Neonatology最新文献

{"title":"Association of Two Neonatal Encephalopathy Scores with Neurophysiology in Newborns with Suspected Hypoxic Ischemic Encephalopathy.","authors":"Emily M Herzberg, Sara V Bates, Jason Boulanger, Ivana Culic, Mohamed El-Dib, Hoda El-Shibiny, Munish Gupta, Anne Hansen, Terrie Inder, Kyoung E Joung, Carol Keohane, Jessica R Landers, Silvia Patrizi, Arnold Sansevere, Brian H Walsh, Bo Zhang, Janet S Soul","doi":"10.1159/000545422","DOIUrl":"https://doi.org/10.1159/000545422","url":null,"abstract":"<p><strong>Background/objective: </strong>Severity of hypoxic-ischemic encephalopathy (HIE) is traditionally assessed by neurologic exam; however, electroencephalography (EEG) is a more standardized, reproducible measure of NE. We aimed to compare two numeric NE scores with neurophysiological measures of encephalopathy, to describe EEG patterns in newborns with low NE scores, and to assess evolution of NE scores within 6 hours after birth.</p><p><strong>Study design/methods: </strong>We retrospectively analyzed associations between two NE scores, aEEG, and cEEG in 321 newborns in a 14-center collaborative NE Registry.</p><p><strong>Results: </strong>There was a significant association between both NE scores and aEEG/cEEG (p<0.001), with higher scores in newborns with more abnormal aEEG background patterns. A minority of newborns with low NE scores (<4) had abnormal aEEG/cEEG, but all were treated with therapeutic hypothermia (TH). Most newborns with serial NE scores (74%) had evolution of encephalopathy; more newborns had decreasing/improving (48%) than increasing/worsening (26%) NE scores. Newborns with improving versus worsening scores were more likely to have a first NE score completed before 1 hour after birth.</p><p><strong>Conclusions: </strong>Both NE scores showed a significant correlation with neurophysiology, but NE scores have limitations. Since HIE evolves in most newborns, serial NE exams are recommended with the initial or at least confirmatory NE exam completed at >1 hour of age. aEEG/cEEG may be particularly useful for identifying more substantial NE warranting TH treatment in newborns with mild NE by exam. Data from this study support standardized use of neurophysiology in evaluating asphyxiated, encephalopathic newborns.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061345","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}

{"title":"Medical Needs of Very Low Birth Weight Preterm Infants Post-Discharge: A Population-Based Study in Taiwan.","authors":"Jui-Hsing Chang, Chia-Huei Chen, Chun-Chih Peng, Chia-Ying Lin, Hung-Yang Chang, Chyong-Hsin Hsu, Wai-Tim Jim","doi":"10.1159/000546115","DOIUrl":"https://doi.org/10.1159/000546115","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to explore the outcomes, home use of medical assistive devices, and interdisciplinary medical needs of very-low-birth-weight (VLBW) infants at a corrected age of 2 years.</p><p><strong>Methods: </strong>Analyses were performed using perinatal, neonatal, and 2-year follow-up data from VLBW infants registered in the Taiwan Premature Infant Follow-up Network (TPFN) between 2011-2017. Basic information, survival, and disease conditions during hospitalization were recorded. Medical needs at discharge, outcomes at a corrected age of 2 years, active involvement in outpatient healthcare services, and referrals were investigated.</p><p><strong>Results: </strong>From 2011-2017, a total of 9243 VLBW preterm neonates were enrolled in the TPFN. Of these neonates, 140 had severe congenital anomalies, 8044 survived to discharge, and 6150 returned for follow-up evaluation. At discharge, 10.2% of infants received home oxygen therapy (HOT), and 6.5% used home monitoring devices. Among the infants diagnosed with chronic lung disease, 26.6% received HOT. At a corrected age of 2 years, the most common interventions and recommended referrals were rehabilitative treatments (34.5%), followed by early intervention system services (16.5%), ophthalmology/otolaryngology management (4.4%), neurological follow-up (4.1%), and mental health assessment and treatment (2.5%).</p><p><strong>Conclusion: </strong>After hospital discharge, VLBW preterm infants exhibit substantial healthcare needs, with significant demands of home oxygen therapy, rehabilitation, and early intervention services by a corrected age of 2 years. These findings highlight the importance of coordinated outpatient care and long-term follow-up to address the developmental and medical challenges faced by this vulnerable population.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048967","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}

{"title":"Dexmedetomidine as a Promising Neuroprotective Sedoanalgesic in Neonatal Therapeutic Hypothermia: A Systematic Review and Meta-Analysis.","authors":"Enrico Cocchi, Juleda Shabani, Arianna Aceti, Gina Ancora, Luigi Corvaglia, Federico Marchetti","doi":"10.1159/000546017","DOIUrl":"https://doi.org/10.1159/000546017","url":null,"abstract":"<p><strong>Background: </strong>Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal mortality and neurodevelopmental disabilities. Therapeutic hypothermia (TH) is the standard of care, but optimized sedoanalgesic strategies remain critical. Dexmedetomidine shows promise as an alternative to traditional sedatives, but its role in this context remains systematically underexplored.</p><p><strong>Objective: </strong>This meta-analysis evaluates the safety and efficacy of dexmedetomidine in neonates undergoing TH for HIE.</p><p><strong>Methods: </strong>A systematic search of Medline, Scopus, EMBASE, WOS, ClinicalTrials, and Cochrane Library identified studies published from January 2014 to October 2024. Studies focusing on dexmedetomidine in neonatal TH with relevant outcomes were included. Selection followed PRISMA guidelines, with independent quality assessments. The protocol was registered in PROSPERO (CRD42024605817). Results are presented as meta-analyses or evidence-based discussions when pooling was unfeasible.</p><p><strong>Results: </strong>Seven studies involving 609 neonates were included: four cohort studies (n = 486) and three case series (n = 123). Dexmedetomidine provided comparable sedation to traditional agents (MD = -0.01 [-0.68 - 0.66], p = 0.99) and significantly reduced seizure risk (OR 0.31 [0.10 - 0.98], p < 0.05) with a non-inferior safety profile. Trends suggested shorter duration of mechanical ventilation and time to full enteral feeding. Substantial heterogeneity in dosing protocols highlights the need for standardization.</p><p><strong>Conclusions: </strong>Dexmedetomidine appears to be a safe and promising sedative in neonatal TH for HIE, with potential neuroprotective, respiratory, and gastrointestinal benefits. Despite limited evidence and the absence of randomized clinical trials, its non-inferior efficacy and safety warrant further exploration and urges the development of standardized dosing protocols.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028477","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}

{"title":"Comparing malposition and complications associated with Ultrasound-guided versus Radiography-guided central catheter tip-position in neonates: A Systematic Review and Meta-analysis.","authors":"Adel Mohamed, Nada Mohsen, Gonzalo Solis-Garcia, Nehad Nasef, Prakesh Shah","doi":"10.1159/000545772","DOIUrl":"https://doi.org/10.1159/000545772","url":null,"abstract":"<p><strong>Background: </strong>There is a growing interest in ultrasound-guided central catheter (CC) tip-position, driven by its potential to improve accuracy and reduce complications.</p><p><strong>Objective: </strong>To systematically review and meta-analyze studies that reported complications associated with ultrasound-guided versus radiography-guided CC tip-position in neonates.</p><p><strong>Methods: </strong>We searched MEDLINE, COCHRANE, EMBASE, CINAHL, and clinicaltrials.gov for Randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) comparing the complications of ultrasound- versus X-ray-guided CC tip-position in neonates up to June 2024. RCTs and NRSs were analyzed separately. The outcomes included malposition, number of X-rays, procedure time, catheter manipulation, cardiac tamponade, extravasation, occlusion, and sepsis rates. Subgroup meta-analysis based on catheter type was performed. Statistical analyses were conducted using Review Manager 5.4.1 and R 4.1.0, and the GRADE methodology was applied to assess evidence certainty.</p><p><strong>Results: </strong>Seven studies (4 RCTs and 4 NRSs, N=1322 neonates) were included. Ultrasound-guided catheter tip-position significantly reduced malposition rates (3 RCTs, N=181, RR 0.51, CI 95% 0.37 to 0.70; 4 NRSs, N=1110, RR 0.25, CI 95% 0.11 to 0.57) and decreased the need for X-rays (2 RCTs, N=112, MD -1.22, CI 95% -2.32 to -0.11; 2 NRSs, N=401, MD -0.31, CI 95% -0.47 to -0.15). No significant differences were found in procedure time, catheter manipulation, or sepsis rates. All evidence was of low certainty per grade.</p><p><strong>Conclusions: </strong>The use of ultrasound-guided CC tip-position in neonates is associated with a reduction in malposition rates and radiation exposure (low-certainty evidence). Further research is needed to confirm the benefits of ultrasound-guided CC tip-position in neonates.</p><p><strong>Registration: </strong>The protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/HA9Q6).</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047600","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}

{"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":"10.1159/000545306","url":null,"abstract":"<p><strong>Introduction: </strong>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. Aim was to quantify the shift of partial oxygen tension (PO2) associated with HbF and with changes after transfusion of adult erythrocytes (TAE) in preterm infants.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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 and 95%, the ODC was shifted to the left (13 mm Hg, 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 HbF 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 mm Hg, 0.97 kPa).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-7"},"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}

{"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":"10.1159/000545526","url":null,"abstract":"<p><strong>Introduction: </strong>Delaying clamping of the umbilical cord (deferred cord clamping [DCC]) in preterm infants reduces mortality and the 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.</p><p><strong>Materials and methods: </strong>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 s) or immediate cord clamping. We examined whether placental transfusion or initial severity of illness mediated the reduced requirement for blood transfusions for infants randomized to DCC. Peak hematocrit 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 of illness. We quantified the natural indirect effect of peak Hct and then for all mediators in a joint model with sequential mediation.</p><p><strong>Results: </strong>Data from 1,260 (of 1,401) 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Postnatal Weight Loss: Is It a Problem?","authors":"William W Hay","doi":"10.1159/000545565","DOIUrl":"10.1159/000545565","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756958","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}

{"title":"Feeding Dynamics in Very Preterm Infants with Delayed Oral Feeding Attainment.","authors":"Samuel J Gentle, Vivek V Shukla, Abigail Cooley, Namasivayam Ambalavanan, Waldemar A Carlo, Sarah N Taylor, Ariel A Salas","doi":"10.1159/000543833","DOIUrl":"10.1159/000543833","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to characterize features that can accurately identify preterm infants at risk of delay in oral feeding attainment.</p><p><strong>Methods: </strong>A prospective observational study of infants born between 250/7 and 326/7 weeks' gestation. Early independent oral feed attainment (EPO) was defined as independent oral feeding within 35 days of initiation and late attainment (LPO) defined at or after 35 days following initiation. Candidate characteristics of comparison included feeding interventions and reasons for feeding discontinuation.</p><p><strong>Results: </strong>Of the 257 infants included, 162 infants achieved EPO. Over the first week of oral feeding, LPO infants received fewer feeding interventions (e.g., side lying position, pacing, and re-alertment) and were fed less frequently (2 vs. 3 times per day; p < 0.001).</p><p><strong>Conclusions: </strong>Compared to infants with EPO, infants with LPO differ in employed feeding strategies. These findings could guide resource allocation and facilitate the provision of individualized care.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639941","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}

{"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":"<p><strong>Introduction: </strong>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 aimed to examine changes in microRNA (miRNA) expression in umbilical cord blood from neonates of mothers infected with SARS-CoV-2 during pregnancy.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-11"},"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}

{"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":"10.1159/000545106","url":null,"abstract":"<p><strong>Introduction: </strong>Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants are not well known. This review explored the association between early PWL and outcomes in very premature infants (<32 weeks).</p><p><strong>Methods: </strong>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, necrotising enterocolitis (NEC), retinopathy of prematurity, 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).</p><p><strong>Results: </strong>Eighteen studies (25,158 infants) were included. Pooling of adjusted ORs in EWL group from cohort studies found significant association with mortality (OR 1.39 confidence interval [CI; 1.10-1.75]), severe IVH (OR 1.37 CI [1.18-1.59]), NEC (OR 2.05 CI [1.05-4.03]), and \"Mortality or IVH\" (OR 1.40 CI [1.10-1.78]). 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.\"</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}