Seminars in perinatology最新文献

The education pillar of the neuro-NICU: A framework for competency-based neonatal neurocritical care. 神经-新生儿重症监护室的教育支柱：基于能力的新生儿神经危重症护理框架。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-10-19 DOI: 10.1016/j.semperi.2026.152319

Khorshid Mohammad, Mohamed El-Dib, Lina Chalak

{"title":"The education pillar of the neuro-NICU: A framework for competency-based neonatal neurocritical care.","authors":"Khorshid Mohammad, Mohamed El-Dib, Lina Chalak","doi":"10.1016/j.semperi.2026.152319","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152319","url":null,"abstract":"Neonatal neurocritical care has evolved into an organized model of practice, with dedicated programs, bedside brain monitoring, standardized imaging, and quality improvement. Each depends on the knowledge and skill of the clinicians delivering care. Wide variation in how at-risk newborns are managed reflects, in part, a lack of training standardization. This perspective positions education as a defining pillar of the Neuro-NICU, the component that determines whether technology and protocols translate into benefit. We describe training content across five clinical pillars: neuro-assessment, neuromonitoring, neuroimaging, neuroprotection, and neurodevelopment, with shared language and family partnership as cross-cutting competencies. We propose a tiered learner framework specifying competencies for all NICU clinicians, role-specific providers, and Neuro-NICU leaders. We outline delivery from fellowship and institutional onboarding to case-based sessions and simulation, and connect training to registries that identify practice gaps. Societies, conferences, review series, and remote education extend specialist teaching to centers where most affected newborns are born. We identify the unresolved gaps: no validated competency framework, inadequate faculty development, and the difficulty of linking educational effort to patient outcomes. Treating education as a measured pillar, rather than an informal byproduct of clinical work, is the most direct path to reducing variation in newborn brain care.","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152319"},"PeriodicalIF":3.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Are both hemolysis and impaired myocyte integrity associated with glucose-6-phosphate dehydrogenase deficiency? 溶血和肌细胞完整性受损是否与葡萄糖-6-磷酸脱氢酶缺乏症有关？

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-10-17 DOI: 10.1016/j.semperi.2026.152309

Vinod K Bhutani, Sabrina Lane

{"title":"Are both hemolysis and impaired myocyte integrity associated with glucose-6-phosphate dehydrogenase deficiency?","authors":"Vinod K Bhutani, Sabrina Lane","doi":"10.1016/j.semperi.2026.152309","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152309","url":null,"abstract":"Glucose-6-phosphate dehydrogenase (G6PD) is a potent antioxidant enzyme. G6PD deficiency, predominant among males, is a neonatal \"neurotoxic\" risk, characterized by episodic hemolysis that is sometimes infection triggered. Clinical risk among heterozygous G6PD-deficient females is often under-recognized. Recent reports of rhabdomyolysis among G6PD-deficient individuals are reviewed here. In one case, a male athlete with G6PD deficiency (<10% activity) experienced multiple, acute episodes of rhabdomyolysis, painful muscle symptomatology, injury and hemolysis after strenuous exertion. Both his mother with G6PD-deficiency (<45% activity) and maternal grandmother have chronic histories of episodic or triggered fatigue-related disruptive symptoms. Other case reports of G6PD-deficient individuals with muscle injury and exertional symptoms (with or without hemolysis) showed unique laboratory findings of elevated creatine kinase, myoglobin, lactate dehydrogenase, creatinine, and aminotransferases levels and myoglobinuria. Disrupted myocyte energetics and loss of cellular integrity can be attributed to impaired downstream pentose phosphate pathway (PPP)-related oxidant stress protection, which is a key enzymatic consequence of G6PD-deficiency. These triggered stresses may explain the muscle fatigue and propensity to exertional injury. Correlation between stress-sensitive-impaired muscle injury among all G6PD-deficient individuals, including neonates, requires further clinical validation to ascertain oxidant-stress impact of impaired PPP-dependent cellular energetics of red blood, white blood, neural, and muscle cells.","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152309"},"PeriodicalIF":3.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The hidden threat: A case of neonatal kernicterus secondary to glucose-6-phosphate dehydrogenase (G6PD) deficiency. 潜在威胁：新生儿核黄疸继发于葡萄糖-6-磷酸脱氢酶（G6PD）缺乏1例。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-30 DOI: 10.1016/j.semperi.2026.152310

Sarah Milburn, Andrea Weintraub

引用次数: 0

Raising a king: a parent's perspective on bilirubin neurotoxicity. 养育一个国王：一个父母对胆红素神经毒性的看法。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-27 DOI: 10.1016/j.semperi.2026.152311

Elizabeth Bostic, Maritza Bostic, Kate Ahern, Michael Scola

{"title":"Raising a king: a parent's perspective on bilirubin neurotoxicity.","authors":"Elizabeth Bostic, Maritza Bostic, Kate Ahern, Michael Scola","doi":"10.1016/j.semperi.2026.152311","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152311","url":null,"abstract":"This article chronicles the life of James Earl Bostic, known affectionately to his family and friends as \"King James.\" We provide a parental and family perspective on the incredibly challenging journey he faced with his family resulting from unnecessary suffering due to kernicterus, a completely preventable disease. As his mother, I struggled to understand the significant impact of hyperbilirubinemia triggered by glucose-6-phosphate dehydrogenase (G6PD) deficiency, while also raising his sibling and navigating broken systems of care. I became a tireless advocate, pushing his educational team to assume capability and ensure he had access to robust language and literacy skills. I also repeatedly advocated for deep brain stimulation (DBS) to manage his tone, which was only granted after going before an Independent Review Board while he experienced prolonged, life-threatening dystonic crisis. My advocacy proved highly effective. DBS gave him upward and downward eye movement that enabled him to successfully access an eye gaze activated communication device, finally gaining expressive communication. He leveraged that device to validate what those who loved him knew - he had language, emotions, and a very sarcastic sense of humor! King James later addressed medical professionals during the 2019 Kernicterus Symposium at the Pediatric Academic Societies (PAS), describing how hard it was for him without communication and urging everyone to provide a meaningful education to children with special health needs. His story shows the catastrophic impact of bilirubin neurotoxicity while also emphasizing the critical importance of nurturing the whole child, assuming capability, providing equitable access to a high-quality education, and honoring self-direction.","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152311"},"PeriodicalIF":3.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying best practices for global standardization of home phototherapy for neonatal hyperbilirubinemia: An international comparative study. 确定新生儿高胆红素血症家庭光疗全球标准化最佳实践：一项国际比较研究。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-26 DOI: 10.1016/j.semperi.2026.152305

Jessie Spaan, Christian V Hulzebos, Jasper V Been, Andreas Ohlin, Erin Cummings, Miriam Pettersson, Mercy Thomas

{"title":"Identifying best practices for global standardization of home phototherapy for neonatal hyperbilirubinemia: An international comparative study.","authors":"Jessie Spaan, Christian V Hulzebos, Jasper V Been, Andreas Ohlin, Erin Cummings, Miriam Pettersson, Mercy Thomas","doi":"10.1016/j.semperi.2026.152305","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152305","url":null,"abstract":"Objective: To identify insights from home phototherapy protocols for neonatal hyperbilirubinemia in Australia, the Netherlands, and Sweden, and to inform future efforts toward standardizing a curriculum and implementation framework.Methods: We performed a cross-country comparative study of national and local guidelines and protocols on home phototherapy. Documents were collected through publicly available resources and professional networks. Data were extracted on four domains: patient selection and eligibility criteria, parental education, logistics and care delivery models, and safety aspects.Results: Twenty protocols were included: six from Australia, six from the Netherland, and eight from Sweden. While variation in eligibility criteria for home phototherapy was observed across protocols. Eligible neonates were generally required to be ≥36 weeks' gestation, ≥48 h postnatal age, clinically well, with total serum bilirubin (TSB) well below exchange transfusion thresholds, and without evidence of hemolysis. Care delivery models varied, across midwifery-led, nurse-led, and hospital-led approaches. Escalation criteria were present in five (25%) protocols and inconsistently defined. All protocols emphasized structured parental education delivered by qualified nurses and recommended daily TSB monitoring.Conclusion: Home phototherapy protocols demonstrate consistent emphasis on TSB monitoring and parental education, with more variation in eligibility, care delivery models and escalation criteria. A Delphi consensus study is recommended to address observed variability and to inform the development of a globally applicable framework for different healthcare systems.","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152305"},"PeriodicalIF":3.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Molecular mechanisms of neonatal bilirubin neurotoxicity: The Subcellular Cascade. 新生儿胆红素神经毒性的分子机制：亚细胞级联。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-24 DOI: 10.1016/j.semperi.2026.152306

Aniruddha Adhikari

{"title":"Molecular mechanisms of neonatal bilirubin neurotoxicity: The Subcellular Cascade.","authors":"Aniruddha Adhikari","doi":"10.1016/j.semperi.2026.152306","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152306","url":null,"abstract":"Unbound bilirubin (UB) crosses the blood-brain barrier (BBB) and accumulates in the brain, leading to astrocyte dysfunction, activated microglia-driven inflammatory responses, impaired oligodendrocyte maturation and myelination, and ultimately neurotoxicity. UB-induced molecular cascade starts with intercalation and subsequent structural and functional disruption of the plasma membrane and membrane-bound organelles including mitochondria and endoplasmic reticulum (ER). Mitochondrial membrane damage leads to depolarization, membrane potential collapse, swelling, increased reactive oxygen species (ROS) generation, ATP loss, and ultimately initiation of intrinsic apoptotic pathway through cytochrome c release. An ER insult initiates unfolded protein response (leads to adaptive response or autophagy), and increased Ca2+ efflux into the mitochondria. Both processes converge in inducing mitochondrial apoptotic pathway through BAX/Bak translocation. Next, cytosolic release of damaged mitochondrial DNA, ATP, and ROS triggers (primarily in astrocytes and microglia) NRLP3 inflammasome formation, release of pro-inflammatory cytokines, and ultimately pyroptosis. UB can further initiate TNFR-mediated activation of NF-κB, feeding the inflammatory pathway or necroptosis. Disruption of synaptic transmission is through NMDAR-mediated glutamate excitotoxicity, subsequent Ca2+ influx, and activation of downstream apoptotic pathways. While, at low concentration bilirubin is cytoprotective, this review deals with the detrimental subcellular consequences of UB that ultimately leads to bilirubin-induced neurologic dysfunction (BIND).","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152306"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bilirubin-induced neurological dysfunction in the visual system. 胆红素引起的视觉系统神经功能障碍。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-24 DOI: 10.1016/j.semperi.2026.152304

Jillian Cellucci, William V Good

引用次数: 0

The developing auditory system as a window into bilirubin neurotoxicity. 发育中的听觉系统是研究胆红素神经毒性的窗口。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-22 DOI: 10.1016/j.semperi.2026.152308

Gabriella Musacchia, Matthew B Fitzgerald

{"title":"The developing auditory system as a window into bilirubin neurotoxicity.","authors":"Gabriella Musacchia, Matthew B Fitzgerald","doi":"10.1016/j.semperi.2026.152308","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152308","url":null,"abstract":"Neonatal hyperbilirubinemia is one of the most common conditions in infancy and a cause of potentially preventable neurodevelopmental injury worldwide. Auditory impairment is a well-known consequence of bilirubin neurotoxicity, with effects ranging from hearing loss in severe cases to more subtle processing problems with mild to moderate exposure. Several cellular mechanisms can shed light on how these impairments arise and when physiological dysfunction might be reversible before permanent injury. Current clinical tools provide excellent information about bilirubin-induced changes related to hearing thresholds. Emerging methods in this field, including the frequency-following response (FFR), are promising candidates to include more subtle, suprathreshold measures of auditory processing. Our work has shown that the FFR reflects deficits in neonates with moderate hyperbilirubinemia despite conventional measures within normal limits, and rebounds as bilirubin levels improve with treatment. Future studies are needed to better characterize the pattern of auditory deficits, determine when testing is most informative, and establish the extent to which emerging measures can predict later developmental outcomes.","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152308"},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emergency management of extreme hyperbilirubinemia. 极端高胆红素血症的紧急处理。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-19 DOI: 10.1016/j.semperi.2026.152307

Daniele De Luca, Roberta Centorrino

引用次数: 0

Measuring total bilirubin for clinical decision making: are we treating at the right number? 测量总胆红素用于临床决策：我们的治疗是否正确？

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-09-04 DOI: 10.1016/j.semperi.2026.152295

Isabel V Dupont, Stanley F Lo, Peter H Dijk, Christian V Hulzebos

{"title":"Measuring total bilirubin for clinical decision making: are we treating at the right number?","authors":"Isabel V Dupont, Stanley F Lo, Peter H Dijk, Christian V Hulzebos","doi":"10.1016/j.semperi.2026.152295","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152295","url":null,"abstract":"Every clinical decision to start or discontinue phototherapy ultimately depends on a single laboratory value of a total serum bilirubin (TSB) level. Yet that value is neither the biologically most relevant marker of bilirubin neurotoxicity nor necessarily measured with sufficient analytical accuracy. Although TSB remains the most widely used clinically available marker to guide phototherapy, it is an indirect measure of bilirubin neurotoxicity. Unbound bilirubin (UB) levels are considered biologically more relevant, representing the fraction of bilirubin that can cross the blood-brain barrier and potentially cause neurotoxicity. However, UB measurements are not routinely available, technically demanding, and lacks broad standardization for clinical use. The bilirubin-to-albumin (B/A) ratio may provide a pragmatic intermediate marker, as it partly reflects bilirubin-binding capacity, but its clinical value is limited by variability in albumin binding and the influence of illness severity, acidosis, and competing substances. Therefore, despite its limitations, TSB levels remain the practical standard for treatment decisions. But clinically relevant analytical bias remains an important limitation of TSB measurements, emphasizing that the reliability of the assay is as important as the choice of biomarker.","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152295"},"PeriodicalIF":3.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0