Treatment Of Neonates Research Articles

Retrospective analysis of the effect of electronic cardiotocography on selected birth and neonatal variables among 4172 women from a Single Centre in Warsaw, Poland.

Cardiotocography (KTG) is widely used for continuous or intermittent assessment of fetal heart function. This study aimed to compare the effects of continuous and intermittent KTG during labour on selected variables. In a retrospective study, 4172 medical records of Warsaw Hospital (Poland) patients were analysed. The study group consisted of 2111 women with continuous KTG during labour and the control group of 2061 women with periodic KTG. The median age of the women was 30 years, and the median gestation period was 40 Hbd. Most of the women lived in urban areas (87.15%), were in a relationship (82.05%) and had a higher education (86.60%). In the group with intermittent OCT, delivery by caesarean section was indistinguishably more frequent (OR = 1.06; 95% CI = 0.87-1.30), there were significantly fewer grade II perineal ruptures (OR = 1.65, 95% CI = 1.07-2.55), grade III- and IV perineal ruptures (OR = 5.13, 95% CI = 1.12-23.53) and oxygen therapy (OR = 1.76, p = 0.004). More infants with Apgar scores ≤ 7 points at the fifth minute (OR = 0.34, 95% CI = 0.12-0.094), requiring nCPAP (Nasal Continuous Positive Airway Pressure) (OR = 0.56, 95% CI = 0.39-0.86) and resuscitation [OR = 0.37, 95% CI = 0.17-0.79]) were born in the group with periodic ECG. The analysis showed that the group of women with continuous OCT during labour had a lower risk of acid-base disorders (OR = 0.45, 95% CI = 0.21-0.98) CONCLUSIONS: Continuous KTG during labour in high-risk women increases the likelihood of instrumental delivery (using vacuum) and perineal incision compared with periodic KTG. The use of intermittent ECG during labour reduces the number of newborns with Apgar scores ≤ 7 points and decreases the number of neonatal interventions such as nCPAP and resuscitation.

Preclinical use of a clinically-relevant scAAV9/SUMF1 vector for the treatment of multiple sulfatase deficiency

BackgroundMultiple Sulfatase Deficiency (MSD) is a rare inherited lysosomal storage disorder characterized by loss of function mutations in the SUMF1 gene that manifests as a severe pediatric neurological disease. There are no available targeted therapies for MSD.MethodsWe engineered a viral vector (AAV9/SUMF1) to deliver working copies of the SUMF1 gene and tested the vector in Sumf1 knock out mice that generally display a median lifespan of 10 days. Mice were injected as pre-symptomatic neonates via intracerebroventricular administration, or as post-symptomatic juveniles via intrathecal alone or combination intrathecal and intravenous delivery. Cohorts were assessed for survival, behavioral outcomes, and post-mortem for sulfatase activity.ResultsWe show that treatment of neonates extends survival up to 1-year post-injection. Importantly, delivery of SUMF1 through cerebral spinal fluid at 7 days of age alleviates MSD symptoms. The treated mice show wide distribution of the SUMF1 gene, no signs of toxicity or neuropathy, improved vision and cardiac function, and no behavioral deficits. One-year post treatment, tissues show increased sulfatase activity, indicating functional SUMF1. Further, a GLP toxicology study conducted in rats demonstrates favorable overall safety of this approach.ConclusionsThese preclinical studies highlight the potential of our AAV9/SUMF1 vector, the design of which is directly translatable for clinical use, as a gene replacement therapy for MSD patients.

When High-Risk Ductal Stenting Goes Wrong: Use of Percutaneous VV ECMO Support and Acute Left Pulmonary Artery Loss.

Patent ductus arteriosus (PDA) stenting is a vital intervention for neonates with ductal-dependent blood flow, offering an attractive alternative to surgical shunt placement. Despite its benefits, the procedure poses risks such as ductal spasm, branch pulmonary artery compromise, and pseudoaneurysm formation. This report presents two complex neonatal cases with distinct outcomes. The first patient experienced severe ductal spasm, pseudoaneurysm formation, and ductal dissection. Innovative use of percutaneous venovenous extracorporeal membrane oxygenation (VV ECMO) provided hemodynamic stability, enabling staged interventions and eventual successful ductal stenting. The second patient experienced acute left pulmonary artery flow loss due to ductal spasm. Transcatheter attempts to restore flow failed, necessitating surgical stent removal and Blalock-Taussig-Thomas shunt placement. These cases highlight the challenges of PDA stenting in complex ductal anatomies and the importance of advanced imaging, careful wire and catheter selection, and multidisciplinary collaboration. Notably, the first reported use of percutaneous VV ECMO during PDA stenting demonstrates its potential as a lifesaving adjunct for these cases.

Social Vulnerability and Pregnancy Option Counseling in the Setting of Periviable Delivery.

Background/Objectives: According to the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, pregnant people facing periviable delivery should be counseled on expected neonatal outcomes and available pregnancy options. The objective of this study is to evaluate if rates of neonatology consultation and pregnancy option counseling for those facing periviable delivery differ based on social vulnerability factors or Social Vulnerability Index (SVI). Methods: This was a retrospective cohort study of patients who delivered at 22 0/7 weeks to 25 6/7 weeks of gestation at two academic medical centers with level III or IV neonatal intensive care units from 2019 to 2022. We analyzed the association between individual-level social vulnerability factors and census-tract-level SVI (released by the Center for Disease Control) and the rates of neonatology consultation and pregnancy option counseling. Results: In 138 periviable deliveries, 70.3% had a neonatology consultation, 92.0% were offered expectant management, 88.4% were offered neonatal full intervention, 41.3% were offered neonatal comfort care, and 44.9% were offered pregnancy termination. The rate at which neonatology consultations were completed and each pregnancy option was addressed did not differ by individual-level social vulnerability factors including race/ethnicity, government insurance, marital status, English proficiency, and parity, or by SVI. Conclusions: While these findings suggest that individual-level social vulnerability factors and SVI do not influence periviability counseling, we did identify gaps in comprehensive periviability counseling. Focus should be placed on increasing the rate of neonatology consultation and discussing the options of neonatal comfort care and pregnancy termination.

MAIN NEONATAL HARMS ASSOCIATED WITH CESAREAN: A INTEGRATIVE REVIEW

Introduction :The Cesarean Section is a medical procedure widely utilized. Originally, it was conceived as a last-resort intervention to save the life of the mother or fetus in critical situations. Over the years, however, it has become an increasingly common option, often favored by pregnant individuals given the perception of safety at the final stages of pregnancy. Factors such as maternal comorbidities, financial incentives and the lack of birth plans during prenatal care contribute significantly to the increase of CS rates. Nonetheless, this growing preference is not without its adverse impacts. Goals: To analyze the main neonatal harms associated with Cesarean Section.Methodology: This study comprehends an integrative review of the literature, utilizing the PubMed/Medline database and articles repositories (PUC-Goiás and E-Acadêmia). The research was conducted using the boolean operator “AND” and the keywords: “Cesarean Section”, “Infant”, “Newborn” and “Neonatology”. Five articles were selected for full reading, according to inclusion and exclusion criteria – articles published over the past six years and related to the subject, excluding incomplete or duplicated articles.Results: Studies indicate that Cesarean Section is associated with neonatal harms, such as respiratory problems, increased risk of infections, immunological disorders and possible impacts on neurological development. Vaginal delivery promotes the perinatal stress that stimulates pulmonary maturation through increased production of catecholamines and cortisol, processes absent in CS. Babies born by Cesarean Section are colonized by hospital bacteria, impairing immunological development. The correlation between the type of delivery and neurological disorders is yet inconclusive. Beyond that, CS is related with reduced skin-to-skin contact and reduced initial breastfeeding.Discussion: Despite necessary in several cases, CS presents substantial risks to the newborn. The respiratory complications result from the lack of physiological stress of vaginal delivery, which is essential to extrauterine respiratory adaptation. Bacterial colonization in CS can impair the immune system, increasing vulnerability to infections and allergies. Reduced skin-to-skin contact and lack of early breastfeeding can also impact the bond between mother-baby and neonatal health, increasing the need for neonatal interventions. Conclusion: Based on the information analyzed, it is evident that the Cesarean Section, despite being a common practice, is associated with an increase in risk of neonatal complications. The sanitary interventions must be focused on raising awareness of the risks involved and promoting policies that ensure informed choice and appropriate use of this practice. KEYWORDS: Cesarean Section; Newborn; Infant; Neonatology;

Relationship Between Clinical Decision-Making and Moral Distress in Neonatal Intensive Care Unit Nurses: A Multicenter Cross-Sectional Correlational Descriptive Study.

In the neonatal intensive care unit (NICU), nurses care for premature and critically ill neonates, interact with parents, and make clinical decisions regarding the treatment of neonates in life-threatening conditions. The challenges of managing unstable conditions and resuscitation decisions can cause moral distress in nurses. This study aims to determine the relationship between clinical decision-making and moral distress in NICU nurses. This cross-sectional, multicenter, descriptive correlational study involved 190 nurses working in 7 NICUs across hospitals in Khorramabad and Semnan in 2023. Data were collected using demographic questionnaires, the Clinical Decision-Making Laurie Scale (2001), and the Moral Distress Scale-Revised (MDS-R). All nurses in these NICUs were female. No significant correlation was found between clinical decision-making and moral distress (r=-0.03, P =.684). The moral distress score was low. In decision-making, 57.9% of nurses exhibited intuitive analysis (understanding without a rationale). Multiple linear regression analysis revealed that age, education level, and job position were significantly related to clinical decision-making; and being married and having children were inversely correlated with moral distress. 20% of nurses exhibited interpretive intuitive clinical decision-making, which involves care complexities, cognitive understanding, and task-based decisions. Nursing managers should focus on refining these decision-making strategies for NICU nurses. Given the importance of clinical decision-making in the NICU, future research should use quantitative and qualitative methods to explore the decision-making processes and moral distress in NICU nurses.

Therapeutic hypothermia in preterm infants under 36weeks: Case series on outcomes and brain MRI findings.

Perinatal hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal brain injury. Therapeutic hypothermia (TH) is the standard treatment for term neonates, but its safety and efficacy in neonates < 36weeks gestational age (GA) remains unclear. This case series aimed to evaluate the outcomes of preterm infants with HIE treated with TH. Retrospective analysis of preterm infants (< 36w GA) treated with TH (01/2019-06/2024). Data on demographics, clinical complications, coagulation profiles, brain magnetic resonance imaging (MRI), and neurodevelopment outcomes were analyzed. Seventeen patients were included (range 32.5-35.5w, median 34.4; birthweight range 1556-2493g, median 2300g), 58.8% were male. Placental abruption was identified in 7 cases (41.2%), and 8 (47.1%) required advanced resuscitation. Thirteen patients (76.5%) presented anemia, 12 (70.6%) coagulopathy, 9 (52.9%) thrombocytopenia, and 9 (52.9%) acute liver failure. Hypofibrinogenemia (< 1g/L) was significantly associated with severe intracranial hemorrhage (ICH), defined as extracerebral, intraventricular or parenchymal hemorrhage causing mass effect. MRI findings were classified based on the predominant lesion: I- hypoxic-ischemic injury, II- severe ICH, or III- normal/mild findings. Severe ICH was the predominant lesion in 4 cases (23.5%). White matter injury was seen in 12 (76%). Death occurred in 8 cases (47.1%). Of the 9 surviving patients, at 2years, 6 (66.7%) had normal neurodevelopment, while 1 (11.1%) had severe disability. Coagulation abnormalities, particularly hypofibrinogenemia, significantly increase the risk of severe ICH in < 36w infants treated with TH. The safety and efficacy of TH in this population require further investigation.

Hospital level of service, rural-urban location, and neonatal resuscitation interventions: A population study in Alberta Canada from 2000 to 2020.

Advanced neonatal resuscitation interventions (ANRIs) are rarely performed for late preterm and term infants. However, healthcare providers in community hospitals may need to perform ANRIs, while having limited experience and resources. Understanding practice differences between hospitals of different levels of service (LoS) and rural/urban location may inform quality improvement. Our objective are to a) examine how hospital LoS and rural/urban location relate to ANRI rates in Alberta, Canada, a public health system with standardized Neonatal Resuscitation Program® training and b) describe trends in neonatal resuscitation interventions and outcomes. All live births≥34weeks in Alberta from 2000 to 2020 were examined using retrospective, administrative data. Hospitals (n=97) were categorized based on availability of delivery support, cesarian sections, pediatricians/obstetricians, and NICUs, then subcategorized by population and proximity to metropolitan centres. Rates of individual interventions or any ANRI were compared. 966,475 births were included. ANRI rates were: intubation for ventilation (0.8%), chest compression (0.2%), epinephrine (0.02%), any ANRI (0.95%). While ANRIs were lower in community hospitals and home births, with lower hospital level of service, intubation rates decreased and chest compressions rates increased. Level 1A (OR:4.52, 95% CI 3.59-5.62) and home births (OR:3.09, 95% CI 2.52-3.76) had much higher odds of chest compressions. No pattern was observed between rural/remote sites of similar LoS. In this population study, there were higher chest compressions rates and lower intubation rates at hospitals without NICUs, despite standardized training. Reasons for this difference require further investigation.

Efficacy of pulmonary surfactant with budesonide in premature infants: A systematic review and meta-analysis.

Pulmonary surfactant (PS) is one of the main treatment for neonates with respiratory distress syndrome (RDS). Budesonide has recently been studied as an additional treatment in such cases, but there is limited evidence supporting this. This study was implemented to determine the efficacy of PS combined with budesonide in premature infants. To achieve this, we conducted a systematic review and meta-analysis of randomized controlled trials by searching PubMed, Scopus, Embase, and the Cochrane Library from inception until July 12, 2024. We utilized a random-effects model to calculate the risk ratio and mean differences (MDs) with 95% confidence intervals (CIs) for the clinical outcomes of PS with budesonide versus PS alone. We used the GRADE approach to assess the quality of the evidence. We included 26 randomized controlled trials with a total of 2701 patients in the analysis. Treatments of PS with budesonide and PS alone were compared in all trials. PS with budesonide reduced bronchopulmonary dysplasia (BPD) incidence (risk ratio, 0.61; 95% CI, 0.51, 0.73), duration of mechanical or invasive mechanical ventilation (MD, -2.21 days; 95% CI, -2.72, -1.71), duration requiring oxygen (MD, -5.86 days; 95% CI, -8.44, -3.29), and hospitalization time (MD, -5.61 days; 95% CI, -8.65, -2.56). These results were based on low to very low evidence certainty. Only moderate-to-severe BPD or severe BPD showed a significant reduction when PS was used in conjunction with budesonide, a finding supported by moderate evidence certainty. Our study showed that the administration of PS with budesonide significantly improved respiratory outcomes, including the incidence of BPD, duration of mechanical or invasive mechanical ventilation, duration requiring oxygen, and hospitalization time in preterm infants, without short-term adverse drug events. However, the evidence certainty was mostly low to very low.

Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot

To assess the association between primary and staged repair of neonatal symptomatic tetralogy of Fallot (sTOF) and neurodevelopmental outcomes in preschool through school-age children. Multicenter cohort (n=9 sites) study of patients with sTOF who underwent neonatal intervention between 2005 and 2017. The neurodevelopmental outcomes measures included caregivers' ratings of executive function with the Behavior Rating Inventory of Executive Function, and psychosocial functioning with the Behavior Assessment System for Children - third Edition (BASC-3). Results were compared with normative data and by treatment strategy (primary repair vs staged repair). A parent survey assessed history of disabilities and access to services related to neurodevelopment. Although the majority of patients (median age 8.3years, IQR 5.7-11.2) had median Behavior Rating Inventory of Executive Function and BASC-3 scores within the normal range, a proportion had clinically elevated (abnormal) scores, especially in the school-age patient subgroup (Behavior Rating Inventory of Executive Function 24%-30% and BASC 20%-37%). There were no statistically significant differences based on treatment strategy for either the Behavior Rating Inventory of Executive Function or BASC-3. However, lower birth weight, genetic syndrome, and medical complexity were significantly associated with worse executive function, and lower maternal education was associated in school-age children with lower executive and psychosocial functioning. Ongoing disabilities were relatively common (learning disability 35%, speech delay 33%, developmental delay 31%), although up to 50% of children were not receiving educational or developmental services. Elevated executive and psychosocial concerns are present in the patient population with sTOF. Although initial treatment strategy appears unrelated to neurodevelopmental outcomes, lower birth weight, genetic syndrome, and medical complexity and lower maternal education are risk factors. Early recognition of neurodevelopmental concerns can facilitate access to appropriate neurodevelopmental services in this high-risk group.

Development and validation of a prognosis risk score model for neonatal mortality in the Amhara region, Ethiopia. A prospective cohort study

ABSTRACT Background A neonatal mortality prediction score can assist clinicians in making timely clinical decisions to save neonates’ lives by facilitating earlier admissions where needed. It can also help reduce unnecessary admissions. Objective The study aimed to develop and validate a prognosis risk score for neonatal mortality within 28 days in public hospitals in the Amhara region, Ethiopia. Methods The model was developed using a validated neonatal near miss assessment scale and a prospective cohort of 365 near-miss neonates in six hospitals between July 2021 and January 2022. The model’s accuracy was assessed using the area under the receiver operating characteristics curve, calibration belt, and the optimism statistic. Internal validation was performed using a 500-repeat bootstrapping technique. Decision curve analysis was used to evaluate the model’s clinical utility. Results In total, 63 of the 365 neonates died, giving a neonatal mortality rate of 17.3% (95% CI: 13.7–21.5). Six potential predictors were identified and included in the model: anemia during pregnancy, pregnancy-induced hypertension, gestational age less than 37 weeks, birth asphyxia, 5 min Apgar score less than 7, and birth weight less than 2500 g. The model’s AUC was 84.5% (95% CI: 78.8–90.2). The model’s predictive ability while accounting for overfitting via internal validity was 82%. The decision curve analysis showed higher clinical utility performance. Conclusion The neonatal mortality predictive score could aid in early detection, clinical decision-making, and, most importantly, timely interventions for high-risk neonates, ultimately saving lives in Ethiopia.

The association between changes in cerebral hemodynamics and cerebrovascular complications during ECMO treatment in neonates.

To investigate whether changes in cerebrovascular hemodynamic parameters during extracorporeal membrane oxygenation (ECMO) treatment in neonates are associated with the occurrence of cerebrovascular complications. This study selected neonatal patients who received ECMO treatment at a pediatric hospital in China from June 2021 to June 2024. Relevant clinical data were collected from the electronic medical record system. Data from cranial ultrasound examinations before and during ECMO treatment, as well as the occurrence of cerebrovascular complications, were collected for further analysis. A total of 37 neonates were enrolled in this study. Among them, 15 neonates who developed cerebrovascular complications during ECMO were included in the complication group, while the remaining 22 neonates were included in the non-complication group. The age difference between the two groups was statistically significant. The systolic blood pressure coefficient of variation (SBP-CV) and diastolic blood pressure CV (DBP-CV) were significantly higher in the complication group compared to the non-complication group. Additionally, the anterior cerebral artery peak systolic velocity CV (ACA-PSV-CV) and ACA resistance index CV (ACA-RI-CV) were significantly higher in the complication group than in the non-complication group. However, there was no significant difference in the ACA end-diastolic velocity CV (ACA-EDV-CV) between the two groups. The receiver operating characteristic (ROC) curve analysis of risk factors for cerebrovascular complications indicated that the area under the curve (AUC) for ACA-RI-CV was 0.765 (95% CI: 0.608-0.923, p = 0.007). The AUC for ACA-SBP-CV was 0.815 (95% CI: 0.666-0.964, p = 0.001). Moreover, when ACA-RI-CV and ACA-SBP-CV were combined, the AUC was 0.873 (95% CI: 0.758-0.988, p<0.001). High ACA-RI-CV and ACA-SBP-CV were associated with the occurrence of cerebrovascular complications during ECMO treatment in neonates. The combined detection of ACA-RI-CV and ACA-SBP-CV had a predictive role in the early identification of cerebrovascular complications in neonatal ECMO patients.

Integrating Stakeholder Priorities for the Optimization of Care of the Preterm Infant in a Safety-Net NICU.

This study aimed to engage clinical and community stakeholders to create a prioritization matrix of interventions to reduce neonatal brain injury and improve neurodevelopmental outcomes. We collaborated with our community partner to establish a Lived Experience Advisory Group (LEAG). Faculty performed a literature review to identify neonatal neuroprotective interventions; additional priorities from the LEAG were also included. Project leaders scored and presented intervention bundles for impact. Stakeholder priorities for value/feasibility were obtained via questionnaire. Mean values were incorporated into a prioritization matrix. Themes from discussions with LEAG members included the role of the neonatal intensive care unit (NICU) parent, the experience of trauma, shared decision-making, communication and trust with the health care team, and bias in medical care. Five interventions were placed in the highest priority quadrant of the prioritization matrix: thermoregulation, maternal antepartum steroids, delayed cord clamping, optimized oxygen delivery, and optimized glucose regulation. It is feasible to incorporate community and parent values into clinically oriented neuroprotective intervention bundles for preterm infants. This clinical-community collaboration is vital to ensure that our project objectives meet the needs and priorities of the population it is intended to serve. · Including input from parent advisory groups supports interventions that meet the needs of families.. · Collaboration between clinical and community stakeholders can improve neuroprotective and neurodevelopmental strategies.. · Incorporation of clinical interventions into a prioritization matrix improves resource utilization.. · Five perinatal interventions were ranked highly for impact and feasibility in the prioritization matrix..

Antioxidant Therapy in Neonatal Hypoxic Ischemic Encephalopathy: Adjuvant or Future Alternative to Therapeutic Hypothermia?

Oxidative stress-related diseases in newborns arise from pro-oxidant/antioxidant imbalance in both term and preterm neonates. Pro-oxidant/antioxidant imbalance has shown to be present in different pathological conditions such as hypoxic ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and patent ductus arteriosus (PDA). We performed a narrative review according to the most recent available literature (2012-2024), using Scopus and PubMed as electronic databases. Many observational and experimental studies in vitro and in vivo have evaluated the effectiveness of antioxidant therapies such as melatonin, erythropoietin (EPO), allopurinol, N-acetylcisteine (NAS), and nitric oxide synthase (NOS) inhibitors in these diseases. Perinatal asphyxia is one of the most important causes of mortality and morbidity in term and near-term newborns. Therapeutic hypothermia (TH) is the gold standard treatment for neonates with moderate-severe perinatal asphyxia, resulting in a reduction in the mortality and neurodevelopmental disability rates. According to the most recent literature and clinical trials, melatonin, allopurinol, NAS, NOS inhibitors, magnesium sulfate, and stem cells stand out as promising as both adjuvants and future probable alternatives to TH in the treatment of HIE.

Association of cytochrome P450 CYP2C9 (rs1057910) gene polymorphism and ibuprofen response in preterm neonates diagnosed with patent ductus arteriosus

Background Patent ductus arteriosus (PDA) closure is one of the most significant changes necessary to transition to extrauterine life. The failure of closure in preterm infants has been associated with a variety of complications. Aim and objectives This study aim to investigate the correlation between cytochrome P450 CYP2C9 gene polymorphism and the response to ibuprofen treatment in preterm neonates with PDA. Subjects and methods This prospective study was conducted on 64 preterm neonates with patent ductus arteriosus (hsPDA). The neonates were treated with ibuprofen and diagnosed using clinical and echocardiographic examinations. The study was carried out at the Neonatal Intensive Care Unit (NICU), Pediatric Department, Kasr Alainy and ElMounira Pediatric Hospitals, Cairo University, in June 2018. Results A statistically significant difference in respiratory rate was observed between both groups ( p = 0.047). Additionally, there was a significant difference in the duration of treatment with ibuprofen ( p = 0.021). Treatment with ibuprofen had no impact on renal function parameters. The platelet count decreased after treatment with no statistical difference. Conclusion Use of Oral ibuprofen is a highly effective treatment for HsPDA in preterm neonates, demonstrating a remarkable success rate of 92.2% and fewer adverse effects. Whilst no correlation between the CYP2C9 (rs1057910) gene polymorphism and the efficacy of oral ibuprofen response, Other factors affecting the response of oral ibuprofen and subsequent PDA closure include gestational age, birth weight, Apgar score at 5 min, ductal diameter, RDS, and sepsis.

Oral sildenafil versus bosentan for treatment of persistent pulmonary hypertension of the newborn: a randomized controlled trial

BackgroundAccess to inhaled nitric oxide (iNO) is limited in low resource settings due to non-availability and high cost. There is a need for research on low-cost alternative therapies for management of persistent pulmonary hypertension of the newborn (PPHN). We aimed to compare oral sildenafil and bosentan as monotherapy in the treatment of neonates with PPHN.Study designIn this single-centre open-label randomized controlled trial (RCT), term and late preterm neonates with PPHN, defined as pulmonary arterial systolic pressure (PASP) > 35 mmHg and requiring fraction of inspired oxygen (FiO2) > 0.21, were randomized to receive oral sildenafil and bosentan. The primary outcome was reduction of PASP by 25% within 48 h after start of drug.ResultsThirty-six neonates were analyzed (18 in each group). Initial PASPs were similar in both groups. The median (IQR) time for the primary outcome (PASP to reduce by 25% within 48 h) was 36 (24–48) h and 96 (48–120) h in sildenafil and bosentan groups respectively (p = 0.008). There was also a higher need to add other pulmonary vasodilators in bosentan group as compared to sildenafil group (p = 0.006).ConclusionSildenafil was associated with quicker reduction of PASP and FiO2 in neonates with PPHN, as compared to bosentan. Large multicentre blinded trials to assess efficacy and safety of bosentan in comparison with other pulmonary vasodilators would help to get a clearer understanding of its role in the management of PPHN, particularly for use in resource-limited settings that lack iNO.Clinical trial registration:https://ctri.nic.in/Clinicaltrials/rmaindet.php? trialid=63997&EncHid=39716.16132&modid=1&compid=19[CTRI/2022/06/043328].

Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford orthodontic airway plate treatment.

Severe respiratory distress of neonates with Robin sequence is traditionally managed by surgery. Stanford orthodontic airway plate treatment (SOAP) is a nonsurgical option. The study aimed to determine whether SOAP can improve polysomnography parameters of neonates with Robin sequence. Polysomnography of neonates with Robin sequence treated with SOAP at a single hospital were retrospectively analyzed. Patients without polysomnography at all 4 time points (pre, start of, mid, and posttreatment) were excluded. Data were analyzed using a linear mixed effects model. Sixteen patients were included. All patients had cleft palate. The median age (minimum, maximum) at the start of treatment was 1.1 months (0.3, 5.1) with the treatment duration of 4.5 months (3.5, 6.0). The mean obstructive apnea-hypopnea index (95% confidence interval) decreased from 39.3 events/h (32.9, 45.7) to 12.2 events/h (6.7, 17.7) (P < .001), obstructive apnea index decreased from 14.1 (11.2, 17.0) events/h to 1.0 (-1.5, 3.5) events/h (P < .001), and oxygen nadir increased from 79.9% (77.4, 82.5) to 88.2% (85.5, 90.8) (P < .001) between pre and start of treatment. Respiratory improvements were sustained during and after the treatment. All patients avoided mandibular distraction osteogenesis or tracheostomy following SOAP. As being a rare diagnosis, the number of participants was, as expected, low. However, the current study shows that SOAP can improve polysomnography parameters, demonstrating its potential utility before surgical interventions for neonates with Robin sequence and cleft palate experiencing severe respiratory distress. Choo H, Sidell DR, Kim J-W, Ahn H-W, Day HS, Sullivan SS. Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford orthodontic airway plate treatment. J Clin Sleep Med. 2024;20(11):1807-1817.

Altered cerebral oxygen extraction and metabolism in preterm neonates and the relationship to anemia: A noncontrast MRI study

AbstractObjectiveThe preterm brain is susceptible to structural injuries, which may be related to an imbalance between blood supply and oxygen metabolism. However, the effect of preterm birth on cerebral oxygen metabolism and its underlying mechanism have not been fully elucidated. The present study measured cerebral oxygen extraction and metabolism using noncontrast magnetic resonance imaging (MRI) methods in preterm neonates and examined its relationship with anemia of prematurity.MethodsFifty neonates with a gestational age of 28–42 weeks were enrolled. Cerebral oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) were measured with T2‐relaxation‐under‐spin‐tagging (TRUST) MRI, together with cerebral blood flow (CBF).ResultsWe showed that CBF (p = 0.00021) and CMRO2 (p &lt; 0.0001) increased with gestational age while OEF increased with postnatal age (p = 0.0013). Higher OEF was also associated with a higher Apgar score at birth (p = 0.039). Furthermore, hematocrit significantly mediates the increase of OEF with postnatal age (p &lt; 0.001). Structural equation modeling analysis suggested a bidirectional relationship between CBF and CMRO2; both contributed to the changes in OEF.InterpretationThese findings demonstrated an altered cerebral oxygen metabolism in preterm brain, suggesting a potential role of MRI–based oxygenation measurement in the assessment of transfusion and intervention for preterm neonates.

72 Hospital level of service, rural-urban hospital location, and neonatal resuscitation interventions at birth: A population-based study in Alberta, Canada from 2000-2020

Abstract Background Advanced neonatal resuscitation interventions (ANRIs: endotracheal intubation, chest compressions, and epinephrine) are rarely needed for infants born at ≥34 weeks gestational age (GA). However, healthcare providers (HCPs) in community hospitals can encounter the need for ANRIs, while having less experience and resources than HCPs in centers with neonatal intensive care units (NICUs). Understanding practice differences between hospitals of different levels of service (LofS) and rural/urban location can inform quality improvement to reduce health disparities. Objectives To examine how hospital level of service and rural/urban location relate to ANRI rates in Alberta, Canada, a universal public health system with standardized Neonatal Resuscitation Program (NRP) training. Design/Methods All live births ≥34 weeks GA in Alberta from 2000-2020 inclusive were examined using retrospective, population-level administrative data from the Alberta Perinatal Health Program (APHP). Hospitals (n=97) were contacted to determine annual LofS during the study period, with levels (0,1A/B/C,2,3) based on provincial obstetrical triage for availability of delivery support, cesarean-sections, obstetricians, paediatricians/neonatologists, and NICUs. Hospitals were further subcategorized by population and proximity to metropolitan centers.(Table 1) Rates of individual interventions or any ANRI were compared. Results There were 971,403 live births during the study period with a mean GA of 38.9 weeks; 1.6% were missing ANRI data, 955,835 births were included. Most occurred in hospitals with level 2 (57.4%) or level 3 (21.8%) NICUs; few occurred at sites with no delivery support (Level 0, 0.1%). ANRI rates were intubation (0.8%), chest compression (0.2%), and epinephrine (0.02%), any ANRI (0.96%, ~1/1000 live births). However, chest compression rates progressively decrease, and intubation rates progressively increase as LofS increases.(Table 1, Figure 1) When considering rural/urban location, there were outliers in chest compression rates in remote 0 (25.4/1000 live births) and metro-influenced 1A (30.2/1000 live births), intubation in remote 1C (33.3/1000 live births) and metro 0 (193.5/1000 live births) and epinephrine in metro 0 (64.5/1000 live births). Conclusion In this population-based cohort study of ≥34 weeks births, there were higher chest compressions rates and lower intubations rates at hospitals without NICUs despite standardized training. Reasons for this difference require further investigation; potential solutions such as targeted outreach education and introduction of laryngeal mask airways could be explored.

77 Antenatal MgS04 in very preterm babies is not related to improved 36 month neurodevelopmental outcomes once accounting for neonatal interventions

Abstract Background Magnesium Sulphate (MgSO4) has become a standard practice for fetal neuroprotection prior to delivery of very-preterm babies due to an association with MgSO4 and reduction of cerebral palsy at 2 years of age in randomized clinical trials. Objectives In a prospective cohort of very preterm babies, we aimed to define the association between antenatal MgSO4 administration and neurodevelopmental outcome. Design/Methods We included a prospective cohort of 265 infants born ≤ 32 weeks’ gestation recruited at three tertiary neonatal intensive care units (NICU). Infants underwent two brain MRIs, one in the initial weeks after birth and one at term-equivalent age. Neurodevelopmental follow-up assessments were completed using the Bayley-3 at 3 years. Univariate analysis was undertaken to determine whether MgSO4 was associated with outcome. Multiple maternal and neonatal factors were analyzed according to their relationship with outcome. Gestational age was accounted for in all models. Maternal factors associated with MgSO4 administration were hypertension, multiple births and antenatal corticosteroid administration. Neonatal factors were sex, neonatal resuscitation, major surgery, and moderate-severe white matter injury (volume &amp;gt;40mm3). Multivariable linear regression models of maternal and neonatal risk factors were used to account for potential confounders based on those factors that were significantly (p&amp;lt;0.05) associated in univariate analysis. Results On univariate analysis, MgSO4 administration was inversely associated with 36-month motor scores (p&amp;lt;0.05). On the multivariable analysis, no maternal confounders had an impact on the relationship between MgSO4 and outcome (Table 2). MgS04 was no longer statistically related to any Bayley outcomes after adjusting for confounders at 36 months (Table 2). Neonatal surgery was related to poorer 36-month motor and cognitive outcomes. Conclusion Antenatal MgSO4 exposure was not associated with improved measures on the Bayley scales at 3 years after adjusting for potential confounders. However, neonatal interventions remained significant risk factors for poorer neurodevelopmental outcome.