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

Objective: Bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (BPD-PH) is the most severe endotype of BPD; there is insufficient evidence to support the optimal screening strategy in at-risk infants. We hypothesised that serial echocardiography throughout hospitalisation would improve PH detection with increased negative predictive value (NPV) beyond 36 week's postmenstrual age (PMA).

Study design: This was a single centre cohort study conducted between 2017 and 2023. In infants with BPD-PH, all echocardiograms preceding a diagnostic echocardiogram were included and considered false negatives for prediction of later PH. In infants with BPD alone, all echocardiograms were included and were considered true negatives. These indices were then used to estimate the sensitivity and NPV of echocardiographic screening for PH. In addition, we compared the performance of four different potential echocardiographic screening approaches on the ability to identify infants with BPD-PH.

Results: Data from 394 infants were available for this analysis of whom 258 had BPD alone and 136 had BPD-PH. 2542 echocardiograms were used in estimates of diagnostic accuracy. The highest NPVs occurred with echocardiographic screening starting at 36 weeks' and continuing monthly until discharge. Detection of BPD-PH among infants with BPD differed by screening strategy: 34.5% for comprehensive screening, 20.0% for early screening, 15.0% for singular screening and 30.7% for late screening (p<0.05).

Conclusions: While the diagnostic accuracy of echocardiographic screening increases at and beyond 36 weeks' PMA, obtaining a singular echocardiogram may be an insufficient screening strategy for the detection of BPD-PH in at-risk infants.

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 8.9% (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.

Objective: To evaluate enteral feeding practices in preterm infants in neonatal intensive care units (NICUs) in high-income countries across three continents, and compare results with a similar survey 13 years earlier.

Methods: Web-based survey distributed to neonatologists at 258 NICUs across 15 countries in Europe, Australia, New Zealand and Canada, October 2023 and February 2024. Survey domains focused on availability of human milk, onset of enteral feeding, breast milk fortification (BMF), cytomegalovirus (CMV) screening and enteral supplements including probiotics. Results were compared with a similar survey performed in 2010.

Results: Replies were received from 185 (72%) NICUs. Access to donor human milk (DHM) was high (91%). Across all NICUs, feeds were started on day 1 in 64%, 73% and 85% among infants born <25, 25-27 and 28-31 weeks' gestation, respectively. Bovine milk-based BMF was routinely used in 88% of NICUs, with large variation in when it was commenced and discontinued. Routine use of human milk-based BMF was uncommon (4%). Maternal CMV status was routinely determined in 33% of all NICUs who then pasteurised or froze milk if the mother was CMV-seropositive. Probiotics were provided in 66% of the NICUs, with large variations in products and birth weight/gestational age criteria.

Conclusions: Compared with our survey from 2010, more NICUs now start feeding preterm infants on day 1, and DHM availability has increased in some countries. Substantial variation remains in the use of BMF, probiotics and CMV screening. A stronger evidence base is needed to update guidelines, aiming ultimately to improve growth and long-term neurodevelopment.

Maternal immunity is modulated during pregnancy at the placental interface to prevent alloreactivity with the developing fetus. Importantly, however, maternal immunoglobulin G (IgG) freely crosses the placenta, and the presence of pre-existing alloreactive antibodies can lead to injury of fetal tissues and/or cells. Because maternal IgG continues to circulate up to 6 months after birth, these antibodies can also continue to affect the newborn, causing a variety of disease conditions including haemolytic disease of the newborn, neonatal alloimmune thrombocytopenia, neonatal lupus, neonatal Graves' disease, gestational alloimmune liver disease and others. Ig therapy, most typically in the form of intravenous Ig, is indicated in these disorders, as pooled IgG molecules can interfere with the circulating maternal IgG, lessening the interactions with the fetal or neonatal binding targets. Ig is an increasingly used therapy in this population; however, most fetal and neonatal providers do not receive comprehensive training in its development or use. Here, we review the formulation, mechanisms of action, therapeutic indications and administration of intravenous Ig in the context of fetal and neonatal medicine.

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.