OBJECTIVE: This study evaluated clinical, laboratory, and ultrasonographic factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. STUDY DESIGN: This retrospective cohort study included 9...OBJECTIVE: This study evaluated clinical, laboratory, and ultrasonographic factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. STUDY DESIGN: This retrospective cohort study included 96 neonates hospitalized for unexplained hyperbilirubinemia requiring phototherapy. UTI was defined by pyuria (>5 WBC/high-power field) and growth of a single uropathogen (≥50,000 CFU/mL) from catheterized urine samples. Neonates were classified as UTI-positive (n = 30) or UTI-negative (n = 66). Demographic characteristics, bilirubin levels, inflammatory markers, and renal ultrasonography findings were compared. RESULTS: UTI was diagnosed in 31.2% of neonates. Bilirubin levels, white blood cell counts, and C- reactive protein concentrations did not differ between groups. Pathological renal ultrasonography findings were significantly more frequent in the UTI group and were independently associated with UTI (odds ratio 4.62; 95% CI 1.39-15.40). CONCLUSION: Renal ultrasonography findings are strongly associated with UTI in hospitalized neonates with unexplained hyperbilirubinemia and may serve as a useful adjunctive evaluation tool in this high-risk population.
OBJECTIVES: To determine whether temporal profiles of hypoxic-ischemic insult in neonatal encephalopathy (NE) were associated with outcomes, and to assess their prognostic value. STUDY DESIGN: Infants with mild, moderate...OBJECTIVES: To determine whether temporal profiles of hypoxic-ischemic insult in neonatal encephalopathy (NE) were associated with outcomes, and to assess their prognostic value. STUDY DESIGN: Infants with mild, moderate and severe NE treated with hypothermia were included. Placental histopathology, maternal risk factors, and neonatal clinical, biochemical, electrographic, and neuroimaging data were used to classify infants into proximal, distal, and proximal-on-distal profiles. Neurodevelopmental outcomes were assessed at 18 months. RESULTS: Ninety-eight infants were included (34 distal, 43 proximal, 21 proximal-on-distal). Mortality and composite adverse outcomes were similar between distal-predominant and proximal-predominant groups. Timing of insult profiles was not associated with adverse outcome, whereas the deep gray matter injury subscore independently predicted adverse outcome (aOR 1.36, 95% CI 1.15-1.59; p < 0.001) with an area under the curve of 0.89. CONCLUSION: Perinatal timing of insult profiles did not demonstrate prognostic significance after accounting for NE severity, while MRI-defined injury burden provided the strongest prognostic value. IMPACT: Integrating placental pathology with neonatal neuroimaging provides valuable mechanistic insight but limited prognostic value for outcome prediction across the full spectrum of neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy. Once neonatal encephalopathy occurs, outcomes are primarily driven by the severity of the hypoxic-ischemic insult. Timing of insult (proximal versus distal) was not associated with mortality, brain injury severity, or neurodevelopmental outcomes in infants with neonatal encephalopathy treated with therapeutic hypothermia.
OBJECTIVE: To assess the efficacy and safety of maternal respiratory syncytial virus (RSV) vaccination on infant and perinatal outcomes. STUDY DESIGN: Systematic review and random-effects meta-analysis of randomized cont...OBJECTIVE: To assess the efficacy and safety of maternal respiratory syncytial virus (RSV) vaccination on infant and perinatal outcomes. STUDY DESIGN: Systematic review and random-effects meta-analysis of randomized controlled trials (PubMed, Embase, CENTRAL). Six trials (18,011 pregnant women; 17,769 infants) comparing maternal RSV vaccines with placebo were included. Effects were pooled as risk ratios (RR). RESULTS: Maternal RSV vaccination reduced severe RSV-associated lower respiratory tract infection (LRTI) (RR 0.35, 95% CI 0.15-0.87) and hospitalization (RR 0.53, 95% CI 0.37-0.76) within 180 days of birth. Medically attended RSV-LRTI was lower but imprecise (RR 0.47, 95% CI 0.18-1.21). No safety signal was observed for preterm birth (RR 1.15, 95% CI 0.95-1.38), low birth weight, or congenital malformations. CONCLUSION: Maternal RSV vaccination reduces severe infant RSV disease and RSV-related hospitalization with a reassuring perinatal safety profile. TRIAL REGISTRATION: PROSPERO CRD42025636472.
OBJECTIVE: Determine prenatal and neonatal factors that predict infantile outcomes in patients with congenital heart disease (CHD). STUDY DESIGN: Retrospective cohort of 415 neonates with CHD admitted to a neonatal inten...OBJECTIVE: Determine prenatal and neonatal factors that predict infantile outcomes in patients with congenital heart disease (CHD). STUDY DESIGN: Retrospective cohort of 415 neonates with CHD admitted to a neonatal intensive care unit (NICU). Statistical tests included Chi-square, Fisher's Exact, Kruskal-Wallis, and multivariable logistic regression. RESULTS: Cardiac lesion type was associated with mortality, length of stay, and enteral feeding tube support at discharge (EFTD) (p ≤ 0.01). A genetic diagnosis and an extra-cardiac congenital anomaly were associated with higher odds of respiratory support needs at discharge (RSND) [OR 2.8 (95% CI: 1.2, 6.5); 4.8 (1.9, 11.8)] and EFTD [5.5 (2.9, 10.8); 3.4 (2.4-9.7)]. Lower birth weight was associated with higher odds of RSND [0.5 (0.38, 0.66)], and lower gestational age with higher odds of EFTD [0.84 (0.75, 0.95)]. CONCLUSION: Several factors predicted adverse outcomes in infants with CHD, helping to identify high-risk cases for targeted care and improved parental guidance.
Mental health conditions are a leading cause of maternal mortality. Although guidance exists for perinatal mental health screening frequency, the implementation of these guidelines can vary significantly for patients. In...Mental health conditions are a leading cause of maternal mortality. Although guidance exists for perinatal mental health screening frequency, the implementation of these guidelines can vary significantly for patients. Inpatient admissions represent an opportunity for screening that benefits both patients and hospital metrics. A quality improvement team of clinical and administrative personnel implemented a process improvement approach to improve frequency of behavioral health evaluations prior to hospital discharge following elevated depression screening response. Through clinical service foundation, nursing workflow adaptation, and automatic notification of elevated screening responses, the team was able to significantly improve evaluation frequency. The proportion of patients evaluated after an elevated screening increased from ~20% prior to interventions to >80% by conclusion of process improvement project. These results underscore the importance of behavioral health provider integration into obstetric settings and the role of technology in automating screening protocols to enhance patient care.
As artificial womb technology (AWT) nears clinical translation for extreme prematurity, ethical interest has grown. To characterize this ethical landscape, we conducted a scoping review of ethical considerations of AWT s...As artificial womb technology (AWT) nears clinical translation for extreme prematurity, ethical interest has grown. To characterize this ethical landscape, we conducted a scoping review of ethical considerations of AWT searching Medline, Embase, and Web-of-Science through March 2025. Ethical considerations were extracted and organized using thematic analysis. In total, 247 papers were included: 114 (46.2%) focused on AWT for extreme prematurity and 133 (53.8%) on futuristic complete ectogenesis. Most papers were authored by bioethics scholars (157/247, 63.5%), and within this group, the majority addressed complete ectogenesis (98/157, 62.4%). Seven thematic categories were identified: Benefits and Harm; Decision-making; Moral and Legal Status; Justice and Access; Cultural and Societal Perspectives; Research Ethics and Speculative Concerns. Overall, AWT ethics literature is divided between concerns about "complete ectogenesis" and use for extreme prematurity. Insights from clinically focused literature and comprehensive stakeholder engagement are essential for ethical guidance of impending clinical translation of AWT.
OBJECTIVE: To evaluate the impact of a respiratory care protocol (RCP) including stepwise escalation of continuous positive airway pressure (CPAP) guided by FiO and less invasive surfactant administration (LISA) in infan...OBJECTIVE: To evaluate the impact of a respiratory care protocol (RCP) including stepwise escalation of continuous positive airway pressure (CPAP) guided by FiO and less invasive surfactant administration (LISA) in infants born at 30-34 weeks' gestational age (GA). METHODS: We compared maternal and neonatal variables between cohorts of preterm infants born January 2017-Sept 2018, (pre-RCP) and Oct 2018-Dec 2020 (post-RCP). Infants receiving CPAP for ≥24 h were included and infants intubated at birth were excluded. RESULTS: Compared to pre-RCP (n = 325), the post-RCP (n = 395) cohort had higher exposure to antenatal steroid, lower median GA, and received higher CPAP in the delivery room, at admission, and before surfactant therapy. Similarly, the need for mechanical ventilation was lower within the first 72 h of life and during the hospital stay in the post -RCP cohort. CONCLUSION: Implementation of an RCP decreased the need for mechanical ventilation in 30-34 weeks' GA infants.
OBJECTIVE: To assess whether early hypernatremia (HN) and/or hyperglycemia (HG) in the first postnatal week are associated with adverse neurodevelopmental outcomes in extremely preterm (EP; <28 weeks) infants. STUDY DESI...OBJECTIVE: To assess whether early hypernatremia (HN) and/or hyperglycemia (HG) in the first postnatal week are associated with adverse neurodevelopmental outcomes in extremely preterm (EP; <28 weeks) infants. STUDY DESIGN: This was a single-center retrospective cohort study. HN is defined as serum sodium > 145 mmol/L and HG as blood glucose > 10 mmol/L within days 0-7. Infants were classified into HN, HG, or combined HN + HG groups; EP infants without HN/HG served as controls. This study included 748 EP infants: 374 with HN and/or HG and 374 controls. The primary outcome was an adverse neurodevelopmental outcome at 2 years' corrected age. RESULTS: On adjusted analyses, HN, HG and HN + HG were not associated with moderate-to-severe developmental impairment. Moderate-to-severe HN group showed a lower odds of moderate-to-severe developmental impairment than controls (18.3% vs 21.5%; adjusted OR 0.39, 95% CI 0.15-0.99; p = 0.047). CONCLUSIONS: Early hypernatremia and/or hyperglycemia were not associated with adverse neurodevelopment at 2 years' corrected age.
OBJECTIVE: To evaluate the correlation and agreement between the Oxygen Saturation Index (OSI) and Oxygenation Index (OI), and between the SpO/FiO ratio (S/F) and PaO/FiO ratio (P/F) in neonates with persistent pulmonary...OBJECTIVE: To evaluate the correlation and agreement between the Oxygen Saturation Index (OSI) and Oxygenation Index (OI), and between the SpO/FiO ratio (S/F) and PaO/FiO ratio (P/F) in neonates with persistent pulmonary hypertension (PPHN), and to identify noninvasive thresholds for clinical use. STUDY DESIGN: This retrospective study analyzed 2717 paired arterial blood gas and SpO measurements from 377 PPHN infants treated at a tertiary NICU (2012-2021). Correlation (Spearman), linear mixed-effects models (LMMs), Bland-Altman agreement, and ROC analyses were performed across SpO strata. RESULTS: OSI strongly correlated with OI (r = 0.93), and S/F with P/F (r = 0.84), with best performance at SpO ≥80%. Agreement declined under severe hypoxemia. ROC analysis showed excellent discrimination for OSI (AUC > 0.96) and good performance for S/F (AUC up to 0.96). CONCLUSION: OSI and S/F are reliable noninvasive surrogates for invasive oxygenation indices when SpO ≥ 80% and may help reduce arterial sampling in PPHN monitoring.
OBJECTIVE: To characterize availability, utilization, and barriers to bowel ultrasound (BUS) for necrotizing enterocolitis (NEC). METHODS: A survey of neonatologists, surgeons, and radiologists at Children's Hospitals' N...OBJECTIVE: To characterize availability, utilization, and barriers to bowel ultrasound (BUS) for necrotizing enterocolitis (NEC). METHODS: A survey of neonatologists, surgeons, and radiologists at Children's Hospitals' Neonatal Consortium (CHNC) sites. Quantitative data were analyzed descriptively; open-ended responses underwent thematic analysis. RESULTS: In total, 104 respondents from 42/46 institutions participated. BUS was available at 83% of level IV NICU sites, with 64% reporting 24/7 availability. However, only 42% of affiliated level III NICUs had BUS available. BUS was primarily used alongside radiographs in cases of diagnostic uncertainty and variably used to guide surgical decisions. Radiologists frequently used protocols while neonatologists and surgeons reported limited training and few institutional guidelines. Key barriers included lack of standardization, inadequate training, and unclear clinical utility. CONCLUSION: BUS is increasingly available in level IV NICUs but less so in level III NICUs. Even when available, clinical integration is inconsistent due to gaps in standardization, training, and supporting evidence.
We sought to characterize bedside nurses' perceptions of providing intensive care to patients with trisomy 18 (T18) in a level IV neonatal intensive care unit (NICU). NICU nurses were anonymously surveyed with an electro...We sought to characterize bedside nurses' perceptions of providing intensive care to patients with trisomy 18 (T18) in a level IV neonatal intensive care unit (NICU). NICU nurses were anonymously surveyed with an electronic, mixed-methods survey. Items included quantitative questions about whether T18 is "incompatible with life," whether interventions should be offered, open-ended free-text questions, and demographic items. Survey results were analyzed with descriptive statistics and thematic analysis. There were 145 responses (response rate 46%). Most (53%) agreed that T18 was "incompatible with life", and 59% felt that this diagnosis should impact interventions offered. Two major themes emerged from 114 free-text responses, including "perceptions of prognosis" and "ethical considerations." Though most nurses believe that T18 is "incompatible with life" and interventions should be restricted, a substantial minority endorse other perspectives. A range of ethical considerations shape nurses' diverse views, suggesting that they are morally rooted and may contribute to ethical distress.
Graf RJ, Edwards A, Crowley MA
… +2 more, Mukherjee D, Ryan RM
J Perinatol
· 2026 May · PMID 41946930
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Full text
OBJECTIVE: We aimed to investigate the time to positivity of blood cultures in our NICU to determine if we can better inform empiric antibiotic duration decisions in both early-onset (≤72 h) and late-onset (>72 h) sepsis...OBJECTIVE: We aimed to investigate the time to positivity of blood cultures in our NICU to determine if we can better inform empiric antibiotic duration decisions in both early-onset (≤72 h) and late-onset (>72 h) sepsis evaluations. STUDY DESIGN: Retrospective review of all positive blood cultures isolated from infants admitted to the Rainbow Babies and Children's Hospital NICU from July 1, 2018 to July 1, 2023. RESULT: There were 264 positive blood cultures from 125 infants with a median postmenstrual age of 30.9 weeks. The vast majority (86%) of positive cultures were obtained during the late-onset sepsis period. Gram-negative bacteria grew faster than gram-positive bacteria. Overall, 84% of blood cultures for all pathogenic bacteria (excluding coagulase-negative staph, fungi, and likely contaminants) were positive by 24 h. CONCLUSION: Our data do not support discontinuing empiric antibiotics at 24 h as our a priori target of 90% positivity was not met. These results underline the importance of evaluating an individual NICU's data before implementing a practice change.
OBJECTIVE: To evaluate reviews focused on adult outcomes of patients with complex neonatal history. STUDY DESIGN: We searched multiple databases in January 2022 and supplemented by hand searching references in included r...OBJECTIVE: To evaluate reviews focused on adult outcomes of patients with complex neonatal history. STUDY DESIGN: We searched multiple databases in January 2022 and supplemented by hand searching references in included reviews. Two authors assessed reviews for eligibility. Data were extracted by one author, verified by a second. Counts based on neonatal exposure, adult outcome, and journal type for each review were calculated. RESULTS: Eight-seven reviews were included. Most focused on prematurity. The most common adult outcome assessed was cardiovascular. Papers shifted to publication in pediatric journals over the last decade. Gaps include a lack of reviews focused on those with a history of substance exposure in utero and a lack of reviews on adult autoimmune conditions and gynecologic outcomes. CONCLUSION: Reviews of adult outcomes of those with complex neonatal history have moved to publication in pediatric journals recently. We identified gaps in both pediatric populations and adult outcomes assessed.
INTRODUCTION: We examined associations of maternal sociodemographic factors and the Social Vulnerability Index (SVI) with NICU family presence and engagement (breastfeeding, skin-to-skin care, and receipt of discharge te...INTRODUCTION: We examined associations of maternal sociodemographic factors and the Social Vulnerability Index (SVI) with NICU family presence and engagement (breastfeeding, skin-to-skin care, and receipt of discharge teaching 48 h prior to discharge). METHODS: Data was abstracted from medical records at six Massachusetts NICUs participating in a family engagement quality collaborative from 2021-2022. Sociodemographic factors included maternal race and ethnicity, language and insurance. SVI was determined from maternal zip code. We used mixed-effects logistic regression, accounting for clustering by hospital and multiple gestation and adjusting for covariates. RESULTS: Among 450 mother-infant dyads, infants with non-Hispanic Black compared to non-Hispanic White mothers had lower odds of family presence. Public insurance and higher SVI were associated with lower odds of receiving mother's milk at discharge. CONCLUSIONS: Family characteristics linked to social disadvantage were associated with less NICU family presence and engagement, underscoring the need for interventions to improve equitable NICU family engagement.
OBJECTIVE: To evaluate whether late-onset fetal growth restriction (LO-FGR) is associated with distinct alterations in cortical sulcation and midline brain structures compared with small-for-gestational-age (SGA) and app...OBJECTIVE: To evaluate whether late-onset fetal growth restriction (LO-FGR) is associated with distinct alterations in cortical sulcation and midline brain structures compared with small-for-gestational-age (SGA) and appropriately grown (AGA) fetuses, and to examine how these changes relate to cerebroplacental redistribution. STUDY DESIGN: This prospective cross-sectional study included 84 LO-FGR, 64 SGA, and 120 AGA fetuses examined between 32 and 36 weeks' gestation. Targeted neurosonography assessed cortical sulcation, corpus callosum length, and cranio-cortical width, together with Doppler evaluation of the cerebroplacental ratio (CPR). RESULTS: LO-FGR fetuses demonstrated shallower Sylvian fissures, shorter corpus callosum length, increased insular depth, and wider lateral cranio-cortical width compared with both SGA and AGA fetuses (all p < 0.001). These neurosonographic differences were more pronounced in the presence of abnormal CPR. CONCLUSION: LO-FGR is associated with specific cortical and midline brain alterations distinct from both SGA and AGA, with the severity of these changes modulated by cerebroplacental redistribution.