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

{"title":"Effect of enteral supplementation of DHA with or without ARA in preterm infants: a meta-analysis.","authors":"Dan Dang, Zhongyu Gao, Chuan Zhang, Xin Mu, Xiaoming Lv, Hui Wu","doi":"10.1136/archdischild-2024-327606","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327606","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess whether additional enteral docosahexaenoic acid (DHA) supplementation, with or without arachidonic acid (ARA), influences morbidities diagnosed in the neonatal intensive care unit among preterm infants, excluding administration via formula or parenteral nutrition.</p><p><strong>Design and setting: </strong>This meta-analysis involved a comprehensive search of the PubMed, Embase, Web of Science and Cochrane Library databases from their inception to 9 June 2024.</p><p><strong>Patients and interventions: </strong>Randomised controlled trials focusing on the effects of enteral DHA with or without ARA in preterm infants born at ≤34 weeks gestational age or a birth weight ≤2000 g were included.</p><p><strong>Main outcomes and measures: </strong>The main outcomes included in-hospital mortality, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC), sepsis, intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL).</p><p><strong>Results: </strong>Eleven trials evaluating distinct adverse outcomes in preterm infants were incorporated. Of these, nine trials assessing enteral DHA supplementation with or without ARA indicated an increased risk of BPD with a relative risk of 1.11 (95% CI 1.00 to 1.22). Additionally, five trials assessing DHA supplementation without ARA showed an increased risk of BPD with a relative risk of 1.15 (95% CI 1.03 to 1.28). No significant effects were observed on the incidence of ROP, NEC, sepsis, IVH, PVL or in-hospital mortality.</p><p><strong>Conclusions and relevance: </strong>Enteral supplementation of DHA with or without ARA did not demonstrate protective effects against major complications in preterm infants and even increased the risk of BPD. Further research is warranted to evaluate the necessity of DHA and ARA supplementation in this population.</p><p><strong>Prospero registration number: </strong>CRD42024552578.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959318","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":"Validation of a machine learning algorithm for predicting hypoxic ischaemic encephalopathy.","authors":"Kristyn S Beam","doi":"10.1136/archdischild-2024-327783","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327783","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965471","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":"Routine pulse oximetry testing for newborn babies: a framework for practice.","authors":"Vix Monnelly, Thomas McEwan, Kate Hannah Regan, Lambri Yianni, Suzie Hutchinson, Jon Arnold, Kate Dinwiddy, Nicola Brake, Jessica Case-Stevens, Katie Cullum, Kerry Louise Gaskin, Olivia Houlihan, Caroline B Jones, Beth McCleverty, Ayevbekpen Grace Okoye, Sam J Oddie, Ngozi Edi-Osagie, Eleri Adams, Andrew K Ewer","doi":"10.1136/archdischild-2024-328285","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328285","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742067","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":"Congenital neurocutaneous melanocytosis.","authors":"Varshith Santhi Radhakrishnan, Ruppa Mohanram Geethanath, Chike Onwuneme","doi":"10.1136/archdischild-2025-328571","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328571","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727641","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":"Effects of liberal versus restrictive transfusion strategies on intermittent hypoxaemia in extremely low birthweight infants: secondary analyses of the ETTNO randomised controlled trial.","authors":"Axel R Franz, Corinna Engel, Dirk Bassler, Mario Rüdiger, Ulrich H Thome, Rolf F Maier, Ingeborg Krägeloh-Mann, Jochen Essers, Christoph Bührer, Hans-Jörg Bittrich, Claudia Roll, Thomas Höhn, Harald Ehrhardt, Ralf Boettger, Hans Thorsten Körner, Anja Stein, Patrick Neuberger, Tine Brink Henriksen, Gorm Greisen, Christian F Poets","doi":"10.1136/archdischild-2024-327643","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327643","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the effect of liberal versus restrictive transfusion strategies on the proportion of time (%time) spent with intermittent hypoxaemia (IH, ie, arterial haemoglobin oxygen saturation measured by pulse oximetry (SpO₂) <80% lasting ≥60 s) in the 'Effects of Transfusion Thresholds on Neurocognitive Outcome' (ETTNO) population, and to investigate whether infants with above-median exposure to IH might benefit more from liberal transfusion strategies than those with lower exposure.</p><p><strong>Design, setting, patients: </strong>Secondary analysis in all 554/1013 infants of <1000 g birth weight recruited into the ETTNO trial (mean gestational age 26.2 weeks) with >80% completeness of SpO₂ recordings during postnatal days 8-49.</p><p><strong>Intervention: </strong>Randomly assigned liberal (n=268) or restrictive (n=286) transfusion strategies, defining transfusion triggers based on postnatal age and health status.</p><p><strong>Main outcome measures: </strong>%time with IH, rate and mean duration of IH episodes during postnatal days 8-49. Interaction between exposure to IH and transfusion strategies with respect to ETTNO's composite primary outcome, death or disability at 24 months corrected age.</p><p><strong>Results: </strong>The median (quartile 1-quartile 3) %time with IH was similar between treatment groups (0.91% (0.13%-2.83%) with liberal vs 0.79% (0.16%-2.44%) with restrictive transfusions). There was no interaction between exposure to IH and transfusion strategies on outcome at 24 months.</p><p><strong>Conclusions: </strong>In infants <1000 g birth weight, a liberal transfusion strategy did not reduce IH. Blood transfusions should not be administered 'liberally' to reduce IH or to improve neurocognitive outcome in infants with above-average exposure to IH.</p><p><strong>Trial registration number: </strong>NCT01393496.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727642","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":"Reducing device-related pressure injuries in high-risk neonates receiving nasal continuous positive airway pressure: a quality improvement study.","authors":"Margaret Broom, Alison L Kent, Tejasvi Chaudhari","doi":"10.1136/archdischild-2024-327798","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327798","url":null,"abstract":"<p><strong>Objective: </strong>Neonates requiring Non-InVasive respiratory Support (NIVS) are at high risk of device-related pressure injury (DRPI), with incidence rates of 20%-60% in extremely premature infants. Over a 4-year period, our team undertook a Quality Improvement Project to review aspects of the clinical management of NIVS: types of interfaces, introduction of hydrocolloid dressing and the development and implementation of nasal injury care plan (NICP) to reduce DRPI in high-risk neonates.</p><p><strong>Design: </strong>A prospective descriptive study was completed in three stages: trial of nCPAP interfaces, preintroduction NICP (2016-2018), post-NICP (2018-2020) and (2021-2022) to measure sustainability of implementation. Data included: gestational age (GA), birth weight, NIVS days, incidence, grade and day of DRPI. Statistical analysis of incidence rate ratio was completed between pre and postgroups.</p><p><strong>Setting: </strong>Australian neonatal intensive care unit.</p><p><strong>Patients: </strong>All neonates ≤32 weeks requiring nCPAP.</p><p><strong>Interventions: </strong>Evaluation of types of interfaces, introduction of hydrocolloid dressing and the development and implementation of NICPMain outcome measures: incidence and severity of DRPI.</p><p><strong>Results: </strong>Total DRPI recorded in all CPAP babies pre/post NICP were (59/659 (9.0%), 26/574 (4.5%), p=0.0032, respectively). Analysis showed DRPI incidence rates per 1000 NIVS days ((10.6, 5.5), p=0.0001, respectively). 75 (88%) of DRPI occurred in the ≤32 week group of neonates requiring NIVS. Review of babies ≤32 weeks across the three intervals showed significant improvement with time (55 (19%); 27 (13%); 19 (9%), p=0.0001).</p><p><strong>Conclusions: </strong>Preferred nCPAP interface, nasal dressing and NICP have reduced the incidence and severity of DRPI in the NICU.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727645","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":"Research priorities for the most premature babies born <25 weeks' gestation: results of an international priority setting partnership.","authors":"Stacey Peart, Olivia Ray, Laura Galletta, Amber Bates, Rosemarie Anne Boland, Peter G Davis, Chris Gale, Samantha Johnson, Suzannah Kinsella, Marian Knight, Louise S Owen, Louise Pallot, Trisha M Prentice, Patricia Santhanadass, Kayleigh Stanbury, David Tingay, Clare L Whitehead, Brett James Manley, Charles C Roehr, Pollyanna Hardy","doi":"10.1136/archdischild-2024-328133","DOIUrl":"10.1136/archdischild-2024-328133","url":null,"abstract":"<p><strong>Objective: </strong>The James Lind Alliance (JLA) Most Premature Babies Priority Setting Partnership aimed to identify the most important areas for research for infants born <25 weeks' gestation.</p><p><strong>Design: </strong>Employing standardised JLA methodology, questions for research were sought from stakeholders via an online survey. Summary questions were formed and checked against existing evidence, with unanswered questions compiled into a second shortlisting survey for prioritisation by stakeholders. A stakeholder consensus workshop was held to determine the top 10 research priorities.</p><p><strong>Participants: </strong>People with lived experience of neonatal intensive care, including parents/carers of preterm infants and adults born preterm, and healthcare professionals caring for preterm infants across Australia, New Zealand and the UK.</p><p><strong>Main outcome measure: </strong>The top 10 research priorities for infants born <25 weeks' gestation.</p><p><strong>Results: </strong>From 844 questions received from the initial survey, 81 summary questions were formed, of which 80 were unanswered and included in the second shortlisting survey. The 19 top-ranked questions were taken to the final prioritisation workshop, where the top 10 research priorities were determined by people with lived experience and healthcare professionals. The most important research question identified was 'What can be done in the neonatal intensive care unit to improve long-term health and developmental outcomes?'. Other important areas for research included antenatal interventions and neonatal care at birth, preventing intraventricular haemorrhages, managing pain, postnatal corticosteroid treatment and supporting families.</p><p><strong>Conclusions: </strong>This study identified the most important areas of research for infants born <25 weeks' gestation, as determined jointly by stakeholders. These findings should be used to guide future research and funding aimed at improving meaningful outcomes for these infants and their families.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482141","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":"Surfactant therapy via thin catheter in newborn infants in Ireland.","authors":"Robert Thomas Joyce, Lisa K McCarthy, Colm Patrick Finbarr ODonnell","doi":"10.1136/archdischild-2025-328624","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328624","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727648","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":"Facilitators and barriers to the practice of neonatal family integrated care from the perspective of healthcare professionals: a systematic review.","authors":"Nadia Leake, Sarah Edney, Nicholas Embleton, Janet Berrington, Judith Rankin","doi":"10.1136/archdischild-2024-327770","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327770","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a systematic review of barriers and facilitators to the practice of neonatal Family Integrated Care (FICare) from the perspective of healthcare professionals (HCPs).</p><p><strong>Design: </strong>A systematic search strategy was developed to identify qualitative studies exploring neonatal HCPs' views of any of the principles of FICare. Six literature databases (CINAHL, (Cumulated Index in Nursing and Allied Health Literature) Embase, Medline, PsycINFO, Scopus, Web of Science) were searched using the terms Healthcare Professionals, Neonatal, Environment, FICare, Education, Well-being, Culture, Partnership and Empowerment. Studies meeting the inclusion criteria were thematically analysed.</p><p><strong>Results: </strong>11032 titles and abstracts and 85 full-text papers were screened. Thirty-seven studies met the inclusion criteria and reported interviews with 1243 HCPs, predominantly nurses. Three themes were synthesised in relation to barriers and facilitators: (1) 'advocacy and acknowledgement', whereby HCPs are expected to advocate for the emotional and mental health of the whole family, not solely the baby's needs; (2) 'belief and behaviour', whereby the degree to which FICare is practised is dependent on HCPs' belief in its benefits in relation to other activities; (3) 'conditions and consistency', whereby a lack of space, resources, policy and consistent practice of FICare created apathy and contradictory approaches to care.</p><p><strong>Conclusion: </strong>Although HCPs see value in FICare, successful implementation is multifactorial and requires the expectation to deliver FICare to be aligned with resourcing at the hospital, team and individual levels. Shifting the practice paradigm to FICare remains challenging for some HCPs. Greater understanding of HCPs' views on barriers, facilitators and how FICare practice impacts individuals is required.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623321","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":"Azithromycin for eradication of <i>Ureaplasma</i> and prevention of bronchopulmonary dysplasia in preterm infants: a meta-analysis.","authors":"Zhe Chen, Zhimei Jiang, Dan Liu, Yan Wen, Linan Zeng, Liang Huang, Jing Shi, Lingli Zhang","doi":"10.1136/archdischild-2024-328220","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328220","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of azithromycin in eradicating <i>Ureaplasma</i> and preventing bronchopulmonary dysplasia (BPD) in preterm infants.</p><p><strong>Design: </strong>Six literature databases and three clinical trial registration platforms were searched for studies up to 22 July 2024. The meta-analysis was performed using RevMan V.5.3.</p><p><strong>Results: </strong>A total of 1723 preterm infants from 10 randomised controlled trials and 3 case series were included. In all preterm infants, azithromycin significantly improved <i>Ureaplasma</i> clearance (relative risk (RR)=1.47, 95% CI 1.17 to 1.85) and reduced the duration of mechanical ventilation (mean difference (MD)=-2.16, 95% CI -2.65 to -1.68), duration of supplemental oxygen (MD=-5.46, 95% CI -6.65 to -4.37) and length of stay (MD=-4.98, 95% CI -7.19 to -2.76) compared with placebo; however, there was no significant reduction in BPD, BPD-death or mortality, with low quality of evidence. In <i>Ureaplasma</i>-positive preterm infants, azithromycin significantly reduced BPD-death (RR=0.83, 95% CI 0.70 to 0.99) and mechanical ventilation (MD=-2.20, 95% CI -2.72 to -1.69), compared with placebo, and significantly increased <i>Ureaplasma</i> clearance rate. Additionally, compared with erythromycin, azithromycin reduced BPD, without a statistically significant difference. Compared with placebo, azithromycin showed no statistically significant differences in the incidence of necrotising enterocolitis, retinopathy, intraventricular haemorrhage, etc. CONCLUSIONS: Low-quality evidence indicated prophylactic use of azithromycin could reduce the incidence of BPD-death and the duration of mechanical ventilation in <i>Ureaplasma</i>-positive preterm infants. However, such benefits were not observed in all preterm infants. Meanwhile, azithromycin was found to be safe for administration in preterm infants.</p><p><strong>Prospero registration number: </strong>CRD42024585836.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565866","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}