Neonatology最新文献

Introduction: The recent BORN study suggests the incidence of retinopathy of prematurity (ROP) might be significantly reduced by transfusing extremely low gestational age neonates (ELGANs) with red blood cells (RBCs) from term umbilical cord blood. We are uncertain what proportion of infants with severe ROP had no RBC transfusions and thus would not benefit from changing transfusion practice.

Methods: We created detailed transfusion histories of all infants in our health system (2021 - 2024) who developed severe ROP.

Results: Severe (stage ≥3) ROP was diagnosed in 34 infants; 32 of these had received 1-18 RBC transfusions. Eleven also received 1-16 platelet transfusions. Two received no transfusions.

Conclusion: A small minority of infants with severe ROP were never transfused, thus changing transfusion practice would not likely prevent all cases. However, the great majority had multiple RBC transfusions and thus might benefit from cord blood RBC transfusions.

Background: We know little how neonatal research changed at the Paris Foundling Hospital following the Revolution.

Summary: The number of unwanted children rose and 5,392 infants were admitted in 1826 - a quarter of all infants born in Paris. 26% of them died in the infirmary before transport. The infants' appalling mortality was associated with artificial nutrition, and transfer to mercenary nurses in the countryside was organized. In the 1830s, sedentary nurses began to run short, and nearly all babies were fed artificially at some time. François Chaussier was director at the Maternity from 1804. He developed instruments to resuscitate newborns: mask-and-bag ventilation, silver endotracheal tubes, and oxygen tanks. He classified congenital malformations and described osteogenesis imperfecta. Marie-Louise Lachappelle trained midwives in forceps deliveries and use of endotracheal intubation of newborns. Other researchers at the foundling hospital included Antoine Dugès, Jacques-François Baron, Gilbert Breschet, Louis Véron, Johann Heyfelder, Prosper-Sylvain Denis and Charles Billard. The latter investigated neonatal cry in 1827 and associated expiratory grunting with poor prognosis in prematures. His Treatise on Diseases of the Newborn, based on many autopsies and meticulous clinical records, remained neonatology standard for a century. It described peritonitis, megacolon, intestinal hemorrhage, pertussis, spina bifida, patent ductus, single ventricle, and various forms of tuberculosis.

Key messages: Physicians were permanently employed from 1821, their research developed from autopsies. The fusion of Medicine and Surgery into a single faculty moved obstetrics (and thus newborn care) from the barbers' domain to research-oriented science.

The article "Seizure Burden before and after Lidocaine as Add-On Therapy in (Amplitude-Integrated) Electroencephalography-Confirmed Neonatal Seizures" [Neonatology. 2025; https://doi.org/10.1159/000549690] by Rondagh et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been updated.

Background: Persistent pulmonary hypertension of newborn (PPHN) occurs due to the impairment in the expected fall in pulmonary vascular resistance during the fetal to neonatal circulatory transition, with a prevalence of 1.9 per 1000 live births, and a significant mortality rate of 4-33%.

Objective: We aimed to systematically review the genetic variants associated with PPHN in term and late preterm infants without a known genetic syndrome.

Methods: In February 2025, the MEDLINE OVID, SCOPUS, and COCHRANE databases were searched for eligible studies without publication date restriction. Our review included cohort studies, case-control studies, and case series that examined the association of PPHN and genetic variants in term and late preterm infants. We extracted data regarding the methodology, participant characteristics, and outcome measures.

Results: We included nine studies (7 case-control studies and 2 cohort studies) that enrolled 1,494 participants. The risk of bias assessment using the Quality of Genetic Association Studies tool showed that 91% of the studies were of moderate or good quality. Our review found reports of positive associations between specific genetic variants in genes such as CPS1, CRHR1, NOTCH3, EDN1, EPAS1, WWC2, ABCA3, RFX3, EP300, GNA11, PKLR, SLC2A1, BMPR2, and EGLN1. One study reported no association between an ACE gene variant and PPHN.

Conclusion: Studies of common genetic variants associated with an increased risk of PPHN in term and late preterm infants are limited, based on small cohorts and frequently focused on small sets of candidate genes, yielding inconsistent results across studies.

The article "Deferred Cord Clamping in Very Preterm Triplets and Outcomes: A Retrospective Cohort Study" [Neonatology. 2025; https://doi.org/10.1159/000550056] by Shah et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been corrected.

Introduction The Bilistick is a handheld point-of-care device for measuring total bilirubin levels in small blood volumes. We assessed its diagnostic accuracy and user convenience in near-term neonates cared for at home. Methods A prospective cohort study was conducted in nine Dutch community midwifery practices. Neonates ≥35 weeks' gestation were eligible if they were at home between postnatal days 2-8 and had not received phototherapy. A Bilistick version 2.0 was used in parallel to laboratory-based bilirubin (LBB) quantification when significant visible jaundice was observed or the transcutaneous bilirubin reading was elevated. Results 2314 neonates were included in the study, with 423 blood samples analyzed across 13 laboratories. On 203 occasions, the Bilistick was not used. Among the remaining 220 Bilistick readings, 104 failed, and two lacked corresponding LBB results. A Bland-Altman plot of 114 paired measurements of Bilistick and LBB showed a mean difference of +9.7 µmol/L (0.57 mg/dL) with corresponding 95% limits of agreement of -179.7 to +199.2 µmol/L (-10.5 to 11.7 mg/dL). The positive predictive value of a Bilistick reading for having a TSB level above the phototherapy threshold was 36.4%. The negative predictive value was 90.1%, sensitivity 60% and specificity 77.6%. Hemolysis (24%) contributed to overestimations by the Bilistick. Community midwives expressed multiple barriers related to user convenience. Conclusion Diagnostic accuracy of the Bilistick when used in the home setting was limited. Its use was further hindered by a significant proportion of failed readings and low user-convenience when operated by midwives.

Introduction: Availability and expertise of healthcare professional are essential for the quality of care of preterm infants. Objective was to survey different healthcare professionals' availability for management of preterm neonates <29 weeks' gestation among neonatal intensive care units (NICU) of 12 population-based neonatal networks.

Methods: Questionnaires were distributed to 608 NICU participating in the International Network for Evaluating Outcomes in Neonates (iNeo). Networks included: Australia/New-Zealand (n= 30), Brazil (n=20), Canada (n=32), Finland (n=5), France (n=70), Israel (n=26), Japan (n=292), Poland (n=56), Spain (n=55), Sweden (n=9), Switzerland (n=9) and Tuscany (n=4). Questions focused on availability of physicians, nurses and additional healthcare professionals in 2023.

Results: A total of 382 (63%) NICU responded. The 24/7 availability of healthcare professionals varied within and between networks and overall was reported to be 66% for neonatologists, 55% for neonatal fellows, 62% for pediatric residents and 55% for nurse practitioners. Nurse-to-patient ratios were most commonly 1:1 for complex critical care infants (53%) and 1:2 for intensive care infants (48%). Low 24/7 availability was reported for respiratory therapists and pharmacists.

Conclusions: Marked variations exist in health care professionals' availability, which might be associated with NICU organization and management of infants <29 weeks' gestation. While majority of NICU have reported 24/7 availability of neonatologists, the availability of other healthcare professionals was inconsistent. Nurse-to-patient ratio has improved. Further evaluation is needed to understand how these variations are associated with outcomes of extremely preterm infants and to optimize resource utilization.

Every year new evidence emerges about how best to care for babies with respiratory distress. We report the seventh version of "European Guidelines for the Management of RDS" by a panel of European neonatologists and a perinatal obstetrician based on available literature up to mid-2025. Optimising outcome involves collaboration with obstetricians to predict risk of preterm delivery, consideration of transfer to perinatal centres and perinatal optimisation including antenatal steroids. Delivery room protocols should include maintenance of normal body temperature whilst aiming to promote spontaneous breathing before clamping the umbilical cord, using non-invasive respiratory support where possible and considering early use of surfactant via thin catheter in an attempt to avoid intubation. Ongoing non-invasive respiratory support and judicious use of surfactant will improve outcomes. If mechanical ventilation is needed, lung protective strategies should be employed and ventilation continued for the shortest time possible to reduce risk of bronchopulmonary dysplasia. Protocols for supportive care are also reviewed. What is New? Prenatal management remains largely unchanged, perhaps with more emphasis on confirming preterm labour, to allow more judicious use of antenatal steroids. In the delivery room we suggest physiological based cord clamping rather than time based, with an emphasis on strategies for managing thermal care if equipment is available before the cord is cut. Starting FiO2 of 0.6 rather than 0.3 at birth should reduce bradycardia and need for chest compressions and adrenaline for infants born < 29 weeks' gestational age. Surfactant prophylaxis has reappeared for extremely preterm infants in the current era of Less Invasive Surfactant Administration (LISA), with an emphasis on use of videolaryngoscopy for LISA catheter placement or intubation because of greater first pass success for intubations. Nasal ventilation rather than CPAP now seems the most potent mode of non-invasive respiratory support, both after initial stabilisation and when coming off mechanical ventilation, although there is no unified approach as to how best to provide it. For babies who have not received prophylactic surfactant, the treatment thresholds of FiO2 0.3 are unchanged, but with more emphasis on using ultrasound where possible to diagnose RDS regardless of FiO2 requirements in babies with signs of respiratory distress.