OBJECTIVE: This study examines annual trends and regional disparities in interventions and in-hospital outcomes for trisomies 18 and 13. STUDY DESIGN: We conducted a retrospective cohort study using nationwide data from...OBJECTIVE: This study examines annual trends and regional disparities in interventions and in-hospital outcomes for trisomies 18 and 13. STUDY DESIGN: We conducted a retrospective cohort study using nationwide data from 2011 to 2022. Patients with trisomies 18 and 13 admitted on the day of birth were identified. Nonsurgical and surgical intervention rates, survival to discharge, length of stay, and costs were analyzed by year and region. RESULT: This study identified 2 245 neonates with trisomy 18 (n = 1 808) and trisomy 13 (n = 437). Nonsurgical and surgical intervention rates increased annually. Between 2011 and 2022, survival to discharge rates improved from 44.5 to 57.9%, and both hospital length of stay and costs nearly doubled. Regional disparities in survival to discharge rates were significant, with differences of up to 21.5%. CONCLUSION: We observed an increase in interventions and a corresponding improvement in survival to discharge, with significant regional variations.
BACKGROUND: Near-infrared spectroscopy (NIRS) is widely used to assess cerebral oxygenation, its role in evaluating regional pulmonary oxygenation in preterm infants remains underexplored. OBJECTIVE: Evaluate regional pu...BACKGROUND: Near-infrared spectroscopy (NIRS) is widely used to assess cerebral oxygenation, its role in evaluating regional pulmonary oxygenation in preterm infants remains underexplored. OBJECTIVE: Evaluate regional pulmonary oxygen saturation (rpSO₂) relative to regional cerebral oxygenation (rcSO₂) using NIRS and examine the effects of surfactant administration and hemodynamically significant patent ductus arteriosus (hsPDA). METHODS: Thirty preterm infants underwent 12-h rpSO₂ and rcSO₂ monitoring. Surfactant effects were assessed with pre- and post-administration rpSO₂ values. Fractional Oxygen Extraction (FOE) and SpO₂/FiO₂ (S/F) ratio were calculated. RESULTS: Mean rcSO₂ was higher and less variable than rpSO₂ values (78% vs. 72%, p < 0.01). Right lung rpSO₂ exceeded left (74% vs. 71%, p < 0.01), especially in infants with hsPDA. Surfactant increased rpSO₂ bilaterally (p < 0.01), with greater increase in the right lung. rpSO₂ correlated strongly with the S/F ratio (r = 0.83, p < 0.01). CONCLUSIONS: Regional differences of rpSO₂ and FOE were observed, particularly in the setting of hsPDA and after surfactant therapy.
BACKGROUND: Infants with severe bronchopulmonary dysplasia (sBPD) progress through phases of illness. We created a longitudinal interdisciplinary assessment tool to track infant progress, then utilized it to evaluate the...BACKGROUND: Infants with severe bronchopulmonary dysplasia (sBPD) progress through phases of illness. We created a longitudinal interdisciplinary assessment tool to track infant progress, then utilized it to evaluate the impact of tracheostomy. METHODS: An iterative interview process with interprofessional experts was used to develop the tool for infants with grade 2/3 BPD. Qualitative coding determined common themes, which interviewees ranked by importance to develop the tool. We then retrospectively compared pairwise scores before and after tracheostomy placement. RESULTS: The assessment tool has twelve categories with items corresponding to four phases of illness. Total scores improved post tracheostomy, driven by significant improvements in systemic steroid, sedation, FiO, weight, tolerance of cares, and developmental participation. CONCLUSIONS: We present a user-friendly interdisciplinary scoring tool for sBPD to help providers and families align care goals and track longitudinal progress. Tracheostomy placement was associated with a change to less acute phases of sBPD.
Komvilaisak P, Wichajarn K, Laoaroon N
… +7 more, Paopongsawan P, Jirapradittha J, Kiatchoosakun P, Suwannaying K, Sawatjui N, Komwilaisak R, Kachenchat R
J Perinatol
· 2026 May · PMID 41840148
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BACKGROUND: Neonatal jaundice is most commonly caused by blood group incompatibility but may also result from hereditary elliptocytosis (HE) associated with heterozygous SPTB mutations. METHODS: A retrospective descripti...BACKGROUND: Neonatal jaundice is most commonly caused by blood group incompatibility but may also result from hereditary elliptocytosis (HE) associated with heterozygous SPTB mutations. METHODS: A retrospective descriptive study was conducted among 1,584 neonates presenting with jaundice over a 3-year period. RESULTS: Seventy-six neonates (4.8%) were diagnosed with HE, all carrying heterozygous SPTB mutations (Providence variant, n = 67; Buffalo variant, n = 9). Five had coexisting hemoglobinopathies. Early-onset jaundice occurred in 71 patients, with a median onset of 38 h. Peak total bilirubin levels ranged from 12.2 to 22.3 mg/dL. Most neonates required single phototherapy; seven required double phototherapy, and none underwent exchange transfusion. Anemia developed in 23 patients, of whom 17 required red cell transfusion. CONCLUSION: HE is an under-recognized cause of early-onset neonatal jaundice and anemia. Despite early hyperbilirubinemia, most neonates have a benign clinical course with minimal long-term complications and infrequent need for transfusion.
J Perinatol
· 2026 Mar · PMID 41826671
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OBJECTIVES: Examine relationships between quantitative measures of language and sound exposure in the NICU and infant neurobehavior. STUDY DESIGN: Sixty-four preterm infants (≤28 weeks of gestation) had language and soun...OBJECTIVES: Examine relationships between quantitative measures of language and sound exposure in the NICU and infant neurobehavior. STUDY DESIGN: Sixty-four preterm infants (≤28 weeks of gestation) had language and sound exposure measured across four time points: within two weeks of birth and at 30, 34, and 35-41 weeks postmenstrual age (PMA). Neurobehavior was assessed at 35-41 weeks PMA using the NICU Network Neurobehavioral Scales. RESULTS: Higher average decibel levels in the NICU environment were associated with lower infant orientation scores (p = 0.04, β = -0.33). Higher peak decibel levels were associated with greater hypertonia (p = 0.01, β = 0.37). More electronic sound exposure was associated with less infant hypotonia (p = 0.047; β = -0.003). Increased silence was associated with greater infant hypertonia (p = 0.01; β = 0.001). Higher adult word counts were related to lower infant stress (p = 0.045, β = -1.37). CONCLUSION: NICU sound exposures were related to neonatal neurobehavior near term age, highlighting the neurological impact of the auditory environment on preterm infants.
Boutzoukas AE, Le J, Kilpatrick R
… +9 more, Smith MJ, Laughon M, Gonzalez D, Wade KC, Greenberg RG, Babilonia-Rosa M, Benjamin DK, Cohen-Wolkowiez M, Zimmerman KO
J Perinatol
· 2026 Jun · PMID 41826670
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OBJECTIVE: Determine if preterm infants have prolonged therapeutic post-discontinuation antibiotic exposures (PDAE) following empiric ampicillin. STUDY DESIGN: Prospective study of 27 infants ≤7 days and <37 weeks gestat...OBJECTIVE: Determine if preterm infants have prolonged therapeutic post-discontinuation antibiotic exposures (PDAE) following empiric ampicillin. STUDY DESIGN: Prospective study of 27 infants ≤7 days and <37 weeks gestational age (GA) receiving ampicillin (200 mg/kg/day); 49 post-discontinuation PK samples were collected. Exposures were predicted using PK simulations and a prior ampicillin PK model. The probability of target attainment 24- and 36-h after the final ampicillin dose for various minimum inhibitory concentrations (MICs) and the duration of therapeutic PDAE was calculated. RESULT: At 24- and 36-h after ampicillin, the probability of exposures ≥1 μg/mL was 95% and 60%, respectively. PDAE (≥1 μg/mL) lasted a median 33 h (95% confidence interval: 15, 79), and varied with GA, from median 53 h (<28 weeks GA) to 27 h (34-36 weeks GA). CONCLUSION: Many preterm infants experience therapeutic exposures at least 24 h after the final ampicillin dose. Shorter courses could be considered.
OBJECTIVE: The aim of this quality improvement project was to increase preoperative enteral feeding and breastfeeding rates in term neonates with congenital heart disease (CHD). METHODS: A multidisciplinary team develope...OBJECTIVE: The aim of this quality improvement project was to increase preoperative enteral feeding and breastfeeding rates in term neonates with congenital heart disease (CHD). METHODS: A multidisciplinary team developed and implemented a preoperative feeding protocol for neonates with congenital heart disease. The primary outcome was the presence of preoperative enteral feeding by May 2025. Secondary outcomes included breastfeeding rates and time to first feed. The process measure was the rate of reference to the feeding protocol in provider notes. Our balancing measure was a rule out or diagnosis of necrotizing enterocolitis requiring medical or surgical treatment in the preoperative period. Infants were identified using the Pediatric Cardiac Critical Care Collaborative (PC4). Data was collected from chart review and analyzed with statistical process control charts. The pre-implementation period was from June 2022 to June 2023, the implementation period was from July 2023 to June 2024, and the sustainment period was from July 2024 through May 2025. RESULTS: The number of neonates that met the inclusion criteria was 121. The rate of overall enteral feeding increased significantly from 72% in the pre-implementation phase (June 2022-June 2023) to 93% in the sustainment phase (July 2024-May 2025) (p = 0.026). Additionally, we found an improvement in our secondary outcomes and no change to the balancing measures. CONCLUSION: This quality improvement initiative, which centered on creating and implementing a clear, standardized, evidence-based feeding protocol while utilizing interdisciplinary collaboration, led to an increase in overall rates of preoperative enteral feeding for newborns with CHD in a level IV intensive care nursery.
OBJECTIVE: To determine if Neonatal Intensive Care Unit (NICU) specific language card use increased infant care activity involvement among Spanish-preferred families. STUDY DESIGN: Multisite NICU pilot pre-post intervent...OBJECTIVE: To determine if Neonatal Intensive Care Unit (NICU) specific language card use increased infant care activity involvement among Spanish-preferred families. STUDY DESIGN: Multisite NICU pilot pre-post intervention (implementation of infant care activity language card) assessing Spanish-preferred family involvement. Chart review was conducted 8 months before and after card implementation (12/2021-11/2023). Outcomes were analyzed using bi-variate analyses and mixed effect models. RESULT: Of the 989 infants, 5.9% were Spanish-preferred, 91.4% English-preferred, and 2.5% non-English-non-Spanish preferred. Prior to language card implementation, Spanish-preferred families had significantly lower odds of participating in care activities compared to English-preferred families (e.g., overall participation OR 0.64 [95% CI 0.43-0.96]). Following implementation, Spanish-preferred families had significantly higher odds of overall care participation (OR 2.27 [95% CI 1.51-3.41]) and improved odds across all activities. CONCLUSION: Language cards are associated with increased Spanish-preferred family involvement in infant care activities in the NICU.
BACKGROUND: Infants with congenital diaphragmatic hernia (CDH) remain at high risk for ECMO and mortality. We previously reported improved outcomes after implementing new CDH care guidelines. This study reassesses ECMO r...BACKGROUND: Infants with congenital diaphragmatic hernia (CDH) remain at high risk for ECMO and mortality. We previously reported improved outcomes after implementing new CDH care guidelines. This study reassesses ECMO rates, survival, and guideline adherence to determine if improvements persisted. METHODS: Retrospective review of all neonatal CDH cases at a single center during pre-guideline (2003-2015, n = 229) and post-guideline (2016-2024, n = 160) periods, with post-guideline subdivided into two epochs: post-1 (2016-2019, n = 70) and post-2 (2020-2024, n = 90). RESULTS: Survival without ECMO improved (pre-53%; post-1 74%; post-2 82%; p < 0.001), as did overall survival (72% vs. 83% vs. 86%; p = 0.006). ECMO use decreased (31% vs. 14% vs. 6%; p < 0.001). Inhaled nitric oxide use remained low, and vasoactive medication use dropped significantly in post-2. CONCLUSION: Sustained survival improvement and reduced ECMO use followed guideline changes emphasizing minimal stimulation, gentle ventilation, delayed transfer, pre-ductal saturation monitoring, and limited vasoactive therapy.
OBJECTIVE: To quantify the trajectory of lung ultrasound scores (LUSSc) and estimate their association on inpatient respiratory trajectories in preterm infants with potentially evolving bronchopulmonary dysplasia (BPD) S...OBJECTIVE: To quantify the trajectory of lung ultrasound scores (LUSSc) and estimate their association on inpatient respiratory trajectories in preterm infants with potentially evolving bronchopulmonary dysplasia (BPD) STUDY DESIGN: We measured LUSSc prospectively in infants <32 weeks' gestation weekly from 2 weeks of life through 44 weeks' post-menstrual age (PMA) or discharge. The primary outcome was the age, in PMA, to achieve liberation of respiratory support (LRS) defined as room air or < 1 L/min (FO = 100%). RESULT: In 16 infants, 10 patients had Grade 2-3 BPD, and LUSSc declined over time. The median age to achieve LRS was 42 weeks' PMA (33.6, 47.9). Using the maximum LUSSc each infant had between 30 and 32 weeks' PMA, each 1-point increase in the LUSSc was independently associated with a 9-day increase in the age to achieve LRS. CONCLUSION: LUSSc may serve as a diagnostic marker for inpatient respiratory trajectories of preterm infants with evolving BPD.
A fluid bolus is administered to correct hypoperfusion, hypotension, and metabolic acidosis for resuscitation at birth or in the neonatal intensive care unit (NICU). However, there is a lack of evidence-based support for...A fluid bolus is administered to correct hypoperfusion, hypotension, and metabolic acidosis for resuscitation at birth or in the neonatal intensive care unit (NICU). However, there is a lack of evidence-based support for any particular fluid choice. The most used intravenous fluid is 0.9% sodium chloride or "normal saline" (NS). There is a growing body of evidence that NS is associated with hyperchloremic metabolic acidosis and acute kidney injury. Balanced crystalloid solutions such as lactated Ringer's solution and solutions with a more physiological composition similar to plasma may offer some advantages compared to NS based on adult literature. Here we discuss indications and challenges with the use of balanced crystalloids and propose a practical approach to fluid choice in the NICU. Further research is needed to better understand indications for and optimal fluid therapy to correct hypoperfusion and metabolic acidosis in neonates.
OBJECTIVE: To investigate the relationship of post-hemorrhagic ventricular dilatation (PHVD) with neurodevelopmental outcomes in preterm infants. STUDY DESIGN: Retrospective cohort study of infants <29 weeks' gestation a...OBJECTIVE: To investigate the relationship of post-hemorrhagic ventricular dilatation (PHVD) with neurodevelopmental outcomes in preterm infants. STUDY DESIGN: Retrospective cohort study of infants <29 weeks' gestation admitted from 2010-2018 with intraventricular hemorrhage and neurodevelopmental assessment at 18-21 months corrected age. Eligible infants were grouped as 'no PHVD', 'PHVD without neurosurgical intervention', and 'symptomatic PHVD with intervention'. Neurodevelopmental impairment (NDI) was assessed using generalized linear models. RESULTS: Of 227 infants, 183 (80.6%) had no PHVD, 28 (12.3%) had PHVD without intervention, and 16 (7.0%) had PHVD with intervention. Severe NDI was observed in 14 (7.7%), 10 (35.7%), and 10 (62.5%) infants, respectively (p < 0.05). PHVD without and with intervention was associated with significantly increased risk of overall NDI (adjusted odds ratios [aOR] 6.2, 95% CI 2.4-16.5 and 18.1, 95% CI 5.5-68.4) as compared to no PHVD. CONCLUSIONS: Progressive PHVD, irrespective of clinical symptoms, predisposes affected preterm infants to significant risk of NDI.
BACKGROUND/OBJECTIVES: To determine, in healthy children born prematurely with very low birth weight (VLBW), whether the cerebral morphometry of the frontal lobe is affected by foetal growth restriction (FGR) and extraut...BACKGROUND/OBJECTIVES: To determine, in healthy children born prematurely with very low birth weight (VLBW), whether the cerebral morphometry of the frontal lobe is affected by foetal growth restriction (FGR) and extrauterine growth restriction (EUGR). SUBJECTS/METHODS: A magnetic resonance imaging study was performed of 117 children during childhood within a cohort of VLBW infants. A neuropsychological study was performed using the WISC-V test and the Child Behaviour Checklist scale. RESULTS: In children with FGR and EUGR, the volume of the lateral orbitofrontal cortex was reduced in both hemispheres. In this group of children, we observed smaller volumes of the pars opercularis in the right hemisphere. CONCLUSIONS: We can conclude that FGR with EUGR in VLBW infants is associated with smaller volumes and surface area of the lateral orbitofrontal cortex in both hemispheres. These nutritional situations do not condition relevant structural modifications in the rest of the studied structures of the frontal lobe in our sample.
BACKGROUND: Very low birth weight infants (VLBWI) are at high risk of mortality and severe morbidities. While many neonatal networks monitor risk-adjusted outcomes separately, the relationship between mortality and major...BACKGROUND: Very low birth weight infants (VLBWI) are at high risk of mortality and severe morbidities. While many neonatal networks monitor risk-adjusted outcomes separately, the relationship between mortality and major morbidities across centers remains unclear. OBJECTIVE: To evaluate the association between risk-adjusted in-hospital mortality and six major morbidities in VLBWI across 20 South American NICUs participating in the NEOCOSUR Network between 2011 and 2023. METHODS: Retrospective cohort study including 14,100 VLBWI (500-1500 g) from 20 NICUs in Argentina, Chile, Paraguay, Peru, and Uruguay. Observed-to-expected (O/E) ratios for mortality and for each morbidity-late-onset sepsis, bronchopulmonary dysplasia at 36 weeks (BPD), severe intraventricular hemorrhage (IVH grade III-IV), retinopathy of prematurity (ROP ≥ stage III), necrotizing enterocolitis (NEC ≥ stage II), and periventricular leukomalacia (PVL)-were calculated using logistic regression models adjusted for perinatal risk factors. Center-level associations were evaluated using Poisson regression models. RESULTS: O/E mortality varied widely across centers (range from 0.62 to 1.48), with 7 centers showing significantly lower-than-expected mortality and 4 with higher-than-expected values. Significant positive associations were found between mortality O/E and O/E of late-onset sepsis (χ² = 53.6, p < 0.01), severe IVH (χ² = 18.0, p < 0.01), ROP (χ² = 38.0, p < 0.01), and PVL (χ² = 23.4, p < 0.01). An inverse association was observed between mortality and BPD (χ² = 36.2, p < 0.01). No significant association was found for NEC. CONCLUSIONS: Centers with higher-than-expected mortality also showed excess rates of several severe morbidities, suggesting that shared care practices may be associated with multiple outcomes. The inverse association with BPD may reflect a survival bias. These findings support the integration of multiple adjusted outcomes in quality benchmarking across NICUs.
O'Brien EA, Wypij D, Rofeberg V
… +16 more, Chamseddine R, Velasco-Annis C, Taylor K, Herrera Pujols K, Hart NJ, Morton SU, Litwin J, Kumar N, Kennedy K, Wilkins-Haug L, Newburger JW, Odibo AO, Gholipour A, Shimony JS, Rollins CK, Ortinau CM
J Perinatol
· 2026 Mar · PMID 41826659
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OBJECTIVE: Investigate the association between placental vascular abnormalities and regional brain volumes in congenital heart disease (CHD) fetuses with and without genetic abnormalities. STUDY DESIGN: Secondary analysi...OBJECTIVE: Investigate the association between placental vascular abnormalities and regional brain volumes in congenital heart disease (CHD) fetuses with and without genetic abnormalities. STUDY DESIGN: Secondary analysis of brain magnetic resonance imaging (MRI) and placental pathology data from 121 CHD fetuses enrolled in prospective neuroimaging studies at two centers. RESULTS: Placental vascular abnormality was present in 46% of fetuses, and genetic abnormality was present in 19%, including 12% with both abnormalities. Fetuses with the combination of placental and genetic abnormalities had smaller brain volumes compared to fetuses without either abnormality for total brain, subcortical gray matter, brainstem, and cerebellum, with a significant interaction (P < 0.05) between placental and genetic abnormalities for intracranial and subcortical gray matter volumes. CONCLUSION: Smaller brain volumes for CHD fetuses with placental and genetic abnormalities may suggest common genetic pathways affect placental, heart, and brain development, or that genetic abnormalities heighten vulnerability when placental changes occur.
Bronchopulmonary dysplasia (BPD) is a leading cause of chronic respiratory failure in infants. Severe BPD is associated with prolonged mechanical ventilation, pulmonary hypertension, and high morbidity and mortality. As...Bronchopulmonary dysplasia (BPD) is a leading cause of chronic respiratory failure in infants. Severe BPD is associated with prolonged mechanical ventilation, pulmonary hypertension, and high morbidity and mortality. As disease severity increases, extracorporeal membrane oxygenation (ECMO) is being reconsidered as a potential rescue therapy. Historically, ECMO has been reserved for neonates with reversible respiratory failure and those who required mechanical ventilation for less than 14 days, while infants with BPD were excluded. However, advancements in ECMO technology, anticoagulation strategies, and ventilatory management have led to a reassessment of its role in this population. Emerging reports suggest ECMO may serve as a bridge to recovery or lung transplantation for select infants with severe BPD and refractory respiratory failure. Careful patient selection remains critical, considering factors such as pulmonary hypertension severity, right ventricular dysfunction, and potential for lung recovery.
OBJECTIVE: Direct breastfeeding (DBF) during Neonatal Intensive Care Unit (NICU) admission has many benefits. This quality improvement (QI) project aimed to increase DBF at discharge in a community hospital level II NICU...OBJECTIVE: Direct breastfeeding (DBF) during Neonatal Intensive Care Unit (NICU) admission has many benefits. This quality improvement (QI) project aimed to increase DBF at discharge in a community hospital level II NICU. METHODS: This is a single center time series QI study that used serial plan do study act cycles occurring over 12 months and data collection over 3.5 years. Outcome measure was successful breastmilk transfer in the 48 h prior to discharge. Balancing measures were provision of own human milk and gestational age at discharge. RESULTS: DBF prior to discharge increased from 34% (14/41) to 79% (53/67) after initiating the QI project, p < 0.01. There was no change in the provision of own human milk at discharge. Gestational age at discharge increased from 37.2 to 37.7 weeks, p = 0.05. CONCLUSION: QI interventions increased DBF in the NICU, supporting feasibility of breastfeeding among premature infants.