Neonatology最新文献

{"title":"Effect of Cerebral Oximetry-Guided Treatment on Brain Injury in Preterm Infants as Assessed by Magnetic Resonance Imaging at Term Equivalent Age: An Ancillary SafeBoosC-III Study.","authors":"Miguel Alsina-Casanova, Mathias Lühr-Hansen, Victoria Aldecoa-Bilbao, Ruth Del Rio, Pierre Maton, Kosmas Sarafidis, Pamela Zafra-Rodriguez, Zachary Andrew Vesoulis, Emmanuele Mastretta, Ilia Bresesti, Marta Gomez-Chiari, Mónica Rebollo, Jamil Khamis, Angelos Baltatzidis, Isabel Benavente-Fernandez, Joshua Shimony, Giovanni Morana, Massimo Agosti, Nuria Carreras, Adriana Cuaresma, Ambre Gau, Athanasia Anastasiou, Simón Pedro Lubian-López, Dimitrios Alexopoulos, Paola Sciortino, Francesca Dessimone, Markus Harboe Olsen, Thais Agut, Gorm Greisen","doi":"10.1159/000539175","DOIUrl":"10.1159/000539175","url":null,"abstract":"<p><strong>Introduction: </strong>The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA).</p><p><strong>Methods: </strong>MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors.</p><p><strong>Results: </strong>A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91-0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1-4) and the usual care group (median 3, IQR: 1-4; median difference -1 to 0, 95% HLCI: -1 to 0; p value 0.1196).</p><p><strong>Conclusions: </strong>In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"38-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461446","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":"Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries.","authors":"Maha Azhar, Rahima Yasin, Sawera Hanif, Sharib Afzal Bughio, Jai K Das, Zulfiqar A Bhutta","doi":"10.1159/000542154","DOIUrl":"10.1159/000542154","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We updated evidence of Every Newborn Series published in The Lancet 2014 by ident","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"209-223"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735455","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":"European Reference Network for Inherited and Congenital Anomalies Evidence-Based Guideline on Surgical Aspects of Necrotizing Enterocolitis in Premature Neonates.","authors":"Jan Hulscher, Willemijn Irvine, Andrea Conforti, Antonio Di Cesare, Martina Ichino, Rony Sfeir, Omid Madadi Sanjani, Joanna Strohm, Maria Hukkinen, Laura Moschino, Lorenzo Norsa, Alena Kokešová, Roel Bakx, Elisabeth Kooi, Sylvia Obermann-Borst, Elena Palleri, Marijn Vermeulen, Marie Spruce, Udo Rolle, Marc Miserez, Irene de Haro Jorge, Claudia Keyzer-Dekker, Francesco Fascetti Leon, Iris den Uijl, Simon Eaton, Carmen Mesas Burgos","doi":"10.1159/000542540","DOIUrl":"10.1159/000542540","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) is a severe intestinal condition primarily affecting preterm neonates. It has a high mortality rate, particularly in infants with a birthweight of below 1,500 g or for those requiring surgical intervention. The European Reference Network for Inherited and Congenital Anomalies (ERNICA) has developed a clinical practice guideline to aid clinical decision-making pertaining to the surgical treatment and management of NEC in preterm neonates. This guideline was developed in accordance with the Guidelines 2.0 checklist and GRADE methodology. A multidisciplinary group of Europe's top experts collaborated with patient representatives to develop this guideline. After selecting critical points in care for which recommendations are required, a systematic review of the literature and critical appraisal of the evidence was performed. The Evidence to Decision framework was used as a guide to structure the consensus meetings and draft the recommendations. The panel developed seven recommendations and three good practice statements on the following topics: indications for surgery, peritoneal drainage, surgical technique, management of extensive NEC, enteral feeding, and neurodevelopmental outcomes in premature neonates with NEC. The certainty of evidence was graded as (very) low for most recommendations. However, the panel weighed up the benefits and harms in light of all relevant arguments and expert opinion. This guideline provides recommendations on caring for premature neonates with NEC. These recommendations can assist clinicians in their care decisions and can inform families on treatment options and relevant considerations. This guideline will be revised every 5 years to ensure it remains up to date.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"376-384"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384579","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":"Association of Early Nutrition with Bronchopulmonary Dysplasia Severity and Magnetic Resonance Imaging Lung Characteristics in Preterm Infants.","authors":"Ekaterina Dianova, Nara S Higano, Kera M McNelis, Shelley R Ehrlich, Chunyan Liu, Jason C Woods, Paul S Kingma","doi":"10.1159/000543605","DOIUrl":"10.1159/000543605","url":null,"abstract":"<p><strong>Introduction: </strong>Restricted fetal and neonatal growth is a known risk factor for bronchopulmonary dysplasia (BPD) in premature infants. However, the impact of nutrition and infant growth specifically on lung growth in BPD is unknown. Moreover, whether all lung growth in BPD is beneficial is unclear. We hypothesized that lung growth and development and severity of BPD directly relate to caloric and protein intake, weight gain, and linear growth of premature neonates.</p><p><strong>Methods: </strong>In this retrospective study, caloric and protein intake for the first 4 weeks of life, growth parameters along with lung volume, mass, density, and BPD severity obtained by ultrashort echo time (UTE) MRI, were analyzed.</p><p><strong>Results: </strong>The cohort included 95 neonates with mean GA 26.1 weeks and BW 790 g. Infants with grade 2 and 3 BPD had less caloric and protein intake during first 4 weeks of life vs. grade 1 BPD (96/98 vs. 106 kcal/kg/day; 3.79/3.75 vs. 3.99 g protein/kg/day; p < 0.05). UTE MRI showed that lung mass per body surface area increased with increasing BPD severity (237, 311, 384 g/m2 for grade 1, 2, and 3, respectively, p < 0.05). Increased caloric intake was associated with decreased lung mass (p = 0.02) and improved BPD score on MRI (p = 0.04).</p><p><strong>Conclusion: </strong>Decreased nutritional intake during the first 4 weeks of life appears to be associated with more severe BPD, increased lung mass and more severe lung disease on MRI.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"319-328"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026061","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":"Urinary Lactate-To-Creatinine Ratio during the First Days of Life Correlates with the Degree of Brain Damage in Premature Infants.","authors":"Magdalena Zasada, Marta Olszewska, Aleksandra Kowalik, Joanna Berska, Jolanta Bugajska, Paulina Karcz, Izabela Herman-Sucharska, Przemko Kwinta","doi":"10.1159/000542793","DOIUrl":"10.1159/000542793","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This study aimed to assess the association between the urinary lactate-to-creatinine ratio (ULCR) and brain spectroscopy (1H-MRS) findings in very low gestational age (VLGA) infants with and without preterm brain injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Urine samples were collected from 54 VLGA infants during the first week of life, after 1 month of life, and at term-equivalent age (TEA). Urinary lactate was measured via highly selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a quantitative organic acid analysis kit and expressed as the ULCR. Magnetic resonance imaging and 1H-MRS were performed at TEA. The Kidokoro grading system was used to assess the Global Brain Abnormality Score (GBAS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VLGA infants with a GBAS moderate + severe had higher ULCRs on the 2nd and 3rd days of life (DOLs) than those with a GBAS normal or mild. Only the GBAS moderate + severe subgroup presented with a secondary increase in the ULCR on the 3rd DOL, whereas in the GBAS normal or mild, the ULCR oscillated around similar values or gradually decreased. Significant positive correlations were detected between the ULCR on the 3rd DOL and the lactate/creatinine and lactate/N-acetyl aspartate ratios measured via 1H-MRS at TEA (r = 0.308; p = 0.022 and r = 0.334; p = 0.013, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;An increased ULCR during the first 3 DOLs in patients with a GBAS moderate + severe suggest an energy catastrophe that may play a role in the development of premature brain injury. Serial measurement of the ULCR during the first DOLs may help in the early identification of premature infants at risk for moderate + severe brain damage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This study aimed to assess the association between the urinary lactate-to-creatinine ratio (ULCR) and brain spectroscopy (1H-MRS) findings in very low gestational age (VLGA) infants with and without preterm brain injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Urine samples were collected from 54 VLGA infants during the first week of life, after 1 month of life, and at term-equivalent age (TEA). Urinary lactate was measured via highly selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a quantitative organic acid analysis kit and expressed as the ULCR. Magnetic resonance imaging and 1H-MRS were performed at TEA. The Kidokoro grading system was used to assess the Global Brain Abnormality Score (GBAS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VLGA infants with a GBAS moderate + severe had higher ULCRs on the 2nd and 3rd days of life (DOLs) than those with a GBAS normal or mild. Only the GBAS moderate + severe subgroup presented with a secondary increase in the ULCR on the 3rd DOL, whereas in the GBAS normal or mild, the ULCR oscillated around similar values or gradually decreased. Significant positive correlations were detected between the ULCR on the 3rd DOL and the lactate/creatinine and lactate/N-a","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"222-231"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808920","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":"Less Invasive Surfactant Administration in Preterm Infants in Tertiary Neonatal Intensive Care Units in Germany: A Survey.","authors":"Christian A Maiwald, Axel R Franz, Christian F Poets, Laila Springer","doi":"10.1159/000539302","DOIUrl":"10.1159/000539302","url":null,"abstract":"<p><strong>Introduction: </strong>The European guideline for treatment of respiratory distress syndrome recommends less invasive surfactant administration (LISA) as the preferred method of surfactant administration in spontaneously breathing preterm infants. However, there is limited evidence on practical aspects such as sedation and catheter types, leading to considerable variability between centers.</p><p><strong>Methods: </strong>An anonymous online survey (<ext-link ext-link-type=\"uri\" xlink:href=\"http://www.soscisurvey.de\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">www.soscisurvey.de</ext-link>) was sent to 164 tertiary neonatal intensive care units (NICUs) in Germany including 43 questions on practical aspects of LISA.</p><p><strong>Results: </strong>Of 122 (74%) participating NICUs, 117 (96%) reported experience with LISA with 82% of those reporting LISA as their preferred method of surfactant administration. Indications for surfactant administration differed widely between NICUs. Most (89%) used FiO2-thresholds only or in combination with other criteria, such as Silverman score/signs of dyspnea (41%) or lung ultrasound findings (3%). Prophylactic surfactant was administered by 42%. Differences in use of LISA in extremely immature infants were reported (e.g., 36% did not perform LISA in infants below 24-26 weeks). Preferred drugs for sedation were (Es-)Ketamine, followed by Propofol and Midazolam. Minimum time interval between subsequent LISA procedures was 4 (2-6) h. Catheters specifically designed for LISA were used by most NICUs (69%).</p><p><strong>Conclusion: </strong>This survey shows that LISA is common practice in German NICUs, but with considerable variability in practical aspects. These data may serve as a guidance for NICUs that have not yet implemented LISA and might be helpful design clinical trials with the aim to standardize and/or optimize LISA.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"46-55"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636353","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":"Post-Asphyxial Aftercare and Management of Neonates in Low- and Middle-Income Countries: A Systematic Evidence Synthesis.","authors":"Oviya Muralidharan, Sarah Rehman, Davneet Sihota, Leila Harrison, Tyler Vaivada, Zulfiqar A Bhutta","doi":"10.1159/000541862","DOIUrl":"10.1159/000541862","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift toward prevention, and strategies that emphasize improving antenatal and obstetric care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"84-105"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635121","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":"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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"366-375"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545481","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":"Near-Term and Intrapartum Care of Mothers for Perinatal and Newborn Outcomes.","authors":"Rahima Yasin, Maha Azhar, Hamna Amir Naseem, Ayesha Arshad Ali, Jai K Das, Zulfiqar A Bhutta","doi":"10.1159/000543384","DOIUrl":"10.1159/000543384","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Near-term and intrapartum care play pivotal roles in ensuring a safe childbirth experience and are essential components of a comprehensive approach to maternal and neonatal health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The following interventions were identified: antibiotics for preterm premature rupture of membrane, antenatal corticosteroids for fetal lung maturation, partograph use during labor and delivery, induction of labor at or post-term, skilled birth care and safe childbirth checklist during labor and delivery. A scoping exercise was conducted to ascertain the most up-to-date evidence, and reviews of topics of interest were updated in case the evidence was not recent, with a focus on low- and middle-income countries (LMICs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Antibiotics reduced the overall risk of neonatal infection including pneumonia (RR 0.67 [0.52 to 0.85]). LMIC evidence showed a significant effect of antenatal steroids on the risk of neonatal mortality (RR 0.64 [0.43 to 0.97]) and respiratory distress syndrome (RR 0.65 [0.44 to 0.96]). Induction of labor practices at term or post-term reduced the risk of meconium aspiration syndrome (RR 0.51 [0.34 to 0.76]). The use of the WHO childbirth checklist significantly raised the standard of preeclampsia care (OR 8.09 [2.55 to 25.63]) as well as of maternal infection management (OR 25.44 [4.09 to 158.08]). LMIC-specific evidence also demonstrated a significant reduction in the risk of stillbirth (OR 0.92 [0.87 to 0.96]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Further research initiatives pertaining to health interventions delivered to expectant mothers near-term or during the intrapartum period can contribute to a more inclusive understanding of health challenges in LMICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Near-term and intrapartum care play pivotal roles in ensuring a safe childbirth experience and are essential components of a comprehensive approach to maternal and neonatal health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The following interventions were identified: antibiotics for preterm premature rupture of membrane, antenatal corticosteroids for fetal lung maturation, partograph use during labor and delivery, induction of labor at or post-term, skilled birth care and safe childbirth checklist during labor and delivery. A scoping exercise was conducted to ascertain the most up-to-date evidence, and reviews of topics of interest were updated in case the evidence was not recent, with a focus on low- and middle-income countries (LMICs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Antibiotics reduced the overall risk of neonatal infection including pneumonia (RR 0.67 [0.52 to 0.85]). LMIC evidence showed a significant effect of antenatal steroids on the risk of neonatal mortality (RR 0.64 [0.43 to 0.97]) and respiratory distress syndrome (RR 0.65 [0.44 to 0.96]). Induction of labor practices at term or post-term reduced the risk of meconium aspiration syndrome (RR 0.51 [0.34 to 0.76]).","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"42-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019218","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":"Neonatal Outcomes following 2 Cases of Maternal CAR-T Therapy for High-Grade B-Cell Lymphoma.","authors":"Daniel O'Reilly, Charlotte Jones, Aisling Smith, David Mackin, Laura Mc Donald, John Quinn, Maeve O'Reilly, Aisling M Flinn, Ronan Leahy, David Williams, Jennifer Donnelly, David Corcoran","doi":"10.1159/000542016","DOIUrl":"10.1159/000542016","url":null,"abstract":"<p><strong>Introduction: </strong>Chimeric antigen receptor T cells (CAR-Ts) targeting CD19 represent a significant advance in treatment for patients with relapsed/refractory B-cell malignancies. Although a significant minority of recipients are women during their reproductive years, there is a paucity of data regarding pregnancy and neonatal outcomes in women previously treated with CAR-T. This is important as maternal T cells are known to cross the placenta and into breastmilk during pregnancy and breastfeeding, respectively.</p><p><strong>Case presentation: </strong>Here we present two successful pregnancies following CAR-T therapy where both neonates were initially breastfed. These represent the first cases of neonates born following CAR-T therapy comprehensively described in medical literature.</p><p><strong>Conclusion: </strong>Pregnancy following CAR-T therapy does not appear to be associated with adverse neonatal outcomes. Further work is required to delineate the outcomes in this population.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"146-150"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607632","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}