Seminars in Fetal & Neonatal Medicine最新文献_第2页

An emerging consensus about treatment of the tiniest babies 关于如何对待最小婴儿的共识正在形成。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-02-27 DOI: 10.1016/j.siny.2026.101712

John D. Lantos

{"title":"An emerging consensus about treatment of the tiniest babies","authors":"John D. Lantos","doi":"10.1016/j.siny.2026.101712","DOIUrl":"10.1016/j.siny.2026.101712","url":null,"abstract":"<div><div>Over the past three decades, a broad consensus has emerged that decisions about life-sustaining treatment for extremely premature infants should be grounded in shared decision-making (SDM) between clinicians and parents. This consensus is endorsed by professional societies, bioethics commissions, and parents of babies in the neonatal intensive care unit. Despite this robust consensus, there is evidence that SDM is not always practiced. The evidence comes from observations of actual studies in which there is substantial practice variation that seems unlikely to reflect individualized decisions. In this paper, I examine the sources of that variation and argue that current SDM frameworks rest on an overly simplistic assumption that outcomes are stable, objective, unambiguous, and communicated clearly. In reality, prognostic data for survival and neurodevelopmental impairment are deeply contingent on treatment practices, prenatal management, institutional culture, and reporting conventions. These ambiguities complicate counseling, obscure value-laden judgments, and contribute to moral distress among clinicians. Moreover, parental preferences are heterogeneous and often reflect attitudes about disabilities that are different from the attitudes of health professionals. I propose a more dynamic model of SDM that acknowledges emotional complexity, evolving prognostic clarity, and the need for iterative decision-making over time. Rather than centering decisions on a single variable such as gestational age, this approach emphasizes individualized assessment, a trial of therapy when appropriate, and longitudinal conversations grounded in trust, empathy, and responsiveness to changing clinical realities. As neonatology continues to push the boundaries of viability—and as emerging technologies reshape the therapeutic landscape—ethical deliberation must keep pace. Clinicians and parents alike must navigate persistent uncertainty with humility, attentiveness to suffering, and a shared commitment to doing what is best for each infant and family.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"31 2","pages":"Article 101712"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693289","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 case for improving care for patients and families affected by birth at <25 weeks’ gestation 改善对受妊娠<25周分娩影响的患者和家庭的护理的案例。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-02-27 DOI: 10.1016/j.siny.2026.101713

Matthew A. Rysavy

引用次数: 0

Inhaled nitric oxide in premature infants for respiratory failure: Discussion and consensus 吸入一氧化氮在早产儿呼吸衰竭：讨论和共识。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-20 DOI: 10.1016/j.siny.2026.101723

Shazia Bhombal , Adrianne Rahde Bischoff , Amir M. Khan

引用次数: 0

Extremely premature infant care: Reasonable progress or therapeutic fury? 极早产儿护理：合理进展还是治疗狂怒？

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-04 DOI: 10.1016/j.siny.2026.101714

Joseph W. Kaempf

{"title":"Extremely premature infant care: Reasonable progress or therapeutic fury?","authors":"Joseph W. Kaempf","doi":"10.1016/j.siny.2026.101714","DOIUrl":"10.1016/j.siny.2026.101714","url":null,"abstract":"<div><div>Application of palliative comfort care versus neonatal intensive care for extremely premature births is a judgment fraught with uncertainty and risk, principally for the pregnant woman and family. Survival and good health are possible, but suffering, chronic health issues, and socio-economic inequities are burdensome to families. Survival rates of infants born at 22, 23, and 24 weeks’ gestation are increasing, but morbidity rates and long-term neurodevelopmental impairments are substantial and not improving. Outcomes acceptable to some pregnant women and families are not acceptable to others. Autonomy of pregnant women contrasted with the rights of the fetus and infant are affected by culture, religion, technology, and powerfully persuaded by physicians who possess conflicts-of-interest related to career goals, income, and research priorities. Interventions related to extreme prematurity care such as cesarean deliveries create serious health risks for pregnant women. Intensive care of extremely premature infants is expensive, and lost opportunity costs for families and society are under-appreciated. Physicians should resist dogmatic positions tethered to non-rigorous evidence and technology. Physicians best serve pregnant women by listening to their concerns and preferences, objectively reviewing clinical outcomes, and by avoiding care options presented as restrictive protocols, or wide-open menus. The legitimate zone of parental discretion embraces value pluralistic shared decision-making and informed consent. This principle is unequivocally endorsed by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Because there is no unifying cultural, religious, or bioethical ethos, we should embrace shared decision-making recognizing the inherent contingencies and disagreements of extreme prematurity.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"31 2","pages":"Article 101714"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476016","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 case for inhaled nitric oxide use in preterm infants 早产儿吸入一氧化氮的案例。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-20 DOI: 10.1016/j.siny.2026.101721

Adrianne R. Bischoff

引用次数: 0

Critical thinking in red blood cell transfusion decisions: Donor, product, recipient, and outcomes 红细胞输血决策中的批判性思考：供体、产品、受体和结果。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-01 DOI: 10.1016/j.siny.2026.101717

Cassandra D. Josephson , Ravi M. Patel

{"title":"Critical thinking in red blood cell transfusion decisions: Donor, product, recipient, and outcomes","authors":"Cassandra D. Josephson , Ravi M. Patel","doi":"10.1016/j.siny.2026.101717","DOIUrl":"10.1016/j.siny.2026.101717","url":null,"abstract":"<div><div>Red blood cell (RBC) transfusion is a common and potentially lifesaving intervention in neonatal care, particularly for very low birth weight (VLBW) infants. Transfusion decisions are often guided by hemoglobin thresholds; however, these surrogate markers may incompletely capture the complex physiologic, immunologic, and developmental factors that influence transfusion benefit and risk. This review presents a critical thinking framework for neonatal RBC transfusion decision-making that integrates donor characteristics, blood product attributes, recipient vulnerability, and clinical outcomes. We summarize infectious and non-infectious risks of RBC transfusion. Contemporary strategies to mitigate transfusion-transmitted cytomegalovirus (CMV), including leukoreduction and CMV-seronegative donor selection, are discussed in the context of evidence demonstrating extremely low residual risk and maternal breast milk as the primary source of postnatal infection in VLBW infants. We also note variability in blood banking practices and clinical implications. Emerging physiological data suggests that storage-related changes, particularly following irradiation, may affect regional tissue oxygenation in preterm infants, although the clinical significance is uncertain. Evidence from randomized trials does not support routine use of fresh RBCs to improve major neonatal outcomes, underscoring the need to move beyond storage age alone when evaluating transfusion practices. Finally, we highlight future research directions, including vein-to-vein studies linking donor and product characteristics to recipient outcomes, and emphasize the importance of close collaboration between neonatologists and transfusion medicine specialists to optimize neonatal patient blood management and improve outcomes in this highly vulnerable population.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"31 2","pages":"Article 101717"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934974","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

Packed red blood cell transfusion in the very low birth weight infant: Aggressive, conservative, or neither? 极低出生体重婴儿的填充红细胞输注：积极，保守，还是两者都不？

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-02-28 DOI: 10.1016/j.siny.2026.101719

Matthew A. Saxonhouse , Cassandra Josephson , Robin Ohls , Ravi Patel

引用次数: 0

The case against use of inhaled nitric oxide for hypoxic respiratory failure in the premature neonate 反对使用吸入一氧化氮治疗早产儿缺氧呼吸衰竭的病例。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-20 DOI: 10.1016/j.siny.2026.101722

Amir M. Khan

引用次数: 0

Human milk fortification in preterm infants: Navigating evidence, practice, and controversy 早产儿母乳强化：导航证据，实践和争议。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-04-02 DOI: 10.1016/j.siny.2026.101711

Amy B. Hair , Brenda B. Poindexter

{"title":"Human milk fortification in preterm infants: Navigating evidence, practice, and controversy","authors":"Amy B. Hair , Brenda B. Poindexter","doi":"10.1016/j.siny.2026.101711","DOIUrl":"10.1016/j.siny.2026.101711","url":null,"abstract":"<div><div>Human milk is universally recognized as the optimal source of nutrition for preterm infants, providing immunologic, bioactive, and enzymatic components that provide health benefits and are associated with decreased morbidities of prematurity. However, fortification of both maternal breast milk (MBM) and donor breast milk (DBM) is needed to meet the elevated metabolic needs and nutrient requirements of preterm infants. This narrative review, reflecting the content presented, audience questions, and the roundtable discussion from the 2025 Neonatal Insights Conference, synthesizes current evidence and literature to evaluate the rationale, composition, and outcomes associated with differing fortification approaches. Randomized controlled trials evaluating fortifier type remain limited to small studies with high MBM usage. Future research must focus on trials evaluating fortifier type in infants who receive MBM and those that receive primarily DBM. Advancing fortification practices requires individualized nutrition planning and maternal breastfeeding support to achieve optimal growth and developmental trajectories for preterm infants.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"31 2","pages":"Article 101711"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724399","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

Combined use of erythropoiesis-stimulating agents and transfusion guidelines in NICU infants 新生儿重症监护病房婴儿联合使用促红细胞生成剂和输血指南。

IF 2.8 3区医学

Seminars in Fetal & Neonatal Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-10 DOI: 10.1016/j.siny.2026.101718

Robin K. Ohls

{"title":"Combined use of erythropoiesis-stimulating agents and transfusion guidelines in NICU infants","authors":"Robin K. Ohls","doi":"10.1016/j.siny.2026.101718","DOIUrl":"10.1016/j.siny.2026.101718","url":null,"abstract":"<div><div>Red blood cell transfusions from adult donors can be lifesaving for neonates with severe anemia or acute massive hemorrhage but can be associated with specific and significant risks. Infectious transmission, acute lung injury, and circulatory overload are well known risks and are part of blood transfusion informed consent. Less well-described, but more common, are the risks that occur when transfusing the smallest and most immature neonates, those less than 1000 g. Repeated adult red cell transfusions may worsen inflammatory conditions, such as pulmonary inflammation, and they can increase the incidence and severity of retinopathy of prematurity and neurodevelopmental delay. In this review, we will provide an overview of neonatal transfusion stewardship including instituting both non-pharmacological transfusion-avoidance techniques and pharmacologic strategies to reduce transfusion rates. Erythropoiesis-stimulating agents like erythropoietin and darbepoetin further reduce and can eliminate the need for a transfusion. Instituting non-pharmacologic and pharmacologic strategies will increase the number of NICU infants who remain transfusion free, even those born weighing less than 1000 g.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"31 2","pages":"Article 101718"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494479","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