NeonatologyPub Date : 2025-01-01Epub Date: 2024-11-07DOI: 10.1159/000542016
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
{"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}
NeonatologyPub Date : 2025-01-01Epub Date: 2025-01-02DOI: 10.1159/000543277
Kelsey Christoffel, Josepheen De Asis Cruz, Kevin Michael Cook, Kushal Kapse, Nickie Andescavage, Sudeepta Basu, Catherine Limperopoulos, Adre du Plessis
{"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}
NeonatologyPub Date : 2025-01-01Epub Date: 2024-09-25DOI: 10.1159/000540886
Michael Obladen
{"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}
NeonatologyPub Date : 2025-01-01Epub Date: 2025-03-03DOI: 10.1159/000544811
Jantine J Wisse, Tom G Goos, Diederik Gommers, Henrik Endeman, André A Kroon, Irwin K M Reiss, Annemijn H Jonkman
{"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}
NeonatologyPub Date : 2025-01-01Epub Date: 2024-11-13DOI: 10.1159/000541862
Oviya Muralidharan, Sarah Rehman, Davneet Sihota, Leila Harrison, Tyler Vaivada, Zulfiqar A Bhutta
{"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":"<p><strong>Introduction: </strong>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).</p><p><strong>Methods: </strong>Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Introduction: </strong>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).</p><p><strong>Methods: </strong>Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews.</p><p><strong>Results: </strong>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":"Inhaled Nitric Oxide for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Systematic Review and Narrative Synthesis.","authors":"Hiroki Kitaoka, Ryota Kobayashi, Kosuke Tanaka, Masahiko Watanabe, Tetsuya Isayama","doi":"10.1159/000545034","DOIUrl":"10.1159/000545034","url":null,"abstract":"<p><strong>Introduction: </strong>Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. However, its effectiveness in the treatment of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) and severe BPD remains uncertain. Here we systematically reviewed whether iNO treatment increased or decreased mortality and morbidity among preterm infants with severe BPD or BPD-PH.</p><p><strong>Methods: </strong>We systematically searched the Ovid MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, and ICHUSHI databases for randomized and non-randomized studies that compared the effects of iNO in patients with severe BPD or BPD-PH. The primary outcome was mortality. Two authors independently screened the articles and extracted the data. A meta-analysis and certainty of evidence assessment using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation criteria were planned.</p><p><strong>Results: </strong>Among the 1,710 articles, none had a relevant control group and no studies met the eligibility criteria. Using a post hoc analysis, we summarized the ineligible studies that evaluated patients with severe BPD or BPD-PH who received iNO therapy. Although some studies included in the narrative review indicated a decreased pulmonary arterial pressure in patients with severe BPD or BPD-PH at the initiation of iNO therapy, none included a comparator group.</p><p><strong>Conclusion: </strong>Despite the use of iNO in patients with severe BPD and BPD-PH, no published studies compared the outcomes among patients with BPD treated with versus without iNO. Although some studies without comparator groups reported the effectiveness of iNO in patients with severe BPD and BPD-PH, our results suggest that iNO therapy should be initiated with caution and careful consideration of the target population.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"467-476"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545482","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":"Dexmedetomidine as a Promising Neuroprotective Sedoanalgesic in Neonatal Therapeutic Hypothermia: A Systematic Review and Meta-Analysis.","authors":"Enrico Cocchi, Juleda Shabani, Arianna Aceti, Gina Ancora, Luigi Corvaglia, Federico Marchetti","doi":"10.1159/000546017","DOIUrl":"10.1159/000546017","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal mortality and neurodevelopmental disabilities. Therapeutic hypothermia (TH) is the standard of care, but optimized sedoanalgesic strategies remain critical. Dexmedetomidine shows promise as an alternative to traditional sedatives, but its role in this context remains systematically under-explored. This meta-analysis aimed to address this gap by assessing the safety and efficacy of dexmedetomidine in neonates undergoing TH for HIE.</p><p><strong>Methods: </strong>A systematic search of Medline, Scopus, Embase, WOS, ClinicalTrials, and Cochrane Library identified studies published from January 2014 to October 2024. Studies focusing on dexmedetomidine in neonatal TH with relevant outcomes were included. Selection followed PRISMA guidelines, with independent quality assessments. The protocol was registered in PROSPERO (CRD42024605817). Results are presented as meta-analyses or evidence-based discussions when pooling was unfeasible.</p><p><strong>Results: </strong>Seven studies involving 609 neonates were included: four cohort studies (n = 486) and three case series (n = 123). Dexmedetomidine provided comparable sedation to traditional agents (MD = -0.01 [-0.68 to 0.66], p = 0.99) and significantly reduced seizure risk (OR: 0.31 [0.10 to 0.98], p < 0.05) with a non-inferior safety profile. Trends suggested shorter duration of mechanical ventilation and time to full enteral feeding. Substantial heterogeneity in dosing protocols highlights the need for standardization.</p><p><strong>Conclusions: </strong>Dexmedetomidine appears to be a safe and promising sedative in neonatal TH for HIE, with potential neuroprotective, respiratory, and gastrointestinal benefits. Despite limited evidence and the absence of randomized clinical trials, its non-inferior efficacy and safety warrant further exploration and urge the development of standardized dosing protocols.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"495-504"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeonatologyPub Date : 2025-01-01Epub Date: 2025-03-06DOI: 10.1159/000545107
Hye Won Cho, Sumin Jung, Kyu Hee Park, Jin Wha Choi, Ju Sun Heo, Jaeyoung Kim, Heerim Yun, Donghoon Yu, Jinho Son, Byung Min Choi
{"title":"Deep-Learning-Based Multi-Class Classification for Neonatal Respiratory Diseases on Chest Radiographs in Neonatal Intensive Care Units.","authors":"Hye Won Cho, Sumin Jung, Kyu Hee Park, Jin Wha Choi, Ju Sun Heo, Jaeyoung Kim, Heerim Yun, Donghoon Yu, Jinho Son, Byung Min Choi","doi":"10.1159/000545107","DOIUrl":"10.1159/000545107","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate and timely interpretation of chest radiographs is essential for assessing respiratory distress and guiding clinical management to improve outcomes of critically ill newborns. This study aimed to introduce a deep-learning-based automated algorithm designed to classify various neonatal respiratory diseases and healthy lungs using a large dataset of high-quality, multi-class labeled chest X-ray images from neonatal intensive care units.</p><p><strong>Methods: </strong>Portable supine chest X-ray images for six common conditions (healthy lung, respiratory distress syndrome [RDS], transient tachypnea of the newborn [TTN], air leak syndrome [ALS], atelectasis, and bronchopulmonary dysplasia [BPD]) and demographic variables (gestational age and birth weight) were retrospectively collected from 10 university hospitals in Korea. Ground truth for manual classification of these conditions was generated by 20 neonatologists and validated by others from different hospitals. The dataset, consisting 34,598 for training, 4,370 for validation, and 4,370 for testing, was used to train a modified ResNet50-based deep-learning model for automatic classification.</p><p><strong>Results: </strong>The automatic classification algorithm showed high concordance with human-annotated classifications, achieving an overall testing accuracy of 83.96% and an F1 score of 83.68%. The F1 score for each condition was 87.38% for \"healthy lung\" and 92.19% for \"BPD,\" 90.65% for \"ALS,\" 90.30% for \"RDS,\" 86.56% for \"atelectasis,\" and 70.84% for \"TTN.\"</p><p><strong>Conclusion: </strong>We introduced a deep-learning-based automated algorithm to classify neonatal respiratory diseases using a large dataset of high-quality, multi-class labeled chest X-ray images, incorporating non-imaging data, which could support neonatologists in making timely and accurate decisions for critically ill newborns.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"446-454"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575064","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}
NeonatologyPub Date : 2025-01-01Epub Date: 2025-03-15DOI: 10.1159/000543833
Samuel J Gentle, Vivek V Shukla, Abigail Cooley, Namasivayam Ambalavanan, Waldemar A Carlo, Sarah N Taylor, Ariel A Salas
{"title":"Feeding Dynamics in Very Preterm Infants with Delayed Oral Feeding Attainment.","authors":"Samuel J Gentle, Vivek V Shukla, Abigail Cooley, Namasivayam Ambalavanan, Waldemar A Carlo, Sarah N Taylor, Ariel A Salas","doi":"10.1159/000543833","DOIUrl":"10.1159/000543833","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to characterize features that can accurately identify preterm infants at risk of delay in oral feeding attainment.</p><p><strong>Methods: </strong>A prospective observational study of infants born between 250/7 and 326/7 weeks' gestation. Early independent oral feed attainment (EPO) was defined as independent oral feeding within 35 days of initiation and late attainment (LPO) defined at or after 35 days following initiation. Candidate characteristics of comparison included feeding interventions and reasons for feeding discontinuation.</p><p><strong>Results: </strong>Of the 257 infants included, 162 infants achieved EPO. Over the first week of oral feeding, LPO infants received fewer feeding interventions (e.g., side lying position, pacing, and re-alertment) and were fed less frequently (2 vs. 3 times per day; p < 0.001).</p><p><strong>Conclusions: </strong>Compared to infants with EPO, infants with LPO differ in employed feeding strategies. These findings could guide resource allocation and facilitate the provision of individualized care.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"426-434"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}