Archives of Disease in Childhood - Fetal and Neonatal Edition最新文献

Objective: To assess the predictive accuracy of early neurophysiological and neuroimaging biomarkers, alone and in combination, for adverse neurodevelopmental disorders in term-born infants with neonatal encephalopathy (NE).

Design: Systematic review and meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines. Eligible studies included infants born at term with NE who underwent amplitude-integrated EEG (aEEG) or EEG and MRI of the brain within the first month of life. Adverse outcomes, assessed at 18-36 months of age, were defined as cerebral palsy, postneonatal epilepsy, severe hearing or visual impairment, moderate-to-severe developmental delay, or death attributable to NE. Searches were conducted in MEDLINE, CINAHL, Embase and Web of Science from database inception to 10 June 2025; risk of bias of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool.

Main outcome measures: Sensitivity, specificity and diagnostic odds ratio (DOR) of abnormal aEEG background, EEG background, EEG seizures and MRI injury, individually and in combination, for predicting adverse outcomes, pooled using Bayesian bivariate random effects meta-analyses.

Results: 27 studies including 1843 infants were analysed. MRI injury was the individual predictor with higher DOR estimate (31.01, 95% CI 15.07 to 72.82), followed by abnormal EEG background (16.84, 95% CI 5.88 to 50.59), while abnormal aEEG background and EEG seizures performed less well (7.99, 95% CI 2.40 to 33.00; 4.46, 95% CI 1.86 to 11.42). Combining EEG background with MRI injury improved DOR (78.59, 95% CI 19.72 to 321.36) and specificity (93.8%, 95% CI 85.2% to 97.9%) compared with MRI alone.

Conclusions: MRI is a strong individual predictor of adverse outcomes in NE. Combining it with early EEG improves prognostic accuracy and may better support clinical decision-making.

Prospero registration number: CRD42024585816.

Objective: Existing predictive models for bronchopulmonary dysplasia (BPD) often lack external validation, limiting their clinical use. This study aimed to externally validate recent BPD prediction models using baseline variables, in a population-based cohort.

Design: This was an external validation study conducted on data collected from 2014 to 2021.

Setting: This was a retrospective, multicentre, population-level cohort with prospectively collected data.

Participants: Extremely low gestational age neonates recorded in the SwissNeoNet registry across all nine level III neonatal care units in Switzerland (n=1748) were included.

Interventions: Recent BPD prediction models estimating the risk of BPD or death at 36 weeks postmenstrual age, based on predictors available within the first 24 hours of life.

Main outcome measures: The primary outcome was survival without BPD. A systematic literature search identified five eligible models, which were externally validated and recalibrated for the Swiss cohort. The most performant model was further optimised to improve local applicability.

Results: Among 693 screened studies, five models based solely on perinatal variables were included. Without recalibration, models showed fair discrimination (area under the curve (AUC) 0.70-0.76) but variable calibration (observed/expected (O/E) 0.58-0.80). After recalibration, AUCs ranged from 0.69 to 0.76, and calibration improved (O/E 0.58-1.61). The optimised version of the best-performing model demonstrated improved calibration (O/E 1.03) and was validated in the Swiss population.

Conclusion: By comparing and externally validating existing BPD prediction models, we propose an optimised model using baseline variables at birth, enhancing its applicability to both the Swiss population and similar clinical contexts.

Rationale: Information on lung volume characteristics in infants with clinical signs of respiratory distress immediately after birth is limited.

Objectives: To assess changes in respiratory dynamics and physiological parameters in infants with and without respiratory distress in the delivery room and to determine the effect of continuous positive airway pressure (CPAP) support.

Methods: Electrical impedance tomography data were obtained from late preterm and term infants, born via caesarean section in a tertiary referral centre. Changes in the ratio of inspiratory to expiratory time (Ti/Te-ratio), end-expiratory lung impedance (∆EELI), oxygen saturation (SpO₂) and heart rate (HR) over the first 10 min as well as corresponding changes after CPAP application were assessed.

Measurements and main results: Of 73 infants, 18 (25%) received CPAP after birth (11 not admitted (CPAP group) and 7 admitted to the neonatal intensive care unit (CPAP/NICU)). Ti/Te ratio differed significantly between groups with the highest values in the CPAP/NICU group, mostly due to a reduced Te. There was no difference in ∆EELI. Similarly, infants in the CPAP/NICU group had lower SpO₂ and HR trajectories over time than the other two groups. After CPAP application, ΔEELI increased significantly. There were no changes in Ti/Te ratio, SpO₂ and HR after CPAP initiation.

Conclusions: In infants with more severe respiratory distress, Ti/Te ratio was increased, and SpO₂ and HR were reduced, suggesting that these parameters may serve as early predictors of respiratory failure. Application of CPAP resulted in an immediate increase in EELI, highlighting the importance of early CPAP initiation for infants with respiratory distress.

Objective: Decision-making in the neonatal intensive care unit (NICU) is complex. In grey zones (where there are multiple morally acceptable pathways), families and clinicians may disagree about the best plan. While negative moral phenomena (NMP) such as moral distress are well recognised within clinicians, little is known about parental experiences. We sought to understand parental experiences of decision-making, particularly if parents experienced NMP.

Design: This was a mixed-methodology phenomenological study, using surveys. Statistical analysis was used for categorical data and thematic analysis for textual data.

Setting: Four tertiary or quaternary NICUs in Australia and Canada.

Participants: Parents of infants admitted to NICUs between July 2018 and August 2022 who engaged in decision-making in grey zones.

Results: 71 parents (80% mothers) completed the survey. 80% were bereaved.Thematic analysis revealed five themes: (1) decision burdens, (2) internal tensions, (3) actualising beliefs and values through decision-making, (4) inauthentic shared decision-making (SDM) and (5) external factors that shaped decision-making.Parents reported variable experiences of SDM. Despite decisions being described as burdensome, 89% wanted to be very involved in SDM, while 63% felt included. Actualisation of beliefs and values was important. Time pressures, competing interests and environmental factors influenced internal tensions experienced. Despite framing as SDM, some parents reported feeling coerced and experiences consistent with NMP.

Conclusion: Some parents do experience significant NMP during SDM in the grey zones of the NICU. Clinician awareness of NMP and their antecedents may enhance communication and the SDM process in this challenging setting.

Objective: Investigate whether enteral supplementation with arachidonic acid (AA) and docosahexaenoic acid (DHA), from birth to term-equivalent age (TEA), promotes brain maturation as a prespecified secondary outcome of a multicentre randomised controlled trial.

Participants: 206 infants born at 22-28 weeks gestational age (GA) were randomised into intervention or control groups from three university hospitals in Sweden.

Intervention: The intervention group received an oil with AA (100 mg/kg/d) and DHA (50 mg/kg/d) starting at birth until 40 weeks postmenstrual age (PMA) in addition to standard nutrition. Standard-of-care infants received standard nutrition according to national guidelines.

Main outcome and measures: MRI volumetrics were defined a priori as a secondary outcome of the trial and included total brain, white and cortical grey matter, central structures and cerebellum. Univariable and multivariable linear regression models were used for comparisons.

Results: MRI data in 117 infants had sufficient quality for inclusion (n=58 intervention). Birth weight, GA at birth, sex distribution, and PMA at MRI were similar in the groups. Infants receiving intervention had significantly larger white-matter volume at TEA, as compared with standard of care, in models adjusted for GA at birth, sex, study centre and PMA at MRI (β=6.8 cm³, 95% CI 0.7 to 12.9, p=0.028). The contribution of the intervention to white-matter volume corresponded to 10 days of prolonged gestation.

Conclusion and relevance: Our findings in this hypothesis-generating study suggest that AA+DHA promotes white matter growth, which may protect the developing brain in this vulnerable population.

Trial registration number: NCT03201588.

Objective: To compare feeding strategies on preterm infants' growth during hospitalisation, neonatal morbidities, mortality and neurodevelopmental outcome (NDO) at 18-26 months corrected age.

Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for network meta-analysis . We searched five medical databases for randomised controlled trials comparing different feeding approaches in preterm infants and their effects on growth, neonatal morbidities, mortality and NDO. The Cochrane Collaboration's tool was used to assess the risk of bias. We used a random-effects model. Pooled mean differences (MD) or risk ratios with 95% CIs were calculated.

Results: Ninety-five studies (9663 infants) were included.Human milk (HM) with bovine milk fortifier (BMF) (adjusted according to blood urea nitrogen) achieved the best length increment (MD=0.56 cm/week; 95% CI 0.19 to 0.93). Notably, HM+BMF (3.5 gm/kg/d protein) showed the best head circumference growth (MD 0.46 cm/week; 95% CI 0.10 to 0.81) but no significant difference in weight gain. There were no significant differences in neonatal morbidities/mortality. While MOM|+PTF (supp) displayed significantly lower NDO delay in the domain of mild cognitive delay.

Conclusion: Overall, there is a lack of strong evidence to support a specific enteral feeding strategy and further high-quality research is required. Targeted HM fortification appears to improve head growth, while adjusted fortification enhances length. Given the significant inconsistency detected, which may compromise the reliability of the network estimates, these results must be interpreted carefully.

Objective: To identify the location of the left ventricle (LV) and identify the structures below the lower third of the sternum when chest compressions (CCs) are performed using transthoracic echocardiography.

Design: Prospective observational cohort study.

Setting: The Lois Hole Hospital for Women and the Grey Nuns Community Hospital, Edmonton, Alberta, Canada.

Patients: Newborn infants born between 37 and 41⁺⁶ weeks' gestation admitted to postnatal unit. Newborns of diabetic mothers, large or small for gestational age and with known congenital anomalies were excluded.

Interventions: Transthoracic echocardiogram to obtain views as per the American Society of Echocardiography guidelines including (1) parasternal long axis, (2) parasternal short axis, (3) apical four chamber and (4) subcostal view.

Main outcome measures: To assess the positions of the right ventricle and LV and their perception on the chest wall when CCs are performed.

Results: A total of 50 newborn infants were recruited with a mean (SD) gestational age of 39 (1) weeks and birth weight of 3409 (347) g. The LV was located at the third left sternal border in one (2%) newborn infant. In 22 (44%) infants, the LV was located at the fourth left sternal border, in 25 (50%) infants the LV was located at the fifth and in 2 (4%) infants, it was located at the sixth left sternal border.

Conclusions: In newborn infants, CC delivered at the currently recommended lower third of the sternum is likely to compress the right heart, great veins and aorta and not the LV.

Introduction: Children born preterm often have anatomical and functional visual abnormalities, even in the absence of retinopathy of prematurity. This includes suboptimal visual acuity (VA), defined as binocular VA between 5-6.3/10 and 8/10. We examine relationships between suboptimal VA and neurodevelopment in children born preterm.

Methods: Secondary analysis of the French EPIPAGE-2 cohort with children born between 24+0 weeks and 31+6 weeks of gestation, eligible for follow-up at 5.5 years. Children were classified into three VA groups: 5-6.3/10, 8/10 and 10/10 as reference group. Neurodevelopment was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, the Movement Assessment Battery for Children-II (MABC-2) and the Strengths and Difficulties Questionnaire (SDQ). Comparisons between groups were adjusted for neonatal and socioeconomic characteristics using generalised estimating equations models.

Results: Among 1787 included children, 62% had suboptimal VA. Compared with the 10/10 VA group, the mean full-scale IQ decreased by -3.09 (95 % CI -4.75 to -1.42) and -4.97 (95 % CI -6.47 to -3.46) points, the mean MABC-2 total score by -0.66 (95 % CI -0.71 to -0.61) and -1.06 (95 % CI -1.09 to -1.00), and the mean total SDQ scores increased by 0.40 (95 % CI -0.16 to 0.94) and 0.60 (95 % CI 0.10 to 1.1) in groups with VA groups at 8/10 and 5-6.3/10, respectively.

Discussion: In this French population-based cohort of children born preterm, suboptimal VA was frequent and associated with increased risk of neurodevelopmental difficulties. A comprehensive neurodevelopmental and neurovisual assessment is warranted in children born preterm with suboptimal VA.