Neonatology最新文献

{"title":"Diuretics for Preventing Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-Analysis.","authors":"Shin Kato, Masato Koizumi, Jun Nirei, Katsuaki Honda, Akio Ishiguro, Mutsumi Yamazaki, Tetsuya Isayama","doi":"10.1159/000553435","DOIUrl":"10.1159/000553435","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials (RCTs) have not demonstrated that diuretics prevent bronchopulmonary dysplasia (BPD), but recent observational studies warrant an updated synthesis. We evaluated the preventive effects and safety of diuretics in preterm infants at risk of developing BPD.</p><p><strong>Methods: </strong>MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched through June 2025. We included randomized and non-randomized studies of various diuretic classes with different routes, dosing regimens, and treatment durations. The risk of bias was assessed using the RoB 2 and ROBINS-I and the certainty of evidence using GRADE. Random-effects models were used to calculate the risk ratios and 95% confidence intervals.</p><p><strong>Results: </strong>Forty studies, including six RCTs, were analyzed. Furosemide was the most frequently used diuretic. The RCTs predominantly focused on short-term changes in lung mechanics and did not demonstrate any preventive effect of diuretics on BPD. The meta-analysis showed no significant effects of diuretics on death or BPD (RR, 1.10; 95% CI, 0.77-1.59) or mortality (RR, 0.44; 95% CI, 0.19-1.04). Electrolyte abnormalities were not significantly increased (RR, 1.51; 95% CI, 0.81-2.83). Non-randomized studies have reported a potential reduction in BPD occurrence. However, the overall certainty of the evidence is low to very low due to the small sample sizes and confounding.</p><p><strong>Conclusion: </strong>The current evidence does not confirm that diuretics prevent BPD. Given the uncertainty of the current evidence and the favorable safety profiles, adequately powered RCTs are needed to explore the potential role of diuretics in BPD prevention.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-17"},"PeriodicalIF":3.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427757","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":"NeoCardioLab: A Digital Platform for Neonatal Hemodynamics Education.","authors":"Gabriel Altit","doi":"10.1159/000553491","DOIUrl":"10.1159/000553491","url":null,"abstract":"<p><strong>Introduction: </strong>Targeted neonatal echocardiography and neonatal hemodynamics are increasingly integrated into neonatal intensive care practice. However, access to structured, standardized educational resources and reference tools remains variable across settings. We aimed to describe the global reach, patterns of utilization, and perceived educational value of NeoCardioLab, a digital platform designed for neonatal hemodynamics education and support.</p><p><strong>Methods: </strong>We conducted a descriptive, mixed-methods study combining retrospective analysis of anonymized usage data from January 2019 to June 2025 with a cross-sectional anonymous online survey conducted from December 2024 to July 2025. Data sources included Google Analytics, App Store Connect, Calconic, and YouTube analytics. Survey responses captured user demographics, utilization patterns, and perceived educational value.</p><p><strong>Results: </strong>NeoCardioLab reached 98,004 active users across 203 countries between April 2022 and June 2025, with 342,911 page views and 5,861 mobile application downloads. English (75%), Spanish (6%), and French (5%) were the most common user languages from browser settings. Calculator tools were accessed 1,951 times over a 12-month period. Among 128 survey respondents (59% neonatologists), 84% reported increased confidence in neonatal hemodynamics, and perceived usefulness was noted for modules on pulmonary hypertension, congenital heart disease, and congenital diaphragmatic hernia. Reported impacts reflect self-perceived influence on knowledge and practice.</p><p><strong>Conclusions: </strong>Our results suggest that NeoCardioLab has broad global reach and sustained user engagement as an open-access digital platform for neonatal hemodynamics. These findings support a potential role as a complementary educational resource and knowledge translation tool across diverse educational settings in neonatology.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-11"},"PeriodicalIF":3.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427770","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":"Standardised versus Individualised Fortification of Expressed Breastmilk for Preterm Outcomes: A Systematic Review and Meta-Analysis.","authors":"Chloe Mary Bell, Barbara Elizabeth Cormack, Mariam Buksh, Frank H Bloomfield, Luling Lin","doi":"10.1159/000553366","DOIUrl":"10.1159/000553366","url":null,"abstract":"<p><strong>Introduction: </strong>Although the precise nutrient requirements of preterm infants remain uncertain, routine human milk fortification is standard practice despite limited evidence of long-term benefit. Whether current fortification strategies optimally balance benefits, risks, and resource use remains unclear. This review evaluates whether individualised fortification improves preterm infant outcomes.</p><p><strong>Methods: </strong>Randomised controlled trials comparing individualised with standardised fortification were included, evaluating outcomes including mortality, neurodevelopment, growth, and neonatal morbidities. Four databases and three trial registries were searched. Screening, data extraction, and quality assessment were conducted independently by two reviewers using Cochrane Risk of Bias-1 tool. Certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>Twelve studies including 575 participants were included. Evidence is very uncertain about the effect of individualised fortification on mortality [181 infants, relative risk (RR) 0.20, 95% confidence interval (CI) (0.02, 1.66), p = 0.14, I2 = 0%] and necrotising enterocolitis [193 infants, RR 0.29 (0.05, 1.72), p = 0.17, I2 = 0%], both very low certainty. Effect on neurodevelopment at 18 months remains very uncertain. Individualised fortification likely increases head circumference [224 infants, mean difference (MD) 1.76 (0.76, 2.76) mm/week, p = 0.0005, I2 = 52%], weight gain [454 infants, MD 2.87 (1.36, 4.39) g/kg/day, p < 0.0002, I2 = 79%], length gain [261 infants, MD 3.20 (1.22, 5.18) mm/week, p = 0.002, I2 = 81%] and fat-free mass [106 infants, MD 121.4 (25.6, 217.2) g, p = 0.01, I2 = 0], all with moderate-certainty. It may increase fat mass [106 infants, MD 68.9 (6.1, 131.8) g, p = 0.03, I2 = 63%] with low certainty.</p><p><strong>Conclusion: </strong>Individualised fortification likely increases growth in preterm infants; however, whether this is beneficial to clinical and long-term functional health is uncertain. Further high-quality trials with long-term follow-up are needed.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-19"},"PeriodicalIF":3.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378845","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":"Prospective Economic Evaluation Ancillary to a Trial of Higher versus Lower Hemoglobin Transfusion Thresholds for Preterm Infants.","authors":"John A F Zupancic, Brian C King, Meredith Mowitz, Wenyang Mao, Dmitry Dukhovny, Barbara Schmidt, Sylvia Tan, Aasma S Chaudhary, Margaret M Crawford, Edward F Bell, Jeanette O'Donnell Auman, Michele C Walsh, Rosemary D Higgins, Abhik Das, Haresh Kirpalani","doi":"10.1159/000551672","DOIUrl":"10.1159/000551672","url":null,"abstract":"<p><strong>Introduction: </strong>The Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants randomized trial compared higher versus lower hemoglobin transfusion thresholds in extremely low birth weight infants. This publication compares the economic implications of the two strategies.</p><p><strong>Methods: </strong>We undertook a prospectively planned economic evaluation, using patient-level data from the parent clinical trial. We report costs in 2020 US dollars, from health sector and modified societal perspectives, with a time horizon through the end of clinical follow-up. We derived costs from hospital finance systems, Medicaid fee schedules, family questionnaires, and efficacy from trial data.</p><p><strong>Results: </strong>Of the 1,824 patients enrolled at 19 centers in the trial, data were available for 1,305 for analysis from a health sector perspective and 752 for analysis from a societal perspective. The mean cost from the health sector perspective was USD 331,186 per patient in the higher hemoglobin transfusion threshold group and USD 351,579 in the lower hemoglobin transfusion threshold group; the difference was not statistically significant after adjustment for study site and birth weight stratum (p = 0.085). The difference in mean costs from the societal perspective was also not statistically significant (p = 0.094). The incremental cost-effectiveness ratios for adoption of a lower transfusion threshold from health sector and societal perspectives were USD 6,797,666 and USD 5,596,666 per additional survivor without neurodevelopmental impairment, respectively. There was substantial uncertainty in these cost-effectiveness estimates.</p><p><strong>Discussion: </strong>Similarly to prior results for clinical efficacy, choosing between a lower or higher hemoglobin transfusion threshold for extremely preterm infants has no significant economic advantage.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-12"},"PeriodicalIF":3.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355137","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":"Mechanisms of Injury from Environmental Exposures in the Neonatal Intensive Care Unit Impacting Neurodevelopmental Outcomes for Neonates.","authors":"Ryan Kilpatrick, Neha Chaudhary, Chioma Eze-Njoku, Nandita Meharwal, Rachana Singh","doi":"10.1159/000553267","DOIUrl":"10.1159/000553267","url":null,"abstract":"<p><strong>Background: </strong>Technological advancement in neonatal-perinatal care has improved the survival of critically ill neonates with complex medical and surgical conditions. As part of diagnostic and therapeutic management, these vulnerable neonates are exposed to potential harmful and unintended exposures in the NICU, including diagnostic imaging, sensory environments, medications, nutrition, blood products, and devices.</p><p><strong>Summary: </strong>The negative effects on multiple organs at cellular levels can not only impact the growth, development, and neurocognitive outcomes for the neonate but have the potential of being transmitted to future generations through epigenetic changes. Families, nurses, clinicians, and researchers invested in improving neonatal outcomes need to be aware of these negative impacts.</p><p><strong>Key message: </strong>Concerted efforts should focus on eliminating known toxic and harmful substances from commercial products used in neonatal care, and alternatives should be made available. Generational population health globally from early neonatal period to adulthood can be improved by allocating resources to research and mitigation strategies.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321368","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":"The Effect of Liberal versus Restrictive Haemoglobin Thresholds on Cerebral Tissue Oxygenation in Preterm Infants: A Systematic Review and Meta-Analysis.","authors":"Danielle N Bailey, Amelia N Noone, Tara M Crawford, Chad C Andersen, Michael J Stark","doi":"10.1159/000553042","DOIUrl":"10.1159/000553042","url":null,"abstract":"<p><strong>Introduction: </strong>Near-infrared spectroscopy (NIRS) is emerging as a promising method of assessing individualized cerebral oxygenation responses to red blood cell (RBC) transfusion. However, the impact of liberal (high) versus restrictive (low) haemoglobin thresholds on transfusion-related changes in cerebral tissue oxygenation (crSO₂) remains unclear. This meta-analysis compares cerebral oxygenation changes in preterm neonates following transfusion with liberal compared to restrictive haemoglobin thresholds.</p><p><strong>Methods: </strong>Data were extracted (PubMed/MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews) and risk of bias and certainty of evidence reviewed. Included studies reported changes in cerebral oxygenation in preterm infants receiving RBCs in response to reaching either a liberal or restrictive transfusion threshold. A random-effects model was used to determine effect size and 95% confidence for the primary outcome of change in crSO₂.</p><p><strong>Results: </strong>Forty-three full-text articles were assessed for eligibility with 7 studies included for meta-analysis (restrictive threshold: n = 357, liberal threshold: n = 220). crSO₂ increased following transfusion in both the restrictive (6.40% 95% CI [3.85, 8.95], p < 0.001) and liberal (2.75% 95% CI [0.35, 5.14], p = 0.03) groups. However, the magnitude of change was greater for those transfused at a restrictive threshold (Q = 4.19, df = 1, p = 0.04). The restrictive group also demonstrated a greater transfusion-related decrease in cerebral fractional oxygen extraction than the liberal group (Q = 8.30, df = 1, p < 0.001).</p><p><strong>Conclusion: </strong>Greater improvements to cerebral oxygenation occurred in preterm neonates with a restrictive threshold, suggesting enhanced physiological benefit in response to transfusion. However, meaningful clinical conclusions are limited due to low certainty of evidence and considerable inconsistencies across reporting.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-11"},"PeriodicalIF":3.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280538","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 Total versus Conventional Feeding between 27 and 32 Weeks' Gestation: A Randomized Controlled Trial.","authors":"Sushma Nangia, Shriya Akanksha, Gunjana Kumar, Tapas Bandyopadhyay, Pratima Anand","doi":"10.1159/000551793","DOIUrl":"10.1159/000551793","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to compare the time of attainment of full enteral feeds in sick neonates between 27 and 32 weeks of gestation receiving early total enteral feeding (ETEF) versus conventional enteral feeding (CEF).</p><p><strong>Methods: </strong>In this randomized controlled trial, 183 infants were allocated to either the ETEF (n = 90) or CEF (n = 93) group. In the ETEF group, feeding was initiated as complete enteral feeds, whereas in the CEF group, feeding was initiated as trophic feeding at 20 mL/kg. The rest of the day's requirements for the CEF group were provided as intravenous fluids.</p><p><strong>Results: </strong>The ETEF group infants had marginally higher mean birth weight, slightly greater gestational age, fewer infants with SGA at birth, and a lesser need for resuscitation, although these differences were not statistically significant. The neonates in the ETEF group reached full enteral feeds significantly earlier than the CEF group (6.8 ± 1.8 vs. 9.1 ± 4.3 days postnatal age; mean difference -2.3 [-3.2 to -1.3]; p < 0.001). There was a significant reduction in the episodes of feed intolerance and clinical or probable sepsis with significantly higher weight gain at 1 month of age (17.4 vs. 15.5 g/kg/d; p = 0.001), and a shorter duration of hospital stay (25.9 vs. 38.1 days; p = 0.001) in the ETEF as compared to the CEF group. None of the neonates in the ETEF group developed necrotizing enterocolitis (NEC).</p><p><strong>Conclusion: </strong>ETEF in sick neonates between 27 and 32 weeks' gestation leads to early attainment of full feeds without increasing the incidence of feed intolerance and NEC. This feeding practice also reduces pre-maturity-associated complications and the duration of hospital stay.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274365","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 Metabolic Alterations Are Associated with Intraventricular Hemorrhage and Its Complications in Very Preterm Infants.","authors":"Aviv Schupper, Brian Reichman, Inna Zaslavsky-Paltiel, Shlomo Almashanu, Nadav Sagiv, Dan Coster, Iris Morag, Liat Lerner-Geva, Haim Bassan","doi":"10.1159/000552886","DOIUrl":"10.1159/000552886","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to identify early metabolic alterations associated with intraventricular hemorrhage (IVH) and its complications, periventricular hemorrhagic infarction (PVHI), and post-hemorrhagic ventricular dilatation (PHVD), in very preterm infants.</p><p><strong>Methods: </strong>This population-based observational cohort included 7,313 preterm infants born at 24-32 weeks' gestation between 2009 and 2019. Twenty-one analytes were quantified from dried blood samples collected within the first 96 h of life using tandem mass spectrometry. Multivariable logistic regression models were used to examine the association between analyte concentration quartiles and IVH, including analysis stratified by IVH-related complications.</p><p><strong>Results: </strong>IVH was diagnosed in 882 infants, while 6,431 had normal neurosonography. Compared with infants in the lowest quartile, those in the highest quartile of methionine and proline concentrations had increased odds of IVH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.21-1.86 and OR 1.74, 95% CI: 1.40-2.17, respectively). In contrast, infants in the highest quartile of free carnitine concentrations had significantly lower odds of IVH (OR 0.53, 95% CI: 0.42-0.67). These associations were more pronounced among infants with PVHI (n = 149) and PHVD (n = 152) (p < 0.001).</p><p><strong>Conclusion: </strong>Among very preterm infants, higher methionine and proline concentrations within the first 96 h of life were associated with increased risks of IVH and its complications, whereas higher free carnitine concentrations were associated with lower risks. Whether these metabolic alterations reflect secondary responses to ischemic-hemorrhagic brain injury or act as modulators of germinal matrix vulnerability warrants further investigation.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-11"},"PeriodicalIF":3.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213916","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 Outcome up to 5 Years after Isolated Mild Non-Cystic White Matter Injury in Very Preterm Infants.","authors":"Barbara Hofer, Elke Griesmaier, Nina Gande, Anna Staudt, Ulrike Pupp Peglow, Ursula Kiechl-Kohlendorfer, Vera Neubauer","doi":"10.1159/000552747","DOIUrl":"10.1159/000552747","url":null,"abstract":"<p><strong>Introduction: </strong>Mild non-cystic white matter injury (WMI) is commonly detected on MRI in very preterm infants, but its prognostic significance remains uncertain. We assessed neurodevelopmental outcomes up to 5 years in infants with isolated mild non-cystic WMI on term-equivalent MRI compared with those without brain injury.</p><p><strong>Methods: </strong>In this population-based retrospective cohort study, infants born <32 gestational weeks in Tyrol, Austria (2011-2018), were included. MRI was performed at term-equivalent age. Infants with isolated mild non-cystic WMI (Kidokoro PVL grade 1-2) and those without brain injury were analysed. Neurodevelopmental outcomes were assessed at 12 and 24 months' corrected age using the Bayley Scales and at 5 years using standardized cognitive tests (WPPSI-III, KABC-II, SON-R) and the MABC-2.</p><p><strong>Results: </strong>Of 363 infants, 35 (9.6%) had isolated mild non-cystic WMI. Median cognitive and motor scores were within the normal range in both groups at all time points, with no significant differences, although cognitive scores were numerically higher in the WMI group at 12 months (p = 0.087). Rates of developmental delay (<85) and impairment (<70) did not differ between groups. All infants with isolated mild non-cystic WMI were born at ≥28 gestational weeks; findings were consistent in this subgroup.</p><p><strong>Conclusion: </strong>Isolated mild non-cystic WMI was not associated with adverse neurodevelopmental outcomes up to 5 years. In settings with routine MRI at term-equivalent age, these findings suggest that isolated mild non-cystic WMI may have limited prognostic value and should not be overinterpreted as markers of adverse outcome in clinical counselling.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-10"},"PeriodicalIF":3.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166311","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":"Oxygen Saturation Targeting and Retinopathy Management in Very Preterm Neonates: An International Survey.","authors":"Brian A Darlow, Elizabeth M Hurrion, Malcolm Battin, Mikael Norman, Mark Adams, Alina Kowalczykiewicz-Kuta, Tetsuya Isayama, Gil Klinger, Laura San Feliciano, Valerie Biran, Marco Moroni, Jamil Pedro de Siqueira Caldas, Dirk Bassler, Satoshi Kusuda, Maximo Vento, Brian Reichman, Neha Goswami, Prakesh S Shah, Kei Lui","doi":"10.1159/000552726","DOIUrl":"10.1159/000552726","url":null,"abstract":"<p><strong>Introduction: </strong>Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units (NICUs) might contribute to clinical variability. The objective was to survey current oxygen saturation targets (SpO₂), the use of automatic adjustment of inspired oxygen in infants on respiratory support, the criteria for routine retinal examinations for retinopathy of prematurity (ROP), and the use of anti-vascular endothelial growth factor (VEGF) agents to treat ROP in the International Network for Evaluating Outcomes for Neonates (iNeo).</p><p><strong>Methods: </strong>Online pre-piloted anonymous questionnaires on care practices in 2023 for extremely preterm (<29 weeks) infants were sent to the directors of 608 NICUs in the iNeo. Four questions concerned ROP management and results were compared with a similar 2015 survey.</p><p><strong>Results: </strong>There were 11 participating networks from 12 high-income countries and one from a middle-income country. The overall NICU response rate was 63% (382 units). Despite variability between NICUs, within networks, there was limited change in SpO₂ targets between 2015 and 2023. The median upper and lower SpO₂ targets were 95% and 89%; in 18% of NICUs, the upper target was ≥96%, and in 13%, the lower target was ≤85%. Automated loop systems for controlled oxygen delivery were used in 24% of NICUs. Most NICUs (78%) used a combination of birthweight and gestation as ROP screening criteria. Intravitreal anti-VEGF agents were used to treat ROP in all networks and by 76% of NICUs.</p><p><strong>Discussion: </strong>There was considerable variation in care practices between NICUs, and the relationship of this to clinical outcomes should be explored.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13363109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019693","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}