Neonatology最新文献

Introduction: As many as 40-100% of the neonates admitted to a neonatal intensive care unit (NICU) require peripheral intravenous (PIV) cannulation, for varying reasons. Though unproven, splinting is conventionally thought to increase the lifespan of the cannula. The objective of this study was to determine whether standard fixation without splinting, after cannula insertion near a joint, influences its lifespan.

Methods: This unmasked, parallel group, randomized controlled trial was approved by the Hospital Ethics Committee. Eligible PIV cannula insertions were divided into: "No Splint" and "Splint" group. In the "Splint group" after standard fixation of the PIV, a readymade splint was used. Written informed consent was obtained from parents. The primary outcome was measured as difference in the lifespan of the PIV cannula in both the groups.

Results: We enrolled 341 cannulations in "No Splint" and 344 in "Splint" group. The demographic details of both the groups were comparable. Mean gestational age, age at time of enrollment, and birthweight was 33+3 weeks, 3.4 days and 2,160 g, respectively. The mean (95% confidence interval) life of PIV cannula in the "No splint" and the "Splint" groups were 48.5 (45.1, 52.2) and 47.5 (43.6, 51.3) hours (p value 0.7), respectively. Subgroup analysis showed longer PIV cannula life in "No Splint" group neonates who were term and weighed ≥2,500 g.

Conclusion: In neonates with a PIV cannula placed over a joint, standard fixation without splinting did not shorten the cannula life. Not splinting may be associated with increased lifespan of the PIV cannula in term, normal birthweight neonates.

Introduction: The impact of intrauterine growth status as measured by BW percentiles on retinopathy of prematurity (ROP) pathogenesis remains inadequately characterized. The objectives of the study were to establish BW percentile-specific risk gradients for ROP development.

Methods: A multicenter cohort study was conducted with data were collected from Chinese Neonatal Network between January, 2019 and December, 2021. The exposure was GA- and sex-specific BW percentile. The primary outcome was incidence of ROP. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated, adjusted for potential confounders, and stratified by GA, infant sex, maternal hypertension, singleton/multiple birth.

Results: Totally 17,882 preterm infants were enrolled, BW was 1,300.0 (1,100.0-1,500.0) g and GA was 29.9 (28.6-31.0) weeks. The incidence was 27% for any stage ROP and 3.7% for severe ROP (stage 3 or above). Each decrease of BW percentile by 10% was associated with 15% increase of odds for either any stage ROP (aOR 0.85 [95% CI: 0.83-0.86]) or severe ROP (aOR 0.85 [95% CI: 0.82-0.89]). The optimal discriminative BW percentile on receiver operating characteristic curve was 26% for predicting any stage ROP and 19% for predicting severe ROP. Lower BW percentile under these cut-offs were associated with elevated odds of any stage ROP (aOR 2.20 [95% CI: 1.97-2.47] and severe ROP (aOR 2.91 [95% CI: 2.22-3.80]).

Conclusions: ROP incidence was negatively associated with BW percentile. Each 10% decreased BW percentile was associated with 15% increased odds of any stage ROP and severe ROP.

Introduction: Evidence regarding the association between patent ductus arteriosus (PDA) and brain development in very preterm infants is inconclusive. The aim of the current study was to systematically evaluate brain injury and microstructural brain maturation as assessed by magnetic resonance imaging (MRI) at term-equivalent age in a contemporary cohort of very preterm infants with and without PDA.

Methods: This was a retrospective, single-center study. Preterm infants born at <32 weeks' gestation with PDA and cerebral MRI were eligible for this study. They were matched 1:1 according to gestational age (GA) to infants without PDA. MRI was assessed for brain injury. We measured fractional anisotropy and apparent diffusion coefficient in 12 brain regions as indicators for microstructural brain maturation.

Results: We included 148 infants with PDA and 148 matched controls. We found no significant differences in brain injury rates between the groups. The evaluation of microstructural brain maturation revealed differences in some regions. After adjusting for differences in neonatal characteristics, a significant difference was seen only in the right middle cerebellar peduncle. Among infants with PDA, those who underwent surgical ligation exhibited elevated rates of both cerebellar hemorrhage and severe IVH and further showed a more immature brain maturation pattern. Statistical difference was lost for all variables after adjusting for GA.

Conclusion: Our results indicate that the presence of PDA is not intrinsically associated with brain injury or impaired brain development.

Introduction: Congenital erythropoietic porphyria (CEP), especially neonatal-onset CEP, is a rare autosomal recessive disorder with an estimated incidence of one in one million. It is caused by UROS gene variants and may mimic severe systemic conditions, delaying diagnosis.

Case presentation: We report 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 were negative. 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 previously reported only 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.

Introduction: The aim of this study was to correlate oxygenation index (OI) and oxygen saturation index (OSI) in congenital diaphragmatic hernia (CDH) and determine the impact of guideline changes from two different epochs.

Methods: Retrospective analysis of 390 CDH neonates managed at University of Utah/Primary Children's Hospitals from 2003 to 2024. We performed regression analysis for paired OI and OSI values over the first week of life (2,604 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. 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.

Discussion: 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.

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.

Introduction: The aim of the study was 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 across 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 was rated 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.

Discussion: 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.