Neonatology最新文献

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.

Introduction: This study aimed to assess the feasibility of using specific defined daily doses for neonates (DDDn) as a standardized metric for monitoring antimicrobial consumption in neonatal populations, thereby enhancing antimicrobial stewardship programs (ASPs). To this end, DDDn values have been established for those antimicrobials that had not previously been defined.

Methods: This observational study was conducted in the Neonatology Unit of a tertiary-care teaching hospital. Data on antimicrobial use were prospectively collected from January 2016 to December 2023. Both the DDDn values validated in a previous study and the new DDDn values obtained in the present work were used. Antimicrobial consumption was measured quarterly and expressed as DDDn per 1,000 occupied bed days (OBDs). Additionally, a conversion factor was defined to transform DDD into DDDn.

Results: Out of 1,326 prescriptions, 310 met the inclusion criteria. The study successfully validated DDDn for 10 antimicrobials, including piperacillin-tazobactam, cefepime, and amoxicillin-clavulanic acid. However, DDDn for certain antimicrobials could not be established due to insufficient prescribing data. The mean global antimicrobial consumption was 5.271 ± 1.435 DDDn per 1,000 OBDs per year. The most commonly used antimicrobials were cefotaxime, amoxicillin-clavulanic acid, and ampicillin. The conversion factor was established for five oral antimicrobials and 17 intravenous ones.

Conclusion: DDDn proved to be a feasible tool for monitoring antimicrobial consumption in neonatal populations, offering a standardized metric that could improve ASPs and optimize antibiotic usage. More research is needed to validate DDDn across different antimicrobials and clinical settings.

Introduction: Hypoxic-ischaemic encephalopathy (HIE) due to perinatal asphyxia remains a significant cause of neonatal morbidity and mortality. Despite therapeutic hypothermia (TH), a considerable proportion of survivors experience a wide range of deficits, including auditory impairment (AI), which needs deeper knowledge. This review aimed to describe AI outcomes in infants with HIE.

Methods: A systematic literature review was performed using standard methods outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A qualitative synthesis of all the included studies and a meta-analysis with seven eligible studies were conducted.

Results: In the sixteen studies comprised, a mean incidence of 4.54% of AI occurred among participants meeting the inclusion criteria. In the meta-analysis, in subgroup A (healthy newborns vs. newborns with HIE), an OR = 10.74 with a 95% CI 2.02-57.16 and a p value of 0.010 was observed, indicating tenfold higher odds of AI in HIE newborns; subgroup B (newborns with HIE who received standard care vs. those who underwent TH) exhibited an OR = 0.77 with a 95% CI 0.35-1.68 and a p value of 0.510, demonstrating that newborns who received TH had a 0.77-fold lower odds of developing AI.

Conclusion: This review highlights HIE as a risk factor for AI and the possibility of TH being a protective factor. However, the variations in participant characteristics, HIE criteria, and methods of hearing assessment contribute to significant variability between studies, identifying the need for a standard evaluation of auditory outcomes in this setting, extended over the long term.

Background: Oxygen has been a key component of neonatal resuscitation for nearly two centuries. Based on clinical trials that demonstrated worse outcomes when neonatal resuscitation was initiated with 100% oxygen, there was a change in approach to using 21% oxygen at the initiation of ventilation for newborns at birth. However, for extremely preterm newborns, lower oxygen levels lead to early hypoxia and bradycardia, leading to higher rates of severe intraventricular hemorrhage and death. The balance between hyperoxia and hypoxia-related injury needs further refinement and may not be generalizable to all gestations and birth conditions. Summary: This article reviews the current evidence on oxygen use during delayed cord clamping, during resuscitation of term and preterm neonates, during chest compressions, after return of spontaneous circulation and in the post-resuscitation phase, and the impact of hyperoxia. Key Messages: Supplemental oxygen during neonatal resuscitation is actively being investigated by researchers worldwide to fill the knowledge gap to avoid hypoxia and hyperoxia while improving neonatal outcomes. Until further evidence emerges, we recommend starting resuscitation in the delivery room of very-low-birth-weight infants with an FiO₂ of 0.3-1, probably in the lower part of this scale, and titrating up by 10-20% every 30 s to achieve the target SpO₂ for age. An SpO₂ of 80-85% should be targeted by 5 min after birth.

Introduction: Bifidobacteria typify the gut microbiota of healthy, breastfed infants. Altered gut microbiota composition in early infancy characterized by decreased Bifidobacterium abundance has been linked with a heightened risk of non-communicable diseases. Our goal was to assess factors impacting on the gut microbiota composition in infants throughout the allergy and obesity epidemics of the past decades.

Methods: We studied deliveries from a series of clinical studies, grouped by the year of birth into three time periods (1997-2001, 2005-2009, 2015-2022). Altogether, 48 full-term breastfed infants' having fecal samples available at the age of 1-3 months were studied for microbiota profiling by 16S rRNA gene amplicon sequencing. Perinatal factors including mode of birth and antibiotic exposure during pregnancy and at birth were taken into account.

Results: The richness and diversity of the infant gut microbiota decreased significantly over the three time periods. Reduced abundance of the phylum Actinobacteriota and its genus Bifidobacterium was detected in children born in 2015-2022 as compared to those born during the time periods 1997-2001 and 2005-2009. The time period of birth was the strongest determinant of the gut microbiota composition, followed by maternal pre-pregnancy body mass index, antibiotic exposure during pregnancy, and mode of birth. The relative abundance of members of the genus Bifidobacterium was significantly associated with elapsed time (1997-2022) and intrapartum antibiotic exposure.

Conclusions: The depletion of gut microbiota richness and diversity and the selective reduction of relative abundance of the genus Bifidobacterium have occurred parallel to the increase in the prevalence of non-communicable diseases.

Introduction: Electroencephalography (EEG), including both conventional EEG (cEEG) and amplitude-integrated EEG, is early prognostic tools utilized in neonates with hypoxic ischemic encephalopathy (HIE). However, the reported predictive accuracy of EEG varies widely.

Methods: We evaluate the diagnostic accuracy of EEG in predicting neurodevelopment impairment (NDI) among neonates ≥35 weeks with any stage HIE. MEDLINE, Embase, Cochrane Library, and Scopus were searched from inception until 24th December 2024. Observational studies evaluating EEG performed in the first 72 h of life in neonates with HIE, and reporting NDI outcomes assessed after 12 months were included. Two authors independently extracted data. A Bayesian random-effects bivariate model was used for diagnostic test accuracy meta-analysis. Risk of bias was assessed using QUADAS-2, and certainty of evidence (CoE) with GRADE. NDI defined as cognitive/motor scores <1 SD below the mean or presence of motor disability.

Results: Sixty-two studies (n = 3,929) were included. In neonates who underwent therapeutic hypothermia (TH) (34 studies, n = 2,538), EEG showed a sensitivity of 88.3% (95% credible interval [CrI]: 83.7%, 92.8%) and specificity of 63.9% (53.6%, 72.8%). In no TH group (33 studies, n = 1,391), the sensitivity was 87.2% (77.5%, 93.5%) and specificity was 76.3% (61.5%, 86.8%). Further, in neonates who received TH (12 studies, n = 868), cEEG had an acceptable sensitivity of 84.1% (77.3%, 89.9%) and specificity of 76.7% (66.9%, 84.3%). CoE being predominantly moderate.

Conclusion: EEG has good sensitivity in predicting NDI regardless of TH status and may aid in identifying high-risk neonates for further evaluation.

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: Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of long-term neurological morbidity. Magnetic resonance imaging (MRI) abnormalities are reported in up to 84% of CDH survivors but have only been rarely compared with neurodevelopmental outcomes. This study aims to investigate whether assessment of postnatal MRI in CDH survivors allowed association with and prediction of long-term outcome.

Methods: Brain MRI was performed in 36 neonates with CDH using the Weeke score, assessing the mammillary bodies, the corpus callosum, cortical folding, and cerebrospinal fluid space (CSF). Outcomes were measured using Bayley-III-examinations at 12 months.

Results: In total, 91.6% of the neonates exhibited MRI abnormalities. Among them, 83.3% showed white matter (WM), 16.6% gray matter abnormalities, 8.3% cerebellar abnormalities, and 20% had an intracranial hemorrhage. A total of 30.5% showed abnormal mammillary bodies, 44.4% enlarged CSF, 5.5% reduced cortical folding, and 8.3% reduced corpus callosum thickness. While the use of the Weeke score was not helpful for outcome prediction, specific MRI abnormalities were associated with adverse long-term outcomes. Based on these findings, a novel MRI-scoring system was developed. This easy-to-perform score effectively predicted adverse outcomes at 12 months.

Conclusion: Interpretation of MRI in neonates with CDH should focus on WM pathologies, CSF enlargement, internal capsule involvement, mammillary body abnormalities, and intraventricular hemorrhage. Our novel simple scoring system helps identify neonates at risk for adverse neurological outcomes at discharge and aids to implement therapeutic strategies at an early point.