Neonatology最新文献

Introduction: Intermittent hypoxemia (IH) is common in preterm infants and linked to brain injury. S100B is a glial-derived protein that rises early after neural injury and can be measured noninvasively in urine. We evaluated the relationship between IH burden and urinary S100B in preterm infants ≤32 weeks' gestation.

Methods: Preterm infants ≤32 weeks' gestation were prospectively enrolled. Oxygen saturation was continuously monitored, and IH profiles were quantified using validated algorithms. Urine S100B was measured by ultrasensitive immunoassay and normalized for urinary creatinine. Infants with severe intraventricular hemorrhage were excluded. Weighted Spearman correlations examined associations between IH metrics and urinary S100B, overall and by gestational age subgroups.

Results: Twenty-one infants contributed 53 urine samples. Higher urinary S100B correlated with greater IH frequency, percent time in hypoxemia, longer event duration, and lower nadir saturations (all p<0.05). Short events showed the strongest correlations for frequency (ρ=0.49) and percent time (ρ=0.51), while longer events correlated most strongly with nadir (ρ=-0.69). Extremely preterm infants demonstrated stronger associations for nadir and duration; very preterm infants only for event severity. S100B increased stepwise across IH burden tertiles.

Conclusions: Urinary S100B increases with IH burden, with patterns varying by gestational age and event duration. Urinary S100B may provide an early, noninvasive biomarker of IH-related brain injury in preterm infants.

Introduction: Placental transfusion at caesarean sections (CS) is affected by different factors, such as cord clamping (CC) time and the cardiopulmonary transition of the infant. Measuring residual placental blood volume (RPBV) is one method to assess the magnitude of placental transfusion. The aim of this study was to evaluate the association between CC time and RPBV in elective and emergency CS, and to evaluate the association with other potential factors that may influence placental transfusion.

Methods: Observational multicenter study. Data collection at elective and emergency CS at gestational ages ≥35+0 weeks, by direct observation and measurement of RPBV.

Results: A total of 185 subjects with CS were included (78 emergency CS). Birth weight was significantly associated to RPBV with a 13.0 mL increase of RPBV per kg birth weight. RPBV decreased by 4.7mL/kg/min of deferred CC. Significant variables in the final adjusted model included CC time, indication for CS with a higher RPBV in emergency CS, and time to placental emptying. Non-significant variables included sex, form of anesthesia, cord gas blood sampling, and position of infant.

Conclusion: RPBV, used as an inverse proxy for placental transfusion, was found to be associated with CC time at CS. The finding remained when adjusting for other variables that may influence RPBV and was particularly pronounced for emergency CS.

Introduction: The impact of maternal Ureaplasma colonization on vertical transmission and its contribution to acute neonatal morbidity remains unclear.

Methods: In this retrospective cohort of 1,647 mother-neonate dyads from a Chinese tertiary center (2020-2025), maternal vaginal and neonatal respiratory Ureaplasma colonization was detected via quantitative real-time polymerase chain reaction. We analyzed associations between maternal colonization and perinatal outcomes, and assessed determinants of vertical transmission and whether neonatal colonization independently predicted severe morbidity in Ureaplasma-positive mothers.

Results: Maternal Ureaplasma colonization (prevalence 65.9%) significantly increased risks of very preterm birth (16.2% vs. 8.7%), term premature rupture of membranes (9.3% vs. 5.3%), very low birth weight (11.4% vs. 6.9%), neonatal intensive care unit (NICU) admission (58.6% vs. 52.0%), and respiratory distress syndrome (RDS) (10.6% vs. 7.3%). In Ureaplasma-positive mothers, vertical transmission occurred in 20.7% of exposed neonates, was strongly associated with vaginal delivery (25.4% vs. 15.8% for cesarean) and was inversely correlated with gestational age (43.7% at <28 weeks vs. 6.4% at term). Colonized neonates had significantly higher rates of NICU admission (86.7% vs. 51.3%), RDS (16.4% vs. 9.1%), and intrauterine infection/sepsis (35.6% vs. 25.8%). After confounder adjustment, neonatal colonization remained an independent risk factor for severe illness (adjusted odds ratio 3.06, 95% confidence interval 1.55-6.06).

Conclusion: Maternal Ureaplasma colonization predisposes to preterm birth and neonatal morbidity. Vertical transmission varies by delivery mode and is the highest with extreme prematurity. Neonatal Ureaplasma colonization independently predicts severe acute morbidity, underscoring the need for targeted risk stratification and intervention in high-risk dyads.

Introduction: In patients with Tuberous sclerosis complex (TSC), seizure onset can be as early as in the neonatal period. Recent studies showed that earlier treatment of TSC positively improves epilepsy and neurodevelopmental outcomes.

Methods: This is an international retrospective study on neonates with TSC monitored with long-term video-EEG.

Results: Six of ten neonates with a perinatal diagnosis of TSC were found to have electrographic-only seizures within the first 10 days of life on long-term video-EEG. All patients in this series were found to have TSC2 variants and, except for one patient, had difficult-to-treat seizures requiring multiple anti-seizure medications.

Conclusion: Our study suggests that early video-EEG for electrographic-only seizures may be valuable in neonates with TSC who otherwise would go untreated.

Background: Thermal homeostasis remains a fundamental aspect of neonatal intensive care, yet modern practice differs significantly from earlier studies. Contemporary cohorts include infants at the edge of viability, characterised by immature skin, limited thermogenic capacity, and extended ventilatory support. Simultaneously, incubator design has evolved from basic normothermic chambers to servo-controlled, high-humidity environments. Additionally, infants often require weeks of support with heated respiratory circuits. These developments introduce complex, interacting thermal inputs that were not present in earlier physiology, yet current protocols remain largely empirical.

Summary: Evaporative heat loss, caused by transepidermal water loss (TEWL), mainly influences the thermal balance of very preterm infants. TEWL can be equal to or greater than metabolic heat production, especially in the early postnatal period. Its factors include gestation, vapour pressure gradients, and environmental dew point. High relative humidity lessens evaporative stress but reduces the safety margin, raising the risk of condensation and subsequent cooling. Additional instability comes from convective and conductive losses during handling, as well as the thermal effects of ventilator circuits.

Key messages: We suggest reframing neonatal thermal care as actively managing thermal and vapour gradients, rather than only maintaining core normothermia. Evidence-based strategies include keeping high relative humidity soon after birth, minimising isolette openings, pre-warming contact surfaces, and recognising dew point thresholds. Research priorities involve defining optimal humidity protocols, measuring circuit thermal load, and validating monitoring systems that combine oxygen consumption with environmental factors. Tackling these gaps may reduce metabolic stress, enhance survival, and optimise outcomes for the most vulnerable infants.  .

Introduction: The aims of this study were to evaluate iron metabolism changes and overload risk in preterm infants after red blood cell transfusion (RBCT) and to assess hepcidin's diagnostic value.

Methods: This prospective study analyzed 72 preterm infants (mean GA: 30.1 weeks; BW: 1,356 g) at Shenzhen Children's Hospital (2023). Groups were stratified by the volume of RBCT (>40 mL/kg vs. ≤40 mL/kg). Serum ferritin (SF) and hepcidin levels were measured alongside clinical parameters.

Results: The >40 mL/kg RBCT group had significantly lower GA (p = 0.039) and BW (p = 0.013). SF and hepcidin levels were elevated in the >40 mL/kg RBCT group (p < 0.001), with higher risks of iron overload (RR = 1.6, 95% CI: 1.3-2.3) and severe overload (RR = 4.5, 95% CI: 1.8-12.4). The volume of RBCT was an independent risk factor (p = 0.034). Hepcidin showed predictive value (area under the curve = 0.731, sensitivity: 92%, cutoff: 45.08 ng/mL).

Conclusions: High-volume of RBCT (>40 mL/kg) significantly increase iron overload risk in preterm infants. Hepcidin demonstrates potential as a predictive biomarker.

Introduction: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa CUAMM, the Ethiopian Paediatric Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian NICUs, identify gaps, and guide targeted interventions.

Methods: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation 'Train the Trainers' course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites.

Results: The survey showed that most units lacked essential resuscitation equipment. Non-invasive respiratory support mainly relied on homemade CPAP systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas.

Conclusions: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures, and promote delivery room and respiratory care.

Introduction: Neonatal jaundice is a leading cause of early post-discharge referrals. Community follow-up commonly relies on visual assessment and clinic-based evaluation, generating avoidable visits. Scalable home pathways that maintain safety are needed. We evaluated a nurse-led, home pathway that integrates transcutaneous bilirubin (TcB) screening with targeted pediatric teleconsultation.

Methods: Prospective before-after study within routine nurse-led home visits for eligible infants (firstborn and preterm) ≥35 weeks' gestation. A 3-month pre-intervention phase (usual visual assessment) was compared with a 9-month intervention using TcB-guided thresholds and teleconsultation via a secure digital platform. The primary analysis targeted infants who, under usual care, would be referred ("baseline-eligible"), estimating the absolute difference in referral at the home visit. Secondary outcomes were agreement between clinical cues and TcB, teleconsultation utilization, and phototherapy requirement.

Results: 1,236 infants were enrolled (157 pre-intervention; 1,079 intervention). Among baseline-eligible infants (n=840), 152 (18.1%) were referred; thus 688/840 (81.9%) potential referrals were avoided (absolute reduction 81.9%; 95% CI 79.2-84.4; NNR 1.22, 95% CI 1.19-1.26). TcB identified all infants requiring phototherapy (4/1,079; 0.4%) within 14 days. Agreement between clinical cues and TcB-defined need for follow-up was slight (weighted κ=0.075; 95% CI 0.059-0.091). The reduction in referrals corresponded to an absolute decrease of 0.67 visits per infant.

Conclusions: A nurse-led, digitally supported home pathway that integrates TcB screening and targeted teleconsultation substantially reduces unnecessary neonatal referrals, with no missed cases requiring phototherapy. This pragmatic precision-triage model is implementable within existing community services and can relieve post-discharge system burden while preserving safety.

Introduction: Intraventricular haemorrhage (IVH) leads to significant morbidity among preterm infants. We conducted an overview of systematic reviews of RCTs assessing the effects of perinatal/neonatal interventions in reducing IVH among preterm infants.

Methods: PubMed, Embase, Cochrane database for systematic reviews, and systematic review repositories were searched for meta-analyses of RCTs involving preterm infants or women at high risk of preterm birth and reporting on IVH. Metaumbrella package of R software was used to pool outcome data for each intervention. Quality of the systematic reviews was assessed using AMSTAR 2 tool. Certainty of evidence (COE) was reported using GRADE recommendations.

Results: A total of 148 systematic reviews (110 Cochrane vs. 38 non-Cochrane) were included. Postnatal interventions were reported in 118 reviews. Severe IVH was reported in 100/148 reviews that included 39,483 infants and 20,400 antenatal women. In total, 78% (n = 116) of the reviews were rated high or moderate quality on AMSTAR-2 assessment. Antenatal corticosteroids and magnesium sulphate for imminent preterm birth, volume-targeted ventilation, early rescue surfactant administration through thin catheter, prophylactic indomethacin significantly reduced the rates of severe IVH (moderate COE). Use of respiratory function monitors and heated humidified respiratory gases in the delivery room and early prophylactic erythropoietin supplementation for preterm infants may reduce the rates of severe IVH (very low COE).

Discussion: Antenatal steroids and magnesium sulphate administration and early neonatal lung protective strategies reduce the rates of IVH in preterm neonates. Adequately powered RCTs evaluating IVH care bundles with long-term follow-up are required.