Neonatology最新文献

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.

Introduction: Metalloporphyrins, competitive heme oxygenase (HO) inhibitors, may potentially be used as drugs for preventing neonatal hyperbilirubinemia. Metalloporphyrins that specifically target the inducible HO-1 without inhibiting the constitutive HO-2 are the most ideal. Zinc protoporphyrin (ZnPP) has the most promise. We have derived a plant-based ZnPP (ZnPP-Plant) and evaluated its inhibitory potency and selectivity for the HO-1 isozyme.

Methods: Eleven-µM ZnPP-Plant or technical grade ZnPP (ZnPP-TG) were added to reaction vials containing heme, NADPH, and adult mouse spleen, brain, and liver sonicates. Gas chromatography was used to measure total in vitro HO activity in sonicates. Percent inhibition of control HO activity was then compared.

Results: At a 11-µM concentration, ZnPP-Plant and ZnPP-TG inhibited HO activity in the liver (69.7 ± 9.3% and 74.2 ± 10.3%, respectively); spleen (65.8 ± 17.9% and 46.8 ± 8.7%, respectively); and brain (54.1 ± 13.3%, and 38.1 ± 13.9%, respectively).

Conclusion: ZnPP-Plant has equal inhibitory potency as ZnPP-TG, and thus has potential use for treating neonatal hyperbilirubinemia.

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: 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: 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.

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: Peripheral intravenous catheterization is commonly required in sick neonates but remains challenging due to small vessels, leading to multiple attempts and complications. This review evaluated the benefits and harms of device-assisted techniques versus standard technique.

Methods: We searched MEDLINE, Embase, CENTRAL, Cochrane Reviews, WHO ICTRP, and ClinicalTrials.gov (October 2024) for randomized controlled trials (RCTs). Data collection and analysis followed Cochrane methodology.

Results: We included 12 RCTs (1,251 neonates). Devices were used for placement in 5 studies (417 neonates) and tip confirmation in 6 studies (740 neonates). One study used ultrasound for both PICC placement and tip confirmation (94 neonates). Devices may increase first-attempt success compared to standard technique: risk ratio (RR): 1.18, 95% confidence interval (CI): 1.04-1.33 for placement and RR: 1.20, 95% CI: 1.10-1.30 for tip confirmation. Six studies (528 neonates) reported a shorter time to successful catheterization. Devices likely reduce hematoma (RR: 0.32, 95% CI: 0.13-0.75), bleeding (MD: -0.68, 95% CI: -0.83 to -0.53), and phlebitis (RR: 0.19, 95% CI: 0.06-0.58). Evidence was of very low certainty for thrombosis for placement (RR: 0.33, 95% CI: 0.01-7.99) and tip confirmation (RR: 0.25, 95% CI: 0.05-1.16), catheter-related bloodstream infection (RR: 1.25, 95% CI: 0.34-4.58), and arrhythmia (RR: 0.09, 95% CI: 0.01-0.70).

Conclusion: Device-assisted catheterization may improve first-attempt success and reduce procedure time in neonates. Evidence on safety is limited. Due to variability in study methodologies and outcome reporting, high-quality RCTs with standardized outcome measures are needed.

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: Neonatal gastrointestinal perforation is a life-threatening condition that requires timely and accurate diagnosis. However, interpreting abdominal radiographs in this population is often challenging. In this study, we aimed to develop a deep convolutional neural network (DCNN) model to segment pneumoperitoneum on neonatal abdominal radiographs and to evaluate its potential to assist in detecting neonatal gastrointestinal perforation.

Methods: This multicenter retrospective study included 1,187 abdominal radiographs (181 perforation and 1,006 control images) from neonates with gastrointestinal perforation and controls. Pneumoperitoneum regions were annotated by experienced clinicians. The dataset was randomly divided into training (n = 830), validation (n = 118), and test (n = 239) sets. A DeepLabV3+ model with ResNet50 backbone was fine-tuned for pixel-level segmentation. A single pixel-based threshold, derived from ROC analysis, was used to classify gastrointestinal perforation, with diagnostic performance subsequently compared to that of clinicians.

Results: The DCNN model achieved a median Dice similarity coefficient of 0.81 on the test dataset, indicating strong overlap between predicted and actual pneumoperitoneum regions. Furthermore, segmentation performance was positively correlated with pneumoperitoneum volume (Spearman ρ = 0.83, p < 0.001). Classification using the pixel-based cut-off demonstrated excellent diagnostic accuracy (AUC, 0.999; sensitivity, 100%; specificity, 98.5%), comparable to experienced clinicians.

Conclusion: The DCNN model demonstrated robust segmentation and classification performance, highlighting its potential as a clinical decision support tool for early detection of gastrointestinal perforation in neonates. Future studies should validate the model's generalizability and assess its integration into clinical practice.

Introduction: The use of reliable, validated, and multidimensional tools for pain evaluation has been recommended to manage neonatal pain. However, these tools have limited use in Japan due to their complexity, which involves numerous evaluation and observation items, making thorough observation challenging.

Methods: We developed a new method based on the Premature Infant Pain Profile-Revised (PIPP-R), a multidimensional evaluation tool that includes physiological and behavioral indicators, to simplify the evaluation of facial expressions. Instead of assessing three facial expressions individually, we evaluate them in four categories. We also created a system that automatically records changes in vital signs and calculates scores. In this study, we determined if the facial expression score aligns with the conventional PIPP-R-based facial expression score. The scoring methods were categorized into three types: (1) a real-time new method, where facial expressions were evaluated concurrently with the puncture procedure using a new method; (2) an individual assessment method using recorded videos from the puncture sessions with facial expressions scored later using the PIPP-R; and (3) a new video-based method, in which facial expressions were evaluated using the new method while watching recorded videos.

Results: The study included 63 healthy neonates (born at ≥37 weeks' gestation) delivered at our hospital. The degree of agreement among the methods and the inter-rater agreement showed high levels of consistency.

Conclusion: The new facial expression assessment method based on the PIPP-R demonstrated equivalence to conventional scoring in full-term neonates. Further validation, particularly in preterm infants and diverse clinical settings, is needed.