Neonatology最新文献

The latest American Academy of Pediatrics guidelines for managing jaundice in late preterm and term neonates have increased the bilirubin thresholds to start phototherapy. This was considered safe based on expert consensus but its cost-effectiveness has not yet been evaluated. We found that implementing the new guidelines decreased hospitalisations due to phototherapy by 68.7%, 70.2%, and 60% for the total population and the late preterm and term subgroups, respectively (p<0.001 for the three analyses). The hospitalisation costs were decreased from €1,289,040 to €423,120 (i.e. an absolute saving of €865,920, or 68%, for the entire population composed by late preterm and term neonates). Implementing the new treatment threshold nationwide would entail an estimated cost reduction of €191,964,324. In conclusion, the new jaundice guidelines significantly decreased the use of phototherapy and associated healthcare costs.

Introduction: Multi-morbidity is a known cause of adverse outcomes and resource utilization in adults. Our objective was to describe the co-occurrence of neonatal morbidities and their association with neurodevelopmental outcomes in preterm neonates.

Methods: We included 17,438 preterm neonates of <29 weeks' gestation admitted to Canadian NICU between 2010 and 2020, of whom 7,943 children had neurodevelopmental information. Neonatal outcomes were mortality, late-onset sepsis, necrotizing enterocolitis, and severe neurological injury. The outcomes were neurodevelopmental impairments, with significant impairment defined as any of: Bayley-III score <70, cerebral palsy with GMFCS ≥3, hearing amplification, or bilateral visual impairment; and severe impairment defined as any of: Bayley-III score <55, cerebral palsy with GMFCS 4-5, or bilateral blindness.

Results: The mean (SD) gestational age was 26.1 (1.6) weeks and 54.5% were male. Any neonatal mortality/morbidity occurred in 40.1% of children. Among survivors, 16.3% had significant neurodevelopmental impairment and 5.8% had severe neurodevelopmental impairment. However, 51% of children with significant impairment and 43% with severe neurodevelopmental impairment and had no neonatal morbidities. Late-onset sepsis (aOR 1.60, 95%CI 1.36, 1.88), necrotizing enterocolitis (aOR 1.91, 95% CI 1.36, 2.69) and severe neurological injury (aOR 3.54, 95%CI 2.85, 4.38) were associated with significant neurodevelopmental impairment among survivors. An increase in the count of neonatal morbidities correlated with a rise in the count of neurodevelopmental impairments.

Conclusions: Sixty percent of infants <29 weeks' gestation experienced no adverse neonatal outcomes and the majority were free of significant neurodevelopmental impairment. Neonatal morbidities had a direct and combined association with neurodevelopmental impairment.

Introduction: Preterm infants are commonly treated with antibiotics on admission to the neonatal unit as part of routine care. We aimed to identify infants <32 weeks' gestation at low risk of early onset sepsis (EOS) in whom antibiotics could be safely withheld.

Methods: This retrospective cohort study included infants <32 weeks' gestation admitted between January 2012 and June 2022. Data were extracted from electronic databases. Low risk for EOS (LR) was defined as caesarean section delivery, rupture of membranes <1 hour prior to birth, no preterm labour and no features of maternal chorioamnionitis. Maternal and neonatal characteristics and neonatal outcomes were compared between LR and not low risk (NLR) infants. IBM SPSS Statistics (Version 29) was used for data analysis.

Results: There were 3285 infants included in the analysis of which 1035 (31.5%) were LR and 2250 (68.5%) NLR. No LR infants had culture-confirmed EOS compared with 35 (1.6%) NLR infants. Antibiotics were commenced in the first 48 hours of life in 794 (76.7%) LR and 2159 (96.0%) NLR infants (p <0.001) and continued for ≥5 days in 226/782 (28.8%) LR and 603/2107 (28.6%) NLR infants, despite negative blood cultures. There was no difference in mortality or late-onset sepsis between LR and NLR infants.

Conclusion: Simple clinical parameters available at birth can be used to identify very preterm infants at lower risk of EOS in whom withholding empiric antibiotics could be considered.

In the article "Azithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis" [Neonatology. 2025; https://doi.org/10.1159/000547537] by Joseph et al., the third author's name was incorrectly listed as Vanessa Karlinksi Vizentin. The correct spelling should be Vanessa Karlinski Vizentin.

Introduction: Retinopathy of prematurity (ROP) remains a leading cause of preventable blindness in preterm infants. This study aimed to develop machine learning (ML) models using non-imaging clinical data to predict ROP, severe ROP (sROP), and treated ROP (tROP) in very low birth weight (VLBW) infants.

Methods: We utilized nationwide clinical data from the Korean Neonatal Network, including 44 perinatal and neonatal variables. Two deep learning models, Multilayer Perceptron (MLP) and Neural Oblivious Decision Ensembles (NODE), optimized for tabular data, were applied. Additionally, we developed simplified models using eight key variables selected through clinical and algorithmic relevance.

Results: MLP and NODE models demonstrated high predictive performance. For the full 44-variable models, the area under the receiver operating characteristic curve (AUROC) was as follows: ROP (0.853/0.855), sROP (0.888/0.890), and tROP (0.905/0.909). The reduced 8-variable models yielded comparable AUROCs: ROP (0.851/0.855), sROP (0.895/0.895), and tROP (0.910/0.909).

Conclusion: The proposed ML models based on nationwide non-imaging clinical data enable early risk identification and timely intervention for ROP in VLBW infants. This cost-effective and scalable approach may help improve outcomes, especially in resource-limited settings.

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 best-corrected visual acuity (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.

Introduction: Pulse oximeters may systematically overestimate arterial oxygen saturation in neonates with darker skin pigmentation. We performed a survey in practicing neonatologists to explore knowledge of this bias and the implications for clinical care.

Methods: An email survey was distributed assessing knowledge of melanin-related pulse oximeter bias, perceived clinical significance, and communication practices. Responses were compared to data from emergency medicine (EM) clinicians.

Results: Survey results from 120 neonatologists showed that 45.0% agreed that bias exists in pulse oximetry based on skin pigmentation. Among respondents aware of the bias, less than half correctly identified its direction. Most clinicians reported no change in clinical management for dark-skinned neonates. Compared to EM clinicians, neonatologists changed clinical practice less often and rated discussions with families as less important.

Conclusion: Awareness of pulse oximetry bias related to skin pigmentation remains limited among neonatologists, with low rates of modification to daily clinical practice.

Introduction: Premature infants are predisposed to respiratory failure. Body position impacts lung volumes and pulmonary function. Respiratory inductance plethysmography (RIP) measures thoracoabdominal motion and can provide objective, noninvasive diagnostic measurements of work of breathing (WOB) indices. The objective of this study was to compare WOB indices and oxygen saturation in the semi-reclined position to the supine position for preterm infants with and without BPD at discharge.

Methods: A prospective, observational study of premature infants (<32 weeks of gestation) admitted to the neonatal intensive care unit. RIP is a noninvasive way to objectively measure WOB indices. Measurements (phase angle [Փ]) were made with infants in the semi-reclined and supine positions.

Results: This study included 28 premature infants with both supine and semi-reclined data. Infants demonstrated decreased phase angle (supine vs. semi-reclined Φ deg (standard error of mean [SEM], 65.2 [10.2] vs. 28.5 [5.9], p = 0.027) and LBI (supine vs. semi-reclined, 1.82 [0.27] vs. 1.13 [0.04], p < 0.01) in the semi-reclined position. Saturations were statistically but not clinically lower in the semi-reclined position (supine vs. semi-reclined %, 96.7 [0.4] vs. 95.3 [0.4]). Infants with BPD demonstrated a greater improvement in WOB in the semi-reclined position compared to premature controls.

Conclusion: This is the first study to evaluate and compare discharge oxygen saturation and WOB indices in premature infants with and without BPD in the semi-reclined and supine position. Our findings demonstrate improved breathing parameters and a small clinically insignificant decrease in saturations in the semi-reclined position.

Introduction: Azithromycin, with its antimicrobial and anti-inflammatory properties, has been explored as a potential option for preventing bronchopulmonary dysplasia (BPD) in preterm infants.

Objective: We performed a meta-analysis of randomized controlled trials (RCTs) comparing azithromycin with placebo for the prevention of BPD in preterm infants.

Methods: PubMed, Scopus, ClinicalTrials.gov, and Cochrane Central databases were searched for studies comparing azithromycin versus placebo in preterm infants. Outcomes of interest included the composite of BPD and death, BPD, death, grade 2 or higher necrotizing enterocolitis (NEC), grade 3 or 4 intraventricular hemorrhage (IVH), retinopathy of prematurity (RoP), duration of mechanical ventilation, and postnatal corticosteroid requirement. Random-effects model was used to generate risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) (CRD42024558752).

Results: The meta-analysis included 6 RCTs including 1,360 infants (azithromycin n = 680, 50%). The composite of BPD or death (RR: 0.95; 95% CI: 0.83-1.10; p = 0.53; I2 = 50.2%), BPD (RR: 0.98; 95% CI: 0.83-1.15; p = 0.77; I2 = 38.1%), death (RR: 0.88; 95% CI: 0.66-1.19; p = 0.41; I2 = 0%), NEC (RR: 0.94; 95% CI: 0.69-1.26; p = 0.67; I2 = 0%), IVH (RR: 1.22; 95% CI: 0.89-1.68; p = 0.22; I2 = 3.5%), RoP (RR: 1.35; 95% CI: 0.43-4.28; p = 0.61; I2 = 76.3%), duration of mechanical ventilation (MD: 0.13; 95% CI: -1.35 to 1.60; p = 0.87; I2 = 0%), and postnatal corticosteroid requirement (RR: 0.84; 95% CI: 0.64-1.08; p = 0.18; I2 = 34.5%) were similar between the groups.

Conclusion: In preterm infants, azithromycin did not significantly change the risk of adverse clinical outcomes compared with placebo.