Neonatology最新文献

{"title":"Third-Trimester Development of Central Autonomic Network Connectivity Is Altered in an Extrauterine Environment.","authors":"Kelsey Christoffel, Josepheen De Asis Cruz, Kevin Michael Cook, Kushal Kapse, Nickie Andescavage, Sudeepta Basu, Catherine Limperopoulos, Adre du Plessis","doi":"10.1159/000543277","DOIUrl":"10.1159/000543277","url":null,"abstract":"<p><strong>Introduction: </strong>The central autonomic network (CAN), which involves complex interconnected brain regions that modulate the autonomic nervous system, may be key to understanding higher risk for psychosocial and behavioral challenges in preterm neonates.</p><p><strong>Methods: </strong>We compared resting-state functional connectivity of the CAN in 94 healthy term-born controls and 94 preterm infants at term-equivalent age. In preterm infants, we correlated CAN connectivity with postmenstrual age (PMA). The preterm cohort underwent the Infant-Toddler Social and Emotional Assessment at 18-month follow-up, and these scores were correlated with CAN connectivity.</p><p><strong>Results: </strong>CAN connectivity at the amygdala (p < 0.001), hippocampus (p < 0.001), insula (p < 0.001), brainstem (p = 0.003), and thalamus (p = 0.032) was significantly higher in term (n = 94) than preterm (n = 94) neonates. In preterm neonates, CAN connectivity positively correlated with PMA at the thalamus (r = 0.438, p < 0.001), insula (r = 0.304, p < 0.001), precuneus (r = 0.288, p < 0.001), hippocampus (r = 0.283, p < 0.001), and amygdala (r = 0.142, p = 0.034). At 18-month follow-up (n = 30, mean age 19.8 ± 3.4 months), CAN connectivity at the insula was negatively correlated with externalizing behaviors (r = -0.529, p = 0.003).</p><p><strong>Conclusion: </strong>In preterm neonates, the CAN evolves dynamically over the extrauterine third trimester and is measurably different compared to term-born neonates in ways that impact developmental outcomes. This is the first study to describe CAN connectivity using resting-state functional MRI in large cohort of term and preterm neonates and to report an association of CAN connectivity and behavioral outcomes.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"302-310"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923309","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":"\"Flux in the Belly:\" A History of Infantile Gastroenteritis.","authors":"Michael Obladen","doi":"10.1159/000540886","DOIUrl":"10.1159/000540886","url":null,"abstract":"<p><strong>Background: </strong>Although a major cause of infant mortality for centuries, little research was done on the causes of infants' diarrhea. Artificial feeding, teething, and summer heat were believed to cause the severe disease that spared breastfed infants.</p><p><strong>Summary: </strong>Since antiquity, infants' digestive disorders were termed dyspepsia, flux of the belly, diarrhea, gastroenteritis, watery gripes, the runs, dysentery, or cholera, without definitions. Alois Bednar discerned 3 grades (dyspepsia, diarrhea, and cholera) of the same disease. Infants' neurologic symptoms were interpreted as alimentary toxicosis. Chronic diarrhea caused emaciation and dehydration. In 1950, Laurence Finberg found diarrhea with hypernatremia causing cerebral damage. Seasonal influence was known since Hippocrates. Baudelocque recommended obtaining infant milk fresh from the cow because it decomposes in the summer heat. In the cities, summer diarrhea caused a third of total infant mortality. Physicians debated whether heat acted directly on the infant or spoiled the food. The discovery of microorganisms in the 1860s revolutionized medical understanding. However, influential researchers such as Adalbert Czerny classified nutritional disturbances by assumed pathogenesis (\"ex alimentation, ex infection, ex constitution\"), but denied the possibility of bacterial infection via milk. Heating baby food, practiced for centuries, was introduced in Denmark, Sweden, and France, whereas in Britain and Germany, professional and public debate on pasteurization persisted.</p><p><strong>Key messages: </strong>It took half a century to implement effective hygienic measures once the bacterial origin became known. Foodborne infection was rejected, and the prejudice that raw milk possesses essential \"living\" properties, adopted by influential scientists, contributed to delaying pasteurization.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"11-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335368","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":"Reply to Letter to the Editor by Maiwald et al. on \"Less Invasive Surfactant Administration for Preterm Infants - State of the Art\".","authors":"Christoph Härtel, Angela Kribs, Wolfgang Göpel, Peter A Dargaville, Egbert Herting","doi":"10.1159/000542819","DOIUrl":"10.1159/000542819","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"253-254"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741770","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":"Immediate Care for Common Conditions in Term and Preterm Neonates: The Evidence.","authors":"Li Jiang, Georgia Dominguez, Aoife Cummins, Oviya Muralidharan, Leila Harrison, Tyler Vaivada, Zulfiqar A Bhutta","doi":"10.1159/000541037","DOIUrl":"10.1159/000541037","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns &lt;32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages: &lt;/strong&gt;We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns &lt;32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia i","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"106-128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635110","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":"Fifteen Years of Neonatal Therapeutic Hypothermia: Clinical Trends Show Unchanged Post-Rewarming Outcomes despite Reduction in Hypoxic-Ischemic Encephalopathy Severity.","authors":"Bregje O van Oldenmark, Andrea van Steenis, Linda S de Vries, Floris Groenendaal, Sylke J Steggerda","doi":"10.1159/000541472","DOIUrl":"10.1159/000541472","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoxic-ischemic encephalopathy (HIE) affects 1-2 per 1,000 births and is associated with mortality and long-term neurodevelopmental challenges. At present, therapeutic hypothermia (TH) is the only neuroprotective intervention for these infants. This study examines whether HIE severity, clinical management during TH, and post-rewarming outcomes have changed since its introduction 15 years ago.</p><p><strong>Methods: </strong>Neonatal characteristics, HIE severity, management during TH, and post-rewarming MRI of all infants with HIE undergoing TH between 2008 and 2023 were compared across three five-year epochs. Linear regression was used to estimate annual changes over time.</p><p><strong>Results: </strong>In total, 252 infants underwent TH. Median gestational age (39.5 weeks), birth weight (3,376 g), and time to start TH (4.25 h) remained stable over time. Apgar score at 5 min (p = 0.031) and lowest pH <1 h postpartum (p = 0.020) increased over time. Thompson score at 1-3 h decreased across epochs (p = 0.046). There was an increase in percentage with normal-mild aEEG background patterns on admission (p = 0.041) and a decrease in aEEG-confirmed seizures (p < 0.001) and antiseizure medication (p < 0.001). Inotropic support decreased (p = 0.007), and use of invasive mechanical ventilation decreased over the last 5 years. Mortality (28.6%) and post-rewarming composite adverse outcome (i.e., neonatal mortality and/or adverse MRI score) (37.9%) remained unchanged. Number of infants seen at 2-year follow-up increased (p < 0.001).</p><p><strong>Conclusion: </strong>Over the last 15 years, we treated more infants with milder HIE, as indicated by lower Thompson and milder aEEG scores, and the need for invasive cardiorespiratory support declined. However, there were no improvements in composite adverse outcome (mortality and/or adverse MRI score).</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"191-201"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515551","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":"Neurodevelopmental Changes and Postnatal Growth in the First 3 Years of Extremely Preterm Infants.","authors":"Yuka Matsunaga, Hirosuke Inoue, Yuta Miyauchi, Takahide Watabe, Kazuaki Yasuoka, Toru Sawano, Masayuki Ochiai, Yasunari Sakai, Shouichi Ohga","doi":"10.1159/000541129","DOIUrl":"10.1159/000541129","url":null,"abstract":"<p><strong>Introduction: </strong>Infants born extremely preterm are at high risk for neurodevelopmental problems. However, their neurodevelopment exhibits a variety of trajectories. This study aimed to investigate the association between changes in neurodevelopmental outcomes and clinical characteristics among extremely preterm infants.</p><p><strong>Methods: </strong>This is a retrospective study of surviving children born at gestational age 22-28 weeks in Kyushu University Hospital between 2010 and 2020. We collected perinatal and post-discharge data and investigated the association between clinical characteristics and changes in developmental quotient (DQ) scores between 1.5 and 3 years of corrected age.</p><p><strong>Results: </strong>Out of the 179 eligible extremely preterm infants, 115 (64%) underwent neurological evaluations at 1.5 and 3 years of corrected age. Among them, 33 (29%) showed improvement in their DQ scores (+10 or more), 62 (54%) showed no change (-9 to +9), and 20 (17%) showed a decline (-10 or less). Gestational age, birth weight, and perinatal complications during the NICU stay did not affect individual changes in DQ scores. Multivariable analysis revealed that greater growth in height until age 3 years was a significant predictor of increasing DQ scores, while male sex and having siblings had a negative effect on changes in the DQ scores.</p><p><strong>Conclusion: </strong>We first demonstrate clinical data conceptualizing that growth in height, sex, and sibling status, rather than perinatal complications, are biologically linked with favorable or unfavorable neurodevelopmental changes of extremely preterm infants during the first 3 years of life.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"181-190"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402498","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 Role of Infant Gut Microbiota Modulation by Perinatal Maternal Probiotic Intervention in Atopic Eczema Risk Reduction.","authors":"Reetta Puisto, Carlos Gómez-Gallego, Maria Carmen Collado, Olli Turta, Erika Isolauri, Samuli Rautava","doi":"10.1159/000540075","DOIUrl":"10.1159/000540075","url":null,"abstract":"<p><strong>Introduction: </strong>Probiotics have shown potential in reducing the occurrence of atopic eczema in high-risk infants. We aimed here to assess whether the preventive effect of maternal probiotic administration stems from compositional changes in early gut microbiota.</p><p><strong>Methods: </strong>This study included 46 mother-infant pairs from an original randomized controlled trial assessing the impact of maternal probiotic intervention with either the combinations of Lacticaseibacillus rhamnosus LPR and Bifidobacterium longum BL999, or Lacticaseibacillus paracasei ST11 and Bifidobacterium longum BL999, or placebo beginning 2 months before expected delivery and ending 2 months after birth. All children were vaginally delivered, full term and breastfed. During the 2-year follow-up period, the children were clinically evaluated by physicians for atopic eczema, and their gut microbiota was profiled at 1 and 6 months of age by 16S rRNA gene sequencing using an Illumina sequencing platform.</p><p><strong>Results: </strong>Altogether, 19 of 46 children developed atopic eczema by the age of 2 years. At 1 and 6 months of age, gut microbial diversity was similar between children who developed atopic eczema and their healthy controls, but at the age of 6 months, children who developed atopic eczema manifested with significantly higher relative abundance of Clostridia. Probiotic intervention did not significantly influence microbial diversity, and the effects on microbial composition were not consistent with the changes associated with the development of atopic eczema.</p><p><strong>Conclusion: </strong>The reduction of the risk of atopic eczema achieved by perinatal maternal probiotic intervention does not seem to require substantial gut microbiota modulation.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"84-94"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794456","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":"Antenatal Care Strategies to Improve Perinatal and Newborn Outcomes.","authors":"Rahima Yasin, Maha Azhar, Zoha Allahuddin, Jai K Das, Zulfiqar A Bhutta","doi":"10.1159/000542702","DOIUrl":"10.1159/000542702","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Antenatal care strategies (ANC) play a pivotal role in ensuring a healthy gestational period for expectant mothers and promote optimal outcomes for their babies. Implementing these interventions can contribute to a supportive environment for pregnant women, resulting in positive perinatal and neonatal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;We summarize evidence for a total of twenty-seven interventions pertaining to ANC from Every Newborn Series published in The Lancet 2014 by identifying the most recent systematic reviews, extracting data from each review, and conducting a subgroup analysis for low-income and lower-middle-income countries (LMICs) for outcomes relevant to maternal and neonatal health. Findings from our paper suggest a paucity in evidence from LMICs, and consolidated efforts are required to narrow this gap to build on more inclusive evidence on ANC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages: &lt;/strong&gt;Evidence from LMICs suggests that antenatal multiple micronutrient supplementation when compared to iron and folic acid had a significant effect on stillbirth, small for gestational age, and low birthweight (LBW). Vitamin D supplementation reduced the risks of preterm birth and LBW. High-dose calcium supplementation, when compared to placebo in pregnancy, lowered the likelihood of developing high blood pressure, preeclampsia, and preterm birth. Antihypertensives significantly reduced the probability of developing severe hypertension, proteinuria/preeclampsia, and severe preeclampsia. Metformin for GDM reduced the risk of neonatal death or serious morbidity composite. Cervical cerclage had no effect on stillbirth, preterm birth, or perinatal and neonatal mortality. Data for anti-D administration for rhesus alloimmunization were limited to HICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Antenatal care strategies (ANC) play a pivotal role in ensuring a healthy gestational period for expectant mothers and promote optimal outcomes for their babies. Implementing these interventions can contribute to a supportive environment for pregnant women, resulting in positive perinatal and neonatal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;We summarize evidence for a total of twenty-seven interventions pertaining to ANC from Every Newborn Series published in The Lancet 2014 by identifying the most recent systematic reviews, extracting data from each review, and conducting a subgroup analysis for low-income and lower-middle-income countries (LMICs) for outcomes relevant to maternal and neonatal health. Findings from our paper suggest a paucity in evidence from LMICs, and consolidated efforts are required to narrow this gap to build on more inclusive evidence on ANC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages: &lt;/strong&gt;Evidence from LMICs suggests that antenatal multiple micronutrient supplementation when compared to iron and folic acid had a significant effect on stillbirth, small for gestational age, and low birthweight (LBW). Vitamin D supplementation r","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"13-31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712343","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 between Early Postnatal Hydrocortisone and Retinopathy of Prematurity in Extremely Preterm Infants.","authors":"Mariya Petrishka-Lozenska, Aldina Pivodic, Anders Flisberg, Ingrid Hansen-Pupp, Lois E H Smith, Pia Lundgren, Ann Hellström","doi":"10.1159/000543659","DOIUrl":"10.1159/000543659","url":null,"abstract":"<p><strong>Introduction: </strong>Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness. We investigated the association of early postnatal low-dose intravenous hydrocortisone used for the prevention of bronchopulmonary dysplasia (BPD) with ROP outcome among extremely preterm infants in a Swedish cohort.</p><p><strong>Methods: </strong>This retrospective cohort study included extremely preterm infants born before 28 weeks of gestational age (GA). Infants born September 2020-August 2022, treated with low-dose intravenous hydrocortisone for prevention of BPD, were compared to untreated controls born September 2016-August 2020. Hydrocortisone was administered postnatally with a dose of 0.5 mg/kg twice daily for 7 days, followed by 0.5 mg/kg per day for 3 days. Logistic regression, adjusted for GA, birth weight (BW), sex, and parenteral nutrition, was used in the primary analysis. For robustness, we performed 1:1 propensity score (PS) matching followed by logistic regression.</p><p><strong>Results: </strong>Of 245 preterm infants included, 65 were treated with low-dose hydrocortisone and 180 were untreated controls. Incidence of ROP treatment was reduced in the hydrocortisone group 18.5% (12/65) versus controls 32.2% (58/180), p = 0.038. One-to-one PS matching (n = 62 + 62) confirmed the reduced incidence of ROP treatment in the hydrocortisone-treated infants (odds ratio [OR]: 0.38, 95% confidence interval [95% CI]: 0.16-0.88, p = 0.025). After adjusting for GA, BW, sex, and parenteral nutrition ≥14 days, the reduced risk of ROP treatment after early hydrocortisone treatment persisted (OR: 0.31, 95% CI: 0.16-0.60, p = 0.0005).</p><p><strong>Conclusion: </strong>Early postnatal low-dose intravenous hydrocortisone used to prevent BPD may reduce the risk of ROP treatment among extremely preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"329-338"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019200","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":"Supportive Care for Common Conditions in Small Vulnerable Newborns and Term Infants: The Evidence.","authors":"Li Jiang, Rachel Lee Him, Davneet Sihota, Oviya Muralidharan, Georgia Dominguez, Leila Harrison, Tyler Vaivada, Zulfiqar A Bhutta","doi":"10.1159/000541872","DOIUrl":"10.1159/000541872","url":null,"abstract":"<p><strong>Introduction: </strong>Small vulnerable newborns (SVNs) are at an increased risk of early death and other morbidities. Essential interventions provided to SVN, and other high-risk newborns have been proven critical in improving their outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).</p><p><strong>Method: </strong>Following a comprehensive literature scope, we updated or reanalyzed LMIC-specific evidence for essential SVN care interventions.</p><p><strong>Results: </strong>A total of 113 individual LMIC studies were identified. Most of them were of high risk of bias. Kangaroo mother care significantly reduced SVN's mortality by discharge. Early erythropoiesis stimulating agent lowered SVN's risk of receiving blood transfusion. Prophylactic oral or intravenous ibuprofen resulted in a decreased risk of patent ductus arteriosus in SVN. But it did not have a significant effect on mortality and led to a higher risk of gastrointestinal bleeding. No pooled LMIC data were available for universal screening of hyperbilirubinemia in high-risk newborns. Sunlight therapy had no effect in treating hyperbilirubinemia but increased the risk of hyperthermia. Reflective curtains with phototherapy resulted in a greater and faster decline in bilirubin than standard phototherapy in treating hyperbilirubinemia. Early child development interventions were shown to have a favorable effect on cognitive and motor scores in SVN. The evidence for family involvement and family support was limited and uncertain.</p><p><strong>Conclusion: </strong>We present the most updated LMIC evidence for interventions targeting SVN. Despite their effectiveness and safety in improving certain neonatal outcomes, further high-quality trials are required.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"129-151"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690166","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}