BACKGROUND: Growing evidence links thrombocytopenia to retinopathy of prematurity (ROP) in preterm infants. However, it remains unclear whether the degree of thrombocytopenia affects the severity of ROP. METHODS: VLBW (<...BACKGROUND: Growing evidence links thrombocytopenia to retinopathy of prematurity (ROP) in preterm infants. However, it remains unclear whether the degree of thrombocytopenia affects the severity of ROP. METHODS: VLBW (<1500 g) infants were divided into two groups. Group (A) with and Group (B) without thrombocytopenia. Chi square test, logistic regression, and correlation coefficient analysis models were used for statistical analysis. Statistical significance was set at a p value < 0.05. RESULTS: Of the 305 VLBW infants, 47% developed ROP in group A compared to 16% in group B. Severe ROP occurred in 20% of infants in group A, whereas none in group B developed severe ROP. There was a significant inverse relationship between platelets count as a continuous variable and the grade of ROP (Spearman correlation coefficient: -0.36, p < 0.001). CONCLUSION: Thrombocytopenia is an independent risk factor for ROP in VLBW infants, with lower platelet counts associated with increased ROP severity.
OBJECTIVE: To evaluate the impact of cardiac lesions on outcomes to discharge in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN: Retrospective analysis of infants with CDH identified in the Children's H...OBJECTIVE: To evaluate the impact of cardiac lesions on outcomes to discharge in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN: Retrospective analysis of infants with CDH identified in the Children's Hospitals Neonatal Database (CHND) from 2010 to 22. Patients were stratified into groups based on associated congenital heart disease (CHD): (1) noCHD (2) CDH + atrial, ventricular septal defects (avCHD); (3) CDH + severe CHD (sevCHD). RESULTS: Among 2940 neonates with CDH, 570 (19%) had CHD (453 avCDH, 117 sevCHD). CHD of any severity was associated with small for gestational age at birth, a 5 minute Apgar <5, and additional anomalies or syndromes (p < 0.05 for all). Mechanical ventilation days, use of extra-corporeal membrane oxygenation, length of stay, and mortality increased with CHD severity (p < 0.005). Home medical needs were more frequent in infants with associated CHD (p < 0.001). CONCLUSIONS: Comorbid CHD of any severity adds complexity and risk to patients with CDH.
J Perinatol
· 2026 Mar · PMID 41748935
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Preterm birth increases the risk of chronic kidney disease (CKD) and hypertension later in life. To address these risks, the National Institutes of Health sponsored the Neonatal Kidney Health Consensus Workshop in Februa...Preterm birth increases the risk of chronic kidney disease (CKD) and hypertension later in life. To address these risks, the National Institutes of Health sponsored the Neonatal Kidney Health Consensus Workshop in February 2024, where a multidisciplinary group of experts reviewed current evidence, identified knowledge gaps, and developed consensus-based recommendations for kidney health follow-up in infants born <34 weeks. Key recommendations include a kidney evaluation before NICU discharge and at two years of age, with comprehensive kidney assessment for those at highest risk (birth <28 weeks, with acute kidney injury, intrauterine growth restriction, or small for gestational age). Cohesive, evidence-based parental education at multiple timepoints was emphasized to support early CKD detection and long-term management. This consensus provides a framework to optimize follow up and highlights research priorities aimed at improving risk stratification, early diagnosis, and interventions in individuals born preterm.
OBJECTIVE: Racial and ethnic disparities in healthcare resource utilization (HCRU) are well-documented among extremely and very preterm infants but remain understudied among more mature preterm populations. This study ev...OBJECTIVE: Racial and ethnic disparities in healthcare resource utilization (HCRU) are well-documented among extremely and very preterm infants but remain understudied among more mature preterm populations. This study evaluated HCRU by race/ethnicity among moderate (32-33 weeks) and late preterm infants (34-36 weeks) with respiratory distress syndrome (RDS; defined as ICD-10-CM P22.0) at Kaiser Permanente Northern California (2019-2023). STUDY DESIGN: Infants (n = 1674) with RDS requiring >12 h of respiratory support were included. HCRU was evaluated during birth hospitalization [respiratory support, length of stay (LOS)] and one-year post-discharge [emergency department (ED) visits, hospitalization]. RESULT: No racial or ethnic differences were observed during hospitalization. Post-discharge, Black and Hispanic infants had higher risk of respiratory/infectious ED visits (Black, aOR=1.72 [95% CI = 1.05-2.81]; Hispanic, aOR=2.18 [95% CI = 1.56-3.06]; reference=White). Hispanic infants also had higher risks of respiratory/infectious hospitalizations (aOR=2.53 [95% CI = 1.11-5.78]). CONCLUSION: While inpatient HCRU was similar across race/ethnicity, disparities emerged one-year post discharge, particularly in Black and Hispanic infants.
OBJECTIVE: Preterm infants have pulmonary ventilation and perfusion abnormalities, yet few imaging modalities can inform clinicians about this ventilation/perfusion (V/Q) relationship. Electrical impedance tomography (EI...OBJECTIVE: Preterm infants have pulmonary ventilation and perfusion abnormalities, yet few imaging modalities can inform clinicians about this ventilation/perfusion (V/Q) relationship. Electrical impedance tomography (EIT) is an imaging technique with V/Q imaging capabilities that has not been well described in infants with BPD. STUDY DESIGN: EIT was performed every 4 weeks in preterm infants for a maximum of 5 visits per infant. Term infants with healthy lungs had one EIT imaging visit as controls. RESULTS: Data were collected from a total of 51 EIT visits. Novel V/Q maps were generated from each visit. Ventilation heterogeneity (measured by the global inhomogeneity index) and V/Q heterogeneity (measured by coefficient of variation of V/Q maps) were significantly higher in preterm infants at the visit closest to 36 weeks post-menstrual age than controls (p = 0.002 and p = 0.039, respectively). CONCLUSIONS: Pulmonary ventilation, perfusion, and V/Q relationship can be quantified by EIT, and may be indicators of chronic lung disease.
J Perinatol
· 2026 Apr · PMID 41731049
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OBJECTIVE: Examine 11-year trends in opioid and sedative exposure and dosing practices in a level IV neonatal intensive care unit (NICU). METHODS: This retrospective cohort study included NICU admissions from 2014 to 202...OBJECTIVE: Examine 11-year trends in opioid and sedative exposure and dosing practices in a level IV neonatal intensive care unit (NICU). METHODS: This retrospective cohort study included NICU admissions from 2014 to 2024 that received at least one opioid or sedative. Temporal changes in patient characteristics, exposure patterns, continuous infusion regimen composition, and morphine and dexmedetomidine infusion rates were evaluated across three epochs (2014-2017, 2018-2021, 2022-2024). RESULTS: Of 2055 admissions, 1060 (51.6%) encounters were analyzed. Infants admitted in later years were more premature with greater morbidity. Dexmedetomidine continuous infusion use increased fivefold (7.9% to 44.1%; p < 0.001), while morphine infusion use also increased (36.7% to 50.4%; p = 0.0021). Morphine plus dexmedetomidine became the most common continuous infusion regimen by 2022-2024 (28.7%), with higher infusion rates in combination therapy than in monotherapy. CONCLUSION: NICU sedation strategies shifted from morphine monotherapy toward combination therapy with dexmedetomidine. Standardized, outcome-oriented guidelines and multicenter studies are needed.
Over the past 50 years, therapeutic advances have significantly improved the management of cystic fibrosis (CF). Recently, cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been widely regarded a...Over the past 50 years, therapeutic advances have significantly improved the management of cystic fibrosis (CF). Recently, cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been widely regarded as a therapeutic revolution, and their use is associated with a marked increase in pregnancies among affected women. However, pregnant women were excluded from clinical trials, limiting what is known about maternal and fetal safety. Maternal and fetal outcome tend to be poorer when the disease is severe, but there is limited data on such pregnancies exposed to CFTR modulators. While available data suggest a low risk of birth defects, information on neurological development is lacking and concerns remain regarding lung abnormalities in animal studies, as well as a few cases of congenital cataracts reported in humans. For fetuses affected by CF, the transplacental transfer of CFTR modulators could potentially prevent severe complications, such as meconium ileus, opening promising therapeutic avenues.
Among the most pressing topics in neonatal-perinatal medicine today is intensive care for infants born at ≤24 weeks' gestation. Infants born at 22-24 weeks comprise ~1 in 500 live births, with ~7500 liveborn infants annu...Among the most pressing topics in neonatal-perinatal medicine today is intensive care for infants born at ≤24 weeks' gestation. Infants born at 22-24 weeks comprise ~1 in 500 live births, with ~7500 liveborn infants annually in the U.S.-more common than Down syndrome or critical congenital heart disease-and make up 1 in 5 U.S. infant deaths. Major uncertainties exist about clinical decisions, including regarding obstetric care, delivery room procedures, incubator management, nutrition, respiratory support, and the optimal developmental environment. Partnering with families, we can develop a sound basis for safe and effective medical care of pregnant women and infants affected by birth at ≤24 weeks.
J Perinatol
· 2026 Jun · PMID 41731046
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Despite ample research in acute pulmonary hypertension in neonates with congenital diaphragmatic hernia (CDH) leading to improved survival, there is a paucity of literature on the physiology of chronic pulmonary hyperten...Despite ample research in acute pulmonary hypertension in neonates with congenital diaphragmatic hernia (CDH) leading to improved survival, there is a paucity of literature on the physiology of chronic pulmonary hypertension in this population. Serial hemodynamic assessments and physiology-centric care have been shown to be safe and effective in the acute transitional and peri-operative care of these neonates and will likely be informative in the discussion of chronic pulmonary hypertension as well. Herein, we discuss the epidemiology, contributors, and proposed physiology-based phenotypes of chronic pulmonary hypertension in neonates with CDH. Further investigation is needed to contribute to our understanding and treatment of chronic pulmonary hypertension in this complex, heterogeneous population.
OBJECTIVE: Substance use during pregnancy may affect fetal development and have implications for newborn, childhood, and life-long health. While standardized maternal screening protocols may reduce testing disparities, t...OBJECTIVE: Substance use during pregnancy may affect fetal development and have implications for newborn, childhood, and life-long health. While standardized maternal screening protocols may reduce testing disparities, there are limited data describing the effects of standardized drug screening protocols on neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study of deliveries at a tertiary care center during pre-(7/1/2020-6/9/2021) and post-intervention(6/10/2021-5/31/2022) periods around implementation of a standardized obstetric substance use screening/testing protocol. Associations between neonatal testing and maternal race, ethnicity, and insurance status were assessed using generalized estimating equations (SAS 9.4,α = 0.05). RESULT: Among 3163 pre-intervention and 3389 post-intervention neonates, testing decreased post-intervention (4.5% vs. 6.2%, p = 0.0035), though a higher proportion lacked corresponding maternal tests (70.8% vs. 32.3%, p < 0.001). Black neonates had higher testing odds, which attenuated after adjusting for insurance status. CONCLUSION: Use of a maternal screening protocol was associated with a reduction in neonatal testing, but disparities persist, warranting further study.
OBJECTIVE: To examine the variability in neonatologists' screening and management practices of corticosteroid-induced adrenal insufficiency (adrenal suppression; AS) in the NICU. STUDY DESIGN: A cross-sectional survey wa...OBJECTIVE: To examine the variability in neonatologists' screening and management practices of corticosteroid-induced adrenal insufficiency (adrenal suppression; AS) in the NICU. STUDY DESIGN: A cross-sectional survey was disseminated nationally via REDCap to 160 neonatologists who serve as members of Children's Hospitals Neonatal Consortium. Descriptive statistics were used to capture variability in AS screening modalities, diagnostic tools, management approaches, and discharge planning. RESULT: Of the 82 respondents, only 56.1% screen infants for AS following prolonged systemic corticosteroid exposure, 46.3% after 2-4 weeks, 59.8% utilizing ACTH stimulation testing. Only 2.4% screen after prolonged high dose inhaled corticosteroids, reflecting uncertainty regarding their suppressive potential. Additionally, only 30.5% provide structured caregiver AS education at discharge. CONCLUSION: Variable nationwide screening and management of adrenal suppression in the NICU underscores uncertainty and inconsistency in practice, revealing the need for clinical guidelines to optimize care.
BACKGROUND: Bronchopulmonary Dysplasia (BPD) is the most common complication associated with prematurity. Caffeine citrate is a commonly used medication in the neonatal intensive care unit (NICU) for apnea of prematurity...BACKGROUND: Bronchopulmonary Dysplasia (BPD) is the most common complication associated with prematurity. Caffeine citrate is a commonly used medication in the neonatal intensive care unit (NICU) for apnea of prematurity (AOP). In the Caffeine Therapy for Apnea of Prematurity study, or CAP trial, infants who received caffeine at 5 mg/kg had reduced rates of BPD compared to the placebo group. Recently, there have been questions regarding the optimal dose of caffeine and if higher doses may have increased benefit on decreasing rates of BPD. OBJECTIVE: The objectives of this study were to determine if infants who received a higher maintenance dose of caffeine have decreased rates of BPD, decreased severity of BPD and improved neurodevelopmental outcomes compared to those who received a lower maintenance dose of caffeine. DESIGN/METHODS: This was a retrospective, observational cohort study at a level IV NICU including infants less than 28 weeks gestational age (GA) receiving caffeine. Maternal and infant demographics and clinical data from the infant's hospital course were collected. Infants were assigned to low-dose (n = 62) or high-dose (n = 111) cohorts based on average daily caffeine dose. The low-dose cohort received an average daily dose of ≤6 mg/kg/day, while the high-dose cohort received an average daily dose of >6 mg/kg/day. BPD rates and severity were then evaluated for each subject. Neurodevelopmental follow-up Bayley scores were assessed at 6, 12, 18, and 24-month follow-up visits. Chi-square test, T test, Mann-Whitney U Test, Logistic regression, and Linear regression statistics were completed to evaluate data. RESULTS: Demographics and clinical characteristics were similar between the low and high-dose caffeine groups. The duration of caffeine in each group was similar as well. The percentage of individuals requiring invasive ventilation was similar between the two groups, however, infants in the high-dose group required less intense forms of ventilation and were on invasive ventilation for a shorter time than the low-dose group (Table 1). The rates of BPD were similar in the two groups (79% vs 78%, p = 0.92), however the severity of BPD based on Jensen Criteria was significantly different between the two groups, with lower rates of severe BPD in the high-dose group (p < 0.001) (Tables 2 and 3). Patients in the higher-dose caffeine group had higher Bayley composite scores at 6 months (p < 0.02). No significant differences were noted at later follow-up (Table 3). CONCLUSIONS: The decreased rates of severe BPD in the high-dose group, along with improved Bayley scores at 6-month follow-up suggest the potential benefit of high-dose maintenance caffeine in the extremely premature and extremely low birth weight population. Additional large, prospective studies are required to evaluate the efficacy of high-dose caffeine in preventing BPD and improving long-term outcomes in this most vulnerable population.
BACKGROUND: A "high" concentration of nucleated red blood cells (NRBC) in the blood of neonates at birth has been used as a biomarker of fetal hypoxia and a risk factor for poor outcome. Previous neonatal reference inter...BACKGROUND: A "high" concentration of nucleated red blood cells (NRBC) in the blood of neonates at birth has been used as a biomarker of fetal hypoxia and a risk factor for poor outcome. Previous neonatal reference intervals for NRBC counts were likely contaminated by high counts from neonates born after unrecognized fetal hypoxia. We hypothesized that a new method for creating reference intervals, refineR, would produce more accurate physiological intervals for neonatal NRBC counts. STUDY DESIGN: We utilized refineR and real-world multicentered data from Intermountain Health to create new neonatal NRBC count reference intervals. RESULTS: Using 4 ½ years of multi-hospital data, refineR created reference interval charts for NRBC counts at birth and over the first days. The new intervals are narrower than the previous version, with lower median and upper-limit values. CONCLUSION: With the new charts, clinicians can more confidently assess whether a neonate's NRBC count is normal vs. elevated.
Coletti K, Lee SS, Cohen S
… +6 more, Dizon MLV, Hersh DS, Mietzsch U, Ocal E, Sewell EK, Children’s Hospitals Neonatal Consortium (CHNC) Neurosurgery Focus Group
J Perinatol
· 2026 Jun · PMID 41731041
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OBJECTIVE: To assess the proportion of Level IV NICUs with post-hemorrhagic ventricular dilatation (PHVD) management pathways and compare the pathways. STUDY DESIGN: A survey was distributed to 49 Children's Hospitals Ne...OBJECTIVE: To assess the proportion of Level IV NICUs with post-hemorrhagic ventricular dilatation (PHVD) management pathways and compare the pathways. STUDY DESIGN: A survey was distributed to 49 Children's Hospitals Neonatal Consortium (CHNC) Level IV NICUs. A summarized pathway was developed from written pathways. RESULT: Survey response rate was 82%. Twelve (30%) NICUs have written pathways, 11 (28%) report informal consensus, and 17 (43%) lack consensus. Among the 12 written pathways, all serially monitor ventricular dilatation on cranial ultrasound (CUS) using ventricular index (58%) or frontal-occipital-horn-ratio (33%). Threshold for surgery varies: 33% of sites rely on CUS alone, while 67% incorporate clinical symptoms. Half of sites use lumbar puncture to decrease PHVD before surgery. Criteria for converting temporizing to permanent shunt is present in 67% of pathways. CONCLUSION: Amongst centers with written PHVD pathways, variable monitoring and intervention criteria exist. Most NICUs lack formal pathways, demonstrating opportunities to standardize care.
Mascari J, Millen S, Batish T
… +7 more, Suarez K, Slattery S, Lagoski M, Henner N, Raucci J, Porta N, Murthy K
J Perinatol
· 2026 Apr · PMID 41731040
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OBJECTIVE: To quantify midazolam (MID) and dexmedetomidine (DEX) exposure in preterm infants with chronic respiratory failure (CRF) due to severe bronchopulmonary dysplasia (sBPD) and assess associations with Behavioral...OBJECTIVE: To quantify midazolam (MID) and dexmedetomidine (DEX) exposure in preterm infants with chronic respiratory failure (CRF) due to severe bronchopulmonary dysplasia (sBPD) and assess associations with Behavioral Signs of Respiratory Instability (BSRI) scores. STUDY DESIGN: Infants born <32 weeks' gestation with sBPD requiring tracheostomy and chronic ventilation were included. Daily MID and DEX exposure was quantified from NICU admission until discharge, death, or transfer. Multivariable mixed-effects models evaluated associations between medication exposure and weekly BSRI scores, adjusting for selected confounders. RESULTS: Among 40 infants (median NICU stay: 202 days), median exposures were 4.4 weeks for DEX and 2 weeks for MID, with peak doses surrounding tracheostomy. Medication exposure was not independently associated with BSRI scores. Higher respiratory severity scores correlated with increased medication doses. CONCLUSION: Neurosedative medication dosing correlated with disease severity. These findings highlight the need to optimize dosing strategies and neurodevelopmental outcomes in this vulnerable population.
OBJECTIVE: Therapeutic hypothermia (TH) reduces mortality in neonatal hypoxic-ischemic encephalopathy (HIE), yet nearly half of treated infants suffer adverse outcomes. This study aimed to define the "Hypothermia Resista...OBJECTIVE: Therapeutic hypothermia (TH) reduces mortality in neonatal hypoxic-ischemic encephalopathy (HIE), yet nearly half of treated infants suffer adverse outcomes. This study aimed to define the "Hypothermia Resistance" phenotype by characterizing the 4-day trajectories of multi-organ dysfunction and identifying the physiological signals associated with severe MRI injury. STUDY DESIGN: This retrospective cohort study included 24 term neonates with moderate-to-severe HIE treated with whole-body hypothermia. Patients were stratified into "Responder" (n = 18) and "Resistant" (n = 6) phenotypes based on systemic recovery patterns. Serial biomarkers (Lactate, Creatinine, AST, Platelets) were analyzed daily from Day 1 to Day 4. The primary outcome was brain injury severity on MRI assessed by the Weeke score. RESULTS: Admission characteristics and Day 1 biomarkers were comparable between groups. However, trajectories diverged significantly by Day 3 (72 h). The Resistant phenotype was characterized by a failure to clear systemic dysfunction, manifesting as persistent renal impairment (Median Creatinine: 1.39 vs 0.65 mg/dL; p < 0.01) and worsening thrombocytopenia (Median Platelets: 114 vs 190 × 10³/µL; p < 0.05) at 72 h. This "Day 3 Cliff" profile (Creatinine >1.0 mg/dL combined with Platelets <120 × 10³/µL) was strongly associated with severe MRI injury (diffusion restriction in basal ganglia/thalamus). CONCLUSION: Physiological recovery during cooling is a dynamic process. Persistent multi-organ dysfunction on Day 3 constitutes a "Hypothermia Resistance" profile that serves as a robust surrogate marker for ineffective neuroprotection, distinct from early severity markers.