Seminars in Fetal & Neonatal Medicine最新文献

{"title":"Maternal vaccination to prevent neonatal infections and combat antimicrobial resistance","authors":"Eva P. Galiza ,&nbsp;Eve Nakebembe ,&nbsp;Robert Mboizi ,&nbsp;Erick Okek ,&nbsp;Kirsty Le Doare","doi":"10.1016/j.siny.2025.101680","DOIUrl":"10.1016/j.siny.2025.101680","url":null,"abstract":"<div><div>Maternal vaccination during pregnancy is emerging as a powerful strategy in protecting newborns from infectious diseases, improving neonatal outcomes, and potentially reducing antimicrobial use and resistance.</div><div>Maternal immunisation works by eliciting protective antibodies in the mother that are transferred to the fetus transplacentally and through breastmilk postnatally to provide the infant with passive immunity during the first vulnerable months of life. There is sufficient evidence to support the role of maternal vaccination in averting many neonatal infections that would otherwise require medical intervention.</div><div>By preventing infections in mothers and their newborn, maternal vaccination also holds significant potential for reducing antimicrobial use and antimicrobial resistance. Fewer neonatal infections translate to a reduced need for antimicrobial use in the neonatal period and in postpartum women, therefore lowering the selective pressure for drug-resistant bacteria.</div><div>Routine maternal vaccines (tetanus, diphtheria, acellular pertussis (Tdap), influenza, COVID-19, respiratory syncytial virus) already confer measurable antibiotic-sparing benefits by preventing infections that typically trigger antimicrobial therapy in mothers and neonates. Pipeline candidates (<em>Group B Streptococcus</em>, <em>Klebsiella pneumoniae</em>, <em>Escherichia coli</em>) could further lower neonatal sepsis burden, reducing broad-spectrum antimicrobial use in neonatal intensive care units to help slow antimicrobial resistance. Integrated with antibiotic stewardship and infection-prevention measures, maternal immunisation offers a practical, scalable practice to limit perinatal antibiotic exposure.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101680"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427138","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":"Vaccinations in preterm infants: Which and when?","authors":"Charline Schmitt ,&nbsp;Sybelle Goedicke-Fritz ,&nbsp;Ingmar Fortmann ,&nbsp;Michael Zemlin","doi":"10.1016/j.siny.2025.101670","DOIUrl":"10.1016/j.siny.2025.101670","url":null,"abstract":"<div><div>Preterm infants, who represent around 10 % of births worldwide, are at markedly increased risk of infections due to their immunological immaturity and reduced maternal antibody transfer. Although international guidelines recommend immunization based on chronological age, vaccination in this population is frequently delayed or incomplete. This review summarizes the current evidence on vaccine safety, efficacy, and timing in preterm infants, with particular emphasis on primary immunizations and vaccines administered during the first year of life. Distinct immunological characteristics—including impaired T- and B-cell responses as well as altered microbiome development—contribute to reduced vaccine responsiveness. Emerging approaches such as mRNA vaccine technologies, novel adjuvants, maternal immunization, and microbiome modulation hold promise for enhancing vaccine efficacy. Ensuring timely immunization and adherence to vaccination recommendations in preterm infants is essential to reduce preventable morbidity and mortality in this highly vulnerable group.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101670"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309765","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":"Current standards for HIV vertical transmission prevention","authors":"Juanita Lishman ,&nbsp;Lars Naver ,&nbsp;Helena Rabie","doi":"10.1016/j.siny.2025.101663","DOIUrl":"10.1016/j.siny.2025.101663","url":null,"abstract":"<div><div>Vertical transmission of HIV to newborns and infants during pregnancy, labour and delivery, and breastfeeding ranges from 15 % to 45 % without intervention. The most important risk factor for transmission is a high maternal viral load. Prevention guidelines for low- and middle-income (high-burden) countries differ from those for high-income (lower-burden) settings, with a key differences in provision of caesarean section, post delivery antiretroviral care of the baby and infant feeding practice. This review will focus on a comprehensive approach to the elimination of paediatric HIV. We will discuss aspects of prevention of HIV and the current standards of care in the prevention of vertical transmission. We highlight the differences between well-resourced and lower-resourced settings including approaches to caesarean section and breastfeeding and infant prophylaxis. We also touch on the potential of emerging strategies to further reduce vertical transmission of HIV. Lastly, despite progress in prevention, challenges persist, particularly in sub-Saharan Africa due to structural health system gaps and loss to care. The recent reduction in donor funding threatens the progress made in transmission prevention.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101663"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402581","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":"Can artificial intelligence predict failure of non-invasive respiratory support in the neonatal unit?","authors":"Eleanor Jeffreys, Allan Jenkinson, Theodore Dassios, Anne Greenough","doi":"10.1016/j.siny.2025.101683","DOIUrl":"https://doi.org/10.1016/j.siny.2025.101683","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive ventilation (NIV) is a key form of respiratory support in neonatal intensive care units (NICU). Non-invasive ventilation failure, however, can lead to adverse outcomes in preterm infants. This narrative review explores the potential of using artificial intelligence (AI) to improve the prediction of NIV failure, potentially reducing the mortality and morbidity within this population.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed with terms relating to AI, machine learning, NIV and neonatology. Studies which used AI models to predict NIV failure or the need for intubation, within the neonatal population, were included. Model performance was assessed using area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Six studies, including 3421 infants, were identified. Various AI techniques were used including deep learning models, for example multimodal deep neural networks, as well as simpler machine learning models such as logistic regression and support vector machines. AUC values ranged from 0.78 to 0.93, with most models exhibiting clinically useful performance defined as an AUC >0.8. The modal key predictive factors across the six studies were gestational age, SpO₂ and maximum FiO_2. CONCLUSION: AI- generated models for predicting NIV failure as first intention in the NICU setting show potential. Deep learning models demonstrate particular promise; however, further large multicenter externally validated studies are required to assess generalizability and to aid integration into routine clinical practice. Implementation of AI models to predict NIV failure as first intention and post-extubation could lead to improved clinical decision making and personalized care.</p>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":" ","pages":"101683"},"PeriodicalIF":2.8,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582517","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":"Fetal therapies in congenital diaphragmatic hernia: a review of possibilities and practical challenges","authors":"Adriana Dekirmendjian ,&nbsp;Fabian Doktor ,&nbsp;Lina Antounians ,&nbsp;Augusto Zani","doi":"10.1016/j.siny.2025.101656","DOIUrl":"10.1016/j.siny.2025.101656","url":null,"abstract":"<div><div>Congenital diaphragmatic hernia (CDH) is characterized by pulmonary hypoplasia. CDH lungs exhibit an inflammatory signature with impaired growth, maturation, and vascularization, which postnatally result in altered gas exchange and pulmonary hypertension. These pulmonary abnormalities are drivers of poor survival and long-term morbidity. Improving lung development before birth remains a key strategy to enhance outcomes, and several antenatal therapies have emerged to address this need. These include surgical procedures, pharmacologic agents, and regenerative approaches. Fetal Endoluminal Tracheal Occlusion has shown the most robust evidence, improving survival in selected CDH cases. However, concerns about its generalizability, complications, and its limited effect on overall lung development have underscored the need for complementary or alternative strategies. A wide range of pharmacologic agents, some of which are in clinical use while others remain experimental, has been studied in experimental CDH models, such as corticosteroids, anti-inflammatory drugs and vasoactive medications. In parallel, regenerative medicine strategies via the antenatal administration of stem cells or their derivatives (extracellular vesicles) offer promise through multi-targeted mechanisms that address several aspects of pulmonary hypoplasia. Encouraging preclinical results provide a promising basis for advancing these regenerative therapies toward clinical application, with ongoing investigations focused on establishing their safety, efficacy, and feasibility.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 3","pages":"Article 101656"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976394","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":"Transitioning to adulthood in congenital diaphragmatic hernia, how do we design the right services?","authors":"S. Kamphuis Lieke ,&nbsp;M. Schnater Johannes ,&nbsp;C.W. Spaander Manon ,&nbsp;IJsselstijn Hanneke","doi":"10.1016/j.siny.2025.101653","DOIUrl":"10.1016/j.siny.2025.101653","url":null,"abstract":"<div><div>For children who have undergone surgical and neonatal intensive care treatment for congenital diaphragmatic hernia (CDH), health care providers’ concerns have shifted from survival rates to the management of associated morbidities. In recent decades, an increasing number of children born with CDH have reached adulthood. Although long-term outcome data remain limited, available evidence suggests that lifelong, multidisciplinary care is necessary across multiple healthcare domains. Moreover, the natural course of many associated morbidities remains poorly understood. This review explores the outcomes of CDH survivors during childhood and young adulthood – periods in which complications often become more evident – and underscores the importance of lifelong care. It also addresses the challenges associated with transitional care programs for adolescents living with chronic health conditions. Finally, the review offers recommendations for designing effective services that support children born with CDH throughout their lifespan.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 3","pages":"Article 101653"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676338","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":"Optimizing ECLS strategies in the management of congenital diaphragmatic hernia: Recent advances and best practices","authors":"Kylie I. Holden ,&nbsp;Devin Saljuud ,&nbsp;Kevin Johnson ,&nbsp;Matthew T. Harting","doi":"10.1016/j.siny.2025.101659","DOIUrl":"10.1016/j.siny.2025.101659","url":null,"abstract":"<div><div>Infants with congenital diaphragmatic hernia (CDH) face severe pulmonary hypoplasia, pulmonary hypertension, and cardiac dysfunction, making it one of the most challenging neonatal conditions to manage. Advances in extracorporeal life support (ECLS) have the potential to significantly improve outcomes for the most severe infants with CDH. There has been significant evolution in indications, technology, and clinical strategies which have enhanced its role and improved early stabilization, management, and outcomes. While ECLS remains the foundational management strategy for the most challenging and highest-risk CDH patients, there remains no standard, evidence-based, or widely adopted approach, with variability across centers and ongoing equipoise regarding the optimal timing and criteria, highlighting the need for the development of evidence, further understanding, and refined approaches in CDH. In this review, we highlight recent advances and progressive approaches to ECLS in CDH.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 3","pages":"Article 101659"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058653","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":"Challenges and controversies in the surgical management of Congenital Diaphragmatic Hernia","authors":"Carmen Mesas Burgos ,&nbsp;Erin E. Perrone ,&nbsp;Katrin Zahn ,&nbsp;Holly L. Hedrick","doi":"10.1016/j.siny.2025.101648","DOIUrl":"10.1016/j.siny.2025.101648","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div><div>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.</div><div>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.</div><div>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.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 3","pages":"Article 101648"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","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":"In search of “optimal care”: where should congenital diaphragmatic hernia be managed?","authors":"Jessica C. Pollack ,&nbsp;Tim Jancelewicz ,&nbsp;Yigit S. Guner","doi":"10.1016/j.siny.2025.101655","DOIUrl":"10.1016/j.siny.2025.101655","url":null,"abstract":"<div><div>Management of congenital diaphragmatic hernia (CDH) varies widely between institutions, and emerging data suggest that these center-specific practices influence patient outcomes. Given the resource-intensive nature of extracorporeal life support (ECLS) and its reliance on multidisciplinary expertise, regional and hospital level factors are likely critical in optimizing outcomes for this high-risk population. This review synthesizes the existing literature on institutional factors contributing to observed differences in outcomes across centers, explores the complexity of center-level variation in CDH management, and describes targeted research and quality improvement initiatives aimed at enhancing outcomes for neonates affected by this condition<strong>.</strong></div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 3","pages":"Article 101655"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700147","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":"Congenital Diaphragmatic Hernia: what are the priorities for the next 20 years?","authors":"David McCulley ,&nbsp;Florian Kipfmueller ,&nbsp;Neil Patel","doi":"10.1016/j.siny.2025.101658","DOIUrl":"10.1016/j.siny.2025.101658","url":null,"abstract":"<div><div>Advances in clinical care, biomedical research, and health advocacy have significantly improved survival and quality of life across the lifespan. To sustain and accelerate this progress, it is essential to define clear goals for the future. Congenital diaphragmatic hernia (CDH), one of the most common and severe congenital malformations, serves as a model condition where coordinated efforts in clinical care, research, and advocacy have led to important advances in understanding disease mechanisms and improving outcomes. Reflecting on this progress reveals several key themes, including the value of disease modelling, novel therapeutic strategies, and sustained innovation. Achieving a better future for people with CDH will require strategic prioritization of research, engagement of methodological expertise, addressing practical barriers, and promotion of collaboration. We propose that coordinated global efforts—including for example the creation of an international research platform, leveraging technological advances, and raising the visibility of CDH—will empower clinicians, researchers, and the CDH community to drive continued progress.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 3","pages":"Article 101658"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976403","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}