Neonatology最新文献

Background: Thermal homeostasis remains a fundamental aspect of neonatal intensive care, yet modern practice differs significantly from earlier studies. Contemporary cohorts include infants at the edge of viability, characterised by immature skin, limited thermogenic capacity, and extended ventilatory support. Simultaneously, incubator design has evolved from basic normothermic chambers to servo-controlled, high-humidity environments. Additionally, infants often require weeks of support with heated respiratory circuits. These developments introduce complex, interacting thermal inputs that were not present in earlier physiology, yet current protocols remain largely empirical.

Summary: Evaporative heat loss, caused by transepidermal water loss (TEWL), mainly influences the thermal balance of very preterm infants. TEWL can be equal to or greater than metabolic heat production, especially in the early postnatal period. Its magnitude is determined by gestation, vapour pressure gradients, and environmental dew point. High relative humidity reduces evaporative stress but narrows the safety margin, increasing the risk of condensation and subsequent cooling. Additional instability comes from convective and conductive losses during handling, as well as the thermal effects of ventilator circuits.

Key messages: We suggest reframing neonatal thermal care as actively managing thermal and vapour gradients, rather than simply maintaining core normothermia. Evidence-based strategies include maintaining high relative humidity soon after birth, minimising isolette openings, pre-warming contact surfaces, and recognising dew point thresholds. Research priorities include defining optimal humidity protocols, measuring the circuit thermal load, and validating monitoring systems that integrate oxygen consumption with environmental factors. Tackling these gaps may reduce metabolic stress, enhance survival, and optimise outcomes for the most vulnerable infants.

Introduction: The aims of this study were to evaluate iron metabolism changes and overload risk in preterm infants after red blood cell transfusion (RBCT) and to assess hepcidin's diagnostic value.

Methods: This prospective study analyzed 72 preterm infants (mean GA: 30.1 weeks; BW: 1,356 g) at Shenzhen Children's Hospital (2023). Groups were stratified by the volume of RBCT (>40 mL/kg vs. ≤40 mL/kg). Serum ferritin (SF) and hepcidin levels were measured alongside clinical parameters.

Results: The >40 mL/kg RBCT group had significantly lower GA (p = 0.039) and BW (p = 0.013). SF and hepcidin levels were elevated in the >40 mL/kg RBCT group (p < 0.001), with higher risks of iron overload (RR = 1.6, 95% CI: 1.3-2.3) and severe overload (RR = 4.5, 95% CI: 1.8-12.4). The volume of RBCT was an independent risk factor (p = 0.034). Hepcidin showed predictive value (area under the curve = 0.731, sensitivity: 92%, cutoff: 45.08 ng/mL).

Conclusions: High-volume of RBCT (>40 mL/kg) significantly increase iron overload risk in preterm infants. Hepcidin demonstrates potential as a predictive biomarker.

Introduction: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions.

Methods: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation "Train the Trainers" course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites.

Results: The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas.

Conclusions: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.

Introduction: Neonatal jaundice is a leading cause of early post-discharge referrals. Community follow-up commonly relies on visual assessment and clinic-based evaluation, generating avoidable visits. Scalable home pathways that maintain safety are needed. We evaluated a nurse-led home pathway that integrates transcutaneous bilirubin (TcB) screening with targeted pediatric teleconsultation.

Methods: A prospective before-after study was conducted within routine nurse-led home visits for eligible infants (firstborn or preterm) ≥35 weeks of gestation. A 3-month pre-intervention phase (usual visual assessment) was compared with a 9-month intervention using TcB-guided thresholds and teleconsultation via a secure digital platform. The primary analysis targeted infants who, under usual care, would be referred ("baseline-eligible"), estimating the absolute difference in referral at the home visit. Secondary outcomes were agreement between clinical cues and TcB, teleconsultation utilization, and phototherapy requirement.

Results: A total of 1,236 infants were enrolled (157 pre-intervention; 1,079 intervention). Among baseline-eligible infants (n = 840), 152 (18.1%) were referred; thus, 688/840 (81.9%) potential referrals were avoided (absolute reduction 81.9%; 95% CI 79.2-84.4; NNR 1.22, 95% CI 1.19-1.26). TcB identified all infants requiring phototherapy (4/1,079; 0.4%) within 14 days. Agreement between clinical cues and TcB-defined need for follow-up was slight (weighted κ = 0.075; 95% CI 0.059-0.091). The reduction in referrals corresponded to an absolute decrease of 0.67 visits per infant.

Conclusions: A nurse-led, digitally supported home pathway that integrates TcB screening and targeted teleconsultation substantially reduces unnecessary neonatal referrals, with no missed cases requiring phototherapy. This pragmatic precision-triage model is implementable within existing community services and can relieve post-discharge system burden while preserving safety.

Introduction: Intraventricular haemorrhage (IVH) leads to significant morbidity among preterm infants. We conducted an overview of systematic reviews of RCTs assessing the effects of perinatal/neonatal interventions in reducing IVH among preterm infants.

Methods: PubMed, Embase, Cochrane database for systematic reviews, and systematic review repositories were searched for meta-analyses of RCTs involving preterm infants or women at high risk of preterm birth and reporting on IVH. Metaumbrella package of R software was used to pool outcome data for each intervention. Quality of the systematic reviews was assessed using AMSTAR 2 tool. Certainty of evidence (COE) was reported using GRADE recommendations.

Results: A total of 148 systematic reviews (110 Cochrane vs. 38 non-Cochrane) were included. Postnatal interventions were reported in 118 reviews. Severe IVH was reported in 100/148 reviews that included 39,483 infants and 20,400 antenatal women. In total, 78% (n = 116) of the reviews were rated high or moderate quality on AMSTAR-2 assessment. Antenatal corticosteroids and magnesium sulphate for imminent preterm birth, volume-targeted ventilation, early rescue surfactant administration through thin catheter, prophylactic indomethacin significantly reduced the rates of severe IVH (moderate COE). Use of respiratory function monitors and heated humidified respiratory gases in the delivery room and early prophylactic erythropoietin supplementation for preterm infants may reduce the rates of severe IVH (very low COE).

Discussion: Antenatal steroids and magnesium sulphate administration and early neonatal lung protective strategies reduce the rates of IVH in preterm neonates. Adequately powered RCTs evaluating IVH care bundles with long-term follow-up are required.

Introduction: We aimed to evaluate the effect of Family Integrated Care (FICare) in single family rooms (SFR) on infant outcomes, compared with standard neonatal care (SNC) in open bay units (OBU).

Methods: A prospective cohort study was conducted in three Dutch level II neonatal units. Preterm infants hospitalized ≥7 days were included between 2017 and 2020. The intervention site provided FICare in SFR; control sites provided SNC in OBU. Predefined secondary outcomes included length of stay (LOS), breastfeeding, growth, late-onset sepsis, days with tube feeding (TF), respiratory support and intravenous access, discharge with TF, and readmissions. Linear mixed models accounting for multiple births, and exploratory mediation analyses, were used.

Results: A total of 358 infants were included (169 FICare; 189 SNC; median gestational age 33+3 weeks [interquartile range 30+5-35+0]). FICare was associated with a 9% reduction in LOS (adjusted mean ratio [aMR] 0.91 ≈ 2 days, 95% CI 0.84-0.99). Infants in the FICare group were more likely to be discharged with TF (adjusted odds ratio 5.77, 95% CI 2.25-14.79) and had fewer days with TF in hospital (aMR 0.79, 95% CI 0.66-0.94) and intravenous access (adjusted incidence rate ratio 0.55, 95% CI 0.39-0.76), while maintaining similar growth and readmission rates. Days with TF and intravenous access fully mediated the effect on LOS (adjusted total indirect effect 0.91, 95% CI 0.85-0.97). Other outcomes did not differ.

Conclusions: FICare in SFR was associated with decreased LOS, mediated by acquiring feeding skills. Further research should include robust study designs, including diverse parental populations.

Introduction: The aim of this study was to determine if episodes of desaturation, either with or without bradycardia, are associated with cerebral and abdominal hypoxemia in preterm infants.

Methods: Secondary analysis of a single-center pilot randomized clinical trial including preterm infants <29 weeks of gestation on positive pressure respiratory support. Rates of cerebral hypoxemia (<55% for ≥10 s) and abdominal hypoxemia (<40% for ≥10 s) on near-infrared spectroscopy corresponding with episodes of desaturation (oxygen saturations <85% for ≥10 s) either with or without bradycardia (<100 bpm for ≥10 s) were compared using a generalized estimating equation to address repeated events from the same subject.

Results: Twenty-five infants with a gestational age (mean + SD) of 24 weeks 6 days ± 11 days and birth weight 645 ± 142 grams were included. Desaturations with and without bradycardia were both associated with cerebral hypoxemia and abdominal hypoxemia (all p < 0.05). Cerebral hypoxemia was more strongly associated with desaturations with bradycardia compared to episodes without bradycardia (adjusted odds ratio [aOR], 95% confidence intervals [CI]: 0.34, 0.25-0.47; p < 0.001). There were also more episodes of abdominal hypoxemia during desaturations with bradycardia versus desaturations with no bradycardia (aOR, 95% CI: 0.35, 0.26-0.46; p < 0.001). The rate of concurrent cerebral and abdominal hypoxemia was also higher during desaturations with bradycardia.

Discussion: Desaturations, whether occurring with or without bradycardia, are associated with cerebral and abdominal hypoxemia in very preterm infants. Cerebral and abdominal hypoxemia are more likely during episodes of desaturation with bradycardia than during episodes without bradycardia.

Introduction: In congenital diaphragmatic hernia (CDH), infants with left heart disease are at the highest risk of extracorporeal membrane oxygenation (ECMO) and mortality, but the association between maternal-fetal environmental characteristics and these adverse postnatal outcomes is unknown.

Methods: Maternal-fetal dyads with CDH who were enrolled in a single-center birth defects biorepository and also in comprehensive postnatal echocardiographic studies from 2019 to 2023 were included in a retrospective analysis. Geocoded census tract was used to generate maternal neighborhood characteristics from conception to birth from the American Community Survey (ACS), Child Opportunity Index, Air Quality Index (AQI), and Food and Drug Administration percent food insecurity. Infant characteristics including ECMO and survival were abstracted from the biorepository. Quantification of left heart hypoplasia and/or left ventricular (LV) dysfunction was performed on postnatal echocardiograms. Disease-specific and neighborhood characteristics were compared by ECMO/mortality status and by the presence of left heart disease.

Results: Seventy-seven patients (58% male, 82% left CDH, 68% liver herniation) were included. Twenty-four (31%) patients required ECMO, 61 (77%) had left heart hypoplasia or LV dysfunction, and 19 (25%) received pulmonary vasodilators. ECMO utilization was higher in patients with left heart disease. Worse neighborhood air quality by AQI was identified in patients who required ECMO and/or died and in patients with left heart disease. A higher percentage of female-headed households was seen in patients who required ECMO and/or died.

Conclusion: Maternal neighborhood characteristics may impact outcomes in CDH. Future study of these environmental factors may inform individualized treatment strategies.

Introduction: Noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is used in preterm infants as a synchronized and proportional mode of noninvasive ventilation. Finding the ideal NAVA level to support preterm infants remains challenging.

Methods: A single-center prospective interventional study was conducted to study the effect of increasing NAVA levels on tidal ventilation measured with electrical impedance tomography (EIT). Preterm infants supported with NIV-NAVA were included. After a baseline registration and following a predefined titration protocol, NAVA levels were progressively increased by 0.5 cmH₂O/µV up to a NAVA level of 3 cmH₂O/µV. Before and during the titration procedure, the evolution of EIT parameters (end-expiratory lung impedance, end-inspiratory lung impedance, silent spaces, and center of ventilation) and respiratory parameters (electrical diaphragm activity [Edi] peak and minimum [Edi min] and peak inspiratory pressure [PIP]) were measured.

Results: Sixteen patients with a mean (standard deviation) gestational age (GA) at birth of 26.7 (1.2) weeks and birth weight of 838 (205) g were included for analysis. EIT parameters did not change significantly with titration of NAVA levels. PIP increased significantly with each increase in NAVA level and Edi peak decreased significantly from NAVA level 1 tot 1.5 cmH₂O/µV. Edi min and transcutaneous CO₂ (TcCO₂) remained constant during the titration procedure.

Conclusion: There was no effect of increasing NAVA levels on regional ventilation parameters. PIP increased with each increase in NAVA level, whereas Edi peak largely remained stable.