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

{"title":"Effects of a live versus heat-inactivated probiotic <i>Bifidobacterium</i> spp in preterm infants: a randomised clinical trial.","authors":"Gayatri Athalye-Jape, Meera Esvaran, Sanjay Patole, Elizabeth A Nathan, Dorota A Doherty, Edric Sim, Lakshmi Chandrasekaran, Chooi Kok, Stephan Schuster, Patricia Conway","doi":"10.1136/archdischild-2023-326667","DOIUrl":"10.1136/archdischild-2023-326667","url":null,"abstract":"<p><strong>Background: </strong>Heat-inactivated probiotics (HPs) may provide an effective alternative to live probiotics (P) by avoiding their risks (eg, probiotic sepsis) while retaining the benefits. We assessed the safety and efficacy of a HP in very preterm (VP: gestation <32 weeks) infants.</p><p><strong>Methods: </strong>VP infants were randomly allocated to receive a HP or P mixture (<i>Bifidobacterium breve</i> M-16V, <i>Bifidobacterium longum</i> subsp. <i>infantis</i> M-63, <i>Bifidobacterium longum</i> subsp. <i>longum</i> BB536, total 3×10⁹CFU/day) assuring blinding. Primary outcome was faecal calprotectin (FCP) levels were compared after 3 weeks of supplementation. Secondary outcomes included faecal microbiota and short chain fatty acid (SCFA) levels.</p><p><strong>Results: </strong>86 VP infants were randomised to HP or P group (n=43 each). Total FCP and SCFA were comparable between HP and P groups within 7 days (T1) and between day 21 and 28 (T2) after supplementation. At T2, median (range) FCP was 75 (8-563) in the HP group and 80 (21-277) in the P group (p=0.71). Propionate was significantly raised in both groups, while butyrate was significantly raised in the HP group (all p<0.01). Bacterial richness and diversity increased but was comparable between HP and P (p>0.05). Beta diversity showed similar community structures in both groups (all p>0.05). Changes in faecal Actinobacteria, Bacteroidetes and Bifidobacteriacae levels were comparable in both groups at T1 and T2. There was no probiotic sepsis.</p><p><strong>Conclusions: </strong>HP was safe and showed no significant difference in FCP as compared with a live probiotic. Adequately powered trials are needed to assess the effects of HP on clinically significant outcomes in preterm infants.</p><p><strong>Trial registration number: </strong>ACTRN12618000489291.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"177-184"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995131","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":"Voices of experience: insights from Dutch parents on periviability guidelines and personalisation.","authors":"Lien De Proost, Angret de Boer, Eduard Verhagen, Marije Hogeveen, Rosa Geurtzen, E J T Joanne Verweij","doi":"10.1136/archdischild-2024-327398","DOIUrl":"10.1136/archdischild-2024-327398","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the perspectives of experienced parents regarding guidelines and personalisation for managing imminent extremely premature births (22-26 weeks gestational age (GA)) . The study examined four scenarios: no guideline, a guideline based on GA, a guideline based on GA plus other factors and a guideline based on a calculated prognosis.</p><p><strong>Design: </strong>Nineteen semistructured qualitative interviews were conducted with Dutch parents who experienced (imminent) extremely premature births between 23+5 and 26+2 weeks of gestation. Diversity was aimed for through purposive sampling from a database created prior to this study. Four of the parents opted for palliative care. Among the parents who chose intensive care, in nine cases the infant(s) survived.</p><p><strong>Results: </strong>All participants acknowledged the necessity of having a periviability guideline because it would provide valuable decision-making support, and counterbalance decisions solely based on parental instincts to save their infant. Parents preferred guidelines that considered multiple prognostic factors beyond GA alone, without overwhelming parents with information, because more information would not necessarily make the decision easier for parents. Personalisation was defined by parents mainly as 'being seen and heard' and associated with building relationships with healthcare professionals and effective communication between them and professionals.</p><p><strong>Conclusions: </strong>The results underscore the importance of having a periviability guideline including multiple prognostic factors to assist parents in making decisions at the limit of viability, and the importance of a personalised care approach to meet parental needs in the context of imminent extremely preterm birth.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"165-170"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995132","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":"Evaluating the efficacy of endotracheal and intranasal epinephrine administration in severely asphyxic bradycardic newborn lambs: a randomised preclinical study.","authors":"Justine de Jager, Romy Pothof, Kelly J Crossley, Georg M Schmölzer, Arjan B Te Pas, Robert Galinsky, Nhi T Tran, Nils Thomas Songstad, Claus Klingenberg, Stuart B Hooper, Graeme R Polglase, Calum T Roberts","doi":"10.1136/archdischild-2024-327348","DOIUrl":"10.1136/archdischild-2024-327348","url":null,"abstract":"<p><strong>Objective: </strong>Intravenous epinephrine administration is preferred during neonatal resuscitation, but may not always be rapidly administered due to lack of equipment or trained staff. We aimed to compare the time to return of spontaneous circulation (ROSC) and post-ROSC haemodynamics between intravenous, endotracheal (ET) and intranasal (IN) epinephrine in severely asphyxic, bradycardic newborn lambs.</p><p><strong>Methods: </strong>After instrumentation, severe asphyxia (heart rate <60 bpm, blood pressure ~10 mm Hg) was induced by clamping the cord in near-term lambs. Resuscitation was initiated with ventilation followed by chest compressions. Lambs were randomly assigned to receive intravenous (0.02 mg/kg), ET (0.1 mg/kg) or IN (0.1 mg/kg) epinephrine. If ROSC was not achieved after three allocated treatment doses, rescue intravenous epinephrine was administered. After ROSC, lambs were ventilated for 60 min.</p><p><strong>Results: </strong>ROSC in response to allocated treatment occurred in 8/8 (100%) intravenous lambs, 4/7 (57%) ET lambs and 5/7 (71%) IN lambs. Mean (SD) time to ROSC was 173 (32) seconds in the intravenous group, 360 (211) seconds in the ET group and 401 (175) seconds in the IN group (p<0.05 intravenous vs IN). Blood pressure and cerebral oxygen delivery were highest in the intravenous group immediately post-ROSC (p<0.05), whereas the ET group sustained the highest blood pressure over the 60-min observation (p<0.05).</p><p><strong>Conclusion: </strong>Our study supports neonatal resuscitation guidelines, highlighting intravenous administration as the most effective route for epinephrine. ET and IN epinephrine should only be considered when intravenous access is delayed or not feasible.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"207-212"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139119","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":"Evaluating decision regret after extremely preterm birth.","authors":"Laura Belden, Joseph Kaempf, Amy Mackley, Finley Kernan-Schloss, Chiayi Chen, Wendy Sturtz, Mark W Tomlinson, Ursula Guillen","doi":"10.1136/archdischild-2024-327287","DOIUrl":"10.1136/archdischild-2024-327287","url":null,"abstract":"<p><strong>Objectives: </strong>Little is known about decision regret following extremely premature birth. We assessed decision regret in women who delivered an extremely premature infant, comparing decision regret scores based on resuscitation decision.</p><p><strong>Methods: </strong>Electronic survey assessment of decision regret using a validated tool included women who delivered at 22-25 completed weeks of gestation at two hospitals 2004-2019. Comparison of 'active care', 'comfort care' and 'other' groups was quantified and comments reviewed.</p><p><strong>Results: </strong>442 of 787 (56%) eligible women were contacted, 242 of 442 (55%) completed surveys, response rate 242 of 787 (31%). Women not contacted were younger (p=0.0001) and/or delivered in an earlier year (p=0.002). There was a higher percentage of white women who completed the survey (p=0.004). Decision regret was elevated in all groups, varied widely, but was lower in 'active care' compared with 'comfort care' (Decision Regret Score 14 vs 39, p<0.0001). Lower decision regret occurred in women who recalled a prenatal consult (p=0.014) or identified as the primary decision-maker compared with women who perceived the doctor had a major role (p=0.02) or made the decision (p<0.0001). Lower decision regret occurred in women whose infant was alive at survey completion compared with women whose infant died in the hospital (p<0.0001) or after discharge (p=0.01).</p><p><strong>Conclusions: </strong>Decision regret was elevated in all groups. Women who recalled prenatal consultation, identified as the primary decision-maker, chose intensive care and/or whose infant survived had lower regret scores.</p><p><strong>Clinical trial registration: </strong>NCT04074525.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"191-199"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008108","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":"Motor and functional characteristics in school-age survivors of congenital diaphragmatic hernia: a cross-sectional observational study.","authors":"Takamasa Mitsumatsu, Yuji Ito, Yukako Muramatsu, Yoshiaki Sato, Tadashi Ito, Sho Narahara, Ryosuke Miura, Hiroyuki Yamamoto, Miharu Ito, Anna Shiraki, Tomohiko Nakata, Tomomi Kotani, Jun Natsume, Masahiro Hayakawa, Yoshiyuki Takahashi, Hiroyuki Kidokoro","doi":"10.1136/archdischild-2024-327942","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327942","url":null,"abstract":"<p><strong>Background: </strong>Children born with congenital diaphragmatic hernia (CDH) are at risk of poor developmental outcomes. This study aimed to clarify the motor and functional characteristics of school-age CDH survivors and identify perinatal factors associated with motor function deficits.</p><p><strong>Methods: </strong>Motor function was comprehensively assessed in CDH survivors aged 6-10 years (CDH group, n=24) and in age- and sex-matched controls (n=72). Assessments included physical activity time, grip strength, the five times sit-to-stand test, one-leg standing time, 6 min walking distance and gait ability using a three-dimensional gait analysis. In the CDH group, correlations between perinatal factors and motor function outcomes were analysed.</p><p><strong>Results: </strong>In the CDH group, all children had isolated CDH. Three were extracorporeal membrane oxygenation (ECMO) treated and 21 were non-ECMO treated. The CDH group exhibited shorter stature, lower weight and reduced physical activity time than the controls. They also showed significantly lower grip strength, longer five times sit-to-stand test time, shorter one-leg standing time and decreased 6 min walking distance. No significant differences were found between the two groups regarding walking speed, step length or Gait Deviation Index. Within the CDH group, a higher observed-to-expected lung area-to-head circumference ratio (o/e LHR) was positively correlated with better grip strength.</p><p><strong>Conclusions: </strong>School-age survivors of CDH are at risk of impaired motor function. Particularly, grip strength measurement is crucial for those born with a low o/e LHR. Implementing follow-up and intervention programmes focused on improving limb muscle strength, balance, and endurance, and promoting adequate physical activity may enhance motor function.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432289","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":"Nasal mask ventilator-delivered versus face maskT-piece resuscitator positive pressure ventilation during resuscitation of preterm neonates: a cohort study.","authors":"Nosheen Akhtar, Aman Hemani, Bonny Jasani, Brittany Lindsay, Brent Morgan, Amish Jain, Michelle Baczynski","doi":"10.1136/archdischild-2024-327966","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327966","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical impact of nasal mask ventilator-delivered positive pressure ventilation (PPV) versus face mask manual T-piece resuscitator PPV during resuscitation of preterm neonates.</p><p><strong>Design: </strong>We conducted a pre-post cohort study in a tertiary neonatal unit, comparing consecutive neonates born 25^0/7-28^6/7 weeks of gestational age (GA) who received PPV ≤10 min after birth, before and after changing the approach during resuscitation from face mask manual T-piece resuscitator PPV (epoch 1, April 2018-April 2020) to nasal mask ventilator-delivered PPV (epoch 2, May 2020-February 2022). The association between birth epoch and the primary outcome of emergent intubation (EI) during resuscitation was examined by multivariable logistic regression and inverse probability of treatment weighting models. Additional outcomes compared between epochs were rates of advanced resuscitation, and early (≤7 days) and late (>7 days) prematurity-related morbidities.</p><p><strong>Results: </strong>Of 545 eligible births, 336 (62%) received PPV; 176 (58%) in epoch 1 and 160 (66%) in epoch 2. Neonates in epoch 1 had lower GA (26.7 (25.9-27.9) vs 27.4 (26.0-28.1) weeks; p=0.02) but similar birth weight (900 (730-1060) vs 880 (740-1085) g; p=0.53). Neonates in epoch 2 had lower rates of EI (16% vs 44%; p<0.001) and less use of post-resuscitation invasive ventilation (22% vs 59%; p<0.001). After accounting for confounders, nasal mask ventilator-delivered PPV remained associated with lower odds of EI (adjusted OR 0.23 (95% CI 0.13 to 0.42)). Secondary outcomes were similar between groups.</p><p><strong>Conclusion: </strong>Nasal mask ventilator-delivered PPV may reduce EI during resuscitation of preterm neonates. Our observations support a large trial of nasal mask ventilator-delivered PPV in this context.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370333","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 skin antisepsis with alcohol-based compared to aqueous 2% chlorhexidine, used in moderate preterm infants or extremely preterm infants after the first week of life, is safe and may be associated with a reduced incidence of catheter-related bloodstream infections.","authors":"Alejandro Pinilla-González, Lucía Pérez-Fiérrez, Alvaro Solaz-García, Laura Torrejón-Rodríguez, Anna Parra-Llorca, Teresa Pérez-Oliver, Ana Gimeno Navarro, María Dolores Lorena Mocholí Tomás, Rosario Ros Navarret, Maximo Vento, Marta Aguar, Maria Cernada","doi":"10.1136/archdischild-2024-327728","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327728","url":null,"abstract":"<p><strong>Background: </strong>Skin antisepsis is one of the most important bundle measures to decrease central line-related bloodstream infections (CRBSIs). However, in the neonatal population, the use of alcoholic chlorhexidine is limited by the risk of skin lesions.</p><p><strong>Objective: </strong>We hypothesised that skin antisepsis with alcohol-based 2% chlorhexidine instead of aqueous 2% chlorhexidine could reduce the incidence of CRBSI without increasing skin complications.</p><p><strong>Design: </strong>We conducted a double cohort study comparing two periods of 3 years, first using aqueous and second using alcohol-based chlorhexidine, leaving a 1-year washout interval between them. In extremely preterm infants, aqueous chlorhexidine was used during the first week of life in both periods.</p><p><strong>Results: </strong>A total of 1783 patients and 2493 episodes of central line catheter were analysed. There were no statistically significant differences in clinical and demographic data from infants in both periods. There was a significant reduction in the pooled incidence density of CRBSI in the second compared with the first period (4.03 vs 9.05 episodes/1000 central line days, OR 0.45 (95% CI 0.29 to 0.68)). The overall absolute risk reduction was 0.039 (95% CI 0.023 to 0.056) and the number needed to treat was 25. A similar but not significant reduction of the small number of CRBSI was observed in extremely preterm infants within the first week of life OR 0.43 (95% CI 0.134 to 1.379). No statistically significant differences in skin lesions were observed between periods, making erythema the most common injury(5.1% vs 4.2%).</p><p><strong>Relevance: </strong>Alcohol-based 2% chlorhexidine as a skin antiseptic could reduce the incidence of CRBSI in neonates without producing an increase in skin lesions.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187981","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":"Outcomes used to measure the clinical application of neonatal palliative and/or end-of-life care in neonatal settings: a systematic review.","authors":"Katie Gallagher, Kathy Chant, Veronica Parisi, Mehali Patel, Helena Dunbar, Fauzia Paize, Sophie Bertaud, Agnes Agyepong, Alexandra Mancini, Myra Bluebond-Langner, Neil Marlow","doi":"10.1136/archdischild-2024-328252","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328252","url":null,"abstract":"<p><strong>Objectives: </strong>Standardised reporting of outcomes in neonatal palliative and/or end-of-life care would facilitate comparison of practice and lead to more informed decisions about practice. We systematically reviewed evidence evaluating outcomes currently used to characterise the clinical provision of palliative and/or end-of-life care in neonatal settings.</p><p><strong>Methods: </strong>A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken using Ovid Medline, Ovid Embase, OVID PsycINFO, OVID MIDIRIS and EBSCOhost CINAHL. No date or language restrictions were used. Studies were included if they measured or reported outcomes related to the clinical practice of neonatal palliative care in a neonatal unit.</p><p><strong>Results: </strong>Of 7998 records identified through database searching, 20 articles were included. Identified studies were retrospective chart reviews. No studies used standardised outcomes and all used proxy outcome measures. Results were organised according to the WHO domains of paediatric palliative care. All studies (n=20) reported documentation of physical symptoms and functional status (physical domain); six documented parental emotional and support needs (psychological domain); four reported sibling support and wider family presence (social and cultural domain), and three reported support from spiritual services (spiritual domain).</p><p><strong>Conclusion: </strong>Despite neonatal death accounting for the largest category of child death under 5 years of age, there are no standardised outcomes from which to characterise or develop clinical practice. Developing a core outcome set for neonatal palliative and end-of-life care would ensure that services can be compared using reliably collected and collated data and help advance care in this area.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073636","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 injury and long-term neurodevelopment impairment in children following severe fetomaternal transfusion: a retrospective cohort study.","authors":"Salma El Emrani, Marie-Louise van der Hoorn, Ratna N G B Tan, Sylke J Steggerda, Linda S de Vries, Monique C Haak, Jeanine M M van Klink, Masja de Haas, Lotte E van der Meeren, Enrico Lopriore","doi":"10.1136/archdischild-2024-328135","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328135","url":null,"abstract":"<p><strong>Objective: </strong>Fetomaternal transfusion (FMT) is associated with increased perinatal mortality and morbidity, but data on postnatal outcomes are scarce. Our aim was to determine the incidence of adverse short-termand long-term sequelae of severe FMT.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Dutch tertiary neonatal intensive care unit.</p><p><strong>Patients: </strong>Liveborn neonates with FMT admitted in 2017-2022.</p><p><strong>Main outcome measures: </strong>Severe FMT was defined as ≥30 mL of fetal red blood cells in the maternal circulation diagnosed with positive Kleihauer-Betke/flow cytometry test. Adverse outcomes were compared between severe and mild FMT (10-30 mL blood loss) to highlight the impact of FMT severity. Primary outcome was an adverse composite outcome consisting of neonatal mortality or severe neurological morbidity (ie, severe cerebral injury and/or neurodevelopmental impairment (NDI) at 2 years). Secondary outcome was perinatal asphyxia.</p><p><strong>Results: </strong>109 neonates with FMT were included, 16 with severe FMT and 93 with mild FMT. Neonatal mortality occurred in 19% (3/16) of neonates with severe FMT and in 4% (4/93) with mild FMT (p=0.063). Perinatal asphyxia was diagnosed in 25% (4/16) of neonates with severe FMT compared with 6% (6/93) with mild FMT (p=0.038). Long-term outcome was assessed in 60 neonates. NDI occurred in 22% (2/9) of children with severe FMT compared with 16% (8/51) with mild FMT (p=0.637). Adverse outcome occurred in 43% (95% CI 38 to 50%) of neonates with severe FMT compared with 18% (95% CI 17% to 24%) with mild FMT (p=0.074).</p><p><strong>Conclusion: </strong>Neonatal mortality or long-term neurological morbidity occurred in 38%-50% of children with fetal blood loss and anaemia due to severe FMT.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051001","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":"Plasma transfusions in neonatal intensive care units: a prospective observational study.","authors":"Nina A M Houben, Suzanne Fustolo-Gunnink, Karin Fijnvandraat, Camila Caram-Deelder, Marta Aguar Carrascosa, Alain Beuchée, Kristin Brække, Francesco Stefano Cardona, Anne Debeer, Sara Domingues, Stefano Ghirardello, Ruža Grizelj, Emina Hadžimuratović, Christian Heiring, Jana Lozar Krivec, Jan Maly, Katarina Matasova, Carmel Maria Moore, Tobias Muehlbacher, Miklos Szabo, Tomasz Szczapa, Gabriela Zaharie, Justine de Jager, Nora Johanna Reibel-Georgi, Helen V New, Simon J Stanworth, Emöke Deschmann, Charles C Roehr, Christof Dame, Saskia le Cessie, Johanna G van der Bom, Enrico Lopriore","doi":"10.1136/archdischild-2024-327926","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327926","url":null,"abstract":"<p><strong>Objective: </strong>Despite lack of evidence supporting efficacy, prophylactic fresh frozen plasma and Octaplas transfusions may be administered to very preterm infants to reduce bleeding risk. International variation in plasma transfusion practices in neonatal intensive care units (NICUs) is poorly understood, therefore, we aimed to describe neonatal plasma transfusion practice in Europe.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>64 NICUs in 22 European countries, with a 6-week study period per centre between September 2022 and August 2023.</p><p><strong>Patients: </strong>Preterm infants born below 32 weeks of gestational age.</p><p><strong>Interventions: </strong>Admission to the NICU.</p><p><strong>Main outcome measures: </strong>Plasma transfusion prevalence, cumulative incidence, indications, transfusion volumes and infusion rates and adverse effects.</p><p><strong>Results: </strong>A total of 92 of 1143 infants included (8.0%) received plasma during the study period, collectively receiving 177 transfusions. Overall prevalence was 0.3 plasma transfusion days per 100 admission days, and rates varied substantially across Europe. By day 28 of life, 13.5% (95% CI 10.0% to 16.9%) of infants received at least one plasma transfusion, accounted for competing risks of death or discharge. Transfusions were given for a broad range of indications, including active bleeding (29.4%), abnormal coagulation screen results (23.7%) and volume replacement/hypotension (21.5%). Transfusion volumes and infusion rates varied significantly; the most common volume was 15 mL/kg (range: 5-30 mL/kg) and the most common duration was 2 hours (range: 30 min to 6 hours).</p><p><strong>Conclusions: </strong>We found wide variation in plasma transfusion practices in Europe, highlighting the need for evidence to inform neonatologists in daily practice and guidelines, in particular for non-bleeding indications.</p><p><strong>Trial registration number: </strong>ISRCTN17267090.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998965","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}