Neonatology Pub Date : 2025-03-29 DOI: 10.1159/000545306

Thomas E Bachman, Truong An Nguyen, Leos Tejkl, Richard Plavka

{"title":"Changes in fetal hemoglobin associated with erythrocyte transfusions are clinically relevant in SpO2 targeting: a retrospective cohort observational study.","authors":"Thomas E Bachman, Truong An Nguyen, Leos Tejkl, Richard Plavka","doi":"10.1159/000545306","DOIUrl":"https://doi.org/10.1159/000545306","url":null,"abstract":"Background There is a broad awareness of shifts in the oxygen hemoglobin dissociation (ODC) relationship associated with fetal hemoglobin (HbF) changes. However, quantification of the shift has been limited. Objective To quantify the shift of partial oxygen tension (PO2) associated with HbF and with changes after transfusion of adult erythrocytes (TAE) in preterm infants. Methods This is a single center, retrospective observational analysis of blood gas samples. The shifts of ODC and PO2 related to HbF were evaluated in two models. Either HbF or TAE status (0, 1, ≥2) were used as the independent variable. Multivariate analysis was used to correct for confounding effects (gestational age, postnatal age, source of blood gas sample as well as pH, SO2 and PCO2). Results There were 3,452 blood gas observations analyzed from 2,464 infants whose median gestational age was 334 weeksdays (IQR 296-363). With SpO2 between 90-95%, the ODC was shifted to the left (13 mmHg, 1.3 kPa). After adjusting for confounding variables, the number of TAEs (0, 1, ≥2), was highly significantly related to a shift (p<0.001), consistent with the percent fetal hemoglobin level (p<0.001). Based on the multivariate model (i.e., holding confounding parameters constant), with a SpO2 of 92% the PaO2 could be expected to shift markedly higher with 2 or more TAEs in an extremely preterm infant (7.3 mmHg, 0.97 kPa). Conclusion While preliminary, these data suggest that in vulnerable preterm infants a change to a slightly lower SpO2 target range following TAE could maintain equivalent PaO2 exposure.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early postnatal weight loss-is it a problem?

Neonatology Pub Date : 2025-03-28 DOI: 10.1159/000545565

William W Hay

引用次数: 0

Investigating the Mechanisms of Reduced Blood Transfusions after Delayed Umbilical Cord Clamping: The TITANS causal mediation analysis.

Neonatology Pub Date : 2025-03-28 DOI: 10.1159/000545526

Sol Libesman, Anna Lene Seidler, Ava G Tan-Koay, Peter S Cunningham, Kristy Robledo, Sam Cruise, Makayla Wadsworth, Martin Kluckow, Andrew W Gill, Koert de Waal, William Tarnow-Mordi, Helen G Liley

{"title":"Investigating the Mechanisms of Reduced Blood Transfusions after Delayed Umbilical Cord Clamping: The TITANS causal mediation analysis.","authors":"Sol Libesman, Anna Lene Seidler, Ava G Tan-Koay, Peter S Cunningham, Kristy Robledo, Sam Cruise, Makayla Wadsworth, Martin Kluckow, Andrew W Gill, Koert de Waal, William Tarnow-Mordi, Helen G Liley","doi":"10.1159/000545526","DOIUrl":"https://doi.org/10.1159/000545526","url":null,"abstract":"Introduction Delaying clamping of the umbilical cord (DCC) in preterm infants reduces mortality and need for blood transfusions. The mechanisms leading to these benefits are not well understood. The TITANS study investigates potential mediators of the reduction in blood transfusions in infants who received DCC. Materials and Methods Additional patient data was sourced from Australian and New Zealand sites from the Australian Placental Transfusion Study (APTS). APTS randomized preterm infants <30 weeks' gestation to receive DCC (60 seconds) or immediate-cord-clamping (ICC). We examined whether placental transfusion or initial severity of illness mediated the reduced requirement for blood transfusions for infants randomized to DCC. Peak haematocrit in the first 7 days (Hct) was used as an indicator of placental transfusion quantity. Cumulative blood sampled, mechanical ventilation, and arterial sampling lines were used as indicators of severity if illness. We quantified the natural indirect effect of peak Hct and then for all mediators in a joint model with sequential mediation. Results Data from 1260 (of 1401) Australian and New Zealand APTS infants were obtained. The effect of DCC on subsequent blood transfusion was mediated through peak Hct (indirect effect OR = 0.85, 95%CI:0.79-0.93; p<0.001), which accounted for 37% of the total effect. Indicators of severity of illness did not mediate the effect independently of peak Hct. Discussion/Conclusion Peak Hct mediated some, but not all, of the effect of DCC on blood transfusion, whereas markers of severity of illness were not independent mediators.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Feeding Dynamics In Very Preterm Infants With Delayed Oral Feeding Attainment.

Neonatology Pub Date : 2025-03-15 DOI: 10.1159/000543833

Samuel J Gentle, Vivek V Shukla, Abigail Cooley, Namasivayam Ambalavanan, Waldemar A Carlo, Sarah N Taylor, Ariel A Salas

引用次数: 0

MicroRNA signatures in umbilical cord blood of neonates exposed to maternal SARS-CoV-2 infection during pregnancy.

Neonatology Pub Date : 2025-03-14 DOI: 10.1159/000544972

Ira Winkler, Christina Fröschl, Christoph Hochmayr, Eva Huber, Martina Urbanek, Ursula Kiechl-Kohlendorfer, Elke Griesmaier, Anna Posod

{"title":"MicroRNA signatures in umbilical cord blood of neonates exposed to maternal SARS-CoV-2 infection during pregnancy.","authors":"Ira Winkler, Christina Fröschl, Christoph Hochmayr, Eva Huber, Martina Urbanek, Ursula Kiechl-Kohlendorfer, Elke Griesmaier, Anna Posod","doi":"10.1159/000544972","DOIUrl":"10.1159/000544972","url":null,"abstract":"Introduction: Pregnant women are particularly susceptible to SARS-CoV-2 infection, which can provoke placental inflammation, potentially causing malperfusion and adverse pregnancy outcomes. The fetal immune system may respond to maternal infection, even without direct viral transmission. However, the molecular mechanisms driving these responses are not well understood. This study aims to examine changes in microRNA (miRNA) expression in umbilical cord blood from neonates of mothers infected with SARS-CoV-2 during pregnancy.Methods: We conducted a retrospective analysis of prospectively enrolled subjects at Innsbruck University Hospital, Austria. Umbilical cord blood was collected from 58 neonates of mothers infected with SARS-CoV-2 during pregnancy (either antepartum or peripartum) born in 2020-2023 and compared with 41 healthy controls born in 2017-2018. Total RNA was extracted, followed by miRNA next-generation sequencing and differential gene expression analysis. Ingenuity Pathway Analysis (IPA) was used to explore potential miRNA-target interactions.Results: Differential gene expression analysis identified 14 upregulated and 36 downregulated miRNAs in the cord blood of neonates from SARS-CoV-2-infected mothers compared to controls. IPA revealed enrichment in inflammatory pathways, particularly involving cytokines such as interleukin (IL)-6 and IL-10. No significant differences in miRNA expression were observed between neonates exposed antepartum versus peripartum.Discussion/conclusion: Maternal SARS-CoV-2 infection during pregnancy is linked to altered miRNA expression in neonates' umbilical cord blood, potentially influencing inflammatory pathways. These findings shed light on the molecular mechanisms of fetal responses to maternal SARS-CoV-2 infection.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early postnatal weight loss and its association with outcomes in very preterm neonates: a systematic review and meta-analysis.

Neonatology Pub Date : 2025-03-06 DOI: 10.1159/000545106

Sreeja Kothapally, Chandra Rath, Bhanu B Gowda, Jay Sharma, Sanjay K Patole, Shripada Rao

{"title":"Early postnatal weight loss and its association with outcomes in very preterm neonates: a systematic review and meta-analysis.","authors":"Sreeja Kothapally, Chandra Rath, Bhanu B Gowda, Jay Sharma, Sanjay K Patole, Shripada Rao","doi":"10.1159/000545106","DOIUrl":"https://doi.org/10.1159/000545106","url":null,"abstract":"Introduction: Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants is not well known. This review explored the association between early PWL and outcomes in very premature infants (<32 weeks).Methods: This is a systematic review and meta-analyses of the observational studies. PubMed, Medline, EMBASE, Cochrane Library, EMCARE and MedNar databases were searched in April 2024. Outcomes of interest were mortality and morbidities such as intraventricular-haemorrhage (IVH), chronic lung disease (CLD), patent ductus arteriosus (PDA), necrotising enterocolitis (NEC), retinopathy of prematurity (ROP) and long-term neurodevelopmental outcomes. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Separate analyses were conducted for case-control and cohort studies. Data were pooled separately for the excess weight loss (EWL) group (>15% from birth weight) and inadequate weight loss (IWL) group (<5% from birth weight).Results: Eighteen studies (25158 infants) were included. Pooling of adjusted ORs in EWL group from cohort studies found significant association with mortality (OR 1.39 CI (1.10 to1.75)), severe IVH (OR 1.37 CI (1.18 to1.59)), NEC (OR 2.05 CI (1.05 to4.03)) and \"Mortality or IVH\" (OR 1.40 CI (1.10 to1.78)). Pooling adjusted ORs from case-control studies showed a significant association between EWL and CLD, and between IWL and mortality or CLD. Certainty of evidence was 'Low' or 'Very-low'.Conclusion: EWL or IWL in very-preterm infants may be associated with higher odds of mortality and morbidity. However, cofactors of severity of associated disease, insufficient nutrition, and treatments could not be assessed.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deep Learning-based Multi-class Classification for Neonatal Respiratory Diseases on Chest Radiographs in Neonatal Intensive Care Units.

Neonatology Pub Date : 2025-03-06 DOI: 10.1159/000545107

Hye Won Cho, Sumin Jung, Kyu Hee Park, Jin Wha Choi, Ju Sun Heo, Jaeyoung Kim, Heerim Yun, Donghoon Yu, Jinho Son, Byung Min Choi

{"title":"Deep Learning-based Multi-class Classification for Neonatal Respiratory Diseases on Chest Radiographs in Neonatal Intensive Care Units.","authors":"Hye Won Cho, Sumin Jung, Kyu Hee Park, Jin Wha Choi, Ju Sun Heo, Jaeyoung Kim, Heerim Yun, Donghoon Yu, Jinho Son, Byung Min Choi","doi":"10.1159/000545107","DOIUrl":"https://doi.org/10.1159/000545107","url":null,"abstract":"Objective Accurate and timely interpretation of chest radiographs is essential for assessing respiratory distress and guiding clinical management to improve outcomes of critically ill newborns. This study aimed to introduce a deep learning-based automated algorithm designed to classify various neonatal respiratory diseases and healthy lungs using a large dataset of high-quality, multi-class labeled chest X-ray images from neonatal intensive care units (NICUs). Methods Portable supine chest X-ray images for six common conditions (healthy lung, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), air leak syndrome (ALS), atelectasis, and bronchopulmonary dysplasia (BPD)) and demographic variables (gestational age and birth weight) were retrospectively collected from 10 university hospitals in Korea. Ground truth for manual classification of these conditions was generated by 20 neonatologists and validated by others from different hospitals. The dataset, consisting 34,598 for training, 4,370 for validation, and 4,370 for testing, was used to train a modified ResNet50-based deep-learning model for automatic classification. Results The automatic classification algorithm showed high concordance with human-annotated classifications, achieving an overall testing accuracy of 83.96% and an F1-score of 83.68%. The F1-score for each condition was 87.38% for \"healthy lung\", and 92.19% for \"BPD\", 90.65% for \"ALS\", 90.30% for \"RDS\", 86.56% for \"atelectasis\", and 70.84% for \"TTN\". Conclusion We introduced a deep learning-based automated algorithm to classify neonatal respiratory diseases using a large dataset of high-quality, multi-class labeled chest X-ray images, incorporating non-imaging data, which could support neonatologists in making timely and accurate decisions for critically ill newborns.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inhaled Nitric Oxide for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Systematic Review and Narrative Synthesis.

Neonatology Pub Date : 2025-03-03 DOI: 10.1159/000545034

Hiroki Kitaoka, Ryota Kobayashi, Kosuke Tanaka, Masahiko Watanabe, Tetsuya Isayama

{"title":"Inhaled Nitric Oxide for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Systematic Review and Narrative Synthesis.","authors":"Hiroki Kitaoka, Ryota Kobayashi, Kosuke Tanaka, Masahiko Watanabe, Tetsuya Isayama","doi":"10.1159/000545034","DOIUrl":"10.1159/000545034","url":null,"abstract":"Introduction: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. However, its effectiveness in the treatment of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) and severe BPD remains uncertain. Here we systematically reviewed whether iNO treatment increased or decreased mortality and morbidity among preterm infants with severe BPD or BPD-PH.Methods: We systematically searched the Ovid MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, and ICHUSHI databases for randomized and non-randomized studies that compared the effects of iNO in patients with severe BPD or BPD-PH. The primary outcome was mortality. Two authors independently screened the articles and extracted the data. A meta-analysis and certainty of evidence assessment using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation criteria were planned.Results: Among the 1,710 articles, none had a relevant control group and no studies met the eligibility criteria. Using a post hoc analysis, we summarized the ineligible studies that evaluated patients with severe BPD or BPD-PH who received iNO therapy. Although some studies included in the narrative review indicated a decreased pulmonary arterial pressure in patients with severe BPD or BPD-PH at the initiation of iNO therapy, none included a comparator group.Conclusion: Despite the use of iNO in patients with severe BPD and BPD-PH, no published studies compared the outcomes among patients with BPD treated with versus without iNO. Although some studies without comparator groups reported the effectiveness of iNO in patients with severe BPD and BPD-PH, our results suggest that iNO therapy should be initiated with caution and careful consideration of the target population.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Electrical Impedance Tomography during the Extubation Phase in Very Preterm Born Infants.

Neonatology Pub Date : 2025-03-03 DOI: 10.1159/000544811

Jantine J Wisse, Tom G Goos, Diederik Gommers, Henrik Endeman, André A Kroon, Irwin K M Reiss, Annemijn H Jonkman

{"title":"Electrical Impedance Tomography during the Extubation Phase in Very Preterm Born Infants.","authors":"Jantine J Wisse, Tom G Goos, Diederik Gommers, Henrik Endeman, André A Kroon, Irwin K M Reiss, Annemijn H Jonkman","doi":"10.1159/000544811","DOIUrl":"10.1159/000544811","url":null,"abstract":"Introduction: Although many preterm born infants require invasive mechanical ventilation, it is also associated with detrimental effects. Early extubation should be pursued, but extubation failure is yet common. The critical transition to noninvasive ventilation is characterized by respiratory physiological changes, warranting noninvasive monitoring. We aimed to determine whether electrical impedance tomography (EIT) could provide insights into the respiratory mechanics of neonates around extubation, and if findings were different between successful and failed extubation.Methods: Single-center observational study where EIT and transcutaneous CO2 measurements were performed in preterm born infants <32 weeks gestational age. Measurements were performed from 24 h before up to 48 h after extubation. EIT parameters extracted from the hour before and after extubation were analyzed to evaluate the short-term physiological changes.Results: Twenty-one patients were included and 6 (29%) were reintubated. End-expiratory lung impedance and tidal impedance variation were stable around extubation (p = 0.86 and p = 0.47, respectively). Compared to successfully extubated patients, reintubated patients showed more lung inhomogeneity (GI index) after extubation (0.75 vs. 0.84, p = 0.03). The percentage of nondependent silent spaces decreased after extubation in successfully extubated patients (p < 0.001). Body position and ventilator mode influenced these findings.Conclusion: EIT measurements in preterm neonates provide valuable insight into the respiratory physiology during the transition from invasive to noninvasive ventilation, with significant differences in ventilation distribution and lung homogeneity between successfully extubated and reintubated patients. EIT has the potential to guide personalized respiratory support by assessing ventilation distribution and quantifying inhomogeneity, aiding in the optimization of ventilation settings.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

ChatGPT-4o in Risk-of-Bias Assessments in Neonatology: A Validity Analysis. 新生儿科偏倚风险评估中的 ChatGPT-4o - 有效性分析。

Neonatology Pub Date : 2025-02-25 DOI: 10.1159/000544857

Ilari Kuitunen, Lauri Nyrhi, Daniele De Luca

{"title":"ChatGPT-4o in Risk-of-Bias Assessments in Neonatology: A Validity Analysis.","authors":"Ilari Kuitunen, Lauri Nyrhi, Daniele De Luca","doi":"10.1159/000544857","DOIUrl":"10.1159/000544857","url":null,"abstract":"Introduction: Only a few studies have addressed the potential of large language models (LLMs) in risk-of-bias assessments and the results have been varying. The aim of this study was to analyze how well ChatGPT performs in risk-of-bias assessments of neonatal studies.Methods: We searched all Cochrane neonatal intervention reviews published in 2024 and extracted all risk-of-bias assessments. Then the full reports were retrieved and uploaded alongside the guidance to perform a Cochrane original risk-of-bias analysis in ChatGPT-4o. The concordance between the original assessment and that provided by ChatGPT-4o was evaluated by inter-class correlation coefficients and Cohen's kappa statistics (with 95% confidence intervals) for each risk-of-bias domain and for the overall assessment.Results: From 9 reviews, a total of 61 randomized studies were analyzed. A total of 427 judgments were compared. The overall κ was 0.43 (95% CI: 0.35-0.51) and the overall intraclass correlation coefficient was 0.65 (95% CI: 0.59-0.70). The Cohen's κ was assessed for each domain and the best agreement was observed in the allocation concealment (κ = 0.73, 95% CI: 0.55-0.90), whereas the poorest agreement was found in incomplete outcome data (κ = -0.03, 95% CI: -0.07-0.02).Conclusion: ChatGPT-4o failed to achieve sufficient agreement in the risk-of-bias assessments. Future studies should examine whether the performance of other LLM would be better or whether the agreement in ChatGPT-4o could be further enhanced by better prompting. Currently, the use of ChatGPT-4o in risk-of-bias assessments should not be promoted.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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