Neonatology最新文献

Introduction: Severe intraventricular hemorrhage (sIVH) remains a significant complication for very preterm infants (VPIs). This study aimed to assess heritable and environmental contributions to sIVH .

Methods: A total of 2074 twin pairs born at gestational age <32 weeks with known sIVH status were identified. Three statistical methods were applied, including the Pearson χ2 test, intra-class correlation (ICC), and ACE modeling.

Results: Both Pearson's χ2 test (P =0.224) and ICC analysis (P =0.534) revealed no significant difference after comparing neither, one, or both of the monochorionic and dichorionic twin pairs who developed sIVH. ACE modeling revealed no contribution of heritability to sIVH risk, while the common environmental impacts on sIVH development were 27.9% (95% CI [23.9%, 31.9%] and 72.1% (95% CI [68.1%, 76.1%]), respectively. Assisted conception (aOR 1.45, 95% CI [1.06, 1.97]), inotropes (<3 days) (aOR 1.71, 95% CI [1.22, 2.39]) , invasive mechanical ventilation (<3 days) (aOR 2.38, 95% CI [1.56, 3.64]) and sedations (<7 days) (aOR 2.25, 95% CI [1.55, 2.06]) had contribution to sIVH, while larger gestational age (aOR 0.77 [0.71, 0.85]) and early surfactant administration (≤2 hours）(aOR 0.58, 95% CI [0.42, 0.79]) prevented VPIs from sIVH.

Conclusions: We recognized that environmental factors instead of heritability may play major contribution to the development of sIVH. Quality improvement studies focusing on the potential environmental factors to decrease the incidence of sIVH are warranted.

Introduction: FIREFLEYE next 3 years of age efficacy and safety outcomes after intravitreal aflibercept 0.4 mg injection versus laser therapy for retinopathy of prematurity (ROP) in the randomized, FIREFLEYE trial are reported.

Methods: Children born prematurely (gestational age ≤32 weeks) or with low birth weight (≤1,500 g) were treated for ROP in FIREFLEYE. Efficacy and safety end points for this prespecified interim analysis included ROP status, unfavorable structural outcomes, disease recurrence, treatment of ROP complications, vascularization completion, visual function, adverse events, and growth outcomes.

Results: One hundred children were enrolled (aflibercept, 66 [128 eyes]; laser, 34 [64 eyes]). Data for the 3-year analysis were available for 90 children (aflibercept, 60; laser, 30). Most children had no ROP or unfavorable structural outcomes (aflibercept, 98.3% and 93.9% vs. laser, 96.7% and 94.1%), with no ROP reactivation after age 50 weeks. Two children (aflibercept) with re-activated disease received bilateral laser treatment prior to age 50 weeks. Most children could fix and follow a 5-cm toy (aflibercept, 96.6%; laser, 98.3% of eyes). Binocular BCVA (Snellen equivalent) was ≥20/200 and ≥20/40 in 97.8% and 66.7% (aflibercept) versus 100% and 47.8% (laser) of children, respectively. High myopia was present in 8.9% (aflibercept) and 24.1% (laser) of eyes. Adverse events and growth outcomes were as expected for the population.

Conclusion: Descriptive analyses of the 3-year outcomes confirm long-term, stable disease control following aflibercept 0.4 mg treatment of severe acute-phase ROP, with age-appropriate visual function, less frequent/severe myopia compared with laser, and no ocular or systemic safety concerns.

Trial registration: ClinicalTrials.gov Identifier: NCT04015180.

Introduction: Congenital erythropoietic porphyria (CEP), especially neonatal-onset CEP, is an ultra-rare autosomal recessive disorder caused by variations in the UROS gene that may mimic severe systemic conditions, which can delay diagnosis.

Case presentation: We report the case of a male neonate born with asphyxia, hepatosplenomegaly, cytopenia, and multiorgan dysfunction, initially suspected to have familial hemophagocytic lymphohistiocytosis. Targeted panels for familial hemophagocytic lymphohistiocytosis and autoinflammatory disorders yielded negative results. Red urine and photosensitive blistering lesions were observed. Rapid trio whole genome sequencing identified a homozygous NM_000375.3 (UROS):c.562G>T (p.Gly188Trp) variant that had previously only been reported in compound heterozygous patients and classified as pathogenic in ClinVar (RCV000003959). Subsequent biochemical testing confirmed markedly elevated porphyrin levels, establishing a diagnosis of CEP.

Conclusion: This case highlights the diagnostic challenges of neonatal CEP, where systemic illness may obscure the classical signs. This underscores the value of a genomics-first approach in critically ill neonates.

Objectives: To correlate oxygenation index (OI) and oxygen saturation index (OSI) in congenital diaphragmatic hernia (CDH) and determine guideline changes impact from two different epochs.

Study design: Retrospective analysis of 390 CDH neonates managed at University of Utah/Primary Children's Hospitals from 2003-2024. We performed regression analysis for paired OI and OSI values over the first week of life (2604 pairs), comparing pre- (2003-2015) and post- (2016-2024) epoch effects of a 2016 CDH guideline. We analyzed predictive abilities for OI and OSI within and between epochs for extracorporeal membrane oxygenation (ECMO) and/or death.

Results: OI and OSI showed higher correlation in the post- (R2 = 0.755) vs pre-epoch (R2 = 0.650). Between epochs analysis demonstrated lower inspired oxygen, mean airway pressure, arterial oxygen pressure, OI, and OSI in the post epoch. Extracorporeal membrane oxygenation (ECMO) use was lower in post epoch (9.8% vs 33%), but pre-ECMO OI and OSI were similar between epochs. Classification of severe lung dysfunction by OI > 25 or OSI > 12 showed similar abilities to predict ECMO and/or death.

Conclusions: OI and OSI were highly correlated in CDH but affected by variation in CDH management. OSI classified severity of cardiopulmonary dysfunction as effectively as OI.

Introduction: There is a paucity of data with regards to benefits and harms associated with deferred cord clamping (DCC) in triplets. The objective was to compare outcomes of triplets following exposure to DCC in a national cohort admitted to the NICU in Canada with a gestational age of <33 weeks.

Methods: We conducted a retrospective, population-representative, cohort study of triplets born before 33 weeks of gestation in a Canadian NICU. DCC was defined as cord clamping conducted after 30 s of the birth of the neonate. Our primary outcome was survival without neurological injury or late-onset sepsis, and individual outcomes of neonatal survival, severe neurological injury, and late-onset sepsis. We utilized the target trial emulation technique to analyze data considering discordant exposure, discordant outcomes, and the correlated nature of outcomes within the triplet set.

Results: Of the 226 sets of triplets included in the study, 100 sets had all 3 received DCC, 22 had 2/3 received DCC, 32 had 1/3 received DCC, and 72 had none received DCC for a total of 376 neonates who received DCC and 302 did not receive DCC. There was no association of benefit or harm between DCC and any of the outcomes studied in any of the analyses. Univariate comparison of outcomes indicated higher receipt of inotropes and higher length of stay among those who did not receive DCC compared to other groups.

Conclusion: In this retrospective cohort study, DCC was not associated with benefit or harm in very preterm triplets.

In the article "No Short-Term Effect of Low-Dose Nicotine on Inflammation after Global Hypoxia in Newborn Piglets" [Neonatology. 2025;122:171-180; https://doi.org/10.1159/000541217] by Volstad et al., the following corrections to the legend of Table 1 should be observed.The sentence "Statistically significant differences (<0.05) are highlighted in bold" has been removed as these differences are indicated using superscript letters (a-d).Superscript letter c incorrectly read "Significant lower pH in control versus LN group (p = 0.041)" and should correctly read "Significant lower pH in control versus HN group (p = 0.041)."Superscript letter d incorrectly read "Significant lower pH in HN versus LN group (p = 0.040)" and should correctly read "Significant lower lactate in HN versus LN group (p = 0.040)."The original article has been updated to reflect the above.

Introduction: Morbidities of prematurity are often analyzed as if their epidemiology is shared, but this assumption may mask key differences in morbidity risk. This study assesses the association between three birth size metrics and development of chronic lung disease (CLD), severe retinopathy of prematurity (sROP), severe intraventricular hemorrhage (sIVH), and severe necrotizing enterocolitis (sNEC) when stratified by gestational age (GA) with morbidity-specific GA ranges and covariates.

Methods: For each morbidity, data from the Pediatrix Clinical Data Warehouse (2013-2018) were included for GAs with at least 1% morbidity. Birth weight, length, and head circumference were classified as small (SGA), appropriate (AGA), or large for GA (LGA) using the Olsen curves. Odds ratios and 95% confidence intervals (AGA as referent) for each morbidity by GA were calculated using logistic regression, adjusting for morbidity-specific adjustors.

Results: SGA weight increased the odds of CLD (OR: 1.6-2.9) and sROP (OR: 1.7-3.6) for most GAs and sNEC (OR: 1.6-1.8) in at least half of the GAs, but not sIVH at any GA. LGA weight decreased the odds of CLD in some GAs and increased the odds of sIVH only at 27 weeks GA, but was not associated with sROP or sNEC at any GA. Results were similar for length and head circumference.

Conclusion: CLD, sROP, sNEC, and sIVH are associated with GA, birth size, and covariates differently. CLD and sROP were consistently associated with size classification and GA, while sNEC demonstrated variability in its association. However, sIVH was rarely associated with birth size in this sample.

Objective: To analyze for which reasons the certainty of evidence was downgraded in neonatal Cochrane reviews.

Methods: We performed a systematic meta-epidemiological review for Cochrane neonatal reviews published in 2022-2024. The search was performed in January 2025, and all reviews were screened by two authors. We extracted the information from the summary of findings tables. As the main outcome we compared the reasons for downgrading per evidence certainty categories. Secondary outcomes included the analysis of null effects and comparison of confidence interval width. Chi2 was used to analyze the categorized variables.

Results: We included 54 reviews with 467 outcomes of which evidence certainty wasrated very low (35%), low (43%), moderate (20%), and high (2%). Imprecision and risk of bias were the most frequent reasons for downgrading certainty of evidence (p<0.001). Outcomes with effect estimates including the null were more often downgraded for imprecision, whereas outcomes without null effects were more often downgraded for risk of bias. A strong association was observed between certainty level and null effects: very low certainty evidence most often included the null effect, followed sequentially by low, moderate, and high certainty evidence (p<0.001). Among dichotomous outcomes, wide confidence intervals were the predominant driver of imprecision, with CI width clearly associated both with certainty categories and with the frequency of downgrading due to imprecision.

Conclusion: The neonatal evidence was mainly limited due to imprecision and risk of bias. This indicates that larger scale high-quality studies in various neonatal topics are still greatly warranted.

Introduction: Quantitative lung ultrasound (LUS) predicts bronchopulmonary dysplasia (BPD), but variability in BPD definitions raises concerns about its predictive consistency. We hypothesized that predictive accuracy of LUS would remain stable regardless of the definition applied.

Methods: In this prospective, multicenter cohort study, preterm infants ≤30 weeks of gestation underwent extended LUS (eLUS, adj-eLUS) aeration score at days 10, 21, and 28. BPD was assessed at 36 weeks of postmenstrual age using Jobe and Bancalari (2001), NICHD (2018), and Jensen (2019) definitions. Receiver operating characteristic (ROC) analysis compared predictive performance (areas under ROC curve [AUC]) across definitions.

Results: Among 337 infants (mean gestational age: 27 weeks, mean birth weight: 941 g), BPD incidence ranged from 22.8 to 25.8% depending on definition. AUCs for BPD prediction ranged between 0.732 and 0.832. The mean difference (ΔAUC) between definitions was minimal (≈0.02, 95% confidence interval: 0.01-0.03) and nonsignificant at all time points.

Conclusions: Quantitative LUS reliably predicts BPD regardless of its definition, and this support its use in early respiratory care and monitoring.