Neonatology最新文献

Introduction: We aimed to investigate international variation in gestational age (GA) specific severe intraventricular hemorrhage (IVH) rates, among infants of <30 weeks' GA from the neonatal networks of 11 high-income countries/region.

Methods: Retrospective cohort study of outcomes of grade 3/4 IVH rates and composite of g3/4 IVH or death in GA groups of 22-23, 24-25, 26-27, and 28-29 weeks infants admitted to networks of Australia and New Zealand, Canada, Finland, Israel, Italy (Tuscany), Japan, Spain, Sweden, Switzerland, and the UK. Their risk adjusted trends across 3 epochs (2007-11, 2012-15, and 2016-19) were also evaluated.

Results: Outcomes of 165,329 infants (median GA 27 weeks, birthweight 950 g) were analyzed. Overall, the lowest grade 3/4 IVH rate was observed in Japan (6.4%) and the highest in Israel (16.1%). The overall gestation-specific rate of IVH grade 3/4 were 25.8%, 18.6%, 9.0%, and 3.8% and composite outcome of grade 3/4 IVH/death rates 52.2%, 33.6%, 15.6%, and 6.7% for the 22-23, 24-25, 26-27, and 28-29 weeks' GA groups, respectively. These inter-network variations were greater at lower GA. In epoch comparisons, almost all networks showed significant decreases in GA specific composite outcome rates, particularly in the 26-27 week' GA group. Japan and Canada demonstrated significant decreases in each GA group while Spain demonstrated significant decreases in each GA group except for 22-23 weeks' gestation.

Conclusions: Rates of grade 3/4 IVH and composite outcome rates varied internationally and have decreased over time. Identification of the driving factors behind variations may allow for opportunities for practice review and improvement.

Introduction: Restricted fetal and neonatal growth is a known risk factor for bronchopulmonary dysplasia (BPD) in premature infants. However, the impact of nutrition and infant growth specifically on lung growth in BPD is unknown. Moreover, whether all lung growth in BPD is beneficial is unclear. We hypothesized that lung growth and development and severity of BPD directly relate to caloric and protein intake, weight gain, and linear growth of premature neonates.

Methods: In this retrospective study, caloric and protein intake for the first 4 weeks of life, growth parameters along with lung volume, mass, density, and BPD severity obtained by ultrashort echo time (UTE) MRI, were analyzed.

Results: The cohort included 95 neonates with mean GA 26.1 weeks and BW 790 g. Infants with grade 2 and 3 BPD had less caloric and protein intake during first 4 weeks of life vs. grade 1 BPD (96/98 vs. 106 kcal/kg/day; 3.79/3.75 vs. 3.99 g protein/kg/day; p < 0.05). UTE MRI showed that lung mass per body surface area increased with increasing BPD severity (237, 311, 384 g/m2 for grade 1, 2, and 3, respectively, p < 0.05). Increased caloric intake was associated with decreased lung mass (p = 0.02) and improved BPD score on MRI (p = 0.04).

Conclusion: Decreased nutritional intake during the first 4 weeks of life appears to be associated with more severe BPD, increased lung mass and more severe lung disease on MRI.

Introduction: The European guideline for treatment of respiratory distress syndrome recommends less invasive surfactant administration (LISA) as the preferred method of surfactant administration in spontaneously breathing preterm infants. However, there is limited evidence on practical aspects such as sedation and catheter types, leading to considerable variability between centers.

Methods: An anonymous online survey (www.soscisurvey.de) was sent to 164 tertiary neonatal intensive care units (NICUs) in Germany including 43 questions on practical aspects of LISA.

Results: Of 122 (74%) participating NICUs, 117 (96%) reported experience with LISA with 82% of those reporting LISA as their preferred method of surfactant administration. Indications for surfactant administration differed widely between NICUs. Most (89%) used FiO2-thresholds only or in combination with other criteria, such as Silverman score/signs of dyspnea (41%) or lung ultrasound findings (3%). Prophylactic surfactant was administered by 42%. Differences in use of LISA in extremely immature infants were reported (e.g., 36% did not perform LISA in infants below 24-26 weeks). Preferred drugs for sedation were (Es-)Ketamine, followed by Propofol and Midazolam. Minimum time interval between subsequent LISA procedures was 4 (2-6) h. Catheters specifically designed for LISA were used by most NICUs (69%).

Conclusion: This survey shows that LISA is common practice in German NICUs, but with considerable variability in practical aspects. These data may serve as a guidance for NICUs that have not yet implemented LISA and might be helpful design clinical trials with the aim to standardize and/or optimize LISA.

Introduction: Chimeric antigen receptor T cells (CAR-Ts) targeting CD19 represent a significant advance in treatment for patients with relapsed/refractory B-cell malignancies. Although a significant minority of recipients are women during their reproductive years, there is a paucity of data regarding pregnancy and neonatal outcomes in women previously treated with CAR-T. This is important as maternal T cells are known to cross the placenta and into breastmilk during pregnancy and breastfeeding, respectively.

Case presentation: Here we present two successful pregnancies following CAR-T therapy where both neonates were initially breastfed. These represent the first cases of neonates born following CAR-T therapy comprehensively described in medical literature.

Conclusion: Pregnancy following CAR-T therapy does not appear to be associated with adverse neonatal outcomes. Further work is required to delineate the outcomes in this population.

Background: Although a major cause of infant mortality for centuries, little research was done on the causes of infants' diarrhea. Artificial feeding, teething, and summer heat were believed to cause the severe disease that spared breastfed infants.

Summary: Since antiquity, infants' digestive disorders were termed dyspepsia, flux of the belly, diarrhea, gastroenteritis, watery gripes, the runs, dysentery, or cholera, without definitions. Alois Bednar discerned 3 grades (dyspepsia, diarrhea, and cholera) of the same disease. Infants' neurologic symptoms were interpreted as alimentary toxicosis. Chronic diarrhea caused emaciation and dehydration. In 1950, Laurence Finberg found diarrhea with hypernatremia causing cerebral damage. Seasonal influence was known since Hippocrates. Baudelocque recommended obtaining infant milk fresh from the cow because it decomposes in the summer heat. In the cities, summer diarrhea caused a third of total infant mortality. Physicians debated whether heat acted directly on the infant or spoiled the food. The discovery of microorganisms in the 1860s revolutionized medical understanding. However, influential researchers such as Adalbert Czerny classified nutritional disturbances by assumed pathogenesis ("ex alimentation, ex infection, ex constitution"), but denied the possibility of bacterial infection via milk. Heating baby food, practiced for centuries, was introduced in Denmark, Sweden, and France, whereas in Britain and Germany, professional and public debate on pasteurization persisted.

Key messages: It took half a century to implement effective hygienic measures once the bacterial origin became known. Foodborne infection was rejected, and the prejudice that raw milk possesses essential "living" properties, adopted by influential scientists, contributed to delaying pasteurization.

Introduction: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. However, its effectiveness in the treatment of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) and severe BPD remains uncertain. Here we systematically reviewed whether iNO treatment increased or decreased mortality and morbidity among preterm infants with severe BPD or BPD-PH.

Methods: We systematically searched the Ovid MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, and ICHUSHI databases for randomized and non-randomized studies that compared the effects of iNO in patients with severe BPD or BPD-PH. The primary outcome was mortality. Two authors independently screened the articles and extracted the data. A meta-analysis and certainty of evidence assessment using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation criteria were planned.

Results: Among the 1,710 articles, none had a relevant control group and no studies met the eligibility criteria. Using a post hoc analysis, we summarized the ineligible studies that evaluated patients with severe BPD or BPD-PH who received iNO therapy. Although some studies included in the narrative review indicated a decreased pulmonary arterial pressure in patients with severe BPD or BPD-PH at the initiation of iNO therapy, none included a comparator group.

Conclusion: Despite the use of iNO in patients with severe BPD and BPD-PH, no published studies compared the outcomes among patients with BPD treated with versus without iNO. Although some studies without comparator groups reported the effectiveness of iNO in patients with severe BPD and BPD-PH, our results suggest that iNO therapy should be initiated with caution and careful consideration of the target population.

Introduction: Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal mortality and neurodevelopmental disabilities. Therapeutic hypothermia (TH) is the standard of care, but optimized sedoanalgesic strategies remain critical. Dexmedetomidine shows promise as an alternative to traditional sedatives, but its role in this context remains systematically under-explored. This meta-analysis aimed to address this gap by assessing the safety and efficacy of dexmedetomidine in neonates undergoing TH for HIE.

Methods: A systematic search of Medline, Scopus, Embase, WOS, ClinicalTrials, and Cochrane Library identified studies published from January 2014 to October 2024. Studies focusing on dexmedetomidine in neonatal TH with relevant outcomes were included. Selection followed PRISMA guidelines, with independent quality assessments. The protocol was registered in PROSPERO (CRD42024605817). Results are presented as meta-analyses or evidence-based discussions when pooling was unfeasible.

Results: Seven studies involving 609 neonates were included: four cohort studies (n = 486) and three case series (n = 123). Dexmedetomidine provided comparable sedation to traditional agents (MD = -0.01 [-0.68 to 0.66], p = 0.99) and significantly reduced seizure risk (OR: 0.31 [0.10 to 0.98], p < 0.05) with a non-inferior safety profile. Trends suggested shorter duration of mechanical ventilation and time to full enteral feeding. Substantial heterogeneity in dosing protocols highlights the need for standardization.

Conclusions: Dexmedetomidine appears to be a safe and promising sedative in neonatal TH for HIE, with potential neuroprotective, respiratory, and gastrointestinal benefits. Despite limited evidence and the absence of randomized clinical trials, its non-inferior efficacy and safety warrant further exploration and urge the development of standardized dosing protocols.

Introduction: Although many preterm born infants require invasive mechanical ventilation, it is also associated with detrimental effects. Early extubation should be pursued, but extubation failure is yet common. The critical transition to noninvasive ventilation is characterized by respiratory physiological changes, warranting noninvasive monitoring. We aimed to determine whether electrical impedance tomography (EIT) could provide insights into the respiratory mechanics of neonates around extubation, and if findings were different between successful and failed extubation.

Methods: Single-center observational study where EIT and transcutaneous CO2 measurements were performed in preterm born infants <32 weeks gestational age. Measurements were performed from 24 h before up to 48 h after extubation. EIT parameters extracted from the hour before and after extubation were analyzed to evaluate the short-term physiological changes.

Results: Twenty-one patients were included and 6 (29%) were reintubated. End-expiratory lung impedance and tidal impedance variation were stable around extubation (p = 0.86 and p = 0.47, respectively). Compared to successfully extubated patients, reintubated patients showed more lung inhomogeneity (GI index) after extubation (0.75 vs. 0.84, p = 0.03). The percentage of nondependent silent spaces decreased after extubation in successfully extubated patients (p < 0.001). Body position and ventilator mode influenced these findings.

Conclusion: EIT measurements in preterm neonates provide valuable insight into the respiratory physiology during the transition from invasive to noninvasive ventilation, with significant differences in ventilation distribution and lung homogeneity between successfully extubated and reintubated patients. EIT has the potential to guide personalized respiratory support by assessing ventilation distribution and quantifying inhomogeneity, aiding in the optimization of ventilation settings.