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

{"title":"Cerebral injury and retinopathy as risk factors for blindness in extremely preterm infants.","authors":"Benjamin M Honan, Scott A McDonald, Colm P Travers, Vivek V Shukla, Namasivayam Ambalavanan, C Michael Cotten, Viral G Jain, Hope E Arnold, Nehal A Parikh, Jon E Tyson, Susan R Hintz, Stephen A Walker, Marie G Gantz, Abhik Das, Waldemar A Carlo","doi":"10.1136/archdischild-2024-327707","DOIUrl":"10.1136/archdischild-2024-327707","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates whether and to what extent cerebral injury is associated with bilateral blindness in extremely preterm infants, which has been attributed mainly to retinopathy of prematurity (ROP).</p><p><strong>Design: </strong>Multicentre analysis of children born from 1994 to 2021 at gestational age 22 0/7 to 28 6/7 weeks with follow-up at 18-26 months. Logistic regression examined the adjusted association of bilateral blindness with severe ROP and/or cerebral injury among extremely preterm infants.</p><p><strong>Exposures: </strong>Severe ROP and cerebral injury, the latter defined as any of the following on cranial imaging: ventriculomegaly; blood/increased echogenicity in the parenchyma; cystic periventricular leukomalacia.</p><p><strong>Main outcome measures: </strong>Bilateral blindness, defined as a follow-up examination meeting criteria of 'blind-some functional vision' or 'blind-no useful vision' in both eyes.</p><p><strong>Results: </strong>The 19 863 children included had a mean gestational age of 25.6±1.7 weeks, mean birth weight of 782±158 g and 213 (1%) had bilateral blindness. Multiplicative interaction between ROP and cerebral injury was statistically significant. For infants with only severe ROP (n=3130), odds of blindness were 8.14 times higher (95% CI 4.52 to 14.65), and for those with only cerebral injury (n=2836), odds were 8.38 times higher (95% CI 5.28 to 13.28), compared with the reference group without either condition. Risks were not synergistic for infants with both severe ROP and cerebral injury (n=1438, adjusted OR=28.7, 95% CI 16.0 to 51.7, p<0.0001).</p><p><strong>Conclusions: </strong>In a group of extremely preterm infants, severe ROP and cerebral injury were equally important risk factors for blindness. Besides ROP, clinicians should consider cerebral injury as a cause of blindness in children born extremely preterm.</p><p><strong>Trial registration number: </strong>NCT00063063.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"253-260"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339975","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":"Recognising uncertainty: an integrated framework for palliative care in perinatal medicine.","authors":"Dominic Wilkinson, Sophie Bertaud, Alexandra Mancini, Edile Murdoch","doi":"10.1136/archdischild-2024-327662","DOIUrl":"10.1136/archdischild-2024-327662","url":null,"abstract":"<p><p>In perinatal medicine, the number of babies with life-limiting or life-threatening conditions is increasing and the benefits of providing palliative care with a holistic, interdisciplinary approach are well documented. It can be particularly challenging, however, to integrate palliative care into routine care where there exists uncertainty about a baby's diagnosis or potential outcome.This framework, developed collaboratively by the British Association of Perinatal Medicine (BAPM) and the Association of Paediatric Palliative Medicine (APPM), offers supportive guidance for all healthcare professionals working in perinatal medicine across antenatal and neonatal services. It explicitly acknowledges that palliative care is not just for babies who are dying or who will certainly die in early life; incorporating a palliative approach into antenatal and neonatal care for all babies with an uncertain outcome can be particularly valuable. The framework provides guidance on recognising babies who may benefit from palliative care and outlines the key elements of perinatal palliative care: holistic family support, empowering parents to be parents, parallel planning, symptom management and loss and bereavement care. It provides recommendations for the delivery of palliative care services, advocating for a unified approach that involves all members of the perinatal team, supported by specialist services as needed.This framework calls for a shift in the philosophy and practice of perinatal care to integrate palliative care into the everyday and to recognise and embrace the challenge of uncertain prognosis.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"236-244"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680681","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":"Fetal haemoglobin and oxygen requirement in preterm infants: an observational study.","authors":"Tommy Ulinder, William Hellström, Christian Gadsbøll, Linda Nilsson, Margareta Gebka, Gustav Robertz, Matteo Bruschettini, Ann Hellstrom, David Ley","doi":"10.1136/archdischild-2024-327411","DOIUrl":"10.1136/archdischild-2024-327411","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between the fraction of fetal haemoglobin (HbF(%)) and oxygen requirement as determined by the fraction of inspired oxygen (FiO₂) and alveolar-arterial gradient (A-a gradient). Increased alveolar exposure to oxygen may explain the association between decreased HbF(%) and the development of bronchopulmonary dysplasia (BPD).</p><p><strong>Design: </strong>Longitudinal, retrospective, observational study.</p><p><strong>Setting: </strong>Tertiary-level neonatal intensive care unit, referral centre for southern Sweden.</p><p><strong>Patients: </strong>Four hundred forty very preterm infants born before gestational week 30, 2009-2015.</p><p><strong>Intervention: </strong>Regular clinical practice.</p><p><strong>Main outcome measures: </strong>The FiO₂ and A-a gradient were determined at the time-point of 10 015 arterial blood gas analyses obtained during postnatal days 1-7. The relationship between HbF(%) and FiO₂ and A-a gradient and the modifying influence of other factors affecting haemoglobin oxygen affinity were evaluated.</p><p><strong>Results: </strong>We found a significant relationship between a low fraction of HbF and an increase in FiO₂ and A-a gradient, respectively. These relationships remained significant after adjusting for pH, pCO₂, postnatal age, gestational age and sex.</p><p><strong>Conclusion: </strong>These high-resolution data show that decreased HbF(%) during the first postnatal week is associated with increased FiO₂ and A-a gradient in very preterm infants. Increased alveolar exposure to oxygen and resulting oxidative stress may, at least partly, explain the previously reported associations between decreased HbF, blood transfusions and the development of BPD in preterm infants.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"285-290"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339977","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":"Perinatal medicine's best treatment: how should we be using antenatal steroids?","authors":"Katherine Jane Pettinger, R Spencer, Sam J Oddie","doi":"10.1136/archdischild-2024-327418","DOIUrl":"10.1136/archdischild-2024-327418","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"245-246"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811868","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":"Intermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover study.","authors":"Judith Leigh Hough, Luke Jardine, Matthew James Hough, Michael Steele, Gorm Greisen, Christian Heiring","doi":"10.1136/archdischild-2024-327445","DOIUrl":"10.1136/archdischild-2024-327445","url":null,"abstract":"<p><strong>Objective: </strong>To determine if combining high-frequency oscillatory ventilation (HFOV) with additional sigh breaths would improve end-expiratory lung volume (EELV) and oxygenation in preterm infants.</p><p><strong>Design: </strong>Prospective interventional crossover study.</p><p><strong>Setting: </strong>Neonatal intensive care unit.</p><p><strong>Patients: </strong>Ventilated preterm infants <36 weeks corrected gestational age receiving HFOV.</p><p><strong>Interventions: </strong>Infants were randomly assigned to receive HFOV with sigh breaths followed by HFOV-only (or vice versa) for four alternating periods. Sigh breaths were delivered with an inspiratory time of 1 s, peak inspiratory pressure of 30 cmH₂0 and frequency of three breaths/min.</p><p><strong>Main outcome measures: </strong>Electrical impedance tomography measured the effect of sigh breaths on EELV and ventilation distribution. Physiological variables were recorded to monitor oxygenation. Measurements were taken at 30 and 60 min postchange of HFOV mode and compared with baseline.</p><p><strong>Results: </strong>Sixteen infants (10 males, 6 females) with a median (range) gestational age at birth of 25.5 weeks (23-31), study weight of 950 g (660-1920) and a postnatal age of 25 days (3-49) were included in the study. The addition of sigh breaths resulted in a significantly higher global EELV (mean difference±95% CI) (0.06±0.05; p=0.04), with increased ventilation occurring in the posterior (dependent) and left lung segments, and improved oxygen saturations (3.31±2.10; p<0.01).</p><p><strong>Conclusion: </strong>Intermittent sigh breaths during HFOV were associated in the short-term with an increased EELV in the posterior and left lungs, and improved oxygen saturations in preterm infants.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"297-302"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456718","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":"Response to: 'Randomised crossover study on pulse oximeter readings from different sensors in very preterm infants' by Sharma <i>et al</i>.","authors":"Christian Achim Maiwald, Christoph E Schwarz, Katrin Böckmann, Laila Springer, Christian F Poets, Axel R Franz","doi":"10.1136/archdischild-2024-327973","DOIUrl":"10.1136/archdischild-2024-327973","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"342"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563891","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-2025-328909","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328909","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":"110 3","pages":"229"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962953","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":"Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial.","authors":"Gopalakrishnan Jayapradha, Lakshmi Venkatesh, Prakash Amboiram, Radish Kumar Balasubramanium, Umamaheswari Balakrishnan","doi":"10.1136/archdischild-2024-327494","DOIUrl":"10.1136/archdischild-2024-327494","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm (PT) infants at discharge.</p><p><strong>Design: </strong>Single-centre randomised control trial.</p><p><strong>Setting: </strong>Level III B neonatal intensive care unit in a quaternary care hospital in South India.</p><p><strong>Patients: </strong>A total of 76 PT infants born between 26 and 33⁺⁶ weeks of gestational age, stratified into <30 weeks and 30-33⁺⁶ weeks, were randomised to intervention group (MA-OSMI) or standard care (SC).</p><p><strong>Interventions: </strong>MA-OSMI in addition to SC versus SC alone. The stimulation included 12 techniques administered by the principal investigator. SC included kangaroo mother care and non-nutritive sucking.</p><p><strong>Outcome measures: </strong>Exclusive breastfeeding (EBF) rate and breastfeeding performance at the time of discharge, assessed using standardised tools by clinician and mothers.</p><p><strong>Results: </strong>Infants in MA-OSMI group (66%) had significantly higher EBF rate compared with the SC group (16%) (OR: 10.25; 95% CI: 3.41 to 30.80). Improved breastfeeding performance was noted as per the clinician's observation. Significantly lower scores for MA-OSMI groups (63.42±36.43) than SC groups (126.61±60.94) on mothers' ratings suggested better feeding skills.</p><p><strong>Conclusion: </strong>Prefeeding oral stimulation contributed significantly to the achievement of EBF among PT infants at discharge. The present findings may benefit speech-language pathologists, paediatricians/neonatologists and nurses in the intervention of oral feeding among neonates.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"313-318"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638209","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":"Young adult reflections on life experiences following preterm birth: a cross-sectional descriptive study.","authors":"Cheryl Anne Mackay, Caitlin Gray, Catherine Campbell, Mary Sharp","doi":"10.1136/archdischild-2024-327862","DOIUrl":"10.1136/archdischild-2024-327862","url":null,"abstract":"<p><strong>Background: </strong>Increasingly, preterm-born children are entering adulthood as survival at earlier gestational ages improves. However, there is little understanding of the lived experience in preterm-born adults.</p><p><strong>Methods: </strong>A cross-sectional descriptive study was conducted including young adults from a regional birth cohort of infants born <33 weeks in Western Australia. Participants provided written reflections of their experiences growing up and included messages for future families experiencing preterm birth. Content analysis was conducted according to SRQR (Standards for Reporting Qualitative Research) guidelines. Ethics approval was granted by the Women and Newborn Health Service Ethics Committee.</p><p><strong>Results: </strong>Forty-one adults reflected on their life experiences, and 31 included messages for future families. Two predominant themes were (1) neonatal experiences and (2) experiences from childhood and adulthood which were divided into 'positive' and 'negative' subthemes. Participants made 44 references to the neonatal period: 31 (70.5%) 'challenging' including sickness (17, 54.8%), uncertainty (10, 32.3%), family separation (4, 12.9%); and 13 (29.5%) 'positive' including survival (6, 46.2%), support (5, 38.5%), strength (2, 15.4%). Childhood and adulthood was described as 'positive' in 119 (73.5%) references including a good life (41, 33.3%), supportive family (20, 16.3%), success (18, 14.6%), strength (18, 14.6%), gratitude (15, 12.2%), positive self-talk (7, 5.7%); and 'negative' in 43 (26.5%) including health challenges (19, 44.2%), school difficulties (10, 23.3%), family difficulties (9, 20.9%). Messages for future families included what to expect (56, 75.7%) and helpful advice (18, 24.3%).</p><p><strong>Conclusion: </strong>Our preterm-born young adults predominantly describe positive life experiences of childhood and adulthood balanced with an awareness of particular challenges.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"326-333"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680617","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":"Delivery room dextrose gel for preterm hypoglycaemia (the GEHPPI study): a randomised placebo-controlled trial.","authors":"Graham King, Julie Sloan, Peter Duddy, Anne O'Sullivan, Niamh Ó Catháin, Jan Miletin, Sharon Dempsey, Shirley Moore, Jyothsna R Purna, Christine McDermott, Margaret Moran, Jean James, Johannes Buca Letshwiti, Kryštof Tabery, Aneta Kubátová, Jan Janota, John Kelleher","doi":"10.1136/archdischild-2024-327313","DOIUrl":"10.1136/archdischild-2024-327313","url":null,"abstract":"<p><strong>Objective: </strong>Early hypoglycaemia at the time of neonatal intensive care unit (NICU) admission is common in very/extreme preterm infants. This study aimed to determine whether buccal dextrose gel in the delivery room (DR) would improve rates of early hypoglycaemia in this population.</p><p><strong>Design: </strong>Randomised, blinded, placebo-controlled trial.</p><p><strong>Setting: </strong>Four level-3 and one level-2 neonatal units.</p><p><strong>Patients: </strong>Inborn infants≤32+0 weeks gestational age (GA).</p><p><strong>Interventions: </strong>Infants were randomised to 40% dextrose or placebo gel in the DR (≤29+0 GA: 0.5 mL gel, ≥29+1 GA: 1 mL gel).</p><p><strong>Main outcome measure: </strong>Hypoglycaemia (<1.8 mmol/L) measured at the time of first intravenous access at NICU admission.</p><p><strong>Results: </strong>Between November 2020 and August 2022, the recruitment rate was slow (impacted by the requirement for antenatal consent). This fact, coupled with finite research resources, led to a decision to end recruitment early. Data analysis of 169 newborns (33% of target sample size) showed no significant difference in the frequency of the primary outcome between dextrose 24/84 (29%) and placebo 25/85 (29%) groups (OR 0.95; 95% CI 0.49 to 1.86; p=0.88). A post-hoc analysis indicated that the trial had a low (47% conditional power) chance of detecting a statistically significant benefit from the intervention (had the target sample been achieved).</p><p><strong>Conclusions: </strong>This study showed no evidence of benefit of 40% dextrose gel on rates of hypoglycaemia at NICU admission. Management of these vulnerable newborns should continue to focus on vascular access and commencement of dextrose-containing intravenous fluids as early as possible.</p><p><strong>Trial registration number: </strong>NCT04353713.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"319-325"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613647","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}