Archives of Disease in Childhood - Fetal and Neonatal Edition最新文献

{"title":"Accounting for multiple births in systematic reviews of randomised trials: a methodological systematic review.","authors":"Lisa N Yelland, Kristy P Robledo, Kylie M Lange, Thomas R Sullivan, Sol Libesman, Emily Shepherd","doi":"10.1136/archdischild-2025-330137","DOIUrl":"https://doi.org/10.1136/archdischild-2025-330137","url":null,"abstract":"<p><strong>Objective: </strong>Multiple births are common in randomised trials targeting preterm populations. Clustering due to multiple births is often overlooked in individual trials and may impact the results of meta-analyses that pool their results. We aimed to assess how multiple births have been handled in the reporting and meta-analyses of recent systematic reviews.</p><p><strong>Design: </strong>We conducted a methodological systematic review of Cochrane and non-Cochrane systematic reviews. The search was conducted on 10 September 2024 in the Cochrane Database of Systematic Reviews and PubMed for articles published in the previous 12 months. Reviews were eligible if they involved randomised trials of interventions delivered in pregnancy or infancy, included multiple births and reported results of at least one aggregate data meta-analysis for an infant outcome.</p><p><strong>Results: </strong>After screening 222 articles, 39 had unclear eligibility due to making no mention of multiple births and nine met the eligibility criteria (five Cochrane and four non-Cochrane reviews). Multiple births were inconsistently handled across included reviews. The degree of clustering due to multiple births was poorly described and meta-analyses accounting for clustering were rarely reported (2/9 reviews; 22%). CIs around pooled treatment effect estimates were wider after accounting for clustering.</p><p><strong>Conclusions: </strong>Clustering due to multiple births is a poorly recognised issue in systematic reviews and meta-analyses. Given the potential for this clustering to alter conclusions about the effectiveness of interventions, we recommend accounting for clustering due to multiple births in future meta-analyses.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715659","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":"Value of targeted testing for cytomegalovirus in preterm infants: 7 years' experience at a tertiary London hospital.","authors":"Helen Payne, Rebecca Faber, Ravi D Mistry, Aaron Colin John Bell, Harry James, Malaz Elsaddig, Ana Silva Ferreira, Grace Li, Anjali Rampersad, Lidia Tyszczuk, Paul Randell, Elizabeth Whittaker, Hermione Lyall","doi":"10.1136/archdischild-2025-329084","DOIUrl":"10.1136/archdischild-2025-329084","url":null,"abstract":"<p><strong>Background: </strong>Targeted testing for cytomegalovirus (CMV) in preterm infants <21 days has two benefits: timely congenital CMV (cCMV) diagnosis, and differentiation between cCMV and postnatal CMV (pCMV). We present an audit of targeted testing for cCMV alongside rates of clinically suspected pCMV in preterm infants.</p><p><strong>Methods: </strong>We collected data on CMV testing from 2016 to 2023 in infants born <30 weeks gestation during admission to a tertiary London neonatal centre.</p><p><strong>Results: </strong>Of all infants, 77% (899/1162) were tested for CMV during their admission with 74.6% tested <21 days of age. CMV infection was confirmed in 58 infants, 4 cases of cCMV (0.4%) and 54 cases of pCMV (6.0%). One infant with cCMV died, and all were symptomatic: microcephaly, thrombocytopenia, leucopenia, white matter hyperintensity on brain imaging, but none had hearing loss. Most pCMV cases (92.6%) were symptomatic, with bone-marrow suppression (92.6%), sepsis-like syndrome (50%), respiratory (31.5%) and gastrointestinal symptoms (29.6%). All infants with cCMV and 38.9% of infants with pCMV received treatment. Overall, 6% (54/899) had symptomatic CMV disease, 16.7% of infants with CMV died during their neonatal intensive care unit admission, and 42.6% were discharged on home oxygen.</p><p><strong>Conclusions: </strong>CMV causes a substantial disease burden in infants born <30 weeks gestation, whereby 6% have symptomatic CMV disease. We show the feasibility and value of targeted cCMV and opportunistic pCMV testing. In the absence of universal screening, targeted birth testing for cCMV in infants <30 weeks gestational age should be considered.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F256-F261"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666399","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":"Closed-loop automated oxygen control in preterm ventilated infants: a randomised controlled trial.","authors":"Ourania Kaltsogianni, Theodore Dassios, Allan Jenkinson, Eleanor Jeffreys, Kenta Ikeda, Masashiro Sugino, Anne Greenough","doi":"10.1136/archdischild-2025-329022","DOIUrl":"10.1136/archdischild-2025-329022","url":null,"abstract":"<p><strong>Objective: </strong>To compare the duration of mechanical ventilation between preterm infants receiving closed-loop automated oxygen control (CLAC) or manual oxygen control.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>Tertiary neonatal unit in London, UK.</p><p><strong>Patients: </strong>Infants (n=69) with a median (IQR) gestational age of 27.0 (25.6-29.0) weeks studied at a corrected postmenstrual age of 27.6 (25.9-29.1) weeks.</p><p><strong>Interventions: </strong>Infants were randomised to CLAC or manual oxygen control within 48 hours of initiation of mechanical ventilation if less than 7 days of age until successful extubation.</p><p><strong>Main outcome measures: </strong>Duration of mechanical ventilation.</p><p><strong>Results: </strong>The CLAC infants (n=34) compared with those who received manual control had a shorter duration of mechanical ventilation (median (range): 11 (1-57) vs 40 (3-134) days, p=0.027), a shorter duration of supplemental oxygen (median (range): 33 (0-100) vs 47 (3-335) days, p=0.031), a lower incidence of bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age (55% vs 83.9%, p=0.015) and fewer required home oxygen (26.5% vs 51.4%, p=0.016). In the CLAC infants, the time spent in the target oxygen range (91%-95%) was increased (p<0.001) and the times spent in hypoxaemia (peripheral oxygen saturation level (SpO₂)<85%) and hyperoxaemia (SpO₂>95%) were reduced (p<0.001).</p><p><strong>Conclusions: </strong>Use of CLAC in preterm, ventilated infants was associated with improved achievement of oxygen saturation targets, shorter durations of mechanical ventilation and supplemental oxygen treatment and a lower incidence of BPD. These results need to be replicated in larger multicentre studies before any change in routine practice could be recommended.</p><p><strong>Trial registration number: </strong>NCT05030337.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F243-F248"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494400","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":"Serial physical examination for screening and management of early-onset neonatal sepsis: a pragmatic next step in the journey of antibiotic stewardship?","authors":"Sujoy Banerjee","doi":"10.1136/archdischild-2025-329946","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329946","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715715","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":"Role of debriefing after neonatal resuscitation: resident doctors' perspectives from London.","authors":"Hannah Elizabeth Ballheimer, Katie Bub, Conan Lundy, Eva Loucaides","doi":"10.1136/archdischild-2025-329200","DOIUrl":"10.1136/archdischild-2025-329200","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F288-F290"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910199","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":"Parent reports as developmental outcome measures in neonatal trials: the way forward?","authors":"Samantha Johnson, Neil Marlow","doi":"10.1136/archdischild-2025-328570","DOIUrl":"10.1136/archdischild-2025-328570","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F186-F187"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147465","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":"Movement of peripherally inserted central catheters in relation to limb movement in neonates: a prospective observational study.","authors":"Andrea Gronska, Donna Tolentino, Donovan Duffy, Sandeep Shetty, Justin Richards, Anay M Kulkarni","doi":"10.1136/archdischild-2025-328992","DOIUrl":"10.1136/archdischild-2025-328992","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F286"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231321","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":"Follow-up of children born very preterm: the need for evidence-based frameworks to drive best practice and standardised care.","authors":"Jeanie Ling Yoong Cheong, Angela Morgan, Susan R Hintz, Katrina Williams","doi":"10.1136/archdischild-2025-330134","DOIUrl":"https://doi.org/10.1136/archdischild-2025-330134","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715676","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":"Cerebral fuels within the first week of life in very preterm infants: a cohort study.","authors":"Gordon Xin Hua Liu, Loredana Marcovecchio, K Beardsall","doi":"10.1136/archdischild-2025-328701","DOIUrl":"10.1136/archdischild-2025-328701","url":null,"abstract":"<p><strong>Background: </strong>Ketones and lactate may contribute towards overall cerebral fuel availability in term infants, yet the availability of such cerebral fuels in very preterm infants is unclear. We undertook a prespecified substudy to explore ketone and lactate concentrations in the first week of life in infants recruited to the REACT trial (real-time continuous glucose monitoring in the newborn): an international multicentre randomised controlled trial of 182 very low birth weight infants investigating the use of continuous glucose monitoring in glycaemic care.</p><p><strong>Methods: </strong>Ketone and lactate measurements were prospectively collected over the first week of life using the Nova Biomedical point-of-care meter. A longitudinal analysis was undertaken to explore lactate and ketone concentration trends across time and their relationships with blood glucose, baseline demographics, nutritional support and insulin treatment.</p><p><strong>Results: </strong>Data were available for 168 infants (85 females) including 2902 blood glucose, 2084 ketone and 2017 lactate samples. The mean (SD) gestational age was 27.4 (2.0) weeks. Lactate concentrations were higher initially, with mean (SD) 1.72 (1.26) mmol/L on day 2 and lowered to 1.19 (1.1) mmol/L on day 7. Ketone concentrations remained consistently low at 0.1 mmol/L. Neither simultaneous blood glucose concentrations, macronutrient intake nor receipt of insulin was consistently related to ketone or lactate concentrations.</p><p><strong>Conclusion: </strong>In this cohort of very preterm infants, there were persistently low concentrations of ketones and relatively higher concentrations of lactate throughout the first week of life. Future research should evaluate changes in these metabolites during episodes of acute hypoglycaemia or hyperglycaemia over more prolonged periods of neonatal intensive care.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F196-F202"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290716","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}

{"title":"Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial.","authors":"Seyran Naghdi, Shalini Ojha, Jon Dorling, Josie Anderson, Chris Gale, Sophie Susannah Hall, Mark John Johnson, Samantha Johnson, Charlotte Kenyon, William McGuire, Garry Meakin, Eleanor Mitchell, Alan Montgomery, Sam J Oddie, Reuben Ogollah, Christopher Partlett, Yuanfei Su, Kate F Walker, Hema Mistry","doi":"10.1136/archdischild-2025-329964","DOIUrl":"10.1136/archdischild-2025-329964","url":null,"abstract":"<p><strong>Objective: </strong>To assess the economic consequences of initiating full milk feeds from birth compared with intravenous fluids with gradual feeding in infants born preterm.</p><p><strong>Design: </strong>Within-trial economic evaluation alongside a prospective, multicentre, randomised controlled trial (Fluids Exclusively Enteral from Day 1). A cost-consequence approach was used (revised from the planned cost-effectiveness analysis to avoid double counting length of stay within costs).</p><p><strong>Setting: </strong>46 UK National Health Service (NHS) neonatal units.</p><p><strong>Patients: </strong>Preterm infants born at 30+0to 32+6 weeks' gestation.</p><p><strong>Interventions: </strong>Infants were allocated to either full milk feeds or gradual feeding with intravenous support within 3 hours of birth.</p><p><strong>Main outcome measure: </strong>Resource use and costs were captured from birth to 6 weeks' corrected age. Costs were assessed from an NHS and personal social services perspective. The primary clinical outcome was length of hospital stay.</p><p><strong>Results: </strong>2088 infants were enrolled. There was no statistically significant difference in mean (95% CI) length of hospital stay between groups (-0.050 days (-0.638 to 0.538)). Mean total costs were £670 lower in the full milk group (95% CI: -£1562 to £223; p=0.141). Subgroup analyses suggested lower costs among infants born at 30 weeks' gestation and those below the 10th birth weight centile; no evidence of interaction was found.</p><p><strong>Conclusions: </strong>Initiating full milk feeds from birth was associated with a modest reduction in costs compared with gradual feeding. While overall hospital stays and costs were not significantly reduced, early full feeding may offer economic advantages in selected subgroups. Further research is needed to assess long-term outcomes.</p><p><strong>Trial registration number: </strong>ISRCTN89654042.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F262-F269"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802990","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}