty percent of infants of <29 weeks' gestation experienced no adverse neonatal outcomes and the majority were free of significant neurodevelopmental impairment. Neonatal morbidities had a direct and combined association with neurodevelopmental impairment. </p>.
Erratum.
Neonatology · 2026 · PMID 41563937 · Full text
In the article "Azithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis" [Neonatology. 2025; https://doi.org/10.115...
In the article "Azithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis" [Neonatology. 2025; https://doi.org/10.1159/000547537] by Joseph et al., the third author's name was incorrectly listed as Vanessa Karlinksi Vizentin. The correct spelling should be Vanessa Karlinski Vizentin.
Prediction of Retinopathy of Prematurity and Treatment in Very Low Birth Weight Infants Using Machine Learning on Nationwide Non-Imaging Clinical Data.
Hwang JK, Jung D, Park HK … +6 more , Kim D, Do HJ, Oh SH, Kim SH, Kim TH, Jin H
Neonatology · 2026 · PMID 41553943 · Full text
UNLABELLED: <p>Introduction: Retinopathy of prematurity (ROP) remains a leading cause of preventable blindness in preterm infants. This study aimed to develop machine learning (ML) models using non-imaging clinical data...
UNLABELLED: <p>Introduction: Retinopathy of prematurity (ROP) remains a leading cause of preventable blindness in preterm infants. This study aimed to develop machine learning (ML) models using non-imaging clinical data to predict ROP, severe ROP (sROP), and treated ROP (tROP) in very low birth weight (VLBW) infants. METHODS: We utilized nationwide clinical data from the Korean Neonatal Network, including 44 perinatal and neonatal variables. Two deep learning models, Multilayer Perceptron (MLP) and Neural Oblivious Decision Ensembles (NODE), optimized for tabular data, were applied. Additionally, we developed simplified models using eight key variables selected through clinical and algorithmic relevance. RESULTS: MLP and NODE models demonstrated high predictive performance. For the full 44-variable models, the area under the receiver operating characteristic curve (AUROC) was as follows: ROP (0.853/0.855), sROP (0.888/0.890), and tROP (0.905/0.909). The reduced 8-variable models yielded comparable AUROCs: ROP (0.851/0.855), sROP (0.895/0.895), and tROP (0.910/0.909). CONCLUSION: The proposed ML models based on nationwide non-imaging clinical data enable early risk identification and timely intervention for ROP in VLBW infants. This cost-effective and scalable approach may help improve outcomes, especially in resource-limited settings. </p>.
Role of Heritable and Environmental Contributions to the Development of Severe Intraventricular Hemorrhage in Very Preterm Infants: Results from a Multicenter Twins Cohort Study.
Xu F, Chen X, Gu X … +9 more , Jiang S, Zhou J, Xiao T, Lei X, Zhu Y, Du L, Lee SK, Zhou W, Hu L
Neonatology · 2026 · PMID 41505397 · Publisher ↗
INTRODUCTION: Severe intraventricular hemorrhage (sIVH) remains a significant complication for very preterm infants (VPIs). This study aimed to assess heritable and environmental contributions to sIVH. METHODS: A total o...
INTRODUCTION: Severe intraventricular hemorrhage (sIVH) remains a significant complication for very preterm infants (VPIs). This study aimed to assess heritable and environmental contributions to sIVH. METHODS: A total of 2,074 twin pairs born at gestational age <32 weeks with known sIVH status were identified. Three statistical methods were applied, including the Pearson χ2 test, intra-class correlation (ICC), and ACE modeling. RESULTS: Both Pearson's χ2 test (p = 0.224) and ICC analysis (p = 0.534) revealed no significant difference after comparing neither, one, or both of the monochorionic and dichorionic twin pairs who developed sIVH. ACE modeling revealed no contribution of heritability to sIVH risk, while the common environmental impacts on sIVH development were 27.9% (95% CI [23.9%, 31.9%]) and 72.1% (95% CI [68.1%, 76.1%]), respectively. Assisted conception (aOR 1.45, 95% CI [1.06, 1.97]), inotropes (<3 days) (aOR 1.71, 95% CI [1.22, 2.39]), invasive mechanical ventilation (<3 days) (aOR 2.38, 95% CI [1.56, 3.64]), and sedations (<7 days) (aOR 2.25, 95% CI [1.55, 2.06]) had contribution to sIVH, while larger gestational age (aOR 0.77 [0.71, 0.85]) and early surfactant administration (≤2 h) (aOR 0.58, 95% CI [0.42, 0.79]) prevented VPIs from sIVH. CONCLUSIONS: We recognized that environmental factors instead of heritability may play major contribution to the development of sIVH. Quality improvement studies focusing on the potential environmental factors to decrease the incidence of sIVH are warranted.
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