Background:Invasive surfactant delivery via endotracheal intubation increases exposure to invasive mechanical ventilation (IMV) in extremely preterm infants (EPIs, <28 weeks). This quality improvement (QI) initiative aimed to evaluate whether minimally invasive surfactant administration (MISA) was associated with a reduced IMV burden in EPIs. Methods:A single-center retrospective QI study (2013-2024) included 115 infants (24-27⁺⁶ weeks) with spontaneous breathing diagnosed with respiratory distress syndrome (RDS). Controls (2013-2019, n = 55) received surfactant via intubation; the MISA group (2020-2024, n = 60) received surfactant via thin catheter during nasal continuous positive airway pressure/nasal intermittent positive pressure ventilation (NCPAP/NIPPV). Apart from the structured implementation of MISA, background respiratory and supportive care practices evolved gradually over time without other major structural changes. Multivariable regression and interrupted time-series analyses were performed to account for potential confounding and secular trends. Results:Baseline infant characteristics were comparable. The median duration of IMV within the first 72 h after birth was 0 h (IQR: 0-0) in the MISA group compared to 71.0 h (IQR: 19.0-72.0) in the control group (P < 0.001), and the difference remained significant after adjustment. Additionally, total IMV duration was reduced [0 h (IQR: 0-14) vs. 111 h (IQR: 39-264); P < 0.001], while non-invasive ventilation (NIV) duration was longer [51.5d (IQR: 41-57) vs. 37d (IQR 30-50); P < 0.001]. Lower incidences of hemodynamically significant patent ductus arteriosus (hsPDA) (35.0% vs. 69.1%; P < 0.001) and nosocomial pneumonia (18.9% vs. 67.9%; P < 0.001) were observed during the MISA implementation period, with consistent findings after multivariable adjustment. No significant differences were observed in severe intraventricular hemorrhage (IVH grade 3-4) (8.33% vs. 20.4%; P = 0.123), mortality (6.7% vs. 16.4%; P = 0.101), or other secondary outcomes (all P > 0.05). Interrupted time-series analysis demonstrated an immediate reduction in early IMV duration following MISA implementation, whereas changes in secondary outcomes did not reach statistical significance. Conclusion:MISA was associated with reduced early and overall IMV exposure in EPIs <28 weeks, and with lower observed incidences of hsPDA and nosocomial pneumonia. These associations warrant confirmation in prospective multicenter studies.

Background:Maternal early-onset preeclampsia (EOPE) may affect gastrointestinal function in very preterm infants, but its independent association with feeding intolerance (FI) and in-hospital morbidities remains unclear. Methods:This retrospective 1:1 gestational age-matched cohort study included 87 very preterm infants (<32 weeks) exposed to EOPE and 87 controls born to normotensive mothers. The primary outcome was FI. The secondary outcomes included bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), late-onset sepsis (LOS), retinopathy of prematurity (ROP), parenteral nutrition-associated cholestasis (PNAC), extrauterine growth restriction (EUGR), and mortality. Results:EOPE-exposed infants exhibited a significantly higher incidence of FI (77.0% vs. 41.4%, P < 0.001) and a prolonged time to full enteral feeding (13.0 vs. 9.5 days, P = 0.017). Multivariable logistic regression identified EOPE as an independent factor associated with FI (OR=2.290, 95% CI: 1.061-4.944, P = 0.035). Lower birth weight was also independently associated with an increased risk of FI. Conclusion:Maternal EOPE may be associated with an increased risk of FI in very preterm infants, underscoring the necessity for targeted feeding monitoring and nutritional support in this population.

Purpose:The incidence of preterm birth is reported as more than 10% in 2020 all over the world, and the disability and mortality rate are high due to incomplete development. The microvascular developments of neonates with different gestational ages (GAs) are unknown, which are related to cerebral development. This study assessed the cerebral microvascular development of preterm neonates with different GAs using the ultrafast power Doppler imaging technique. Methods:Seventy neonates were enrolled, including 7 full-term (GA = 37 weeks) and 63 preterm neonates (ranging from extremely preterm [GA ≤ 28 weeks] to late preterm [GA = 36 weeks]). Quantitative metrics including microvascular area (MArea) and microvascular diameter (MDiam) were evaluated in three regions of interest (ROIs): the cingulate gyrus (ROI 1), the frontal and parietal junction (ROI 2), and a branch of the anterior cerebral artery near the central sulci (ROI 3). Electroencephalogram signals were recorded and amplitude-integrated electroencephalography (aEEG) was used to measure the brain activity. Statistical correlations were assessed among microvascular quantitative metrics, GA, and aEEG. Results:All the microvascular quantitative metrics have a statistically significant (p < 0.05) positive correlation with GA and aEEG. MArea in ROI 1 has the highest correlation coefficient of 0.67 (p < 0.0001) with GA. Similarly, MArea in ROI 1 has the highest correlation coefficient of 0.53 (p < 0.0001) with aEEG. Conclusion:This study showed that MArea- and MDiam-related parameters were associated with increasing GA in preterm neonates, suggesting a trend toward cerebral microvascular maturation.

Objective:To investigate the effect of bundle management strategies on reducing the incidence of local sterile abscesses following leuprolide acetate microsphere injections. Methods:A single-center, intervention evaluation with a historical control study was conducted. Female children treated with leuprolide acetate microspheres for central precocious puberty (CPP) at the Pediatric Outpatient Department of Peking University Third Hospital from January 2016 to December 2024 were included as study participants. Patients from January 2016 to December 2018 served as the control group (277 individuals, 5,023 injections), during which high-risk factors for sterile abscesses were identified and bundle improvement strategies were formulated for continuous quality improvement. Patients from January 2019 to December 2024 were assigned to the intervention group (994 individuals, 13,498 injections). The control group received conventional management protocols, while the intervention group implemented a bundle management scheme encompassing medical and nursing staff training, standardized procedures, use of standardized tools, health education, and follow-up management. The incidence of local sterile abscesses was compared between the two groups. Results:After implementation of the bundle management strategies, the incidence of sterile abscesses in the control group was 5.1% (14/277) by patient count and 3.2‰ (16/5,023) by injection count, which decreased to 0.6% (6/994) and 0.4‰ (6/13,498) in the intervention group, respectively, with statistically significant intergroup differences (P < 0.001 for both). Conclusion:Implementation of bundle management strategies significantly reduces the incidence of local sterile abscesses after leuprolide acetate microsphere injections, enhances nurses' standardized operational proficiency and professional competence, alleviates patient suffering, improves treatment adherence, and warrants clinical adoption.

BACKGROUND/OBJECTIVE:Preterm birth poses notable neurodevelopmental risks, with cerebral microcirculatory disturbances potentially contributing to long-term impairment. Existing monitoring modalities lack bedside capacity to evaluate these microvascular changes during critical brain development. We characterized cerebral microperfusion and functional maturation patterns in preterm versus full-term neonates using combined ultra-micro angiography (UMA) and an amplitude-integrated electroencephalogram (aEEG). METHODS:In this prospective study, 76 neonates (23 extremely/very preterm [EP/VPT], 27 moderate-late preterm, and 26 term controls) were assessed at term-equivalent age. UMA helped quantify regional microperfusion (color pixel percentage, abbreviated as CPP in this context to differentiate from cerebral perfusion pressure), whereas aEEG (Burdjalov scores) helped evaluate functional maturation at 37-38 and 40 weeks' postmenstrual age. RESULTS:EP/VPT infants demonstrated significant cerebral hyperperfusion with distinct cortex-white matter perfusion gradients. Although preterm infants showed advanced aEEG maturation at 37-38 weeks, this difference normalized by 40 weeks. CONCLUSION:Gestation-dependent cerebral hyperperfusion and transient EEG maturation differences in EP/VPT infants at term-equivalent age support the value of UMA-aEEG integration for neurovascular assessment. The observed perfusion-EEG patterns suggest prematurity-specific neuroadaptation, warranting further investigation of long-term functional correlates.

Glomerular filtration rate (GFR) maturation is critical for drug dosing in neonates and children. Current equations face dual limitations: they are primarily derived from Caucasian populations and fail to account for the fundamental physiological differences between neonates and children. This study aimed to develop Chinese-specific GFR equations and to characterize how the key predictors of GFR differ between these two developmental stages. Creatinine clearance as measured GFR (mGFR) in 58 hospitalized neonates (gestational age range, 30.3-41.0 weeks, postnatal age range, 0 to 26 days, mGFR = 3.08 ± 1.86 mL/min) without renal impairment were enrolled. Moreover, a published database of Chinese children (N = 87, age range, 1 to 18 years, mGFR = 97.0 ± 31.9 mL/min/1.73 m2) was applied. Demographic and renal function markers were included to develop equations using the stepwise regression method in allometric form. The GFR prediction equation of serum cystatin C, blood urea nitrogen and postmenstrual age of Chinese neonates was established. In children, GFR is associated with cystatin C, creatinine, weight and age. In an internal comparison with 16 published equations, our newly developed models showed favorable performance within our cohorts, with correlation (R2 of 0.617 and 0.578) and accuracy (P20 of 46.6% and 70.1%, P50 of 93.1% and 100%), respectively. The equations would provide scientific basis for aiding diagnosis of renal function of Chinese neonates and children, and supporting better precision medicine of drugs mainly excreted by kidney.

General movement assessment (GMA) is a non-invasive method used to evaluate neuromotor behavior in infants under six months of age and is considered a reliable tool for the early detection of cerebral palsy (CP). However, traditional GMA relies on the subjective judgment of multiple internationally certified physicians, making it time-consuming and limiting its accessibility for widespread use. Furthermore, artificial intelligence (AI) approaches may overcome these limitations but are usually based on motion skeletons and lack the ability to capture detailed body information. Here, we propose CoGMA (Collaborative General Movements Assessment), a novel multi-modality co-learning framework for GMA. By integrating multimodal large language model as auxiliary network during training, CoGMA incorporates four types of input data—skeleton data, clinical information, RGB video, and text descriptions—to enhance representation learning. During inference, however, CoGMA achieves efficient and accurate prediction using only skeleton data and clinical information. Experimental evaluations indicate that CoGMA demonstrates robust performance across both the writhing and fidgety movement stages, while also excelling in zero-shot evaluation of fidget movement, thereby mitigating the issue of limited training samples in this stage. This framework significantly enhances the GMA methodology and lays the groundwork for future advancements in early detection and research on infant neuromotor behavior. Additionally, to facilitate anonymized data sharing, we introduce InfantAnimator, a tool that generates non-identifiable videos while preserving essential motion features, thereby supporting broader research and collaboration. The code is available at GitHub: https://github.com/wwYinYin/CoGMA.

Importance:Respiratory distress syndrome (RDS) remains a leading cause of morbidity and mortality in preterm infants. Evidence regarding the optimal initial noninvasive ventilation (NIV) mode for extremely preterm infants (<30 weeks' gestation) with RDS is inconsistent. Objective:To determine whether nasal continuous positive airway pressure (NCPAP) is noninferior to nasal intermittent positive pressure ventilation (NIPPV) as primary respiratory support before minimally invasive surfactant administration (MISA) for reducing intubation within 72 hours in preterm infants with RDS. Design, Setting, and Participants:This multicenter, noninferiority randomized clinical trial was conducted across 11 tertiary neonatal intensive care units in China from December 2021 to October 2024. The trial was designed to enroll 960 infants but was stopped early after enrolling 312 (32.5% of the target) based on prespecified stopping criteria. The enrolled participants were spontaneously breathing preterm infants at 24 to 29+6 weeks' gestation with a diagnosis of RDS requiring noninvasive respiratory support after birth. Data were analyzed from January 7 to May 9, 2025. Intervention:Infants were randomized 1:1 to receive NCPAP or NIPPV as initial respiratory support. All received MISA within 120 minutes after birth via a 1.67-mm catheter. Main Outcomes and Measures:The primary outcome was NIV failure, defined as requiring intubation and invasive mechanical ventilation within 72 hours after birth. The noninferiority margin was set at a 10% risk difference. Secondary outcomes included NIV failure within 7 days, surfactant redosing, and major complications (eg, pneumothorax, bronchopulmonary dysplasia). Results:A total of 312 preterm infants (median [IQR] gestational age, 28.0 [28.6-29.4] weeks; 174 boys [55.8%]) were randomized to the NCPAP group (153 infants) or the NIPPV group (159 infants). NIV failure within 72 hours occurred in 40 infants (26.1%) in the NCPAP group vs 21 infants (13.2%) in the NIPPV group (adjusted risk difference, 12.8%; 95% CI, 4.2%-21.6%; P = .004; O'Brien-Fleming adjusted α = .005), exceeding the noninferiority margin and conclusively demonstrating inferiority of NCPAP. NIV failure within 7 days was also higher in the NCPAP group (42 infants [27.5%] vs 24 infants [15.1%]; risk difference, 12.4%; 95% CI, 3.4%-21.4%; P = .008). No significant differences were observed between groups for most complications. Conclusions and Relevance:In this randomized clinical trial of preterm infants with RDS, NIPPV with MISA as initial respiratory support significantly reduced NIV failure within 72 hours compared with NCPAP. These findings suggest that NIPPV may be the preferred primary respiratory strategy for this high-risk population, although further evaluation of long-term outcomes is warranted due to early trial termination. Trial Registration:ClinicalTrials.gov Identifier: NCT05137340.

BackgroundRapid and reliable heart-rate (HR) assessment is critical during neonatal resuscitation. Contactless monitoring may serve as a valuable adjunct to conventional methods, but the clinical performance of millimeter-wave radar under routine resuscitation-related maneuvers remains unclear. We evaluated the performance and workflow feasibility of a millimeter-wave multiple-input multiple-output (MIMO) radar system for contactless neonatal HR assessment.MethodsIn this single-center prospective study, we conducted two sequential experiments. In the factor-quantification experiment, 60 clinically stable neonates in the neonatal intensive care unit (NICU) were monitored simultaneously with radar and a 3-lead ECG bedside monitor as the reference. We assessed HR measurement performance under quiet baseline conditions and four simulated resuscitation-related maneuvers: drying, oronasal suctioning, auscultation, and postural change. Measurement error was quantified using root-mean-square error (RMSE), and agreement was evaluated using Bland-Altman analysis. In the real-workflow experiment, 26 neonates on a radiant warmer in the operating room were enrolled. We analyzed 115 auscultation windows by comparing mean radar-derived HR with auscultated HR at the window level and by stratifying per-second radar-derived HR errors within each window.ResultsUnder quiet baseline conditions, radar-derived HR showed agreement with ECG, with most RMSE values below the predefined 10-bpm descriptive benchmark. Measurement performance was relatively preserved during simulated drying, suctioning, and auscultation. In contrast, postural change significantly increased error and caused systematic HR underestimation. In the real-workflow experiment, window-level differences between mean radar-derived HR and auscultated HR within auscultation windows were centered near 0 bpm. In the per-second error analysis within auscultation windows, errors of ≤5 bpm were the most frequent category, whereas errors of >15 bpm were uncommon.ConclusionMillimeter-wave MIMO radar showed relatively small HR measurement error for contactless short-window assessment under quiet baseline conditions, particularly when the infant remained stable and oriented toward the sensor. Postural change was the dominant source of increased measurement error and may limit reliability during thoracic reorientation. These findings support the potential role of radar as an adjunct tool for short-window HR assessment during neonatal care and resuscitation-related conditions. Continuous beat-to-beat accuracy was not validated in this study and requires further investigation using continuous ECG-based reference standards.

Mothers with abnormal glucose and lipid metabolism during pregnancy are at a higher risk of metabolic disorders in their children. This study investigates whether interventions such as feeding practices, sleep management, and vitamin D supplementation can mitigate the risk of obesity in their offspring. We are conducting an ongoing cohort study aimed at determining whether a combination of feeding, sleep, and vitamin D can reduce the risk of obesity in children born to mothers with abnormal glucose and lipid metabolism.We plan to recruit 1,000 pregnant women and their offspring who are at risk for glucose and lipid metabolism disorders. Participants will receive guidance on optimal feeding practices, sleep duration, and vitamin D supplementation for their children. This study has been registered in the Chinese Clinical Trial Registry (ChiCTR240008953). We will assess the risk of obesity in the offspring at 6 months, 12 months, and 24 months of age. The primary outcome measure will be neonatal obesity, while secondary outcome measures will include neonatal blood glucose levels, insulin, C-peptide (C-P), total triglycerides (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) at the three time points post-birth.

The number of women with gestational obesity has been increasing year by year and is a serious global challenge. Maternal obesity during pregnancy not only leads to gestational diabetes, hypertension, preterm birth, and miscarriage, but also adversely affects offspring growth and development after birth by increasing the risk of offspring obesity and other metabolic diseases. Changes in the maternal gut microbiota during pregnancy and delivery play important roles, and microbiota-derived metabolites are closely related to the metabolic regulation of obesity. This review summarizes the potential mechanisms by which the maternal gut microbiota in gestational obesity influences offspring, aiming to deepen understanding of how maternal gut microbiota affects offspring and to provide research targets and ideas for clinical intervention.

IntroductionWe aimed to establish normative developmental patterns of cerebral microperfusion using ultra-micro angiography and evaluate regional microvascular differences in neonates across gestational ages.MethodsThis prospective observational cohort study enrolled 115 neonates from a single-center neonatal intensive care unit or neonatal ward at Peking University Third Hospital (2023–2024). The patients were stratified by postmenstrual age into extremely/very preterm (n = 30), moderate/late preterm (n = 23), and term (n = 62) groups, excluding those with major anomalies/hemodynamic instability. Ultra-micro angiography was performed via the anterior/sphenoid fontanelles during quiet sleep (3–14 days postnatal). Regional color pixel percentage (CPP) and large-vessel hemodynamics [peak systolic velocity [PSV]/end-diastolic velocity [EDV]/ resistance index [RI]] were measured.ResultsUltra-micro angiography revealed distinct postmenstrual age-dependent microvascular perfusion patterns, with cortical and white matter CPP demonstrating progressive increase across postmenstrual age groups (extremely preterm vs. term infants: frontal lobe CPP 22.97 [IQR 20.12–28.92] vs. 47.57 [40.07–55.93]; parietal lobe CPP 25.09 [20.96–29.94] vs. 47.69 [38.93–55.97]), while basal ganglia CPP remained stable [32.96 [30.64–35.02] vs. 33.77 [31.52–37.46]]. Midline regions consistently exhibited the highest perfusion across all ages [term infants: 66.26 (61.33–70.62)]. Concurrent macrovascular assessment showed that anterior/middle cerebral artery peak systolic and end-diastolic velocities increased with maturation, although resistance indices maintained stability.ConclusionUltra-micro angiography-derived CPP quantifies gestational age-dependent microvascular maturation, revealing distinct regional perfusion patterns. Differences in the progression of CPP in various brain regions may serve as a biomarker for risk stratification of neurodevelopment in premature infants.

Objectives: Current guidelines for pulmonary surfactant (PS) administration in preterm infants with respiratory distress rely on clinical signs and FiO2 thresholds. Lung ultrasound offers a promising alternative for accurately diagnosing neonatal respiratory distress syndrome (NRDS) and assessing its severity. This randomized controlled trial aimed to evaluate whether a lung ultrasound-guided strategy for NRDS diagnosis and lung ultrasound scores (LUS)-guided PS administration could improve respiratory outcomes in preterm infants (<32 weeks' gestation), compared to conventional methods. Methods: In this non-blinded randomized controlled trial, 89 preterm infants (≤32 weeks' gestation) with respiratory distress after birth were enrolled. Participants were randomly assigned to either the ultrasound group (PS administration based on ultrasound-confirmed NRDS and LUS criteria) or the control group (PS administration according to standard clinical signs and FiO2 requirements). Results: The ultrasound group demonstrated a significantly lower rate of invasive mechanical ventilation (p = 0.007) and a shorter duration of ventilation (p = 0.005) compared to the control group. Furthermore, the ultrasound group required less PS (p = 0.03), received their first dose at an earlier time (p = 0.017), and experienced fewer radiation exposures both before surfactant treatment and within the first week after birth (p = 0.023 and p = 0.019, respectively). Conclusions: The integration of lung ultrasound for NRDS diagnosis and LUS-guided surfactant therapy facilitates more precise and timely PS use. This strategy reduces the need for and duration of invasive mechanical ventilation and limits early radiation exposure in very preterm infants.

Background/Objectives: Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) affect the prognosis of preterm infants, and their coexistence is a risk factor for poor long-term outcomes in very low-birth-weight infants. However, there has been limited in-depth assessment of common and independent risk factors for BPD and ROP within the same cohort. Therefore, we aimed to investigate the risk factors for BPD and ROP in very low-birth-weight infants born at ≤32 weeks of gestation and to explore the interaction between these two diseases. Methods: The participants were divided into four groups: BPD+ROP+, BPD-ROP-, BPD+ROP-, and BPD-ROP+. Gestational age, birth weight, maternal pregnancy complications, birth and postnatal diseases, and treatment conditions were compared among the groups. Subsequently, univariate and multivariate binary logistic regression analyses were conducted to explore the independent risk factors for BPD and ROP. Results: Common risk factors of BPD and ROP included gestational age and prolonged oxygen therapy. The multivariate analysis revealed that gestational age (OR: 4.44; 95% CI: 3–6.57), intubation resuscitation (OR: 2.35; 95% CI: 1.09–5.05), mechanical ventilation duration ≥ 7 days (OR: 1.01; 95% CI: 1.01–1.01), and prolonged total oxygen therapy (OR: 3.13; 95% CI: 1.28–7.64) were independent risk factors for BPD. Additionally, gestational age (OR: 0.66; 95% CI: 0.54–0.81) and prolonged oxygen therapy (OR: 1.02; 95% CI: 1–1.03) were independent risk factors for ROP. Conclusions: The proper control of the duration and concentration of oxygen therapy, along with the minimization of mechanical ventilation time, is crucial for reducing the incidence of both BPD and ROP.

Objective: Early-onset sepsis (EOS) is a serious, grave, and frequently fatal condition in premature infants. This study aimed to assess the diagnostic value of interleukin-6 (IL-6) levels in umbilical cord blood for identifying EOS in preterm infants. Methods: This prospective cohort study was conducted on preterm infants between May 2019 and April 2021. Based on the diagnostic criteria for EOS, the participants were divided into EOS and non-EOS groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of cord blood IL-6 levels for EOS. Results: The levels of IL-6 were significantly higher in the EOS group (n = 10) compared to the non-EOS group (n = 178) [617.5 pg/mL (323.3, 1579.8) vs. 49.7 pg/mL (15.8, 142.8), respectively; p = 0.000]. ROC curve analysis demonstrated that a cutoff value of 250.5 pg/mL for cord blood IL-6 yielded a sensitivity of 90%, specificity of 82%, and area under the curve of 0.876, with a confidence interval of 0.753–0.999, indicating its high accuracy as a diagnostic marker for EOS among preterm infants (p < 0.001). Conclusions: The detection of IL-6 in the umbilical cord blood offers convenience and exhibits significant diagnostic potential for EOS in preterm infants, thereby providing valuable support for clinical decision-making.

Non-contact, rapid and accurate measurement of respiratory rates (RR) and heart rates (HR) in neonates has significant clinical importance. Existing methods predominantly focus on thoracic respiratory signal measurement. This thoracic-focused approach, when applied to neonates who exhibit predominantly abdominal breathing, leads to a low signal-to-interference ratio (SIR) that compromises the accuracy of RR measurement compared with using abdominal signal. Moreover, neonatal and staff motion in clinical environments pose challenges for the robustness of monitoring systems. In this paper, a method for the separation of thoracic and abdominal measurements based on MIMO radar is proposed to make use of the RR information contained within the abdominal signal, while extracting HR information from thoracic signal, in which case RR can be extracted more precisely from abdominal signal with a high SIR. In order to ensure proper separation of radar beams under the interference from neonatal and staff motion, this paper presents an integrated measurement system that combines a monocular camera and MIMO radar to achieve precise and real-time guidance for the radar beams. Experimental results demonstrate significant improvements in RR measurement accuracy and system robustness. We report maximum root mean square errors of 2.16 Beats Per Minute(BPM) for RR measurements and 3.54 BPM for HR measurements.

Neonatal hydrocephalus is a serious neurological disease; however, advancements in neonatal care and the increasing survival rate of extremely preterm infants and its incidence, etiology, diagnosis and management have also undergone significant changes. In this study, we aimed to summarize the above clinical changes in neonatal hydrocephalus at our hospital over the past 12 years to provide a reference for clinical practice. This was a single-center retrospective study. To comprehensively collect data on neonatal hydrocephalus, we conducted a case search among hospitalized patients in both the obstetrics and pediatrics departments from January 1, 2010, to December 31, 2021. In the comparative analysis, the infants were divided according to the time of admission into a group for the first 6 years and one for the second 6 years. Between-group comparisons of gestational age, birth weight, etiology, treatment, and prognosis were performed. Sixty-two patients (28 in the first 6 years; 34 in the latter 6 years) were diagnosed with neonatal hydrocephalus. Their gestational ages ranged from 25 to 39+6 weeks (median, 30 weeks), and their birth weights ranged from 600 to 4046 g (median, 1255 g). The gestational age and birth weight were significantly lower in the second 6-year group than in the first 6-year group. Furthermore, there was a significant increase in severe germinal matrix-intraventricular hemorrhage (GMH-IVH) in infants and cerebral parenchymal hemorrhage in the latter 6-year group. In terms of surgical treatment, there are more applications of ventricular access devices (VADs) in the latter 6-year group. Among the 62 infants, 21 (33.9

BackgroundPreventing early invasive mechanical ventilation (IMV) in preterm infants is critical for reducing bronchopulmonary dysplasia (BPD) and improving outcomes. While delayed cord clamping (DCC) enhances cardiopulmonary stability and minimally invasive surfactant administration (MISA) reduces IMV dependence, evidence on their combined efficacy in extremely preterm infants (<30 weeks gestation) with neonatal respiratory distress syndrome (NRDS) remains limited. We hypothesize that integrating DCC with MISA will synergistically reduce BPD incidence compared to immediate cord clamping (ICC) with either MISA or tracheal intubation-based surfactant delivery.Methods and designThis is a single-center quality improvement study evaluating three treatment regimens for neonates with NRDS born at a gestational age of <30 weeks: (1) Retrospective data collection of cases treated with the conventional approach of ICC + tracheal intubation between 2017 and 2020 (n = 222); (2) Retrospective data collection of cases treated with ICC + MISA between 2021 and 2025 (n = 222); (3) Planned collection of medical records of cases treated with DCC + MISA between 2025 and 2027 (n = 74).The study aims to assess the incidence of BPD and survival outcomes associated with each regimen. Meanwhile, it will compare the short-term efficacy, safety, and long-term outcomes of these three treatment strategies, thereby providing valuable evidence for clinical treatment decision-making.DiscussionCurrent research indicates that both DCC and MISA positively impact the prognosis of very premature infants and help reduce the incidence of BPD. However, there is limited research on whether the combined use of DCC and MISA can further improve survival rates and reduce the incidence of BPD in this vulnerable population. Our NICU has gradually implemented MISA in respiratory management since 2021 and adopted cord management with DCC since 2025. This study retrospectively analyzes data from previous groups: those receiving ICC with MISA, and those receiving ICC with tracheal intubation. We will compare this with prospective data from the DCC combined with MISA group to assess differences in BPD occurrence, other complications and overall outcomes. This study will also collect and analyze the annual application rates and operational success rates of MISA and DCC, so as to promote quality improvement in the NICU. Through this study, we aim to determine whether the combination of DCC and MISA offers greater benefits in improving the prognosis of very premature infants, ultimately providing a stronger foundation for early respiratory and circulatory management strategies for infants born before 30 weeks.Trial Registrationhttps://register.clinicaltrials.gov, Identifier:NCT07092319.

ObjectiveNeonatal obesity may be associated with the intra-uterine environment during pregnancy. The objective of this study was to evaluate the risk of neonatal obesity born from the mothers with abnormal glucose and lipid metabolism.MethodsTwenty neonates born from maternal glucose and lipid metabolism disorders and developed obesity at 6 months of age were enrolled as study group, and 20 neonates without obesity were included as control group. Non-targeted metabolomic analysis was performed in maternal serum during pregnancy and neonatal cord blood at birth to identify differential metabolites.ResultsThe concentrations of aspartyl-glutamate and alanyl-aspartate in maternal serum progressively rise steadily as gestational age advances, peaking in umbilical cord blood. Additionally, at each stage of pregnancy (early, middle, and late), the levels in both maternal serum and umbilical cord blood are significantly higher in the obese group than in the non-obese group. Their mechanisms of action may be associated with pathways involving immune-inflammatory regulation, energy metabolism, and gut microbiota modulation. Their mechanisms of action may be associated with pathways involving immune-inflammatory regulation, energy metabolism, and gut microbiota modulation.ConclusionThrough the analysis of maternal blood during pregnancy and umbilical cord blood, this study putatively identified some differential metabolites associated with neonatal obesity. In the future, it is expected that analyzing maternal blood or umbilical cord blood at birth could help predict potential infant obesity risks, enabling more dietary guidance and interventions during infancy to reduce the risk of obesity later in life.