Neonatology[JOURNAL]
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200 papers
Impact of 2022 AAP Neonatal Hyperbilirubinemia Guidelines in a Middle-Income Country: A Single-Center Study in Thailand.
Vongbhavit K, Rearkyai S, Janyoungsak P … +1 more , Panburana J
Neonatology · 2025 · PMID 40815110 · Publisher ↗
INTRODUCTION: Neonatal hyperbilirubinemia (NH) is common and can cause neurological dysfunction. The AAP updated its guideline in 2022 to improve the management of NH, but its impact in middle-income countries with high...
INTRODUCTION: Neonatal hyperbilirubinemia (NH) is common and can cause neurological dysfunction. The AAP updated its guideline in 2022 to improve the management of NH, but its impact in middle-income countries with high NH and G6PD deficiency rates remains uncertain. This study evaluated the updated guidelines in such a setting. METHODS: This retrospective study analyzed infants born in a Thai institution between January 2021-March 2022 (previous guidelines) and January 2023-March 2024 (updated guidelines). Infants <15 days receiving phototherapy or outpatient bilirubin testing were included, while those born <35 weeks, admitted to the NICU, congenital anomalies, or inborn errors of metabolism were excluded. The primary outcome was the phototherapy rate; secondary outcomes included exchange transfusion, readmissions, NH etiologies, bilirubin testing, hospital stay, and outpatient follow-up. Logistic regression identified associated factors. RESULTS: Among 3,607 infants, 463 met inclusion criteria. Phototherapy rates decreased with the updated guideline (14.9% vs. 11.5%, p = 0.003). Identification of infants with G6PD deficiency declined (16.5% vs. 7.3%, p = 0.004), with affected infants having lower odds of receiving phototherapy under the updated guidelines (adjust OR = 0.40; 95% confidence interval: 0.21-0.76, p = 0.005). Readmission rates (6.6% vs. 5.5%, p = 0.43), hospital stay, and bilirubin testing showed no significant differences. Outpatient follow-up improved, with more infants requiring only one visit and receiving earlier follow-up. DISCUSSION: The updated AAP guidelines were associated with reduced phototherapy use and follow-up visits, with a stable readmission rate. Further research is needed to assess their impact on G6PD-related outcomes in middle-income countries.
A Wireless Neonatal Intensive Care Unit: Fiction or Closer Reality?
Senechal E, Chung HU, Rogers J … +1 more , Sant'Anna G
Neonatology · 2025 · PMID 40815101 · Full text
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Azithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis.
Joseph M, Murali Krishna M, Karlinski Vizentin V … +2 more , Provinciatto H, Ezenna C
Neonatology · 2026 · PMID 40795809 · Full text
UNLABELLED: <p>Introduction: Azithromycin, with its antimicrobial and anti-inflammatory properties, has been explored as a potential option for preventing bronchopulmonary dysplasia (BPD) in preterm infants. OBJECTIVE: W...
UNLABELLED: <p>Introduction: Azithromycin, with its antimicrobial and anti-inflammatory properties, has been explored as a potential option for preventing bronchopulmonary dysplasia (BPD) in preterm infants. OBJECTIVE: We performed a meta-analysis of randomized controlled trials (RCTs) comparing azithromycin with placebo for the prevention of BPD in preterm infants. METHODS: PubMed, Scopus, <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, and Cochrane Central databases were searched for studies comparing azithromycin versus placebo in preterm infants. Outcomes of interest included the composite of BPD and death, BPD, death, grade 2 or higher necrotizing enterocolitis (NEC), grade 3 or 4 intraventricular hemorrhage (IVH), retinopathy of prematurity (RoP), duration of mechanical ventilation, and postnatal corticosteroid requirement. Random-effects model was used to generate risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) (CRD42024558752). RESULTS: The meta-analysis included 6 RCTs including 1,360 infants (azithromycin n = 680, 50%). The composite of BPD or death (RR: 0.95; 95% CI: 0.83-1.10; p = 0.53; I2 = 50.2%), BPD (RR: 0.98; 95% CI: 0.83-1.15; p = 0.77; I2 = 38.1%), death (RR: 0.88; 95% CI: 0.66-1.19; p = 0.41; I2 = 0%), NEC (RR: 0.94; 95% CI: 0.69-1.26; p = 0.67; I2 = 0%), IVH (RR: 1.22; 95% CI: 0.89-1.68; p = 0.22; I2 = 3.5%), RoP (RR: 1.35; 95% CI: 0.43-4.28; p = 0.61; I2 = 76.3%), duration of mechanical ventilation (MD: 0.13; 95% CI: -1.35 to 1.60; p = 0.87; I2 = 0%), and postnatal corticosteroid requirement (RR: 0.84; 95% CI: 0.64-1.08; p = 0.18; I2 = 34.5%) were similar between the groups. CONCLUSION: In preterm infants, azithromycin did not significantly change the risk of adverse clinical outcomes compared with placebo. </p>.
Continuous Chest Compressions with Asynchronous Ventilation in Asphyxiated Preterm Lambs with Asystole.
Giusto E, Sankaran D, Riley E … +6 more , Lesneski A, Persiani M, Valdez R, Hammitt VL, Lakshminrusimha S, Vali P
Neonatology · 2025 · PMID 40753890 · Full text
INTRODUCTION: Gas exchange and perfusion are impaired during neonatal cardiopulmonary resuscitation. Continuous chest compressions with asynchronous ventilation (CCCaV) improve oxygenation and hemodynamics in term animal...
INTRODUCTION: Gas exchange and perfusion are impaired during neonatal cardiopulmonary resuscitation. Continuous chest compressions with asynchronous ventilation (CCCaV) improve oxygenation and hemodynamics in term animal models compared to synchronized 3:1 compressions-to-ventilation (C:V). We hypothesized that CCCaV improves gas exchange and hemodynamics in preterm lambs. METHODS: Sixteen extremely preterm (124-126 days gestation) lambs were asphyxiated to cardiac arrest by umbilical cord occlusion. Lambs were randomized to 3:1 C:V following the International Liaison Committee on Resuscitation algorithm or CCCaV (120 compressions and 40 asynchronized ventilations per minute). Epinephrine was given 3 min into resuscitation and repeated every 3 min until return of spontaneous circulation (ROSC). RESULTS: All lambs achieved ROSC with no difference in time to ROSC. There was no difference in cerebral oxygen delivery (C-DO) in lambs resuscitated with CCCaV versus 3:1 C:V (0.05 [0.041] vs. 0.03 [0.031] mL O/kg/min, respectively) during chest compressions. CCCaV yielded higher arterial oxygen content (CaO 2.07 [1.00] vs. 1.07 [0.69] mL O/dL), mean arterial pressure (14.2 [2.6] vs. 13.2 [2.3] mm Hg), and diastolic pressure (8.1 [1.8] vs. 7.1 [1.4] mm Hg) during chest compressions compared to 3:1 C:V. There was no difference in plasma reduced to oxidized glutathione [GSH/GSSG ratio] between groups at 10 min post-ROSC. DISCUSSION: CCCaV in asystolic preterm lambs did not alter C-DO, frequency, or time to ROSC compared to standard 3:1 C:V resuscitation but increased CaO, mean, and diastolic arterial pressure compared to 3:1 C:V without increasing plasma oxidative stress markers.
Neurobehavioral Outcomes at 10 Years of Age following Delayed Umbilical Cord Clamping: A Follow-Up Study after a Randomized Trial.
Isacson M, Hellström-Westas L, Domellöf M … +3 more , Dahlgren J, Roswall J, Andersson O
Neonatology · 2025 · PMID 40744000 · Full text
UNLABELLED: <p>Introduction: The aim of this study was to explore long-term behavioral consequences of early versus delayed cord clamping (CC) in school-aged children. The hypothesis was that early CC would be associated...
UNLABELLED: <p>Introduction: The aim of this study was to explore long-term behavioral consequences of early versus delayed cord clamping (CC) in school-aged children. The hypothesis was that early CC would be associated with an increased risk of symptoms associated with attention deficit hyperactivity disorder (ADHD) due to the lower iron stores following early CC compared with delayed CC. METHODS: Exploratory, long-term follow-up study of a randomized controlled trial in Sweden. Full-term, vaginally born, neonates to healthy mothers were originally included and randomized to either early (≤10 s) or delayed (≥180 s) CC. At 10 years of age, scores from the screening questionnaire Swanson, Nolan and Pelham Scale IV (SNAP-IV), that identifies symptoms suggestive of ADHD (but do not diagnose ADHD), were compared between groups of early and delayed CC. RESULTS: We assessed 139/382 (36.4%) children, 64 early CC and 75 delayed CC. No significance in total score and subgroup scores of SNAP-IV was seen when comparing early and delayed CC. In the primary outcome, total scores, mean (standard deviation) of early CC was 14.64 (13.94) and for delayed CC 13.59 (13.41), p = 0.65. CONCLUSION: Timing of umbilical CC and iron status were not associated with symptoms associated with ADHD in 10-year-old children. Studies with higher follow-up rates and in populations with high prevalence of iron deficiency are needed to verify or discard the findings. Understanding if delayed CC has long-lasting neurobehavioral or neurodevelopmental effects can help develop guidelines and program about neonatal care. </p>.
Neonatal Training across Union of European Medical Specialists Member Countries: A Survey from the Next Generation of Neonatologists.
Williams E, Dassios T, Alonso-Ojembarrena A … +4 more , Roehr CC, Been JV, de Boode WP, Jost K
Neonatology · 2025 · PMID 40738026 · Full text
UNLABELLED: <p>Introduction: Taking care of critically ill newborn infants is challenging, even more so in the current era of greater use of non-invasive support, leaving limited exposure to learn critical skills. Suppor...
UNLABELLED: <p>Introduction: Taking care of critically ill newborn infants is challenging, even more so in the current era of greater use of non-invasive support, leaving limited exposure to learn critical skills. Supporting a growing workforce of neonatologists requires training of doctors with formal curriculums and assessment of skills ensuring delivery of high-quality care. Our aim was to gain an understanding of neonatal trainee experiences regarding current neonatal training across Union of European Medical Specialists (UEMS) member countries. The main focus of this survey was on pulmonology-related skills and decision-making. METHODS: A structure online survey was sent via the European Society for Paediatric Research (ESPR) newsletter and targeted national neonatology societies from 35 full and associate member countries of the UEMS. Doctors currently in neonatal subspecialty training or having finished training within the last 3 years were eligible. The survey took place between December 2023 and June 2024. All answers were anonymous. RESULTS: One hundred and eight individual responses from 24 countries were received. Trainees were confident in endotracheal intubation and postnatal surfactant administration. Current year of neonatal training was the most strongly associated factor with reported confidence in training requirements and procedures, as opposed to having a formal curriculum. Adequate face to face supervision also affected confidence in decision-making. DISCUSSION: There currently is no "unified" pathway for training, curricula and formal assessments across member countries of the UEMS. Future developments include provision of simulation-based training approaches and collaborative mentorship opportunities in caring for complex respiratory diseases affecting newborns. </p>.
Neonatal Outcomes of the Intubation-Surfactant-Extubation versus Less Invasive Surfactant Administration Method: A National Cohort Study in Korea.
Cho H, Lee J
Neonatology · 2025 · PMID 40730036 · Full text
UNLABELLED: <p>Introduction: This study aimed to compare the outcomes of intubation-surfactant-extubation (INSURE) and less invasive surfactant administration (LISA) in very preterm infants with respiratory distress synd...
UNLABELLED: <p>Introduction: This study aimed to compare the outcomes of intubation-surfactant-extubation (INSURE) and less invasive surfactant administration (LISA) in very preterm infants with respiratory distress syndrome. METHODS: This study included preterm infants born in South Korea at <32 weeks' gestation and registered in the Korean Neonatal Network database between January 2019 and December 2022. We analyzed and compared the ventilator support duration, mortality, and major morbidities before discharge from the neonatal intensive care unit treated with INSURE and LISA methods. RESULTS: A total of 1,112 infants who received surfactants via INSURE (n = 627) or LISA (n = 485) were included. No significant intergroup differences were observed in the duration of invasive ventilation, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, or mortality. However, infants in the LISA group had a lower risk of severe BPD (adjusted odds ratio [aOR], 0.514; 95% confidence interval [CI], 0.346-0.763; p = 0.001), severe BPD or death (aOR, 0.586; 95% CI, 0.402-0.854; p = 0.005), massive pulmonary hemorrhage (aOR, 0.314; 95% CI, 0.122-0.807; p = 0.014), patent ductus arteriosus (aOR, 0.67; 95% CI, 0.497-0.902; p = 0.008), and culture-proven sepsis (aOR, 0.607; 95% CI, 0.411-0.896; p = 0.012) than did those in the INSURE group. CONCLUSION: Although LISA did not demonstrate a reduction in either the requirement for respiratory support or its duration compared to INSURE, it was associated with a decrease in severe BPD. These results imply that LISA provides substantial advantages for mitigating severe forms of neonatal morbidities. </p>.
Neonatal Thymic Hemorrhage Secondary to Vitamin K Deficiency: A Case Report.
Asdell N, Halling C, Lopata SM … +3 more , Wilson SD, Mangray S, Farmer ZJ
Neonatology · 2025 · PMID 40706579 · Publisher ↗
INTRODUCTION: Vitamin K deficiency bleeding (VKDB) in newborns is a preventable yet serious condition. Maternal malabsorption, such as in Crohn's disease, may impair transplacental vitamin K transfer, increasing neonatal...
INTRODUCTION: Vitamin K deficiency bleeding (VKDB) in newborns is a preventable yet serious condition. Maternal malabsorption, such as in Crohn's disease, may impair transplacental vitamin K transfer, increasing neonatal coagulopathy risk. CASE REPORT: A 32-year-old woman with Crohn's disease and prior bowel resections delivered at 35+3 weeks due to preeclampsia and fetal distress. Her infant developed severe coagulopathy and a hemorrhagic thymic mass. Laboratory results showed elevated INR and PIVKA-II, which improved with vitamin K and plasma. The mother experienced postpartum hemorrhage and coagulopathy, requiring transfusions, embolization, and vitamin K. Both recovered with treatment. At 13 months, the infant showed only mild left-hand weakness and normal development. CONCLUSION: This case highlights the risk of neonatal VKDB and maternal bleeding due to undiagnosed maternal vitamin K deficiency. Screening and supplementation should be considered in pregnancies affected by malabsorptive disorders like Crohn's disease.
Preoperative Cerebral and Renal Saturations in Neonates with Congenital Heart Defects: A Prospective Cohort Study.
Michel Macías C, Rampakakis E, Mir M … +11 more , Mazzarello M, Moore SS, Wutthigate P, Simoneau J, Villegas M D, Shemie SD, Brossard-Racine M, Dancea A, Bertolizio G, Wintermark P, Altit G
Neonatology · 2025 · PMID 40701141 · Full text
UNLABELLED: <p>Introduction: Congenital heart disease (CHD) is one of the most common birth defects. Cerebral (cStO) and renal (rStO) saturations measured by near-infrared spectroscopy (NIRS) and the corresponding fracti...
UNLABELLED: <p>Introduction: Congenital heart disease (CHD) is one of the most common birth defects. Cerebral (cStO) and renal (rStO) saturations measured by near-infrared spectroscopy (NIRS) and the corresponding fractional tissue oxygen extraction (FTOE) during the first week of life in neonates with CHD are described comparing those with and without diastolic steal. METHODS: Single-center prospective cohort study (Montreal Children's Hospital, Montreal, QC, Canada) was conducted, including neonates >34 weeks with CHD without chromosomal anomalies. CStO/rStO was monitored from enrollment until day 7 of life. FTOE was calculated using systemic saturation (SpO) as [SpO - (cStO or rStO)]/SpO. Daily echocardiography was performed during the monitoring period. Random mixed-effects models were constructed to assess the association between NIRS/FTOE and the presence of retrograde postductal aortic flow on last available echocardiography. RESULTS: Among 49 included neonates, 27 (55%) exhibited retrograde flow in the postductal aorta on the last day of monitoring. Prostaglandin exposure was 100% in the retrograde group vs. 27% in the non-retrograde group. CStO/rStO progressively declined in neonates with CHD over the first week of life. Retrograde aortic flow was associated with negative cStO (β = -9.1%, 95% CI [-14.3; -3.8]) and rStO (β = -8.4%, 95% CI [-14.5; -2.3]). Cerebral FTOE was lower in the non-retrograde group, while renal FTOE was similar between groups. CONCLUSION: During the first week of life, neonates with CHD who displayed retrograde aortic flow exhibited lower cStO and rStO as well as higher cerebral FTOE. Future studies should evaluate whether these markers in neonates with CHD are modifiable factors that could influence cerebral or renal injury when addressed. </p>.
The Effect of Oral Immunotherapy on Preterm Neonates: A Promising Adjuvant Therapy in a Clinical Trial Study.
Atef Abdelsattar Ibrahim H, Elkhashab K, Khaled Ayada I … +2 more , Magdy H, Sobhy Menshawy S
Neonatology · 2025 · PMID 40690903 · Publisher ↗
INTRODUCTION: Breastfeeding is currently recommended as the optimal and initial feeding option for all newborns, as it protects against illness and reduces neonatal mortality. Furthermore, premature infants exhibit reduc...
INTRODUCTION: Breastfeeding is currently recommended as the optimal and initial feeding option for all newborns, as it protects against illness and reduces neonatal mortality. Furthermore, premature infants exhibit reduced swallowing ability and an increased risk of developing necrotizing enterocolitis (NEC), which may hinder suckling and delay the initiation of enteral feeding. Our aim was to investigate the effects of oropharyngeal colostrum delivery in preterm neonates <34 weeks of gestation on hospital outcomes, specifically differences in hospital stay between neonates who received colostrum for 3 days and those who did not. METHODS: This prospective, interventional, randomized controlled trial enrolled ninety-six preterm neonates, who were allocated into three groups: group A, neonates who received oropharyngeal colostrum for 3 days along with routine care; group B, neonates who received oropharyngeal colostrum for 10 days along with routine care; and group C, neonates who received routine care only. The Kruskal-Wallis test was used to compare medians among the three groups. Associations between categorical variables were analyzed using the chi-squared test and Monte Carlo test. RESULTS: The two groups that received colostrum showed significantly reduced median hospital stays, time to reach full enteral intake, and sepsis rates compared to the control group (p < 0.001). A significant difference in daily weight gain was observed between groups, particularly between the control group and neonates who received colostrum for 10 days (p = 0.028). Regarding the incidence of NEC, no significant difference was found among the groups (p = 0.314). CONCLUSION: Oropharyngeal colostrum may be considered a potential oral immunotherapy.
Association of Heart Rate Variability with Postnatal Maturation in Preterm Infants.
Kaempfen S, Sanchez C, Delgado-Eckert E … +1 more , Schulzke SM
Neonatology · 2025 · PMID 40652921 · Full text
UNLABELLED: <p>Introduction: We assessed whether longitudinal measurements of sample entropy (SampEn) of heart rate time series reflect postnatal maturation in preterm infants and evaluated its predictive value at 32 wee...
UNLABELLED: <p>Introduction: We assessed whether longitudinal measurements of sample entropy (SampEn) of heart rate time series reflect postnatal maturation in preterm infants and evaluated its predictive value at 32 weeks of postmenstrual age (PMA) for estimating discharge home. We further compared SampEn of preterm infants at discharge with that of term infants. METHODS: We conducted a prospective study at the University Children's Hospital Basel, Switzerland, from 2018 to 2022. We included preterm infants born before 32 weeks of gestation and a control group of term infants. Heart rate was recorded using the clinical monitoring system. We assessed preterm infants at 32 and 36 weeks of PMA, and at discharge, term infants were evaluated between 3 and 28 days of life. SampEn was calculated from 90-min recordings using custom analytical software. RESULTS: We obtained valid data from 183/183 preterm infants (mean [range] 28.4 [23.3-31.7] weeks of gestation) and from 80/104 (76%) term infants. In preterm infants, SampEn increased from 32 to 36 weeks of PMA (0.35 vs. 0.40; p < 0.01) without further increase to discharge. SampEn was positively associated with maturation and growth, and negatively with complications of prematurity, particularly with bronchopulmonary dysplasia. SampEn at 32 weeks of PMA did not improve clinical predictions of PMA at discharge. At discharge, SampEn did not differ significantly between preterm and term infants. CONCLUSION: SampEn of heart rate time series increased with postnatal maturation in preterm infants, reaching values of term infants at discharge. It was negatively associated with complications of prematurity but its prognostic value for discharge timing is limited. </p>.
Treatment with Plasma Transfusion and Plasma-Derived Human Plasminogen in a Newborn with Plasminogen Deficiency and Recurrent Hydrocephalus: A Case Report.
Iovannitti G, Bianchi F, Massimi L … +2 more , Frassanito P, Tamburrini G
Neonatology · 2025 · PMID 40618734 · Publisher ↗
INTRODUCTION: Plasminogen deficiency is a congenital autosomal recessive disorder. Ligneous conjunctivitis is pathognomonic for the disease; however, hydrocephalus is a rare complication. CASE PRESENTATION: A neonate wit...
INTRODUCTION: Plasminogen deficiency is a congenital autosomal recessive disorder. Ligneous conjunctivitis is pathognomonic for the disease; however, hydrocephalus is a rare complication. CASE PRESENTATION: A neonate with prenatal diagnosis of hydrocephalus associated with Dandy-Walker syndrome was sent to our observation. Surgery was followed by multiple shunt malfunctions in the early postoperative period. An ophthalmological evaluation suggested the diagnosis of ligneous conjunctivitis. Laboratory tests lead to the diagnosis of a systemic PLGD. The disease caused the formation of multiple membranes, which prevented the proper functioning of the ventricular shunts. We started an alternated treatment with plasma transfusions and plasma-derived human plasminogen. This has allowed the control of the complications related to the treatment of the hydrocephalus. DISCUSSION: Ligneous conjunctivitis was pivotal in the diagnosis of pathology. It is currently difficult to get sufficient doses of plasma-derived human plasminogen for ev administration, considering that it is still not officially authorized in Europe.
Tabula Rasa? A History of Fetal Learning and Neonatal Perception.
Obladen M
Neonatology · 2025 · PMID 40562022 · Publisher ↗
BACKGROUND: Sensory capacities of the fetus and newborn are still incompletely known. This paper delineates the history of understanding and evidence. SUMMARY: In the 2nd century, Galen propagated the tabula rasa theory...
BACKGROUND: Sensory capacities of the fetus and newborn are still incompletely known. This paper delineates the history of understanding and evidence. SUMMARY: In the 2nd century, Galen propagated the tabula rasa theory comparing newborns to a blank writing tablet, without senses of sight, hearing, taste, or smell. Somatosensory: once the microscope was available, tactile receptors were identified in mid-17th century. But the tabula rasa theory persisted, and physicians maintained until the 1980s that neonates feel no pain. Auditory: the inner ear's development begins at 10 weeks of gestation at the cochlear basis and ends at its apex at 24 weeks. Researchers believed still into the 19th century that the fetus lacked auditory sensitivity. The uterus is not a quiet place, as the fetus hears uterine vessels, maternal voice, peristalsis, diaphragmatic movement, and heartbeat. In 1980, DeCasper proved that newborns preferred hearing their mothers' voice when compared to that of another mother. The evidence is weaker for sounds originating outside the maternal body. Despite little in utero stimulation, the newborn's visual apparatus functions from birth. Infants enter the world with innate perceptual knowledge of the human face. Olfactory: human infants are attracted by the smell of their mother's breast. It took 1,500 years to discard the tabula rasa theory and to grant the newborn full personhood in the 20th century. KEY MESSAGES: Fetal sensory organs are developed by mid-gestation. Neonates know their mother's voice and smell, which encourages maternal contact, prudent disinfectant use, and reduced noise in the nursery.
Impact of Implementing Nasal High Flow Therapy on Body Growth in Preterm Infants.
de Ridder R, Katz TA, van Kaam AH … +13 more , Mugie SM, Weber EH, de Groof F, Kunst A, van den Heuvel MEN, Counsilman CE, Rijpert M, Schiering IA, Wilms J, Visser F, Aarnoudse-Moens CSH, Leemhuis AG, Onland W
Neonatology · 2025 · PMID 40544838 · Full text
UNLABELLED: <p>Introduction: The objective of this study was to determine the impact of nasal high flow (nHF) implementation on lung growth at 6 months corrected age (CA) in preterm infants. METHODS: This single-center r...
UNLABELLED: <p>Introduction: The objective of this study was to determine the impact of nasal high flow (nHF) implementation on lung growth at 6 months corrected age (CA) in preterm infants. METHODS: This single-center retrospective cohort study included preterm infants born <30 weeks' gestation and surviving to 6 months CA at the neonatal intensive care unit of the Amsterdam University Medical Centers. In the nCPAP cohort (2009-2012), continuous distending pressure (CDP) was applied solely with nasal continuous positive airway pressure support. In the nHF cohort (2015-2018), nCPAP was used and followed by nHF therapy to deliver CDP. Bodyweight and length at 6 months CA were used as a proxy for lung growth. We also assessed the impact on respiratory management and neonatal morbidity. Multivariate analysis was performed after multiple imputation, using a linear regression adjusting for confounding variables. RESULTS: Of the 598 eligible infants, 313 infants were included in the nCPAP cohort and 285 infants in the nHF cohort. The analyses showed no differences between the nCPAP and nHF cohort in body weight (7.29 vs. 7.31 kilogram, 95% CI -0.14 to 0.20, p = 0.71) and length (66.6 vs. 66.8 centimeters, 95% CI -0.30 to 0.81, p = 0.26) at 6 months CA. No differences in moderate/severe bronchopulmonary dysplasia (BPD) were reported, but nHF implementation was associated with longer CDP duration, a trend toward more days on supplemental oxygen, and a shift from moderate to severe BPD. CONCLUSIONS: Implementation of nHF did not impact body growth, which is associated with lung growth, at 6 months CA in preterm infants born <30 weeks. </p>.
MicroRNA Expression Profiles in Very Preterm Infants with Patent Ductus Arteriosus: A Pilot Study.
Winkler I, Posod A, Staudt A … +4 more , Huber E, Urbanek M, Kiechl-Kohlendorfer U, Griesmaier E
Neonatology · 2025 · PMID 40544819 · Publisher ↗
INTRODUCTION: Very preterm infants are at risk for developing hemodynamically significant patent ductus arteriosus (hsPDA), which contributes to increased morbidity. The optimal management of hsPDA remains controversial,...
INTRODUCTION: Very preterm infants are at risk for developing hemodynamically significant patent ductus arteriosus (hsPDA), which contributes to increased morbidity. The optimal management of hsPDA remains controversial, and treatment options are associated with complications. Developing accurate prediction tools for hsPDA closure is essential to guide management strategies. The aim of the present pilot study was to investigate microRNA expression profiles in very preterm infants with and without hsPDA and to assess their potential as biomarkers for hsPDA. METHODS: We prospectively enrolled preterm infants with a birth weight of ≤1,250 g and a gestational age of <30 weeks at Innsbruck Medical University Hospital, Austria. Infants with spontaneous ductus closure within the first week comprised the control group, while those with persistent hsPDA formed the hsPDA group. Total RNA was extracted from dried blood spots (umbilical cord blood and infant blood of week 1), followed by microRNA sequencing and differential gene expression analysis. RESULTS: The study included 25 infants (control group: n = 14; hsPDA group: n = 11). Differential expression analysis of umbilical cord blood identified significant downregulation of hsa-miR-218-5p in the hsPDA group compared to the control group (log2 fold change = -3.444; FDR = 0.099, Benjamini-Hochberg corrected). In the analysis of infant blood of week 1, no significant differences in micro-ribonucleic acid expression profile between hsPDA and control group were detected. CONCLUSION: MicroRNAs could be potential biomarkers for hsPDA closure in preterm infants. Larger studies are needed to validate our findings of this pilot study and to assess clinical applicability.
Unveiling the Hidden Burden: An Umbrella Review of Congenital Anomalies among Newborns in Low- and Middle-Income Countries.
Zemariam AB, Kitaw TA, Haile RN … +6 more , Tilahun BD, Yilak G, Ayele M, Bizuayehu MA, Ngusie HS, Alamaw AW
Neonatology · 2025 · PMID 40505644 · Publisher ↗
INTRODUCTION: Congenital anomalies (CAs) are a major cause of newborn mortality and long-term disabilities, especially in developing countries. Research on CAs is limited and inconclusive. This umbrella review evaluates...
INTRODUCTION: Congenital anomalies (CAs) are a major cause of newborn mortality and long-term disabilities, especially in developing countries. Research on CAs is limited and inconclusive. This umbrella review evaluates the pooled prevalence, patterns, and determinants of CAs among newborns in low- and middle-income countries. METHODS: We conducted a comprehensive search across databases, including PubMed and Cochrane Library, until 31 December 2024. Study quality was assessed using the AMSTAR checklist. Heterogeneity was measured with the I2 test and Cochrane Q test, while publication bias was evaluated through funnel plots, Egger's, and Begg's tests. The pooled prevalence of CAs and determinants was calculated using the DerSimonian and Laird random-effects model. RESULTS: Seven studies revealed a pooled prevalence of CAs at 15 per 1,000 births (95% CI: 9.00, 21.00), with the highest rate in low-income countries at 18 per 1,000 (95% CI: 8.00, 27.00). Musculoskeletal and urogenital anomalies were the most prevalent, at 8 and 4 per 1,000 births, respectively. Key predictors include lack of folic acid supplementation (AOR 4.18, 95% CI: 2.35, 6.02), kchat chewing (AOR 3.5, 95% CI: 2.97, 4.03), maternal illness (AOR 3.55, 95% CI: 3.37, 4.73), and drug use during pregnancy (AOR 4.37, 95% CI: 1.21, 7.54). CONCLUSION: The pooled prevalence of CAs is significantly higher than WHO reports, with musculoskeletal and urogenital defects being the most common. Key risk factors include maternal illness, unidentified drug use, kchat chewing, and lack of folic acid supplementation. Enhancing folic acid intake and targeting these risk factors are essential for policymakers.
Severe Neonatal Anemia with Multi-Organ Failure, Extreme Placentomegaly, and Placental Megaloblastic Erythroblastosis as Features in Identifying Congenital Dyserythropoietic Anemia Type 1: A Case Report.
Roose O, Gengler C, Stoykova S … +3 more , Good JM, Tolsa JF, Beauport L
Neonatology · 2025 · PMID 40472828 · Full text
<p>Introduction: Congenital dyserythropoietic anemia type 1 (CDA-1) is a rare inherited erythroid disorder. The neonatal clinical presentation is non-specific, making diagnosis challenging and requiring a multidisciplina...
<p>Introduction: Congenital dyserythropoietic anemia type 1 (CDA-1) is a rare inherited erythroid disorder. The neonatal clinical presentation is non-specific, making diagnosis challenging and requiring a multidisciplinary approach. To date, no specific placental characteristics have been associated to this condition, highlighting the importance of placental examination and pathologic investigations. Case Presentation: We present the case of a term newborn affected by CDA-1. The patient displayed poor neonatal adaptation with severe anemia, persistent pulmonary arterial hypertension, right ventricular dysfunction, hypotensive shock, cholestasis, hepatitis, severe hyperferritinemia, disseminated intravascular coagulation, thrombocytopenia, acute renal failure, and transient hyperinsulinism. Placentomegaly was noted and histology demonstrated severe megaloblastic erythroblastosis. Genetic research confirmed the diagnosis. The patient required intensive care during the first weeks of life and blood cell transfusions every 5 weeks until 6 months. The outcome was favorable. Conclusion: CDA-1 is a rare, serious disorder requiring a complex diagnostic approach. Placental analysis provides additional clues for establishing a diagnosis. </p>.
Routine Emollient Therapy with Coconut Oil in Preterm Infants and Allergic Sensitization at 1-Year Corrected Age.
Williams T, Weidinger J, Metcalfe JR … +5 more , Thomas S, Mountain J, Currie A, O Apos Sullivan M, Strunk T
Neonatology · 2025 · PMID 40472816 · Full text
UNLABELLED: <p>Introduction: Skin care for very and extremely preterm infant is an important and previously underappreciated topic. Coconut oil skin care for preterm infants is a promising option, but several important q...
UNLABELLED: <p>Introduction: Skin care for very and extremely preterm infant is an important and previously underappreciated topic. Coconut oil skin care for preterm infants is a promising option, but several important questions remain including the theoretical potential for allergic sensitization. METHODS: This prospective study conducted skin prick testing and allergy questionnaires in a cohort of very preterm infants who received routine skin care with virgin coconut oil during their neonatal admission. RESULTS: Ninety infants (median GA 28.2 weeks, median BW 1,048 g) were assessed at corrected age 15 months. A total of 8 children had positive skin prick tests to 1 or more of the most common allergens (egg, peanut, cashew, dust mite). No child was sensitized to coconut oil or extract. CONCLUSIONS: We did not find evidence of allergic sensitization following neonatal skin care with coconut oil in children born preterm. </p>.
Cerebral Saturation and Fractional Tissue Oxygen Extraction Are Associated with Anterior Cerebral Artery Doppler Parameters in Neonates with Congenital Heart Defects.
Kanaprach P, Michel-Macias C, Mazzarello M … +12 more , Mir M, Rampakakis E, Wutthigate P, Simoneau J, Villegas D, Moore SS, Shemie SD, Brossard-Racine M, Dancea A, Bertolizio G, Wintermark P, Altit G
Neonatology · 2025 · PMID 40451174 · Full text
UNLABELLED: <p>Introduction: The aim of the study was to explore the relationship between near-infrared spectroscopy parameters (cerebral saturation [CSat] and corresponding cerebral fractional tissue oxygen extraction [...
UNLABELLED: <p>Introduction: The aim of the study was to explore the relationship between near-infrared spectroscopy parameters (cerebral saturation [CSat] and corresponding cerebral fractional tissue oxygen extraction [cFTOE]) with resistive (RI) and pulsatility indices (PI) of the anterior cerebral artery (ACA) obtained simultaneously in neonates with congenital heart defect (CHD) during the first week of life. METHODS: Prospective observational study on neonates ≥35 weeks with CHD was conducted. Cerebral FTOE was based on concomitant pre-ductal oxygen saturation (SpO) during CSat measurement. ACA was assessed via Doppler ultrasound (US). Continuous CSat/SpO monitoring was collected during the first week of life. Daily ACA Doppler was obtained from day 1-7. RESULTS: A total of 142 concomitant measurements of NIRS and US parameters during the first week of life were collected in 34 neonates with various CHD. Mixed effect models showed significant association between CSat/cFTOE and time-corresponding RI-ACA (p = 0.02 and 0.005) and PI-ACA (p = 0.006 and 0.002), respectively. A 0.1-point increase in RI was associated to a 2.3% decrease in CSat and a 3-point increase in cFTOE. A 0.1-point increase in PI was associated to a 0.9% decrease in CSat and 1.1-point increase in cFTOE. CONCLUSIONS: In neonates with CHD during their first week of life, lower CSat and higher cerebral FTOE were associated with elevated RI and PI values of the ACA obtained simultaneously. Future research should assess whether a multimodal bedside approach to monitoring cerebrovascular hemodynamics can facilitate early detection of cerebral hypoperfusion and prevent brain injury, as well as adverse neurodevelopmental outcomes in this vulnerable population. </p>.
International Variation and Trends of Intraventricular Hemorrhage in Very Preterm Infants.
Hollens G, Schindler T, Battin M … +14 more , Klinger G, Adams M, Vento M, Santacroce A, Håkansson S, Isayama T, Norman M, Kusuda S, Lehtonen L, Helenius K, Modi N, Shah PS, Lui K, iNeo Neonatal Network
Neonatology · 2025 · PMID 40451146 · Full text
UNLABELLED: <p>Introduction: We aimed to investigate international variation in gestational age (GA) specific severe intraventricular hemorrhage (IVH) rates, among infants of <30 weeks' GA from the neonatal networks of 1...
UNLABELLED: <p>Introduction: We aimed to investigate international variation in gestational age (GA) specific severe intraventricular hemorrhage (IVH) rates, among infants of <30 weeks' GA from the neonatal networks of 11 high-income countries/region. METHODS: Retrospective cohort study of outcomes of grade 3/4 IVH rates and composite of g3/4 IVH or death in GA groups of 22-23, 24-25, 26-27, and 28-29 weeks infants admitted to networks of Australia and New Zealand, Canada, Finland, Israel, Italy (Tuscany), Japan, Spain, Sweden, Switzerland, and the UK. Their risk adjusted trends across 3 epochs (2007-11, 2012-15, and 2016-19) were also evaluated. RESULTS: Outcomes of 165,329 infants (median GA 27 weeks, birthweight 950 g) were analyzed. Overall, the lowest grade 3/4 IVH rate was observed in Japan (6.4%) and the highest in Israel (16.1%). The overall gestation-specific rate of IVH grade 3/4 were 25.8%, 18.6%, 9.0%, and 3.8% and composite outcome of grade 3/4 IVH/death rates 52.2%, 33.6%, 15.6%, and 6.7% for the 22-23, 24-25, 26-27, and 28-29 weeks' GA groups, respectively. These inter-network variations were greater at lower GA. In epoch comparisons, almost all networks showed significant decreases in GA specific composite outcome rates, particularly in the 26-27 week' GA group. Japan and Canada demonstrated significant decreases in each GA group while Spain demonstrated significant decreases in each GA group except for 22-23 weeks' gestation. CONCLUSIONS: Rates of grade 3/4 IVH and composite outcome rates varied internationally and have decreased over time. Identification of the driving factors behind variations may allow for opportunities for practice review and improvement. </p>.
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