Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced therapy for refractory pediatric cardiac arrest. This review outlines the clinical and organizational components necessary to implement and sustain a successful pediatric ECPR program. Registry analyses and updated resuscitation guidelines emphasize the importance of minimizing low-flow time, optimizing cardiopulmonary resuscitation (CPR) quality, and rapidly deploying ECPR in select patients. Shorter CPR duration and lower post-cannulation lactate are associated with improved outcomes, highlighting the need for formalized activation pathways and efficient team dynamics. Evidence supports the use of standardized protocols, predefined team roles, equipment bundling, and simulation-based training to reduce time to cannulation and improve reliability. Human factors and systems engineering frameworks, including the Systems Engineering Initiative for Patient Safety (SEIPS) model, provide structured approach to aligning personnel, tasks, technology, environment, and organizational processes across the continuum of ECPR care. ECPR is a complex, time-sensitive therapy that requires deliberate programmatic development to translate technical capability into meaningful survival and neurologic outcomes. Institutions seeking to offer ECPR should adopt structured activation criteria, simulation-based systems testing, and ongoing performance evaluation to ensure safe, timely, and effective delivery.

To provide the reader with understanding of neonatal physiology relating to fluids and electrolytes, and how optimal enteral and parenteral fluid provision should be provided during the transition from intra- to extrauterine life and during management of the various disorders that may occur in the neonatal period. Traditional recommendations of parenteral fluid volumes for late preterm and term infants may overestimate their fluid needs, placing them at risk for overhydration reflected by inadequate postnatal weight loss and hyponatremia. Preterm infants require larger parenteral fluid volumes than those born at term, due to their greater insensible water loss and high urine output related to their inability to adequately concentrate urine. However, care must be taken not to provide excessive fluids as it increases their risk of morbidity, mortality and adverse developmental outcomes. When providing neonates with fluids and electrolytes the uniqueness of their physiology needs to be considered. Meticulous monitoring of serum sodium, body weight and fluid balance is needed to optimize fluid and electrolyte management, especially in extremely preterm and sick infants. The volume and composition of fluid given must be adequate to maintain body homeostasis, but excessive fluid administration increases the risk of adverse neonatal outcomes.

This review critically examines the role of furosemide and chlorothiazide in the prevention and management of bronchopulmonary dysplasia (BPD). We describe their common use, pharmacotherapeutic mechanisms, and summarize evidence from clinical trials and cohort studies evaluating their effects on diuresis and respiratory outcomes. Most evidence comes from studies in the 1980s that generalize poorly to contemporary neonatal care. However, a trial in 80 extremely preterm infants was published in 2025, reporting no certain effect of furosemide on death or BPD or on adverse effects other than electrolyte imbalances. The trial was not designed to address BPD prevention. Two recent large observational studies reported associations between greater diuretic exposure and lower risk of death or BPD but are limited by potential confounding. Earlier trials suggest diuretics may offer short-term improvements in urine output, pulmonary mechanics and gas exchange. The role of diuretics in the prevention and management of BPD remains uncertain. While transient, modest improvements in diuresis and respiratory function are likely, existing evidence does not convincingly support either clinically meaningful benefit or harm. In the absence of robust evidence-based guidance, minimizing routine diuretic use and considering short-term, selective treatment with measurable individualized goals is prudent. Addressing the disconnect between widespread use and limited supporting evidence will require well-designed studies that consider optimal patient selection, timing, dosing and duration in the context of current diuretic practice patterns.