Semin Perinatol
· 2026 Mar · PMID 41033904
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Gastroesophageal reflux disease (GERD) is common in neonates, and a wide variety of symptoms have been attributed to reflux in this age group, including regurgitation, fussiness, and respiratory symptoms. Though the natu...Gastroesophageal reflux disease (GERD) is common in neonates, and a wide variety of symptoms have been attributed to reflux in this age group, including regurgitation, fussiness, and respiratory symptoms. Though the natural history of GERD is one of resolution in most infants, treatment may be needed when symptoms are particularly bothersome or associated with concerning medical complications. An array of management options exists for neonatal GERD, including both medical and surgical treatments. The goal of this review is to present an overview of nonpharmacologic, pharmacologic, and surgical GERD treatments and to review the available evidence on these treatments with a focus on research completed in the neonatal population.
In this era of rapid digital transformation, media has become an essential tool for education, communication, collaboration, and advocacy in neonatal-perinatal care. This article explores the evolving media ecosystem wit...In this era of rapid digital transformation, media has become an essential tool for education, communication, collaboration, and advocacy in neonatal-perinatal care. This article explores the evolving media ecosystem within the neonatal intensive care unit (NICU), highlighting how healthcare professionals are using traditional media, video content, blogs, podcasts, and social media to connect with one another, share the latest research, educate peers and families, improve clinical practice, and amplify public health messaging. Drawing on diverse examples and expert commentary, the authors argue that strategic engagement in media enhances family-centered care, bridges the gap between research and bedside application, and fosters a connected, informed, and empowered neonatal community. The article presents a framework for assessing media engagement and invites clinicians to consider how media integration can shape their professional identity and expand their impact beyond their units.
Bronchopulmonary dysplasia (BPD) is among the most common and serious complications of prematurity. The pathobiology of BPD and BPD associated pulmonary arterial hypertension (BPD-PH) is multifactorial and not yet fully...Bronchopulmonary dysplasia (BPD) is among the most common and serious complications of prematurity. The pathobiology of BPD and BPD associated pulmonary arterial hypertension (BPD-PH) is multifactorial and not yet fully defined. Gastroesophageal reflux (GER), a physiologic process that occurs in most preterm infants and is typically benign, has been proposed as a potential contributor to the development or worsening of BPD and BPD-PH. Infants who develop BPD compared to those who do not are more frequently diagnosed with symptomatic GER and undergo therapeutic interventions to treat GER. However, current evidence does not support a direct causal relationship between GER and the onset or progression of BPD or BPD-PH in preterm infants. While GER may contribute to respiratory morbidity in individual cases, population-level data do not implicate it as a major driver of BPD pathogenesis. Moreover, the limited available data from clinical trials and observational studies does not consistently demonstrate improved outcomes in patients with BPD who are treated for GER. This narrative review summarizes the current literature evaluating the relationship between GER, BPD, and BPD-PH.
Despite widespread use, electronic fetal monitoring (EFM) has not demonstrably reduced perinatal morbidity or mortality, and likely contributed to the rise in cesarean delivery. To improve its utility, a number of adjunc...Despite widespread use, electronic fetal monitoring (EFM) has not demonstrably reduced perinatal morbidity or mortality, and likely contributed to the rise in cesarean delivery. To improve its utility, a number of adjunctive approaches have been introduced over the past three decades, including fetal pulse oximetry, ST segment analysis (STAN), and maternal oxygen supplementation. Each intervention was supported by strong physiologic rationale, yet none achieved widespread clinical adoption due to inconsistent evidence of benefit and, in some cases, potential harm. This review critically evaluates landmark studies on EFM adjuncts, highlights the limitations that have impeded progress, and outlines emerging innovations, including artificial intelligence and multimodal surveillance. The persistent challenges in intrapartum fetal assessment underscore the need for high-quality evidence, rigorous implementation strategies, and a patient-centered reframing of EFM goals.
Neonatal follow-up programs are critical in monitoring the long-term outcomes of infants born preterm. The current focus is on neurodevelopmental impairment (NDI). However, such deficit-based outcomes often exclude paren...Neonatal follow-up programs are critical in monitoring the long-term outcomes of infants born preterm. The current focus is on neurodevelopmental impairment (NDI). However, such deficit-based outcomes often exclude parental perspectives, failing to capture what matters the most to families: function and quality of life over diagnoses. This paper explores the integration of new family-important outcomes (FIO) measures into neonatal follow-up using patient-reported outcome measures. FIO measures are patient-completed questionnaires that assess a range of health outcomes such as health status, functional ability, and quality of life. We discuss the importance and ethical imperative of integrating FIO measures into neonatal follow-up programs to better align care with family priorities and challenges in bringing practice changes. We propose using an implementation science approach to successfully embed FIO measures into practice and research, enhancing the relevance, equity, and quality of neonatal follow-up care.
Pallotto EK, Peña MM, Bertoni CB
… +3 more, Brozanski BS, Moyer LB, Piazza A
Semin Perinatol
· 2025 Nov · PMID 40998613
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Quality improvement collaborative (QIC) networks have been instrumental in improving care and outcomes across various populations, demonstrating a consistent track record of success, particularly within neonatal intensiv...Quality improvement collaborative (QIC) networks have been instrumental in improving care and outcomes across various populations, demonstrating a consistent track record of success, particularly within neonatal intensive care units on both national and international levels. Successful networks require many structural factors to be in place at both the collaborative and local level. Engagement and investment in QICs promote equitable care by decreasing variation and driving practice improvements. This review provides an overview of the historical context and a successful methodology in neonatology.
Semin Perinatol
· 2025 Nov · PMID 40987618
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Traditional measures of neurodevelopmental outcomes in preterm children are deficit focused and not informed by parent and family perspectives. Parents care less about medical classification of severity of disability and...Traditional measures of neurodevelopmental outcomes in preterm children are deficit focused and not informed by parent and family perspectives. Parents care less about medical classification of severity of disability and more about the child's ability to function and participate. Positive health encompasses a broad and dynamic perspective on health that goes beyond the absence of disease and focuses on physical, mental, and social well-being, life-satisfaction, and goal attainment. Measuring positive health as an outcome in children at high risk of disability is challenging but possible. Further exploration of positive health as an outcome may meet the needs of both families and researchers.
Both apnea and gastroesophageal reflux are nearly universal in premature infants delivered before 32 weeks gestational age. Apnea of prematurity is multifactorial, secondary to immaturity of several different aspects of...Both apnea and gastroesophageal reflux are nearly universal in premature infants delivered before 32 weeks gestational age. Apnea of prematurity is multifactorial, secondary to immaturity of several different aspects of respiratory control. Amongst these is the laryngeal chemoreflex, when stimulated in newborns results in central and obstructive apnea as opposed to a cough reflex in older infants, an observation leading to a hypothesis that reflux and apnea may be linked. The current evidence for a role of reflux as a causative factor for apnea of prematurity is poor despite multiple studies seeking to prove a relationship. The studies have been hampered by poor design, inadequate measurement techniques and differing endpoints as well as heterogeneous patient populations. Whether subsets of premature infants can be identified in whom GER plays a larger role in disorders of respiratory control will require careful identification of specific patient populations to be studied, accurate measurement of acidic and non-acidic reflux events, and strict definitions of cardiorespiratory endpoints.
Stress exposure in the neonatal intensive care unit (NICU) is ubiquitous and affects long-term outcomes for preterm infants. The NICU hospitalization occurs during a critical period of experience-dependent and experience...Stress exposure in the neonatal intensive care unit (NICU) is ubiquitous and affects long-term outcomes for preterm infants. The NICU hospitalization occurs during a critical period of experience-dependent and experience-expectant development when the immature brain is particularly sensitive to environmental exposures, but the experiences of preterm infants are often poorly matched to their neurologic expectations. The mismatch between preterm infants' experiences and neurologic expectations may cause abnormal brain development and programming of the stress response systems. Routine nursing care and parental separation are two neurologically unexpected experiences that, while often overlooked, may be amenable to interventions, including system-level changes. To guide the development and implementation of effective interventions, it is necessary to understand how nurse caregiving practices and parental separation specifically contribute to the preterm infant's stress burden. The purpose of this paper is to provide an overview of the effects of routine nursing care and parental separation, two persistent NICU stressors, and offer recommendations for interventions that nurses and other care providers can use to mitigate the negative effects of these exposures.
The objective of this review is to summarize current knowledge on epilepsies presenting in the neonatal period and to highlight their implications for diagnosis and treatment. While most seizures in newborns are due to a...The objective of this review is to summarize current knowledge on epilepsies presenting in the neonatal period and to highlight their implications for diagnosis and treatment. While most seizures in newborns are due to acute brain injuries, a significant minority are caused by genetic epilepsies, which require distinct clinical management. Advances in genetic testing have clarified the major etiologic categories, including channelopathies, synaptopathies, inborn errors of metabolism, and brain malformations. Bedside clinicians must be alert to a possible genetic epilepsy in a newborn with seizures, as precise diagnosis informs prognosis and directly guides therapy. Sodium channel blockers can improve seizure control in specific channelopathies, vitamin therapies are effective in certain metabolic epilepsies, dietary therapy is transformative in glucose transporter deficiency syndrome, and targeted approaches are emerging for tuberous sclerosis complex. Rapid exome and genome sequencing now enable timely diagnosis in critically ill neonates and support precision treatment. Even with improvements in seizure control, developmental outcomes often remain poor, underscoring the urgent need for disease-modifying therapies. In conclusion, early recognition of epilepsies in the neonatal intensive care unit is essential to optimize care today and to accelerate the development of future targeted treatments.
Barrett R, Lawler B, Liu S
… +7 more, Park WY, Davoodi M, Martin B, Kalyanam SM, Makker K, Kuiper JR, Aziz KB
Semin Perinatol
· 2025 Nov · PMID 40973564
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Significant strides have been made in utilizing data, information, and knowledge to enhance neonatal outcomes. This review examines how data informatics, encompassing electronic health records (EHRs), data standards, and...Significant strides have been made in utilizing data, information, and knowledge to enhance neonatal outcomes. This review examines how data informatics, encompassing electronic health records (EHRs), data standards, and artificial intelligence (AI), has facilitated advancements in neonatal care and research. Vast amounts of data, structured and unstructured, have been produced from clinical care. In turn AI stands to improve patient care, safety, and quality improvement initiatives. Facilitated by AI, clinicians' interaction with neonatal informatic tools is transitioning from reactive to real-time, proactive care. Historically, necrotizing enterocolitis, sepsis, medical imaging, and neonatal mortality have been the targets of AI-integrated neonatal care. While much progress has been made in developing state-of-the-art AI tools, their development and implementation must consider optimization of patient care, clinical workflows, and aim to decrease clinician burnout. Employing a sociotechnical framework to assess both technical and human factors is key to effectively evaluating clinical utility, promoting adoption, and facilitating successful deployment. Beyond technical concerns, ethical considerations such as trust in AI, data security, and model transparency are critical to the responsible deployment of informatics tools. Ongoing advancements in neonatal care coupled with informatics, multi-omics, AI, and federated learning expands the possibilities of personalized care for neonates.
Bronchopulmonary dysplasia (BPD) is the most common morbidity experienced by infants born extremely preterm. With improved survival of extremely preterm infants, rates of BPD have increased and the number of infants with...Bronchopulmonary dysplasia (BPD) is the most common morbidity experienced by infants born extremely preterm. With improved survival of extremely preterm infants, rates of BPD have increased and the number of infants with established BPD being cared for in neonatal intensive care units (NICU) is increasing. To address the complex clinical needs of infants with established BPD, interdisciplinary BPD programs have been developed at level-IV NICUs throughout the United States. Interdisciplinary BPD programs adopt the principles of chronic care models that differ in size, scope, and practices when compared to traditional acute care NICU's clinical programs. The purpose of this review is to summarize the collaborative and innovative features of interdisciplinary BPD clinical care programs.
Semin Perinatol
· 2025 Nov · PMID 40973562
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Neonatal Neurocritical Care (NNCC) is transforming neonatal medicine through a brain-centered approach that reflects the complexity and rapid progression of early neurodevelopment. NNCC provides a comprehensive care mode...Neonatal Neurocritical Care (NNCC) is transforming neonatal medicine through a brain-centered approach that reflects the complexity and rapid progression of early neurodevelopment. NNCC provides a comprehensive care model built on a foundation of real-time neuromonitoring, advanced neuroimaging, and multidisciplinary collaboration to deliver timely neurological support for newborns at risk of injury. This framework has evolved to bridge the full arc of early brain development, linking fetal evaluation, neonatal management, and post-discharge follow-up into a cohesive continuum. Recent technological advances in bedside monitoring, functional neuroimaging, machine learning, and rapid genomics are shifting NNCC toward a more proactive and personalized model of care. Emerging therapies are also expanding the clinical reach of NNCC, opening new frontiers for early intervention and neurorepair. As the field continues to advance, the central goal of NNCC remains to improve neurodevelopmental outcomes while ensuring widespread access to high-quality, family-centered neurological care. This review outlines the evolving landscape of NNCC and highlights its essential role in guiding brain-focused care from the earliest stages of development through childhood and beyond.
Bachinsky E, Guyer L, Patel R
… +5 more, Amoah SK, Ortega D, Robinson S, Helmbrecht H, Jantzie LL
Semin Perinatol
· 2025 Dec · PMID 40947352
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The placenta serves as an essential communicative organ between a mother and fetus throughout gestation. The placenta is critical in the development and maintenance of pregnancy while serving as a hub for immune signalin...The placenta serves as an essential communicative organ between a mother and fetus throughout gestation. The placenta is critical in the development and maintenance of pregnancy while serving as a hub for immune signaling. In the context of an ever-changing microenvironment, the placenta responds dynamically to infection, inflammation, and other potentially harmful exposures. As in chorioamnionitis and preterm birth, a placental inflammatory response can impart harm to the developing fetal brain and facilitate the presentation of perinatal brain injury. Through various functional and structural disruptions, including changes to neural networks and complex neural immune interactions, neurodevelopmental disorders can manifest. In this review, we utilize chorioamnionitis as a platform for understanding immune signaling and inflammatory cell communication along the maternal-placental-fetal axis. We delineate how immune dysfunction changes neurodevelopment and explore cellular and molecular mechanisms associated with adverse clinical outcomes after birth. Together with discussion of unique inflammatory pathophysiology and triggers of perinatal brain injury, we explore avenues for neuroimmunomodulation, novel biomarker discovery, and precision medicine approaches for clinical practice.
We explore how and why early detection of cerebral palsy (CP) should occur in community settings across low and middle income countries (LMICs) and high income countries (HICs). Early diagnosis is best clinical practice...We explore how and why early detection of cerebral palsy (CP) should occur in community settings across low and middle income countries (LMICs) and high income countries (HICs). Early diagnosis is best clinical practice and can happen in the first year of life using evidence-based tools such as the General Movements Assessment (GMA) and the Hammersmith Infant Neurological Examination (HINE). In HICs, primary care surveillance guided by published motor "red flags" can identify children who need prompt referral, yet uptake remains uneven. In LMICs, clinicians demonstrate high diagnostic accuracy when tools are available, but the main barrier is health system reach rather than clinical capability. Across settings, caregiver studies show that delayed diagnosis reduces empowerment, increases mental health burden, and erodes trust in services. The central implementation task is to build reliable pathways that connect families from home to timely diagnosis, aligning community surveillance with referral networks, provider training, and policy support. Strengthening these pathways is essential to improve participation, reduce comorbidity burden, and enhance wellbeing for children with CP and their families.
Prematurity, birth complications, and congenital brain abnormalities can lead to neurological conditions that require intensive monitoring and treatment. Ensuring healthy sleep is needed to help infants recover from thes...Prematurity, birth complications, and congenital brain abnormalities can lead to neurological conditions that require intensive monitoring and treatment. Ensuring healthy sleep is needed to help infants recover from these conditions and positively influence neurodevelopmental outcomes. Yet, achieving optimal sleep represents a challenge in the complex setting of neonatal neurocritical care. In this narrative review, we examine the role of sleep within the context of neonatal neurocritical care. Specifically, we analyze the underlying physiological mechanisms of sleep and how these processes are altered by the intensive care environment and neurological pathology. We evaluate current evidence regarding the contribution of sleep to neurological recovery and its impact on long-term neurodevelopmental outcomes. Finally, we discuss existing and emerging strategies to monitor and optimize sleep in neonatal neurocritical care settings.
Semin Perinatol
· 2025 Nov · PMID 40946007
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In 2022, United States infant mortality increased for the first time in over 20 years, driven largely by deaths due to maternal complications and preterm birth, and highlighted significant racial/ethnic and socioeconomic...In 2022, United States infant mortality increased for the first time in over 20 years, driven largely by deaths due to maternal complications and preterm birth, and highlighted significant racial/ethnic and socioeconomic inequities in both infant mortality and morbidities. This underscores the relationship between maternal and infant health outcomes. This article presents a framework for understanding the mother-infant dyad using an adaptation of the socio-ecological model and focuses on patient and family factors, provider and healthcare system factors, community factors, and policy and societal factors that perpetuate inequities in infant outcomes. The neonatal intensive care unit (NICU) is a driver of inequities, but also provides critical, yet underutilized, opportunities for intervention. Strategies to promote physical, emotional, social, and financial well-being of mothers and infants include NICU-based lactation and mental health support, culturally responsive care, screening for social determinants of health, and engagement of families in care and quality improvement. Beyond the NICU, broader structural and policy changes are essential, including equitable access to risk-appropriate care, paid family leave, comprehensive health insurance, and investments in community partnerships. Addressing these drivers of inequity through coordinated healthcare, policy, and community action can better support the mother-infant dyad and improve the well-being of all families.
Human milk (HM) is the gold standard for infant feeding due to its associations with significant reductions in short and long-term serious morbidities. It is also associated with improved brain growth and development and...Human milk (HM) is the gold standard for infant feeding due to its associations with significant reductions in short and long-term serious morbidities. It is also associated with improved brain growth and development and neurodevelopmental outcomes, particularly in the preterm population. The myriad of bioactives found in HM, such as growth factors, stem cells, human milk oligosaccharides, and the human milk microbiome, presumably play a large role in these outcomes. Given the significant improvements in infant outcomes, components of HM are now being studied as targeted neurological therapy for brain injury. This narrative review will summarize the unique components of HM that are thought to be responsible for brain health and how they may affect brain structure and development in the term and preterm neonate. Neurodevelopmental improvements seen with HM feeding will also be reviewed. Finally, pre-clinical and clinical studies utilizing whole HM or HM components to treat brain injury will be summarized so that providers can better share the science of this remarkable biologic with multi-disciplinary teams and families.
Gastroesophageal reflux is physiologically normal in infants but can become gastroesophageal reflux disease when it leads to significant symptoms (persistent vomiting, weight loss, feeding difficulties). Gastroesophageal...Gastroesophageal reflux is physiologically normal in infants but can become gastroesophageal reflux disease when it leads to significant symptoms (persistent vomiting, weight loss, feeding difficulties). Gastroesophageal reflux disease is highly prevalent among infants and contributes to increased health care utilization. There are several physiologic and lifestyle factors that predispose infants to a higher degree of gastroesophageal reflux and disease related to it. Preterm infants and infants admitted to the neonatal intensive care unit, are a special population that have unique risk factors for gastroesophageal reflux disease and have a high prevalence of gastroesophageal reflux disease. To better understand gastroesophageal reflux in infants and neonates with medical complexity, this article will first review the physiology of typical swallowing and motility of the upper gastrointestinal tract in infants. Then, the pathophysiology of gastroesophageal reflux in infants will be reviewed. Finally, this article also addresses specific physiological differences in preterm infants that are important to aid in the understanding of management of gastroesophageal reflux disease in this specific population.