Seminars in Fetal & Neonatal Medicine最新文献

{"title":"Challenges and controversies in the surgical management of Congenital Diaphragmatic Hernia.","authors":"Carmen Mesas Burgos, Erin E Perrone, Katrin Zahn, Holly L Hedrick","doi":"10.1016/j.siny.2025.101648","DOIUrl":"https://doi.org/10.1016/j.siny.2025.101648","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) is a rare yet serious congenital condition marked by a diaphragmatic defect, pulmonary hypoplasia, and often pulmonary hypertension. While surgical repair is essential for survival, many controversies remain regarding its timing, approach, and techniques. Delayed repair after physiological stabilization is the current standard, though optimal timing varies. Earlier repair within 24-48 h may reduce hospital stay in some cases, while others benefit from extended stabilization. CDH patients on extracorporeal life support (ECLS) pose additional challenges, balancing bleeding risks against potential survival benefits when surgery is done on ECLS. Open surgical repair remains the gold standard, especially for large defects, with laparotomy preferred over thoracotomy. Minimally invasive surgery (MIS), although associated with better cosmetic and recovery outcomes, has higher recurrence rates and a steep learning curve. MIS is generally suited for smaller defects, though recent experience shows promising outcomes even in complex cases with patch repairs. Repair technique depends on defect size. Primary repair is preferred for small defects, while larger defects require synthetic or biological patches with emphasis on a tension-free repair for all defects. Synthetic patches offer strength but carry infection risks, whereas biological materials may lack durability. Muscle flap techniques offer an alternative, especially for recurrent or large defects. Recurrence remains a major concern, especially with large defects and patch repairs. Open reoperation is standard for recurrences, with MIS reserved for select cases. Prevention strategies include tension-free repair, appropriate patch choice, and meticulous technique. Emerging strategies, such as regenerative medicine, composite patches, and tissue engineering, show promise but are not yet widely available. Multicenter research, individualized care, and standardized reporting are essential to optimize outcomes and guide future innovations in CDH management.</p>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":" ","pages":"101648"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602098","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":"Cardiorespiratory transition in CDH.","authors":"Deepika Sankaran, Satyan Lakshminrusimha, Michelle J Lim","doi":"10.1016/j.siny.2025.101649","DOIUrl":"https://doi.org/10.1016/j.siny.2025.101649","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly that occurs due to incomplete closure of the diaphragm followed by herniation of abdominal contents into the chest. Fetal hemodynamics are altered in CDH due to pulmonary alveolar and vascular hypoplasia, low pulmonary venous return and in some cases, hypoplasia or dysfunction of the left heart. CDH is associated with high risk of morbidity and mortality due to pulmonary hypoplasia and persistent pulmonary hypertension of the newborn secondary to pulmonary vascular hypoplasia and remodeling. Resuscitation in the delivery room involves optimizing cardiopulmonary transition from fetal to neonatal circulation through gentle ventilation, endotracheal intubation and gastric decompression. Infants with CDH often present with hypoxemic respiratory failure in the immediate postnatal period due to pulmonary hypertension. The understanding of critical cardiopulmonary interactions and the distinguishing features of CDH sub-phenotypes and degree of cardiac involvement may aid in an augmented precision-based approach to invasive ventilation, vasoactive use, and ECMO management. Improved survival is reported after fetal in-utero interventions such as fetoscopic endoluminal tracheal occlusion (FETO) with CDH and severe secondary pulmonary hypoplasia. Clinical outcomes can potentially be improved by optimizing cardiopulmonary transition in the delivery room and cardiopulmonary interactions in the immediate the postnatal period.</p>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":" ","pages":"101649"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565363","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":"Nutrition in congenital diaphragmatic hernia: How and when?","authors":"Ulla Lei Larsen, John T Wren, Christy Gilcrease, Mark Bremholm Ellebaek, Patrick E Sloan","doi":"10.1016/j.siny.2025.101650","DOIUrl":"https://doi.org/10.1016/j.siny.2025.101650","url":null,"abstract":"<p><p>Survival for infants with congenital diaphragmatic hernia (CDH) has improved, but they continue to face significant nutritional morbidity. They are at risk of growth failure, malnutrition, gastroesophageal reflux disease (GERD), oral aversion, and the need for nutritional tube feeding support after the initial hospitalization. Malnutrition and poor nutritional outcomes impact neurodevelopment, underlining the importance of addressing these issues. Available evidence in this area is scarce, and controversies remain about the timing and mode of enteral feeding in the peri-operative period, the role of enteral nutrition on extracorporeal membrane oxygenation (ECMO), and nutritional growth targets for infants with CDH. In this manuscript, we discuss enteral and parenteral targets for infants with CDH, growth targets, the timing and advancement of enteral feeding. In addition, we discuss post-discharge nutritional support, identify gaps in the current literature and address parental concerns around nutrition and growth in infants with CDH.</p>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":" ","pages":"101650"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565364","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":"Management of Congenital Diaphragmatic Hernia (CDH) care: Addressing what matters to patients and their families?","authors":"K Saint Denny, J Lawer, S Mur, T M Prentice","doi":"10.1016/j.siny.2025.101651","DOIUrl":"https://doi.org/10.1016/j.siny.2025.101651","url":null,"abstract":"<p><p>Despite advances in care, Congenital Diaphragmatic Hernia remains a complex and challenging condition to manage and is often associated with long term morbidity. Families are required to navigate considerable uncertainty, challenges in prognostication and communication, and must adapt to an evolving clinical trajectory. This review addresses considerations and practical tips for healthcare professionals to improve the family and patient experience from diagnosis to adult care, from the perspective of clinicians and CDH families. This paper emphasizes the importance of including those with lived experience with CDH in defining topics of priority in research and in clinical and support interventions.</p>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":" ","pages":"101651"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576760","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":"Developmental pathophysiology and genetic contributions in CDH.","authors":"Gabriel Guevara, K Taylor Wild, Richard Keijzer, David J McCulley","doi":"10.1016/j.siny.2025.101652","DOIUrl":"https://doi.org/10.1016/j.siny.2025.101652","url":null,"abstract":"","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":" ","pages":"101652"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592748","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":"Use of human milk and fortification in the neonatal intensive care unit","authors":"David H. Adamkin","doi":"10.1016/j.siny.2025.101632","DOIUrl":"10.1016/j.siny.2025.101632","url":null,"abstract":"<div><div>Human milk is the gold standard for the nutrition of very-low-birthweight (VLBW) infants. Pasteurized donor human milk (DM) should be provided for VLBW infants when own mother's milk (OMM) is not available. Prevention of Necrotizing enterocolitis (NEC) is an important short-term benefit associated with human milk feeding. Human milk alone does not meet the nutritional requirements for VLBW infants leading to nutritional inadequacy, postnatal growthfaltering,and risk of poor neurodevelopmental outcome. Human milk fortification with multicomponent fortifiers increases calories and provides additional protein and minerals and should minimize nutritional deficits. Human milk derived fortifiers (HMDF) provide an exclusive human milk diet but recent evidence to recommend their use over cow milk derived fortifiers is lacking. Individualized fortification using human milk analyzers in real time is an emerging practice that allows for a more personalized provision of nutrient needs.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 2","pages":"Article 101632"},"PeriodicalIF":2.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086842","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":"Post-discharge nutrition to optimize preterm infant short- and long-term outcomes","authors":"Sarah N. Taylor,&nbsp;Catherine O. Buck","doi":"10.1016/j.siny.2025.101637","DOIUrl":"10.1016/j.siny.2025.101637","url":null,"abstract":"<div><div>The preterm infant misses fetal nutrition, and the nutritional deficit is proportional to the degree of preterm birth with very preterm infants demonstrating the greatest need for supplemental nutrition to overcome deficiencies. Preterm infants’ growth patterns are linked to both their risk for neurodevelopmental difficulties and to the development of obesity. Therefore, establishing healthy growth patterns by providing the best nutrition both in the hospital and post-hospital discharge is critical for long-term health. Despite numerous clinical trials, uncertainty persists as to the duration of nutritional supplement, the degree of benefit of maternal milk feedings, and the best short-term measures of growth and body composition to predict long-term outcomes. As more is learned about optimal post-discharge nutrition, it is very likely that best practice in post-discharge nutrition will include use of a standardized approach to deliver individualized care.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 2","pages":"Article 101637"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054125","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":"Gastrointestinal (GI)-lung-brain axis","authors":"Catalina Bazacliu,&nbsp;Juan Carlos Roig,&nbsp;Josef Neu","doi":"10.1016/j.siny.2025.101639","DOIUrl":"10.1016/j.siny.2025.101639","url":null,"abstract":"<div><div>The GI tract-lung-brain axis refers to the communication network linking the gastrointestinal tract, central nervous system, and respiratory system. This axis is particularly significant in preterm neonates because their immune and nervous systems are undergoing rapid development and thus are susceptible to various conditions influenced by GI tract and lung microbiota that are key mediators in this axis. This communication network is connected via neural, hormonal, and immunological regulatory pathways, all of which are pivotal in disease pathogenesis and health. Here we provide a brief introduction to this axis along with interactive mechanisms and perturbations that can affect this system and the roles they play in health and disease.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 2","pages":"Article 101639"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004451","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":"Human milk for preterm infants","authors":"Neena Modi","doi":"10.1016/j.siny.2025.101634","DOIUrl":"10.1016/j.siny.2025.101634","url":null,"abstract":"<div><div>The term “human milk” conceals important differences between that from an infant's own mother and that obtained from a person or persons who have donated or sold their breast milk. These include differences in nutritional content, and a wide range of non-nutritional components that promote immune, metabolic, and brain development and have evolved over the course of time to transmit biological information from mother to infant. Human milk feeding to preterm babies also encompasses elements such as processing and storage, differences between feeding expressed breast milk versus suckling at the breast, and societal and economic considerations. Current evidence of clinical effectiveness of donated or commercial human milk, and whether macro and micronutrient supplementation are required indicates considerable uncertainty and the possibility of harm. Preterm nutrition is an emotive subject, but important evidence gaps need to be recognised, acknowledged, and addressed if the care of very preterm babies is to improve through a strong evidence-base.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 2","pages":"Article 101634"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038246","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":"Donor human milk pasteurization methods and the effect on milk components as they relate to Necrotizing enterocolitis","authors":"Laiken Price ,&nbsp;Kelly A. Orgel ,&nbsp;Misty Good","doi":"10.1016/j.siny.2025.101638","DOIUrl":"10.1016/j.siny.2025.101638","url":null,"abstract":"<div><div>Necrotizing enterocolitis (NEC) is an intestinal disease that predominantly occurs in preterm infants. While there are no definitive treatment options for NEC, the administration of human milk is protective against the development of NEC in preterm infants. However, human milk composition is highly dynamic, containing numerous bioactive components that can be affected by both maternal and perinatal factors. Furthermore, when maternal milk is unavailable, donor human milk, which goes through a rigorous preparation process including pooling and pasteurization, is used. The different pasteurization methods can have implications for the bioactive components of human milk. In this review, we explore the current literature surrounding the benefits of human milk in the prevention of NEC. We further review the bioactive components and the microbiome of human milk and the many factors that affect the diversity of milk content between human milk samples. Finally, we review the different methods of pasteurization and their effects on the components of human milk.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 2","pages":"Article 101638"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043209","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}