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

Objective:  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.

Study Design:  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.

A model for teaching radiology to clinical specialty trainees: A pilot study in pediatric neuroradiology and neonatology.

This article describes the development and assessment of a neuroimaging curriculum for neonatology fellows. The curriculum is focused on topics that are relevant to the practice of neonatology and employs contemporary teaching methods, such as flipped classroom, learner engagement, and spaced repetition. Since its implementation 2018 the curriculum has been appreciated by our trainees and demonstrated improvements in trainee knowledge.

Reducing the percentage of surviving infants with acute symptomatic seizures discharged on anti-seizure medication.

Objective: To evaluate the impact of inclusion of an anti-seizure medication (ASM) weaning protocol in a neonatal seizure pathway on the percent of infants discharged on ASMs.

Study Design: This cohort study included surviving infants with acute symptomatic seizures treated with ASMs across three institutions. We evaluated infants in 2 epochs, pre- and post-implementation of the ASM weaning protocol.

Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study.

Objective: To (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH).

Design: Cohort study of the Children's Hospitals Neonatal Database from 2010 to 2022.

Setting: 41 referral neonatal intensive care units (NICUs) in North America.

The Current State of Neonatal Neurodevelopmental Follow-up Programs in North America: A Children's Hospitals Neonatal Consortium Report.

Objective:  This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers.

Study Design:  This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC).

Results:  Survey response rate was 76%, and 97% of respondents had a formal NDFU program.

Evaluation of heterogeneity in effect of therapeutic hypothermia by sex among infants with neonatal encephalopathy.

Background: Our objective was to examine heterogeneity in the effect of therapeutic hypothermia by sex in infants with moderate or severe neonatal encephalopathy.

Methods: We conducted a post hoc analysis of the Induced Hypothermia trial, which included infants born at gestational ages ≥36 weeks, admitted at ≤6 postnatal hours with evidence of severe acidosis or perinatal complications and moderate or severe neonatal encephalopathy. Multivariate modified Poisson regression models were used to compare the treatment effect of whole-body hypothermia versus control, with an evaluation of interaction by sex, on the primary outcome of death or moderate or severe disability at 18-22 months of corrected age.

Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy: an observational study.

Objectives: To assess variability in continuation of antiseizure medication (ASM) at discharge and to evaluate if continuation of ASM at discharge is associated with death or disability among infants with hypoxic-ischaemic encephalopathy (HIE) and seizures.

Design: Retrospective study of infants enrolled in three National Institute of Child Health and Human Development Neonatal Research Network Trials of therapeutic hypothermia.

Setting: 22 US centres.

Association between anti-seizure medication and outcomes in infants.

Objective: To compare treatment failure between: (1) infants treated with phenobarbital versus levetiracetam for first-line treatment and (2) infants treated with phenytoin versus levetiracetam for second-line treatment following phenobarbital.

Study Design: This retrospective cohort study included infants with seizures receiving phenobarbital or levetiracetam as the initial anti-seizure medication. Treatment failure was defined as the need for additional anti-seizure medication within 24-72 h and compared using mixed-effect logistic regression after adjustment for confounding factors, including center.

Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus.

Objective: This study aimed to determine clinical care practices for infants at risk for posthemorrhagic hydrocephalus (PHH) across level IV neonatal intensive care units (NICUs).

Study Design: Cross-sectional survey that addressed center-specific surveillance, neurosurgical intervention, and follow-up practices within the Children's Hospitals Neonatal Consortium.

Results: We had a 59% (20/34 sites) response rate, with 10 sites having at least two participants.

Association of Infection in Neonates and Long-Term Neurodevelopmental Outcome.

Perinatal and neonatal infection and associated inflammatory response may adversely affect brain development and lead to neurodevelopmental impairment. Factors that predict the risk of infection and subsequent adverse outcomes have been identified but substantial gaps remain in identifying mechanisms and interventions that can alter outcomes. This article describes the current epidemiology of neonatal sepsis, the pathogenesis of brain injury with sepsis, and the reported long-term neurodevelopment outcomes among survivors.

Inotrope Needs in Neonates Requiring Extracorporeal Membrane Oxygenation for Respiratory Failure.

Objective: To evaluate how inotropic requirements in neonates with respiratory failure are affected by extracorporeal membrane oxygenation (ECMO) mode and whether high requirements predict mortality.

Study Design: This retrospective chart review included all neonates undergoing ECMO for primary respiratory failure from 2010 to 2016 at a single institution. The vasoactive inotropy score (VIS) was calculated as described in the literature.

Neuroimaging for Neurodevelopmental Prognostication in High-Risk Neonates.

Predicting neurodevelopmental outcomes in high-risk neonates remains challenging despite advances in neonatal care. Early and accurate characterization of infants at risk for neurodevelopmental delays is necessary to best identify those who may benefit from existing early interventions and novel therapies that become available. Although neuroimaging is a promising biomarker in the prediction of neurodevelopmental outcomes in high-risk infants, it requires additional resources and expertise.

Perinatal Care of Infants with Congenital Birth Defects.

Prenatal diagnosis has changed perinatal medicine dramatically, allowing for additional fetal monitoring, referral and counseling, delivery planning, the option of fetal intervention, and targeted postnatal management. Teams participating in the delivery room care of infants with known anomalies should be knowledgeable about specific needs and expectations but also ready for unexpected complications. A small number of neonates will need rapid access to postnatal interventions, such as surgery, but most can be stabilized with appropriate neonatal care.

Evolution of Amplitude-Integrated Electroencephalogram as a Predictor of Outcome in Term Encephalopathic Neonates Receiving Therapeutic Hypothermia.

Objectives:  This study aims to evaluate the ability of (1) a novel amplitude-integrated electroencephalogram (aEEG) background evolution classification system; and (2) specific hour of life (HOL) cut points when observation of aEEG normalization and development of cycling can predict adverse neurological outcomes in infants with hypoxic-ischemic encephalopathy (HIE).

Study Design:  Continuous aEEG data of term neonates with HIE were reviewed for background pattern and aEEG cycling from start of monitoring through rewarming. Infants were classified by overall background evolution pattern.

Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy.

Objective: To develop normative ranges for citrate-modified and heparinase-modified thromboelastography (TEG) in term neonates.

Design: Prospective observational study.

Setting: An outborn neonatal and cardiac intensive care unit in a free-standing academic children's hospital.

Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda.

Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda.