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

Objective: To describe early management of infants born to a parent with gene-positive long QT syndrome (LQTS) referred for specialist review. Review the diagnostic utility of the early neonatal and first clinic ECG.

Design: Retrospective cohort study, including a review of the first neonatal and first clinic ECG.

Setting: Quaternary paediatric-only referral hospital with specialised unit for the management of paediatric inherited cardiovascular diseases.

Patients: Infants born 2015-2022 referred in the setting of parental LQTS who subsequently underwent predictive genetic testing for a parental LQTS-causative genetic variant.

Main outcome measures: Age (at first early neonatal ECG, referral, first clinic attendance), genetic testing data, clinical course, exposure to QT-prolonging medications, neonatal hypoxia-ischaemia and cardiac events (cardiac arrest or death) in the infant's first year.The first neonatal and first clinic ECGs were evaluated for QTc and T-wave morphology, by two observers.

Results: Twenty-six infants met inclusion criteria. Eighteen (69%) were referred in the first month of life. Twelve (46%) inherited the familial LQTS variant. Fourteen (54%) commenced beta-blocker therapy to treat suspected or genetically confirmed LQTS, two subsequently ceased treatment due to a negative genetic result. There were no cardiac events. For the ECG analysis, 40 ECGs from 26 infants were reviewed (early neonatal n=14 (54%)). The first clinic ECG allowed more accurate determination of genetic status with better interobserver variability. Inclusion of T-wave morphology assessment improved its sensitivity.

Conclusions: Streamlined pathways to manage families with LQTS across institutions need to be firmly established to permit a timely diagnosis. Incorporation of formalised T-wave morphology assessment adds value.

Objective: To establish normative ranges for fetal brain volume (FBV) and investigate its relationship with gestational age, using MRI to improve the understanding of fetal brain development.

Design: A prospective, cross-sectional study.

Setting: A single-centre study conducted at a tertiary care hospital equipped with the world's only fetal-dedicated MRI system, located at Necker Hospital, Paris.

Patients: A total of 260 healthy singleton pregnancies between 16 and 36 weeks' gestation were included. Inclusion criteria required confirmed gestational age by first-trimester ultrasound, absence of fetal or maternal anomalies and no high-risk conditions impacting fetal growth.

Interventions: T2-weighted fetal MRI scans were acquired using standardised protocols. Brain and cerebellar volumes were manually segmented using dedicated three-dimensional post-processing software, with volume calculations. Manual segmentations were performed by experienced raters. Intra-rater and inter-rater reproducibility were assessed on randomly selected subsets of 50 cases each, demonstrating excellent agreement (intraclass correlation coefficient>0.96 for both comparisons).

Main outcome measures: The primary outcome was the normative range of FBV by gestational age. Secondary outcomes included identifying variations in brain growth rates during gestation.

Results: FBV increased significantly with gestational age, from a median of 20.1 cm³ at 16 weeks to 307.3 cm³ at 36 weeks. Growth rates showed the highest acceleration between 20 and 28 weeks' gestation, followed by a plateau. Linear regression demonstrated a strong correlation between FBV and gestational age (R²=0.95; p<0.001).

Conclusions: This study provides normative data on FBV, demonstrating consistent growth patterns during mid-to-late gestation. These findings highlight the potential for MRI to serve as a reference tool for monitoring fetal brain development and detecting anomalies in early pregnancy.

Objective: To evaluate the effect of low-dose postnatal dexamethasone therapy for bronchopulmonary dysplasia (BPD) prevention/treatment on MRI-derived regional brain volumes at term-equivalent age (TEA) and neurodevelopmental outcomes in a regional cohort of preterm infants.

Study design: We prospectively recruited 392 preterm infants (≤32 weeks gestational age (GA)), who underwent structural MRI (3T Philips Ingenia) at TEA. We automatically segmented T2-weighted MRI scans using the Developing Human Connectome Project pipeline to derive a priori selected, two primary outcomes of interest: volumes of the cerebellum and subcortical grey matter. We estimated propensity scores for subjects with a logistic regression model and used weighted linear regression to determine the independent effects of dexamethasone on primary and two secondary outcomes: cortical surface area at TEA and motor scores at 2 years corrected age.

Results: Of 392 infants, 41 were treated with low cumulative dose dexamethasone (total 0.89 mg/kg) initiated at 36 days (median) of age for evolving BPD: 21 males; mean (SD) GA was 25.5 (1.6) weeks; postmenstrual age at MRI was 43.7 (1.2) weeks; and 33 had severe BPD. In multivariable linear regression, dexamethasone was significantly correlated with larger cerebellar (difference=0.510; 95% CI: 0.079 to 0.941) and subcortical grey matter volume (difference=0.138; 95% CI: 0.014 to 0.263). Dexamethasone was also positively correlated with motor scores (difference=5.220; 95% CI: 0.845 to 9.594).

Conclusion: Low-dose dexamethasone therapy after the first postnatal week for evolving/established BPD did not result in adverse macrostructural effects and may have a protective effect on motor development in preterm infants.

Objectives: To determine the percentage of adequate umbilical cord blood (UCB) collections defined as ≥70 mL of UCB after delayed cord clamping for 3 min was applied. Second, to correlate the UCB volume to gestational age at birth, birth weight and sex.

Design: We conducted a multicentre, prospective, feasibility study in near-term infants delivered through caesarean section between November 2023 and December 2024. UCB was collected ex-utero, immediately after the placenta was removed from the womb.

Results: A total of 195 UCB collections were attempted. In 11 cases (5.6%), the attempt failed due to rupture of the umbilical cord or damaged placenta by removal of the placenta from the uterus. The median volume of the remaining 184 UCB collections was 72 mL (IQR 56-86 mL). In only 54% (100/184), the UCB volume reached the target volume of ≥70 mL. We found that UCB volume was positively associated with birth weight (R²=0.0813, F(1181)=16.02, p value <0.001) but not with gestational age at birth (R²=0.0014, F(1181)=0.2553, p value=0.614).

Conclusions: A sufficient UCB volume (≥70 mL) was obtained in approximately half of the attempts. A higher birth weight was associated with a larger volume of UCB collection.

Objective: Assess the feasibility and safety of a purpose-built automated tactile stimulation device (ATSD) responding to cardiorespiratory events in preterm infants.

Design: Randomised cross-over study.

Setting: Level-III neonatal intensive care unit in the Netherlands.

Patients: Infants born between 24 and 30 weeks gestational age, receiving non-invasive respiratory support and experiencing apnoea, bradycardia and/or hypoxia for>10 s.

Interventions: Infants underwent two study periods of 24 hours. In the control period, the ATSD was attached but inactive. In the intervention period, ATSD was activated and used in addition to standard care, providing direct vibratory stimulation in response to clinical alarms.

Main outcome measure: Feasibility of using ATSD, expressed by the number of infants completing the study, the ability to provide stimulation on the skin and the perceived feasibility by the nurses.

Results: 16 infants were included, of which 14 (88%) completed both study periods. Two infants were withdrawn from the study prematurely: one infant required intubation for cyanotic spells and the other developed local non-blanching erythema consistent with a mild pressure ulcer, on which the device was removed. During the intervention period, ATSD correctly detected 84% of the cardiorespiratory events, with automatic stimulation following 100% of the events. Nurses found the ATSD easy to use and rated the clinical utility neutral to positive.

Conclusion: Applying automated tactile stimulation in preterm infants using a purpose-built device is feasible, was well tolerated by infants and nurses considered our device useful and easy to use.

Trial registration details: Dutch national trial register, NL9606.

Newborn infants must undergo complex physiological changes when transitioning from fetal to extrauterine life, including rapid lung aeration, fluid clearance and major haemodynamic shifts. Although the majority breathe spontaneously, a significant minority may require respiratory support. Resuscitation guidelines recommend face-mask positive pressure ventilation with a T-piece resuscitator, but effectiveness in the delivery room (DR) is typically assessed by subjective measures such as chest wall movement.This narrative review summarises the evidence regarding the use of respiratory function monitors (RFMs) to provide real-time objective feedback on tidal volumes, pressures and mask leak during DR resuscitation. We examine the potential for RFMs to reduce the risk of both underventilation and overventilation and whether their employment in the first few hours of life could mitigate long-term complications such as bronchopulmonary dysplasia and intraventricular haemorrhage. We also explore practical considerations such as sensor technology, dead space, staff training, usability and cost-effectiveness. While systematic reviews and major international guidelines have not yet endorsed their routine implementation, citing limited randomised controlled trial data, multiple observational studies demonstrate that RFMs can improve DR ventilation. Ultimately, RFMs may facilitate individualised, lung-protective approaches to DR ventilation, particularly in vulnerable preterm infants. Future directions include high-quality trials with comprehensive clinical outcomes, cost-effectiveness evaluations and clarifications of training requirements for effective RFM use.

Objective: To determine the diagnostic accuracy of an over-the-counter infant pulse oximeter for cardiorespiratory events.

Design: Single-centre prospective diagnostic accuracy study.

Setting: University of Alabama at Birmingham.

Patients: Infants weighing ≥1500 g, <44 weeks' postmenstrual age (PMA) and off ventilator/continuous positive airway pressure support.

Interventions: Test device for 48 hours in addition to standard hospital monitors, ECG and pulse oximetry.

Main outcome measures: Data were time aligned and analysed using MATLAB. The coprimary outcomes were the diagnostic accuracy of the test device for the detection of events with heart rate (HR) <50 beats per minute (bpm) and events with oxygen saturations (SpO₂) <80% for ≥3 s.

Results: 66 infants with a median gestational age of 31 weeks (range 23-40) were studied at a median 35 weeks' PMA (range 32-42) weighing 1930 g (range 1500-3605 g) from April to July 2023. The sensitivity for detection of HR <50 bpm ≥3 s was 6% and 39% for smoothed and raw data, respectively, while the specificity was >99% for both smoothed and raw data. The sensitivity for SpO₂ <80% ≥3 s was 14% and 74%, while the specificity was >99% and 96% for smoothed and raw data, respectively. Sensitivity for bradycardia events was higher for events with longer durations and/or when using higher thresholds. Sensitivity was higher for hypoxaemia events with longer durations and/or when using higher thresholds.

Conclusion: An over-the-counter infant pulse oximeter had high specificity for bradycardia and hypoxaemia events consistent with a low false alarm rate. Sensitivity improved with longer events and higher event thresholds.

Trial registration number: NCT05774470.

Objective: To evaluate the impact of a change in national guidance on the management of hypoglycaemia on UK term neonatal unit (NNU) admissions, describe perinatal risk factors for hypoglycaemia and identify opportunities to reduce term infant hypoglycaemia admissions.

Design: Retrospective observational cohort study, the UK National Neonatal Research Database.

Patients: Term infant NNU admissions in England and Wales, 2012-2020.

Main outcome measures: Term admission rate to NNU primarily for hypoglycaemia/1000 term live births. Change between epoch 1 (36 months before the publication of the British Association of Perinatal Medicine (BAPM) Framework in April 2017) and epoch 2 (36 months after the publication of the BAPM Framework in April 2017).

Results: Term admissions primarily for hypoglycaemia decreased from 4.9 (95% CI 4.8 to 5.1) to 3.3 (95% CI 3.1 to 3.4) admissions/1000 term live births; proportion of potentially avoidable hypoglycaemia admissions (enteral feeds and special care only) decreased (from 12.8% (95% CI 12.1% to 13.4%) to 8.0% (95% CI 8.3% to 9.5%)), time to NNU admission and median length of stay were unchanged between epoch 1 and epoch 2. 46.5% (11 825/25 406) of infants admitted primarily for hypoglycaemia had one or more BAPM hypoglycaemia risk factors. Of infants with hypoglycaemia without BAPM risk factors, 44% (5990/13 581) had a birth weight above the 90th centile or between the 2nd centile and the 9.9th centile.

Conclusions: The publication of a national framework for term hypoglycaemia management was associated with a reduction in term NNU admission rates without delays in admission time or increased length of stay. One in two infants admitted for hypoglycaemia had no BAPM risk factors. Future research should explore birth weight between the 2nd centile and the 9.9th centile and above the 90th centile as additional factors that may further enhance hypoglycaemia risk stratification.