@kaltirkawi.bsky.social
Early prophylactic paracetamol for PDA in extremely preterm infants (RCT, n=778) increased ductal closure at day 7 (71% vs 52%) but did NOT improve survival without severe morbidity at 36w PMA (66% vs 64%).
Routine prophylaxis?
Not supported.
#Neosky #pedsky
jamanetwork.com/journals/jam...
A recent study reviewed 148 systematic reviews of RCTs.
These interventions reduce severe IVH significantly
• Antenatal steroid
• MgSO4 for preterm birth
• Volume-targeted ventilation
• Early surfactant via LISA
• Prophylactic indomethacin
#neosky #pedsky
pubmed.ncbi.nlm.nih.gov/41642734/
A new study suggests that >50%of preterm birth in GDM is preventable.
Smoking, depression, and obesity mattered in all pregnancies, while age, inactivity, and poor sleep raised PTB risk in GDM only —arguing for risk-stratified prenatal care.
#Neosky #pedsky
www.frontiersin.org/journals/ped...
Echo in 50 newborns shows the LV rarely lies under the lower third of the sternum. Current NRP chest compressions likely hit the RV/great vessels, not the LV, suggesting compression site or technique may need reconsideration to improve effectiveness.
#Neosky #pedsky
fn.bmj.com/content/earl...
Oral vitamin K for VKDB prevention—how effective?
In a Swiss cohort of 505,708 births, 9 VKDB cases occurred, all were breastfed and with risk factors such as cholestasis. However, IM vitamin K administration remains the most reliable option.
#Neosky #pedsky
pubmed.ncbi.nlm.nih.gov/41545738/
Funded by a CDC grant, a trial in Guinea-Bissau randomize newborns to either receive or be denied the hepatitis B birth dose—despite the fact that this vaccine is protective and is recommended by WHO.
"Is this another Tuskegee?"
#Neosky #pedsky
insidemedicine.substack.com/p/scoop-the-...
Antenatal steroids and CP.
A study of more than 20K preterm births (32–36 wks), used a regression discontinuity design at the 34-week cutoff, found no difference in CP risk just before vs after 34 weeks (RR 0.98; 95% CI 0.50–1.98).
#Neosky #pedsky
www.jpeds.com/article/S002...
In a meta-analysis including more than 20,000 preterm infants, iNO use was linked to mild reduction in BPD, mortality (only in RCTs), higher ROP (but not the severe disease), and no significant effects on brain injury, IVH, or NEC.
#Neosky #pedsky
link.springer.com/article/10.1...
In a cohort of very preterm infants, n = 713, exposure to sedation was associated with an increased risk of BPD or death (aOR, 5.32; 95% CI, 3.15–8.98; p < 0.001), but not with adverse neurodevelopmental outcomes at 18 months of corrected age.
#Neosky #pedsky
www.frontiersin.org/journals/med...
#Neosky #pedsky
Have you ever wondered why the certainty of evidence is frequently downgraded in neonatal Cochrane reviews?
Here is the answer.
Imprecision and risk of bias were the most common reasons for downgrading the certainty of evidence
pubmed.ncbi.nlm.nih.gov/41379741/
The NeoVitaA study evaluated the long-term effects of early high-dose enteral vitamin A supplementation in ELBW infants. At 24 months, no benefit was observed for pulmonary infections or neurodevelopmental outcomes. A disappointing result.
#Neosky #pedsky
www.thelancet.com/journals/ecl...
Not all monitors are created equal.
In NICUs, we make critical decisions based on numbers — SpO₂, HR, etc. — assuming our tools are equally accurate. A new study found significant performance gaps between two commonly used pulse-ox systems.
#Neosky #pedsky
www.nature.com/articles/s41...
A study of 15,102 infants (23–28 weeks GA) found that each 1-week delay in reaching full enteral feeds (≥120 mL/kg/day) was linked to:
+16% risk of sepsis (ARR 1.16)
Higher NEC risk (ARR 1.20)
More growth faltering in weight, length, and HC.
#Neosky #pedsky
jamanetwork.com/journals/jam...
#Neosky #pedsky
this study produced a model that can safely reduce ROP screens. Trained on >100k infants and validated on >25k, the model has AUROC 0.916. With 100% sensitivity, NPV was 99.9% and screens dropped 12%. A good tool to improve risk-stratification.
pubmed.ncbi.nlm.nih.gov/41252350/
A pilot study evaluated whether hyperglycemia and HbA1c levels can predict severe ROP. It found that a 30-day mean glucose of ~ 5.2 mmol/L with HbA1c of 5.6% predicted severe ROP with a 94% PPV. Another step toward improving ROP prevention.
#Neosky #pedsky
www.frontiersin.org/journals/ped...
3/3
#Neosky #pedsky
Why it matters:
Vaginal birth may provide cues that jump-start immune & stress pathways.
C-section infants might miss this activation window, possibly contributing to slightly higher rates of asthma/allergies.
pubmed.ncbi.nlm.nih.gov/41220118/
2/3
#Neosky #pedsky
Key findings:
- 95 genes were more active in the vaginal-birth group
- IL-6 and IL-8 were also higher
Suggesting vaginal birth “activates” the newborn immune system.
After correction, effects weren’t significant—likely due to small sample size. Think trend, not conclusion
1/3
#Neosky #pedsky
Does the mode of delivery program a newborn’s immune system?
A new study from Finland suggests yes—possibly.
The study compared babies born vaginally vs. via elective C-section and examined genes tied to immune & stress responses
Accurate assessment of heart rate is critical for decision-making in the delivery room. However, the opimsl method for assessing HR in this setting is uncertain. A recent meta-analysis found that the quality of available evidence is low to very low.
www.sciencedirect.com/science/arti...
3/3
Takeaway
Automated O₂ control improved oxygen stability and reduced key complications in preterm infants; BPD and oxygen dependency.
Larger trials are needed before routine clinical adoption.
#Neosky #Pedsky
fn.bmj.com/content/earl...
2/3
Infants managed with CLAC had:
• Shorter ventilation (11 vs. 40 days, p=0.02)
• Less time on O₂ (33 vs. 47 days, p=0.03)
• Lower rates of BPD (55% vs. 84%, p=0.02)
• Fewer required home O₂ (27% vs. 51%, p=0.02)
CLAC reduced hypo- or hypoxemia episodes (p<0.001).
#Neosky #Pedsky
1/3
A new RCT tested closed-loop automated oxygen control (CLAC) vs. manual oxygen adjustment in preterm ventilated infants, aiming to compare how long infants stayed on mechanical ventilation.
N= 69 infants (median GA 27 wks) were randomized within 48 hours of ventilation start
#Neosky #Pedsky
2/2
Among overlapping SRs, 21% reached conflicting conclusions and 69% disagreed on evidence certainty.
Takeaway:
redundant, low-quality SRs waste resources and mislead clinicians. Every new SR should justify its purpose and follow rigorous methods.
#Neosky #pedsky
www.jclinepi.com/article/S089...
1/2
A new study exposes big problems in systematic reviews (SRs). Among 107 recently published SRs, 1/3 overlapped on the same topics. Yet only 6.5% met key quality standards (protocols, full searches, double screening, GRADE, etc.).
#Neosky #pedsky
3/3
Takeaway:
Early rapid genome sequencing not only finds more answers—it saves major costs for the sickest infants.
Researchers call for expanded reimbursement to make early rGS standard care.
#Neosky #pedsky
pubmed.ncbi.nlm.nih.gov/41177396
2/3
Results:
- rGS diagnosed more infants (49% vs 27%)
- Higher upfront cost ($12.3K vs $2.4K)
BUT… over 1 year, early rGS saved an estimated $158K per patient in total healthcare costs
#Neosky #pedsky
1/3
New study (GEMINI) compares two ways to diagnose genetic disorders in critically ill infants:
1- Early rapid genome sequencing (rGS) for all
2- Targeted neonatal sequencing (NewbornDx) + later rGS if needed
Goal: find which approach saves more & helps faster.
#Neosky #pedsky
Constructive feedback
09.11.2025 14:56 — 👍 0 🔁 0 💬 0 📌 0
2/2
#pedsky
#Neosky
Although PA was "more" common in this age group, it was not a key driver of outcomes; no significant association with mortality, IVH, or NDIs.
pubmed.ncbi.nlm.nih.gov/41150609/
1/2
#pedsky
#Neosky
In a Dutch cohort study of 138 extremely preterm infants given active care, perinatal asphyxia (PA, per ACOG) was seen in ~5%.
Researchers looked at mortality, IVH, and 2-year neurodevelopment.
