Neonatology最新文献

{"title":"Respiratory Syncytial Virus Maternal Vaccination in Infants below 6 Months of Age: Meta-Analysis of Safety, Immunogenicity, and Efficacy.","authors":"Muhammad Pradhika Mapindra, Muhammad Pradhiki Mahindra, Paul McNamara, Malcolm G Semple, Howard Clark, Jens Madsen","doi":"10.1159/000536031","DOIUrl":"10.1159/000536031","url":null,"abstract":"<p><strong>Introduction: </strong>Severe respiratory syncytial virus (RSV) disease is most prevalent during infancy, particularly in those born prematurely, who benefit least from maternal antibody transfers. Maternal immunization is an attractive prevention leading to vaccine clinical trials. This meta-analysis aimed to evaluate recent maternal RSV vaccine trials.</p><p><strong>Methods: </strong>Following PRISMA-P guidelines for systematic reviews and registered at <ext-link ext-link-type=\"uri\" xlink:href=\"https://www.crd.york.ac.uk/prospero\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">https://www.crd.york.ac.uk/prospero</ext-link>, this study shortlisted six randomized clinical trials of suitable quality from four databases. Meta-analysis evaluated vaccine safety, immunogenicity, and efficacy in infants and their mothers.</p><p><strong>Results: </strong>From random-effects and fixed-effects meta-analysis between trial and control arms, the maternal post-vaccination geometric antibody (Ab) titers showed pooled standard mean differences (SMDs [95% CI]) at delivery of (4.14 [2.91-5.37]), (3.95 [2.79-5.11]), and (12.20 [7.76, 16.64]) for RSV neutralizing Ab A, B, and F IgG, respectively. Vaccine administration was more likely than placebo to cause local pain, erythema, swelling, and systemic myalgia. Furthermore, the Ab levels in infants at birth showed pooled SMDs of each RSV A (3.9 [2.81-4.99]), RSV B (1.86 [1.09-2.62]), and RSV F IgG (2.24 [1.24-3.23]). The overall reduction of RSV-related lower respiratory tract infections and hospitalizations in the first 6 months of life was 52% and 48%, respectively.</p><p><strong>Conclusions: </strong>Not only does antenatal RSV vaccination look safe and immunogenic in vaccinated mothers, but it also reliably provides effective antibody levels in infants and diminishes RSV-related severe disease in infants under 6 months of age.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"271-282"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577157","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":"Temporal Trends in Severe Brain Injury and Associated Outcomes in Very Preterm Infants.","authors":"Abdul Razak, Emily Johnston, Alice Stewart, Marissa A T Clark, Penelope Stevens, Margaret Charlton, Flora Wong, C McDonald, Rod W Hunt, Suzanne Miller, Atul Malhotra","doi":"10.1159/000537801","DOIUrl":"10.1159/000537801","url":null,"abstract":"<p><strong>Introduction: </strong>Severe brain injury (SBI), including severe intraventricular haemorrhage (sIVH) and cystic periventricular leukomalacia, poses significant challenges for preterm infants, yet recent data and trends are limited.</p><p><strong>Methods: </strong>Analyses were conducted using the Australian and New Zealand Neonatal Network data on preterm infants born &lt;32 weeks' gestation admitted at Monash Children's Hospital, Australia, from January 2014 to April 2021. The occurrence and trends of SBI and sIVH among preterm infants, along with the rates and trends of death and neurodevelopmental impairment (NDI) in SBI infants were assessed.</p><p><strong>Results: </strong>Of 1,609 preterm infants, 6.7% had SBI, and 5.6% exhibited sIVH. A total of 37.6% of infants with SBI did not survive to discharge, with 92% of these deaths occurring following redirection of clinical care. Cerebral palsy was diagnosed in 65.2% of SBI survivors, while 86.4% of SBI survivors experienced NDI. No statistically significant differences were observed in the temporal trends of SBI (adjusted OR [95% CI] 1.08 [0.97-1.20]; p = 0.13) or sIVH (adjusted OR [95% CI] 1.09 [0.97-1.21]; p = 0.11). Similarly, there was no statistically significant difference noted in the temporal trend of the composite outcome, which included death or NDI among infants with SBI (adjusted OR [95% CI] 0.90 [0.53-1.53]; p = 0.71).</p><p><strong>Conclusion: </strong>Neither the rates of SBI nor its associated composite outcome of death or NDI improved over time. A notable proportion of preterm infants with SBI faced redirection of care and subsequent mortality, while most survivors exhibited adverse neurodevelopmental challenges. The development of better therapeutic interventions is imperative to improve outcomes for these vulnerable infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"440-449"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112554","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":"Neurodevelopmental Outcomes Prediction in Newborns with Seizures Caused by KCNQ2 Gene Defects.","authors":"Zhelan Huang, Bo Liu, Tiantian Xiao, Yaqiong Wang, Yulan Lu, Liyuan Hu, Guoqiang Cheng, Zhihua Li, Laishuan Wang, Rong Zhang, Jin Wang, Yun Cao, Xinran Dong, Lin Yang, Wenhao Zhou","doi":"10.1159/000534605","DOIUrl":"10.1159/000534605","url":null,"abstract":"<p><strong>Introduction: </strong>Pathogenic variant in the KCNQ2 gene is a common genetic etiology of neonatal convulsion. However, it remains a question in KCNQ2-related disorders that who will develop into atypical developmental outcomes.</p><p><strong>Methods: </strong>We established a prediction model for the neurodevelopmental outcomes of newborns with seizures caused by KCNQ2 gene defects based on the Gradient Boosting Machine (GBM) model with a training set obtained from the Human Gene Mutation Database (HGMD, public training dataset). The features used in the prediction model were, respectively, based on clinical features only and optimized features. The validation set was obtained from the China Neonatal Genomes Project (CNGP, internal validation dataset).</p><p><strong>Results: </strong>With the HGMD training set, the prediction results showed that the area under the receiver-operating characteristic curve (AUC) for predicting atypical developmental outcomes was 0.723 when using clinical features only and was improved to 0.986 when using optimized features, respectively. In feature importance ranking, both variants pathogenicity and protein functional/structural features played an important role in the prediction model. For the CNGP validation set, the AUC was 0.596 when using clinical features only and was improved to 0.736 when using optimized features.</p><p><strong>Conclusion: </strong>In our study, functional/structural features and variant pathogenicity have higher feature importance compared with clinical information. This prediction model for the neurodevelopmental outcomes of newborns with seizures caused by KCNQ2 gene defects is a promising alternative that could prove to be valuable in clinical practice.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"178-186"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479909","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":"Neonatal Respiratory Support Utilization in Low- and Middle-Income Countries: A Registry-Based Observational Study.","authors":"Nora Switchenko, Vivek Shukla, Musaku Mwenechanya, Elwyn Chomba, Archana Patel, Patricia L Hibberd, Namasivayam Ambalavanan, Lester Figueroa, Manolo Mazariegos, Nancy F Krebs, Shivaprasad S Goudar, Richard Derman, Fabian Esamai, Edward A Liechty, Sheri Bucher, Sarah Saleem, Robert L Goldenberg, Adrien Lokangaka, Antoinette Tshefu, Carl L Bose, Marion Koso-Thomas, Sylvia Tan, Tracy Nolen, Elizabeth M McClure, Waldemar A Carlo","doi":"10.1159/000534777","DOIUrl":"10.1159/000534777","url":null,"abstract":"<p><strong>Background: </strong>Newborns with hypoxemia often require life-saving respiratory support. In low-resource settings, it is unknown if respiratory support is delivered more frequently to term infants or preterm infants. We hypothesized that in a registry-based birth cohort in 105 geographic areas in seven low- and middle-income countries, more term newborns received respiratory support than preterm newborns.</p><p><strong>Methods: </strong>This is a hypothesis-driven observational study based on prospectively collected data from the Maternal and Newborn Health Registry of the NICHD Global Network for Women's and Children's Health Research. Eligible infants enrolled in the registry were live-born between 22 and 44 weeks gestation with a birth weight ≥400 g and born from January 1, 2015, to December 31, 2018. Frequency data were obtained to report the number of term and preterm infants who received treatment with oxygen only, CPAP, or mechanical ventilation. Test for trends over time were conducted using robust Poisson regression.</p><p><strong>Results: </strong>177,728 (86.3%) infants included in this study were term, and 28,249 (13.7%) were preterm. A larger number of term infants (n = 5,108) received respiratory support compared to preterm infants (n = 3,287). Receipt of each mode of respiratory support was more frequent in term infants. The proportion of preterm infants who received respiratory support (11.6%) was higher than the proportion of term infants receiving respiratory support (2.9%, p &lt; 0.001). The rate of provision of respiratory support varied between sites.</p><p><strong>Conclusions: </strong>Respiratory support was more frequently used in term infants expected to be at low risk for respiratory disorders compared to preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"116-124"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483649","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":"Erratum.","authors":"","doi":"10.1159/000539078","DOIUrl":"10.1159/000539078","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"793"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961342","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":"Neuro-Specific and Immuno-Inflammatory Biomarkers in Umbilical Cord Blood in Neonatal Hypoxic-Ischemic Encephalopathy.","authors":"Hanna Toorell, Ylva Carlsson, BouBou Hallberg, Mairead N O'Riordian, Brian Henry Walsh, Marc Paul O'Sullivan, Geraldine B Boylan, Henrik Zetterberg, Kaj Blennow, Deirdre Murray, Henrik Hagberg","doi":"10.1159/000533473","DOIUrl":"10.1159/000533473","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to evaluate neuronal injury and immuno-inflammatory biomarkers in umbilical cord blood (UCB) at birth, in cases with perinatal asphyxia with or without hypoxic-ischemic encephalopathy (HIE), compared with healthy controls and to assess their ability to predict HIE.</p><p><strong>Study design: </strong>In this case-control study, term infants with perinatal asphyxia were recruited at birth. UCB was stored at delivery for batch analysis. HIE was diagnosed by clinical Sarnat staging at 24 h. Glial fibrillary acidic protein (GFAP), the neuronal biomarkers tau and neurofilament light protein (NFL), and a panel of cytokines were analyzed in a total of 150 term neonates: 50 with HIE, 50 with asphyxia without HIE (PA), and 50 controls. GFAP, tau, and NFL concentrations were measured using ultrasensitive single-molecule array (Simoa) assays, and a cytokine screening panel was applied to analyze the immuno-inflammatory and infectious markers.</p><p><strong>Results: </strong>GFAP, tau, NFL, and several cytokines were significantly higher in newborns with moderate and severe HIE compared to a control group and provided moderate prediction of HIE II/III (AUC: 0.681-0.827). Furthermore, the levels of GFAP, tau, interleukin-6 (IL-6), and interleukin-8 (IL-8) were higher in HIE II/III cases compared with cases with PA/HIE I. IL-6 was also higher in HIE II/III compared with HIE I cases.</p><p><strong>Conclusions: </strong>Biomarkers of brain injury and inflammation were increased in umbilical blood in cases with asphyxia. Several biomarkers were higher in HIE II/III versus those with no HIE or HIE I, suggesting that they could assist in the prediction of HIE II/III.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"25-33"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158948","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":"Hospital Variation in Mortality and Failure to Rescue after Surgery for High-Risk Neonatal Diagnoses.","authors":"Steven C Mehl, Jorge I Portuondo, Yao Tian, Mehul V Raval, Alice King, Kristy L Rialon, Adam M Vogel, David E Wesson, Sohail R Shah, Nader N Massarweh","doi":"10.1159/000533825","DOIUrl":"10.1159/000533825","url":null,"abstract":"<p><strong>Introduction: </strong>A large proportion of postoperative mortality after pediatric surgery occurs among neonates with specific high-risk diagnoses. The extent to which there is hospital-level mortality variation among patients with these diagnoses and whether this variation is associated with differences in failure to rescue (FTR) is unclear.</p><p><strong>Methods: </strong>The Pediatric Health Information System® database (2012-2020) was used to identify patients who underwent surgery for eight high-risk neonatal diagnoses: gastroschisis; volvulus; necrotizing enterocolitis; intestinal atresia; meconium peritonitis; tracheoesophageal fistula; congenital diaphragmatic hernia; and perinatal intestinal perforation. Hospitals were stratified into tertiles of reliability-adjusted inpatient mortality rates (lower than average mortality - tertile 1 [T1]; higher than average mortality - tertile 3 [T3]). Multivariable hierarchical regression was used to evaluate the association between hospital-level, reliability-adjusted mortality and FTR.</p><p><strong>Results: </strong>Overall, 20,838 infants were identified across 48 academic, pediatric hospitals. Adjusted hospital mortality rates ranged from 4.0% (95% CI, 0.0-8.2) to 16.3% (12.2-20.4). Median case volume (range, 80-1,238) and number of NICU beds (range, 24-126) were not significantly different across hospital tertiles. Compared to the hospitals with the lowest postoperative mortality (T1), the odds of FTR were significantly higher in hospitals with the highest (T3) postoperative mortality (odds ratio 1.97 [1.50-2.59]).</p><p><strong>Conclusions: </strong>Significant variation in neonatal hospital mortality for high-risk diagnoses does not appear to be explained by hospital structural characteristics. Rather, difference in FTR suggests quality improvement interventions targeting early recognition and management of postoperative complications could improve surgical quality and safety for high-risk neonatal care.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"34-45"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242751","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":"Outcomes at 18-24 Months of Infants with Birth Weight under 500 g Born in Korea during 2013-2017: A Nationwide Cohort Study.","authors":"Soo Hyun Kim, Euiseok Jung, Ha Na Lee, Jeong Min Lee, Sung Hyeon Park, Jiyoon Jeong, Byong Sop Lee, Ellen Ai-Rhan Kim, Ki-Soo Kim","doi":"10.1159/000534194","DOIUrl":"10.1159/000534194","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the outcomes of infants at 18-24 months born in the Korean Neonatal Network with a birth weight &lt;500 g.</p><p><strong>Methods: </strong>The anthropometric and neurodevelopmental data of infants with a birth weight &lt;500 g at a gestational age of ≥22 weeks who were registered in the Korean Neonatal Network 2013-2017 and followed up at a corrected age of 18-24 months were reviewed. Neurodevelopmental impairment was defined as the presence of any of the following: (1) cerebral palsy; (2) severe visual impairment; (3) hearing impairment; or (4) cognitive impairment. Cognitive impairment was defined as (1) a Bayley Scales of Infant Development-II Mental Development Index score &lt;70; and (2) Bayley Scales of Infant and Toddler Development-III Cognitive and Language Composite scores &lt;85. Cognitive testing was performed for infants with suspected problems upon clinician's referral to developmental specialists.</p><p><strong>Results: </strong>At a median corrected age of 20 months, 26/52 (50%) of included infants had neurodevelopmental impairment. Cerebral palsy, severe visual impairment, wearing of glasses, hearing impairment, and cognitive impairment occurred in 22%, 0%, 8%, 5%, and 57% of the included infants, respectively. The proportions of infants with &lt;2 standard deviations of weight, length, and head circumference were 54%, 52%, and 56%, respectively. The majority (70%) of infants were rehospitalized, and the most common cause was respiratory problems.</p><p><strong>Conclusion: </strong>Half of infants with a birth weight &lt;500 g in Korea may exhibit neurodevelopmental impairment and growth retardation at a corrected age of 18-24 months. Multidisciplinary follow-up along with continuous rehabilitation will be needed to improve neurological and physical development in this special population.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"74-80"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695563","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":"International Cohort of Neonatal Timothy Syndrome.","authors":"Alexandra Matthews, Katherine Timothy, Andy Golden, M Cecilia Gonzalez Corcia","doi":"10.1159/000535221","DOIUrl":"10.1159/000535221","url":null,"abstract":"<p><strong>Introduction: </strong>Timothy syndrome (TS) is an extremely rare, multisystem disorder classically associated with long QT, syndactyly, ventricular arrhythmias, and hypoglycaemia. A neonatal diagnosis allows maximal medical and device therapy to be implemented to avoid malignant arrhythmias and sudden cardiac death.</p><p><strong>Methods: </strong>This was a retrospective case series study of type I TS (TS1) patients using data from the Timothy Syndrome Foundation's international registry, encompassing patients with a genetic diagnosis (CACNA1C variant G406R in exon 8A) recruited over a 28-year period.</p><p><strong>Results: </strong>Forty-four cases of TS1 were included (26 male; 60%). Mean gestational age (GA) was 35.6 weeks (range 28 weeks - term), with 43% of patients born less than 37 weeks GA. In TS1 patients presenting with foetal bradycardia, mean GA was significantly lower (34.2 weeks, p &lt; 0.05). Foetal bradycardia secondary to atrioventricular block was present in 20 patients (45%), resulting in premature delivery in 14 patients (32%). Fifteen patients (34%) were diagnosed with TS1 as neonates. Long QT at birth helped secure a diagnosis in 25 patients (57%). Syndactyly was seen in most patients (n = 40, 91%). Twenty patients died, with an average age of death of 2.3 years (range 1 month-6 years). Of the 7 patients who died before the first year of life (16%), the average age of death was 2.5 months.</p><p><strong>Conclusion: </strong>TS is associated with high early mortality. TS should be considered in paediatric patients presenting with long QT and syndactyly. Recognition of TS in the neonatal period allows for early intervention to prevent life-threatening arrhythmias.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"388-395"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139428201","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":"High Flow Nasal Cannula for Weaning Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis.","authors":"Yasser Balhareth, Abdul Razak","doi":"10.1159/000536464","DOIUrl":"10.1159/000536464","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to systematically review the benefits and harms of using a high-flow nasal cannula (HFNC) for weaning continuous positive airway pressure (CPAP) support in preterm infants.</p><p><strong>Methods: </strong>Cochrane Central, EMBASE, Medline, and Web of Science were searched from inception to July 15, 2023. Randomised clinical trials (RCTs) comparing weaning CPAP using HFNC versus weaning CPAP alone and evaluating predefined outcomes were included. Two authors independently performed data extraction and methodological quality assessment. Meta-analysis was conducted using a random-effects model, and the certainty of evidence was assessed using Cochrane GRADE.</p><p><strong>Results: </strong>Among 843 identified records, seven RCTs involving 781 preterm infants were eligible for analysis. The meta-analysis found no statistically significant difference in duration of respiratory support when using HFNC for weaning compared to weaning CPAP alone (mean difference (95% confidence interval) 3.52 (-0.02, 7.05); 5 RCTs; participants = 488; I2 = 29%). The evidence certainty was downgraded to low due to study limitations and imprecision. There were no significant differences in secondary outcomes, except for a lower occurrence of nasal trauma with HFNC for weaning CPAP compared to weaning CPAP alone (relative risk (95% confidence interval) 0.61 (0.38, 0.99); 4 RCTs; participants = 335; I2 = 0%). The evidence certainty for the secondary outcomes was low to very low.</p><p><strong>Conclusion: </strong>Low certainty of evidence suggests using HFNC for weaning CPAP in preterm infants may not impact the duration of respiratory support. Caution is advised when considering HFNC for weaning CPAP, especially in extremely preterm infants, until additional supportive evidence on its safety becomes available.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"359-369"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984918","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}