Background: Vital sign monitoring immediately after birth is a necessity to aid the transition to life, especially in the context of resuscitation. Current monitoring systems pose challenges due to their wired nature. This scoping review aimed to identify and describe non-contact and wireless vital sign monitoring technologies used immediately after birth and summarize their capabilities and any research gaps to better understand the current state of wireless monitoring in the delivery room setting. Methods: The review followed the JBI 9-step framework and PRISMA-ScR guidance. Searches were conducted in Medline, Embase, Scopus, Web of Science, CINAHL, and Cochrane for studies published from 1 January 2015 to 1 October 2025, with additional reference screening of included articles. Study and device characteristics and study outcomes (i.e., accuracy, feasibility, safety) were collected via a data collection form and analyzed and presented by descriptive methods. Results: The search yielded 59,220 records; after duplicate removal and screening, seven full articles were included, one additional article was added through cross-reference screening. All eight studies were conducted in hospital delivery rooms, mostly as prospective observational designs, involving newborns of various gestational ages and weights, with a median of 29 [IQR:35] participants per study. All eight studies evaluated wearable devices. Heart rate was the most commonly monitored vital sign, and Bluetooth was the main data transfer method. Recording periods were mostly under 10 min. Conclusions: New monitoring technologies used immediately after birth are emerging, but data remains preliminary and limited by small studies with short recording periods. Future work should emphasize standardized device placement, larger samples with longer monitoring periods, rigorous accuracy and safety evaluation, and devices that can capture multiple vital signs reliably.

Background: Postnatal corticosteroids (CS) improve respiratory outcomes in preterm infants, but effects on growth and neurodevelopment remain incompletely understood. Methods: This third instalment of a narrative review series builds on physiologic principles to examine systemic CS consequences. Main Findings: We explore the interplay between growth restriction, hypoxia, and neurodevelopmental vulnerability, discussing brain imaging, metabolic disruptions, and HPA axis suppression. Conclusion: This review advocates for a holistic, physiology-informed approach to optimize outcomes by integrating nutritional vulnerability with cardiorespiratory status.

The management of patent ductus arteriosus (PDA) in premature infants remains a significant debate in neonatology. Interventions aimed at accelerating ductal closure, often using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, are common practice. However, recent evidence increasingly challenges this approach. Pharmacological agents for PDA closure demonstrate limited efficacy and carry significant risks of systemic toxicity, affecting renal, gastrointestinal, vascular, and pulmonary systems. Multiple recent randomized controlled trials (RCTs) and meta-analyses have largely failed to demonstrate that early active treatment improves crucial clinical outcomes such as mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), or necrotizing enterocolitis (NEC). Some studies even suggest potential harm, particularly an increased risk of BPD and mortality in vulnerable extremely preterm infants. Procedural closure methods (surgical ligation, transcatheter techniques), while achieving anatomical closure, also pose significant risks and lack evidence of improved clinical outcomes. Given the high rates of spontaneous PDA closure, especially in extremely preterm infants, and the lack of proven benefit alongside potential harm from interventions, a paradigm shift towards expectant or conservative management is gaining support. This approach emphasizes supportive care, minimizing interventions, and may be complemented by the judicious use of postnatal corticosteroids in selected infants with significant lung disease, which might indirectly facilitate ductal closure by addressing underlying inflammation.

Postnatal corticosteroids are frequently administered to extremely preterm infants to support respiratory management, yet their effects on the immature cardiovascular system are complex and underexplored. As the second installment in a series on physiology-informed steroid use, this narrative review focuses on the cardiovascular consequences of systemic corticosteroid therapy in preterm neonates. We examine how corticosteroids influence key aspects of cardiovascular physiology, including ductal closure, systemic and pulmonary vascular resistance, myocardial remodeling, and autonomic regulation. Attention is given to the hemodynamic transition of early postnatal life and how steroid exposure may interact with patency of the ductus arteriosus and vascular development. The potential for corticosteroids to contribute to reactive myocardial hypertrophy, systemic hypertension, and pulmonary hypertension is also reviewed in the context of both short- and long-term outcomes. Emerging diagnostic and monitoring tools are discussed for their potential to guide individualized therapy. These include targeted neonatal echocardiography (TnECHO) to assess cardiac function and structure, electrocardiography (ECG) for rhythm and conduction abnormalities, heart rate variability analysis for autonomic function, and circulating biomarkers to evaluate myocardial stress and inflammation. Together, these tools may inform tailored steroid timing and dosing, especially in the research context, while monitoring for signs of cardiovascular side effects in real time. By synthesizing mechanistic insights with evolving clinical evidence, this review highlights the need for a more nuanced understanding of how corticosteroids affect the developing cardiovascular system. It underscores the importance of integrating cardiovascular monitoring into routine care to optimize therapeutic benefit while minimizing unintended harm. Alongside companion reviews addressing respiratory and growth impacts, this installment contributes to a broader framework for individualized, physiology-driven steroid use in extremely preterm infants.

This Viewpoint discusses speed and safety in pediatric artificial intelligence.

BACKGROUND:To survive, infants born before 26 weeks' gestation require respiratory assistance immediately after birth. However, the respiratory trajectories of these most preterm infants are not well delineated. We aimed to describe the early respiratory trajectories of infants born before 26 weeks' gestation who received surfactant during their initial neonatal intensive care admission. METHODS:This study was a post-hoc exploratory analysis of PLUSS, a randomised controlled trial comparing intratracheal budesonide mixed with surfactant versus surfactant alone. Infants were recruited from 21 neonatal intensive care units in Australia, New Zealand, Canada, and Singapore. Infants born before 28 weeks' gestation and aged less than 48 h were eligible if (1) they were mechanically ventilated, or (2) they were receiving non-invasive respiratory support and there was a clinical decision to treat with surfactant. For this analysis, only infants born before 26 weeks' gestation were included, and treatment and control groups were combined. We aimed to describe early respiratory trajectories, including the levels of respiratory support and oxygen administered during the first 14 days, and respiratory outcomes at 28 postnatal days and 36 weeks' and 40 weeks' postmenstrual age. The main in-hospital respiratory outcomes were the timing and success of the first extubation, the durations of respiratory support, including oxygen requirements, and outcomes at hospital discharge, such as duration of hospital stay and discharge home on oxygen. PLUSS is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000322336), and follow-up is ongoing. FINDINGS:Between Jan 4, 2018, and March 27, 2023, 1062 infants were recruited to the PLUSS trial, of whom 601 were born before 26 weeks' gestation. 131 (97%) of 135 infants born at 22-23 weeks' gestation were intubated at birth, compared with 163 (74%) of 220 infants born at 24 weeks and 157 (64%) of 246 infants born at 25 weeks. The median postnatal age at first extubation ranged from 15 days (IQR 8-26) in infants born at 22-23 weeks' gestation to 6 days (2-18) in those born at 24 weeks and 3 days (1-10) in those born at 25 weeks. 54 (66%) of 82 infants born at 22-23 weeks' gestation required reintubation, compared with 80 (51%) of 158 infants born at 24 weeks and 72 (38%) of 189 infants born at 25 weeks. The median duration of mechanical ventilation in infants who survived to 36 weeks' postmenstrual age was 36 days (IQR 23-49) in those born at 22-23 weeks' gestation, 26 days (14-39) in those born at 24 weeks, and 12 days (3-27) in those born at 25 weeks. At 40 weeks' postmenstrual age, nine (11%) of 83 surviving infants born at 22-23 weeks' gestation were discharged home, and 63 (85%) of 74 infants still in the hospital were receiving oxygen or respiratory support. By contrast, 36 (23%) of 160 surviving infants born at 24 weeks and 61 (30%) of 204 born at 25 weeks were discharged home, and 97 (78%) of 124 in-hospital infants born at 24 weeks and 79 (55%) of 143 in-hospital infants born at 25 weeks required oxygen or respiratory support. INTERPRETATION:The most preterm infants born at the margins of viability require intensive and prolonged respiratory support. Knowledge of the respiratory trajectories in surfactant-treated infants born before 26 weeks' gestation could assist clinicians in family consultations while also guiding future randomised controlled trials. FUNDING:National Health and Medical Research Council, Australia; Chiesi Farmaceutici.

Extremely preterm infants often require prolonged respiratory support due to lung immaturity and inflammation, placing them at high risk of lung injury and development of bronchopulmonary dysplasia (BPD). In many of these infants, systemic postnatal corticosteroids are used to reduce lung inflammation, facilitate mechanical ventilation (MV) weaning and extubation, and improve short-term pulmonary outcomes. However, despite decades of clinical use, substantial variation persists in timing, choice of agent and dosing. These inconsistencies reflect a lack of strong evidence and a limited understanding of the systemic and organ-specific effects of therapy for a highly heterogenous population usually exposed to this medication. This narrative review addresses these gaps by integrating current knowledge of the inflammatory and respiratory effects of postnatal corticosteroids in extremely preterm infants. We explore how corticosteroids modulate pulmonary inflammation, their effects on lung development, and how they affect key clinical outcomes such as extubation success and BPD severity. We also examine evolving approaches to corticosteroid administration and dosing, highlighting the importance of individualized strategies informed by developmental and disease-specific considerations. Comparative data from randomized controlled trials are reviewed, including the efficacy and side-effect profiles of commonly used regimens. Current evidence supports judicious use of late low-dose dexamethasone, while early prophylaxis with inhaled or intratracheal steroids remains experimental and is not routinely advised. In line with a physiology-driven approach, we also discuss emerging domain-specific monitoring tools that may enhance patient selection and optimize timing of intervention. By synthesizing mechanistic insights with clinical evidence, this review supports a more nuanced, individualized approach to postnatal corticosteroid therapy in extremely preterm infants, balancing therapeutic benefits with potential systemic trade-offs.

Despite the ubiquity of apnea among preterm infants, optimal definitions and monitoring practices remain unknown. This scoping review aims to describe the clinical methods used to monitor apnea in preterm infants and apnea definitions employed across the neonatal literature. A search was performed in Cochrane Library, EMBASE, MEDLINE, and Web of Science for studies published in the last 25 years employing monitoring devices or algorithms for the purpose of identifying apneas in premature infants. Data surrounding participant information, devices employed, and apnea definitions were extracted. Across 176 included studies, 12 different devices were used to monitor breathing efforts and 7 devices to monitor respiratory airflow with the aim of capturing apneas. Methods for monitoring airflow remain limited in sensitivity and feasibility. Of 164 apnea definitions extracted from the studies, 110 (67

Objectives:Assess feasibility, safety, and accuracy of electrocardiogram (ECG) and heart rate (HR) monitoring in neonates, using a new wireless skin sensor. Methods:Prospective observational study in infants of any gestational age admitted in the neonatal intensive care unit. ECG/HR signals were simultaneously recorded from a standard wired and new wireless system with bedside annotations. Feasibility was evaluated as signal coverage, gap numbers/durations, and sources of gaps. Safety was appraised by changes in skin condition and pain after/upon wireless sensor removal. Accuracy was measured using bias and 95% limits of agreement, and the coefficient of determination. The ability of the wireless sensors to detect normal and abnormal HR values was evaluated using a Clark Error Grid. Additionally, user satisfaction from parents and nurses were appraised using a short questionnaire. Results:25 infants had 757 h of recorded signals over 96 days. ECG coverage was 99.9% [IQR: 99.9%-99.95%] for the wired vs 97.8% [IQR: 81.6%-99.9%; p < 0.00] for the wireless system, while HR coverage was 99.4% [IQR: 98.6%-99.9%] vs 89.7% [IQR: 75.6%-97.6%; p < 0.00]. Wireless ECG gaps were <5 s in 97% of cases, and HR gaps <30 s in 85%. All ECG gaps and 57% of HR gaps were due to Bluetooth disconnection (BD). 78% of BD in wireless HR were during kangaroo care (78%). Of 192 skin photographs (96 pairs), 98% were taken, showing increased but low skin scores post-removal, with median pain scores also low. Accuracy metrics showed strong agreement, with the Clark Error Grid indicating 97% of paired signals led to the same clinical outcome. Among 23 nurse and 18 parent responses, satisfaction with the wireless system was high. Conclusion:ECG and HR monitoring using a new wireless skin sensor was feasible, safe, and accurate when compared to the wired standard. Future adjustments in the technology are needed to improve signal coverage during handling and KC and test the sensors in unstable and more immature patients. Limitations included challenges in recruiting unstable neonates, variability introduced by multiple raters completing pain assessments, and inability to apply safety metrics to the wired standard of care.

Extremely preterm infants (gestational age [GA] < 28 weeks) have frequent apneas, bradycardias, and desaturations that require tactile stimulation, bag-mask ventilation, and/or intubation. The cumulative impact of these nurse-recorded cardiorespiratory events (CREs) on long-term risk of significant neurodevelopmental impairment (sNDI) is unknown. To explore associations between severe CREs and sNDI at 18 to 24 months corrected age in extremely preterm infants. In this retrospective cohort study, extremely preterm infants admitted to the Montreal Children’s Hospital NICU between 2016 and 2019 were included. The exposure of interest was cumulative CREs from birth until 34 weeks postmenstrual age. The primary outcome was sNDI, defined as global developmental delay (≥2 standard deviations below the mean on standardized tests in at least two developmental domains) or cerebral palsy with gross motor function classification system III-V. Secondary outcomes included Bayley III composite scores for language, motor, and cognition. Characteristics of infants with or without sNDI were compared using univariate and multivariate regression analyses. Correlations between cumulative CREs and Bayley III composite scores were assessed using Pearson correlation coefficients (r). Subgroup analyses were repeated for infants receiving mechanical ventilation (MV) < 7 days and for CREs in the first week only. 151 infants (mean GA 25.79, SD 1.24) were included, of which 44 (29%) had sNDI. Infants with sNDI had significantly more frequent severe intraventricular hemorrhage, more frequent postnatal infections, and longer MV exposure compared to infants without sNDI (Table 1). Weekly and cumulative CREs were higher in infants without sNDI, but only week 4 showed a significant difference (p = 0.002, Fig 1). After adjusting for confounders, only severe intraventricular hemorrhage and MV duration were independently associated with sNDI. Scatter plots of cumulative CREs and Bayley III composite scores did not show significant correlations (r = -0.061, 0.075, and 0.041) for language, motor, and cognitive scores, respectively. Subgroup analyses showed no further significant associations. Although nurse-documented CREs commonly shape decision-making in extremely preterm infants, they are not associated with increased sNDI at 18-24 months corrected age. More precise and quantitative monitoring of CREs may be needed to better understand their association with clinically meaningful long-term outcomes.

Monitoring vital signs in the Neonatal Intensive Care Unit (NICU) typically relies on wired skin sensors, which can limit mobility, cause skin issues, and interfere with parent–infant bonding. Wireless sensors offer promising alternatives, but evaluations to date often emphasize accuracy alone, lack NICU-specific validation, and rarely use standardized frameworks. Our objective was to develop and apply a comprehensive framework for evaluating the feasibility, safety, and accuracy of wireless monitoring technologies using a wireless pulse oximeter, the Anne limb (Sibel Health, USA), in real-world NICU conditions. A prospective study was conducted on a diverse NICU population. A custom system enabled synchronized data recordings from both standard and wireless devices. Feasibility was assessed as signal coverage across a variety of daily care activities and during routine procedures. Safety was evaluated through skin assessments after extended wear. Accuracy was examined sample-by-sample and interpreted using the Clarke Error Grid for clinical relevance. The wireless oximeter device showed high feasibility with reliable Bluetooth connection across a range of patients and activities (median wireless PPG coverage = 100%, IQR: 99.85–100%). Skin assessments showed no significant adverse effects. Accuracy was strong overall (median bias 1.34%, 95% LoA −3.63 to 6.41), with most data points within clinically acceptable Clarke error grid zones A and B, though performance declined for infants on supplemental oxygen. This study presents a robust, multidimensional framework for evaluating wireless monitoring devices in NICUs and offers recommendations for future research design and reporting.

OBJECTIVES:To assess the caffeine response in preterm and term newborns with persistent intermittent hypoxia (IH) as they approach discharge, with particular focus on newborns with chronic lung disease of prematurity (CLD). To identify factors associated with a lack of response to caffeine. DESIGN/SETTINGS:Retrospective cohort study across two neonatal intensive care units between 2015 and 2022. MAIN OUTCOMES FOLLOWING CAFFEINE ADMINISTRATION:Normal oximetry; no need for respiratory support; resolution of hypercapnia. RESULTS:A total of 132 infants received caffeine for persistent IH. Normal oximetry was achieved post-caffeine in 81% (46/57) of newborns with CLD, in 96% (46/48) of preterm with no CLD, in 96% (26/27) of term newborns. Caffeine reduced the % time with SpO2 < 90% from 6.8% (interquartile range, 3.8%-12.2%), to 0.8% (0.4%-1.6%, p < 0.0001). The desaturation index < 80% dropped from 5.3 events/hour (0.9-14.6 events/hour) to 0.2 events/hour (0-0.78 events/hour, p < 0.0001) and the desaturation index ≥ 10% lasting > 10 s went from 6.6 events/hour (3.3-10.7 events/hour) to 1.4 events/hour (0.7-2.4 events/hour, p < 0.0001). Of the 61 infants on respiratory support, 74% (45/61) were weaned within a few days following caffeine. Caffeine normalized PCO2 in 63% (41/65) of newborns with elevated PCO2 pre-caffeine. Infants failing caffeine were more likely to have CLD compared to responders (79% vs. 39%, p < 0.005). Caffeine was successfully discontinued (first attempt, normal oximetry) in 101 infants (88%) at postmenstrual age of 46.1 weeks (45.3-48.3 weeks). CONCLUSION:Caffeine improved respiratory outcomes in the majority of preterm and term born infants with persistent IH, including those with CLD.

Optimizing neonatal nutrition and diagnosing serious gastrointestinal diseases remains a challenge, as traditional guideline-based approaches often fail to address the individualized needs of preterm and term infants. Advances in artificial intelligence and machine learning provide opportunities for precision diagnostics and therapeutics by incorporating multiomic data and clustering infants based on risk factors and metabolic profiles. For example, machine learning is redefining necrotizing enterocolitis as a spectrum of intestinal injuries rather than a single disease, while digital twin models offer the potential for real-time personalized nutrition optimization. Moreover, integration of advanced gastrointestinal monitoring methods using novel biomarkers and sensor technologies may further enhance early detection and intervention strategies. Altogether, these digital technological advancements may lead to identification of early predictors of nutritional deficiencies and prompt recognition of gastrointestinal pathologies, thereby allowing for proactive interventions and potentially improved outcomes in the neonatal population.

Bubble continuous positive airway pressure (bCPAP) supports neonatal respiration by directing air flow through an expiratory limb submerged in a water canister at a fixed pressure, thereby generating pressure oscillations that aid lung expansion, airway stability, and gas exchange. Proper system function is typically assessed by listening to bubbling sounds from the water canister and the patient's lungs. This paper describes the bCPAP canister bubbling sounds and develops a linear regression model relating the sounds at specific frequencies to system pressure and flow rate. Bubbling was found to consistently occur between 100-10,000 Hz, with different settings altering magnitude but maintaining similar minima and maxima within frequency bands. The model accounted for more than 81% of variance across experiments, though refinement is needed to address inter-day variability.Clinical Relevance-This work provides insights into the properties of bCPAP bubbling sounds as used in clinical settings and models their behavior as a function of system pressure and flow rate. By establishing a data-driven approach, it enables the potential development of real-time feedback tools that can quantitatively assess the quality of bubbling as a surrogate metric of the effectiveness of the bCPAP system, thereby improving the consistency and precision of respiratory support in neonatal care.

As a standard of care in the Neonatal Intensive Care Unit (NICU), infants’ vital signs are monitored continuously via wired devices. These often interfere with skin-to-skin contact, patient care, and pose increased risks of skin damage, infection, and tangling around the body. We designed an ongoing study to evaluate the feasibility, accuracy, and safety of wireless vital sign monitoring in the NICU. Vital signs were simultaneously acquired using the wired, standard of care bedside monitor and a novel, wireless, wearable sensor (ANNE Arc). Data from 25 NICU infants were recorded for 8 hours a day, over 4 consecutive days. Previously, we found strong accuracy for wireless heart rate (HR) monitoring, but poor performance for respiratory rate (RR). However, RR measurements derived from impedance pneumography can be erroneous in the presence of movement artifacts and increased noise. Thus, we developed an algorithm to continuously estimate the signal-to-noise ratio (SNR) across wired and wireless impedance recordings, using the Fast Fourier Transform (FFT). Across 72 recording sessions, we found the impedance signal from the wireless sensor had a lower SNR (median SNR of -1.83 dB [IQR: -5.83-1.92]), than the wired reference device (median SNR of 2.12 dB [IQR: -2.14-6.33]). We examined the mean absolute error (MAE) and margin of error (MoE) between paired wired and wireless RR values as a function of the SNR of both systems. The agreement between the wireless and wired RR signals increased during periods of high SNR. The MAE achieved ≤ 10 bpm when wired SNR was ≥ 4 dB and wireless SNR was ≥ 10 dB; for the same SNRs, the MoE ≤±25 bpm. Thus, we showed that the SNR of raw impedance measurements could be used to assess the reliability of RR values displayed on clinical patient monitors.Clinical relevance— This algorithm provides a means of quantifying the signal quality of thoracic impedance measurements acquired from neonates, and assigning confidence to RR values displayed on clinical monitors.

This study aimed to assess the views of parents and neonatal intensive care unit (NICU) health care providers (HCPs) on current wired vital signs monitoring and future wireless alternatives. Prospective cross-sectional survey was conducted between March and July 2023, targeting three groups: (1) NICU parents, (2) physicians, and (3) nurses and respiratory therapists (RT) and physiotherapists (PT). A 17-question survey was developed to assess several perspectives with current vital signs monitoring and a possible wireless monitoring system. NICU parents completed paper surveys and HCPs participated via an anonymous electronic survey. The original English survey was tailored for different respondent groups, translated into French, Spanish, and Portuguese, and distributed through neonatal research networks. Responses from each group were analyzed as totals (%), with within-group comparisons assessed using the Wilcoxon signed-rank test. Additionally, between-group comparisons were conducted using the chi-square test of independence or Fisher's exact test, as appropriate. A total of 1,141 responses were included (25 parents, 438 physicians, and 678 nurses, RTs, and PTs). Only 52% of parents were satisfied with current wired systems; 68% reported wires hindered infant handling, and 52% cited interference with skin-to-skin care. Both physicians and HCPs expressed low satisfaction with the current system. Common concerns included tangling, skin irritation, and workload. Support for wireless technology introduction was high across all groups (parents = 60%, physicians = 91%, and nurses, RTs, and PTs = 87%), with main perceived benefits including improved kangaroo mother care (KMC), reduced patient discomfort, and enhanced bonding. All groups expressed accuracy, safety, battery life, and cost concerns of a possible wireless system. Parents and HCPs are generally dissatisfied with the current NICU vital signs monitoring systems, primarily due to concerns with wires and cables and interference with KMC. Wireless technologies were mostly supported, but data on reliability, safety, and economic feasibility will be critical for development and successful implementation.

Current vital sign monitoring uses skin sensors connected to monitors via wires. Emerging technologies include non-contact and wireless wearable systems. This systematic review aims to determine the current stage of development of these technologies and the prospect for clinical translation. A search on Medline, Embase, Cochrane, Scopus, and Engineering Village was conducted for studies published between January 2014 and August 2024. Two reviewers independently screened articles and extracted data on technology, signals and feasibility, safety, and accuracy outcomes. Risk of bias was assessed using the QUADAS-2; quantitative and qualitative analyses were conducted. Sixty observational studies were included: 43 (72