Seminars in Fetal & Neonatal Medicine最新文献

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Probiotic supplementation – does it prevent or cause neonatal sepsis? 益生菌补充-它是预防还是导致新生儿败血症？

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101668

Nicholas D. Embleton , Chris H.P. van den Akker , Belal N. Alshaikh

Probiotic supplementation in preterm infants is one of the most extensively studied interventions in neonatal medicine, with over 50 randomised controlled trials. This paper examines the relationship between probiotic supplementation and late onset sepsis (LOS), considering mechanistic pathways, clinical evidence, and safety profile.

Multiple systematic reviews and meta-analyses consistently show that probiotics reduce necrotising enterocolitis (NEC) incidence and all-cause mortality in preterm infants, establishing them as one of the most beneficial interventions in neonatology. Current evidence suggests modest effects on LOS, with Cochrane systematic reviews reporting relative risk 0.89 (95 % CI 0.82–0.97) but with low certainty. Mechanisms supporting LOS reduction include competitive pathogen exclusion, enhanced epithelial barrier function, improved immune responses, and reduced time to full enteral feeding with decreased intravenous access requirements.

The safety profile of probiotics is reassuring, with serious adverse events being exceptionally rare. Probiotic-induced sepsis probably occurs in less than 0.5 % of treated infants, representing a very low risk that must be weighed against the likely substantial benefits for NEC and mortality reduction. Product contamination and other quality issues exist but appear manageable with appropriate quality control.

Given the robust evidence for NEC and mortality reduction, probiotics represent a valuable intervention for preterm infants but may have limited, if any impact on sepsis. While their specific role in LOS prevention and impacts on the resistome requires further investigation, the overall benefit-risk profile strongly favors their use. Future research will further refine understanding of optimal strain selection and implementation strategies for maximizing clinical benefits while maintaining safety.

早产儿补充益生菌是新生儿医学中研究最广泛的干预措施之一，有50多个随机对照试验。本文探讨了益生菌补充与迟发性脓毒症（LOS）之间的关系，考虑了机制途径、临床证据和安全性。多个系统综述和荟萃分析一致表明，益生菌可以降低早产儿坏死性小肠结肠炎（NEC）的发病率和全因死亡率，使其成为新生儿学中最有益的干预措施之一。目前的证据表明对LOS的影响不大，Cochrane系统评价报告的相对风险为0.89 (95% CI 0.82-0.97)，但确定性较低。支持LOS减少的机制包括竞争性病原体排斥、上皮屏障功能增强、免疫反应改善、完全肠内喂养时间缩短和静脉通路需求减少。益生菌的安全性令人放心，严重的不良事件非常罕见。益生菌引起的脓毒症可能发生在不到0.5%的接受治疗的婴儿中，这代表了一个非常低的风险，必须与NEC和死亡率降低的可能实质性益处进行权衡。产品污染和其他质量问题存在，但似乎可以通过适当的质量控制。鉴于NEC和死亡率降低的有力证据，益生菌对早产儿来说是一种有价值的干预措施，但对败血症的影响可能有限。虽然它们在LOS预防中的具体作用和对抵抗组的影响需要进一步调查，但总体的利益-风险概况强烈支持它们的使用。未来的研究将进一步完善对最佳菌株选择的理解和实施策略，以最大限度地提高临床效益，同时保持安全性。

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引用次数: 0

Central line-associated blood stream infections in newborns: From vulnerability to prevention 新生儿中央静脉相关血流感染：从易感性到预防。

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101665

Varvara Dimopoulou , Kirsten Glaser , Eric Giannoni

Newborns, especially preterm infants, are vulnerable to invasive infections due to their developing immune system and frequent need for central venous catheters. Central line-associated bloodstream infections (CLABSI) are among the most common invasive infections in this population and represent the leading cause of neonatal bloodstream infection in many settings. Neonatal CLABSI is associated with substantial mortality, long-term morbidity, and increased healthcare costs. Most importantly, CLABSI is preventable. Bundles centered on rigorous hand hygiene combined with standardized practices for catheter insertion, maintenance and removal have proven effective in reducing infection rates in neonates. Benchmarking and quality improvement initiatives enable neonatal intensive care units (NICUs) to track progress and share best practices. While no novel prevention strategies with robust evidence have emerged, sustained declines in CLABSI rates in many NICUs and networks over the past decades highlight the importance of a comprehensive multidisciplinary approach to implement and maintain best practices.

新生儿，特别是早产儿，由于其免疫系统发育不全和经常需要中心静脉导管，容易受到侵袭性感染。中心线相关性血流感染（CLABSI）是这一人群中最常见的侵袭性感染之一，在许多情况下是新生儿血流感染的主要原因。新生儿CLABSI与大量死亡率、长期发病率和医疗费用增加有关。最重要的是，CLABSI是可以预防的。以严格的手部卫生为中心，结合导管插入、维护和取出的标准化做法，已被证明对降低新生儿感染率有效。标杆和质量改进举措使新生儿重症监护病房（nicu）能够跟踪进展并分享最佳做法。虽然没有新的预防策略出现强有力的证据，但在过去几十年中，许多新生儿重症监护室和网络的CLABSI率持续下降，这突出了采用综合多学科方法实施和保持最佳做法的重要性。

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引用次数: 0

Respiratory syncytial virus. What's new in prevention? 呼吸道合胞病毒。预防方面有什么新进展？

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101667

Nestor E. Vain , Paolo Manzoni , Kee Thai Yeo

Prevention of RSV lower respiratory tract infections (LRTI) in infants has been limited to general measures and palivizumab, a monoclonal antibody indicated for the highest risk groups. Recently developed RSV vaccines used during pregnancy generate antibodies that cross the placenta. Randomized controlled trials (RCT) and real-life monitoring have demonstrated their effectiveness in protecting newborns and infants during the first months of life. Likewise, novel extended half-life monoclonal antibodies, nirsevimab and the recently approved clesrovimab, opened the possibility of large-scale protection targeted to all infants born during the winter season and those <6 months at the beginning of it. Several RCTs and results from populations adopting nirsevimab prophylaxis demonstrated a large decrease in the incidence of RSV-LRTIs and a great impact in infant public health. Deployment of either strategies or in combination as part of immunization programs can be complement each other even as newer immunologic agents are being introduced.

婴儿RSV下呼吸道感染（LRTI）的预防仅限于一般措施和帕利珠单抗，这是一种单克隆抗体，适用于最高风险人群。最近开发的RSV疫苗在怀孕期间使用，产生抗体，穿过胎盘。随机对照试验（RCT）和实际监测证明了它们在生命最初几个月保护新生儿和婴儿方面的有效性。同样，新型延长半衰期的单克隆抗体nirsevimab和最近批准的clesrovimab，为所有在冬季和冬季出生的婴儿提供了大规模保护的可能性

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Advancements and potential in the prevention of congenital CMV infection 预防先天性巨细胞病毒感染的进展和潜力。

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101662

Yarlini Vipulanandan, Suresh Boppana, Karen B. Fowler, David W. Kimberlin

Congenital cytomegalovirus (CMV) infection is a large contributor to neurodevelopmental delay and non-genetic sensorineural hearing loss, which can often be delayed in onset. While a majority of CMV infections are asymptomatic in healthy children and adults, periconceptual and early in utero infection can cause clinically significant and potentially long-term sequelae. The complex relationship between congenital CMV infection and maternal immunity provides a challenging backdrop for CMV prevention. Increased awareness of the significance of congenital CMV is reflected in the proliferation of prevention strategies over the past 30 years, including education initiatives, behavioral modifications, and maternal antiviral prophylaxis. This review explores different levels of congenital CMV prevention and highlights a variety of prevention strategies, including the potential for development of effective vaccines for CMV.

先天性巨细胞病毒（CMV）感染是神经发育迟缓和非遗传性感音神经性听力损失的主要原因，通常可以延迟发病。虽然大多数巨细胞病毒感染在健康儿童和成人中是无症状的，但围孕期和子宫早期感染可引起临床显著的和潜在的长期后遗症。先天性巨细胞病毒感染与母体免疫之间的复杂关系为巨细胞病毒的预防提供了一个具有挑战性的背景。在过去的30年里，人们对先天性巨细胞病毒重要性的认识不断提高，这反映在预防策略的激增上，包括教育倡议、行为改变和孕产妇抗病毒预防。这篇综述探讨了先天性巨细胞病毒预防的不同层面，并强调了各种预防策略，包括开发有效的巨细胞病毒疫苗的潜力。

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The role of parents to prevent infections in the neonatal intensive care unit 父母在新生儿重症监护病房预防感染中的作用。

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101669

Isabelle Ommert , Caroline-Aleksi Mägi , Siri Lilliesköld , Ylva Thernström Blomqvist , Anna Axelin , Agnes Linnér

Late onset sepsis is a major cause of morbidity and mortality in the neonatal intensive care unit, and it is frequently acquired from the environment. Infant- and family-centered developmental care, which involves skin-to-skin contact, breastfeeding and continuous parental participation in the care, is an effective infection prevention strategy. Kangaroo mother care, including skin-to-skin contact supports the development of a diverse skin microbiome, distinct from that of the hospital environment. Breastmilk further contributes to infection prevention and immune system development through multiple mechanisms. Parental involvement may improve the safety and quality of care delivery by hospital staff. In summary, parents play an important role in infection prevention in the neonatal intensive care unit. The risks of not including parents in the care of their infants should be further considered both in research and clinical practice.

迟发性脓毒症是新生儿重症监护病房发病和死亡的主要原因，它通常是由环境获得的。以婴儿和家庭为中心的发育照料，包括皮肤接触、母乳喂养和父母持续参与照料，是一项有效的感染预防战略。袋鼠式母亲护理，包括皮肤对皮肤的接触，支持不同于医院环境的多样化皮肤微生物群的发展。母乳通过多种机制进一步促进感染预防和免疫系统发育。父母的参与可以提高医院工作人员提供护理的安全性和质量。综上所述，父母在新生儿重症监护病房的感染预防中起着重要的作用。在研究和临床实践中都应进一步考虑不让父母参与婴儿护理的风险。

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Antibiotic stewardship in the neonatal intensive care unit and prevention of antimicrobial resistance 新生儿重症监护病房的抗生素管理和抗菌素耐药性的预防。

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101666

Ashraf Kharrat , Najla Tabbara , Prakesh S. Shah

Antimicrobial resistance is an evolving threat to infants admitted to the neonatal intensive care unit. Antibiotic-resistant organisms may colonize infants, cause infections, or contribute to nosocomial outbreaks, and are associated with infant morbidity and mortality. As microorganisms continue to acquire resistance to available antimicrobials, infants become at risk of therapeutic failure. One key strategy to prevent the development of antimicrobial resistance is through antimicrobial stewardship to optimize antimicrobial use. This review starts with an overview of neonatal sepsis and drivers of antimicrobial resistance. It subsequently discusses strategies to address and minimize the burden and transmission of antibiotic-resistance organisms as well as implement antimicrobial stewardship programs in the neonatal intensive care unit.

抗菌素耐药性是新生儿重症监护病房收治的婴儿面临的不断演变的威胁。耐抗生素生物可能在婴儿体内定植，引起感染，或导致医院暴发，并与婴儿发病率和死亡率有关。随着微生物继续获得对现有抗菌素的耐药性，婴儿面临治疗失败的风险。预防抗菌素耐药性发展的一项关键战略是通过抗菌素管理来优化抗菌素的使用。这篇综述首先概述了新生儿败血症和抗菌药物耐药性的驱动因素。随后讨论了解决和尽量减少抗生素耐药生物的负担和传播以及在新生儿重症监护病房实施抗菌素管理规划的战略。

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Herpes simplex virus – state of the art of prevention and treatment 单纯疱疹病毒——预防和治疗的最新进展。

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101664

Kia Hee Schultz Dungu , Emma Louise Malchau Carlsen , Olav Bjørn Petersen , Nadja Hawwa Vissing , Ulrikka Nygaard

Neonatal herpes simplex virus (HSV) infection remains a life-threatening condition with high morbidity and mortality despite advances in diagnostics and therapy. Transmission occurs predominantly during delivery and the three main clinical phenotypes; skin-eye-mouth disease, central nervous system disease, and disseminated disease, carry distinct prognoses. This state-of-the-art review focuses on prevention and consideration of empirical treatment. Maternal antiviral prophylaxis in late pregnancy has shown to reduce the frequency of active HSV outbreaks at delivery. Decisions on empirical acyclovir therapy must balance early recognition against overtreatment, guided by the number needed to treat, which in European settings among term and near-term infants ranges from over 1,000 for early-onset sepsis to ∼150 for late-onset sepsis. Ongoing research focuses on preventive strategies, including vaccine development and novel biomarkers on dried blood spot samples to improve outcomes.

尽管在诊断和治疗方面取得了进展，新生儿单纯疱疹病毒（HSV）感染仍然是一种危及生命的疾病，发病率和死亡率都很高。传播主要发生在分娩和三种主要的临床表型；皮肤-眼-口病、中枢神经系统疾病和播散性疾病具有不同的预后。这一最新的审查侧重于预防和考虑经验治疗。孕妇在妊娠后期进行抗病毒预防已显示可减少分娩时HSV活动性暴发的频率。经验性阿昔洛韦治疗的决定必须在早期识别和过度治疗之间取得平衡，以治疗所需的数量为指导，在欧洲，足月和近期婴儿的治疗数量从早发性败血症的1000多例到晚发性败血症的150例不等。正在进行的研究侧重于预防策略，包括疫苗开发和干燥血斑样本的新型生物标志物，以改善结果。

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Neonatal skin: barrier, immunity and infection prevention in the NICU 新生儿皮肤：新生儿重症监护病房的屏障、免疫和感染预防。

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101681

Tobias Strunk , Jakob Steer , Andrew Currie

The neonatal skin is central to early survival and immune development. Far from being a passive mechanical barrier, it integrates physical, chemical, and microbial defences that together protect the infant in the immediate postnatal period. In preterm infants, structural immaturity, reduced antimicrobial capacity, and altered microbial colonisation confer heightened vulnerability to infection and inflammation. At the same time, the neonatal period represents a critical window during which skin–microbe interactions shape tolerance and long-term immune trajectories. This review summarises recent advances in understanding the development of the skin barrier, antimicrobial and innate immune defences, and the role of commensals in immune programming. Translational opportunities for neonatal care are discussed, including skin protective practices, antisepsis, and emollient use that may reduce infection risk in the neonatal intensive care unit. Finally, we consider future directions in microbiome-informed and skin-centred strategies.

新生儿皮肤对早期生存和免疫发育至关重要。它远不是一个被动的机械屏障，它集成了物理、化学和微生物防御，共同保护婴儿在出生后的直接时期。在早产儿中，结构不成熟、抗微生物能力降低和微生物定植改变会增加感染和炎症的易感性。同时，新生儿期是皮肤微生物相互作用形成耐受性和长期免疫轨迹的关键窗口期。本文综述了近年来在理解皮肤屏障、抗菌和先天免疫防御的发展以及共生体在免疫编程中的作用方面的进展。讨论了新生儿护理的转化机会，包括皮肤保护实践，消毒和润肤剂的使用，可以降低新生儿重症监护病房的感染风险。最后，我们考虑了微生物组信息和以皮肤为中心的策略的未来方向。

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Antifungal prophylaxis-Where are we today? 抗真菌预防——我们今天在哪里？

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101682

David A. Kaufman

In the past decades more infants of lower gestational ages (GAs) have developed invasive Candida infection (ICI) from nonmodifiable risk factors of immature immunity and underdeveloped immune barriers (skin, gastrointestinal and respiratory tracts). Rates of ICI vary secondary to modifiable clinical practices, resuscitation practices and the nonmodifiable factor of the number of infants cared for at the lowest GAs of 22–24 weeks. Standardization of ICI definitions and reporting by each GA are needed to optimally elucidate actual rates, outcomes and differences across units, countries and regions. In extremely low birth weight (ELBW, <1000 g at birth) infants with ICI, mortality and neurodevelopmental impairment (NDI) have remained high despite appropriate antifungal therapy and (if candidemia) prompt removal of central venous catheters (CVC). Targeted fluconazole prophylaxis (3 or 6 mg/kg) twice a week in high-risk ELBW infants has been shown to be effective in preventing ICI and is safe without the emergence of azole resistance. Compared to nystatin, fluconazole prophylaxis for ELBW infants is more effective in preventing ICI and since it can be given intravenously, it is not dependent on enteral feeding status. Risk factors (e.g., receiving treatment with antibiotics or parenteral nutrition, presence of a CVC, vaginal delivery) can be used to both identify high-risk patients and define the time period when antifungal prophylaxis is beneficial. Independently of GA, high-risk infants also include those receiving third and fourth generation cephalosporins or carbapenems and those with complex gastrointestinal conditions (e.g. necrotizing enterocolitis, bowel perforation, gastroschisis).

在过去的几十年里，越来越多的低胎龄婴儿（GAs）由于免疫不成熟和免疫屏障（皮肤、胃肠道和呼吸道）发育不全等不可改变的危险因素而发生侵袭性念珠菌感染（ICI）。ICI的发生率随可改变的临床实践、复苏实践以及在最低GAs（22-24周）时照顾的婴儿数量的不可改变因素而变化。需要标准化ICI的定义和每个GA的报告，以最佳地阐明单位、国家和地区之间的实际比率、结果和差异。在极低出生体重（ELBW），

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Vaccinations in preterm infants: Which and when? 早产儿接种疫苗：什么时候接种？

IF 2.8 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.siny.2025.101670

Charline Schmitt , Sybelle Goedicke-Fritz , Ingmar Fortmann , Michael Zemlin

Preterm infants, who represent around 10 % of births worldwide, are at markedly increased risk of infections due to their immunological immaturity and reduced maternal antibody transfer. Although international guidelines recommend immunization based on chronological age, vaccination in this population is frequently delayed or incomplete. This review summarizes the current evidence on vaccine safety, efficacy, and timing in preterm infants, with particular emphasis on primary immunizations and vaccines administered during the first year of life. Distinct immunological characteristics—including impaired T- and B-cell responses as well as altered microbiome development—contribute to reduced vaccine responsiveness. Emerging approaches such as mRNA vaccine technologies, novel adjuvants, maternal immunization, and microbiome modulation hold promise for enhancing vaccine efficacy. Ensuring timely immunization and adherence to vaccination recommendations in preterm infants is essential to reduce preventable morbidity and mortality in this highly vulnerable group.

早产儿约占全世界新生儿的10%，由于其免疫不成熟和母体抗体转移减少，其感染风险明显增加。尽管国际指南建议根据实足年龄进行免疫接种，但这一人群的疫苗接种经常被推迟或不完全。这篇综述总结了目前关于早产儿疫苗安全性、有效性和接种时间的证据，特别强调了初级免疫和在出生后第一年接种疫苗。不同的免疫学特征——包括T细胞和b细胞反应受损以及微生物群发育改变——导致疫苗反应性降低。诸如mRNA疫苗技术、新型佐剂、母体免疫和微生物组调节等新兴方法有望提高疫苗效力。确保早产儿及时免疫和遵守疫苗接种建议对于降低这一高度脆弱群体的可预防发病率和死亡率至关重要。

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