Seminars in perinatology最新文献

{"title":"The role of sleep in neonatal neurocritical care and the influence on long-term outcome.","authors":"Leonie M Paciello, Mirja Quante, Hendrik Rosewich, Renée A Shellhaas","doi":"10.1016/j.semperi.2025.152127","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152127","url":null,"abstract":"<p><p>Prematurity, birth complications, and congenital brain abnormalities can lead to neurological conditions that require intensive monitoring and treatment. Ensuring healthy sleep is needed to help infants recover from these conditions and positively influence neurodevelopmental outcomes. Yet, achieving optimal sleep represents a challenge in the complex setting of neonatal neurocritical care. In this narrative review, we examine the role of sleep within the context of neonatal neurocritical care. Specifically, we analyze the underlying physiological mechanisms of sleep and how these processes are altered by the intensive care environment and neurological pathology. We evaluate current evidence regarding the contribution of sleep to neurological recovery and its impact on long-term neurodevelopmental outcomes. Finally, we discuss existing and emerging strategies to monitor and optimize sleep in neonatal neurocritical care settings.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152127"},"PeriodicalIF":3.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058652","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}

{"title":"Interventions to address inequities in infant mortality and morbidity in the NICU and beyond: A focus on the mother-infant dyad.","authors":"Mattie F Wolf, Diana Montoya-Williams, Michelle-Marie Peña","doi":"10.1016/j.semperi.2025.152141","DOIUrl":"10.1016/j.semperi.2025.152141","url":null,"abstract":"<p><p>In 2022, United States infant mortality increased for the first time in over 20 years, driven largely by deaths due to maternal complications and preterm birth, and highlighted significant racial/ethnic and socioeconomic inequities in both infant mortality and morbidities. This underscores the relationship between maternal and infant health outcomes. This article presents a framework for understanding the mother-infant dyad using an adaptation of the socio-ecological model and focuses on patient and family factors, provider and healthcare system factors, community factors, and policy and societal factors that perpetuate inequities in infant outcomes. The neonatal intensive care unit (NICU) is a driver of inequities, but also provides critical, yet underutilized, opportunities for intervention. Strategies to promote physical, emotional, social, and financial well-being of mothers and infants include NICU-based lactation and mental health support, culturally responsive care, screening for social determinants of health, and engagement of families in care and quality improvement. Beyond the NICU, broader structural and policy changes are essential, including equitable access to risk-appropriate care, paid family leave, comprehensive health insurance, and investments in community partnerships. Addressing these drivers of inequity through coordinated healthcare, policy, and community action can better support the mother-infant dyad and improve the well-being of all families.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152141"},"PeriodicalIF":3.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human milk as therapy: neurodevelopment and neonatal brain injury.","authors":"Katie M Strobel, Krystle M Perez, Hannah Benjamin, Rebecca Hoban","doi":"10.1016/j.semperi.2025.152140","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152140","url":null,"abstract":"<p><p>Human milk (HM) is the gold standard for infant feeding due to its associations with significant reductions in short and long-term serious morbidities. It is also associated with improved brain growth and development and neurodevelopmental outcomes, particularly in the preterm population. The myriad of bioactives found in HM, such as growth factors, stem cells, human milk oligosaccharides, and the human milk microbiome, presumably play a large role in these outcomes. Given the significant improvements in infant outcomes, components of HM are now being studied as targeted neurological therapy for brain injury. This narrative review will summarize the unique components of HM that are thought to be responsible for brain health and how they may affect brain structure and development in the term and preterm neonate. Neurodevelopmental improvements seen with HM feeding will also be reviewed. Finally, pre-clinical and clinical studies utilizing whole HM or HM components to treat brain injury will be summarized so that providers can better share the science of this remarkable biologic with multi-disciplinary teams and families.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152140"},"PeriodicalIF":3.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041341","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}

{"title":"Physiology of gastroesophageal reflux in the neonate.","authors":"Alexandra Pottorff, Eric B Ortigoza, Rinarani Sanghavi, Alejandro Llanos-Chea","doi":"10.1016/j.semperi.2025.152130","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152130","url":null,"abstract":"<p><p>Gastroesophageal reflux is physiologically normal in infants but can become gastroesophageal reflux disease when it leads to significant symptoms (persistent vomiting, weight loss, feeding difficulties). Gastroesophageal reflux disease is highly prevalent among infants and contributes to increased health care utilization. There are several physiologic and lifestyle factors that predispose infants to a higher degree of gastroesophageal reflux and disease related to it. Preterm infants and infants admitted to the neonatal intensive care unit, are a special population that have unique risk factors for gastroesophageal reflux disease and have a high prevalence of gastroesophageal reflux disease. To better understand gastroesophageal reflux in infants and neonates with medical complexity, this article will first review the physiology of typical swallowing and motility of the upper gastrointestinal tract in infants. Then, the pathophysiology of gastroesophageal reflux in infants will be reviewed. Finally, this article also addresses specific physiological differences in preterm infants that are important to aid in the understanding of management of gastroesophageal reflux disease in this specific population.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152130"},"PeriodicalIF":3.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006595","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}

{"title":"Neuroprotective therapies for neonatal hypoxic-ischemic brain injury - a contemporary update.","authors":"Hemmen Sabir","doi":"10.1016/j.semperi.2025.152128","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152128","url":null,"abstract":"<p><p>Neonatal encephalopathy of hypoxic-ischemic origin remains a leading cause of global neonatal mortality. Over the past decades, various neuroprotective strategies have been explored; however, therapeutic hypothermia remains the only clinically approved intervention to date. This review outlines emerging and adjunctive treatment modalities beyond therapeutic hypothermia and emphasizes the critical need for robust and reproducible translational research to bridge the gap between preclinical findings and clinical applications.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152128"},"PeriodicalIF":3.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967691","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}

{"title":"The advantages and limitations of animal models for understanding acute neonatal brain injury.","authors":"Kelly Q Zhou, Raymand Pang, Nicola J Robertson, Justin M Dean, Laura Bennet, Joanne O Davidson, Alistair J Gunn","doi":"10.1016/j.semperi.2025.152129","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152129","url":null,"abstract":"<p><p>Neonatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of death and disability around the world. Therapeutic hypothermia is now established to improve outcomes in term and near-term infants in high-income countries, but even in this setting, many infants still survive with disability. To further improve outcomes, experimental models are needed to test new interventions before clinical translation. In the present review, we discuss the strengths and weaknesses of a range of near-term and term models and their utility for understanding the pathophysiology of HIE and to test potential treatments. It is important to reflect that the strength of the evidence base for therapeutic hypothermia before it went to trial was that multiple groups using different and complementary models all showed benefit and that these models had been used to define the key parameters needed to achieve neuroprotection. We strongly advocate that this should be the expectation for all new neuroprotective interventions before large pragmatic randomized controlled trials are carried out.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152129"},"PeriodicalIF":3.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967712","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}

{"title":"Leveraging neonatal neuroimaging for neuroprognostication in presumed hypoxic-ischemic encephalopathy: A framework for clinicians.","authors":"Mehmet N Cizmeci, Andrea van Steenis, Rhandi Christensen, Sylke Jeanne Steggerda, Linda S de Vries","doi":"10.1016/j.semperi.2025.152126","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152126","url":null,"abstract":"<p><p>Brain magnetic resonance imaging (MRI) in neonates with presumed hypoxic-ischemic encephalopathy (HIE) offers a unique window into the extent and timing of injury, providing valuable insights for neuroprognostication. Brain MRI refines the prediction of functional outcomes, crucial for guiding family counseling and early interventions. The present article focuses on the role of post-rewarming brain MRI in this context, exploring specific MRI findings associated with diverse neurodevelopmental outcomes and highlights the potential of neuroimaging to improve the understanding and prediction of long-term functional outcomes. Utilizing a framework with likelihood categories, this work aims to enhance the accuracy of prediction of adverse outcomes within specific developmental domains, thereby refining neuroprognostication for informed discussions with caregivers.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152126"},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967461","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}

{"title":"Remote neonatal neurocritical care: from the bedside to the cloud.","authors":"Gabriel Fernando Todeschi Variane, Danieli Mayumi Kimura Leandro, Silvia Schoenau de Azevedo, Juliana Querino Teixeira, Marcelo Jenné Mimica","doi":"10.1016/j.semperi.2025.152124","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152124","url":null,"abstract":"<p><p>Neonatal neurocritical care (NNCC) has emerged as a specialized discipline to address the unique neurological needs of critically ill newborns. However, disparities in access to brain-focused expertise and neuromonitoring technologies remain a significant global challenge. Remote NNCC, supported by telemedicine and digital health tools, offers a promising approach to extend specialized neurological care beyond tertiary centers, particularly to underserved or resource-limited settings. This review explores the current landscape, opportunities, and limitations of remote NNCC. Key applications include remote consulting and rounding, tele-interpretation of neurophysiological data, integration of multimodal monitoring, remote neuroimaging evaluation, and virtual neurological examinations. Additionally, telehealth platforms are increasingly used to support neurodevelopmental follow-up and therapeutic interventions after NICU discharge. These approaches can enhance diagnostic precision, enable timely intervention, reduce unnecessary transfers, and promote equity in care delivery. Advancements in artificial intelligence, immersive reality, and digital twins modeling may further expand the capabilities of remote NNCC. These emerging technologies hold the potential to optimize real-time decision-making, personalize interventions, and foster large-scale collaboration through cloud-based data integration. However, significant barriers remain, including limitations in infrastructure, interoperability between systems, variability in training, and ethical concerns related to data privacy, algorithmic bias, and equitable access. To ensure the safe and effective adoption of remote NNCC, standardized protocols, robust governance frameworks, and investments in workforce development and infrastructure are essential. Interdisciplinary collaboration and global partnerships will be critical in addressing these challenges and realizing the full potential of remote NNCC in improving neurological outcomes for high-risk neonates worldwide.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152124"},"PeriodicalIF":3.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859578","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}

{"title":"Neonatal neuroimaging: from research to bedside practice.","authors":"Mehmet N Cizmeci, Mohamed El-Dib, Linda S de Vries","doi":"10.1016/j.semperi.2025.152125","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152125","url":null,"abstract":"<p><p>Neonatal neuroimaging is essential in research and clinical practice, offering important insights into brain development and neurologic injury mechanisms. Visualizing the brain enables researchers and clinicians to improve neonatal care and parental counselling through better diagnosis and prognostication of disease. Common neuroimaging modalities used in the neonatal intensive care unit (NICU) are cranial ultrasonography (cUS) and magnetic resonance imaging (MRI). Between these modalities, conventional MRI provides the optimal image resolution and detail about the developing brain, while advanced MRI techniques allow for the evaluation of tissue microstructure and functional networks. Over the last two decades, medical imaging techniques using brain MRI have rapidly progressed, and these advances have facilitated high-quality extraction of quantitative features as well as the implementation of novel devices for use in neurological disorders. Major advancements encompass the use of low-field dedicated MRI systems within the NICU and trials of ultralow-field portable MRI systems at the bedside. Additionally, higher-field magnets are utilized to enhance image quality, and ultrafast brain MRI is employed to decrease image acquisition time. Furthermore, the implementation of advanced MRI sequences, the application of machine learning algorithms, multimodal neuroimaging techniques, motion correction techniques, and novel modalities are used to visualize pathologies that are not visible to the human eye. In this narrative review, we will discuss the fundamentals of these neuroimaging modalities, and their clinical applications to explore the present landscape of neonatal neuroimaging from bench to bedside.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152125"},"PeriodicalIF":3.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837597","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}

{"title":"Physiological basis of non-invasive ventilation in the newborn","authors":"Theodore Dassios","doi":"10.1016/j.semperi.2024.152023","DOIUrl":"10.1016/j.semperi.2024.152023","url":null,"abstract":"<div><div>Non-invasive ventilation (NIV) is a form of respiratory support provided primarily to preterm born infants in an effort to avoid any endotracheal intubation or as a weaning step following invasive ventilation. In the context of the respiratory distress syndrome of the newborn, NIV could target and partially reverse specific pathophysiological phenomena, by improving alveolar recruitment and establishing adequate functional residual capacity. It can also assist in minimizing lung injury by avoiding excessive pressure delivery, which can be harmful for the developing lung. Non-invasive ventilation can unload the respiratory muscles and decrease the work of breathing as reported by studies that compare the measured work of breathing at increasing levels of non-invasive support. NIV can also be beneficial in moderating the frequency and intensity of apnea of prematurity. Unintended physiological effects of NIV include gaseous distension of the gastrointestinal tract and increased incidence of air-leak complications. During NIV there is also a lack of direct access to the trachea for suctioning and pulmonary toiletry. Insufficient non-invasive respiratory support could be associated with inadequate oxygenation and ventilation, insufficient gas exchange and atelectotrauma. Excessive provision of non-invasive support could be inefficient or harmful, as overdistention can be associated with decreased compliance of the respiratory system, impaired gas exchange and abnormal diaphragmatic function. An individualized physiological approach could, thus, aim to optimize the beneficial effects of non-invasive ventilation while avoiding inadequate or excessive levels of support.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 5","pages":"Article 152023"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966952","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}