Neonatology最新文献

{"title":"Strengthening Neonatology in Ethiopia: From Survey Data to System Improvement.","authors":"Corrado Moretti, Camilla Gizzi, Daniele Trevisanuto, Gianluca Lista, Virgilio Carnielli, Ola Didrik Saugstad, Luigi Gagliardi, Giulia Vertecchi, Lelisa Amanuel Jira, Asrat Demtse, Gesit Metaferia, Luisa Gatta, Fabio Manenti, Dante Carraro, Worku Bogale","doi":"10.1159/000550774","DOIUrl":"10.1159/000550774","url":null,"abstract":"<p><strong>Introduction: </strong>Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions.</p><p><strong>Methods: </strong>A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation \"Train the Trainers\" course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites.</p><p><strong>Results: </strong>The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas.</p><p><strong>Conclusions: </strong>The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"318-328"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151663","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":"Awareness of Racial Bias in Pulse Oximetry among Practicing Neonatologists: A Cross-Sectional Survey.","authors":"Patrick J Maher, Neha Goel, Carol R Horowitz, Mariana G Figueiro, Lynne D Richardson, Mark Rea","doi":"10.1159/000549617","DOIUrl":"10.1159/000549617","url":null,"abstract":"<p><strong>Introduction: </strong>Pulse oximeters may systematically overestimate arterial oxygen saturation in neonates with darker skin pigmentation. We performed a survey in practicing neonatologists to explore knowledge of this bias and the implications for clinical care.</p><p><strong>Methods: </strong>An email survey was distributed assessing knowledge of melanin-related pulse oximeter bias, perceived clinical significance, and communication practices. Responses were compared to data from emergency medicine (EM) clinicians.</p><p><strong>Results: </strong>Survey results from 120 neonatologists showed that 45.0% agreed that bias exists in pulse oximetry based on skin pigmentation. Among respondents aware of the bias, less than half correctly identified its direction. Most clinicians reported no change in clinical management for dark-skinned neonates. Compared to EM clinicians, neonatologists changed clinical practice less often and rated discussions with families as less important.</p><p><strong>Conclusion: </strong>Awareness of pulse oximetry bias related to skin pigmentation remains limited among neonatologists, with low rates of modification to daily clinical practice.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"13-17"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552576","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":"Desaturations with or without Bradycardia Are Associated with Cerebral and Abdominal Hypoxemia: Secondary Analysis of a Randomized Clinical Trial.","authors":"Colm P Travers, Arie Nakhmani, Inmaculada Aban, Deborah Laney, Vivek V Shukla, Samuel J Gentle, Waldemar A Carlo, Namasivayam Ambalavanan","doi":"10.1159/000550648","DOIUrl":"10.1159/000550648","url":null,"abstract":"<p><p><p>Introduction: The aim of this study was to determine if episodes of desaturation, either with or without bradycardia, are associated with cerebral and abdominal hypoxemia in preterm infants.</p><p><strong>Methods: </strong>Secondary analysis of a single-center pilot randomized clinical trial including preterm infants <29 weeks of gestation on positive pressure respiratory support. Rates of cerebral hypoxemia (<55% for ≥10 s) and abdominal hypoxemia (<40% for ≥10 s) on near-infrared spectroscopy corresponding with episodes of desaturation (oxygen saturations <85% for ≥10 s) either with or without bradycardia (<100 bpm for ≥10 s) were compared using a generalized estimating equation to address repeated events from the same subject.</p><p><strong>Results: </strong>Twenty-five infants with a gestational age (mean + SD) of 24 weeks 6 days ± 11 days and birth weight 645 ± 142 grams were included. Desaturations with and without bradycardia were both associated with cerebral hypoxemia and abdominal hypoxemia (all p < 0.05). Cerebral hypoxemia was more strongly associated with desaturations with bradycardia compared to episodes without bradycardia (adjusted odds ratio [aOR], 95% confidence intervals [CI]: 0.34, 0.25-0.47; p < 0.001). There were also more episodes of abdominal hypoxemia during desaturations with bradycardia versus desaturations with no bradycardia (aOR, 95% CI: 0.35, 0.26-0.46; p < 0.001). The rate of concurrent cerebral and abdominal hypoxemia was also higher during desaturations with bradycardia.</p><p><strong>Discussion: </strong>Desaturations, whether occurring with or without bradycardia, are associated with cerebral and abdominal hypoxemia in very preterm infants. Cerebral and abdominal hypoxemia are more likely during episodes of desaturation with bradycardia than during episodes without bradycardia. </p>.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"302-308"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095403","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":"The Future Was Yesterday: Artificial Intelligence in Newborn Medicine.","authors":"Raquel Dias, Josef Neu, Ola Didrik Saugstad","doi":"10.1159/000551248","DOIUrl":"10.1159/000551248","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"403-408"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319365","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":"Comparative Diagnostic Performance of Early and Term Magnetic Resonance Imaging in Preterm Infants: A Diagnostic Test Accuracy Systematic Review and Bayesian Meta-Analysis.","authors":"Linda Bonezzi, Lucia Rocchitelli, Tommaso Biagioni, Olena Chorna, Kerstin Pannek, Carly Luke, Robert S Ware, Jurgen Fripp, Andrea Guzzetta, Simona Fiori, Roslyn N Boyd","doi":"10.1159/000552875","DOIUrl":"10.1159/000552875","url":null,"abstract":"<p><p><p>Introduction: Early identification of neurodisability and delay after preterm birth is critical for timely intervention. Term-equivalent magnetic resonance imaging (MRI) (36-44 weeks) is widely used for prognostication, and earlier MRI (<36 weeks) may offer additional value.</p><p><strong>Methods: </strong>To provide a comparative diagnostic test accuracy synthesis of early versus term-equivalent MRI for motor and non-motor neurodevelopmental outcomes, incorporating advanced imaging modalities including volumetric and diffusion measures, PubMed, Embase, Cochrane Central, Scopus, and Web of Science were searched to January 22, 2026. PRISMA-DTA guidelines were followed with PROSPERO registration (CRD42024528207). Studies enrolling preterm infants (<37 weeks) undergoing both early and term-equivalent MRI with neurodevelopment assessment between 12 and 36 months were included. Two reviewers extracted data and assessed bias risk. Meta-analysis used a Bayesian bivariate random-effects model pooling diagnostic metrics for the presence of lesion, intraventricular haemorrhage, white matter injury, and cerebellar haemorrhage.</p><p><strong>Results: </strong>Of 3,249 records screened, 30 studies met inclusion. Term-equivalent MRI lesion presence (diagnostic odds ratio [DOR] = 14.17 vs. 2.67; sensitivity 84% vs. 76%; specificity 73% vs. 45%) and white matter injury (DOR = 5.92 vs. 2.20; sensitivity 65% vs. 52% and specificity 76% vs. 67%) demonstrated superior predictivity than early MRI. White matter injury at term best predicted motor outcomes (DOR = 18.43). Volumetric and diffusion measures improved predictive accuracy, especially for cognitive outcomes. Heterogeneity in MRI protocols, biomarker definitions, and outcomes limited comparability, and the modest study number reduced precision.</p><p><strong>Conclusion: </strong>Term-equivalent MRI offers higher predictivity than early MRI. Standardised scoring and multimodal integration are needed to optimise early risk stratification in preterm populations. </p>.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"663-675"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177440","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":"The Future of Neonatal Medicine: Reducing Global Neonatal Mortality Is A Matter of Political Will - A Commentary on The Lancet Child &amp;amp; Adolescent Health Commission on the Future of Neonatology.","authors":"Ola Didrik Saugstad, Waldemar A Carlo, Haresh Kirpalani, Satyan Lakshminrusimha, Christian P Speer","doi":"10.1159/000548520","DOIUrl":"10.1159/000548520","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088603","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":"Response to Letter from Dr. Arti Maria: \"Priority Neonatal Interventions Are Powerful - When Rooted in Nurturing Care\".","authors":"Zulfiqar A Bhutta, Tyler Vaivada, Jai K Das","doi":"10.1159/000548645","DOIUrl":"10.1159/000548645","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"131-132"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194202","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":"10.1159/000551110","DOIUrl":"10.1159/000551110","url":null,"abstract":"<p><p>The article \"Seizure Burden before and after Lidocaine as Add-On Therapy in (Amplitude-Integrated) Electroencephalography-Confirmed Neonatal Seizures\" [Neonatology. 2025; https://doi.org/10.1159/000549690] by Rondagh et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been updated.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"401-402"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483085","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":"Impact of Availability of Waiver of Consent on the Preterm Cord Milking versus Deferred Cord Clamping Trial (PREMOD2).","authors":"Anup C Katheria, Nicole Wilson, Matthew A Rysavy, Louise S Owen, Kathy Arnell, Jeff M Szychowski","doi":"10.1159/000549575","DOIUrl":"10.1159/000549575","url":null,"abstract":"<p><strong>Introduction: </strong>The PREMOD2 trial, comparing cord milking (CM) and deferred cord clamping (DCC) in preterm infants, was stopped for increased severe intraventricular hemorrhage (sIVH) with CM. Six of 9 centers had approval for waiver of antenatal consent.</p><p><strong>Methods: </strong>We examined the relationship of enrollment procedures with characteristics and outcomes of trial-enrolled patients.</p><p><strong>Results: </strong>A total of 474 infants were enrolled. Participants enrolled at sites with waiver of consent (N = 375, 79% of participants) were less likely exposed to antenatal steroids and magnesium. The overall effect of CM on sIVH was independently observed in sites with a waiver but not observed in sites without a waiver. However, the effects of CM observed between sites based on availability of waiver were not different. Chorioamnionitis exposure also modified the risk of sIVH from CM vs. DCC.</p><p><strong>Conclusions: </strong>Trial-enrolled infants differed between hospitals with and without access to initial waiver, including in exposure to chorioamnionitis. These observations may be helpful to designing future studies.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"162-166"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552584","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":"Less Invasive Surfactant Administration in Extreme Preterm Infants: A Systematic Review and Meta-Analysis.","authors":"Shivashankar Diggikar, Paula Trif, Diana Mudura, Arun Prasath, Aakash Pandita, Maria Livia Ognean, Cristian Nicolae Sava, Sara Dhanawade, Jan Mazela, Radu Galis, Boris W Kramer","doi":"10.1159/000551691","DOIUrl":"10.1159/000551691","url":null,"abstract":"<p><strong>Introduction: </strong>Surfactant therapy is performed in different ways in respiratory distress syndrome. Surfactant therapy in spontaneously breathing infants <28 weeks' gestation (LIST/MIST) was compared to intubation with different periods of mechanical ventilation (MV/intubation; INSURE) for efficacy and safety.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed PRISMA guidelines with PROSPERO registration (CRD42025630748) using GRADE recommendations. Primary outcomes were BPD at 36 weeks' postmenstrual age, MV in first 72 h; and death before discharge. Secondary outcomes were intraventricular hemorrhage (IVH), necrotizing enterocolitis, retinopathy of prematurity (ROP), periventricular leukomalacia, and pneumothorax.</p><p><strong>Results: </strong>No RCT compared directly LISA/MIST versus INSURE in infants <28 weeks. A total of twenty-six studies were included and 12 studies in quantitative analysis were included. LISA/MIST compared to INSURE was not different in reducing BPD; or death; but reduced MV within 72 h (relative risk [RR], 0.70; 95% confidence interval [CI], 0.55-0.90; events/n = 58/153; INSURE events/n = 82/144). This effect was not detectable when only RCTs were analyzed. Compared to intubation, LISA/MIST reduced BPD (RR, 0.76; 95% CI, 0.59-0.97, n = 6,585), MV (RR, 0.61; 95% CI, 0.45-0.82, n = 6,197), death (RR, 0.63;95% CI, 0.54-0.74, n = 6,597), IVH (RR, 0.62; 95% CI, 0.54-0.73), pneumothorax (RR, 0.58; 95% CI, 0.46-0.73), and ROP (RR, 0.61; 95% CI, 0.50-0.73). Composite outcome analysis BPD/death was not possible due to small numbers.</p><p><strong>Conclusion: </strong>LISA/MIST reduced MV, but not BPD, or separately death when compared with INSURE. The findings should be interpreted cautiously due to limited power and competing risk dynamics in extremely preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"490-507"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610942","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}