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

{"title":"Postnatally acquired cytomegalovirus infection in preterm infants: an update on diagnosis, management and outcomes.","authors":"Ekaterina Gritsay, Yury Petrunin, Andrei Bachnak, Burak Salgin, Helen Payne, Hermione Lyall, Justin Penner","doi":"10.1136/archdischild-2026-330609","DOIUrl":"10.1136/archdischild-2026-330609","url":null,"abstract":"<p><p>Postnatally acquired cytomegalovirus infection (pCMV) in very preterm and/or very low-birth-weight infants (GA<32w/VLBW) is increasingly recognised as a cause of acute and longer-term morbidity. This review presents a narrative synthesis of evidence published between April 2019 and October 2025, with expert commentary on diagnosis and management.Across study designs, there is growing evidence linking pCMV to prolonged hospitalisation, respiratory, gastrointestinal and ophthalmic morbidity. Prospective surveillance data reveal pCMV as a frequently underdiagnosed cause of sepsis-like presentations, cardiorespiratory instability and necrotising enterocolitis, often occurring without typical signs such as thrombocytopenia or liver derangement. A lower threshold for early CMV testing in symptomatic infants may identify candidates for timely targeted treatment and support antibiotic stewardship.Emerging evidence suggests that viral dynamics in pCMV differ substantially from congenital CMV (cCMV) because viral shedding in urine and saliva can be delayed or intermittent in acute disease, blood PCR may be the most pragmatic diagnostic modality for early symptomatic presentations. Targeted CMV screening of all GA<32w/VLBW infants at birth helps distinguish pCMV from cCMV, which is essential for management.Antiviral treatment with ganciclovir or valganciclovir is considered in infants with severe or sustained end-organ disease. Therapy is informed by clinical response, blood viral load, emerging pharmacokinetic data and therapeutic drug monitoring to balance efficacy with haematological toxicity. Larger-scale collaborative research is needed to ascertain the burden of pCMV disease and support future randomised controlled trials evaluating prevention and treatment strategies.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F425-F432"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148373655","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":"Neonatal jaundice assessment across all skin tones: finding the gaps between guidelines and practice.","authors":"Jacques Cornwell, Mailis Michaud Maturana, Joanna Mena, Kamla Pillay, Judith Meek, Cheentan Singh, Sasha R Howard, Eva Loucaides","doi":"10.1136/archdischild-2025-330053","DOIUrl":"10.1136/archdischild-2025-330053","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F474-F475"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589530","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":"Making sense of the evidence: designing randomised controlled trials for preterm infants with high-shunt volume patent ductus arteriosus.","authors":"Cheryl Battersby, Philip T Levy, Samir Gupta, Willem P de Boode, Souvik Mitra, Patrick J McNamara","doi":"10.1136/archdischild-2025-330266","DOIUrl":"10.1136/archdischild-2025-330266","url":null,"abstract":"<p><p>Management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Randomised controlled trials (RCTs) have shown that administering pharmacotherapy, predominantly ibuprofen, a cyclooxygenase (COX) inhibitor, to infants selected based on the standard echocardiography approach to diagnosis (eg, duct diameter and shunt direction), does not improve outcomes and may lead to harm. It remains uncertain, however, whether eliminating or reducing PDA shunt volume using an intervention with higher efficacy and fewer adverse effects, or in a more selective population, would show different results. It is possible that an imprecise approach to patient selection exposes low-risk infants to the adverse effects of pharmacotherapy without benefit and high-risk infants to the synergistic adverse effects of pharmacotherapy and persistent high volume pathological shunt when treatment fails. Whether targeted management of moderate-high volume PDA shunts, informed by comprehensive echocardiography adjudication, in the highest risk infants is beneficial remains untested in an RCT setting. Furthermore, both pharmacological and non-pharmacological interventions warrant further investigation. High quality practice changing research requires a collaborative approach between haemodynamic specialists, epidemiologists and trial methodologists to (1) define the study population based on phenotypic profiles of high-risk infants; (2) enhance the choice and timing of intervention; and (3) identify outcome measures that are relevant and clinically meaningful to families. In this review, we summarise evidence from RCTs and observational studies by discerning discrepancies and exploring potential explanations. Such an approach is essential to establish whether active PDA treatment confers any measurable benefit for high-risk preterm infants.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F413-F424"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760427","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":"Reducing antibiotic exposure in early life: how low can we go?","authors":"Eric Giannoni","doi":"10.1136/archdischild-2025-329377","DOIUrl":"10.1136/archdischild-2025-329377","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F409-F410"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773349","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":"Prenatal characteristics and postnatal outcomes of small fetal hepatic lesions: a retrospective cohort study.","authors":"Sophia Heiman, Batia Weiss, Shayan Yousefi, Simon Lassman, Tal Elkan-Miller, Eran Kassif, Tal Weissbach","doi":"10.1136/archdischild-2025-329312","DOIUrl":"10.1136/archdischild-2025-329312","url":null,"abstract":"<p><strong>Objective: </strong>To describe prenatal characteristics and postnatal outcomes of fetal hepatic lesions diagnosed on prenatal ultrasound and to identify prognostic factors of this condition.</p><p><strong>Methods: </strong>A retrospective study was conducted in a cohort of fetuses diagnosed with hepatic lesions between 2011 and 2023 at a tertiary referral center. Prenatal and postnatal data were collected, including lesion type, size, gestational age at detection, associated anomalies, genetic abnormalities, growth restriction and pregnancy outcomes. Postnatal follow-up included imaging, lesion resolution and overall health status.</p><p><strong>Results: </strong>65 fetuses were identified. Most lesions were echogenic (n=55); a minority were cystic (n=7), mixed (n=1) or subcapsular hematomas (n=2). Multiple lesions were present in 38%. Stillbirths, including fetal death and pregnancy termination, occurred in 18%, predominantly in the setting of major associated anomalies, fetal growth restriction and/or genetic abnormalities. Of 48 liveborn infants, 96% were healthy at discharge. Among 31 infants followed postnatally, 75% showed lesion resolution by 21 months. At the 5-year median follow-up, 79% were healthy. Echogenic lesions were more common in healthy infants, while a cystic component was associated with a higher rate of concurrent clinically significant health conditions, although liver function was typically normal.</p><p><strong>Conclusion: </strong>Isolated small echogenic fetal hepatic lesions display a favorable prognosis with spontaneous resolution in most cases. Adverse pregnancy outcomes are common in cases with associated anomalies, fetal growth restriction and genetic abnormalities; therefore, counseling should be guided by a comprehensive anomaly assessment and appropriate genetic evaluation.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F460-F465"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615676","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":"Neonatal physicians' perceptions of message framing when delivering serious news to parents: a randomised crossover study.","authors":"Hannah Stümer, Fiona A Wocheslander, Florian Hammerle, Jochem König, Michael S Urschitz, Philipp Neuweiler, Sophie Jaisli, Eva Mildenberger, André Kidszun","doi":"10.1136/archdischild-2025-329611","DOIUrl":"10.1136/archdischild-2025-329611","url":null,"abstract":"<p><strong>Objective: </strong>To examine neonatal physicians' perceptions of optimistic versus pessimistic prognostic framing when delivering serious news to parents.</p><p><strong>Design: </strong>Multicentre, double-blind, randomised crossover study.</p><p><strong>Setting: </strong>Conducted online between February and April 2022 at the University Medical Centre Mainz, Germany.</p><p><strong>Participants: </strong>Neonatal physicians from tertiary perinatal centres in Germany, Austria, Switzerland and Italy.</p><p><strong>Intervention: </strong>Participants viewed two scripted videos of a physician-parent conversation about a very preterm infant with severe intraventricular haemorrhage. Both conveyed identical numerical prognostic estimates but differed in framing: emphasising survival without disability (optimistic) or risk of death and impairment (pessimistic).</p><p><strong>Main outcome measures: </strong>Primary outcome was framing preference. Secondary outcomes included Likert scale ratings of parental preparedness, physician professionalism and compassion, prognostic severity and optimism regarding survival and non-impairment, as well as free-text comments on challenges in prognostic communication.</p><p><strong>Results: </strong>Of 115 participants, 99 (86%) preferred the optimistic video (period-corrected preference odds (95% CI): 8.6 (7.4 to 9.7)). Optimistic framing was associated with higher ratings of parental preparedness and more favourable evaluations of the consulting physician, including professionalism and compassion, but had no effect on perceived prognostic severity, or optimism about survival or non-impairment. Communication was frequently described as an interpersonal challenge, involving the difficulty of maintaining trust, empathy and hope while communicating under prognostic uncertainty.</p><p><strong>Conclusions: </strong>Neonatal physicians strongly preferred optimistic framing. Framing effects were primarily affective rather than cognitive and highlight implicit and complex framing biases in neonatal communication.</p><p><strong>Trial registration number: </strong>German Clinical Trials Register (DRKS), www.drks.de/DRKS00024466.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F441-F446"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282023","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":"Comparison of functional features and user experience with different types of video laryngoscopes when used on neonatal manikins.","authors":"Prakash Kannan Loganathan, Tayyaba Yasmeen, Vrinda Nair, Joyce O'Shea","doi":"10.1136/archdischild-2025-329515","DOIUrl":"10.1136/archdischild-2025-329515","url":null,"abstract":"<p><strong>Background: </strong>A wide range of neonatal-specific video laryngoscopes (VLs) are now available, each offering unique design features. Understanding these differences is essential to support training and optimise clinical use in neonatal airway management.</p><p><strong>Objective: </strong>To compare the physical and functional characteristics of four commonly used neonatal VLs and assess user experience.</p><p><strong>Methods: </strong>In this observational study, four VL systems-C-MAC, GlideScope, InfantView and NeoView were evaluated. A technical comparison of blade design and dimensions was performed across available blade sizes, alongside a conventional Miller blade. Medical professionals attending a neonatal airway workshop then used each device on neonatal manikins and rated their experience using a 4-point scale across six domains: ease of use, airway visualisation, ease of intubation, image quality, blade size and blade design.</p><p><strong>Results: </strong>A total of 23 participants with varied clinical backgrounds completed the evaluation. While 65% routinely performed neonatal intubations, 80% reported fewer than 10 intubations annually and 65% preferred conventional laryngoscopy. Following the trial, most participants favoured the C-MAC and NeoView VLs, and GlideScope was perceived to mimic conventional laryngoscope. The NeoView and C-MAC devices had the shortest distance between the camera and the distal blade tip. All VLs supported video and image capture. NeoView and GlideScope used disposable blades, while others employed reusable blades.</p><p><strong>Conclusions: </strong>This study provides a systematic comparison of the physical features and user preferences for commonly available neonatal VLs. These insights can guide equipment selection, inform training programmes and promote safer neonatal airway management.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F453-F459"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525646","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":"Management of muscular hypertonia in infants: survey of current UK practice.","authors":"Nandhika Rabindranathnambi, Rajesh Karuvattil, Brigitte Vollmer, Anthony R Hart","doi":"10.1136/archdischild-2026-330549","DOIUrl":"10.1136/archdischild-2026-330549","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F475-F476"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832893","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":"Genetic considerations in perinatal stroke.","authors":"Mahesh Kamate, Thanuja Basavanagowda","doi":"10.1136/archdischild-2025-329981","DOIUrl":"10.1136/archdischild-2025-329981","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F403-F404"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013154","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":"Complex communication.","authors":"Jennifer Lh Peterson, Michael Stark","doi":"10.1136/archdischild-2026-330454","DOIUrl":"10.1136/archdischild-2026-330454","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F407-F408"},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040724","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}