Neonatology[JOURNAL]
Sun
200 papers
Transfusion Practices in 12 Neonatal Networks: Are We Closer to Adopting a Restrictive Transfusion Approach?
Klinger G, Helenius K, Vento M … +18 more , Kusuda S, Norman M, Procianoy RS, Goswami N, Biran V, Bassler D, Reichman B, Skubisz A, Battin M, Lehtonen L, Lui K, Mori A, Beltempo M, Adams M, San Feliciano L, Isayama T, Shah PS, iNeo Investigators
Neonatology · 2025 · PMID 40435998 · Full text
UNLABELLED: <p>Introduction: Recent evidence suggests a restrictive approach toward blood transfusions for management of preterm infants. Objective was to survey blood transfusion practises in preterm neonates <29 weeks'...
UNLABELLED: <p>Introduction: Recent evidence suggests a restrictive approach toward blood transfusions for management of preterm infants. Objective was to survey blood transfusion practises in preterm neonates <29 weeks' gestation among 12 population-based neonatal networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo). METHODS: An online survey based on 2023 practices was sent to 608 neonatal intensive care units (NICUs): Australia/New Zealand (30), Brazil (20), Canada (32), Finland (5), France (70), Israel (26), Japan (292), Poland (56), Spain (55), Sweden (9), Switzerland (9), and Tuscany, Italy (4). Transfusion thresholds in 4 different scenarios were surveyed: (a) infants invasively ventilated within first 7 postnatal days, (b) infants invasively ventilated after 7 days, (c) stable infants on noninvasive respiratory support, and (d) stable infants requiring no respiratory support. RESULTS: A total of 382 NICUs (63%) responded. Transfusion practices varied within networks and between countries. For invasively ventilated infants, the transfusion threshold during first 7 days after birth was a hematocrit <underline>≤</underline>35% in 79% of NICUs, and at an age ≥8 days, the transfusion threshold was a hematocrit <underline>≤</underline>30% in 68% of NICUs. For stable infants on noninvasive ventilation, the transfusion threshold was a hematocrit <underline>≤</underline>30% in 80%, and in those without respiratory support, the transfusion threshold was a hematocrit of <underline>≤</underline>25% in 68% of NICUs. CONCLUSIONS: Variations exist in blood transfusion practises between countries and within networks. A restrictive transfusion approach based on recent recommendations has been adopted by more than two-thirds of NICUs. Additional research is needed to evaluate whether practices align with intentions and how they impact outcomes. </p>.
Intermittent Hypoxemia and Neurodevelopmental Impairment at 12 and 24 Months in Preterm Infants.
Di Fiore JM, Wilson-Costello D, Chen Z … +3 more , Minich NM, Martin RJ, Hibbs AM
Neonatology · 2025 · PMID 40418912 · Full text
INTRODUCTION: Neonatal studies have shown a relationship between intermittent hypoxemia (IH) and long-term sequelae although definitions of IH have varied. Employing multiple thresholds of IH and a wider gestational aged...
INTRODUCTION: Neonatal studies have shown a relationship between intermittent hypoxemia (IH) and long-term sequelae although definitions of IH have varied. Employing multiple thresholds of IH and a wider gestational aged cohort of preterm infants, we hypothesized that increased IH exposure during the first month of life was associated with neurodevelopmental impairment (NDI) at 12 and 24 months corrected age. METHODS: IH (<80% or <90%) were documented from day of life 8 to 28 (n = 175 infants <31 weeks gestation). Referral for NDI was identified (Ages and Stages Questionnaire, ASQ-3) at 12- and 24-month corrected age (>2 SD below the mean for gross motor, communication, fine motor, problem solving, and/or personal-social skills). RESULTS: Unadjusted models revealed a significant association between increased IH and scores in referral range for gross motor, and communication skills (12 months) and gross motor, communication, fine motor, problem solving, and personal-social skills (24 months). In adjusted models, a greater % time <90% and referral scores for communication skills (p = 0.0158) at 12 months remained significant. Subgroup analyses revealed an association between greater % time <80% (12 months, p = 0.0311) and longer IH duration <90% (24 months, p = 0.0374) and scores in referral range for any domain in infants ≥29 weeks gestation. CONCLUSION: There was a limited relationship between IH and ASQ-3 scores in referral range for NDI with an association between IH and ASQ-3 referral at 12 and 24 months in infants ≥29 weeks gestation suggesting IH may be a risk factor for NDI in older infants with less competing morbidities.
Non-Invasive Intermittent Positive Pressure Ventilation: Addressing the "Achilles Heel" of Systematic Reviews on Non-Invasive Ventilation in Premature Infants - An Argument for More Contemporaneous, Well-Conducted Trials.
Farley H, Ojha S, Roehr CC
Neonatology · 2025 · PMID 40414216 · Full text
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Accuracy and Safety of a Continuous Noninvasive Blood Pressure Monitor in Neonates.
Hunter RB, Saruwatari MS, Bliss ND … +8 more , Kim S, Turcu R, Krbec BA, Yusuf K, Rao A, Quan X, Soghier L, Boppli Research Group
Neonatology · 2025 · PMID 40388896 · Full text
INTRODUCTION: Accurate and continuous blood pressure (BP) monitoring in neonates is crucial in the intensive care unit. Invasive arterial lines (IALs), oscillometric cuffs, and current noninvasive continuous BP monitorin...
INTRODUCTION: Accurate and continuous blood pressure (BP) monitoring in neonates is crucial in the intensive care unit. Invasive arterial lines (IALs), oscillometric cuffs, and current noninvasive continuous BP monitoring devices have significant limitations. The Boppli® device is a novel, continuous, noninvasive BP device that requires no calibration, designed for neonates. METHODS: This prospective, multicenter study evaluated the performance, usability, and safety of the Boppli device in neonates <5 kg. We compared mean arterial pressure (MAP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) measurements from the Boppli with IAL reference values by calculating average values of mean average error (MAE) and standard deviation (SD) for each patient, then averaging those means. Safety and usability were evaluated by analysis of adverse events and survey data, respectively. RESULTS: The Boppli device demonstrated good performance, meeting the FDA requirements of MAE and SD of the entire cohort: MAE (SD) 0.7 (5.3) mm Hg for MAP, -0.8 (7.7) mm Hg for SBP, and 1.4 (4.7) mm Hg for DBP. Patients with elevated MAPs, Asian ethnicity, and lower extremity IALs were the subgroups with MAE >±5 mm Hg. Various subgroups had SDs >8 mm Hg attributed to low sample sizes. The device received high usability scores from clinicians and parents. No serious adverse events were reported. CONCLUSION: The Boppli device is a promising alternative for continuous noninvasive BP monitoring in neonates, offering good accuracy and usability. The device, which received 510(k) clearance in September 2023, was well received by clinicians and parents, with a low-risk profile.
Association between Pneumothorax and Neonatal Outcomes among Very Preterm Infants: A Multicenter Cohort Study.
Sun M, Jiang H, Zhao L … +8 more , Cao Y, Yuan L, Hu L, Lee SK, Du L, Yang J, Li X, Chinese Neonatal Network (CHNN)
Neonatology · 2025 · PMID 40383120 · Publisher ↗
INTRODUCTION: We aimed to evaluate whether the incidence of pneumothorax is associated with adverse neonatal outcomes in very preterm infants. METHODS: This multicenter cohort study included all infants with a gestationa...
INTRODUCTION: We aimed to evaluate whether the incidence of pneumothorax is associated with adverse neonatal outcomes in very preterm infants. METHODS: This multicenter cohort study included all infants with a gestational age of 24-31 weeks, admitted to the tertiary neonatal intensive care units of the Chinese Neonatal Network, from 2019 to 2022. Pneumothorax was diagnosed via chest X-ray or lung computed tomography. The primary outcome was a composite measure of mortality and/or any severe neonatal morbidity. Multivariable logistic or linear regression analyses were performed to assess the association between pneumothorax and neonatal outcomes. Propensity score matching was used to ensure the robustness of the results. RESULTS: Among the 37,917 infants in the study, 465 (1.2%) developed pneumothorax. Pneumothorax was significantly associated with a higher risk of mortality and/or severe neonatal morbidity (adjusted odds ratio = 3.15, 95% confidence interval: 2.36, 4.20). Pneumothorax exposure was also independently associated with increased mortality, severe intraventricular hemorrhage, moderate or severe bronchopulmonary dysplasia, and the need for invasive ventilation and its duration. Additionally, pneumothorax was associated with an increased length of hospital stay among survivors (adjusted odds ratio = 7.62, 95% confidence interval: 4.33, 10.91). The usage of high-frequency invasive mechanical ventilation before pneumothorax and pneumothorax treated with an intercostal chest drain seemed to have the most significant harmful effect (adjusted odds ratios were 3.34 and 3.27, respectively). CONCLUSION: Our study underscores the significant impact of pneumothorax on increasing mortality and severe morbidities in very preterm infants.
POCUS for Vascular Access in Neonatology Is Here to Stay.
Alonso-Ojembarrena A, Oulego-Erroz I
Neonatology · 2025 · PMID 40383111 · Publisher ↗
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Association of Two Neonatal Encephalopathy Scores with Neurophysiology in Newborns with Suspected Hypoxic-Ischemic Encephalopathy.
Herzberg EM, Bates SV, Boulanger J … +15 more , Culic I, El-Dib M, El-Shibiny H, Gupta M, Hansen A, Inder T, Joung KE, Keohane C, Landers JR, Patrizi S, Sansevere A, Walsh BH, Zhang B, Soul JS, CRICO Neonatal Encephalopathy Registry
Neonatology · 2025 · PMID 40349687 · Publisher ↗
INTRODUCTION: Severity of hypoxic-ischemic encephalopathy (HIE) is traditionally assessed by neurologic exam; however, electroencephalography (EEG) is a more standardized, reproducible measure of neonatal encephalopathy...
INTRODUCTION: Severity of hypoxic-ischemic encephalopathy (HIE) is traditionally assessed by neurologic exam; however, electroencephalography (EEG) is a more standardized, reproducible measure of neonatal encephalopathy (NE). We aimed to compare two numeric NE scores with neurophysiological measures of encephalopathy, to describe EEG patterns in newborns with low NE scores, and to assess evolution of NE scores within 6 h after birth. METHODS: We retrospectively analyzed associations between two NE scores, amplitude-integrated EEG (aEEG), and conventional-video EEG (cEEG) in 321 newborns in a 14-center collaborative NE Registry. RESULTS: There was a significant association between both NE scores and aEEG/cEEG (p < 0.001), with higher scores in newborns with more abnormal aEEG background patterns. A minority of newborns with low NE scores (<4) had abnormal aEEG/cEEG, but all were treated with therapeutic hypothermia (TH). Most newborns with serial NE scores (74%) had evolution of encephalopathy; more newborns had decreasing/improving (48%) than increasing/worsening (26%) NE scores. Newborns with improving versus worsening scores were more likely to have a first NE score completed before 1 h after birth. CONCLUSION: Both NE scores showed a significant correlation with neurophysiology, but NE scores have limitations. Since HIE evolves in most newborns, serial NE exams are recommended with the initial or at least confirmatory NE exam completed at >1 h of age. aEEG/cEEG may be particularly useful for identifying more substantial NE warranting TH treatment in newborns with mild NE by exam. Data from this study support standardized use of neurophysiology in evaluating asphyxiated, encephalopathic newborns.
Medical Needs of Very-Low-Birth-Weight Preterm Infants Post-Discharge: A Population-Based Study in Taiwan.
Jim WT, Chang JH, Chen CH … +6 more , Peng CC, Lin CY, Chang HY, Hsu CH, Jim WT, for Taiwan Premature Infant Follow-up Network
Neonatology · 2025 · PMID 40334647 · Full text
UNLABELLED: <p>Introduction: The aim of this study was to explore the outcomes, home use of medical assistive devices, and interdisciplinary medical needs of very-low-birth-weight (VLBW) infants at a corrected age of 2 y...
UNLABELLED: <p>Introduction: The aim of this study was to explore the outcomes, home use of medical assistive devices, and interdisciplinary medical needs of very-low-birth-weight (VLBW) infants at a corrected age of 2 years. METHODS: Analyses were performed using perinatal, neonatal, and 2-year follow-up data from VLBW infants registered in the Taiwan Premature Infant Follow-up Network (TPFN) between 2011 and 2017. Basic information, survival, and disease conditions during hospitalization were recorded. Medical needs at discharge, outcomes at a corrected age of 2 years, active involvement in outpatient healthcare services, and referrals were investigated. RESULTS: From 2011 to 2017, a total of 9,243 VLBW preterm neonates were enrolled in the TPFN. Of these neonates, 140 had severe congenital anomalies, 8,044 survived to discharge, and 6,150 returned for follow-up evaluation. At discharge, 10.2% of infants received home oxygen therapy (HOT), and 6.5% used home monitoring devices. Among the infants diagnosed with chronic lung disease, 26.6% received HOT. At a corrected age of 2 years, the most common interventions and recommended referrals were rehabilitative treatments (34.5%), followed by early intervention system services (16.5%), ophthalmology/otolaryngology management (4.4%), neurological follow-up (4.1%), and mental health assessment and treatment (2.5%). CONCLUSION: After hospital discharge, VLBW preterm infants exhibit substantial healthcare needs, with significant demands of HOT, rehabilitation, and early intervention services by a corrected age of 2 years. These findings highlight the importance of coordinated outpatient care and long-term follow-up to address the developmental and medical challenges faced by this vulnerable population. </p>.
Dexmedetomidine as a Promising Neuroprotective Sedoanalgesic in Neonatal Therapeutic Hypothermia: A Systematic Review and Meta-Analysis.
Cocchi E, Shabani J, Aceti A … +3 more , Ancora G, Corvaglia L, Marchetti F
Neonatology · 2025 · PMID 40319876 · Publisher ↗
INTRODUCTION: Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal mortality and neurodevelopmental disabilities. Therapeutic hypothermia (TH) is the standard of care, but optimized sedoanalgesic strategi...
INTRODUCTION: Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal mortality and neurodevelopmental disabilities. Therapeutic hypothermia (TH) is the standard of care, but optimized sedoanalgesic strategies remain critical. Dexmedetomidine shows promise as an alternative to traditional sedatives, but its role in this context remains systematically under-explored. This meta-analysis aimed to address this gap by assessing the safety and efficacy of dexmedetomidine in neonates undergoing TH for HIE. METHODS: A systematic search of Medline, Scopus, Embase, WOS, ClinicalTrials, and Cochrane Library identified studies published from January 2014 to October 2024. Studies focusing on dexmedetomidine in neonatal TH with relevant outcomes were included. Selection followed PRISMA guidelines, with independent quality assessments. The protocol was registered in PROSPERO (CRD42024605817). Results are presented as meta-analyses or evidence-based discussions when pooling was unfeasible. RESULTS: Seven studies involving 609 neonates were included: four cohort studies (n = 486) and three case series (n = 123). Dexmedetomidine provided comparable sedation to traditional agents (MD = -0.01 [-0.68 to 0.66], p = 0.99) and significantly reduced seizure risk (OR: 0.31 [0.10 to 0.98], p < 0.05) with a non-inferior safety profile. Trends suggested shorter duration of mechanical ventilation and time to full enteral feeding. Substantial heterogeneity in dosing protocols highlights the need for standardization. CONCLUSIONS: Dexmedetomidine appears to be a safe and promising sedative in neonatal TH for HIE, with potential neuroprotective, respiratory, and gastrointestinal benefits. Despite limited evidence and the absence of randomized clinical trials, its non-inferior efficacy and safety warrant further exploration and urge the development of standardized dosing protocols.
Comparing Malposition and Complications Associated with Ultrasound-Guided versus Radiography-Guided Central Catheter Tip-Position in Neonates: A Systematic Review and Meta-Analysis.
Mohamed A, Mohamed A, Mohsen N … +3 more , Solis-Garcia G, Nasef N, Shah P
Neonatology · 2025 · PMID 40203814 · Full text
UNLABELLED: <p>Introduction: There is a growing interest in ultrasound-guided central catheter (CC) tip-position, driven by its potential to improve accuracy and reduce complications. We aimed to systematically review an...
UNLABELLED: <p>Introduction: There is a growing interest in ultrasound-guided central catheter (CC) tip-position, driven by its potential to improve accuracy and reduce complications. We aimed to systematically review and meta-analyze studies that reported complications associated with ultrasound-guided versus radiography-guided CC tip-position in neonates. METHODS: We searched Medline, Cochrane, Embase, CINAHL, and <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">clinicaltrials.gov</ext-link> for randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) comparing the complications of ultrasound- versus X-ray-guided CC tip-position in neonates up to June 2024. RCTs and NRSs were analyzed separately. The outcomes included malposition, number of X-rays, procedure time, catheter manipulation, cardiac tamponade, extravasation, occlusion, and sepsis rates. Subgroup meta-analysis based on catheter type was performed. Statistical analyses were conducted using Review Manager 5.4.1 and R 4.1.0, and the GRADE methodology was applied to assess evidence certainty. RESULTS: Eight studies (4 RCTs and 4 NRSs, N = 1,322 neonates) were included. Ultrasound-guided catheter tip-position significantly reduced malposition rates (3 RCTs, N = 181, RR: 0.51, 95% CI: 0.37 to 0.70; 4 NRSs, N = 1,110, RR: 0.25, 95% CI: 0.11 to 0.57) and decreased the need for X-rays (2 RCTs, N = 112, MD: -1.22, 95% CI: -2.32 to -0.11; 2 NRSs, N = 401, MD: -0.31, 95% CI: -0.47 to -0.15). No significant differences were found in procedure time, catheter manipulation, or sepsis rates. All evidence was of low certainty per grade. CONCLUSIONS: The use of ultrasound-guided CC tip-position in neonates is associated with a reduction in malposition rates and radiation exposure (low certainty evidence). Further research is needed to confirm the benefits of ultrasound-guided CC tip-position in neonates. </p>.
Early Postnatal Weight Loss: Is It a Problem?
Hay WW
Neonatology · 2025 · PMID 40159412 · Publisher ↗
Abstract loading — click title to view on PubMed.
Investigating the Mechanisms of Reduced Blood Transfusions after Delayed Umbilical Cord Clamping: The TITANS Causal Mediation Analysis.
Libesman S, Seidler AL, Tan-Koay AG … +9 more , Cunningham PS, Robledo K, Cruise S, Wadsworth M, Kluckow M, Gill AW, de Waal K, Tarnow-Mordi W, Liley HG
Neonatology · 2025 · PMID 40159334 · Full text
INTRODUCTION: Delaying clamping of the umbilical cord (deferred cord clamping [DCC]) in preterm infants reduces mortality and the need for blood transfusions. The mechanisms leading to these benefits are not well underst...
INTRODUCTION: Delaying clamping of the umbilical cord (deferred cord clamping [DCC]) in preterm infants reduces mortality and the need for blood transfusions. The mechanisms leading to these benefits are not well understood. The TITANS study investigates potential mediators of the reduction in blood transfusions in infants who received DCC. MATERIALS AND METHODS: Additional patient data was sourced from Australian and New Zealand sites from the Australian Placental Transfusion Study (APTS). APTS randomized preterm infants <30 weeks' gestation to receive DCC (60 s) or immediate cord clamping. We examined whether placental transfusion or initial severity of illness mediated the reduced requirement for blood transfusions for infants randomized to DCC. Peak hematocrit in the first 7 days (Hct) was used as an indicator of placental transfusion quantity. Cumulative blood sampled, mechanical ventilation, and arterial sampling lines were used as indicators of severity of illness. We quantified the natural indirect effect of peak Hct and then for all mediators in a joint model with sequential mediation. RESULTS: Data from 1,260 (of 1,401) Australian and New Zealand APTS infants were obtained. The effect of DCC on subsequent blood transfusion was mediated through peak Hct (indirect effect OR = 0.85, 95% CI: 0.79-0.93; p < 0.001), which accounted for 37% of the total effect. Indicators of severity of illness did not mediate the effect independently of peak Hct. CONCLUSION: Peak Hct mediated some, but not all, of the effect of DCC on blood transfusion, whereas markers of severity of illness were not independent mediators.
Changes in Fetal Hemoglobin Associated with Erythrocyte Transfusions Are Clinically Relevant in SpO2 Targeting: A Retrospective Cohort Observational Study.
Bachman TE, Nguyen TA, Tejkl L … +1 more , Plavka R
Neonatology · 2025 · PMID 40159229 · Publisher ↗
INTRODUCTION: There is a broad awareness of shifts in the oxygen hemoglobin dissociation (ODC) relationship associated with fetal hemoglobin (HbF) changes. However, quantification of the shift has been limited. Aim was t...
INTRODUCTION: There is a broad awareness of shifts in the oxygen hemoglobin dissociation (ODC) relationship associated with fetal hemoglobin (HbF) changes. However, quantification of the shift has been limited. Aim was to quantify the shift of partial oxygen tension (PO2) associated with HbF and with changes after transfusion of adult erythrocytes (TAE) in preterm infants. METHODS: This is a single-center, retrospective observational analysis of blood gas samples. The shifts of ODC and PO2 related to HbF were evaluated in two models. Either HbF or TAE status (0, 1, ≥2) were used as the independent variable. Multivariate analysis was used to correct for confounding effects (gestational age, postnatal age, source of blood gas sample as well as pH, SO2, and PCO2). RESULTS: There were 3,452 blood gas observations analyzed from 2,464 infants whose median gestational age was 334 weeksdays (IQR 296-363). With SpO2 between 90 and 95%, the ODC was shifted to the left (13 mm Hg, 1.3 kPa). After adjusting for confounding variables, the number of TAEs (0, 1, ≥2), was highly significantly related to a shift (p < 0.001), consistent with the percent HbF level (p < 0.001). Based on the multivariate model (i.e., holding confounding parameters constant), with a SpO2 of 92% the PaO2 could be expected to shift markedly higher with 2 or more TAEs in an extremely preterm infant (7.3 mm Hg, 0.97 kPa). CONCLUSION: While preliminary, these data suggest that in vulnerable preterm infants a change to a slightly lower SpO2 target range following TAE could maintain equivalent PaO2 exposure.
MicroRNA Signatures in Umbilical Cord Blood of Neonates Exposed to Maternal SARS-CoV-2 Infection during Pregnancy.
Winkler I, Fröschl C, Hochmayr C … +5 more , Huber E, Urbanek M, Kiechl-Kohlendorfer U, Griesmaier E, Posod A
Neonatology · 2025 · PMID 40090320 · Publisher ↗
INTRODUCTION: Pregnant women are particularly susceptible to SARS-CoV-2 infection, which can provoke placental inflammation, potentially causing malperfusion and adverse pregnancy outcomes. The fetal immune system may re...
INTRODUCTION: Pregnant women are particularly susceptible to SARS-CoV-2 infection, which can provoke placental inflammation, potentially causing malperfusion and adverse pregnancy outcomes. The fetal immune system may respond to maternal infection, even without direct viral transmission. However, the molecular mechanisms driving these responses are not well understood. This study aimed to examine changes in microRNA (miRNA) expression in umbilical cord blood from neonates of mothers infected with SARS-CoV-2 during pregnancy. METHODS: We conducted a retrospective analysis of prospectively enrolled subjects at Innsbruck University Hospital, Austria. Umbilical cord blood was collected from 58 neonates of mothers infected with SARS-CoV-2 during pregnancy (either antepartum or peripartum) born in 2020-2023 and compared with 41 healthy controls born in 2017-2018. Total RNA was extracted, followed by miRNA next-generation sequencing and differential gene expression analysis. Ingenuity pathway analysis (IPA) was used to explore potential miRNA-target interactions. RESULTS: Differential gene expression analysis identified 14 upregulated and 36 downregulated miRNAs in the cord blood of neonates from SARS-CoV-2-infected mothers compared to controls. IPA revealed enrichment in inflammatory pathways, particularly involving cytokines such as interleukin (IL)-6 and IL-10. No significant differences in miRNA expression were observed between neonates exposed antepartum versus peripartum. CONCLUSION: Maternal SARS-CoV-2 infection during pregnancy is linked to altered miRNA expression in neonates' umbilical cord blood, potentially influencing inflammatory pathways. These findings shed light on the molecular mechanisms of fetal responses to maternal SARS-CoV-2 infection.
Feeding Dynamics in Very Preterm Infants with Delayed Oral Feeding Attainment.
Gentle SJ, Shukla VV, Cooley A … +4 more , Ambalavanan N, Carlo WA, Taylor SN, Salas AA
Neonatology · 2025 · PMID 40090316 · Publisher ↗
INTRODUCTION: We aimed to characterize features that can accurately identify preterm infants at risk of delay in oral feeding attainment. METHODS: A prospective observational study of infants born between 250/7 and 326/7...
INTRODUCTION: We aimed to characterize features that can accurately identify preterm infants at risk of delay in oral feeding attainment. METHODS: A prospective observational study of infants born between 250/7 and 326/7 weeks' gestation. Early independent oral feed attainment (EPO) was defined as independent oral feeding within 35 days of initiation and late attainment (LPO) defined at or after 35 days following initiation. Candidate characteristics of comparison included feeding interventions and reasons for feeding discontinuation. RESULTS: Of the 257 infants included, 162 infants achieved EPO. Over the first week of oral feeding, LPO infants received fewer feeding interventions (e.g., side lying position, pacing, and re-alertment) and were fed less frequently (2 vs. 3 times per day; p < 0.001). CONCLUSIONS: Compared to infants with EPO, infants with LPO differ in employed feeding strategies. These findings could guide resource allocation and facilitate the provision of individualized care.
Deep-Learning-Based Multi-Class Classification for Neonatal Respiratory Diseases on Chest Radiographs in Neonatal Intensive Care Units.
Cho HW, Jung S, Park KH … +7 more , Choi JW, Heo JS, Kim J, Yun H, Yu D, Son J, Choi BM
Neonatology · 2025 · PMID 40049153 · Publisher ↗
INTRODUCTION: Accurate and timely interpretation of chest radiographs is essential for assessing respiratory distress and guiding clinical management to improve outcomes of critically ill newborns. This study aimed to in...
INTRODUCTION: Accurate and timely interpretation of chest radiographs is essential for assessing respiratory distress and guiding clinical management to improve outcomes of critically ill newborns. This study aimed to introduce a deep-learning-based automated algorithm designed to classify various neonatal respiratory diseases and healthy lungs using a large dataset of high-quality, multi-class labeled chest X-ray images from neonatal intensive care units. METHODS: Portable supine chest X-ray images for six common conditions (healthy lung, respiratory distress syndrome [RDS], transient tachypnea of the newborn [TTN], air leak syndrome [ALS], atelectasis, and bronchopulmonary dysplasia [BPD]) and demographic variables (gestational age and birth weight) were retrospectively collected from 10 university hospitals in Korea. Ground truth for manual classification of these conditions was generated by 20 neonatologists and validated by others from different hospitals. The dataset, consisting 34,598 for training, 4,370 for validation, and 4,370 for testing, was used to train a modified ResNet50-based deep-learning model for automatic classification. RESULTS: The automatic classification algorithm showed high concordance with human-annotated classifications, achieving an overall testing accuracy of 83.96% and an F1 score of 83.68%. The F1 score for each condition was 87.38% for "healthy lung" and 92.19% for "BPD," 90.65% for "ALS," 90.30% for "RDS," 86.56% for "atelectasis," and 70.84% for "TTN." CONCLUSION: We introduced a deep-learning-based automated algorithm to classify neonatal respiratory diseases using a large dataset of high-quality, multi-class labeled chest X-ray images, incorporating non-imaging data, which could support neonatologists in making timely and accurate decisions for critically ill newborns.
Early Postnatal Weight Loss and Its Association with Outcomes in Very Preterm Neonates: A Systematic Review and Meta-Analysis.
Kothapally S, Rath C, Gowda BB … +3 more , Sharma J, Patole SK, Rao S
Neonatology · 2025 · PMID 40049150 · Full text
INTRODUCTION: Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants are not well known. This review explored the association between early PWL and outcomes in very pr...
INTRODUCTION: Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants are not well known. This review explored the association between early PWL and outcomes in very premature infants (<32 weeks). METHODS: This is a systematic review and meta-analyses of the observational studies. PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar databases were searched in April 2024. Outcomes of interest were mortality and morbidities such as intraventricular haemorrhage (IVH), chronic lung disease (CLD), patent ductus arteriosus, necrotising enterocolitis (NEC), retinopathy of prematurity, and long-term neurodevelopmental outcomes. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Separate analyses were conducted for case-control and cohort studies. Data were pooled separately for the excess weight loss (EWL) group (>15% from birth weight) and inadequate weight loss (IWL) group (<5% from birth weight). RESULTS: Eighteen studies (25,158 infants) were included. Pooling of adjusted ORs in EWL group from cohort studies found significant association with mortality (OR 1.39 confidence interval [CI; 1.10-1.75]), severe IVH (OR 1.37 CI [1.18-1.59]), NEC (OR 2.05 CI [1.05-4.03]), and "Mortality or IVH" (OR 1.40 CI [1.10-1.78]). Pooling adjusted ORs from case-control studies showed a significant association between EWL and CLD and between IWL and mortality or CLD. Certainty of evidence was "Low" or "Very-low." CONCLUSION: EWL or IWL in very preterm infants may be associated with higher odds of mortality and morbidity. However, cofactors of severity of associated disease, insufficient nutrition, and treatments could not be assessed.
Electrical Impedance Tomography during the Extubation Phase in Very Preterm Born Infants.
Wisse JJ, Goos TG, Gommers D … +4 more , Endeman H, Kroon AA, Reiss IKM, Jonkman AH
Neonatology · 2025 · PMID 40031894 · Full text
INTRODUCTION: Although many preterm born infants require invasive mechanical ventilation, it is also associated with detrimental effects. Early extubation should be pursued, but extubation failure is yet common. The crit...
INTRODUCTION: Although many preterm born infants require invasive mechanical ventilation, it is also associated with detrimental effects. Early extubation should be pursued, but extubation failure is yet common. The critical transition to noninvasive ventilation is characterized by respiratory physiological changes, warranting noninvasive monitoring. We aimed to determine whether electrical impedance tomography (EIT) could provide insights into the respiratory mechanics of neonates around extubation, and if findings were different between successful and failed extubation. METHODS: Single-center observational study where EIT and transcutaneous CO2 measurements were performed in preterm born infants <32 weeks gestational age. Measurements were performed from 24 h before up to 48 h after extubation. EIT parameters extracted from the hour before and after extubation were analyzed to evaluate the short-term physiological changes. RESULTS: Twenty-one patients were included and 6 (29%) were reintubated. End-expiratory lung impedance and tidal impedance variation were stable around extubation (p = 0.86 and p = 0.47, respectively). Compared to successfully extubated patients, reintubated patients showed more lung inhomogeneity (GI index) after extubation (0.75 vs. 0.84, p = 0.03). The percentage of nondependent silent spaces decreased after extubation in successfully extubated patients (p < 0.001). Body position and ventilator mode influenced these findings. CONCLUSION: EIT measurements in preterm neonates provide valuable insight into the respiratory physiology during the transition from invasive to noninvasive ventilation, with significant differences in ventilation distribution and lung homogeneity between successfully extubated and reintubated patients. EIT has the potential to guide personalized respiratory support by assessing ventilation distribution and quantifying inhomogeneity, aiding in the optimization of ventilation settings.
Inhaled Nitric Oxide for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Systematic Review and Narrative Synthesis.
Kitaoka H, Kobayashi R, Tanaka K … +2 more , Watanabe M, Isayama T
Neonatology · 2025 · PMID 40031892 · Full text
INTRODUCTION: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. However, its effectiveness in the treatment of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) and severe BPD remains u...
INTRODUCTION: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. However, its effectiveness in the treatment of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) and severe BPD remains uncertain. Here we systematically reviewed whether iNO treatment increased or decreased mortality and morbidity among preterm infants with severe BPD or BPD-PH. METHODS: We systematically searched the Ovid MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, and ICHUSHI databases for randomized and non-randomized studies that compared the effects of iNO in patients with severe BPD or BPD-PH. The primary outcome was mortality. Two authors independently screened the articles and extracted the data. A meta-analysis and certainty of evidence assessment using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation criteria were planned. RESULTS: Among the 1,710 articles, none had a relevant control group and no studies met the eligibility criteria. Using a post hoc analysis, we summarized the ineligible studies that evaluated patients with severe BPD or BPD-PH who received iNO therapy. Although some studies included in the narrative review indicated a decreased pulmonary arterial pressure in patients with severe BPD or BPD-PH at the initiation of iNO therapy, none included a comparator group. CONCLUSION: Despite the use of iNO in patients with severe BPD and BPD-PH, no published studies compared the outcomes among patients with BPD treated with versus without iNO. Although some studies without comparator groups reported the effectiveness of iNO in patients with severe BPD and BPD-PH, our results suggest that iNO therapy should be initiated with caution and careful consideration of the target population.
ChatGPT-4o in Risk-of-Bias Assessments in Neonatology: A Validity Analysis.
Kuitunen I, Nyrhi L, De Luca D
Neonatology · 2025 · PMID 39999815 · Full text
INTRODUCTION: Only a few studies have addressed the potential of large language models (LLMs) in risk-of-bias assessments and the results have been varying. The aim of this study was to analyze how well ChatGPT performs...
INTRODUCTION: Only a few studies have addressed the potential of large language models (LLMs) in risk-of-bias assessments and the results have been varying. The aim of this study was to analyze how well ChatGPT performs in risk-of-bias assessments of neonatal studies. METHODS: We searched all Cochrane neonatal intervention reviews published in 2024 and extracted all risk-of-bias assessments. Then the full reports were retrieved and uploaded alongside the guidance to perform a Cochrane original risk-of-bias analysis in ChatGPT-4o. The concordance between the original assessment and that provided by ChatGPT-4o was evaluated by inter-class correlation coefficients and Cohen's kappa statistics (with 95% confidence intervals) for each risk-of-bias domain and for the overall assessment. RESULTS: From 9 reviews, a total of 61 randomized studies were analyzed. A total of 427 judgments were compared. The overall κ was 0.43 (95% CI: 0.35-0.51) and the overall intraclass correlation coefficient was 0.65 (95% CI: 0.59-0.70). The Cohen's κ was assessed for each domain and the best agreement was observed in the allocation concealment (κ = 0.73, 95% CI: 0.55-0.90), whereas the poorest agreement was found in incomplete outcome data (κ = -0.03, 95% CI: -0.07-0.02). CONCLUSION: ChatGPT-4o failed to achieve sufficient agreement in the risk-of-bias assessments. Future studies should examine whether the performance of other LLM would be better or whether the agreement in ChatGPT-4o could be further enhanced by better prompting. Currently, the use of ChatGPT-4o in risk-of-bias assessments should not be promoted.
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