{"title":"Infective atrial thrombus.","authors":"Barah Hassan, Stefan Zalewski, Antony Hermuzi","doi":"10.1136/archdischild-2024-327552","DOIUrl":"10.1136/archdischild-2024-327552","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"428"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linn Löfberg, Fredrik Serenius, Lena Hellstrom-Westas, Elisabeth Olhager, David Ley, Aijaz Farooqi, Olof Stephansson, Thomas Abrahamsson
{"title":"Postnatal betamethasone treatment in extremely preterm infants and risk of neurodevelopmental impairment: a cohort study.","authors":"Linn Löfberg, Fredrik Serenius, Lena Hellstrom-Westas, Elisabeth Olhager, David Ley, Aijaz Farooqi, Olof Stephansson, Thomas Abrahamsson","doi":"10.1136/archdischild-2024-327360","DOIUrl":"10.1136/archdischild-2024-327360","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate if postnatal treatment with betamethasone in extremely preterm infants was associated with neurodevelopmental impairment (NDI) at 6.5 years of age.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Extremely Preterm Infants in Sweden Study (gestational age <27 weeks, born 2004-2007).</p><p><strong>Patients: </strong>428 children born extremely preterm were assessed at 6.5 years of age, 115 treated with betamethasone and 313 not treated.</p><p><strong>Main outcome measures: </strong>NDI at 6.5 years of age. Evaluation at 6.5 years included cognitive testing with the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), neurological examination and a medical record review.</p><p><strong>Exposure: </strong>Treatment with postnatal betamethasone.</p><p><strong>Main outcome: </strong>Moderate to severe NDI at 6.5 years of age, defined as a composite including cerebral palsy, and/or impairment in cognition, hearing and vision.</p><p><strong>Results: </strong>Moderate to severe NDI was more prevalent in children treated with postnatal betamethasone (49% treated vs 26% not treated, p<0.001). Betamethasone-treated children had worse cognitive development with mean WISC-IV score of 75 (SD 13.7) vs 87 (SD 14.0, p<0.001). The effect was dose dependent: 1.35 mg/kg vs 1.0 mg/kg (p=0.01) in betamethasone-treated children with moderate to severe versus no or mild NDI, respectively. The differences remained after adjustment for potential confounders with logistic regression (adjusted OR (aOR) 1.80, 95% CI 1.14 to 3.21). The difference in NDI also remained after propensity score matching, with crude OR 2.82 (95% CI 1.42 to 5.61, p=0.003) and aOR 2.17 (95% CI 1.07 to 4.69, p=0.04).</p><p><strong>Conclusion: </strong>Postnatal treatment with betamethasone is associated with increased risk of NDI at 6.5 years.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"382-387"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victoria Butler, Luc Gaulard, Victor Sartorius, Pierre Yves Ancel, François Goffinet, Jeanne Fresson, Jennifer Zeitlin, Héloïse Torchin
{"title":"Trends in the survival of very preterm infants between 2011 and 2020 in France.","authors":"Victoria Butler, Luc Gaulard, Victor Sartorius, Pierre Yves Ancel, François Goffinet, Jeanne Fresson, Jennifer Zeitlin, Héloïse Torchin","doi":"10.1136/archdischild-2024-327814","DOIUrl":"10.1136/archdischild-2024-327814","url":null,"abstract":"<p><strong>Objective: </strong>The objective is to evaluate changes in survival to discharge of liveborn infants less than 32 weeks' gestational age (GA) in France, where the latest available data on very preterm survival at a national-level are from the EPIPAGE-2 <i>(Etude épidémiologique sur les petits âges gestationnels)</i> cohort in 2011.</p><p><strong>Design: </strong>Population-based cohort study.</p><p><strong>Setting: </strong>Metropolitan France in 2011, 2015 and 2020.</p><p><strong>Patients: </strong>All births between 22 and 31 weeks' GA using the EPIPAGE-2 cohort study for the year 2011 and hospital discharge data linked to death certificates from the <i>Système National des Données de Santé</i> for the years 2015 and 2020.</p><p><strong>Main outcome measures: </strong>The primary outcome was survival to hospital discharge among liveborn infants. Survival rates were compared using modified Poisson regression and adjusted for population characteristics (maternal age, multiple birth, sex, small for GA). Data on all births were examined to assess changes to the live birth rate.</p><p><strong>Results: </strong>Survival to discharge among live births increased at 23 and 24 weeks' GA from 1% and 31% in 2011 to 8% and 37% in 2015 and to 31% and 47% in 2020, respectively. From 25 to 28 weeks' GA, survival rates tended to increase, but differences were not significant, and survival rates were stable from 29 to 31 weeks GA. Results were similar after adjustment. The proportion of live births versus stillbirths increased from 22 to 24 weeks' GA.</p><p><strong>Conclusion: </strong>Survival rates among live births improved between 2011 and 2020 from 23 to 28 weeks' GA, with marked changes at 23 and 24 weeks' GA.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"388-394"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristy P Robledo, Sol Libesman, Lisa Nicole Yelland
{"title":"We should do better in accounting for multiple births in neonatal randomised trials: a methodological systematic review.","authors":"Kristy P Robledo, Sol Libesman, Lisa Nicole Yelland","doi":"10.1136/archdischild-2024-327983","DOIUrl":"10.1136/archdischild-2024-327983","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a methodological systematic review of multicentre trials of premature infants to (1) determine if and how multiple births have been considered in the design, analysis and reporting of recent trials and (2) assess whether there has been an improvement since the last review was conducted 10 years ago.</p><p><strong>Design: </strong>A systematic search was conducted in PubMed on 28 June 2023 for articles published between June 2018 and June 2023. Articles were eligible for inclusion if they were a multicentre randomised trial of infants born preterm and reported the results of a primary outcome that was measured on an infant or could be attributed to an infant.</p><p><strong>Results: </strong>We reviewed 62/74 trials (80%), after determining it was unclear if multiple births were present in the other 20%. 87% of trials (54/62) did not account for multiple births in their sample size calculations and 48% (30/62) did not account for clustering due to multiple births in their analyses. Problems were not limited to lower-ranked journals. No trials reported the intraclass correlation coefficient for any outcomes, indicating the degree of clustering present.</p><p><strong>Conclusions: </strong>Persistent problems remain with the design and analysis of multicentre trials of premature infants due to ignoring the complexity that comes with the inclusion of multiple births, despite methods available to address this. Trialists should consider the impact of multiple births in their trial design and analysis. Readers of neonatal trials should be aware of these issues, particularly those who peer review papers.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"362-368"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha Tyrer, Risha Bhatia, Anna Kidman, Riannah Fitzgerald, Calum T Roberts
{"title":"Reducing unplanned extubation in the neonatal intensive care unit: a quality improvement project.","authors":"Samantha Tyrer, Risha Bhatia, Anna Kidman, Riannah Fitzgerald, Calum T Roberts","doi":"10.1136/archdischild-2024-327409","DOIUrl":"10.1136/archdischild-2024-327409","url":null,"abstract":"<p><strong>Background and aim: </strong>Unplanned extubation (UE) is an adverse event that can occur for neonates that are intubated and mechanically ventilated. UE is recognised as an important quality measure in the neonatal intensive care unit (NICU) due to the negative impact these events may have on the neonate. We aimed to use quality improvement (QI) methodology to reduce the rate of UE to the global standard of <1/100 ventilation days.</p><p><strong>Methods: </strong>A 12-month retrospective audit on mechanically ventilated neonates in our NICU identified a mean UE rate of 1.78/100 ventilation days. A clinical guideline focusing on best practice was introduced with key interventions identified by a review of the literature as those which were thought to reduce UE rates. The key interventions in the clinical guideline were introduced sequentially. UE rates were analysed monthly using control charts and the reported cause of each UE event was analysed. Three 12-month periods were included: preintroduction of QI interventions (period 1), during introduction of QI interventions (period 2), and after introduction of QI interventions (period 3).</p><p><strong>Results: </strong>The introduced interventions reduced the mean rate of UE from 1.78/100 ventilation days in period 1 to 0.8/100 ventilation days in period 3 of the QI project.</p><p><strong>Conclusions: </strong>The key interventions introduced in this QI project were successful in reducing rates of UE by 55%, allowing achievement of the global standard of <1/100 ventilation days.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"377-381"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fantoms.","authors":"Ben J Stenson","doi":"10.1136/archdischild-2025-329178","DOIUrl":"10.1136/archdischild-2025-329178","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":"110 4","pages":"343"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current practice of neonatal community outreach teams in England, Wales and Scotland.","authors":"Chuen Wai Lee, Janine Snook, Burak Salgin","doi":"10.1136/archdischild-2024-327865","DOIUrl":"10.1136/archdischild-2024-327865","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":"110 4","pages":"431-432"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandra Terroba-Seara, Ignacio Oulego-Erroz, Daniel Palanca-Arias, Zenaida Galve-Pradel, Sara Delgado-Nicolás, Alicia Pérez-Pérez, Jorge Rodríguez-Ozcoidi, Ana Lavilla-Oíz, María Carmen Bravo, Leticia La Banda-Montalvo, Paula Méndez-Abad, Pamela Zafra-Rodríguez, Lorena Rodeño Fernandez, Jon Montero-Gato, Carmen Bustamante-Hervás, Cristina Vega-Del-Val, Javier Rodríguez-Fanjul, Juan Mayordomo-Colunga, Iosune Alegría-Echauri
{"title":"Pulmonary artery peak Doppler velocity as an estimator of systemic blood flow and predictor of intraventricular haemorrhage in preterm infants: a multicentre prognostic accuracy study.","authors":"Sandra Terroba-Seara, Ignacio Oulego-Erroz, Daniel Palanca-Arias, Zenaida Galve-Pradel, Sara Delgado-Nicolás, Alicia Pérez-Pérez, Jorge Rodríguez-Ozcoidi, Ana Lavilla-Oíz, María Carmen Bravo, Leticia La Banda-Montalvo, Paula Méndez-Abad, Pamela Zafra-Rodríguez, Lorena Rodeño Fernandez, Jon Montero-Gato, Carmen Bustamante-Hervás, Cristina Vega-Del-Val, Javier Rodríguez-Fanjul, Juan Mayordomo-Colunga, Iosune Alegría-Echauri","doi":"10.1136/archdischild-2024-327196","DOIUrl":"10.1136/archdischild-2024-327196","url":null,"abstract":"<p><strong>Objectives: </strong>(1) To assess how main pulmonary artery peak Doppler velocity (MPAVpeak) correlates with right ventricular output (RVO) and superior vena cava flow (SVCf), (2) to assess the reproducibility of MPAVpeak and (3) to test the prognostic accuracy of MPAVpeak to predict high-grade intraventricular haemorrhage (IVH) or death at seventh day of life.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Nine third-level neonatal units in Spain.</p><p><strong>Patients: </strong>Preterm infants <33 weeks of gestational age who had standardised measurements of MPAVpeak, RVO and SVCf at 6, 12 and 24 hours of life.</p><p><strong>Main outcome measures: </strong>High-grade IVH or death at seventh day of life.</p><p><strong>Results: </strong>One hundred and ninety preterm infants with a median (IQR) gestational age and birth weight of 29.7 weeks (27.1-31.8) and 1152 g (892-1491), respectively, were included. High-grade IVH or death at seventh day of life occurred in 24 (12.6%). MPAVpeak was strongly correlated with RVO (Spearman <i>rho</i> 0.826-0.843). MPAVpeak discriminated well for low RVO (<120 mL/kg/min) at 6 (AUROC, area under the receiver operating characteristic curve=0.90), 12 (AUROC 0.94) and 24 hours (AUROC 0.86). Observer reproducibility was better for MPAVpeak (inter-observer limits of agreement ±8.4%) compared with RVO (±18.8%) and SVCf (±32.2%). The prognostic accuracy of MPAVpeak to predict high-grade IVH or death was good (AUROC >0.75) and non-inferior to RVO and SVCf (DeLong's test p>0.05).</p><p><strong>Conclusions: </strong>MPAVpeak is an adequate marker of systemic blood flow with high reproducibility and acceptable prognostic accuracy in preterm infants below 33 weeks of gestational age during the first day of life.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"354-361"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristy P Robledo, Ingrid Rieger, Sarah Finlayson, William Tarnow-Mordi, Andrew J Martin
{"title":"Balancing precision and affordability in assessing infant development in large-scale mortality trials: secondary analysis of a randomised controlled trial.","authors":"Kristy P Robledo, Ingrid Rieger, Sarah Finlayson, William Tarnow-Mordi, Andrew J Martin","doi":"10.1136/archdischild-2024-327762","DOIUrl":"10.1136/archdischild-2024-327762","url":null,"abstract":"<p><strong>Objective: </strong>Large-scale mortality trials require reliable secondary assessments of impairment. We compared the Ages and Stages Questionnaire (ASQ-3), a screening tool self-administered by parents, in classifying impairment using the 'gold standard' Bayley Scales of Infant Development (Bayley-III), a diagnostic tool administered by trained assessors.</p><p><strong>Design: </strong>Analysis of 405 children around 2 years corrected age from the Australian Placental Transfusion Study, a trial conducted over 8 years.</p><p><strong>Setting: </strong>Secondary analysis of international, open-label, multicentre randomised trial.</p><p><strong>Patients: </strong>Children born <30 weeks gestation.</p><p><strong>Interventions: </strong>Immediate (<10 s) versus delayed (60 s+) cord clamping.</p><p><strong>Main outcomes: </strong>ASQ-3 and Bayley-III assessments around 2 years corrected age. Impairment (or developmental delay) was defined as <2 SD below the mean (<70) for Bayley-III domains.</p><p><strong>Results: </strong>The area under the receiver operating curve for ASQ-3 domains predicting delay was 0.75-0.99. Sensitivity for predicting delay was 57%-100%, while specificity was 88%-90%.We modelled the cost and sample size using a less expensive, though less precise, screening assessment for impairment compared with a more costly diagnostic assessment. For detecting a 25% reduction in the relative risk of delay, using ASQ-3 rather than Bayley-III could require double the sample size (15 000 to 30 000), but outcome assessment cost savings would be US$13M (EUR$12M). However, assessment cost savings may be outweighed by upscaling.</p><p><strong>Conclusions: </strong>When measuring developmental outcomes in a large-scale clinical trial, using a more precise diagnostic tool may be financially prohibitive, so increasing the sample size and using a less precise but appropriately calibrated tool may be more affordable.</p><p><strong>Trial registration number: </strong>ACTRN12610000633088.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"409-414"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tom Partridge, Andrew Leslie, Aarti Mistry, Rosalind B Simpson, David E Morris, Donal McNally, John Crowe, Don Sharkey
{"title":"Using a novel smartphone app to track noise and vibration exposure during neonatal ambulance transport.","authors":"Tom Partridge, Andrew Leslie, Aarti Mistry, Rosalind B Simpson, David E Morris, Donal McNally, John Crowe, Don Sharkey","doi":"10.1136/archdischild-2024-327758","DOIUrl":"10.1136/archdischild-2024-327758","url":null,"abstract":"<p><strong>Objective: </strong>To assess the utility of a bespoke smartphone app to map noise and vibration exposure across neonatal road ambulance journeys.</p><p><strong>Design and setting: </strong>Prospective observational study of ambulance journeys across a large UK neonatal transport service. Smartphones, with an in-house developed app, were secured to incubator trolleys to collect vibration and noise data for comparison with international standards. A case study exploring alternative routes between hospitals was undertaken.</p><p><strong>Results: </strong>Over a 12-month period, the app was used to collect data from 1487 interhospital journeys totalling 81 925 km. Noise positively correlated with increasing vehicle speed. Noise exposure never fell below the recommended 45 dB(A) threshold for neonatal patients and exceeded 70 dB(A) for more than 60% of the time. During patient transfers, vibration would be classed as uncomfortable for healthy adults for 68% of journeys. Comparison of 111 journeys on two different routes between the same hospitals demonstrated significantly lower vibration exposure depending on the road type. Safe levels of adult vibration exposure were exceeded on 19% of non-motorway and 3% of motorway journeys between the two hospitals. Vibration and noise levels were significantly higher on concrete compared with asphalt road surface.</p><p><strong>Conclusions: </strong>It is feasible for neonatal teams to collect detailed route, vibration and noise exposure data using a calibrated smartphone and bespoke app. Collecting large amounts of data and providing live measures to teams could help quantify excessive exposures and guide reduction strategies of these environmental stressors for the benefit of babies, staff and equipment.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":"110 4","pages":"395-400"},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}