AIMS:Acute kidney injury (AKI) affects up to one-third of neonates admitted to neonatal intensive care units (NICUs). NICUs are highly data-rich environments, offering opportunities to develop clinical prediction rules (CPRs) that use clinical and demographic data to estimate AKI risk. We sought to identify and critically appraise existing CPRs for predicting neonatal AKI. METHODS:A systematic search of PubMed and OVID-MEDLINE was conducted for literature published from 1946 to Q2-2025. Eligible studies reported the development or validation of CPRs for neonatal AKI in NICU populations. The review followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD420250653606). Data extraction followed the CHARMS checklist, and risk of bias was assessed using the PROBAST tool. RESULTS:From 685 identified articles, 11 underwent full-text review and three met inclusion criteria. Sample sizes ranged from 276 to 706 participants. One CPR was derived from multi-centre data; two used prospectively collected datasets. The number of predictor variables ranged between 4 and 10. Internal validation methods varied, with those who reported commenting on apparent performance only and none performing external validation. Hosmer-Lemeshow testing and calibration plots were the most commonly used forms of analysis. CONCLUSIONS:Current CPRs for neonatal AKI show potential but remain underdeveloped and poorly validated. Rigorous research, including external validation prior to integration into clinical workflows, is essential to enable effective early detection of neonatal AKI.

BACKGROUND:To determine whether chorioamnionitis-exposure in extremely preterm infants was associated with higher transepidermal water loss (TEWL) and to explore whether this relationship varied by gestational age, placental histopathology and illness severity. METHODS:In this prospective single-centre cohort study, infants ≤27+6 weeks' gestational age underwent closed-chamber TEWL measurement on days 1, 3 and 14 in humidified incubators utilizing standardized methodology. Infants were classified according to placental histopathology and inflammation severity. Interactions assessed included gestational and postnatal age, and illness acuity. RESULTS:Thirty-seven infants were included, 13 of which had histological chorioamnionitis. Chorioamnionitis was associated with higher day-one TEWL; however, this was no longer significant after gestational adjustment (p = 0.152). A significant gestation-by-chorioamnionitis interaction was confined to the most immature infants (p = 0.017). In this cohort, higher TEWL was associated with a placental inflammatory response and postnatal instability. Adjusted TEWL declined from days 1 to 14, with the greatest between-group difference on day-one. CONCLUSION:In this exploratory cohort, the association between histological chorioamnionitis and early TEWL was modified by gestational age, with higher TEWL observed among the most immature exposed infants. These hypothesis-generating findings suggest that fetal inflammation and early physiological instability may both contribute to impaired barrier adaptation. IMPACT:Chorioamnionitis-exposure and epidermal immaturity are frequent hallmarks of extreme prematurity. Although several morbidities have been attributed to chorioamnionitis, a skin component remains unclear. We report a gestation-dependent association between chorioamnionitis and skin integrity, most evident in infants at or below approximately 25 weeks' gestational age. A fetal inflammatory response may contribute to both elevated transepidermal water loss and postnatal instability, suggesting these may contribute alongside immaturity to impaired barrier function in the most preterm infants. Our findings suggest extremely preterm infants exposed to intrauterine inflammation may be uniquely vulnerable to fluid imbalance or skin injury owing to compromised barrier integrity.

AIMS:To establish transepidermal water loss values on the first postnatal day in healthy term neonates and associations with perinatal factors utilising a closed-chamber system. METHODS:A cross-sectional single-centre study was conducted over a 7-month period. Healthy infants ≥ 37-week gestation and 2-24 h old were recruited. Transepidermal water loss was measured at a single time-point, non-invasively under typical ambient conditions using a standardised approach. Anthropometric and perinatal variables were collated. Outcomes assessed included device validity and reliability, transepidermal water loss values, and interactions with maternal and infant variables. RESULTS:A total of 120 term infants were recruited. The intra-class correlation coefficient of three consecutive readings was 0.735, indicating good reliability. There was no interaction between transepidermal water loss and ambient conditions. Mean values were 13.9 ± 3.28 g/m2/h. The 5th and 95th percentiles were 9.7 and 20.3 g/m2/h, respectively. Each additional postnatal hour conferred a reduction in transepidermal water loss of 0.11 g/m2/h. Caesarean section increased transepidermal losses by 1.4 g/m2/h. No other associations were significant. CONCLUSION:Early postnatal transepidermal water loss in the term infant is low but variable. Physiological variability is not attributable to typical ambient conditions or common perinatal factors, indicating a uniformly competent skin barrier at term.

Acute kidney injury (AKI) is common and associated with poor clinical outcomes in neonates, affecting nearly a third of infants admitted to a neonatal intensive care unit (NICU). Premature infants and infants with very low birth weight are particularly predisposed to acute kidney injury. The presence of a patent ductus arteriosus (PDA) may result in an inequitable distribution of cardiac output, which may compromise end-organ perfusion. Both conservative management and intervention have the potential to exacerbate AKI. This systematic review sought to assimilate the existing literature pertaining to the study of AKI in infants with PDA. This article collates the relevant literature using a systematic search strategy pertaining to the study of AKI in infants with PDA. Seventeen studies were identified using PRISMA methodology. There is a paucity of literature pertaining to the incidence of acute kidney injury in infants in the setting of a haemodynamically significant patent ductus arteriosus. There is a great degree of heterogeneity in approach taken to define AKI/hsPDA in existing literature. Further research must employ the modified neonatal KDIGO criteria and a robust PDA scoring system which accurately measures ductal significance.

Introduction Neonatal sepsis remains a leading cause of morbidity and mortality across all healthcare systems. Acute kidney injury (AKI) is common in neonates and is associated with poor clinical outcomes. We sought to profile the incidence of AKI in infants with culture-positive bacteraemia and to assess the utility of the neonatal sequential organ failure (nSOFA) tool in AKI prediction.Methods A single-centre retrospective review of infants with culture-positive bacteraemia was performed at the Rotunda Hospital, Dublin, Ireland. Clinical, demographic and biochemical data were collated, with the modified neonatal Kidney Disease: Improving Global Outcomes (KDIGO) criteria and nSOFA scoring applied to each included patient.Results Our cohort of n=35 patients with culture-positive bacteraemia had an AKI incidence of 48.6%. There was no statistically significant association between peak nSOFA and the development of AKI.Conclusion The incidence of AKI in late-onset neonatal clinically significant bacteraemia is high. nSOFA within 24 hours of culture has poor utility in predicting acute kidney injury in neonatal patients with culture-positive bacteraemia.

Necrotising enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Acute kidney injury (AKI) is increasingly recognised as a common complication in this population, yet its relationship with NEC remains under-characterised. We sought to evaluate the incidence of AKI in infants with NEC and examine its association with NEC severity (using Bell staging) in a tertiary neonatal intensive care unit (NICU). Methods: A retrospective 1:2 case–control study was conducted in a single tertiary NICU between October 2018 and October 2023. Forty-nine preterm infants diagnosed with NEC were matched to 100 controls based on birth weight, gestational age, and gender. AKI was defined using modified neonatal KDIGO criteria, incorporating both serum creatinine and urine output. Results: AKI was identified in 25 of 149 infants (16.8

ABSTRACT Aim This study hypothesised that infants with a haemodynamically significant patent ductus arteriosus (hsPDA) as defined by a validated score have a higher incidence of acute kidney injury (AKI). Methods A retrospective study was conducted including infants < 29 weeks' gestation, born at the Rotunda Hospital. The El‐Khuffash patent ductus arteriosus (PDA) severity score was applied following an echocardiographic assessment. Mann Whitney‐U and χ 2 tests were utilised to assess for association with AKI. Results We report a cohort of n = 86 infants with PDA of a mean (standard deviation) gestation of 27 (1) weeks and birth weight of 957 g (235 g). Ten (11.6%) of infants developed AKI. Birth weight, gestation, death‐by‐discharge, high‐risk PDA score, PDA treatment, and ibuprofen receipt were associated with AKI. The presence of a high‐risk PDA score was independently associated with the occurrence of AKI. Therapeutic intervention and ibuprofen use proved significant in their associations with AKI. Conclusion A high‐risk El‐Khuffash PDA score is predictive of AKI in our cohort. Ductal diameter in isolation is ineffective as a measure of haemodynamic significance in the context of AKI prediction. Both PDA treatment and ibuprofen‐use are associated with an increased risk of AKI. Further work to validate the use of this score for AKI prediction is warranted.

A male infant born in a tertiary maternity facility was noted to have microretrognathia, a small mouth and macroglossia at delivery. He was born limp and apnoeic and required multiple attempts at intubation before a definitive airway was eventually sited. Chest X-rays, while in the paediatric intensive care unit, demonstrated dysplastic ribs with associated ‘high-riding’ clavicles. A later X-ray was reported as showing interrupted posterior ribs. A tracheostomy was formed on day of life 9 given the immediate risk to the baby’s airway. Further imaging of the facial bones, skull and brain showed generous CSF spaces over the cerebral convexities and also marked hypoplasia of the mandible and mid-face. The baby’s middle ear cavities were shown to be completely opacified. Genetic testing eventually went on to confirm a diagnosis of cerebrocostomandibular syndrome, with the detection of a pathogenic variant of the small nuclear ribonucleoprotein polypeptide B gene.

To identify potential cases for fetoscopic endoluminal tracheal occlusion (FETO) in a historical cohort of fetuses with congenital diaphragmatic hernia (CDH).

The full blood count (FBC) is commonly measured as part of a partial septic work-up in asymptomatic infants at increased risk of early-onset neonatal sepsis (EOS). To determine the impact of FBC parameters on infants' subsequent management a retrospective cross-sectional study was performed. Infants, born at ≥34 weeks gestation, asymptomatic at birth, undergoing a partial septic work-up and receiving prophylactic antibiotics due to increased risk of EOS in a single centre over a 2-year period, were included. The primary outcome measure was frequency of FBC result impacting on duration of antibiotic therapy. Secondary outcome measures included frequency of FBC parameters outside of the reference range and incidental diagnoses. In total, 16 726 live-born infants were delivered during the study period. A total of 802 (4.8%) were included. Thirteen infants (1.6%) received a prolonged course of antibiotics due to suspicion for EOS. Two of these infants had elevated white cell counts. All had normal neutrophil counts. In no case did the FBC result influence the decision to prolong the antibiotic course. In a cohort of 802 infants, asymptomatic at birth and at increased risk of EOS, the FBC result did not impact on the decision to prolong the course of antibiotics for suspicion of EOS.

Aplasia cutis congenita (ACC) is one of several congenital malformations associated with antithyroid/thiourylene drug use in pregnancy. While uncommon among the general population (1-3/100 000 cases), the risk among those on thiourylenes is between 1.6% and 3%. The scalp is the most common site for this congenital anomaly. We present the case of a male infant with multifocal ACC of the scalp discovered at birth and born to a mother with Graves disease that was controlled during pregnancy using carbimazole. Thyroid function tests were normal throughout the pregnancy. There was no involvement of underlying subcutaneous tissue or structures. At age 18 months, the single largest lesion remained with only partial coverage. Prospective management involved periodic surveillance with planned 2-stage repair. This case reinforces the association between the antithyroid drugs carbimazole (CMZ) and methimazole (MMI) and supports the proposition of an MMI/CMZ embryopathy. It adds to a literature of case reports in which malformations arise in offspring of such mothers whose thyrotoxicosis is controlled antenatally, thereby challenging the suggestion that ACC is attributable to poorly controlled disease rather than thiourylenes. As yet the underlying mechanism is not understood, nor is it known why MMI and CMZ may cause potentially significant embryopathy while congenital defects attributable to the structurally similar propylthiouracil are typically less severe.

Inborn errors of metabolism are an individually rare but collectively significant cause of mortality and morbidity in the neonatal period. They are identified by either newborn screening programmes or clinician-initiated targeted biochemical screening. This study examines the relative contribution of these two methods to the identification of inborn errors of metabolism and describes the incidence of these conditions in a large, tertiary, neonatal unit. We also examined which factors could impact the reliability of metabolic testing in this cohort. This is a retrospective, single-site study examining infants in whom a targeted metabolic investigation was performed from January 2018 to December 2020 inclusive. Data was also provided by the national newborn screening laboratory regarding newborn screening diagnoses. Two hundred and four newborns received a clinician-initiated metabolic screen during the time period examined with 5 newborns being diagnosed with an inborn error of metabolism (IEM) (2.4%). Of the 25,240 infants born in the hospital during the period examined, a further 11 newborns had an inborn error of metabolism diagnosed on newborn screening. This produced an incidence in our unit over the time described of 6.34 per 10,000 births. This number reflects a minimum estimate, given that the conditions diagnosed refer to early-onset disorders and distinctive categories of IEM only. Efficiency of the clinician-initiated metabolic screening process was also examined. The only statistically significant variable in requiring repeat metabolic screening was early day of life ( z -score = − 2.58, p = 0.0098). A total of 28.4% was missing one of three key metabolic investigation parameters of blood glucose, ammonia or lactate concentration with ammonia the most common investigation missing. While hypoglycemia was the most common clinical rationale for a clinician-initiated metabolic test, it was a poor predictor of inborn error of metabolism with no newborns of 25 screened were diagnosed with a metabolic disorder. Conclusion : Clinician-targeted metabolic screening had a high diagnostic yield given the relatively low prevalence of inborn errors of metabolism in the general population. Thoughts should be given to the rationale behind each targeted metabolic test and what specific metabolic disease or category of inborn error of metabolism they are concerned along with commencing targeted testing. What is Known: • Inborn errors of metabolism are a rare but potentially treatable cause of newborn mortality and morbidity. • A previous study conducted in a tertiary unit in an area with limited newborn screening demonstrated a diagnostic yield of 5.4%. What is New: • Clinician-initiated targeted metabolic screening has a good diagnostic performance even with a more expanded newborn screening programme. • Further optimisation could be achieved by examining the best timing and also the rationale of metabolic testing in the newborn period.

Aim: The full blood count (FBC) is commonly measured as part of a partial septic work-up in asymptomatic infants at increased risk of early-onset neonatal sepsis (EOS). To determine the impact of FBC parameters on infants' subsequent management a retrospective cross-sectional study was performed.Methods: Infants, born at >= 34 weeks gestation, asymptomatic at birth, undergoing a partial septic work-up and receiving prophylactic antibiotics due to increased risk of EOS in a single centre over a 2-year period, were included. The primary outcome measure was frequency of FBC result impacting on duration of antibiotic therapy. Secondary outcome measures included frequency of FBC parameters outside of the reference range and incidental diagnoses.Results: In total, 16 726 live-born infants were delivered during the study period. A total of 802 (4.8%) were included. Thirteen infants (1.6%) received a prolonged course of antibiotics due to suspicion for EOS. Two of these infants had elevated white cell counts. All had normal neutrophil counts. In no case did the FBC result influence the decision to prolong the antibiotic course.Conclusion: In a cohort of 802 infants, asymptomatic at birth and at increased risk of EOS, the FBC result did not impact on the decision to prolong the course of antibiotics for suspicion of EOS.

A male infant was born at 39 weeks’ gestation by spontaneous vaginal delivery. The mother was a 32-year-old primigravida. Antenatal course was uneventful. Apgar score was 9 at 1 min and 10 and 5 min. He did not require resuscitation and was transferred to the postnatal ward with the mother. At 30 hours of age, he developed right arm and leg jerking. A bedside cranial ultrasound suggested a left middle-cerebral artery territory infarct. Given the frequent use of levetiracetam in paediatric seizures with a good effect, should this drug be used as first-line in the treatment of neonatal seizures? 1. In neonates diagnosed with seizures, is there evidence to support levetiracetam rather than phenobarbitone as the first-line treatment of neonatal seizures? ### Primary sources MEDLINE, PubMed, Embase and TRIP were searched using the following search terms: ( Neonat* [neonate, neonates, neonatal] OR newborn ) AND ( Levetiracetam OR Keppra) AND (Seizure OR epilepsy OR convulsion ) ( Neonat* [neonate, neonates, neonatal] OR newborn AND (Phenobarb [phenobarbitone, phenobarbital]) AND ( Seizure OR epilepsy OR convulsion ) ### Secondary sources The Cochrane Library was searched using a combination of the terms as …