OBJECTIVE: Describe rates of intraventricular hemorrhage (IVH) in the VentFirst cohort, model risks for severe IVH and compare IVH rates to a contemporaneous population. STUDY DESIGN: Sub-analysis of the VentFirst multi-...OBJECTIVE: Describe rates of intraventricular hemorrhage (IVH) in the VentFirst cohort, model risks for severe IVH and compare IVH rates to a contemporaneous population. STUDY DESIGN: Sub-analysis of the VentFirst multi-center randomized trial. RESULTS: Head ultrasound findings from 548 infants <29 weeks' gestation who survived to first head ultrasound study in the VentFirst trial were analyzed. Any grade of IVH was found in 31% and severe (grade III/ IV) IVH in 8%. Logistic regression indicated gestational age (GA), twin gestation and 1-minute Apgar as risks for severe IVH. Odds of any IVH and severe IVH were lower in the VentFirst population than in a comparable population in the Vermont Oxford Network. CONCLUSION: Severe IVH in the VentFirst trial was associated with low GA, twin gestation and low 1-minute Apgar score. The lower odds of IVH for the study cohort compared to a similar population may reflect optimized delivery conditions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02742454.
OBJECTIVE: Describe caffeine use in late preterm infants (LPIs) in neonatal intensive care units (NICUs) over time METHODS: Cohort study of infants born 34-36 weeks gestation discharged from Pediatrix Medical Group NICUs...OBJECTIVE: Describe caffeine use in late preterm infants (LPIs) in neonatal intensive care units (NICUs) over time METHODS: Cohort study of infants born 34-36 weeks gestation discharged from Pediatrix Medical Group NICUs from 2011-2022. RESULTS: Of 233,804 LPIs, 3.7% (n = 8633) were exposed to caffeine. Caffeine-exposed LPIs had a lower gestational age (GA), were more likely to receive surfactant, had higher and longer respiratory support needs, and longer length of stay (all p < 0.001). Compared to epoch 1 (2011-2016), LPIs in epoch 2 (2017-2022) were exposed to caffeine at an earlier postnatal age (2 vs. 3 days), shorter duration (1 vs. 6 days) and had discontinued at an earlier postmenstrual age (35 vs. 35.4 weeks) (all p < 0.001). CONCLUSION: Caffeine was used more often in LPIs requiring respiratory support and with lower GA. Although incidence of caffeine use was stable over time, details of prescribing practices differed across sites and over time.
BACKGROUND: Understanding the research experiences of bereaved parents is necessary to advance palliative care. OBJECTIVE: To evaluate levels of and factors associated with bereaved parent comfort, benefit, and distress...BACKGROUND: Understanding the research experiences of bereaved parents is necessary to advance palliative care. OBJECTIVE: To evaluate levels of and factors associated with bereaved parent comfort, benefit, and distress from research participation and to qualitatively explore research experiences. STUDY DESIGN: Exploratory analysis of survey data from parents of infants who died in a level IV NICU (2010-2020). Fisher's exact and Chi-square tests were used to identify factors associated with parental comfort, distress, and benefit. Qualitative analyzed was performed using the constant comparative method. RESULTS: 40/146 parents (27%) responded. 83% reported being "very comfortable" or "comfortable", 83% reported "some" to "a lot" of benefit, 26% reported "a great deal" to "a lot" of distress from participation. Goal-discordant care was significantly associated with distress. Research participation themes included "helping others", "processing experiences" and "re-living negative experiences". CONCLUSION: Bereaved NICU parents simultaneously experience distress, comfort, and benefit from research participation.
OBJECTIVE: To assess whether vasoactive-inotropic score (VIS) during early life was predictive of outcomes for infants with congenital diaphragmatic hernia and to determine whether VIS differed by defect size and lateral...OBJECTIVE: To assess whether vasoactive-inotropic score (VIS) during early life was predictive of outcomes for infants with congenital diaphragmatic hernia and to determine whether VIS differed by defect size and laterality. STUDY DESIGN: Retrospective single-center cohort study of 206 infants with CDH. VIS was calculated at 6, 12, 24, 48 and 72 h of life as well as at repair, 24 h and 48 h-post repair. RESULT: Higher VIS scores at all time points were associated with an increased risk of mechanical ventilation at 28 days of life (p < 0.02). VIS in the first 24 h was associated with an increased risk ECMO or death (p < 0.001) and tracheostomy or death (p < 0.02). VIS did not differ between left and right defects, but larger defects had higher scores. CONCLUSION: Early-life VIS scores at 6, 12 and 24 h have predictive value for extended duration of mechanical ventilation, ECMO, tracheostomy or death.
OBJECTIVE: To evaluate gestational age (GA)-specific associations between antenatal corticosteroid (ACS) exposure and early physiologic vulnerability and neonatal outcomes in preterm infants. STUDY DESIGN: This retrospec...OBJECTIVE: To evaluate gestational age (GA)-specific associations between antenatal corticosteroid (ACS) exposure and early physiologic vulnerability and neonatal outcomes in preterm infants. STUDY DESIGN: This retrospective cohort study used Korean Neonatal Network data and included infants born 2013-2021 with birth weight <1500 g or GA < 32 weeks. ACS exposure was categorized as complete, incomplete, or none. Multivariable logistic regression estimated adjusted odds ratios, with GA-stratified analyses and a prespecified subgroup of infants born at <25 weeks. RESULTS: ACS exposure was associated with reduced need for advanced resuscitation at birth, reduced risk of severe intraventricular hemorrhage and decreased mortality, with the strongest associations before 32 weeks' gestation. In infants born at <25 weeks, any ACS exposure was associated with greater physiologic stability and improved survival versus no ACS exposure. CONCLUSIONS: ACS exposure was associated with improved physiologic stability and survival in preterm infants, with benefits greater at lower GAs.
OBJECTIVE: To evaluate whether paracetamol serum concentration monitoring is associated with ductal closure, hepatic or renal toxicity, and to assess the cost-effectiveness of routine serum monitoring in preterm infants...OBJECTIVE: To evaluate whether paracetamol serum concentration monitoring is associated with ductal closure, hepatic or renal toxicity, and to assess the cost-effectiveness of routine serum monitoring in preterm infants treated for haemodynamically significant patent ductus arteriosus (hsPDA). STUDY DESIGN: A multi-centre retrospective cohort study of 172 preterm infants treated with paracetamol for hsPDA (2018-2024). Associations between paracetamol serum concentrations, clinical outcomes, and monitoring costs were examined using multivariable mixed-effects modelling and micro-costing analysis. RESULTS: PDA closure after the first course occurred in 40.7%. On multivariate analysis, paracetamol concentration monitoring was not associated with PDA closure (OR 0.98, 95% CI:0.92-1.03, p = 0.68), ALT elevation (p = 0.443) or creatinine rise (p = 0.88). Across 222 assays, routine monitoring cost £6036 (£120.72 per actionable result) and remained non-cost effective across all sensitivity analyses. CONCLUSION: Routine monitoring of paracetamol serum concentrations offers minimal clinical value and is not cost-effective. Selective, indication-based monitoring should replace universal testing.
OBJECTIVE: To quantify systemic exposure to budesonide following intratracheal administration; evaluate the impact of intratracheal budesonide on blood glucocorticoid activity (cortisol plus betamethasone as cortisol equ...OBJECTIVE: To quantify systemic exposure to budesonide following intratracheal administration; evaluate the impact of intratracheal budesonide on blood glucocorticoid activity (cortisol plus betamethasone as cortisol equivalents); and relate the latter to outcomes. STUDY DESIGN: Sub-study of the PLUSS randomized trial(ACTRN12617000322336) of intratracheal budesonide with surfactant versus surfactant alone. RESULT: Among 63 infants enrolled at Kidz First Neonatal Care, Auckland, systemic exposure to intratracheal budesonide was low, and cortisol equivalents were similar between intervention groups at 36-48 h (adjusted-ratio-geometric-means = 1.16, 95% CI 0.52-2.57). Antenatal betamethasone <24 h before birth contributed to neonatal blood glucocorticoid activity for up to 24-48 h. Infants above the upper tertile for cortisol equivalents at <60 h, compared with those below the lower tertile, had increased likelihood of severe intraventricular hemorrhage and possibly death. CONCLUSION: Systemic exposure to intratracheal budesonide has little to no effect on cortisol equivalents at 36-48 h. High glucocorticoid activity after birth may be associated with poorer neonatal outcomes.
OBJECTIVE: Investigate the association between vitamin D status (as measured by 25-hydroxyvitamin D concentration [25(OH)D]) and gestational age at delivery. STUDY DESIGN: This was a retrospective chart review of electro...OBJECTIVE: Investigate the association between vitamin D status (as measured by 25-hydroxyvitamin D concentration [25(OH)D]) and gestational age at delivery. STUDY DESIGN: This was a retrospective chart review of electronic medical records (n = 15,506) from women delivering at the Medical University of South Carolina, with first maternal 25(OH)D concentrations measured from January 2016 to March 2024. RESULT: Women delivering <37 weeks (n = 1652; 31.3 ± 17.8 ng/mL) had lower 25(OH)D concentrations compared to those delivering at 37 weeks or later (n = 13,451; 34.8 ± 17.3 ng/mL), with a mean difference of -3.46 ng/mL (95% Confidence Interval (CI): -4.54 to -2.38, p < 0.0001). This difference was even more pronounced among women delivering before 32 weeks (n = 385; 26.2 ± 14.9 ng/mL), who had substantially lower 25(OH)D concentrations than term deliveries, with a mean difference of -8.56 ng/mL (95% CI: -10.70 to -6.42, p < 0.0001). CONCLUSION: Maternal vitamin D status was associated with gestational age at delivery. Lower maternal 25(OH)D concentrations were observed among women who delivered preterm compared with those delivering at term. These findings suggest a potential relationship between vitamin D status and preterm birth and support further research into whether optimizing vitamin D status during pregnancy may improve perinatal outcomes.
OBJECTIVE: To examine associations between parental holding during therapeutic hypothermia (TH) and neonatal intensive care unit (NICU) outcomes among infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: Ret...OBJECTIVE: To examine associations between parental holding during therapeutic hypothermia (TH) and neonatal intensive care unit (NICU) outcomes among infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: Retrospective cohort of 379 infants with HIE at two level IV NICUs (2017-2024). Unadjusted and adjusted regression models evaluated associations between holding during TH and NICU outcomes. RESULT: Overall, 28% of infants were held during TH. Holding was less common among infants with greater clinical severity, public insurance, or those identified as Hispanic, Asian, or Black. After adjustment for clinical and sociodemographic factors, holding was associated with faster time to full oral feeding (HR = 1.4, p < 0.01), earlier age at full oral feeding (HR = 1.6, p < 0.01), shorter hospitalization (β = -7.5, p = 0.02), and higher odds of breastmilk feeding at discharge (OR = 3.2, p = 0.03). CONCLUSION: Parental holding during TH is associated with favorable short-term NICU outcomes, supporting its potential role as a family-centered care practice during neonatal neurocritical care.
OBJECTIVE: Staffing needs for an antimicrobial stewardship program (ASP) in the neonatal intensive care unit setting are undefined. STUDY DESIGN: In an ASP collaborative of 29 California NICUs, we surveyed sites to deter...OBJECTIVE: Staffing needs for an antimicrobial stewardship program (ASP) in the neonatal intensive care unit setting are undefined. STUDY DESIGN: In an ASP collaborative of 29 California NICUs, we surveyed sites to determine full-time equivalents (FTE) for ASP implementation effort by clinical role, clinical acuity, patient volume, and other NICU characteristics. RESULTS: 146 staff members performed ASP implementation, including neonatologists, nurses, hospitalists, nurse practitioners, pharmacists, information technology personnel, and infectious disease specialists. The 8-month preparation and 12-month intervention phases required a median (IQR) of 0.015 (0.011-0.025) and 0.071 (0.056-0.091) FTEs (0.6 and 2.8 hours per week), respectively. Neonatologists and nurses performed 43% and 19% of the workload, respectively; effort for site-level stewardship activities and collaborative learning dissemination varied 3.3-fold over the collaborative. Higher clinical acuity and patient volume were associated with higher neonatologist effort. CONCLUSION: Driven by neonatologists and nurses, NICU ASP requires demonstrable effort, and staff needs vary considerably.
OBJECTIVE: To assess for differences in congenital diaphragmatic hernia patient characteristics between those requiring single or multiple intubation attempts, and to determine the relationship between number of intubati...OBJECTIVE: To assess for differences in congenital diaphragmatic hernia patient characteristics between those requiring single or multiple intubation attempts, and to determine the relationship between number of intubation attempts and time to intubation with outcomes. STUDY DESIGN: This was a retrospective cohort study of 205 infants with congenital diaphragmatic hernia born at Texas Children's Hospital. Patient demographics and severity numbers were compared to number of laryngoscopies as a surrogate for intubation attempts. Number of laryngoscopies and time to intubation were compared to clinical outcomes. Binary logistic regression and receiver operating characteristic curve analysis were used. RESULT: There was no significant difference in baseline characteristics or CDH severity in those requiring single or multiple attempts. Greater number of intubation attempts was not associated with adverse outcomes but there was a significant association between longer time to successful intubation and mortality and higher risk of tracheostomy or death before discharge. Each additional minute before successful intubation was associated with 28% higher odds of mortality (p = 0.031) and 42% higher odds of tracheostomy or death before discharge (p = 0.006) CONCLUSION: Delayed time to intubation but not number of intubation attempts was associated with higher mortality and risk of tracheostomy or death in babies with CDH. Prenatal information including receipt of the FETO procedure, CDH severity markers, gestational age and birth weight cannot reliably be used to predict the likelihood of challenging intubations in infants with CDH.
OBJECTIVE: To examine the relationship between feeding milestones and the postnatal growth of preterm infants. STUDY DESIGN: Retrospective study of 77 infants born <32 weeks' gestation. Growth variables at birth and disc...OBJECTIVE: To examine the relationship between feeding milestones and the postnatal growth of preterm infants. STUDY DESIGN: Retrospective study of 77 infants born <32 weeks' gestation. Growth variables at birth and discharge were converted to age- and sex-specific z-scores. Postnatal growth faltering (PGF) was defined as loss of >2 weight z-scores (severe) or simultaneous loss of >1 weight, length, and head circumference z-scores (complex). RESULTS: The prevalence of severe and complex PGF was 11.7% and 22%, respectively. Infants <28 weeks' gestation experienced more PGF (severe: 22.2%; complex: 33.3%) and feeding delays. Older age at first and full enteral feeding, and longer transition from first to full enteral feeding, were associated with slower growth (All, p < 0.05). Feeding delays were associated with prolonged hospitalization (p < 0.05). CONCLUSION: Feeding milestones and postnatal growth are interrelated. Earlier attainment of feeding milestones may support more favorable growth outcomes in preterm-born infants.
OBJECTIVE: Significant variability exists in the indications for and dosing of cryoprecipitate transfusions. We examined cryoprecipitate transfusions in neonates with a focus on indications, dosing, and the incidence of...OBJECTIVE: Significant variability exists in the indications for and dosing of cryoprecipitate transfusions. We examined cryoprecipitate transfusions in neonates with a focus on indications, dosing, and the incidence of multi-donor exposure. STUDY DESIGN: In this retrospective study, cryoprecipitate transfusions administered in a single neonatal intensive care unit from January 2022 to December 2024 were reviewed. Patient characteristics, diagnoses, laboratory values, and transfusion details were collected. RESULTS: In total, 50 patients received 104 cryoprecipitate transfusions. The median pre-transfusion fibrinogen level was 100 mg/dL (range 15-586), the median dose was 5.9 mL/kg (range 2.1-16.2), and the median increase in fibrinogen was 115 mg/dL (range -5 to 513). Based on the volume administered, 30% of transfusions likely resulted in multi-donor exposure, with no significant difference in the post-transfusion fibrinogen level achieved. CONCLUSION: Significant variation in cryoprecipitate transfusion practices exist, even within a single center. Increasing the weight-based dose of transfusion increases multi-donor exposure without significant clinical benefit.
Pregnant people and infants are at risk of adverse health effects from climate change. These climate change-related outcomes include stillbirth, prematurity, low birth weight, congenital anomalies, and aberrant neurodeve...Pregnant people and infants are at risk of adverse health effects from climate change. These climate change-related outcomes include stillbirth, prematurity, low birth weight, congenital anomalies, and aberrant neurodevelopment. Pregnant people and infants are disproportionately affected by climate change, and it is crucial for perinatal healthcare providers to be well-informed about these impacts on patients and their families. Understanding climate change and its related health impacts requires extensive education targeting healthcare workers from medical school throughout their training, those in allied health fields, and those in the professional environment, via continuing educational opportunities. This perspective addresses content for a climate curriculum for perinatal professionals, including health effects, environmental and social justice, disaster planning, and strategies for preparing for and mitigating the impacts of worsening climate change. Further, we discuss the recent evolution of policies impacting climate and opportunities for advocacy.
OBJECTIVE: To explore neonatal nurse practitioners' (NNPs) perspectives on prolonged shift-length, fatigue, and strategies to support well-being and workforce sustainability. STUDY DESIGN: This qualitative study examined...OBJECTIVE: To explore neonatal nurse practitioners' (NNPs) perspectives on prolonged shift-length, fatigue, and strategies to support well-being and workforce sustainability. STUDY DESIGN: This qualitative study examined open-ended responses from a national mixed-methods survey of U.S. NNPs conducted between November 2024 and January 2025. Participants were board-certified NNPs practicing in neonatal intensive care units nationwide. RESULTS: Among 396 respondents, two themes emerged: individual-level and system-level strategies. Individual-level strategies included work-life balance, self-care, and adaptability. Prolonged shifts were viewed positively or neutrally when voluntary and associated with fewer workdays, continuity of care, and reduced commuting. System-level strategies included protected downtime, fatigue monitoring, and scheduling flexibility. Negative perceptions arose when extended shifts were inflexible or imposed, contributing to fatigue and decreased morale. CONCLUSION: Prolonged shifts present benefits and risks. Findings suggest that practitioner choice, protected rest, and organizational recognition of fatigue are essential to supporting NNP well-being, workforce sustainability, and safe neonatal care.
OBJECTIVES: Therapeutic hypothermia (TH) improves outcomes in infants ≥36 weeks with HIE, although safety at 35weeks remains uncertain. We compared TH utilization and associated outcomes in 35- versus 36-week infants wit...OBJECTIVES: Therapeutic hypothermia (TH) improves outcomes in infants ≥36 weeks with HIE, although safety at 35weeks remains uncertain. We compared TH utilization and associated outcomes in 35- versus 36-week infants with HIE. STUDY DESIGN: Using the 2016-2022 National Inpatient Sample, we identified 35- and 36-week infants with HIE. The primary outcome was in-hospital mortality; secondary outcomes included coagulopathy and other complications. Logistic regression adjusted for covariates; Cochran-Armitage tested trends in TH use. RESULTS: Among 1,397,680 infants, HIE occurred in 2354 (0.48%) at 35 weeks and 3972 (0.44%) at 36 weeks; in-hospital mortality was similar (9.98% vs 9.99%). TH was less frequently used at 35 weeks (19.8% vs 22.4%) but increased over time (p < 0.001). 35-week treated infants had higher unadjusted in-hospital mortality (10.3% vs 6.8%) and coagulopathy (28.7% vs 18.4%); adjusted in-hospital mortality did not differ. CONCLUSION: TH use at 35 weeks is increasing that was not associated with differences in in-hospital mortality. Prospective studies are needed to define its role.