OBJECTIVES: To compare the incidence of meconium aspiration syndrome (MAS) among neonates born through meconium-stained amniotic fluid (MSAF) before and after discontinuation of endotracheal suctioning for non-vigorous n...OBJECTIVES: To compare the incidence of meconium aspiration syndrome (MAS) among neonates born through meconium-stained amniotic fluid (MSAF) before and after discontinuation of endotracheal suctioning for non-vigorous neonates. METHODS: We conducted a multicenter retrospective cohort study across three centers comparing two eras. Neonates born through MSAF at ≥36 weeks' gestation were included. Multivariable regression adjusted for sex and birth center. RESULTS: Among 8635 neonates (5554 Era 1; 3081 Era 2), including 1053 non-vigorous neonates, unadjusted MAS incidence did not differ between eras overall (4.8% vs. 5.5%, p = 0.17) or among non-vigorous neonates (21.0% vs. 22.8%, p = 0.55). After adjustment, Era 2 was associated with higher odds of MAS overall (aOR 1.37, 95% CI 1.11-1.69) and among non-vigorous neonates (aOR 1.54, 95% CI 1.07-2.22). Respiratory distress was higher in Era 2, while other outcomes assessed were unchanged. CONCLUSIONS: Discontinuation of routine suctioning was associated with increased MAS incidence among neonates born through MSAF.
OBJECTIVE: To evaluate the efficacy and safety of Tumguide®, a radiation-free, transillumination-guided system for gastric tube (GT) placement in neonates. STUDY DESIGN: This single-center prospective observational study...OBJECTIVE: To evaluate the efficacy and safety of Tumguide®, a radiation-free, transillumination-guided system for gastric tube (GT) placement in neonates. STUDY DESIGN: This single-center prospective observational study enrolled neonates requiring GT placement. Tumguide® was used to guide placement. Primary outcomes were intragastric placement success rate and accuracy, defined as radiographically confirmed positioning not requiring adjustment. RESULTS: A total of 71 procedures were performed in 55 neonates. Median gestational age was 37.1 weeks, and median birth weight was 2480 g. The overall intragastric placement success rate was 99%, with 73% accuracy. No adverse events were reported. Protocol modifications significantly improved accuracy from 17% to 85% (p < 0.001). Tumguide® maintained high accuracy across varying body weights. CONCLUSIONS: Tumguide® enables accurate and successful GT placement in neonates. Its real-time visualization and compatibility with small-caliber tubes support its utility as a practical alternative to traditional methods. CLINICAL TRIAL REGISTRATION (IF ANY): This study was registered in the University Hospital Medical Information Network Clinical Trials Registry in Japan (ID: UMIN000055947, URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000063917 ).
Stefanescu BM, Deford AB, Boyd LJ
… +4 more, Cromlich AE, Henderson-Sears SE, Bruckman HJ, O'Neill SR
J Perinatol
· 2026 Jun · PMID 41912709
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OBJECTIVES: To determine the impact of an automated patient engagement solutions (APES) pathway at discharge on parental communication and length of stay (LOS) compared to traditional approach. STUDY DESIGN: This quasi-e...OBJECTIVES: To determine the impact of an automated patient engagement solutions (APES) pathway at discharge on parental communication and length of stay (LOS) compared to traditional approach. STUDY DESIGN: This quasi-experimental study took place in a level 4 neonatal intensive care unit. The APES at discharge (APES-D) pathway was implemented on January 18, 2022. Infants admitted in year prior formed the Pre-Intervention group. Post-implementation infants were categorized as APES-D Users (opted in) or Non-users (opted out). RESULTS: Pre-Intervention and APES-D groups had similar LOS (p = 0.54). APES-D Users had shorter LOS than APES-D Non-users (p = 0.007) and Pre-Intervention and APES-D Non-users combined (p = 0.03). Time between discharge document completion and actual discharge was longer in APES-D (p < 0.001). Commercial insurance was associated with shorter LOS (p < 0.001). Among APES-D Users, 91.7% engaged with the platform. CONCLUSION: APES-D was associated with high parental engagement and shorter LOS, but usage varied by social determinants, warranting further study.
OBJECTIVE: Describe the well-being of parents of infants during intensive care unit (ICU) admission through 6 months after discharge. STUDY DESIGN: Cohort study of infants with neurological conditions admitted to the ICU...OBJECTIVE: Describe the well-being of parents of infants during intensive care unit (ICU) admission through 6 months after discharge. STUDY DESIGN: Cohort study of infants with neurological conditions admitted to the ICU between 2018 and 2020 whose parents completed surveys at enrollment, discharge, and 6 months after discharge. RESULTS: 40 mothers and 21 fathers of 40 infants were enrolled. Abnormal anxiety scores were most common at enrollment for mothers (58%), and at 6 months post discharge for fathers (71%). Abnormal sleep was most common at enrollment for mothers (75%), and at discharge for fathers (73%). Post traumatic stress disorder (PTSD) scores were abnormal for 47% of mothers and 33% of fathers. CONCLUSION: Parents of infants with neurologic conditions are at risk of poor well-being, including symptoms of anxiety, PTSD, and impaired physical function. Further studies assessing the optimal timing for interventions are needed to improve parental well-being.
Infants in a neonatal intensive care unit (NICU), out of all hospitalized patients, are among those with the highest likelihood of receiving blood products. Because liberal transfusion strategies can be harmful, transfus...Infants in a neonatal intensive care unit (NICU), out of all hospitalized patients, are among those with the highest likelihood of receiving blood products. Because liberal transfusion strategies can be harmful, transfusion risks should be weighed against potential benefits. In the adult population, implementing electronic clinical decision support (CDS) tools for transfusion have resulted in decreased transfusion rates, conservation of resources, and lower costs. The NICU at the University of Utah Hospital has transfusion guidelines, but a recent audit indicated that a considerable proportion of transfusions were not compliant. Clinicians indicated that one reason for guideline deviation is not having guidelines immediately available in a timely reminder during the transfusion ordering process. Therefore, we built a new electronic transfusion CDS tool for our NICU. To our knowledge, this is the first report of an electronic health record-based CDS tool for both red blood cell and platelet transfusions in a NICU.
OBJECTIVE: Develop a birth anthropometry-based model to estimate initial endotracheal tube (ETT) insertion depth for infants with birth weight <500 g. STUDY DESIGN: Retrospective single center cohort (2010-2025) includin...OBJECTIVE: Develop a birth anthropometry-based model to estimate initial endotracheal tube (ETT) insertion depth for infants with birth weight <500 g. STUDY DESIGN: Retrospective single center cohort (2010-2025) including infants with birth weight <500 g, intubated on day 0 and underwent a postintubation chest radiograph. Adequate depth was defined as lip-to-tip placement between the upper border of T1 and the lower border of T2. Linear and quadratic models using birth weight and length were compared; the final model was presented as a bedside nomogram. RESULT: Eighty-two infants met the inclusion criteria. Birth weight and length independently predicted radiograph-derived optimal depth (p < 0.001). A combined quadratic model showed the strongest fit (adjusted R² = 0.70), outperforming single parameter rules. CONCLUSION: In neonates <500 g, a quadratic weight-length model improves the prediction of radiograph-defined midtracheal ETT depth and offers a practical bedside guide for initial placement.
OBJECTIVE: The pressure amount and fluctuations delivered to the nasopharynx by bubble CPAP (BCPAP) is affected by the nasal interface, but the clinical effects of transmitted pressure fluctuations from BCPAP are unknown...OBJECTIVE: The pressure amount and fluctuations delivered to the nasopharynx by bubble CPAP (BCPAP) is affected by the nasal interface, but the clinical effects of transmitted pressure fluctuations from BCPAP are unknown. STUDY DESIGN: Retrospective study of 2432 infants < 33 weeks GA had respiratory variables electronically extracted for: 1) delivery room, 2) initial 72 h, 3) after extubation, and 4) 31 weeks PMA. BCPAP nasal interfaces (RAM® cannula and Babi.Plus) for different bottle pressures (5/6 of 7/8 cmHO) were compared. RESULTS: RAM5/6 had more CPAP failures than RAM7/8 or Babi5/6. Babi5/6 had less CPAP failure in first 72 h in NICU, but RAM7/8 had less in DR. Less infants failed CPAP at extubation in Babi5/6 due to decreased apnea events. CONCLUSION: At similar transmitted nasopharyngeal pressures, Babi.Plus had less CPAP failure and apnea than RAM in NICU, whereas the ease of application of RAM may help in delivery room.
OBJECTIVE: To assess current practices in the diagnosis, monitoring, and follow-up of neonatal AKI across Canadian tertiary neonatal units. STUDY DESIGN: A seven-item electronic survey was distributed to members of the C...OBJECTIVE: To assess current practices in the diagnosis, monitoring, and follow-up of neonatal AKI across Canadian tertiary neonatal units. STUDY DESIGN: A seven-item electronic survey was distributed to members of the Canadian Neonatal Network between December 2023 and January 2024. RESULTS: Of the 32 units contacted, 26 (81.3%) responded. On-site nephrology consultation was available at 15/26 sites (57.7%). Only 5 sites (19.2%) actively tracked AKI incidence in infants born < 33 weeks' gestation. Wide variation was observed in AKI definitions, monitoring practices, and follow-up protocols. Serum creatinine was measured prior to initiating non-steroidal anti-inflammatory drugs at 15 sites (57.7%), and 11 sites (42.3%) monitored creatinine when urine output fell below 0.5 mL/kg/hour. CONCLUSIONS: Substantial variability exists in the identification and monitoring of neonatal AKI among Canadian NICUs. Standardized diagnostic criteria and follow-up strategies are needed to improve early detection and optimize long-term renal outcomes.
OBJECTIVE: To describe SARS-CoV-2 serologic status, associated factors, and neonatal transmission following gestational COVID-19. STUDY DESIGN: Prospective cohort study including neonates born to mothers with gestational...OBJECTIVE: To describe SARS-CoV-2 serologic status, associated factors, and neonatal transmission following gestational COVID-19. STUDY DESIGN: Prospective cohort study including neonates born to mothers with gestational COVID-19 at Hospital del Mar (Barcelona) between March 2020 and May 2022. RESULTS: A total of 263 infants and 261 mothers were included. High seropositivity was observed in infected mothers (88.9%) and their newborns (82.8%), particularly following early gestational and mild-to-moderate infections and among vaccinated mothers. Higher placental antibody transfer ratios were observed in earlier maternal infections. However, a longer infection-to-delivery interval increased transfer ratios only for anti-nucleocapsid antibodies. Neonatal antibodies persisted for at least six months. Only 6.1% of neonates born to mothers with active infection tested positive, with no evidence of congenital transmission. CONCLUSIONS: SARS-CoV-2 antibody placental transfer is frequent and efficient, conferring passive immunity during the first six months of life. Neonatal infection rate was low and attributable to horizontal transmission.
BACKGROUND/OBJECTIVES: We describe the outcomes of pulmonary vein stenosis treatment in a cohort of premature infants using an assertive percutaneous management strategy with echocardiography as the primary method of sur...BACKGROUND/OBJECTIVES: We describe the outcomes of pulmonary vein stenosis treatment in a cohort of premature infants using an assertive percutaneous management strategy with echocardiography as the primary method of surveillance. SUBJECTS/METHODS: This retrospective study included fifteen premature infants (median 24 weeks gestational age) that underwent pulmonary vein intervention from 2018-2023. The primary outcome was patient survival rate, and the secondary outcome was pulmonary vein preservation rate. RESULTS: The estimated patient survival was 100% and 89% at 1 and 2 years after diagnosis. The pulmonary vein preservation rate was 88% and 83% at 1 and 2 years. Patients received a median of 4 echocardiograms between each cardiac catheterization and an average of 1 CT scan for every 1.5 years of observation. CONCLUSIONS: Pulmonary vein stenosis can be successfully managed with a percutaneous approach to pulmonary vein rehabilitation using echocardiography for surveillance, even in extremely premature infants.
Donahue M, Heil MR, Camerota M
… +3 more, Dansereau L, Conradt E, Lester B
J Perinatol
· 2026 Jun · PMID 41862592
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OBJECTIVE: Examine whether neonatal neurobehavioral profiles are related to need for pharmacological treatment among infants with prenatal opioid exposure. STUDY DESIGN: Prospective cohort study of 217 infants with need...OBJECTIVE: Examine whether neonatal neurobehavioral profiles are related to need for pharmacological treatment among infants with prenatal opioid exposure. STUDY DESIGN: Prospective cohort study of 217 infants with need for treatment determined using the Finnegan Neonatal Abstinence Tool (FNAST), Neonatal Withdrawal Inventory (NWI), or Eat Sleep Console (ESC). Neurobehavior was assessed with the NeoNatal Neurobehavioral Scale II (NNNS-II). Latent Profile Analysis (LPA) classified infants into neurobehavioral profiles, and logistic regression assessed the association between NNNS-II profiles and need for treatment. RESULTS: A 3-profile LPA solution best fit the NNNS-II data comprised of typical (67%), hyper-aroused (19%) and hypo-aroused groups (15%). Infants with atypical NNNS-II profiles were more likely to receive treatment (OR = 3.45, 95% CI 1.21-9.81) compared to infants with typical profiles (p < 0.05). CONCLUSION: Newborn neurobehavioral profiles may aid in early identification of infants requiring pharmacological treatment for opioid withdrawal, reducing length of stay and healthcare costs.
OBJECTIVE: Placement of a GT after a ventriculoperitoneal shunt (VPS) is a known risk factor for VPS infection, but the timing and sequence between procedures is poorly delineated in the neonatal population. The aims of...OBJECTIVE: Placement of a GT after a ventriculoperitoneal shunt (VPS) is a known risk factor for VPS infection, but the timing and sequence between procedures is poorly delineated in the neonatal population. The aims of this study were (1) determine the rate of meningitis in infants with a VPS and GT compared to VPS, (2) identify meningitis pathogens, and (3) define the optimal sequence and timing between placement of VPS and GT to minimize device-associated infections. STUDY DESIGN: This retrospective cohort study includes infants with VPS placement from two level IV NICUs from January 1, 2010 to August 31, 2022. Infants with VPS placed for all causes of hydrocephalus were included. We compared infants with and without GTs, defined as gastrostomy or gastrojejunostomy tubes. The outcome of VPS-associated meningitis was defined by positive cerebral spinal fluid culture after VPS placement. RESULT: The incidence of VPS-associated meningitis in VPS and GT infants was 10.6% versus 3.4% in VPS only infants (p = 0.013, OR 0.3, 95% CI 0.12, 0.86). Pseudomonas species were the most common etiology of meningitis in VPS and GT infants while enterococcus was the most the common pathogen in VPS only cohort. In the subgroup of infants with VPS and GT, there was no statistical difference in rates of VPS-associated meningitis in those with VPS placed first and those with GT placed first. CONCLUSION: In infants with hydrocephalus requiring VPS, GT placement was a risk factor for VPS-associated meningitis and may impact pathogenic cause of meningitis. Larger, multicenter cohorts may be helpful to determine optimal sequence and timing of VPS and GT placement in these high-risk infants.
Health insurance coverage is a determinant of access to care, particularly for high-risk patients or those with chronic diseases. Medicaid is the largest insurer of children and state-based differences in eligibility req...Health insurance coverage is a determinant of access to care, particularly for high-risk patients or those with chronic diseases. Medicaid is the largest insurer of children and state-based differences in eligibility requirements often lead to lapses in coverage in early childhood. In recent months, several states have initiated continuous coverage provisions with Medicaid, allowing eligible children to be insured until ages 3-5 years without the need for re-enrollment. We review data on the association of insurance coverage with health outcomes for children and suggest continuous coverage policies may benefit medically-complex graduates of neonatal intensive care units (NICU), highlighting the need for neonatologists to be vocal advocates for states to adopt this pattern of coverage.
Vance AJ, Richardson T, King B
… +7 more, Lagatta J, Lai KC, Lakshmanan A, Lee HC, Lewis T, Patel RM, Kohne JG
J Perinatol
· 2026 Jun · PMID 41844834
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OBJECTIVES: To evaluate trends in neonatal intensive care unit (NICU) admissions, illness acuity, and hospitalization costs among U.S. children's hospitals from 2017 to 2022. METHODS: This retrospective cohort study used...OBJECTIVES: To evaluate trends in neonatal intensive care unit (NICU) admissions, illness acuity, and hospitalization costs among U.S. children's hospitals from 2017 to 2022. METHODS: This retrospective cohort study used data from the Pediatric Health Information System (PHIS) and included all NICU admissions. We examined trends in patient characteristics (e.g., gestational age, complex chronic conditions), illness severity scores, and standardized hospital costs. Interrupted time series analyses assessed changes in NICU costs over time. RESULTS: There were 234,571 infants admitted to NICUs in US children's hospitals between 2017 and 2022. NICU admissions shifted significantly by gestational age with admissions increasing by 10-18% among extremely, very, and late preterm infants. Term infants remained the largest admission group, averaging 45% annually (p < 0.001). Infants with ≥1 complex chronic condition increased from 46.6% in 2017 to 50.9% in 2022 (p < 0.001). NICU-specific illness severity increased modestly over time (1.14-1.24, p < 0.001). Median standardized NICU hospital costs rose by approximately 20% over the study period, with notable inflections in early 2020 and 2021. CONCLUSIONS: Among US children's hospitals in the PHIS database, NICU admissions were increasingly complex and costly. These findings highlight the importance of ongoing monitoring of resource use and patient mix in specialized NICU settings.
OBJECTIVE: This study aimed to evaluate the feasibility of integrating a novel bCPAP device into the NICU of a public referral hospital in India. STUDY DESIGN: We conducted an explanatory sequential prospective mixed-met...OBJECTIVE: This study aimed to evaluate the feasibility of integrating a novel bCPAP device into the NICU of a public referral hospital in India. STUDY DESIGN: We conducted an explanatory sequential prospective mixed-methods study. Eight bCPAP devices were introduced into the NICU in June 2023. Demographic and clinical data were collected prospectively over 12 months. A health worker survey was administered and focus group discussions were conducted. Interviews were transcribed, coded and systematically analyzed to identify emergent themes. RESULTS: Ninety-nine newborns were treated with a novel bCPAP device between June 2023 and June 2024. Of the 70 healthcare workers surveyed, most found integrating it into the NICU feasible (67%) or very feasible (19%). Four themes emerged that affected integration of the bCPAP device: hospital ecosystem, device features, intervention operationalization and clinical acceptability and outcomes. CONCLUSION: Integrating a novel bCPAP device into a public referral hospital NICU in India was feasible.
OBJECTIVE: To evaluate the influence of mode of delivery on repolarisation and QT interval in the neonatal electrocardiogram (ECG). STUDY DESIGN: KUNO-Kids is a prospective, population-based birth cohort study. Neonates...OBJECTIVE: To evaluate the influence of mode of delivery on repolarisation and QT interval in the neonatal electrocardiogram (ECG). STUDY DESIGN: KUNO-Kids is a prospective, population-based birth cohort study. Neonates received an ECG within the first week of life; subgroups were divided according to mode of delivery. Effects on neonatal QT interval were tested by linear and logistic regression analyses, adjusting for age at ECG recording. RESULTS: In total, 712 neonates were included. The primary caesarean section group showed a significant higher mean QTc (regression coefficient 6.03, p = 0.033) and a significantly increased rate of prolonged QTc >450 ms (odds ratio 2.4, p = 0.042), compared to the spontaneous delivery group. CONCLUSION: The mode of delivery has a significant effect on neonatal QTc. Clinicians should consider this influence when deciding on postnatal and follow-up examinations, regarding additional risk factors for acquired long QT interval.
Families with infants hospitalized in the neonatal intensive care unit (NICU) experience high rates of perinatal mental health conditions, which are disproportionately experienced by families i) of minoritized racial ide...Families with infants hospitalized in the neonatal intensive care unit (NICU) experience high rates of perinatal mental health conditions, which are disproportionately experienced by families i) of minoritized racial identities; ii) with a primary language other than English (PLOE); and iii) of low socioeconomic status. Disparities in screening, diagnosis, and treatment for mental health conditions are complex. Multiple individual, interpersonal, institutional, and structural factors may negatively impact marginalized individuals. Multifaceted recommendations to address these challenges are included in this article. This also serves as a call to action for the creation, standardization, and adoption of individual, institutional, and national interventions that can provide equitable mental health support for NICU families to mitigate disparities in mental health outcomes.