The Apgar score, the first clinical assessment to direct measures to stabilize newborn infants, is also used for risk assessment. Its accuracy in estimating outcomes remains poor among very preterm (VPT) infants. To assess the utility of the combined 5-minute Apgar score and umbilical artery pH (UA-pH) for estimating risks of mortality and severe neonatal morbidity among VPT infants. This cohort study (Effective Perinatal Intensive Care in Europe [EPICE]) analyzed infants born at less than 32 weeks' gestation between April 2011 and September 2012 across 11 European countries. All liveborn VPT infants with Apgar scores and UA-pH data were included. Data were analyzed between February and December 2025. Apgar score at 5 minutes and UA-pH. The Apgar score was classified as lower than 7 and 7 or higher, and the UA-pH values were categorized as low (<7.20) and normal (≥7.20). Four groups that combined these 2 measures were defined: Apgar score lower than 7 and low UA-pH; Apgar score lower than 7 and normal UA-pH; Apgar score 7 or higher and low UA-pH; and Apgar score 7 or higher and normal UA-pH. Combined outcome of mortality and/or any adverse morbidity (intraventricular hemorrhage [IVH] >grade 2, cystic periventricular leukomalacia, moderate or severe bronchopulmonary dysplasia [BPD], retinopathy of prematurity ≥stage 2, and necrotizing enterocolitis). Modified Poisson regression was used to estimate relative risks (RRs) between the exposure and the combined mortality and morbidity outcome and 3 individual components: mortality, IVH, and BPD. Models were adjusted for perinatal variables associated with Apgar score and UA-pH and adverse neonatal outcomes. Of 7900 liveborn infants in the EPICE cohort, 4174 (52.8%) had information on Apgar score and UA-pH. These infants included 2249 males (53.9%) and had a median [IQR] gestational age of 29.9 [27.9-31.0] weeks and median [IQR] birth weight of 1240 [960-1520] g. A total of 367 infants (8.8%) had an Apgar score 7 or higher but a low UA-pH, 558 (13.4%) had an Apgar score lower than 7 but a normal UA-pH, and 196 (4.7%) had an Apgar score lower than 7 and a low UA-pH. Infants with an Apgar score lower than 7 had a higher frequency of the combined outcome among those with a normal UA-pH (270 [48.4%] vs 596 [19.5%]) and a low UA-pH (108 [55.1%] vs 596 [19.5%]), with similar adjusted RRs (ARRs; low: 1.4 [95% CI, 1.2-1.7]; normal: 1.4 [95% CI, 1.3-1.6]). For mortality risk, associations were robust for an Apgar score lower than 7 and a low UA-pH (ARR, 2.4; 95% CI, 1.7-3.3) and absent with an Apgar score of 7 or higher and a low UA-pH (ARR, 1.2; 95% CI, 0.8-1.8). IVH risk was increased in all 3 subcategories, including an Apgar score of 7 or higher with a low UA-pH (ARR, 2.0; 95% CI, 1.3-3.0). BPD risk was associated only with an Apgar score lower than 7 and a normal UA-pH (ARR, 1.4; 95% CI, 1.2-1.7). In this cohort study of VPT infants, combining information on UA-pH with the 5-minute Apgar score was associated with improved accuracy in estimating the risk of some adverse outcomes-notably mortality and IVH, which occurred soon after birth. These results highlight the importance of exploring the associations of early markers of risk with neonatal mortality and key neonatal morbidities separately.

Structured clinical guidelines improve outcomes in neonatal care. At Oklahoma Children's Hospital, the need for a standardized approach to extremely low birth weight (ELBW) infants became urgent due to rising acuity and care variability. Despite existing nursing protocols, the unit lacked comprehensive interdisciplinary guidelines for ELBW infants. Key goals included reducing intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).Multidisciplinary teams developed eight clinical pathways using evidence-based models. The Appreciative Inquiry framework was used to engage staff and build consensus. The interdisciplinary workgroups conducted literature reviews, developed system-based protocols, and facilitated iterative revisions. Pathways were implemented and were supported by education, exposure, and saturation strategies. Key metrics were benchmarked using Vermont Oxford Network (VON) data, with IVH, BPD, and ROP as outcome measures and mortality as a balancing measure. Real-time data collection was used to drive further improvement. PDSA (plan, do, study, act) cycles targeted thermoregulation, line placement, early surfactant administration, and glucose and oxygen management.Post implementation data (n = 130) showed a reduction in severe IVH (from 25 to ∼20%), a 7% reduction in grade 2 and grade 3 BPD, consistently low ROP rates (<3%), and a downward mortality trend in 2023.ELBW pathways improved care standardization and outcomes without increasing mortality. Continued efforts beyond the first week of life are needed to sustain and expand improvements. · Multidisciplinary pathways improved standardization and care for ELBW infants.. · Pathways led to modest gains in BPD and IVH, guiding future quality improvement priorities.. · Education and teamwork drove adoption and sustainability without major resource needs..

Transcranial Photobiomodulation for Neuromodulation of Brain Disorders: A Perspective.

To conduct an overview of systematic reviews of RCTs assessing the effects of perinatal/neonatal interventions in reducing IVH among preterm infants. PUBMED, EMBASE, Cochrane database for systematic reviews, and systematic review repositories were searched for meta-analyses of RCTs involving preterm infants or women at high risk of preterm birth and reporting on IVH. Metaumbrella package of R software was used to pool outcome data for each intervention. Quality of the systematic reviews were assessed using AMSTAR 2 tool. Certainty of evidence (COE) was reported using GRADE recommendations. A total of 148 systematic reviews (110 Cochrane vs 38 non-Cochrane) were included. Postnatal interventions were reported in 118 reviews. Severe IVH was reported in 100/148 reviews that included 39483 infants and 20400 antenatal women. 78% (n=116) of the reviews were rated high or moderate quality on AMSTAR -2 assessment. Antenatal corticosteroids and magnesium sulphate for imminent preterm birth, volume targeted ventilation, early rescue surfactant administration through thin catheter, prophylactic indomethacin significantly reduced the rates of severe IVH (moderate COE). Use of respiratory function monitors and heated humidified respiratory gases in the delivery room and early prophylactic erythropoietin supplementation for preterm infants may reduce the rates of severe IVH (Very Low COE). Antenatal steroids and magnesium sulphate administration and early neonatal lung protective strategies reduce the rates of IVH in preterm neonates. Adequately powered RCTs evaluating IVH care bundles with long-term follow up are required.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) frequently causes neurocardiogenic injury, a serious complication characterized by troponin elevation, EKG abnormalities, and reduced left ventricular ejection fraction (LVEF). This cardiac dysfunction is thought to result from an excessive catecholamine release following the initial brain injury. While radiographic scoring systems like the modified Graeb score (measuring intraventricular hemorrhage) and the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) assess early brain injury, their specific ability to predict cardiac complications is not well established. This study tested whether these scores predict neurocardiogenic injury in aSAH. Methods: We conducted a retrospective analysis of 318 adults with aSAH from a prospectively maintained database (REACH, NCT04189471) at the University of Maryland Medical Center (Jan 2020 – Dec 2024). Admission non-contrast head CTs were scored with modified Graeb, SEBES, and SEBES-6c by raters blinded to outcomes. Markers of cardiac injury included the peak troponin level within the first 72 hours, LVEF on echocardiogram, and EKG abnormalities. The association between radiographic scores and cardiac outcomes was analyzed using partial ordinal logistic regression. Results: Higher admission modified Graeb scores showed a significant association with markers of neurocardiogenic injury, specifically troponin elevation (p = 0.0015). Troponin elevation was also significantly associated with the secondary outcome of reduced LVEF (p = 0.004). Patients with modified Graeb scores in the highest quartile (mGraeb &gt; 8) had a 7.0-fold higher odds of substantial troponin elevation (Ref: Troponin I &lt; 0.2) compared to those in the lowest quartile (mGraeb = 0) [95% CI: 2.6–20.7]. In contrast, the SEBES and SEBES-6c scores showed a trend toward correlation with troponin levels but did not reach statistical significance. These models accounted for established risk factors for poor outcomes after aSAH. Conclusion: Intraventricular hemorrhage extent, measured by modified Graeb, is a strong predictor of neurocardiogenic injury after aSAH, outperforming early brain-edema scores. Patients with large intraventricular hemorrhage warrant intensive cardiac monitoring. Utilizing modified Graeb at admission may help stratify high-risk patients and guide integrated neurocardiac care.

Umbilical cord management in extremely preterm infants born by cesarean delivery.

Background. Germinal matrix-intraventricular hemorrhage (GM-IVH) remains a major cause of morbidity and mortality in preterm infants, particularly in the first days of life. Objectives. The aim of this study was to describe the results of introducing the Neonatal Care Bundle (NCB) in the first 72 hours of life on the incidence of GM-IVH in preterm infants. Methods. A retrospective-observational cohort study of preterm infants with a gestational age <30 weeks and with birthweight <1500 g, before and after the implementation of the protocol, with historical control was conducted. The infants were divided into two groups. Group 1 included infants that received standard neonatal care, and Group 2 included infants that received the NCB. The NCB protocol includes keeping the infant in the midline head position, elevating the head of the incubator to 30°, and avoiding a head lowering position, sudden raising of the legs, or sudden position changes for the first 72 hours. Results. In total, 186 preterm infants were enrolled. The frequency of any grade of GM-IVH and severe IVH were statistically significantly lower in NCB group (p <0.05). In the subgroup analyses of the patients according to birth weight, the rate of GM-IVH was seen to decrease from 41% to 24% in preterm infants <1000 g after NCB. Conclusion. This study adds to the limited literature suggesting that rates of GM-IVH may decrease with increased awareness, standardization, and careful neonatal care during the first 72 hours, the period when preterm infants are at the highest risk.

Perinatal and maternal morbidity in the setting of preterm birth may differ by delivery indication. We compared perinatal and maternal outcomes of second trimester (24 0/7 - 27 6/7 weeks' gestation) deliveries indicated for preeclampsia with severe features (PE-SF) with those following preterm premature rupture of membranes (PPROM). Secondary analysis of an observational cohort study of singleton and twin preterm deliveries before 35 weeks' gestation at 33 hospitals across the United States. Singletons without congenital anomalies who were delivered due to PE-SF or PPROM from 24 0/7 - 27 6/7 weeks gestation were included. The primary outcome was a composite of perinatal morbidity or death, defined as fetal or neonatal death, severe bronchopulmonary dysplasia grade III, intraventricular hemorrhage grade III-IV, necrotizing enterocolitis stage IIA or greater, periventricular leukomalacia, retinopathy of prematurity stage III-IV, or culture-proven sepsis. Secondary outcomes included components of the primary outcome, small-for-gestational-age (SGA) birth, and a composite of maternal morbidity. Among 7515 in the original cohort, 164 deliveries for PE-SF and 119 deliveries following PPROM were included. Individuals with PE-SF were more likely to have BMI ≥ 30 kg/m2, hypertensive disorder of pregnancy in a prior pregnancy, chronic hypertension, and cesarean birth (p <0.05) compared with those who delivered following PPROM. Composite perinatal morbidity or death did not differ between groups (aOR 1.60, 95% CI 0.89, 2.85, p=0.11), but fetal death was significantly higher in the PE-SF group (aOR 6.04, 95% CI 1.42, 25.71). Neonates delivered for PE-SF were more likely to be SGA (aOR 13.45, 95% CI 2.92, 61.94). Composite maternal morbidity did not differ between groups (aOR 1.18, 95% CI 0.62, 2.26). Second-trimester preterm birth indicated for PE-SF was associated with a higher rate of fetal death than birth for PPROM. Composite neonatal and maternal morbidity did not differ by indication.

Haemorrhagic stroke is a devastating condition characterized by vessel rupture and free blood within the brain parenchyma or cerebrospinal fluid (CSF) filled spaces. Across the major subtypes of hemorrhagic stroke (subarachnoid, intracerebral, and intraventricular hemorrhages), the presence of blood in the CSF generates significant tissue damage in the first 72 h after the event, known as early brain injury (EBI). EBI includes neuroinflammation, blood-brain barrier breakdown and dysregulation of extracellular matrix (ECM) dynamics. ECM dysfunction has been shown to trigger fibrosis of the cortical blood vessels, limiting normal CSF circulation and resulting in the buildup of metabolic waste or the development of post-hemorrhagic hydrocephalus. Limiting or preventing this fibrosis may therefore reduce the rate of morbidity experienced by survivors, providing a potential avenue for non-surgical treatment to reduce secondary brain injury post-stroke. Despite this, current in vivo approaches fail to differentiate between the effect of blood products and secondary consequences including intracranial pressure (ICP) elevation and mass effect. Here, we describe an adult rat organotypic brain slice culture (OBSC) model of hemorrhagic stroke which enables the identification of the effect of blood products on ECM dysregulation. We demonstrate the distribution of key cell types across a time course of 0, 3 and 7 days in culture, indicating that such cultures are viable for a minimum of 7 days. Using immunofluorescence staining, Western blotting and RNA sequencing, we show that exposure of OBSCs to lysed blood markedly increases ECM deposition around cortical blood vessels. This is accompanied by dysregulation of ECM regulatory genes and upregulation of inflammation and oxidative stress-related genes, successfully recapitulating the changes seen in human stroke survivors. This versatile ex vivo model provides a translational platform to further understanding of hemorrhagic stroke pathophysiology and develop or trial novel therapeutics prior to progression to in vivo stroke studies.

The brain-derived neurotrophic factor (BDNF) plays a crucial role in neuroprotection, and we have previously demonstrated BDNF-mediated neuroprotective effects in mesenchymal stromal cells (MSCs). The present study aimed to investigate whether BDNF-overexpressing MSCs enhance the therapeutic efficacy of naïve MSCs in a preclinical model of severe neonatal intraventricular hemorrhage (IVH). We exposed primary rat neuronal cells to 40 U of thrombin overnight in vitro. Subsequently, the neuronal cells were co-cultured with either naïve MSCs or BDNF-overexpressing MSCs (1×105 cells in 1 mL media) for 24 hours. Next, 300 μL of maternal blood was injected into bilateral ventricles on postnatal day (P)4 to induce severe IVH in newborn Sprague-Dawley male rats. At P6, either naïve MSCs or BDNF-overexpressing MSCs (1×105 cells in 10 μL saline) were transplanted intraventricularly. Behavioral function tests, including passive avoidance, followed by endpoint analyses of brain tissue and cerebrospinal fluid were performed at P35. BDNF-overexpressing MSCs enhanced the effects of naïve MSCs against cell death, cytotoxicity, and oxidative stress in vitro. Notably, naïve and BDNF-overexpressing MSCs did not attenuate post-hemorrhagic ventricular dilatation, neuronal cell death, or gliosis. However, BDNF-overexpressing MSCs attenuated microglial activation. Furthermore, inflammatory cytokine (interleukin [IL]-1α, IL-1β, IL-6, and tumor necrosis factor-α) levels and memory function assessed using a passive avoidance test significantly improved in the BDNF-overexpressing MSC transplanted group compared with the naïve MSC transplanted group. Our data suggest that BDNF-overexpressing MSCs may offer superior protective effects to naïve MSCs in a neonatal IVH model.

To develop an organizational framework that examines the individual contributions of modifiable clinical interventions and non-modifiable physiologic variables on the fluctuating rate of intraventricular hemorrhage (grades 3/4) or death<4 days over time. We developed the Frequency-Adjusted-Risk-difference-versus-OUTcome (FAR-Out) approach to examine risk-differences and risk-frequencies during defined study epochs. We used FAR-Out to study changes in sIVH/death<4 d rates after implementing a set of improved-practice guidelines in a preterm population (230/7-276/7 weeks, n = 537). Epoch-to-epoch variations in FAR-Out Risk Scores track closely (Pearson's r = 0.974) with epoch-to-epoch variations in sIVH/death<4 d rates. Post-implementation changes in sIVH/death <4 d rates were mostly associated with fluctuations in individual non-modifiable risks (immaturity/illness severity) rather than with changes in adherence to the guidelines' modifiable practices. Close correlation between FAR-Out Risk Scores and sIVH/death < 4 d rates supports the FAR-Out approach's potential usefulness in examining the relative influence of individual risk factors on the incidence of sIVH/death <4 d.

We report the case of a 67-year-old Saudi man with multiple comorbidities, including type 2 diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease, who presented with progressive shortness of breath, altered mental status, and fever. His symptoms began five days prior with productive cough, pleuritic chest discomfort, and generalized body aches, initially managed at home. On presentation, he was hypotensive, tachycardic, hypoxemic, and disoriented, with signs of respiratory distress and new ecchymoses. Laboratory evaluation revealed leukocytosis, elevated inflammatory markers, acute kidney injury, and coagulopathy. Chest radiography demonstrated new bilateral multifocal pneumonic patches compared with prior baseline imaging. Blood cultures grew Streptococcus pneumoniae, confirming pneumococcal sepsis. During intensive care unit admission, he developed gross hematuria, progressive thrombocytopenia, prolonged coagulation times, and evidence of disseminated intravascular coagulation. Acute neurological deterioration prompted urgent CT imaging, which revealed extensive intraventricular hemorrhage with early hydrocephalus. Despite aggressive supportive care, including hemodynamic stabilization, transfusions, renal replacement therapy, and tailored antibiotics, the patient developed refractory shock and multiorgan failure. After multidisciplinary discussion and family consultation, care was transitioned to comfort measures, and he subsequently died. This case illustrates the fulminant and often fatal nature of pneumococcal sepsis complicated by disseminated intravascular coagulation and intracranial hemorrhage, emphasizing the need for early recognition, close monitoring, and multidisciplinary management in high-risk patients.

Objectives . The PedsQL Infant Scales parental questionnaire has been developed to assess the health-related quality of life in premature infants. The questionnaire was translated into Russian, but the properties (reliability and validity) of the adapted version remained unexplored. Objective . The aim of the study is to evaluate the reliability and validity of the Russian — language version of the PedsQL Infant Scales parental questionnaire in assessing HRQL in premature infants aged 13–24 months. Methods . The study included parents of children aged 13–24 months who were born prematurely and were treated during the neonatal period in the intensive care unit (ICU). The Russian-language version of the PedsQL Infant Scales parental questionnaire was used to assess physical activity, physical symptoms, emotional state, social, cognitive activity and to obtain an overall assessment of the HRQL of premature infants. The internal consistency of the questionnaire (reliability) was assessed using the Cronbach’s alpha coefficient, Spearman-Brown coefficients, and Guttman split-half. To verify the construct validity and compliance of the questionnaire with the theoretical five-factor structure, a confirmatory factor analysis was done. Factor loads and model compliance indices were evaluated: CFI (Comparative Fit Index), TLI (Tucker – Lewis Index), SRMR (Standardized Root Mean Squared Residual) and relative χ 2 table (χ 2 /df). Results . The results of a survey of parents (mothers) of 91 premature infants (gestational age 32.0 (29.5; 34.0) weeks) aged 16 (15; 19) months were analyzed. The duration of ICU hospitalization was 7 (4; 10) bed days, the duration of invasive mechanical ventilation (IMV) was 168 (120; 234) hours. The coefficient of internal consistency of the Cronbach’s alpha coefficient for the entire questionnaire was 0.832, Spearman – Brown — 0.803, and Guttman split-half — 0.797. The relative 2 table is 2.1, CFI is 0.81, TLI is 0.799, and SRMR is 0.049. The overall assessment of HRQL was 77.6 (67.8; 84.3) points, the highest values were marked on the scale of “Physical Symptoms” — 87.5 (80.0; 92.5) points, the lowest — “Emotional Functioning”, 70.8 (60.4; 78.1) points, and “Cognitive Functioning”, 66.7 (55.6; 83.3) points. The overall PedsQL Infant Scales score was not related to gestational age (p = 0.224), duration of ICU hospitalization (p = 0.071), and duration of IMV (p = 0.670), but was lower in children who had suffered intraventricular hemorrhage with IMV. Conclusion . Satisfactory reliability and constructive validity of the Russian-language version of the PedsQL Infant Scales parental questionnaire have been established. Considering the limits of the study (selection error, remote survey, small sample size), further linguistic and cultural validation of the questionnaire is recommended.

Use of an irrigating external intracranial drainage system has been an active and promising area of investigation in adult patients with intraventricular hemorrhage, ventriculitis, and chronic subdural hematoma. The objective of this study was to report on the safety and feasibility of an irrigating external intracranial drainage system for use in children. Retrospective chart review was undertaken of the medical records of children who required an irrigating external intracranial drain (EID) at two children's hospitals for clearance of infection or blood from the ventricular system or extra-axial space. Irrigation parameters, CSF study results, adverse events during and after the course of irrigation, and ventricular peritoneal shunt outcomes up to 3 months postoperatively were assessed. Twelve patients younger than 18 years of age were treated between September 2023 and May 2025. Four patients were younger than 1 year of age (mean ± SD 4.72 ± 3.81 months), and 8 patients were between 4 and 18 years (mean 11.52 ± 4.33 years). Four patients required intracranial drainage for ventriculitis, 1 for intraventricular hemorrhage, 4 for postoperative clearance of blood following hemispherectomy or tumor resection, and 3 for subdural hematomas. The mean duration of irrigation was 6.45 ± 5.25 days. One patient had an adverse event during irrigation, which was a clinical seizure. Irrigation was stopped and the patient was treated with levetiracetam with no further seizures. This was the only patient who received irrigation using normal saline with vancomycin. All other patients received irrigation with lactated Ringer's solution without antibiotics. Seven patients had a ventriculoperitoneal shunt after treatment-5 of whom had a shunt on presentation-of which 2 required revisions for valve replacement within 3 months. All patients with ventricular pathology had stable ventricular configuration on follow-up imaging. The use of an irrigating EID has potential utility for clearance of intracranial purulence and blood products in children. This is the first published series to delineate the safety and feasibility of this system in a group of children, 4 of whom were infants younger than 1 year of age.

Penetrating brain injuries (PBIs) involving the sella region are rare, anatomically complex, and associated with high morbidity due to the proximity of critical neurovascular structures. Herein, the authors introduce a novel trajectory-based classification system derived from wartime injuries sustained during the conflict in Ukraine, aiming to improve the diagnostic framework, guide management strategies, and support prognostication in this unique population. The authors conducted a retrospective analysis of all PBIs involving an anatomically defined critically important sellar injury zone (CRISIZ) treated at a tertiary care center over a 2.5-year period (February 2022-August 2024). Injuries were classified into 2 main categories based on projectile trajectory to the CRISIZ: transbasal (TB) and transcortical (TC). Each category was further subdivided into 4 anatomical subtypes. Clinical presentation, imaging characteristics, complications, treatment modalities, and outcomes were compared across subgroups. The primary outcome was the Glasgow Outcome Scale (GOS) score at 6 months. A total of 29 patients with PBIs involving the CRISIZ were identified (mean patient age 38 years). TB injuries were more common than TC by a factor of 1.6 (18 vs 11; 62.1% vs 37.9%). TB subtypes included transnasal, transorbital, transmaxillary, and infratemporal trajectories; TC subtypes included transfrontal, transtemporal, transventricular, and transoccipital. TB injuries had a higher prevalence of multiple projectile fragments (88.9% vs 45.5%, p < 0.05) and CSF rhinorrhea (66.7% vs 18.2%, p < 0.05). TC injuries were associated with significantly higher rates of intracranial vascular injury (81.8% vs 22.2%, p < 0.01), subarachnoid hemorrhage, intraventricular hemorrhage, and coma on admission (54.5% vs 11.1%, p < 0.05). Overall, in-hospital mortality was 10.3%, and 75.9% of patients achieved favorable outcomes (GOS scores > 3) at 6 months. Projectile trajectory is a critical determinant of injury pattern and clinical course in PBIs involving the CRISIZ. TC injuries are associated with a higher incidence of neurovascular complications, while TB injuries more commonly involve CSF leaks. Early identification and management of these complications are critical for optimizing outcomes. The proposed classification scheme provides a practical framework to guide evaluation and management in this high-risk patient population.

Introduction . Early noninvasive assessment of brain changes in newborns is a significant challenge in pediatrics. This article presents an approach to noninvasive assessment of brain changes in newborns using radiomics analysis of ultrasound images. Radiomics analysis allows characterization of the morphological structure of neurosonographic ultrasound images using a set of texture parameters and the identification of changes invisible to the naked eye. Aim: To investigate the feasibility of using radiomics analysis of ultrasound images to detect brain changes in diabetic fetopathy in newborns. Material and Methods . Data were collected from brain ultrasound images of 89 full-term neonates (gestational age greater than 37 weeks), including 45 (51%) healthy neonates (control group) and 44 (49%) with diabetic fetopathy (study group). Data were extracted using specialized projections to display four locations: Frontal lobe (F0 scan at the level of the anterior sections of both frontal lobes): 45 healthy and 37 patients. Parasagittal section in the choroid plexus area (S2 scan in the parasagittal plane): 41 healthy and 40 patients. Sagittal section in the corpus callosum area (S0 scan in the midsagittal plane): 44 healthy and 40 patients. Frontal section in the periventricular region (F4 scanning in the area of the parietal and temporal lobes, as well as the cerebellum): 45 healthy and 44 patients. Results . When conducting B-mode neurosonography, the same frequency of subependymal cysts and lateral ventricular dilation was observed in both groups (7% vs. 5%; p = 0.53), but intraventricular hemorrhages and periventricular edema were observed only in the main group (7% vs. 0%; p &lt; 0,05). As a result of radiomics analysis of ultrasound images of the brain, radiomics predictors of texture changes in newborns with diabetic fetopathy were established in four localizations. Classification models were built and ROC analysis was performed. The best results were shown by Model 1 for the frontal lobe (accuracy – 0.71, AUC = 0,69) and Model 4 for the periventricular region (accuracy – 0.89, AUC = 0,85). The established textural changes in the brain of newborns with diabetic fetopathy manifest as follows: an uneven, chaotic distribution of echogenicity with multiple hyperechoic areas is observed in the frontal lobe. The periventricular zone exhibits a marked, diffuse increase in echogenicity, creating a homogenized effect on the image. Radiomics analysis of ultrasound images can reveal changes in brain texture that are not detectable with standard neurosonography. Conclusions . Multiparametric analysis of ultrasound images using a radiomics approach demonstrated the ability to detect structural changes in the brain of newborns with diabetic fetopathy. The results confirm the effectiveness of radiomics analysis in identifying subtle neuroanatomical changes.

The neutrophil-to-lymphocyte ratio (NLR), as an inflammatory marker, has been shown to be associated with the prognosis of various cerebrovascular diseases. However, the specific non-linear relationship between NLR and the prognosis of spontaneous intraventricular hemorrhage (sIVH) remains unclear. This study aimed to investigate the non-linear association between NLR and poor outcomes in sIVH patients. This retrospective study analyzed data from Xiaoshan First People's Hospital, including all patients hospitalized for sIVH. Blood samples were collected immediately upon hospital admission to calculate NLR, and its relationship with 90-day functional outcomes (defined as poor prognosis with a modified Rankin Scale score ≥4) was evaluated. The analysis revealed a J-shaped relationship between NLR and poor outcomes in sIVH patients. As NLR levels increased, the risk of poor outcomes rose, reaching saturation at approximately 8.26. Specifically, when NLR was below 8.26, the odds ratio was 1.49 (95% CI: 1.16-1.91, p = 0.0018); when NLR was above 8.26, the odds ratio was 0.95 (95% CI: 0.84-1.07, p = 0.4194). Multivariate analysis indicated that NLR was an independent predictor of 90-day prognosis in sIVH patients. NLR can serve as an important indicator for assessing the prognosis of sIVH patients. The non-linear relationship between NLR and poor outcomes provides new insights for clinical management. Further studies should explore the mechanisms of NLR and its potential applications in sIVH treatment.

IntroductionExtremely premature infants (EPIs) are at significant risk for early mortality and severe intraventricular hemorrhage. This study aimed to investigate the risk factors associated with early mortality and severe intraventricular hemorrhage in EPIs with a gestational age of less than 28 weeks and to evaluate the predictive value of these risk factors in determining adverse outcomes.MethodsA retrospective analysis was conducted on clinical data from EPIs admitted to the Neonatal Intensive Care Unit at Maternal and Child Health Hospital of Hubei Province between January 2019 and December 2024. Infants were categorized into two groups based on their early outcomes: an adverse outcome group (n = 110) and a favorable outcome group (n = 183). Binary logistic regression analysis was used to identify high-risk factors for adverse outcomes in EPIs, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of these factors.ResultsThis study revealed that the maximum vasoactive-inotropic score (Max VIS) (OR: 1.136, 95% CI: 1.070, 1.216) and middle cerebral artery resistance index (MCA-RI) (OR: 450.489, 95%CI: 36.163, 5,611.780) and vaginal delivery (OR: 3.684, 95%CI: 2.005, 6.768) were independent risk factors for adverse outcomes in EPIs, while gestational age was a protective factor (OR: 0.568, 95% CI: 0.415, 0.778). ROC curve analysis indicated that Max VIS > 9.5, MCA-RI > 0.81, vaginal delivery, and small gestational age had predictive value for adverse outcomes in EPIs (P < 0.05), with area under the curves (AUC) of 0.680 (95% CI: 0.615, 0.745), 0.693 (95%CI: 0.628, 0.758), 0.653 (95% CI: 0.588, 0.718), and 0.660 (95% CI: 0.275, 0.404), respectively. The combination of all four factors yielded the highest predictive performance, with an AUC of 0.833 (95%CI: 0.783, 0.883), sensitivity of 72.7%, and specificity of 81.4%.ConclusionElevated Max VIS, increased MCA-RI, vaginal delivery, and small gestational age are independent risk factors for early mortality and severe intraventricular hemorrhage in EPIs. Each is a valuable predictor of adverse outcomes, and their combination demonstrates the highest predictive value, providing significant clinical reference for the early management of these high-risk neonates.

The study of altered brain structure in preterm infants with low grade intraventricular hemorrhage utilizing 3D T1WI whole brain MR images

CCR2 knockdown attenuates post-hemorrhagic hydrocephalus and improves glymphatic function after intraventricular hemorrhage.