Neonatology最新文献

{"title":"Interventions to Prevent and Manage Infections in Pregnancy.","authors":"Rahima Yasin, Li Jiang, Jai K Das, Zulfiqar A Bhutta","doi":"10.1159/000543690","DOIUrl":"10.1159/000543690","url":null,"abstract":"<p><strong>Background: </strong>Care interventions aimed at preventing and treating maternal infections during the gestational period are of paramount importance. Timely immunizations, screening strategies, and management of maternal infections reduce the risk of complications for the developing fetus and play a pivotal role in improving neonatal outcomes.</p><p><strong>Summary: </strong>We aim to summarize evidence for a total of thirteen interventions, pertaining to the prevention and treatment of maternal infections during the antenatal period, from Every Newborn Series published in The Lancet 2014. We identified the most recent systematic reviews, extracted data from each review, and conducted a sub-group meta-analysis for low-income countries and lower-middle-income countries (LMICs) for outcomes relevant to neonatal health. Findings from our papers indicate limited evidence from LMICs, highlighting the pressing need for coordinated efforts to close this gap and strengthen the body of inclusive evidence on prevention and treatment of maternal infections during pregnancy.</p><p><strong>Key messages: </strong>Evidence from LMICs suggests that influenza virus vaccination had no effect on stillbirth, preterm birth, small for gestational age, or low birthweight (LBW). Insecticide-treated bed nets in pregnancy reduced the risk of fetal loss and improved the babies' birthweight. Changing a two-dose intermittent preventive treatment (IPTp) regimen to more frequent IPTp dosing decreased the risk of LBW and significantly improved babies' birthweight. Addition of antibacterial antibiotic to the IPTp regimen significantly reduced the risk of LBW. Antibiotic treatments for syphilis and chlamydia had a significant effect on LBW. Treatment of documented periodontal disease during pregnancy reduced the risk of LBW.</p><p><strong>Background: </strong>Care interventions aimed at preventing and treating maternal infections during the gestational period are of paramount importance. Timely immunizations, screening strategies, and management of maternal infections reduce the risk of complications for the developing fetus and play a pivotal role in improving neonatal outcomes.</p><p><strong>Summary: </strong>We aim to summarize evidence for a total of thirteen interventions, pertaining to the prevention and treatment of maternal infections during the antenatal period, from Every Newborn Series published in The Lancet 2014. We identified the most recent systematic reviews, extracted data from each review, and conducted a sub-group meta-analysis for low-income countries and lower-middle-income countries (LMICs) for outcomes relevant to neonatal health. Findings from our papers indicate limited evidence from LMICs, highlighting the pressing need for coordinated efforts to close this gap and strengthen the body of inclusive evidence on prevention and treatment of maternal infections during pregnancy.</p><p><strong>Key messages: </strong>Evidence from LMICs suggests th","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"32-41"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061827","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":"Growth and Cognitive Outcome in Very Preterm Infants with Postnatal Cytomegalovirus Infection.","authors":"Elke Griesmaier, Marlene Hammerl, Maria Sappler, Martina Zimmermann, Nina Gande, Ira Winkler, Ursula Kiechl-Kohlendorfer, Vera Neubauer","doi":"10.1159/000542820","DOIUrl":"10.1159/000542820","url":null,"abstract":"<p><strong>Introduction: </strong>There are conflicting data on the association between postnatal cytomegalovirus (CMV) infection and growth and cognitive outcome in very preterm infants. The aim of the current study was to systematically evaluate the effect of postnatal CMV infection on growth and cognitive outcome in an unselected, contemporary cohort of very preterm infants.</p><p><strong>Methods: </strong>Infants <32 gestational weeks (2011-2018) were screened for postnatal CMV infection. We compared head circumference, weight and length from birth to 3 months corrected age, mental development at 12 and 24 months corrected age (Bayley Scales of Infant (Toddler) Development II/III), and intelligence quotient at 5 years (Kaufman Assessment Battery for Children-II, Wechsler Preschool and Primary Scale of Intelligence-III or Snijders-Oomen Non-verbal Intelligence Test) between infants with and without postnatal CMV infection.</p><p><strong>Results: </strong>The final study cohort consisted of 431 infants with a median gestational age of 29.9 (23.7-31.9) weeks. Of these, 20 (4.6%) infants had a postnatal CMV infection. Median ∆ z scores from birth to the corrected age of 3 months for head circumference, weight, and length did not differ between infants with and without postnatal CMV infection. Continuous and categorized parameters of cognitive development did not differ between the two groups. A subgroup analysis of infants <28 gestational weeks showed similar results.</p><p><strong>Conclusion: </strong>We did not observe a negative effect of postnatal CMV infection on growth or cognitive development of very preterm infants. These findings should be taken into account when discussing the use of raw mother's milk in the feeding of preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"129-137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815393","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":"Erratum.","authors":"","doi":"10.1159/000543153","DOIUrl":"10.1159/000543153","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"256"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019211","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":"Gut Pathogen Colonization: A Risk Factor to Bloodstream Infections in Preterm Neonates Admitted in the Neonatal Intensive Care Unit - A Prospective Cohort Study.","authors":"Faiza Iqbal, N Siva, Padmaja A Shenoy, Leslie Edward S Lewis, Jayashree Purkayastha, Vandana Kalwaje Eshwara","doi":"10.1159/000542335","DOIUrl":"10.1159/000542335","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Gut pathogen colonization, where pathogens disrupt the normal gut microbiota, has been implicated in the development of bloodstream infections (BSIs). This study investigates the association between gut pathogen colonization and BSI, hypothesizing that species causing BSI primarily originated from gut.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective cohort study was conducted in the neonatal intensive care unit (NICU) of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Inborn preterm infants were enrolled. The study population was divided into two groups: group A (neonates without sepsis) and group B (neonates with sepsis). Demographic details and blood culture results were collected. Stool samples were taken on day 4 and day 14 for group A, and on day 4 and the day of sepsis diagnosis for group B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Group B had a lower mean birthweight (1,649.6 ± 652.1 g) compared to group A (1,757 ± 656 g). Klebsiella pneumoniae was the most common pathogen causing BSIs (44.1%). The analysis revealed a high abundance of potential pathogens in the gut microbiome of group B neonates, with a concurrent decrease in beneficial gut flora.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides strong evidence for the association between gut pathogen colonization and BSI development in preterm neonates in NICUs. Gut microbiota modulation may serve as preventive strategy against BSIs, emphasizing the need for further research in this area to improve outcomes in vulnerable population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Gut pathogen colonization, where pathogens disrupt the normal gut microbiota, has been implicated in the development of bloodstream infections (BSIs). This study investigates the association between gut pathogen colonization and BSI, hypothesizing that species causing BSI primarily originated from gut.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective cohort study was conducted in the neonatal intensive care unit (NICU) of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Inborn preterm infants were enrolled. The study population was divided into two groups: group A (neonates without sepsis) and group B (neonates with sepsis). Demographic details and blood culture results were collected. Stool samples were taken on day 4 and day 14 for group A, and on day 4 and the day of sepsis diagnosis for group B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Group B had a lower mean birthweight (1,649.6 ± 652.1 g) compared to group A (1,757 ± 656 g). Klebsiella pneumoniae was the most common pathogen causing BSIs (44.1%). The analysis revealed a high abundance of potential pathogens in the gut microbiome of group B neonates, with a concurrent decrease in beneficial gut flora.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides strong evidence for the association between gut pathogen colonization and BSI development in preterm neonates in NICUs. Gut microbiot","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"151-160"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831593","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 Care in Low- and Middle-Income Countries: A Fresh Look.","authors":"Ola D Saugstad, Joy E Lawn, Peter Waiswa, Zulfiqar A Bhutta","doi":"10.1159/000543956","DOIUrl":"10.1159/000543956","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191661","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 Time with Open Ductus Arteriosus and Outcomes in Congenital Diaphragmatic Hernia.","authors":"Srirupa Hari Gopal, Robert Tillman, James D Hammond Ii, Joseph L Hagan, Sharada H Gowda, Nidhy P Varghese, Caraciolo J Fernandes","doi":"10.1159/000541385","DOIUrl":"10.1159/000541385","url":null,"abstract":"<p><strong>Introduction: </strong>While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH.</p><p><strong>Methods: </strong>A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher's exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses.</p><p><strong>Results: </strong>In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge.</p><p><strong>Conclusion: </strong>A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"202-209"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592337","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":"Urinary Output of Very Low Birth Weight Infants during the First Weeks of Life.","authors":"Zülfü Cem Cosgun, Kathrin Burgmaier, Melanie Zeiher, Anna Weber, Ruth Klein, Aynur Aydin, Angela Kribs, Katrin Mehler, Sandra Habbig","doi":"10.1159/000542755","DOIUrl":"10.1159/000542755","url":null,"abstract":"<p><strong>Introduction: </strong>Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age (GA), are missing.</p><p><strong>Methods: </strong>This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants.</p><p><strong>Results: </strong>VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 mL/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGANs), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants.</p><p><strong>Conclusion: </strong>UOP is dynamic in the postnatal period and differs significantly between GA cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"244-250"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Adverse Outcomes among Hospital Livebirths in Canada: A National Retrospective Study.","authors":"Chantal R M Nelson, Joel G Ray, Nathalie Auger, Aideen M Moore, Julian Little, Phil A Murphy, Michiel Van den Hof, Prakesh S Shah","doi":"10.1159/000540559","DOIUrl":"10.1159/000540559","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information's Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia's NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p &lt; 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6-9.5) with 1, 118.1 (108.4-128.4) with 3, and 395.3 (367.2-425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6-6.7), 11.2 (10.9-11.3), and 11.9 (11.6-12.2), and RR for extended hospital stay were 6.6 (6.4-6.7), 12.2 (11.7-12.7), and 26.4 (25.2-27.5). International comparison suggested that Canada had a higher prevalence of NAOI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information's Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia's NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 2,821,671 newborns, the NA","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"114-121"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038133","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":"\"Enriching the Hospital's Scientific Fame\": Research at the Vienna Foundling Hospital.","authors":"Michael Obladen","doi":"10.1159/000543207","DOIUrl":"10.1159/000543207","url":null,"abstract":"<p><strong>Background: </strong>Little is known about medical research at the Vienna Foundling Hospital during the 18th and 19th centuries.</p><p><strong>Summary: </strong>The present article focuses on nutrition, medical care, and research concerning newborn infants. In 1784, Emperor Joseph II merged obstetric and foundling hospitals under common leadership with specific statutes. Admissions rose from 1,704 in 1785 to 9,797 in 1859. A third of all infants born in Vienna in the 1890s were \"foundlings\" - correctly: abandoned infants, illegitimate birth was a prerequisite for admission. Differing from other foundling hospitals, the statutes obliged physicians to research, which focused on the great baby killers of the 18th century: smallpox, puerperal sepsis, connatal syphilis, tuberculosis, and malformations. Researchers included Anton Rechberger, Lucas Boër, Ignaz Semmelweis, Carl Rokitansky, Alois Bednar, and Carl Friedinger. Major scientific achievements were Rechberger's introduction of smallpox inoculation in Austria in 1768; Semmelweis' prevention of puerperal sepsis in 1847, and Bednar's classification of congenital heart malformations in 1852. Mortality statistics were doctored: deaths within 1 year were related to admissions from several years, which yielded maximum \"mortality rates\" of 76% in 1811, and a minimum rate of 13% in 1829. Actual mortality, however, per number of admissions, was over 90% in the first year of life. The institution persisted for 126 years because of the strict anonymity of extramarital birth, faked statistics deceiving supervisors, and esteem for the imperial inaugurator even beyond the end of the Austrian Empire.</p><p><strong>Key message: </strong>Despite appalling mortality, successful research was conducted at the Vienna Foundling Hospital.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879383","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":"Caffeine Therapy for Apnea of Prematurity: Single-Center Study on Dosing Practices and Perceived Effectiveness.","authors":"Kelly K Storm, Robert B Flint, Wes Onland, Anton H van Kaam, Irwin K M Reiss, G Jeroen Hutten, Sinno H P Simons","doi":"10.1159/000543074","DOIUrl":"10.1159/000543074","url":null,"abstract":"<p><strong>Introduction: </strong>Caffeine is the registered pharmacologic treatment for apnea of prematurity and is extensively used in the neonatal intensive care units (NICUs) based on evidence from randomized controlled trials. This study aimed to describe the clinical use of caffeine based on real-world data, hypothesizing a divergence from the registered dosing regimen.</p><p><strong>Methods: </strong>A retrospective analysis included infants born before 30 weeks of gestation, admitted to the NICU of the Erasmus MC Rotterdam from 2018 to 2021. Exclusion criteria comprised infants admitted after postnatal day 2, those not receiving caffeine during admission, patients admitted for less than 24 h, those who spent less than 24 h on non-invasive support, and cases lacking medication data. The primary outcome was the proportion of patients receiving an average caffeine dose higher than registered on the label.</p><p><strong>Results: </strong>A total of 451 patients with a median gestational age of 28+0 weeks (IQR 26+2-29+0) and birthweight of 1,015 g (IQR 800-1,218) were included. Of these, 402 infants (89%) received an average daily caffeine dosage exceeding the registered dose range. The median caffeine maintenance dose per patient was 5.3 mg/kg/day (IQR 5.0-5.8), with additional therapy (mini-load, doxapram, or intubation) needed in 318 patients (71%).</p><p><strong>Conclusion: </strong>This study highlights the frequent use of higher caffeine dosages in clinical practice than registered and recommended based on long-term safety data. Despite these high dosages and frequent mini-loads, 28% of patients still required additional treatment with doxapram and/or invasive mechanical ventilation, indicating the need for individualized dosing strategies or alternative therapies.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840175","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}