OBJECTIVE: To evaluate whether the effect of late surfactant is modified by patent ductus arteriosus (PDA) status with respect to survival without bronchopulmonary dysplasia (BPD) in ventilated infants born <28 weeks' ge...OBJECTIVE: To evaluate whether the effect of late surfactant is modified by patent ductus arteriosus (PDA) status with respect to survival without bronchopulmonary dysplasia (BPD) in ventilated infants born <28 weeks' gestation. METHODS: Secondary analysis of the Trial of Late Surfactant (TOLSURF). A formal test of interaction between PDA presence and late surfactant, with respect to survival without BPD at 36 and 40 weeks' postmenstrual age (PMA), was performed. PDA presence was defined by PDA treatment, either medical or a ligation (definition A), or PDA ligation (definition B), during or after late surfactant administration. RESULTS: All 511 infants were included. No interaction was detected between a PDA and late surfactant for survival without BPD at 36 weeks' PMA (definition A: p = 0.41; definition B: p = 0.33), or at 40 weeks' PMA (definition A: p = 0.84; definition B: p = 0.42). CONCLUSION: PDA presence did not modify the effect of late surfactant for survival without BPD.
Proaño A, Green M, Zevallos Barboza A
… +3 more, Greenberg RG, Puopolo KM, Flannery DD
J Perinatol
· 2026 May · PMID 42009896
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OBJECTIVE: Very low birth weight (VLBW) infants are at risk for congenital and postnatally acquired cytomegalovirus (CMV). NICU utilization rates for anti-CMV active medications are unknown. We assessed utilization of th...OBJECTIVE: Very low birth weight (VLBW) infants are at risk for congenital and postnatally acquired cytomegalovirus (CMV). NICU utilization rates for anti-CMV active medications are unknown. We assessed utilization of these medications among VLBW infants admitted to NICUs across the U.S. over an 8-year period. METHODS: Repeated cross-sectional study using data from the Premier Healthcare Database, including inborn VLBW infants admitted to NICUs from 2016 to 2023. Daily pharmacy charge data were used to estimate the annual proportion of infants who received anti-CMV medications at least once. RESULTS: Among 75,731 VLBW infants admitted to 498 NICUs, 309 (0.4%) infants from 115 NICUs received anti-CMV medications; 228 infants received valganciclovir, 212 infants received ganciclovir. The proportion of VLBW infants receiving these medications was less than 1% annually. Most administrations started after 4 weeks (n = 261,84.5%). CONCLUSION: Usage of anti-CMV medications among VLBW infants in U.S. NICUs was low and usually administered after 4 weeks.
OBJECTIVE: We hypothesised that socioeconomic deprivation as determined by an area measure would be an important risk factor for preterm birth in a contemporary cohort. METHODS: A retrospective study was carried out acro...OBJECTIVE: We hypothesised that socioeconomic deprivation as determined by an area measure would be an important risk factor for preterm birth in a contemporary cohort. METHODS: A retrospective study was carried out across two tertiary maternity hospitals in Ireland between 2018 and 2022 representing approximately 27% of all births in Ireland. Non stillborn infants whose address could be matched to a small area deprivation index (Haase-Pratschke (HP) Index) were included in the analysis. A combination of non-parametric and parametric tests were used to examine the impact of socioeconomic deprivation. RESULTS: 80,231 births were identified from 2018 to 2022. After exclusion criteria were applied, 912 very preterm births were available for analysis. There was a significant difference in population distributions of area level socioeconomic measures of neonates born <32 weeks and those born >=32 weeks(p < 0·001). CONCLUSION: Socioeconomic deprivation remains an important determinant of very preterm birth although has limited effect on acute neonatal outcomes.
A prevalence rate of 8.8/1000 live-births for congenital heart disease has been reported. The clinical outlook of these infants is dependent on transition from intra-uterine life to postnatal life. Preterm infants are al...A prevalence rate of 8.8/1000 live-births for congenital heart disease has been reported. The clinical outlook of these infants is dependent on transition from intra-uterine life to postnatal life. Preterm infants are also commonly administered surfactant to manage respiratory distress syndrome. This physiology-based narrative describes optimal oxygen saturation, mechanical ventilation practices and circulatory imbalances that might happen after surfactant administration in preterm infants with congenital heart disease. Clinicians may consider higher oxygen requirement thresholds for surfactant therapy in this select cohort, in comparison to infants without congenital heart disease. The interplay between surfactant deficiency, surfactant replacement therapy, and the unique interaction with underlying congenital heart disease represents a knowledge gap. This perspectives article discusses the haemodynamic vulnerability of preterm infants and discusses the circulatory impact of surfactant in premature infants without and with structural heart disease. We provide physiology-based suggestions for duct-dependent lesions, parallel circulations and other structural heart disease.
BACKGROUND: Pulmonary vein stenosis (PVS) is increasingly recognized in preterm infants, yet data regarding characteristics and outcomes remain limited. METHODS: A review of hospitalizations from 50 children's hospitals...BACKGROUND: Pulmonary vein stenosis (PVS) is increasingly recognized in preterm infants, yet data regarding characteristics and outcomes remain limited. METHODS: A review of hospitalizations from 50 children's hospitals across the United States participating in the Pediatric Health Information System (PHIS) database was performed. We identified 268,461 pediatric patients (≤24 months of age) with a history of prematurity (<37 weeks' gestation) admitted between 2016 and 2024. PVS was identified in 703 (0.3%) using ICD-10 diagnosis code I28.8. RESULTS: Bronchopulmonary dysplasia, birthweight ≤1.5 kg, Oxygen and ventilator dependency at discharge, pulmonary hypertension, left-to-right shunt lesions, and necrotizing enterocolitis were associated with PVS. Interestingly, gestational age <28 weeks was not associated with PVS. Patients with PVS had higher in-hospital mortality (11.4% vs 2%, p < 0.01), longer hospitalization, and substantially higher adjusted hospitalization costs. After adjusting for prematurity and comorbidities, PVS remained associated with in-hospital mortality (OR 4.3, 95% CI 3.4-5.5, p < 0.01). CONCLUSION: PVS in preterm infants is associated with in-hospital mortality, morbidity, and resource utilization, highlighting the need for improved recognition and structured surveillance.
Premature infants are at higher risk of long-term clinical and developmental sequelae compared to their term counterparts. Specialized, multidisciplinary follow-up care for patients who are discharged from the neonatal i...Premature infants are at higher risk of long-term clinical and developmental sequelae compared to their term counterparts. Specialized, multidisciplinary follow-up care for patients who are discharged from the neonatal intensive care unit is essential; however, there remains significant fragmentation of health services along with geographic and socioeconomic inequities in access and outcomes, contributing to excess healthcare utilization and costs. Technology has the potential to optimize the provision of NICU follow-up care. Recent advances in artificial intelligence, digital health, and connected devices have created novel opportunities for enhanced family education and discharge planning, care coordination, remote patient monitoring, and neurodevelopmental surveillance. Successful adoption of these innovations depends on key operational capabilities, including family-centered design and alignment of payment models. In this Perspective article, we highlight emerging applications of technology-enabled care with an emphasis on pragmatic recommendations focused on care integration, implementation, and equity.
OBJECTIVE: To determine whether post-birth ampicillin levels in umbilical cord blood are affected by prenatal ampicillin administration dose. METHODS: From pregnant women with Group B streptococcus (GBS) colonization, 15...OBJECTIVE: To determine whether post-birth ampicillin levels in umbilical cord blood are affected by prenatal ampicillin administration dose. METHODS: From pregnant women with Group B streptococcus (GBS) colonization, 159 cord blood samples were prospectively collected at delivery and analyzed using liquid chromatography-mass spectrometry. RESULTS: Pharmacokinetic analysis revealed that maternal body mass index (BMI) negatively correlated with ampicillin levels of umbilical cord blood in pregnant women receiving at least 1 dose of 1-g ampicillin after a 2-g ampicillin loading dose (P = 0.005) and those who only received 2-g ampicillin(P = 0.044). The prophylaxis duration had no independent effect. Crucially, all samples exceeded bactericidal thresholds, even in women receiving only a single 2-g loading dose due to rapid delivery. The minimal concentration of ampicillin was 1.13 μg/mL in this cohort. CONCLUSION: The current intrapartum ampicillin regimens remain effective for preventing neonatal GBS infection regardless of maternal BMI or labor duration.
Venous access catheter insertion is a common invasive procedure for hospitalised neonates. In other populations catheter insertion is supported by evidence-based application of technologies. This scoping review aimed to...Venous access catheter insertion is a common invasive procedure for hospitalised neonates. In other populations catheter insertion is supported by evidence-based application of technologies. This scoping review aimed to examine literature about the use of technology in neonatal venous access insertion. Of the 7435 records returned, 91 studies, and 4 guidelines were included. Ultrasound was the most reported technology 81% (n = 74) followed by intracavity electrocardiogram 14% (n = 12). Comparison with gold standard measurement (x-ray) was undertaken in 72% (n = 66) of studies. Studies were predominately conducted on venous access catheters ending centrally 92% (n = 84), with the least studied venous access catheters being short and long peripheral intravenous catheters 7% (n = 7). Guidelines encouraged technology use but noted lack of high-level evidence. Ultrasound has increasing use and utility in neonatal central venous access, there lacks consensus on methods of use and measured outcomes with minimal current focus on the most common venous access catheters.
OBJECTIVE: To describe the incidence and risk factors of tracheitis following tracheostomy placement in infants. STUDY DESIGN: We performed a 14-year (2010-2023) retrospective cohort study of infants with a tracheostomy...OBJECTIVE: To describe the incidence and risk factors of tracheitis following tracheostomy placement in infants. STUDY DESIGN: We performed a 14-year (2010-2023) retrospective cohort study of infants with a tracheostomy placed in a Level IV Neonatal Intensive Care Unit. The primary outcome was tracheitis, defined by a combination of microbial, laboratory, or clinical evidence. RESULT: We identified 152 infants with a tracheostomy, of which 80 (52.6%) had post-operative tracheitis based on the study definition. Sixty-four (80%) infants with post-operative tracheitis had a positive tracheal colonization prior to tracheostomy. After controlling for demographics and variables associated with tracheitis in univariable analysis, days of pre-operative antibiotic administration was identified as protective against tracheitis (OR = 0.81, 95% CI = [0.69, 0.93], p = 0.004) in a multivariable analysis. CONCLUSION: The incidence of tracheitis in this cohort of infants following tracheostomy placement was 52.6%. Obtaining pre-operative tracheal cultures and initiating prophylactic antibiotics if positive may help prevent post-operative tracheitis.
Neurally Adjusted Ventilatory Assist (NAVA) is an innovative mode of ventilation that delivers support in synchrony with the infant's diaphragmatic electrical activity. This technology aims to improve patient-ventilator...Neurally Adjusted Ventilatory Assist (NAVA) is an innovative mode of ventilation that delivers support in synchrony with the infant's diaphragmatic electrical activity. This technology aims to improve patient-ventilator interaction, making its use in neonates with complex respiratory disease appealing. The use of NAVA in preterm infants is becoming more commonplace, but the specific role of NAVA in infants with established bronchopulmonary dysplasia (BPD), congenital diaphragmatic hernia (CDH), and those requiring extracorporeal membrane oxygenation (ECMO) support remain less clearly defined. Few studies have directly compared NAVA to conventional modes in those settings, but existing evidence suggests that NAVA may be feasible and beneficial, particularly by improving synchrony, reducing ventilator days, supporting post-extubation success, reducing sedation needs, and improving neurodevelopmental outcomes. We performed a narrative review of the current literature describing NAVA use in these three high-risk neonatal populations. Despite growing interest, high-quality evidence remains limited, and significant heterogeneity exists in the currently published literature. Further randomized prospective studies are needed to better define the role of NAVA in these complex patient populations and to evaluate long-term respiratory outcomes. This review aims to inform clinicians navigating the nuanced use of NAVA in advanced neonatal respiratory care.
Devlin LA, Kraft WK, Babineau DC
… +12 more, Rhodes E, Das A, Crawford M, Merhar S, Telang S, Leeman L, Sokol GM, Ambalavanan N, DeMauro SB, Hall RW, Lorch SA, HEAL Evaluation of Limited Pharmacotherapies for Neonatal Opioid Withdrawal Syndrome (HELP for NOWS) Consortium
J Perinatol
· 2026 Apr · PMID 41991673
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OBJECTIVE: To evaluate changes in hospital outcomes for infants with neonatal opioid withdrawal syndrome (NOWS) assessed by the Finnegan Tool before (10/1/2019 to 12/31/2019;pre-epoch) and after (7/1/2021 to 3/31/2022;po...OBJECTIVE: To evaluate changes in hospital outcomes for infants with neonatal opioid withdrawal syndrome (NOWS) assessed by the Finnegan Tool before (10/1/2019 to 12/31/2019;pre-epoch) and after (7/1/2021 to 3/31/2022;post-epoch) publication of the 2020 AAP NOWS clinical report. STUDY DESIGN: This subgroup analysis included infants with NOWS assessed with the Finnegan Tool and enrolled in the INFORM NOW study (pre- and post-epoch 183 and 267 infants respectively). RESULTS: No differences were found between epochs in initiation or length of pharmacologic treatment(LOT), or length of stay(LOS). Outcomes were modified by opioid type: LOT was 20% shorter (aMR=0.80; 95%CI:[0.69,0.93]) and LOS was 16% shorter (aMR=0.84; 95%CI:[0.73,0.96]) for buprenorphine treated infants post- compared to pre-epoch, while LOT and LOS were longer in the post-epoch for those treated with methadone. CONCLUSION: There was no difference in outcomes before and after publication of the AAP report. However, the type of postnatal opioid did modify study results.
OBJECTIVE: Furosemide is commonly prescribed in hospitalized infants with grade 2-3 bronchopulmonary dysplasia (BPD). Intravenous (IV), gastric, and duodenal administrations are common, with a 1:2 IV-to-enteral conversio...OBJECTIVE: Furosemide is commonly prescribed in hospitalized infants with grade 2-3 bronchopulmonary dysplasia (BPD). Intravenous (IV), gastric, and duodenal administrations are common, with a 1:2 IV-to-enteral conversion often used despite uncertain bioavailability. Our objective was to compare diuretic responses between routes in infants with BPD. STUDY DESIGN: Single-center observational cohort of very preterm infants with grade 2-3 BPD prescribed furosemide. The association between route (exposure) and diuretic response (change in net fluid balance after administration, outcome) was evaluated using multivariable regression adjusting for dosing and infant characteristics. RESULTS: Among 153 infants (median postmenstrual age of 43.3 weeks at exposure), furosemide reduced fluid balance by -25.6 (29.8) ml/kg/d. Adjusted mean changes were similar across routes: IV, -25.3 (-35.8, -14.7), gastric, -25.8 (-32.2, -19.4), and duodenal, -25.8 (-34.2, -17.4). CONCLUSIONS: Our data suggest a 1:2 IV-to-enteral conversion leads to comparable diuretic effects in infants with established BPD, supporting this common clinical practice.
OBJECTIVES: This study aims to compare the preterm infant care advice generated by ChatGPT with responses from neonatologists in an online medical consultation forum. STUDY DESIGN: This cross-sectional study involving 22...OBJECTIVES: This study aims to compare the preterm infant care advice generated by ChatGPT with responses from neonatologists in an online medical consultation forum. STUDY DESIGN: This cross-sectional study involving 22 evaluators (12 experienced neonatologists and 10 lay users) compared the responses of an AI chatbot (ChatGPT 4o) and online human experts to 60 preterm infant care-related questions from the "Doctor DingXiang" platform accessed in August 2024. Quantitative indicators, including readability, helpfulness, understandability, intent capture, empathy, actionability, accuracy and safety, were used for comparison. Qualitative content analyses were conducted to reveal further more detailed situational information about the differences between them. RESULTS: The mean[SD] score for ChatGPT was higher than human experts on the dimensions of helpfulness (4.07 [0.78] vs 3.50 [1.04]), understandability (4.12 [0.73] vs 3.70 [1.01]), intent capture (4.12 [0.75] vs 3.62 [1.01]), empathy (3.98 [0.73] vs 3.45 [1.05]), actionability (3.97 [0.83] vs 3.37 [1.11]), accuracy (3.97 [0.73] vs 3.32 [1.01]) and safety (3.96 [0.72] vs 3.37 [0.97]). (all P <.001) ChatGPT's responses had few instances of low ratings than human experts' responses. ChatGPT provided more comprehensive and elaborative information, though its responses exhibited higher semantic richness and were more difficult to read. In contrast, human experts were better at offering personalized advice and emotional support, adjusting responses based on specific contexts. CONCLUSION: ChatGPT can provide satisfactory responses to neonatal medical inquiries. However, further improvements are necessary to enhance the precision, decision support, and contextual awareness.
BACKGROUND: Very preterm (VPT) infants face an elevated risk of neurodevelopmental delays, yet early predictors of specific impairments are poorly understood. This study investigated how neonatal brain structure relates...BACKGROUND: Very preterm (VPT) infants face an elevated risk of neurodevelopmental delays, yet early predictors of specific impairments are poorly understood. This study investigated how neonatal brain structure relates to neurodevelopmental delays in VPT toddlers. METHODS: We analysed term-equivalent T2-weighted MRI scans from 352 VPT infants. Neurodevelopmental outcomes were assessed at 18-24 months using the Bayley Scales of Infant and Toddler Development-III. We used tensor-based morphometry to compare voxel-wise whole-brain volumes between infants with and without developmental delay. RESULTS: Toddlers with motor delays showed significantly reduced volume in the left posterior cerebellum at term compared to those without motor delays, even after adjusting for other domains. No significant volumetric differences were observed for cognitive or language delays. CONCLUSION: Reduced cerebellar volume at term is associated with motor delay in VPT toddlers. These findings highlight the cerebellum's key role in early motor development and the value of structural MRI for early risk stratification.
OBJECTIVE: Determine the association between persistent versus resolved microcephaly and motor developmental outcomes in infants with congenital microcephaly. STUDY DESIGN: Bayley Scales of Infant and Toddler Development...OBJECTIVE: Determine the association between persistent versus resolved microcephaly and motor developmental outcomes in infants with congenital microcephaly. STUDY DESIGN: Bayley Scales of Infant and Toddler Development were collected for all children with congenital microcephaly seen in a NICU Follow-Up Clinic 2015-2024. A linear mixed model was fit to assess the relationship between microcephaly (resolved vs. persistent) with respect to Bayley motor composite scores in the first year. RESULTS: Seventy-eight infants had head circumference measurements and Bayley motor composite scores at both visit 1 and visit 2. Infants with persistent microcephaly at 4-6 months had mean motor scores 12.07 (95% CI [-22.94, -1.19], p = 0.02) points lower than peers with resolved microcephaly. By 9-12 months, these differences were no longer significant. CONCLUSION: Persistent microcephaly was associated with lower motor development scores at 4-6 months compared to children with resolved microcephaly. This simple, anthropometric measurement may be useful in predicting early motor development.
OBJECTIVE: To compare outcomes in young adults born prematurely with and without symptomatic patent ductus arteriosus (PDA) during infancy. STUDY DESIGN: Young adults born preterm (≤32 weeks gestation; n = 107) were recr...OBJECTIVE: To compare outcomes in young adults born prematurely with and without symptomatic patent ductus arteriosus (PDA) during infancy. STUDY DESIGN: Young adults born preterm (≤32 weeks gestation; n = 107) were recruited from the Parkland Health Neonatal Intensive Care Unit (NICU) Registry and compared based on presence of symptomatic PDA during their NICU stay (n = 23 with PDA), defined as clinical evidence of large left-to-right shunt or congestive heart failure. RESULTS: Systolic blood pressure was similar, but the PDA group exhibited higher resting diastolic blood pressure (80 ± 10 versus 74 ± 12 mmHg, p = 0.02). Biventricular systolic function was similar. However, tissue Doppler imaging (TDI) velocities at the lateral/septal aspect of the mitral annulus were lower and RV end-diastolic diameter larger in the PDA group. CONCLUSIONS: Individuals born preterm with a symptomatic PDA exhibited elevated diastolic blood pressure, slightly lower diastolic function, and larger right ventricular size in early adulthood.
Ting JY, Sehgal A, Kuan MTY
… +4 more, Soraisham A, Vorhies E, Castaldo M, McNamara PJ
J Perinatol
· 2026 Jun · PMID 41981122
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OBJECTIVE: To determine the relationship between echocardiography indices of heart function and adverse short-term outcomes in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN: This was a retrospective co...OBJECTIVE: To determine the relationship between echocardiography indices of heart function and adverse short-term outcomes in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN: This was a retrospective cohort study of infants with CDH from four neonatal surgical centres between 2018 and 2021. Serial targeted neonatal echocardiography was performed to assess myocardial function. The composite primary outcome was death or invasive mechanical ventilation beyond postnatal day 14. RESULTS: We identified 44 infants, and 18 (40.9%) met the composite primary outcome. They had lower pre-operative left ventricular output (110 vs. 157 mL/kg/min, p = 0.002), right ventricular output (114 vs. 187 mL/kg/min, p = 0.008), and peak systolic myocardial velocities measured at the mitral annulus (4.6 vs. 5.4 cm/s, p = 0.006) and interventricular septum (4.2 vs. 4.8 cm/s, p = 0.001). They exhibited lower post-operative right ventricular output (155 vs. 237 mL/kg/min, p = 0.021) and lower myocardial velocities on tissue Doppler imaging. CONCLUSION: Echocardiographic assessments may provide critical prognostic information regarding post-operative respiratory trajectories.
OBJECTIVE: To characterize how autism spectrum disorder (ASD) risk varies with gestational age at birth. STUDY DESIGN: We conducted a retrospective cohort study of children born between 2011 and 2023. ASD was identified...OBJECTIVE: To characterize how autism spectrum disorder (ASD) risk varies with gestational age at birth. STUDY DESIGN: We conducted a retrospective cohort study of children born between 2011 and 2023. ASD was identified using ICD-10 codes. Each ASD case (n = 1861) was matched to ten controls using exact and propensity-score matching on sex, birth year, maternal age, ethnic sector, socioeconomic status, and region. Gestational age was grouped into clinically relevant categories, and associations with ASD were evaluated using Fisher's exact test and conditional logistic regression. RESULTS: ASD risk increased progressively with prematurity. Compared with term birth (37-42 weeks), adjusted odds ratios (95% CI) were 1.37 (1.10-1.71) at 36 weeks, 1.67 (1.30-2.15) at 34-35 weeks, 2.14 (1.43-3.18) at 32-33 weeks, 2.95 (1.89-4.59) at 28-31 weeks, and 4.37 (2.26-8.44) below 28 weeks. CONCLUSION: Earlier gestational age is associated with increased ASD risk in a dose-response manner.
ABSTARCTS:OBJECTIVE: To evaluate the association between orotracheal versus nasotracheal intubation route and unplanned extubation (UE) risk among infants. STUDY DESIGN: This retrospective cohort study included all trac...ABSTARCTS:OBJECTIVE: To evaluate the association between orotracheal versus nasotracheal intubation route and unplanned extubation (UE) risk among infants. STUDY DESIGN: This retrospective cohort study included all tracheal intubation (TI) events among infants admitted to a level IV NICU from 2022 to 2024. Kaplan-Meier survival analysis was used to assess UE risk by TI route. RESULT: There were 1160 TI events and 23 UEs during the study period. The UE rate was three times lower in the nasotracheal intubation group compared to orotracheal (0.01 vs. 0.03 per 100 ventilator days). UE risk was significantly higher in orotracheally intubated infants (p = 0.03) with no differences when stratified by sex, gestational age, or birth weight. CONCLUSION: Nasotracheal intubation was associated with lower UE risk in infants in a unit that predominantly performs nasotracheal intubation. Prospective randomized studies are needed to further investigate if TI route may contribute to fewer UEs in this population.