BackgroundUrine drug screening (UDS) is commonly utilized to identify substance use during pregnancy and facilitate timely interventions aimed at mitigating adverse parental and neonatal outcomes. Current literature has demonstrated that UDS among pregnant patients is not uniformly applied across populations but less is known about screening practices among neonates. This study aimed to evaluate the demographics, clinical indications, documentation and disclosure practices, and outcomes associated with neonatal drug screening.MethodsA retrospective chart review was completed for neonates at one academic institution whose birthing parent had undergone UDS. Statistical methods to analyze this data included t-tests, calculated percentages, and chi square analysis to compare whether the independent variables evaluated affected screening decisions.ResultsOf 651 neonates of parents who completed a UDS during their pregnancy, 273 (42.5%) screens were positive. Amphetamine (36.8%) and cannabinoid (38.6%) accounted for the majority of positive substances. Neonatal race and ethnicity data showed that the overall racial distribution of neonatal drug screens obtained was proportional to the racial representation in the study's population. However, the proportion of patients screened in the study does not reflect the proportion of patients within each race and ethnicity found among the birthing population. The majority (97.8%) of drug screens obtained did not include documentation of parental consent.ConclusionsSystemic changes need to be made to ensure equitable screening protocols exist for neonatal drug screens as well as ensure parental consent and knowledge of screening results is documented.
We report a term neonate who presented with early-onset conjugated hyperbilirubinemia, acholic stools, and imaging findings concerning for biliary atresia, including a contracted gallbladder and triangular cord sign on abdominal ultrasound. However, intraoperative cholangiography demonstrated normal bile flow. Persistently normal gamma-glutamyl transpeptidase (GGT), cholestasis, and renal tubular dysfunction prompted expanded evaluation. Whole-exome sequencing identified a pathogenic VPS33B variant, confirming Arthrogryposis-Renal dysfunction-Cholestasis (ARC) syndrome. Despite supportive management, his condition progressively declined, and he died at approximately 2 years of age following worsening cholestasis, reduced oral intake, and cardiorespiratory arrest at home. In this infant, the absence of arthrogryposis represented an incomplete and atypical phenotype at birth of an already rare condition. This case report and review of the literature expands the recognized clinical spectrum of ARC syndrome and underscores the importance of considering genetic etiologies in neonates with low-normal GGT cholestasis when conventional evaluation is inconclusive. Early integration of genomic testing may improve diagnostic accuracy, inform family counseling, and refine clinical decision-making in neonatal cholestasis.
ObjectiveNeonatal hyperbilirubinemia (NHB) is a common clinical condition that may lead to long-term neurodevelopmental impairment due to bilirubin-induced neurotoxicity. The development of reliable methods for neurological monitoring in affected newborns remains a major challenge in neonatal care. This study aimed to evaluate the association between treatment and EEG changes on cerebral activity in infants with hyperbilirubinemia using conventional EEG.Methods & MaterialsThis prospective before-and-after study was conducted on neonates aged over 35 weeks of gestation who were diagnosed with hyperbilirubinemia. Demographic and clinical data, including neonatal age, sex, birth weight, presence of ABO incompatibility, and treatment modalities, were collected. Maternal data, including parity, mode of delivery, and maternal and neonatal blood groups, were also recorded.Conventional EEG was performed for all neonates during the first eight hours of hospitalization and repeated after therapeutic interventions, including phototherapy and, when indicated, exchange transfusion.ResultsA total of 26 neonates with hyperbilirubinemia were included in this study. The mean total serum bilirubin level before treatment was 23.01 ± 2.99 mg/dL.A statistically significant change in the EEG spectral power was observed before and after treatment in the frontal regions Fp1, Fp2, and Fz, particularly within the delta and beta frequency bands.Furthermore, the findings demonstrated that delta activity was significantly dominant in the Fp1, Fp2, and Fz regions both before and after treatment. In contrast, no dominant frequency bands were observed in the C3, O1, T3, C4, T4, Cz, and O2 regions either before or after treatment.ConclusionHyperbilirubinemia in neonates may be associated with alterations in cortical electrical activity as assessed by conventional EEG. In our study, delta band activity was significantly predominant in the frontal regions (Fp1, Fp2, and Fz) both before and after treatment. Moreover, delta band activity remained the predominant frequency in the frontal regions (Fp1, Fp2, and Fz) before and after treatment, suggesting persistent frontal cortical involvement despite treatment.Further studies with larger samples are recommended to clarify whether these EEG changes reflect a transient bilirubin effect or age-related maturation patterns.
ObjectiveWe aim to determine delirium prevalence in a Level IV NICU, identify demographic risk factors, controllable risk factors, and associated outcomes.Study DesignSelect NICU patients with at least one Cornell Assessment for Pediatric Delirium score, studied over 1 year period. Demographics and outcomes were compared in relation to delirium status. Medication exposure was analyzed prior to 40 weeks PMA and at significant CAPD score events.ResultPrevalence of delirium in the eligible study group was 64%. The delirium group had a lower median gestational age and birthweight, but higher median length of stay, and possible increased mortality rate. Exposure to benzodiazepines was strongly associated with the delirium group, though confounding may exist. Dexmedetomidine was not significantly associated with the delirium group.ConclusionsIt is possible that delirium is significantly prevalent and under-recognized among NICU patients, particularly those with lower gestational age and birthweight, and may be associated with poor outcomes. Benzodiazepine exposure may be significantly associated with neonatal delirium onset. Further investigation is needed in this area of study.
BackgroundInterventions aimed at providing oral motor stimulation improve the preparedness for oral feeding and support the earlier attainment of full oral feeding in preterm infants. However, utilizing the Premature Infant Oral Motor Intervention (PIOMI) as a structured method may prolong the time needed to reach complete oral feeding and enhance feeding efficiency regarding weight gain and exclusive breastfeeding, compared to an unstructured approach.ObjectiveThe current study aimed to evaluate the impact of PIOMI on the progression of oral feeding and weight gain in premature infants.MethodsThis study represents a randomized controlled trial that took place in a neonatal intensive care unit in 2024. The intervention group received PIOMI, and the control group did not receive the intervention. The participants of the two groups were compared based on weight gain, mean height, head circumference, and length of hospitalization.ResultsThe findings of this study showed that the mean of studied parameters, such as weight, height, and head circumference of the infants in the intervention group, was higher than that of the control group, and this difference was statistically significant (p < 0.05). Moreover, the mean number of uninterrupted sucking of infants in the intervention group was higher, and it was statistically significant (p < 0.001).DiscussionThe PIOMI intervention enhances the sucking strength and consequently boosts the growth metrics of premature infants.ConclusionIt was concluded that the PIOMI intervention increases the sucking power and, as a result, improves the growth indicators of premature neonates, such as weight, height, and head circumference, which is clinically important. Additionally, it reduces the mean hospitalization time.
BackgroundNeonatal jaundice affects most newborns due to immature bilirubin metabolism. Phototherapy continues to be the cornerstone of treatment, having significantly reduced bilirubin-induced neurotoxicity. This study compares continuous and intermittent phototherapy in term neonates with non-hemolytic indirect hyperbilirubinemia to evaluate their relative therapeutic efficacy in achieving effective bilirubin reduction.MethodsThis prospective randomized controlled trial was conducted in the Neonatal Intensive Care Unit of a tertiary care medical university in North India between August 2023 and July 2025. Term neonates (gestational age 37-42 weeks, birth weight ≥2500 g) with non-hemolytic indirect hyperbilirubinemia requiring phototherapy, as per American Academy of Pediatrics guidelines, were enrolled. A total of 150 eligible infants were randomized in equal numbers to receive either continuous phototherapy or intermittent phototherapy (3 h on/3 h off). All participants received standardized double-surface LED phototherapy with an irradiance of ≥30 μW/cm2/nm within a wavelength range of 460-490 nm. Infants were repositioned hourly, and exclusive breastfeeding was actively supported. Total serum bilirubin levels were monitored at 12-h intervals until the predefined discontinuation criteria were met.ResultsBaseline characteristics were comparable (all p > 0.05). Mean baseline TSB was similar (16.07 ± 2.67 vs 15.46 ± 3.04 mg/dL; p = 0.190). Unadjusted bilirubin reduction at 12 h and 24 h did not differ significantly. After adjustment, TSB at 12 h was comparable (p = 0.418), but higher in the continuous group at 24 h (mean difference 0.68 mg/dL; p < 0.001). The total phototherapy exposure time was shorter with intermittent therapy (13.75 ± 1.18 vs 18.15 ± 1.56 h; p = 0.001). Rebound hyperbilirubinemia and adverse events were similar between groups.ConclusionIntermittent phototherapy was as effective as continuous phototherapy in reducing bilirubin levels in term neonates with non-hemolytic indirect hyperbilirubinemia requiring treatment, while reducing total phototherapy exposure time and potentially facilitating feeding, mother-infant bonding, and more resource-efficient family-centered care.
Neonatal hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neonatal morbidity and mortality worldwide. Therapeutic hypothermia (TH) is an established neuroprotective therapy for infants with moderate to severe HIE; however, its role in the management of mild HIE remains uncertain. This review summarizes current evidence regarding neurodevelopmental outcomes in infants with mild HIE and critically evaluates available data on the use of TH in this population. Although mild HIE was excluded from the original hypothermia trials, emerging observational studies suggest that a proportion of affected infants experience adverse short- and long-term neurodevelopmental outcomes. Interpretation of these findings is limited by challenges in the early clinical identification of mild HIE, evolving diagnostic criteria, heterogeneity in outcome definitions, and reliance on retrospective or underpowered cohorts. Consequently, evidence supporting the efficacy or safety of TH in mild HIE is inconclusive, and clinical practice varies widely across institutions and regions. Existing studies have not definitively demonstrated neurodevelopmental benefit and raise concern for potential overtreatment in some infants. Adequately powered, prospective trials are urgently needed to clarify the risk, benefit profile of TH in mild HIE, identify subgroups most likely to benefit from intervention, and establish standardized diagnostic and outcome measures. Until such evidence is available, management of infants with mild HIE should be individualized, balancing potential neuroprotective benefit against known and theoretical risks, while acknowledging persistent gaps in knowledge.
BackgroundEmerging evidence suggests that environmental exposures during pregnancy may influence the risk of autism spectrum disorder (ASD) in offspring. Maternal exposure to second-hand smoke is a potentially modifiable risk factor, but previous studies have reported inconsistent findings. This is the first meta-analysis on the association between maternal second-hand smoke exposure during pregnancy and the risk of ASD in children.Materials and methodsA systematic search of the PubMed, Web of Science, and Scopus databases was conducted, covering articles published up to May 2, 2026, without language or publication date restrictions. Observational studies reporting odds ratios (ORs) for the association between maternal passive smoking during pregnancy and ASD diagnosis in offspring were included. Methodological quality was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to calculate pooled ORs. Subgroup analysis was performed based on study design, and publication bias was evaluated using Begg's and Egger's tests.ResultsNine studies comprising 9,005 participants met the inclusion criteria. The pooled OR from adjusted studies demonstrated a statistically significant association between maternal second-hand smoke exposure during pregnancy and ASD risk (OR = 2.12; 95% CI: 1.59-2.66), indicating that exposed children had more than twice the risk of ASD compared to unexposed children.ConclusionsMaternal exposure to second-hand smoke during pregnancy was associated with increased odds of ASD in offspring. The findings highlight the importance of public health interventions aimed at reducing prenatal second-hand smoke exposure, including smoke-free legislation and smoking cessation counseling for pregnant women and their families.
Objective To evaluate AI-assisted GMA performance for (i) prediction of later cerebral palsy (CP) diagnosis and (ii) classification of expert-rated GMA labels, and to assess heterogeneity and risk of bias. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. A total of 105 studies were included in qualitative synthesis, of which 28 were eligible for quantitative synthesis. Random-effects meta-analysis of proportions with logit transformation was used to estimate pooled diagnostic accuracy. Results Of 105 eligible studies in qualitative synthesis, 28 were included in quantitative synthesis (17 CP diagnosis outcomes; 11 expert GMA label outcomes). For CP diagnosis outcomes, the pooled diagnostic accuracy was 0.884 (95% CI: 0.838–0.918). For expert-rated GMA label outcomes, the pooled classification accuracy was 0.848 (95% CI: 0.761–0.908). Heterogeneity was substantial across analyses. Interpretation AI-assisted GMA shows high pooled performance for both CP diagnosis prediction and expert-label classification; however, certainty remains very low due to heterogeneity and risk of bias. No single GM developmental phase, or sensor modality, demonstrated clear superiority, underscoring the importance of standardized protocols, high-quality datasets, and transparent validation. These findings support the clinical potential of AI-enabled GMA as an objective and scalable screening tool, particularly in settings with limited access to specialized expertise.
BackgroundAcute kidney injury (AKI) is a serious complication in early preterm neonates with severe birth asphyxia, yet its incidence and predictors in this specific population remain incompletely characterised. The effect of caffeine initiation timing on AKI outcomes has not been prospectively examined.MethodsThis prospective observational cohort study enrolled 112 neonates of 28-32 weeks gestational age with severe birth asphyxia admitted to a level III neonatal intensive care unit (NICU) in South India (February-August 2025). AKI was defined by neonatal KDIGO (nKDIGO) criteria. Neonates were categorised according to early (≤6 h) or delayed (>6 h) caffeine initiation; delayed initiation was primarily associated with outborn status and haemodynamic instability at admission. Independent predictors of AKI were identified by multivariate logistic regression with bootstrap confidence intervals.ResultsAKI was diagnosed in 48 of 112 neonates (42.9%; 95% CI 34.1-52.1%). Stage 1 disease predominated (47.9% of AKI cases), with onset in the first 48 h in the majority. On multivariate analysis, early caffeine initiation was independently associated with reduced odds of AKI (aOR 0.22; 95% CI 0.11-0.43; p < 0.001), and cumulative fluid balance at 48 h was associated with increased odds (aOR 6.30 per SD [21.8 ml/kg]; 95% CI 4.27-13.05; p < 0.001). AKI incidence was 24.1% in the early caffeine group versus 60.3% in the delayed group (p < 0.001), with an observed difference in AKI incidence of 36.2%. In-hospital mortality was higher in the AKI group (10.4% vs 0%; p = 0.013).ConclusionsAKI occurred in 42.9% of early preterm neonates with severe birth asphyxia. Early caffeine initiation (≤6 h) was associated with reduced AKI incidence. Positive fluid balance at 48 h was an independent predictor. These findings suggest early caffeine initiation as a potentially modifiable factor associated with reduced AKI risk and identify fluid balance as a clinically relevant early marker in this high-risk population.
BackgroundEarly initiation of breastfeeding (EIBF) within one hour of birth is essential for neonatal survival, yet evidence from Somalia is limited. This study examined determinants of EIBF using nationally representative data.MethodsA secondary analysis of the 2020 Somali Demographic and Health Survey (SDHS) was conducted among 2,020 women with children aged 0-23 months. Sampling weights were applied. EIBF was analyzed as a binary outcome using bivariate and multivariate logistic regression. Statistical significance was set at p ≤ 0.05. Analyses were performed using SPSS version 27.ResultsOverall, 75% of newborns were breastfed within the first hour after birth. In the multivariate analysis, mothers aged 30-39 years were more likely to initiate breastfeeding early compared with those aged 15-19 years (AOR = 1.65; 95% CI: 1.01-2.70). Urban residence was positively associated with EIBF (AOR = 1.31; 95% CI: 1.02-1.68), while nomadic residence was negatively associated (AOR = 0.52; 95% CI: 0.40-0.68). Mothers without radio exposure (AOR = 0.68; 95% CI: 0.47-1.00), unemployed mothers (AOR = 0.17; 95% CI: 0.04-0.85), and those whose husbands were unemployed (AOR = 0.75; 95% CI: 0.63-0.91) had lower odds of EIBF. Facility delivery significantly increased the likelihood of EIBF (AOR = 1.44; 95% CI: 1.03-2.00).ConclusionEIBF in Somalia is influenced by maternal, socioeconomic, and health service related factors. Strengthening facility-based deliveries and expanding health education through mass media may improve EIBF practices.
Background Climate change is increasing the frequency and intensity of heatwaves globally, with potential implications for maternal and neonatal health. While associations between heat exposure and preterm birth (PTB) and low birth weight (LBW) have been documented, the broader spectrum of neonatal morbidities remains incompletely characterized. This scoping review systematically maps the evidence on heatwaves and neonatal outcomes beyond PTB and LBW. Objectives To identify and synthesize evidence on (1) which neonatal morbidities beyond PTB and LBW are studied in relation to heat exposure; (2) exposure windows examined (preconception, trimester-specific, peripartum); and (3) heat metrics employed in the literature. Methods Following PRISMA-ScR guidelines and the JBI Population-Concept-Context (PCC) framework, we searched PubMed, Embase, Web of Science, and Scopus for peer-reviewed studies examining maternal heat exposure during pregnancy and neonatal outcomes in the first 28 days of life other than PTB and LBW. Because this was a scoping review of a heterogeneous literature, we retained variation in study design, exposure metrics, and outcome definitions rather than attempting quantitative pooling. Two reviewers independently screened titles, abstracts, and full texts. Data were extracted on study characteristics, neonatal outcomes, exposure windows, and heat metrics. Risk of bias was assessed using design-appropriate tools. Results From 165 initial records, 15 records informed the review. The evidence base was heterogeneous in design, exposure assessment, and outcome definition, and represented 62,986,500 participants across nine countries (primary study publication period: 2012-2020). Eight neonatal outcome categories were identified: mortality (n = 7 evidence sources), NICU admissions (n = 5), thermoregulation disorders (n = 4), metabolic complications (n = 4), respiratory morbidity (n = 3), clinical assessment/Apgar scores (n = 3), congenital anomalies (n = 3), and infectious complications (n = 2). Third-trimester exposure was most frequently studied (n = 9), followed by peripartum (n = 3), second trimester (n = 2), and first trimester (n = 2). Heat metrics included maximum temperature (n = 5), heat index (n = 4), heatwave definitions (n = 4), mean temperature (n = 4), apparent temperature (n = 2), humidex (n = 1), and WBGT (n = 1). Seven studies (47%) were rated as low risk of bias. Across outcome groups, the literature generally suggested adverse associations with heat exposure, but the magnitude, statistical significance, and certainty varied across designs and metrics. Conclusions This scoping review reveals a growing, yet heterogeneous, body of evidence linking heat exposure to diverse neonatal morbidities beyond PTB and LBW. Third-trimester and peripartum exposures appear especially relevant, but conclusions should remain cautious because the included evidence varies in design, exposure metrics, outcome definitions, and confounder control. Standardization of heat metrics and exposure assessment is needed. Gaps include limited research on preconception and first-trimester exposures, metabolic and infectious complications, and research from low- and middle-income countries. Future research should employ consistent methodologies and examine vulnerable populations to inform climate adaptation strategies for maternal-neonatal health.
BackgroundNeonatal early onset sepsis [EOS] continues to impact the neonatal morbidity and mortality rates worldwide. The diagnosis of suspected EOS in the neonatal intensive care unit (NICU) remains an important challenge for clinicians as the signs of sepsis are often nonspecific and the laboratory investigations may be unreliable or not routinely available.Presepsin (P-SEP) or soluble clusture of Differentiation 14 Subtype (SCD14-ST) is generated as a part of the body's response to bacterial infection, being effective in the early phase of inflammation and detected as an early marker of neonatal sepsis.This study aimed to evaluate the diagnostic value of presepsin in early-onset sepsis, and its prognostic value regarding disease severity, and duration of hospital stay. Moreover, the study aimed to assess the possible predictive ability of presepsin in identifying the type of bacterial organism causing early-onset sepsis in preterm neonates.Materials and methodsThe study recruited 36 preterm neonates with risk factors for early onset sepsis. Control group included 20 sepsis free neonates. Serum Presepsin levels, CRP and blood culture were tested in all studied neonates.ResultsThe predictive performance of presepsin levels between 640 and 970 ng/L was evaluated, and the associated clinical implications were analyzed. The serum baseline presepsin was significantly elevated in Sepsis group (p < 0.001). Moreover, it showed the best diagnostic performance at a cutoff value ≥640 ng/L.Day 3 Presepsin levels demonstrated better performance than day 1 levels in gram negative infections with the best Predictive performance at a cutoff value ≥970 ng/L.ConclusionPresepsin evaluation in preterm neonates may serve as a valuable early marker in detection of early onset sepsis and in distinguishing gram-negative bacteria.
ObjectiveTo identify variables associated with extubation success in preterm infants undergoing first elective extubation and to determine cutoff values to support clinical decision-making.MethodsThis retrospective cohort study included preterm infants (gestational age ≤36 weeks and 6 days) admitted to a neonatal intensive care unit who underwent first elective extubation after orotracheal intubation. Extubation failure was defined as reintubation within 48 h. Bivariate and multivariate analyses were performed. Discriminant analysis defined cutoff values, and bootstrapping (500 replicates) supported comparisons.ResultsAmong 218 eligible infants, 73.9% achieved extubation success. In multivariate analysis, weight at extubation (OR 1.02; 95% CI 1.01-1.04), PaCO2 (OR 0.93; 95% CI 0.89-0.98), and heart rate (OR 0.97; 95% CI 0.94-0.99) were independently associated with success. Cutoff values were 34.7 mmHg for PaCO2 and 156 bpm for heart rate, both with modest sensitivity and specificity.ConclusionsWeight at extubation, PaCO2, and heart rate were independently associated with extubation success. Although their discriminatory performance was modest, these variables may provide clinically relevant information when interpreted within the context of early extubation. Their integration into a multidimensional assessment may support more individualized decision-making.
BackgroundCoronary artery dilatation (CAD) in neonates is an uncommon but clinically important finding on echocardiography. Reported associations include multisystem inflammatory syndrome in the newborn (MIS-N) following COVID-19 infection, congenital cardiac malformations, and perinatal inflammatory states. In the post-COVID era, CAD has been reported more frequently.MethodsThis retrospective, record-based case series conducted at a Government Medical College in South India describes the clinical profile of neonates with CAD who were admitted between January 2023 and December 2024.ResultsA total of 24 neonates with CAD were identified during the study period. They were admitted in NICU for different conditions like respiratory distress syndrome, congenital pneumonia, sepsis, or perinatal asphyxia. The mean (SD) gestational age was 35.5 (2.2) weeks, and the mean birth weight was 2557 (646) g. Respiratory distress was the most common presenting feature (95.8%) followed by shock (75%). CAD was detected incidentally during echocardiography which was performed to evaluate persistent pulmonary hypertension of the newborn (PPHN), assess ventricular dysfunction during shock, and exclude congenital heart disease, particularly in those with an unexpected clinical course. One-third of the neonates (n = 8) met the diagnostic criteria for MIS-N and all of them responded to intravenous immunoglobulin therapy, with no mortality. Mortality was 31.25% (n = 5) among the others. Complete resolution of coronary dilatation was observed in all infants within 3-6 months.ConclusionAssessment of coronary arteries for dilatation should be considered in any sick neonate with an inadequate response to conventional management. It may be a pointer for MIS-N.
BackgroundTo assess the feasibility and efficacy of Vayu continuous positive airway pressure (vCPAP) for preterm and term infants with respiratory distress in the delivery room.MethodsFeasibility study of infants of any gestational age presenting with respiratory distress defined as a Silverman-Anderson Score (SAS) ≥4 in the delivery room, who were started on vCPAP prior to transfer to the NICU and maintained during transport. Efficacy was assessed by comparing SAS, FiO2, and SpO2 before initiation of vCPAP, 1 min after initiation, and at the time of NICU admission. Secondary outcomes were feasibility accessed by a survey applied to all health care professionals (HCP), and safety (pneumothorax or clinical deterioration). Descriptive analysis and parametric and non-parametric tests were applied (alpha of 5%).Results10 preterm and 10 term infants were initially enrolled, but one term was excluded because of a protocol deviation. The median gestational age was 37.6 ± 1.1 weeks for preterm and 34.2 ± 1.6 weeks for term infants. A significant improvement in SAS from five prior to vCPAP initiation (IQR 4-6) to three 1 min after initiation (IQR 2-4, p < 0.01), to two on NICU admission (IQR 1-3, p < 0.001). No significant differences in FiO2, SpO2, or CPAP pressure over these time periods were identified. Among HCP, ease of use and satisfaction were highlighted. No complications were observed.ConclusionIn neonates with respiratory distress after birth, a clinical improvement was noted after initiation of vCPAP in the DR and during transport to the NICU.
Background Traditional diagnostic criteria for hypoxic-ischemic encephalopathy (HIE) rely heavily on documented fetal acidemia, which may be missing or unavailable in resource-limited settings. This study evaluated the diagnostic utility of multi-organ biomarkers in identifying neonates with HIE who do not meet classic acidemic criteria (“non-classic HIE”). Methods This clinical population study analyzed 416 full-term and late-preterm neonates over 3 years at a tertiary neonatal intensive care unit (NICU). Participants were categorized into “classic HIE” (acidemia present) and “non-classic HIE” (no acidemia but presenting with clinical encephalopathy). Cardiac (Troponin-I), renal (urea/creatinine), hepatic (ALT/AST), and hematological (neutrophil-to-lymphocyte ratio [NLR]) biomarkers were evaluated to predict HIE severity and short-term outcomes. Results Of the cohort, 54.8% (n = 228) were classified into the non-classic HIE group. Within this group, 49.1% presented with mild, 43.4% with moderate, and 7.5% with severe clinical features, confirming systemic hypoxia despite “normal or near-normal” initial blood gases. Significant elevations in cardiac Troponin-I and AST were observed in the mild-to-severe classic HIE groups compared to the non-classic cohort ( p < 0.001). Troponin-I showed high performance (AUC = 0.711) in predicting moderate-to-severe HIE across both cohorts. The NLR was significantly higher in all infants with clinical evidence of moderate-to-severe hypoxic insult. Conclusions Multi-organ biomarkers, particularly Troponin-I and NLR, offer valuable adjunctive metrics reflecting the severity of systemic hypoxic insults. They assist in identifying asphyxiated neonates when early blood gases are inconsistently captured or fail to show fetal acidemia.
IntroductionThis study aimed to evaluate the possible associations between specific fetal vascular malperfusion (FVM) findings-beyond standard high- and low-grade criteria-and fetal and neonatal clinical complications in a tertiary high-complexity hospital.MethodsWe conducted a retrospective, observational, descriptive cohort study of 706 placentas, correlating routine histological findings with maternal conditions and fetal and neonatal outcomes. Bivariate and multivariate logistic regression analyses were performed to explore potential associations between detailed microscopic features and clinical variables.ResultsA high frequency of FVM was observed in this high-risk population. Several histologic features were found to be associated with adverse perinatal outcomes, including cases classified as low-grade FVM. Similar patterns of association were observed between FVM and maternal pre-pregnancy conditions as well as gestational complications.DiscussionBecause FVM is typically diagnosed only after delivery, its clinical impact may be underrecognized. Our findings suggest a potential increased risk of neonatal and fetal complications in both low- and high-grade FVM. We highlight the importance of considering the temporal progression of fetal circulatory obstruction, from leukocyte stasis to calcified thrombi.
BackgroundCerebral blood flow (CBF) is critical for neonatal brain health, and disruption of autoregulation may predispose infants to brain injury. The resistive index (RI) of the anterior cerebral artery (ACA), measured via Doppler ultrasonography, is a widely used non-invasive marker of CBF, but its relationship with vital parameters in critically ill neonates remains uncertain.MethodsThis retrospective study at Taipei Veterans General Hospital from January 2022 to December 2024 included neonates admitted to the NICU with ACA Doppler ultrasonography within 24 h of birth. RI values were stratified into three groups: low (<0.6), normal (0.6-0.8), and high (>0.8). Clinical characteristics, resuscitation needs, Apgar scores, blood gas analyses, and short- and long-term outcomes were compared across groups.ResultsAmong 898 admissions, 386 neonates met the inclusion criteria (mean gestational age 35 ± 4 weeks, mean birth weight 2382 ± 847 g), abnormal RI was identified in 25.1% (low RI: 4.1%, high RI: 21.0%). Abnormal RI correlated with significantly lower pH, higher pCO2, lower 5-min Apgar scores, and greater need for delivery room intubation (p < 0.01). After adjusting for gestational age, birth weight, and evaluation timing, low RI remained independently associated with increased risks of systemic hypotension and fluid resuscitation (p < 0.05).ConclusionAbnormal ACA RI within 24 h of birth is associated with cerebral hemodynamic instability in critically ill neonates. Early RI assessment may provide insights into neonatal hemodynamic status and serve as a supplemental clinical indicator for identifying high-risk infants in the NICU.
BackgroundLung recruitment maneuvers (LRM) during high-frequency oscillatory ventilation (HFOV) lack bedside standardized monitoring.AimTo evaluate the efficacy and safety of FiO2-guided LRM in preterm infants with moderate-to-severe respiratory-distress syndrome (RDS) using integrated functional echocardiography (FE) and lung ultrasound (LUS). Also, we hypothesized that a standardized LUS score can accurately guide successful recruitment.MethodsThis a prospective, single-arm, protocol-driven cohort study that was conducted at a tertiary NICU (Alexandria University), and 70 preterm infants (GA 32-37 weeks) requiring HFOV within 24 h of life were included. Integrated LUS and FE were performed at three phases: pre-initiation, maintenance pressure (opening), and pre-weaning. Lung aeration was quantified using a standardized 12-zone LUS protocol (0-3 points per zone) based on international consensus. Hemodynamics were assessed via tricuspid regurgitation (TR) gradient, superior vena cava (SVC) flow, and right ventricular myocardial performance index (RV-MPI).ResultsLRM led to significant improvements in oxygenation and lung aeration. Mean LUS scores decreased significantly from 23.13 ± 1.33 (pre-initiation) to 19.94 ± 1.67 (maintenance) and 3.70 ± 2.49 (pre-weaning) (p < 0.001). FE demonstrated a significant reduction in TR gradient (p < 0.001), while SVC flow and RV-MPI remained stable, indicating preserved myocardial function. Pre-weaning LUS scores were significantly associated with weaning success from HFOV.ConclusionsFiO2-guided LRM is effective and safe in late-preterm infants with RDS. Integrated bedside imaging confirms that recruitment improves lung aeration without compromising hemodynamics. A standardized LUS score is a reliable tool for identifying optimal lung opening and guiding the weaning process.
