Comparison of neonatal outcomes of term neonates with meconium-stained amniotic fluid before and after routine endotracheal suctioning strategy at birth - PubMed Discontinuation of routine suctioning was associated with increased MAS incidence among neonates born through MSAF.

pubmed.ncbi.nlm.nih.gov/41917300/

A recent study (8,600+ neonates) found that discontinuing routine endotracheal suctioning was associated with higher aORof MAS, particularly in non-vigorous infants (aOR 1.54). This suggests that, in some cases, immediate PPV may actually worsen outcomes!
#neosky #pedsky #NICU #NRP

Non-invasive high-frequency oscillation ventilation versus nasal CPAP as primary respiratory support in preterm neonates ≥ 30 weeks with RDS: a non-inferiority randomized controlled trial - PubMed • NHFOV is non-inferior to CPAP as primary support in preterm neonates ≥ 30 weeks with RDS for the outcomes of treatment failure and IMV requirement with equivalent pressures after lung recruitment and nasal mask interface. • A superiority design RCT comparing these two non-invasive respiratory supp …

In this RCT of 142 infants (≥30 wks) with RDS, NHFOV was reported non-inferior to nCPAP for treatment failure (4.2% vs 4.2%; RD 0.00). However, the 20% margin is very wide, limiting confidence that meaningful harm is excluded.
#Neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41876901/

Drying Very Preterm Infants Before Plastic Wrapping at Birth: A Randomized Clinical Trial - PubMed ClinicalTrials.gov Identifier: NCT05740072.

An RCT (354 preemies) compared drying before plastic wrapping vs wet-in-bag at birth. Normothermia at NICU admission was similar (45.8% vs 46.3%; RR 0.99). Drying has no added benefit, and over half of infants were still outside the normal range.
#Neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41774445/

Prostaglandin E1 Infusions for Duct Dependent Congenital Heart Defects Can Cause Severe Ethanol Intoxication - PubMed Prostaglandin E1 Infusions for Duct Dependent Congenital Heart Defects Can Cause Severe Ethanol Intoxication

An infant on PGE1 infusion developed severe ethanol toxicity. The low-strength formulation, though similar in ethanol concentration, delivers ~25× more ethanol per dose.

Lesson: drugs aren’t interchangeable by active ingredient alone.

#Neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41401022/

Neuroprognostication via Radiomics and Machine Learning Following Neonatal Hypoxic-Ischemic Insult - PubMed A machine learning model using only MRI-based radiomic measures from infants with HIE can reliably predict their 18-month developmental outcomes with high accuracy across motor, cognitive, and language domains, regardless of the severity of their brain injury. In addition, our approach allowed us to …

A new retrospective study shows MRI radiomics can accurately predict 18-month developmental outcomes in infants with HIE using only imaging data (R² ~0.87). Despite the objective neuroprognostication, the study still needs external validation.

#Neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41692231/

Deferred cord clamping and weight difference for very preterm infants - PubMed In very preterm infants, at least 30 seconds of DCC is associated with a modest increase (24g) in first-recorded weight. This finding reinforces evidence from small clinical trials showing increased blood volumes and weight gains attributed to deferred cord clamping.

In a cohort of 32,634 infants <32 weeks, DCC (≥30 s) was linked to a 24 g higher first-recorded weight, ~ 18 mL/kg extra blood (~21% more volume). Though observational, these data support meaningful placental transfusion in very preterm infants.

#Neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41720473/

Early prophylactic paracetamol for PDA in extremely preterm infants (RCT, n=778) increased ductal closure at day 7 (71% vs 52%) but did NOT improve survival without severe morbidity at 36w PMA (66% vs 64%).

Routine prophylaxis?
Not supported.

#Neosky #pedsky

jamanetwork.com/journals/jam...

Interventions to Prevent Intraventricular Haemorrhage in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-analyses - PubMed Antenatal steroids and magnesium sulphate administration and early neonatal lung protective strategies reduce the rates of IVH in preterm neonates. Adequately powered RCTs evaluating IVH care bundles with long-term follow up are required.

A recent study reviewed 148 systematic reviews of RCTs.
These interventions reduce severe IVH significantly
• Antenatal steroid
• MgSO4 for preterm birth
• Volume-targeted ventilation
• Early surfactant via LISA
• Prophylactic indomethacin

#neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41642734/

Frontiers | Distinct modifiable risk factors and preventable burdens of preterm birth: a risk-stratified analysis of pregnancies with and without gestational diabetes mellitus Background: Preterm birth (PTB) remains a major clinical and public health challenge worldwide. Gestational diabetes mellitus (GDM), complicating 14-25% of p...

A new study suggests that >50%of preterm birth in GDM is preventable.
Smoking, depression, and obesity mattered in all pregnancies, while age, inactivity, and poor sleep raised PTB risk in GDM only —arguing for risk-stratified prenatal care.

#Neosky #pedsky

www.frontiersin.org/journals/ped...

Chest compression in newborn infants: what anatomical structures are we compressing? Objective To identify the location of the left ventricle (LV) and identify the structures below the lower third of the sternum when chest compressions (CCs) are performed using transthoracic echocardi...

Echo in 50 newborns shows the LV rarely lies under the lower third of the sternum. Current NRP chest compressions likely hit the RV/great vessels, not the LV, suggesting compression site or technique may need reconsideration to improve effectiveness.

#Neosky #pedsky

fn.bmj.com/content/earl...

Oral neonatal vitamin K deficiency bleeding prophylaxis in Switzerland (2018-2024), still valid guidelines for healthy infants - PubMed • Switzerland's 2003 VKDB prophylactic regimen (2 mg oral Konakion® MM (hour 4, day 4, and week 4) remains a valid recommendation for healthy infants. • Again, parental VK prophylaxis refusal and/or unrecognized cholestasis remain risk factors for VKDB.

Oral vitamin K for VKDB prevention—how effective?

In a Swiss cohort of 505,708 births, 9 VKDB cases occurred, all were breastfed and with risk factors such as cholestasis. However, IM vitamin K administration remains the most reliable option.

#Neosky #pedsky

pubmed.ncbi.nlm.nih.gov/41545738/

Scoop: The leaked protocol of the CDC-funded Hepatitis B vaccine trial in Guinea-Bissau. “This is another Tuskegee.” The protocol reveals that the trial will withhold the Hepatitis B birth dose from thousands—without placebos, without universal maternal screening, and with endpoints critics call indefensible.

Funded by a CDC grant, a trial in Guinea-Bissau randomize newborns to either receive or be denied the hepatitis B birth dose—despite the fact that this vaccine is protective and is recommended by WHO.

"Is this another Tuskegee?"

#Neosky #pedsky

insidemedicine.substack.com/p/scoop-the-...

Antenatal Corticosteroids and Risk of Cerebral Palsy: A Regression Discontinuity Study To use a natural experiment to investigate the effect of antenatal corticosteroids on the risk of cerebral palsy.

Antenatal steroids and CP.

A study of more than 20K preterm births (32–36 wks), used a regression discontinuity design at the 34-week cutoff, found no difference in CP risk just before vs after 34 weeks (RR 0.98; 95% CI 0.50–1.98).

#Neosky #pedsky

www.jpeds.com/article/S002...

Inhaled nitric oxide in preterm infants with respiratory disease: a systematic review and meta-analysis - European Journal of Medical Research Background Inhaled nitric oxide (iNO) has been shown to be effective in term and near-term infants with specific respiratory diseases. The effects and potential risks of iNO differ substantially in pr...

In a meta-analysis including more than 20,000 preterm infants, iNO use was linked to mild reduction in BPD, mortality (only in RCTs), higher ROP (but not the severe disease), and no significant effects on brain injury, IVH, or NEC.

#Neosky #pedsky

link.springer.com/article/10.1...

Frontiers | Analgesia and sedation increases bronchopulmonary dysplasia risk without significant neurodevelopmental impairment in very preterm infants BackgroundThe associations between analgesia and/or sedation exposure and adverse outcomes in very preterm infants remain controversial. Evidence linking the...

In a cohort of very preterm infants, n = 713, exposure to sedation was associated with an increased risk of BPD or death (aOR, 5.32; 95% CI, 3.15–8.98; p < 0.001), but not with adverse neurodevelopmental outcomes at 18 months of corrected age.

#Neosky #pedsky

www.frontiersin.org/journals/med...

Why is neonatal evidence mainly very low or low certainty - a meta-epidemiological review of Cochrane Neonatal reviews - PubMed The neonatal evidence was mainly limited due to imprecision and risk of bias. This indicates that larger scale high-quality studies in various neonatal topics are still greatly warranted.

#Neosky #pedsky

Have you ever wondered why the certainty of evidence is frequently downgraded in neonatal Cochrane reviews?

Here is the answer.

Imprecision and risk of bias were the most common reasons for downgrading the certainty of evidence

pubmed.ncbi.nlm.nih.gov/41379741/

Two-year outcomes after early postnatal high-dose fat-soluble enteral vitamin A supplementation in extremely low birth weight infants: follow-up of the NeoVitaA randomized controlled trial Early postnatal high-dose enteral fat-soluble vitamin A supplementation in ELBW infants did not affect pulmonary or developmental outcomes at 24 months’ CA.

The NeoVitaA study evaluated the long-term effects of early high-dose enteral vitamin A supplementation in ELBW infants. At 24 months, no benefit was observed for pulmonary infections or neurodevelopmental outcomes. A disappointing result.

#Neosky #pedsky

www.thelancet.com/journals/ecl...

Identifying performance differences between two pulse oximetry systems in simulated critical neonatal conditions - Journal of Perinatology Journal of Perinatology - Identifying performance differences between two pulse oximetry systems in simulated critical neonatal conditions

Not all monitors are created equal.

In NICUs, we make critical decisions based on numbers — SpO₂, HR, etc. — assuming our tools are equally accurate. A new study found significant performance gaps between two commonly used pulse-ox systems.

#Neosky #pedsky

www.nature.com/articles/s41...

Time to Full Enteral Feeds and Late-Onset Sepsis in Extremely Preterm Infants This cohort study of extremely preterm infants evaluates whether there is an association between full enteral feeding and late-onset sepsis, necrotizing enterocolitis, and growth faltering.

A study of 15,102 infants (23–28 weeks GA) found that each 1-week delay in reaching full enteral feeds (≥120 mL/kg/day) was linked to:
+16% risk of sepsis (ARR 1.16)
Higher NEC risk (ARR 1.20)
More growth faltering in weight, length, and HC.

#Neosky #pedsky

jamanetwork.com/journals/jam...

Machine Learning Risk Prediction for Treated Retinopathy of Prematurity in Infants - PubMed ML models can effectively predict the need for ROP treatment and stratify infants by risk, potentially reducing unneeded screening. Future work is needed to translate model-based ROP predictions to the clinical setting.

#Neosky #pedsky

this study produced a model that can safely reduce ROP screens. Trained on >100k infants and validated on >25k, the model has AUROC 0.916. With 100% sensitivity, NPV was 99.9% and screens dropped 12%. A good tool to improve risk-stratification.

pubmed.ncbi.nlm.nih.gov/41252350/

Frontiers | Identifying neonatal hyperglycemia thresholds in preterm infants based on retinopathy of prematurity outcomes: proof-of-concept study PurposeNeonatal hyperglycemia significantly increases risk for retinopathy of prematurity (ROP) in preterm infants, independent of other major ROP risk facto...

A pilot study evaluated whether hyperglycemia and HbA1c levels can predict severe ROP. It found that a 30-day mean glucose of ~ 5.2 mmol/L with HbA1c of 5.6% predicted severe ROP with a 94% PPV. Another step toward improving ROP prevention.

#Neosky #pedsky

www.frontiersin.org/journals/ped...

Comparative Study Showed Significant Gene Expression Differences in Newborn Infants After Vaginal and Caesarean Deliveries - PubMed This study demonstrates that the mode of delivery significantly influences neonatal gene expression and immune system activation.

3/3
#Neosky #pedsky

Why it matters:
Vaginal birth may provide cues that jump-start immune & stress pathways.
C-section infants might miss this activation window, possibly contributing to slightly higher rates of asthma/allergies.

pubmed.ncbi.nlm.nih.gov/41220118/

2/3
#Neosky #pedsky

Key findings:
- 95 genes were more active in the vaginal-birth group
- IL-6 and IL-8 were also higher
Suggesting vaginal birth “activates” the newborn immune system.
After correction, effects weren’t significant—likely due to small sample size. Think trend, not conclusion

1/3
#Neosky #pedsky

Does the mode of delivery program a newborn’s immune system?
A new study from Finland suggests yes—possibly.
The study compared babies born vaginally vs. via elective C-section and examined genes tied to immune & stress responses

Fast and accurate newborn heart rate monitoring at birth: A systematic review To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth.A search of Medline, SCOPUS, CINAHL an…

Accurate assessment of heart rate is critical for decision-making in the delivery room. However, the opimsl method for assessing HR in this setting is uncertain. A recent meta-analysis found that the quality of available evidence is low to very low.

www.sciencedirect.com/science/arti...

Closed-loop automated oxygen control in preterm ventilated infants: a randomised controlled trial Objective To compare the duration of mechanical ventilation between preterm infants receiving closed-loop automated oxygen control (CLAC) or manual oxygen control. Design Randomised controlled trial....

3/3

Takeaway
Automated O₂ control improved oxygen stability and reduced key complications in preterm infants; BPD and oxygen dependency.
Larger trials are needed before routine clinical adoption.

#Neosky #Pedsky

fn.bmj.com/content/earl...

2/3

Infants managed with CLAC had:
• Shorter ventilation (11 vs. 40 days, p=0.02)
• Less time on O₂ (33 vs. 47 days, p=0.03)
• Lower rates of BPD (55% vs. 84%, p=0.02)
• Fewer required home O₂ (27% vs. 51%, p=0.02)
CLAC reduced hypo- or hypoxemia episodes (p<0.001).

#Neosky #Pedsky

1/3

A new RCT tested closed-loop automated oxygen control (CLAC) vs. manual oxygen adjustment in preterm ventilated infants, aiming to compare how long infants stayed on mechanical ventilation.
N= 69 infants (median GA 27 wks) were randomized within 48 hours of ventilation start

#Neosky #Pedsky

Systematic reviews on the same topic are common but often fail to meet key methodological standards: a research-on-research study To 1) assess the frequency of overlapping systematic reviews (SRs) on the same topic including overlap in outcomes, 2) assess whether SRs meet some key methodological characteristics, and 3) describe ...

2/2
Among overlapping SRs, 21% reached conflicting conclusions and 69% disagreed on evidence certainty.

Takeaway:
redundant, low-quality SRs waste resources and mislead clinicians. Every new SR should justify its purpose and follow rigorous methods.
#Neosky #pedsky

www.jclinepi.com/article/S089...