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

{"title":"High versus low PEEP in the delivery room: a preimplementation and postimplementation cohort study.","authors":"Kriszta Molnar, Jule Broghammer, Paul-Philipp Warth, Pia Michler, Hannah Kressin, Christian F Poets, Corinna Engel, Laila Springer","doi":"10.1136/archdischild-2026-330466","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330466","url":null,"abstract":"<p><strong>Objective: </strong>The optimal positive end-expiratory pressure (PEEP) to aerate the preterm lung directly after birth is still unknown. We aimed to determine whether a PEEP of 10 vs 6 cmH₂O in the first 10 min after birth influences short and long-term outcomes.</p><p><strong>Methods: </strong>This retrospective preimplementation and postimplementation study analysed preterm infants with a gestational age (GA) <32 weeks born between 2015 and 2023 at the University Hospital Tübingen. The local protocol regarding initial PEEP level was changed in 2019, resulting in a high-PEEP (10 cmH₂O) versus a low-PEEP (6 cmH₂O) group.</p><p><strong>Results: </strong>718 infants with median GA of 29 weeks were included. There was no group difference in the primary outcome, that is, the SpO₂/FiO₂ ratio at 5 min after birth. More infants exposed to low PEEP received less-invasive surfactant administration (151 (41%) vs 101 (29%), p<0.05) and had a longer duration of non-invasive ventilation (30 (8-46) vs 19 (6-43.5) days, p<0.05). Moreover, they had a higher risk of being intubated within 72 hours of birth (OR 1.7; 95% CI 1.07 to 2.66, p<0.05) and of developing bronchopulmonary dysplasia (OR 1.7; 95% CI 1.14 to 2.64, p<0.05) or retinopathy of prematurity (OR 1.8; 95% CI 1.17 to 2.79, p<0.05).</p><p><strong>Conclusion: </strong>Applying a higher PEEP (10 cmH₂O) postnatally might be beneficial in preventing short as well as long-term outcomes in preterm infants, but randomised controlled trials are needed to confirm this hypothesis.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350508","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":"Trends in the incidence of low-grade intraventricular haemorrhage among preterm babies: a national cohort study.","authors":"Philippa Rees, Chris Gale, Ben Carter, Noah Pressler, Cheryl Battersby, Alastair G Sutcliffe","doi":"10.1136/archdischild-2026-330421","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330421","url":null,"abstract":"<p><strong>Objective: </strong>To assess regional and temporal variation and influencing factors of low-grade intraventricular haemorrhage (IVH) incidence among preterm infants admitted to neonatal units in England.</p><p><strong>Design: </strong>Population cohort study SETTING: England, UK.</p><p><strong>Patients: </strong>All infants born <34 weeks' gestation between 2008 and 2019 admitted to a National Health Service neonatal unit in England (n=165 269).</p><p><strong>Event: </strong>Low-grade IVH (grade 1-2).</p><p><strong>Main outcome measures: </strong>Crude incidence rates and adjusted incidence rate ratios (IRRs) from Poisson models comparing calendar years, geographically defined operational delivery networks, sex and gestation.</p><p><strong>Results: </strong>Low-grade IVH occurred in 8.7% (14 415/165 269) of preterm admissions. Crude incidence increased from 6.8% in 2008-2009 to 10.1% in 2018-2019. After adjustment for gestation, sex and neonatal network, incidence in 2018-2019 was higher than in 2008-2009 (adjusted IRR 1.64, 95% CI 1.51 to 1.79). Both grade 1 and grade 2 IVH rose over time. Geographical heterogeneity was pronounced: low-grade IVH incidence ranged from 2.6% to 15.9% across networks, a more than sixfold difference that persisted after case-mix adjustment. Temporal patterns also diverged by network, some showed high and rising incidence over time, while others remained lower or stable.</p><p><strong>Conclusion: </strong>Low-grade IVH is common among preterm admissions and recorded incidence increased between 2008 and 2019, with consistent gestational and sex patterns and substantial geographical variation. The contribution of interobserver diagnostic variability to this variation is unknown; nonetheless, the magnitude and consistency of the trends suggest a rising, potentially uneven burden of low-grade IVH in England, warranting further investigation to inform quality improvement interventions.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315335","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":"Apnoeic oxygenation with nasal high flow during neonatal intubation: a prospective audit.","authors":"Tugba Alarcon Martinez, Brett James Manley, Louise S Owen, Peter G Davis, Kate Alison Hodgson","doi":"10.1136/archdischild-2026-330779","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330779","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315290","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":"Postmortem examination after deaths in neonatal units in England and Wales, 2017-2022: a national observational study.","authors":"Cecilia Cirelli, Mohammad Chehrazi, Stefano Giuliani, Antonello Ciccarone, Neena Modi","doi":"10.1136/archdischild-2026-330311","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330311","url":null,"abstract":"<p><strong>Objective: </strong>Postmortem (PM) examination can be valuable after a baby's death, providing information about the cause of death and support for families. However, worldwide trends indicate declining neonatal PM rates. We aimed to analyse trends in PM offer and completion after deaths in neonatal units.</p><p><strong>Methods: </strong>We used data from the National Neonatal Research Database on deaths in neonatal units in England, Wales and the Isle of Man (2017-2022). We used regression models to estimate rates of PM offer and completion and their association with selected clinical, socio-demographic and service-related variables. We report the relative risk (RR), with a p value <0.05 considered statistically significant.</p><p><strong>Results: </strong>PM offer and completion rates ranged from 56% to 62% and 15% to 18%, respectively. Compared with extremely preterm infants, term infants had higher PM completion rates (RR 2.25, 95% CI 1.94 to 2.62, p<0.001). PM completion was less likely for babies of Asian (RR 0.58, 95% CI 0.46 to 0.72, p<0.001) or black mothers (RR 0.78, 95% CI 0.60 to 0.99, p=0.04) when compared with babies of white mothers. Babies of mothers in the country's least deprived decile were more likely to have a PM completed (RR 1.38, 95% CI 1.04 to 2.48, p=0.04), in comparison with the most deprived centile.</p><p><strong>Conclusion: </strong>This national study provides a near-contemporaneous perspective on neonatal PM and adds to existing evidence of low rates. These data indicate the need to address the root causes of variation in PM completion to ensure equity in the care of families after a neonatal death.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148147885","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":"Academic achievement in children born extremely preterm: a cohort study.","authors":"Ylva F Kaul, Martin Johansson, Anu Haavisto, Ulrika Ådén, Karin Källén, Thomas Abrahamsson, Aijaz Farooqi, David Ley, Karin Sävman, Andreas Ohlin, Kerstin Hellgren, Fredrik Serenius, Lisa B Thorell","doi":"10.1136/archdischild-2025-329756","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329756","url":null,"abstract":"<p><strong>Objective: </strong>Children born extremely preterm (EPT) vary greatly regarding academic outcomes, underscoring the need to investigate subgroups in large representative samples. This study aimed to (1) examine academic outcomes in EPT children versus full-term controls and (2) examine the role of maternal education, child sex, maternal origin, cognitive ability and the presence of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) diagnosis.</p><p><strong>Design: </strong>National cohort study.</p><p><strong>Setting: </strong>Sweden.</p><p><strong>Patients: </strong>12-year follow-up of a cohort study, the Extremely Preterm Infants in Sweden Study, including children born EPT (n=449) and full-term controls (n=365).</p><p><strong>Outcome measures: </strong>Data on school grades (mathematics, Swedish and English) and special education school attendance were obtained from registers.</p><p><strong>Exposure: </strong>EPT group versus controls and subgroup analyses within the EPT group.</p><p><strong>Results: </strong>Compared with full-term controls, children born EPT more often attended special education schools (13.6% vs 0.5%; OR 28.5 (95% CI 6.9 to 117.5)) and those attending mainstream school more often received at least one failing grade (32.3% vs 5.2%; OR 8.7 (95% CI 5.2 to 14.5)). Of children with gestational age (GA) ≤23 weeks, 39% attended mainstream school and passed all three core subjects, compared with 65% of those born at 26 weeks (OR 0.34 (95% CI 0.17 to 0.62)). Among EPT children attending mainstream education, low GA, low maternal education, cognitive impairment and ADHD/ASD diagnosis increased the risk of poor academic achievement.</p><p><strong>Conclusions: </strong>EPT birth was associated with poor academic achievement, but the risk varies substantially within the EPT group, primarily based on cognitive impairment, ADHD/ASD diagnosis and maternal education. However, the risk of poor academic achievement among children born EPT remained after adjusting for confounders and mediators.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013143","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 stroke active surveillance BPSU study in the UK and the Republic of Ireland with a meta-analysis of national surveillance studies.","authors":"T'ng Chang Kwok, Robert A Dineen, William P Whitehouse, Richard Michael Lynn, Niamh McSweeney, Don Sharkey","doi":"10.1136/archdischild-2025-329795","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329795","url":null,"abstract":"<p><strong>Objective: </strong>Assess the incidence, presentation, management and short-term outcomes of neonatal stroke in the UK and Ireland (ROI).</p><p><strong>Design: </strong>Active surveillance (British Paediatric Surveillance Unit) study and meta-analysis of national surveillance studies.</p><p><strong>Setting: </strong>UK and ROI.</p><p><strong>Patients: </strong>Neonatal stroke presenting <90 days old in term and preterm infants between March 2022 and April 2023.</p><p><strong>Interventions: </strong>Reporting clinicians completed questionnaires and uploaded de-identified neuroimages via a purpose-built data platform.</p><p><strong>Results: </strong>68 neonatal stroke cases were reported in the UK and ROI. UK incidence was 9.0 per 100 000 live births (95% CI 6.9 to 11.6). Three-quarters were arterial ischaemic and unilateral. Arterial ischaemic and cerebral venous sinus thrombosis (CVST) strokes commonly presented with seizures at 2-3 days of age, while haemorrhagic stroke commonly presented with encephalopathy in the first ten days of age. Neonatal stroke was associated with fetal distress in utero. 61% of infants had an umbilical pH <7.25 and 28% required significant resuscitation at birth, respectively. A meta-analysis of 3 607 864 infants found our reported incidence and associated conditions were similar to surveillance studies in Germany and Australia.Guidelines were available in a quarter of reporting hospitals. 87% of infants with arterial ischaemic and CVST stroke received antiseizure medications. 82% of infants were discharged home at 12 days old (median) with antiseizure medications (42%) alongside paediatric/neonatal (91%), physiotherapy (77%) and paediatric neurology (63%) follow-up.</p><p><strong>Conclusions: </strong>Neonatal stroke is rare, with distinct subtypes associated with different presentations, timings and management strategies, highlighting the need to better understand this condition.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925864","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":"Probiotics for extremely preterm infants: a Norwegian population-based study.","authors":"Nina Clare Hapnes, Hans Jørgen Stensvold, Ingvild Dalen, Hans Jørgen Timm Guthe, Ragnhild Støen, Anne Lee Solevåg, Sissel J Moltu, Arild Rønnestad, Claus Klingenberg","doi":"10.1136/archdischild-2025-330176","DOIUrl":"https://doi.org/10.1136/archdischild-2025-330176","url":null,"abstract":"<p><strong>Objective: </strong>To compare mortality and morbidity in extremely preterm (EPT) and/or extremely low birthweight (ELBW) infants receiving or not receiving probiotic supplementation.</p><p><strong>Design: </strong>Nationwide, population-based registry study.</p><p><strong>Setting: </strong>All neonatal intensive care units (NICUs) in Norway.</p><p><strong>Participants: </strong>All EPT (<28 weeks)/ELBW (<1000 g) infants born between 2014 and 2021, admitted to an NICU. Infants who within the first week of life died, underwent surgery for necrotising enterocolitis (NEC) or did not receive enteral feeds or started with probiotics after the first week of life were excluded from the main analyses. Logistic regression, propensity score matching, inverse probability of treatment weighting (IPTW) and clustering analyses were applied.</p><p><strong>Main outcome measures: </strong>The primary outcome was all-cause mortality after the first week of life. Secondary outcomes were surgical NEC and late-onset sepsis after the first week of life, growth and probiotic sepsis.</p><p><strong>Results: </strong>Among 1596 live-born EPT/ELBW infants, 1268 were included in the main analysis and 676 (53.5%) started probiotics in the first week of life. Probiotics were associated with lower all-cause mortality (IPTW analysis; adjusted OR (aOR) 0.65, 95% CI 0.43 to 0.97), but no reduction in surgical NEC (aOR 0.83, 95% CI 0.49 to 1.43). However, in an emulated intention-to-treat scenario, high (>80%) probiotic use versus low (< 30%) was associated with a reduction in surgical NEC (aOR 0.40, 95% CI 0.19 to 0.86). We found no association between probiotics and sepsis or growth. 5 out of 858 infants (0.58%) exposed to probiotics developed probiotic-associated sepsis, all survived.</p><p><strong>Conclusion: </strong>Probiotic supplementation to EPT/ELBW infants was associated with lower all-cause mortality and possibly reduced NEC.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760365","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":"Variability in the use of therapeutic hypothermia in neonates across Europe.","authors":"Daniele De Luca, Tullio Ghi","doi":"10.1136/archdischild-2025-329513","DOIUrl":"10.1136/archdischild-2025-329513","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F283-F284"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231408","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":"Suboptimal BMI at 5 years after very preterm birth: too early to conclude?","authors":"Cornelia Wiechers","doi":"10.1136/archdischild-2025-329567","DOIUrl":"10.1136/archdischild-2025-329567","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F188-F189"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of targeted testing for cytomegalovirus in preterm infants: 7 years' experience at a tertiary London hospital.","authors":"Helen Payne, Rebecca Faber, Ravi D Mistry, Aaron Colin John Bell, Harry James, Malaz Elsaddig, Ana Silva Ferreira, Grace Li, Anjali Rampersad, Lidia Tyszczuk, Paul Randell, Elizabeth Whittaker, Hermione Lyall","doi":"10.1136/archdischild-2025-329084","DOIUrl":"10.1136/archdischild-2025-329084","url":null,"abstract":"<p><strong>Background: </strong>Targeted testing for cytomegalovirus (CMV) in preterm infants <21 days has two benefits: timely congenital CMV (cCMV) diagnosis, and differentiation between cCMV and postnatal CMV (pCMV). We present an audit of targeted testing for cCMV alongside rates of clinically suspected pCMV in preterm infants.</p><p><strong>Methods: </strong>We collected data on CMV testing from 2016 to 2023 in infants born <30 weeks gestation during admission to a tertiary London neonatal centre.</p><p><strong>Results: </strong>Of all infants, 77% (899/1162) were tested for CMV during their admission with 74.6% tested <21 days of age. CMV infection was confirmed in 58 infants, 4 cases of cCMV (0.4%) and 54 cases of pCMV (6.0%). One infant with cCMV died, and all were symptomatic: microcephaly, thrombocytopenia, leucopenia, white matter hyperintensity on brain imaging, but none had hearing loss. Most pCMV cases (92.6%) were symptomatic, with bone-marrow suppression (92.6%), sepsis-like syndrome (50%), respiratory (31.5%) and gastrointestinal symptoms (29.6%). All infants with cCMV and 38.9% of infants with pCMV received treatment. Overall, 6% (54/899) had symptomatic CMV disease, 16.7% of infants with CMV died during their neonatal intensive care unit admission, and 42.6% were discharged on home oxygen.</p><p><strong>Conclusions: </strong>CMV causes a substantial disease burden in infants born <30 weeks gestation, whereby 6% have symptomatic CMV disease. We show the feasibility and value of targeted cCMV and opportunistic pCMV testing. In the absence of universal screening, targeted birth testing for cCMV in infants <30 weeks gestational age should be considered.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"F256-F261"},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}