INTRODUCTION:Congenital portosystemic shunts (CPSS) are rare vascular anomalies that can lead to hyperammonemia and liver dysfunction. CASE PRESENTATION:A 1-month-old infant was diagnosed with incidental patent ductus venosus (PDV) and a focal nodular hyperplasia-like liver nodule. Laboratory tests revealed hyperammonemia (192 µmol/L) and cholestasis. Imaging confirmed a 7.8-mm shunt connecting the left portal vein to the inferior vena cava. Urgent transcatheter closure was performed via the right jugular vein using a 12/10-mm LifeTech™ Konar-MFO occluder. Post-procedural imaging showed complete shunt occlusion, and ammonia levels rapidly decreased to 71.8 µmol/L. Cholestasis improved, and the patient was discharged without complications. CONCLUSION:This report describes the first global use of the Konar-MFO device for PDV closure. Transcatheter embolization using this device is a safe and effective minimally invasive treatment for symptomatic PDV in young infants.
OBJECTIVE:To develop and validate a deep learning-based multi-class classification model for automated grading of respiratory distress syndrome (RDS) severity on neonatal chest radiographs. METHODS:A total of 23,210 radiographs, including normal and RDS cases, manually annotated by trained neonatologists, were divided into training, validation, and external test sets using patient-level splitting. Lung regions were segmented using UNet++, and RDS severity was classified into five ordered grades using a ResNet-50-based model. RESULTS:The model achieved a quadratic weighted kappa of 0.696, with 85.7% of predictions within one grade and five-class accuracy of 0.575. AUROCs were 0.966 for detecting RDS and 0.866 for clinically significant RDS (Grade ≥3). Gradient-weighted Class Activation Mapping demonstrated attention to lung regions with reduced aeration and granular opacities in severe RDS. CONCLUSIONS:This model may provide objective and interpretable radiographic assessment of RDS severity and support more consistent radiographic evaluation in NICU.
INTRODUCTION:Continuous positive airway pressure (CPAP) is a preferred respiratory support modality for preterm infants. Animal studies have shown long-term detrimental effects on lung/airway development such as airway hyper-reactivity (AHR) may be an unfortunate consequence of sustained stretch associated with neonatal CPAP. The objective of the present study is to investigate the role of the mechanosensitive Piezo2 (PZ2) channel as a potential mediator of AHR and airway smooth muscle morphology using our neonatal mouse model. METHODS:Neonatal mice were fitted with a custom-made mask for delivery of daily CPAP consisting of 3 h/day for 7 consecutive days. At postnatal day 21 (two weeks after CPAP ended), AHR and smooth muscle expression were assessed with and without modulation of PZ. RESULTS:CPAP-induced AHR was prevented by acute PZ2-specific and non-specific (PZ1 and PZ2) antagonist administration. AHR was associated with increased airway smooth muscle (ASM), which was reduced by siRNA treatment targeting PZ2. CONCLUSIONS:These data suggest the long-term effects of CPAP on airway function involve mechanosensitive PZ channels, which could contribute to wheezing disorders in former preterm infants who had received prior CPAP administration.
INTRODUCTION:Survival from cardiac arrest is directly and consistently linked to the quality of chest compressions (CC). Although compressor fatigue is well established, neonatal resuscitation guidelines (NRP) do not offer specific recommendations on rotation intervals beyond suggesting provider changes every 2-5 minutes. By comparison, Pediatric Advanced Life Support recommends a strict 2-minute rotation to prevent fatigue and maintain high-quality CC. METHODS:Prospective observational data from resuscitation of asphyxiated cardiac-arrested neonatal lambs to evaluate changes in chest compression rate, blood pressure, carotid blood flow with duration of CC by a single compressor. 41 near-term lambs were asphyxiated by umbilical cord occlusion until asystole resuscitated using NRP's synchronized three CC to one ventilation algorithm. RESULTS:The error rate of providing >3 or <3 CC between ventilations was <1%. CC rate and the percentage of lambs that received NRP's goal CC rate of 90/min decreased over time (p<0.005). After 91-120 seconds of chest compressions, CC rate decreased by 4% [3%,6%], carotid flow decreased by 21% [7%,35%], systolic blood pressure decreased by 3.1 [1.1,5.0] mmHg or 10% [3%,16%], and mean blood pressure decreased by 1.0 [0.3,1.7] or 7% [2%,12%] at the 95% confidence interval compared to baseline CC during the first 30 seconds (p<0.05). CONCLUSIONS:Extended duration of CC beyond 2 minutes is associated with a decrease in carotid blood flow, CC rate, systolic and mean arterial blood pressure. To maintain optimal cerebral perfusion in an ovine model of cardiac arrest, rotating compressors every two minutes may minimize fatigue-induced decrease in CC efficacy.
INTRODUCTION:Antenatal corticosteroids (ACS) prevent neonatal complications and mortality in women at risk of preterm birth. However, the benefits and risks of ACS in chorioamnionitis (CAM) remain debated. This study evaluated whether ACS in women with clinical CAM was associated with adverse neonatal outcomes. METHODS:This population-based retrospective study included neonates born before 34 weeks of gestation to women with clinical CAM in Japan between April 2010 and March 2023. Data were obtained from the Neonatal Research Network of Japan database. Adjusted odds ratios (aOR) for mortality and morbidity were compared between ACS and non-ACS groups. RESULTS:Of the 6,158 preterm infants born to mothers with clinical CAM, 4,086 (66.4%) received ACS and 2,072 (33.6%) did not. ACS exposure was associated with reduced aORs for respiratory distress syndrome (RDS; aOR: 0.85; 95% confidence interval [CI]: 0.75-0.96), intraventricular hemorrhage (IVH) grade III/IV (aOR: 0.52; 95% CI: 0.41-0.66), periventricular leukomalacia (PVL; aOR: 0.71; 95% CI: 0.54-0.95), sepsis (aOR: 0.78; 95% CI: 0.66-0.92), treated retinopathy of prematurity (ROP; aOR: 0.81; 95% CI: 0.69-0.95), and mortality (aOR: 0.69; 95% CI: 0.55-0.87). In contrast, the aOR for bronchopulmonary dysplasia (BPD) was higher in the ACS group (aOR: 1.51; 95% CI: 1.31-1.73). CONCLUSION:ACS treatment in women with clinical CAM was associated with reduced neonatal death, RDS, severe IVH, PVL, sepsis, and ROP while increasing the risk of BPD. These findings support ACS therapy while underscoring the need for further studies to identify interventions beyond ACS to prevent BPD.
INTRODUCTION:Ophthalmia Neonatorum (ON) is a serious neonatal eye infection, primarily caused by Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG). Although the World Health Organization (WHO) recommends universal antibiotic prophylaxis at birth, many high-resource countries have suspended this procedure. European data on incidence of ON and prophylaxis use are limited. AIMS:To evaluate the routine implementation of prophylaxis across a selected sample of European birth centres, to assess adherence to WHO recommendations, and estimate the incidence of conjunctivitis caused by CT and NG among newborns, comparing centres with and without prophylaxis. METHODS:An electronic questionnaire was distributed to 94 birth centres in 21 European countries, focusing on those with significant birth volumes and university or referral hospital status. Data collection occurred over two days, 20-21 November 2024, with cases of CT/NG conjunctivitis reported for 2023. RESULTS:Among 94 responding centres, 54 (57.5%) routinely implemented prophylaxis, but 74% of them did not adhere to WHO guidelines. Of 1,636 newborns observed, 598 (36.6%) received prophylaxis at birth. Seventeen cases of CT/NG conjunctivitis were reported in 2023, with similar incidence rates in centres with and without prophylaxis (6.2 vs. 5.8 per 100,000 live births; p = 0.89). CONCLUSIONS:Variations in ocular prophylaxis across involved centres, coupled with low rates of NG and CT conjunctivitis and no significant differences between centres using or not using prophylaxis, suggest that this practice could inform antibiotic stewardship in newborns. A unified, evidence-based European protocol is essential to enhance safety and reduce early antibiotic use.
INTRODUCTION:Short peripheral catheters (SPCs) are the most frequently used vascular access devices in neonatal care. However, prospective data quantifying the procedural burden of SPC use and identifying predictors of complications in term and preterm infants remain limited. METHODS:In this prospective cohort study, 170 neonates undergoing SPC insertion during the first 7 days of life were included. A total of 354 cannulation procedures were recorded. The primary outcome was the occurrence of at least one SPC-related complication. Procedural burden was assessed using descriptive and exposure-adjusted analyses, and predictors of complications were evaluated using multivariable logistic regression. RESULTS:First-attempt success was achieved in only 30.6% of infants, and the median number of attempts required per patient was 3 (range 1-23). At least one complication occurred in 66.5% of neonates. In multivariable analysis day of life at first cannulation, more than one insertion attempt, and parenteral nutrition were independently associated with complications. CONCLUSION:SPC use in neonates was associated with substantial procedural burden and frequent complications. Importantly, this burden was not confined to the most immature infants, but was also pronounced in moderate and late preterm neonates. These findings suggest that a routine peripheral-first strategy may not always be appropriate in this group and support earlier consideration of alternative vascular access strategies.
Introduction: In several large cohorts from the United States and China, multiple as opposed to singleton birth was found to be associated with increased mortality, while studies from European countries have yielded conflicting results. We aimed to assess the association between plurality and survival of very low birth weight infants in relation to gestational age. Methods: Data of preterm infants <1500g birth weight obtained from annually published quality improvement data mandatorily collected from all hospitals in Germany (2010-2017, 2019-2024) were analyzed for mortality of singletons versus multiples. Results: Among infants below 1500g birth weight (n=128,057), twins and higher-order multiples accounted for 28.2% and 3.9%, as opposed to 3.5% and 0.1% in all neonates (n=9,986,821). Mortality prior to discharge was lower in twins (7.3%) and triplets (6.2%) than in singletons (9.0%) [relative risk (RR) 0.811, 95% confidence interval (CI) 0.777-0.846, and 0.689 (0.618-0.769), respectively]. However, in infants below 25 weeks’ gestation, mortality was higher in multiples (40.5%) than in singletons (37.6%) [RR (95% CI) 1.076 (1.031-1.124)], whereas it was lower in multiples than in singletons infants with a gestational age of 25-27 weeks (8.5% vs 9.4%, RR (95% CI) 0.907 (0.837-0.983)), 28-30 weeks (2.1% vs 2.9%, RR (95% CI) 0.737 (0.650-0.835)) and more than 30 weeks (1.2% vs 2.0%, RR (95% CI) 0.583 (0.484-0.703)). Conclusions: In this large population-based cohort of preterm infants below 1500g birth weight, multiples had higher survival rates than singletons, except those born before 25 weeks’ gestation.
INTRODUCTION:Central venous catheters (CVCs) are widely used in preterm infants. They secure vascular access, but their value for nutrition and neonatal outcome remains uncertain. METHODS:Within the German Neonatal Network (GNN) cohort, we evaluated data of very low birth weight infants (VLBWI) <29 weeks' gestation with and without CVCs. Associations between CVC use, growth, enteral feeding advancement, and duration of hospitalization were assessed using univariate and multivariate regression models. A survey among all German tertiary level neonatal intensive care units additionally assessed nutrition practices. RESULTS:Among 12,516 infants, 82% received CVCs. Infants with CVCs had a lower mean gestational age (26.28 vs. 27.46 weeks, p<0.001) and birth weight (821 vs. 1,002g, p<0.001) compared to those without CVCs. In adjusted analyses, CVC use was associated with reduced neonatal weight gain (β -0.219 [CI -0.424 to -0.015], p=0.036) and head growth (β -0.040 [-0.054 to -0.025], p<0.001), delayed full enteral feeding (β 4.446 [3.820 to 5.071], p<0.001), and prolonged hospitalization (β 0.412 [0.376 to 0.449], p<0.001). CONCLUSION:Within the limits of an observational design, CVC utilization was associated with reduced growth, delayed full enteral feeding, and prolonged hospitalization in VLBWI. While findings should be interpreted in the context of differences in immaturity and morbidity between groups, they may contribute to further evaluation of current nutritional strategies, including routine CVC use for early-life parenteral nutrition, as well as more individualized approaches to nutritional management and careful consideration of CVC indications in VLBWI.
INTRODUCTION:Although the precise nutrient requirements of preterm infants remain uncertain, routine human milk fortification is standard practice despite limited evidence of long-term benefit. Whether current fortification strategies optimally balance benefits, risks, and resource use remains unclear. This review evaluates whether individualised fortification improves preterm infant outcomes. METHODS:Randomised controlled trials comparing individualised with standardised fortification were included, evaluating outcomes including mortality, neurodevelopment, growth, and neonatal morbidities. Four databases and three trial registries were searched. Screening, data extraction and quality assessment were conducted independently by two reviewers using Cochrane Risk of Bias-1 tool. Certainty of evidence was assessed using GRADE. RESULTS:Twelve studies including 575 participants were included. Evidence is very uncertain about the effect of individualised fortification on mortality [181 infants, relative risk (RR) 0.20, 95% confidence interval (CI) (0.02, 1.66), p=0.14, I²=0%] and necrotising enterocolitis [193 infants, RR 0.29 (0.05,1.72), p=0.17, I²=0%], both very low certainty. Effect on neurodevelopment at 18-months remains very uncertain. Individualised fortification likely increases head circumference [224 infants, mean difference (MD) 1.76 (0.76, 2.76) mm/week, p=0.0005, I²=52%], weight gain [454 infants, MD 2.87 (1.36, 4.39) g/kg/day, p<0.0002, I²=79%], length gain [261 infants, MD 3.20 (1.22, 5.18) mm/week, p=0.002, I²=81%] and fat-free mass [106 infants, MD 121.4 (25.6, 217.2) g, p=0.01, I²=0], all with moderate-certainty. It may increase fat mass [106 infants, MD 68.9 (6.1, 131.8) g, p=0.03, I²=63%] with low-certainty. CONCLUSION:Individualised fortification likely increases growth in preterm infants; however, whether this is beneficial to clinical and long-term functional health is uncertain. Further high-quality trials with long-term follow-up are needed.
Introduction: Multi-morbidity is a known cause of adverse outcomes and resource utilization in adults. Our objective was to describe the co-occurrence of neonatal morbidities and their association with neurodevelopmental outcomes in preterm neonates. Methods: We included 17,438 preterm neonates of <29 weeks' gestation admitted to Canadian NICU between 2010 and 2020, of whom 7,943 children had neurodevelopmental information. Neonatal outcomes were mortality, late-onset sepsis, necrotizing enterocolitis, and severe neurological injury. The outcomes were neurodevelopmental impairments, with significant impairment defined as any of: Bayley-III score <70, cerebral palsy with GMFCS ≥3, hearing amplification, or bilateral visual impairment; and severe impairment defined as any of: Bayley-III score <55, cerebral palsy with GMFCS 4-5, or bilateral blindness. Results: The mean (SD) gestational age was 26.1 (1.6) weeks and 54.5% were male. Any neonatal mortality/morbidity occurred in 40.1% of children. Among survivors, 16.3% had significant neurodevelopmental impairment and 5.8% had severe neurodevelopmental impairment. However, 51% of children with significant impairment and 43% with severe neurodevelopmental impairment and had no neonatal morbidities. Late-onset sepsis (aOR 1.60, 95%CI 1.36, 1.88), necrotizing enterocolitis (aOR 1.91, 95% CI 1.36, 2.69) and severe neurological injury (aOR 3.54, 95%CI 2.85, 4.38) were associated with significant neurodevelopmental impairment among survivors. An increase in the count of neonatal morbidities correlated with a rise in the count of neurodevelopmental impairments. Conclusions: Sixty percent of infants <29 weeks’ gestation experienced no adverse neonatal outcomes and the majority were free of significant neurodevelopmental impairment. Neonatal morbidities had a direct and combined association with neurodevelopmental impairment.
INTRODUCTION:The Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants randomized trial compared higher versus lower hemoglobin transfusion thresholds in extremely low birth weight infants. This publication compares the economic implications of the two strategies. METHODS:We undertook a prospectively planned economic evaluation, using patient-level data from the parent clinical trial. We report costs in 2020 US dollars, from health sector and modified societal perspectives, with a time horizon through the end of clinical follow-up. We derived costs from hospital finance systems, Medicaid fee schedules, family questionnaires, and efficacy from trial data. RESULTS:Of the 1,824 patients enrolled at 19 centers in the trial, data were available for 1,305 for analysis from a health sector perspective and 752 for analysis from a societal perspective. The mean cost from the health sector perspective was USD 331,186 per patient in the higher hemoglobin transfusion threshold group and USD 351,579 in the lower hemoglobin transfusion threshold group; the difference was not statistically significant after adjustment for study site and birth weight stratum (p = 0.085). The difference in mean costs from the societal perspective was also not statistically significant (p = 0.094). The incremental cost-effectiveness ratios for adoption of a lower transfusion threshold from health sector and societal perspectives were USD 6,797,666 and USD 5,596,666 per additional survivor without neurodevelopmental impairment, respectively. There was substantial uncertainty in these cost-effectiveness estimates. DISCUSSION:Similarly to prior results for clinical efficacy, choosing between a lower or higher hemoglobin transfusion threshold for extremely preterm infants has no significant economic advantage.
BACKGROUND:Technological advancement in neonatal-perinatal care has improved the survival of critically ill neonates with complex medical and surgical conditions. As part of diagnostic and therapeutic management, these vulnerable neonates are exposed to potential harmful and unintended exposures in the NICU, including diagnostic imaging, sensory environments, medications, nutrition, blood products, and devices. SUMMARY:The negative effects on multiple organs at cellular levels can not only impact the growth, development, and neurocognitive outcomes for the neonate but have the potential of being transmitted to future generations through epigenetic changes. Families, nurses, clinicians, and researchers invested in improving neonatal outcomes need to be aware of these negative impacts. KEY MESSAGE:Concerted efforts should focus on eliminating known toxic and harmful substances from commercial products used in neonatal care, and alternatives should be made available. Generational population health globally from early neonatal period to adulthood can be improved by allocating resources to research and mitigation strategies.
INTRODUCTION:The aim of the study was to compare the time of attainment of full enteral feeds in sick neonates between 27 and 32 weeks of gestation receiving early total enteral feeding (ETEF) versus conventional enteral feeding (CEF). METHODS:In this randomized controlled trial, 183 infants were allocated to either the ETEF (n = 90) or CEF (n = 93) group. In the ETEF group, feeding was initiated as complete enteral feeds, whereas in the CEF group, feeding was initiated as trophic feeding at 20 mL/kg. The rest of the day's requirements for the CEF group were provided as intravenous fluids. RESULTS:The ETEF group infants had marginally higher mean birth weight, slightly greater gestational age, fewer infants with SGA at birth, and a lesser need for resuscitation, although these differences were not statistically significant. The neonates in the ETEF group reached full enteral feeds significantly earlier than the CEF group (6.8 ± 1.8 vs. 9.1 ± 4.3 days postnatal age; mean difference -2.3 [-3.2 to -1.3]; p < 0.001). There was a significant reduction in the episodes of feed intolerance and clinical or probable sepsis with significantly higher weight gain at 1 month of age (17.4 vs. 15.5 g/kg/d; p = 0.001), and a shorter duration of hospital stay (25.9 vs. 38.1 days; p = 0.001) in the ETEF as compared to the CEF group. None of the neonates in the ETEF group developed necrotizing enterocolitis (NEC). CONCLUSION:ETEF in sick neonates between 27 and 32 weeks' gestation leads to early attainment of full feeds without increasing the incidence of feed intolerance and NEC. This feeding practice also reduces pre-maturity-associated complications and the duration of hospital stay.
Introduction: The aim of this study was to identify early metabolic alterations associated with intraventricular hemorrhage (IVH) and its complications, periventricular hemorrhagic infarction (PVHI), and post-hemorrhagic ventricular dilatation (PHVD), in very preterm infants. Methods: This population-based observational cohort included 7,313 preterm infants born at 24-32 weeks' gestation between 2009 and 2019. Twenty-one analytes were quantified from dried blood samples collected within the first 96 h of life using tandem mass spectrometry. Multivariable logistic regression models were used to examine the association between analyte concentration quartiles and IVH, including analysis stratified by IVH-related complications. Results: IVH was diagnosed in 882 infants, while 6,431 had normal neurosonography. Compared with infants in the lowest quartile, those in the highest quartile of methionine and proline concentrations had increased odds of IVH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.21-1.86 and OR 1.74, 95% CI: 1.40-2.17, respectively). In contrast, infants in the highest quartile of free carnitine concentrations had significantly lower odds of IVH (OR 0.53, 95% CI: 0.42-0.67). These associations were more pronounced among infants with PVHI (n = 149) and PHVD (n = 152) (p < 0.001). Conclusion: Among very preterm infants, higher methionine and proline concentrations within the first 96 h of life were associated with increased risks of IVH and its complications, whereas higher free carnitine concentrations were associated with lower risks. Whether these metabolic alterations reflect secondary responses to ischemic-hemorrhagic brain injury or act as modulators of germinal matrix vulnerability warrants further investigation.
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. METHODS: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. RESULTS: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. CONCLUSION:Term-equivalent MRI offers higher predictivity than early MRI. Standardised scoring and multimodal integration are needed to optimise early risk stratification in preterm populations.
INTRODUCTION:Mild non-cystic white matter injury (WMI) is commonly detected on MRI in very preterm infants, but its prognostic significance remains uncertain. We assessed neurodevelopmental outcomes up to 5 years in infants with isolated mild non-cystic WMI on term-equivalent MRI compared with those without brain injury. METHODS:In this population-based retrospective cohort study, infants born <32 gestational weeks in Tyrol, Austria (2011-2018) were included. MRI was performed at term-equivalent age. Infants with isolated mild non-cystic WMI (Kidokoro PVL grade 1-2) and those without brain injury were analysed. Neurodevelopmental outcomes were assessed at 12 and 24 months' corrected age using the Bayley Scales, and at 5 years using standardized cognitive tests (WPPSI-III, KABC-II, SON-R) and the MABC-2. RESULTS:Of 363 infants, 35 (9.6%) had isolated mild non-cystic WMI. Median cognitive and motor scores were within the normal range in both groups at all time points, with no significant differences, although cognitive scores were numerically higher in the WMI group at 12 months (p = 0.087). Rates of developmental delay (<85) and impairment (<70) did not differ between groups. All infants with isolated mild non-cystic WMI were born at ≥28 gestational weeks; findings were consistent in this subgroup. CONCLUSION:Isolated mild non-cystic WMI was not associated with adverse neurodevelopmental outcomes up to 5 years. In settings with routine MRI at term-equivalent age, these findings suggest that isolated mild non-cystic WMI may have limited prognostic value and should not be overinterpreted as markers of adverse outcome in clinical counselling.
INTRODUCTION:Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units (NICUs) might contribute to clinical variability. The objective was to survey current oxygen saturation targets (SpO2), the use of automatic adjustment of inspired oxygen in infants on respiratory support, the criteria for routine retinal examinations for retinopathy of prematurity (ROP), and the use of anti-vascular endothelial growth factor (VEGF) agents to treat ROP in the International Network for Evaluating Outcomes for Neonates (iNeo). METHODS:Online pre-piloted anonymous questionnaires on care practices in 2023 for extremely preterm (<29 weeks) infants were sent to the directors of 608 NICUs in the iNeo. Four questions concerned ROP management and results were compared with a similar 2015 survey. RESULTS:There were 11 participating networks from 12 high-income countries and one from a middle-income country. The overall NICU response rate was 63% (382 units). Despite variability between NICUs, within networks, there was limited change in SpO2 targets between 2015 and 2023. The median upper and lower SpO2 targets were 95% and 89%; in 18% of NICUs, the upper target was ≥96%, and in 13%, the lower target was ≤85%. Automated loop systems for controlled oxygen delivery were used in 24% of NICUs. Most NICUs (78%) used a combination of birthweight and gestation as ROP screening criteria. Intravitreal anti-VEGF agents were used to treat ROP in all networks and by 76% of NICUs. DISCUSSION:There was considerable variation in care practices between NICUs, and the relationship of this to clinical outcomes should be explored.
