Accurate determination of a cause of death (COD) is fundamental for neonatal quality assessment, parental counseling, and epidemiologic surveillance. Declining autopsy rates raise concerns about the reliability of assigned CODs. Misclassification of COD distorts mortality statistics, hinders understanding of preventable conditions, and limits opportunities for system-level improvement. This narrative review examines literature on infant COD determination and discusses discrepancies between clinically assigned and autopsy-confirmed CODs. Studies show that a substantial proportion of infants were misdiagnosed prior to autopsy. We supplement this with original data from the neonatal unit at Uppsala University Children’s Hospital in Sweden, illustrating discordance between clinically assigned and autopsy-confirmed COD and highlighting subgroups where autopsy proved valuable. Furthermore, we discuss declining autopsy rates and their implications for medicine, families, and quality assessment. Understanding CODs in infants is essential for advancing neonatology. Despite advances in diagnostic technology, autopsy remains the gold standard for determining COD and identifying missed diagnoses.
To review available evidence in the management of established bronchopulmonary dysplasia (BPD). We conducted a structured, domain-specific narrative review of PubMed (MEDLINE) from 2000 to 2025, including randomized trials, cohort studies, systematic reviews, and clinical guidelines in preterm infants with established BPD, with qualitative synthesis across predefined management domains. Published studies support oxygen saturation targets of 90–95% for most infants, with slightly higher targets used for those with pulmonary hypertension. Chronic-phase ventilation strategies accommodating heterogeneous lung mechanics are associated with improved synchrony and gas exchange. Diuretics provide only a transient benefit and are associated with growth and electrolyte disturbances. Systemic corticosteroids may facilitate extubation in selected infants, while inhaled corticosteroids and bronchodilators lack evidence for routine use. Chronic management of established BPD is supported by limited data. Current evidence for infants after 36 weeks’ PMA favors careful oxygen titration, chronic-phase ventilation strategies, and selective pharmacologic therapy.
The primary aim is to determine the clinical efficacy of pure hypochlorous acid solution (pHA) in preventing neonatal skin Staphylococcus aureus colonization. The secondary aim is to evaluate both the cutaneous and systemic safety and tolerability of full-body application of pHA. Neonates born at 22–41 weeks’ gestation were enrolled during three consecutive cohorts. A full-body wipe with pHA soaked gauze was performed three times a week. The incidence of colonization was then compared 6 months before and after intervention. The neonatal skin condition score, CMP, and LFTs were assessed. In total, 444 neonates received 1332 applications. There were 32 MRSA-positive colonizations pre-intervention and 15 after, with 53% decrease in the absolute number and a 47% decrease in the rate. There was minimal change in MSSA colonization. There were no signs of systemic or cutaneous toxicity. Cutaneous application of pHA decreases the incidence of MRSA colonization and demonstrates systemic and topical safety.
OBJECTIVE To characterize temporal trends in ketamine infusion use in extremely preterm infants with severe bronchopulmonary dysplasia (sBPD) and identify associated clinical factors. STUDY DESIGN We conducted a 15-year (2010-2024) retrospective cohort study of extremely preterm infants with sBPD. Time was analyzed as a categorical variable in three 5-year epochs. Ketamine exposures were described, and multivariable logistic regression estimated associations between time periods and use, adjusting for clinical characteristics. RESULTS Among 8888 infants with sBPD, 112 (1.3%) received ketamine infusion, with use increasing over time and rising most sharply between 2020 and 2024. Pulmonary hypertension (adjusted odds ratio, aOR 5.47, 95% CI 1.65-18.09), stage II/III necrotizing enterocolitis (aOR 2.06, 1.24-3.43), and tracheostomy (aOR 8.32, 3.50-19.77) were independently associated with use. CONCLUSIONS Ketamine infusions in sBPD are uncommon but have increased over time, particularly since 2020. Use is associated with markers of greater illness severity.
Objective To evaluate whether a nurse-coordinated, two-clinic high-risk infant follow-up (HRIF) clinical model supported by automated data tracking was associated with reduced loss to follow-up (LTFU) by 24 months adjusted age.Study design We conducted a quasi-experimental pre/post quality improvement study of 2174 NICU graduates (2019-2024). Epoch 1 (2019-2021) received care under the original HRIF model. Epoch 2 (2022-2024) received a redesigned model incorporating nurse-led discharge coordination, diagnosis-stratified clinics, standardized developmental assessments, expanded eligibility criteria, and a REDCap data warehouse. The primary outcome was LTFU by 24 months, adjusted for age.Results Among 4956 completed visits, LTFU decreased from 35% to 17%. Attendance at 6 months improved from 49% to 73%. Patients with neurologic diagnoses or greater subspecialty engagement were more likely to remain in follow-up.Conclusion The HRIF redesign supported by data infrastructure was associated with substantially lower LTFU and may improve developmental surveillance for high-risk infants.
