Background Monitoring cerebral oxygenation during immediate fetal-to-neonatal transition may provide additional information in preterm neonates. Cerebral fractional tissue oxygen extraction (cFTOE), derived from cerebral oxygen saturation (crSO2) and arterial oxygen saturation (SpO2), reflects the relative extraction of oxygen from the arterial to the tissue compartment, providing information about the balance between oxygen delivery and oxygen consumption. We aimed to describe centiles of cFTOE during the first 15 minutes after birth in extremely and very preterm neonates. Methods This is a secondary outcome parameter analysis of the multicentre randomised-controlled COSGOD III trial. Neonates <32 weeks of gestational age included in the NIRS-open-group of the COSGOD III trial with favourable outcome, defined as survival without cerebral injury at term-equivalent age, were assigned for this analysis. CFTOE was calculated for every minute in each included neonate: cFTOE = (SpO2-crSO2)/SpO2. CrSO2 was measured with the INVOS 5100 monitor with the neonatal sensor. Centiles of cFTOE (10th to 90th) from minute two to 15 after birth were described. Results A total of 199 preterm neonates with a median (IQR) gestational age of 29.7 (27.7-30.9)weeks and a weight of 1200 (925-1460)grams were analysed. The 50th centile of cFTOE at minute two, five, ten and 15 was 0.492, 0.296, 0.177 and 0.151, respectively. Conclusion This study provides centile for cFTOE for extremely and very preterm neonates with favourable outcome independent of interventions during postnatal stabilisation period. These centile charts may assist in interpreting cerebral oxygenation patterns.

Postnatal weight loss in infants is physiological, but excessive loss predisposes for dehydration and other morbidities. Existing nomograms, primarily developed in temperate climates, may not apply to arid regions as environmental conditions influence weight loss patterns. This study aimed to develop hour-specific percentile nomograms for postnatal weight loss in exclusively breastfed, healthy infants (≥36 weeks) from an arid region, facilitating early identification of those at risk of excessive loss.

Spontaneous ductal closure is common in preterm populations, however a subset of infants develops a hemodynamically significant PDA (hsPDA), which has been associated with adverse outcomes. The objective was to develop and internally validate a predictive model for (hsPDA) in preterm infants using a machine learning approach.

Premature infants are predisposed to respiratory failure. Body position impacts lung volumes and pulmonary function. Respiratory inductance plethysmography (RIP) measures thoracoabdominal motion and can provide objective, noninvasive diagnostic measurements of work of breathing (WOB) indices. The objective of this study was to compare WOB indices and oxygen saturation in the semi-reclined position to the supine position for preterm infants with and without BPD at discharge.

Oxygen has been a key component of neonatal resuscitation for nearly two centuries. Based on clinical trials that demonstrated worse outcomes when neonatal resuscitation was initiated with 100% oxygen, there was a change in approach to using 21% oxygen at initiation of ventilation for newborns at birth. However, for extremely preterm newborns lower oxygen levels lead to early hypoxia and bradycardia leading to higher rates of severe intraventricular hemorrhage and death. The balance between hyperoxia and hypoxia related injury needs further refinement and may not be generalizable to all gestations and birth conditions.

High-dose ambroxol is an effective pharmacological chaperone therapy for the systemic and neurological symptoms of Gaucher disease (GD). However, no clinical evidence of perinatal-onset GD has been documented.

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.

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.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. However, current screening guidelines may be overly broad, necessitating better models to detect high-risk infants.

Introduction Neonatal gastrointestinal perforation is a life-threatening condition that requires timely and accurate diagnosis. However, interpreting abdominal radiographs in this population is often challenging. In this study, we aimed to develop a deep convolutional neural network (DCNN) model to segment pneumoperitoneum on neonatal abdominal radiographs and to evaluate its potential to assist in detecting neonatal gastrointestinal perforation. Methods This multicenter retrospective study included 1,187 abdominal radiographs (181 perforation and 1,006 control images) from neonates with gastrointestinal perforation and controls. Pneumoperitoneum regions were annotated by experienced clinicians. The dataset was randomly divided into training (n = 830), validation (n = 118), and test (n = 239) sets. A DeepLabV3+ model with ResNet50 backbone was finetuned for pixel-level segmentation. A single pixel-based threshold, derived from ROC analysis, was used to classify gastrointestinal perforation, with diagnostic performance subsequently compared to that of clinicians. Results The DCNN model achieved a median Dice similarity coefficient of 0.81 on the test dataset, indicating strong overlap between predicted and actual pneumoperitoneum regions. Furthermore, segmentation performance was positively correlated with pneumoperitoneum volume (Spearman ρ = 0.83, P < 0.001). Classification using the pixel-based cut-off demonstrated excellent diagnostic accuracy (AUC, 0.999; sensitivity, 100%; specificity, 98.5%), comparable to experienced clinicians. Conclusion The DCNN model demonstrated robust segmentation and classification performance, highlighting its potential as a clinical decision support tool for early detection of gastrointestinal perforation in neonates. Future studies should validate the model's generalizability and assess its integration into clinical practice.

Introduction The primary aim of this study was to evaluate the total seizure burden (TSB) and maximum hourly seizure burden (MSB) before and after the administration of lidocaine (LDC) as add-on therapy in neonates with amplitude-integrated electroencephalography (aEEG)-confirmed seizures. Secondary aims were documenting the need for additional ASM at 4, 12, and 24 hours after LDC, and the rate of seizure freedom for at least 24, 48, and 72 hours after LDC. Methods This single-center, retrospective cohort study included neonates with persistent seizures after phenobarbital who received add-on LDC therapy. Neonates were monitored with a continuous 2-channel aEEG. The TSB and MSB were calculated using raw EEG data collected 4 hours before and after the administration of LDC. Results Sixty-one neonates were included. Seizure etiology consisted of hypoxic-ischemic encephalopathy (n=24), hemorrhagic or ischemic stroke (n=16), central nervous system infection (n=7), genetic (n=8), metabolic disorders (n=4), and unknown etiology (n=2). After LDC administration, median TSB decreased significantly from 31 (interquartile range, IQR 16-68) to 0 minutes (IQR 0-0, p<0.01), and MSB from 10 (IQR 6-41) to 0 min/hour (IQR 0-0, p<0.01). The need for additional ASM was 3% (2/61) within 4h and 41% (25/61) within 24h. Seizure freedom after LDC was achieved in 71% (42/59) for at least 24h and 52% (29/56) for 72h. Discussion LDC significantly reduced TSB and MSB in neonates with (a)EEG-confirmed seizures, achieving 100% seizure reduction in the majority, with half of the neonates remaining seizure-free for at least 72 hours.

Managing neonatal pain through appropriate pain assessment is crucial. The use of reliable, validated, and multidimensional tools for pain evaluation has been recommended. However, these tools have not yet gained widespread use in Japan due to their complexity, which involves numerous evaluation and observation items, making thorough observation challenging.

This study aimed to assess the feasibility of using specific defined daily doses for neonates (DDDn) as a standardized metric for monitoring antimicrobial consumption in neonatal populations, thereby enhancing antimicrobial stewardship programs (ASPs). To this end, DDDn values have been established for those antimicrobials that had not previously been defined.

Metalloporphyrins, competitive heme oxygenase (HO) inhibitors, may potentially be used as drugs for preventing neonatal hyperbilirubinemia. Metalloporphyrins that specifically target the inducible HO-1 without inhibiting the constitutive HO-2, are the most ideal. Zinc protoporphyrin (ZnPP) has the most promise. We have derived a plant-based ZnPP (ZnPP-Plant) and evaluated its inhibitory potency and selectivity for the HO-1 isozyme.

Bifidobacteria typify the gut microbiota of healthy, breastfed infants. Altered gut microbiota composition in early infancy characterized by decreased Bifidobacterium abundance has been linked with a heightened risk of non-communicable diseases. Our goal was to assess factors impacting on the gut microbiota composition in infants throughout the allergy and obesity epidemics of the past decades.

Evidence regarding the association between patent ductus arteriosus (PDA) and brain development in very preterm infants is inconclusive. The aim of the current study was to systematically evaluate brain injury and microstructural brain maturation as assessed by magnetic resonance imaging (MRI) at term-equivalent age in a contemporary cohort of very preterm infants with and without PDA.

Hypoxic-ischaemic encephalopathy (HIE) due to perinatal asphyxia remains a significant cause of neonatal morbidity and mortality. Despite therapeutic hypothermia (TH), a considerable proportion of survivors experience a wide range of deficits, including auditory impairment (AI), which needs deeper knowledge. This review aimed to describe AI outcomes in infants with HIE.

Electroencephalography (EEG), including both conventional EEG (cEEG) and amplitude-integrated EEG, is early prognostic tools utilized in neonates with hypoxic ischemic encephalopathy (HIE). However, the reported predictive accuracy of EEG varies widely.

The impact of intrauterine growth status as measured by BW percentiles on retinopathy of prematurity (ROP) pathogenesis remains inadequately characterized. The objectives of the study were to establish BW percentile-specific risk gradients for ROP development.

Peripheral intravenous catheterization is commonly required in sick neonates but remains challenging due to small vessels, leading to multiple attempts and complications. This review evaluated the benefits and harms of device-assisted techniques versus standard technique.