NeoReviews最新文献

Congenital pulmonary airway malformations (CPAM) are multi-cystic masses in the thorax that contain abnormal lung tissue with highly variable presentations. Whereas some pose no considerable risk to the pregnant individual or fetus, larger or high-risk lesions carry significant morbidity and mortality that present unique diagnostic and management challenges. We present 2 cases of fetal CPAMs with dominant cysts that posed unique challenges during the pregnancy. The first had an early presentation at 13 weeks' gestation, and the second had a rapidly increasing CPAM volume ratio. After careful consideration, both pregnant individuals underwent fetal interventions with placement of thoracoamniotic shunts. The subsequent care during the pregnancies and in the neonatal period was complex and required a multidisciplinary approach to care. These cases highlight the nuances of diagnosing and managing CPAMs in utero and after delivery. We also present a comprehensive review of CPAM literature to help guide management of the pregnancy and neonate. Optimal management requires multidisciplinary prenatal counseling, individualized delivery planning, and neonatal management.

This review examines current approaches to ethics education in neonatal-perinatal medicine (NPM), integrating adult learning theory, diverse teaching modalities, and emerging technologies to enhance training for neonatal clinicians. Foundational strategies include case-based discussions, simulation, interprofessional learning, and structured debriefing, which promote critical reflection, moral reasoning, and shared decision-making skills. Assessment of ethics education is challenging given the interplay of cognitive, emotional, and interpersonal domains. Tools such as knowledge tests, milestone-based competency frameworks, performance-based assessments, and structured feedback checklists offer complementary methods for evaluating knowledge, skills, and attitudes. Innovations in ethics education increasingly leverage artificial intelligence (AI), including generative AI for case creation, conversational agents for virtual role-play, and interactive simulations. These tools can expand access, foster individualized learning, and model complex ethical scenarios, but require safeguards against bias, misinformation, and oversimplification. A structured, theory-informed ethics curriculum, integrated with robust assessment strategies and mindful AI applications, can strengthen ethical competence across the learning continuum and better equip clinicians to navigate moral distress, honor parental values, address equity concerns, and support family-centered decision-making.

Uncertainty exists within many aspects of neonatal care. However, neonatal intensive care unit clinicians report varying comfort levels with managing uncertainty in clinical care. Although accepting ambiguity and demonstrating proficiency in communication are required components of medical education, there is a lack of formal curricula on uncertainty in medicine. Despite this, clinicians must find ways to effectively partner with parents to develop care plans in situations with elements of uncertainty. This article reviews frameworks of uncertainty, perspectives, and experiences of parents and neonatologists; examines approaches to navigating uncertainty in clinical care; and suggests the need for formal training to manage uncertainty in neonatology.

Many of the ethical challenges that arise in the neonatal intensive care unit (NICU) stem from communication difficulties between families and clinicians. Parents in the NICU face tremendous stress, including separation from their infants, uncertainty about clinical outcomes, and fear for the future; they require clear and compassionate communication from clinicians to build trust and engage in shared decision-making. In this review, we explore how trauma that parents experience in the NICU shapes their communication needs, examine the role of communication in providing trauma-informed care, describe competencies in communication for neonatal clinicians, and depict established and novel models of communication training. We propose that communication should be thought of as a core clinical skill for neonatologists, and similar to procedural skills, requires dedicated training and practice to improve.

In the neonatal intensive care unit (NICU), patients, families, and care teams are all likely to undergo traumatic experiences. Infants are separated from their parents and undergo multiple painful or stressful procedures. Families experience fear for their infants' health and survival and the disempowerment coming with a loss of parental role; many also experience differential treatment by race, language, or other factors. Care teams bear witness to the illness and sometimes death of infants and the pain of their families. All these and many other experiences constitute trauma, which may impact the long-term course of infants and families. Trauma-informed care has therefore been promoted as a universal practice. In the NICU, trauma-informed care principles may be applied to help optimally care for infants and their families as well as to support members of the care team.

Applying best neonatal transfusion practices through transfusion stewardship programs can achieve better patient outcomes. Platelets, the focus of the present report, are the second most frequently transfused blood product in the neonatal intensive care unit (after red blood cell transfusion). Like many therapies in this field, platelet transfusions are associated with risks as well as benefits. Ongoing preclinical and clinical research continues to better define these risks and add to our understanding of disease pathogenesis. Although, in some instances, neonatal platelet transfusions obtained from adult donors can be lifesaving, mounting evidence suggests that such transfusions confer a dose-dependent risk of major bleeding, bronchopulmonary dysplasia, adverse neurodevelopment, and death. This review is intended to assist clinicians who care for hospitalized neonates by (1) clarifying the associations between platelet transfusions and adverse infant outcomes, (2) increasing awareness of a subset of neonates who are at high risk for receiving multiple platelet transfusions, (3) applying evidence-based restrictive platelet transfusion practices to mitigate the risks of platelet transfusions, and (4) highlighting both existing and novel experimental methods for treating thrombocytopenic neonates.