Neonatology Staffing Practices: An In-Depth Exploration of Leaders' Perspectives.

Objective: To describe neonatology leaders' perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking.

Study Design: We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders.

Transpyloric feeding is associated with adverse in-hospital outcomes in infants with severe bronchopulmonary dysplasia.

Objective: To estimate the association of transpyloric feeding (TPF) with the composite outcome of tracheostomy or death for patients with severe bronchopulmonary dysplasia (sBPD).

Study Design: Retrospective multi-center cohort study of preterm infants <32 weeks with sBPD receiving enteral feedings. We compared infants who received TPF at 36, 44, or 50 weeks post-menstrual age to those who did not receive TPF at any of those timepoints.

Exploring the Association of Male Sex With Adverse Outcomes in Severe Bronchopulmonary Dysplasia: A Retrospective, Multicenter Cohort Study.

Background: Bronchopulmonary dysplasia (BPD) is a significant contributor to morbidity and death in infants who are born premature. Male sex is an independent risk factor for the development of BPD. However, whether male sex is associated with adverse outcomes that occur after formal diagnosis of severe BPD prior to hospital discharge remains unclear.

Academic neonatologist-a species at the brink of extinction?

Neonatology is a field that is currently facing many challenges. These challenges include outdated work models in clinical environments with increasing acuity and patient workloads, physician burnout exacerbated by gender inequity and the recent COVID-19 pandemic, and inappropriate metrics to measure clinical productivity. Academic neonatologists have additional missions that include research, teaching, and scholarly productivity in the setting of an increasing clinical workload and reduced time and support for teaching and research.

Atrial septal defect closure is associated with improved clinical status in patients ≤ 10 kg with bronchopulmonary dysplasia.

Patients with bronchopulmonary dysplasia (BPD) have shown clinical improvement after secundum atrial septal defect (ASD) closure. We sought to determine if this post-ASD closure improvement is secondary to the expected course in BPD patients or related to the closure itself. A novel BPD-ASD score was created to assess patients' clinical status (higher score = worse disease) and applied to 10 BPD-ASD inpatients weighing ≤ 10 kg who underwent ASD closure.

Bronchopulmonary dysplasia - associated pulmonary hypertension: An updated review.

Bronchopulmonary dysplasia (BPD) is the leading cause of chronic lung disease in infants and the commonest complication of prematurity. Advances in respiratory and overall neonatal care have increased the survival of extremely low gestational age newborns, leading to the continued high incidence of BPD. Pulmonary hypertension (PH) represents the severe form of the pulmonary vascular disease associated with BPD, and affects almost one-third of infants with moderate to severe BPD.

Impact of the COVID-19 pandemic on pediatric faculty: a report from nine academic institutions.

Background: The COVID-19 pandemic affected home and work routines, which may exacerbate existing academic professional disparities. Objectives were to describe the impact of the pandemic on pediatric faculty's work productivity, identify groups at risk for widening inequities, and explore mitigation strategies.

Methods: A cross-sectional study of faculty members was conducted at nine U.

Bronchopulmonary Dysplasia: Ongoing Challenges from Definitions to Clinical Care.

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme prematurity. Its etiology is multifactorial and is attributed to genetic susceptibility to prenatal and postnatal factors. As advancements in neonatology have led to the increased survival of premature infants, a parallel increase in the incidence of BPD has occurred.

Volume-guarantee vs. pressure-limited ventilation in evolving bronchopulmonary dysplasia.

Introduction: Extremely premature infants are at high risk for developing bronchopulmonary dysplasia (BPD). While noninvasive support is preferred, they may require ventilator support. Although volume-targeted ventilation (VTV) has been shown to be beneficial in preventing BPD, no data exists to guide ventilator management of infants with evolving BPD.

Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia.

Importance: Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities.

Vision 2020: How Caregiving and Work Productivity Outlook Shifted for Academic Pediatric Faculty.

The coronavirus disease 2019 (COVID-19) pandemic has affected both home and work routines and may have exacerbated existing inequities. The objectives of this study were to describe pediatric faculty work productivity and caregiving responsibilities during the pandemic, identify groups at risk, and better understand mitigation strategy preferences. We conducted a cross-sectional electronic survey of Department of Pediatric faculty.

Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia.

Objectives: To determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD.

Study Design: Observational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry.

Results: Five hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA.

The challenge of accurately describing the epidemiology of bronchopulmonary dysplasia (BPD) based on the various current definitions of BPD.

Despite marked improvements in the survival of extremely low birth weight preterm infants, bronchopulmonary dysplasia (BPD) remains a prevalent morbidity. BPD has evolved pathologically and epidemiologically but the definition has failed to keep up. The majority of the definitions of BPD still use the respiratory support provided to the infants at a single timepoint.

Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology.

Bronchopulmonary dysplasia (BPD) is a chronic lung disease of primarily premature infants that results from an imbalance between lung injury and repair in the developing lung. BPD is the most common respiratory morbidity in preterm infants, which affects nearly 10, 000 neonates each year in the United States. Over the last two decades, the incidence of BPD has largely been unchanged; however, the pathophysiology has changed with the substantial improvement in the respiratory management of extremely low birth weight (ELBW) infants.

Extracorporeal Membrane Oxygenation in Premature Infants With Congenital Diaphragmatic Hernia.

Prematurity and low birth weight have been exclusion criteria for extracorporeal membrane oxygenation (ECMO); however, these criteria are not evidence based. With advances in anticoagulation, improved technology, and surgical expertise, it is difficult to deny a potential therapy based on these criteria alone. We report the outcome of three neonates who were ineligible based on traditional criteria but were offered ECMO as a life-saving measure.

Evaluation of the Effects of Extracorporeal Membrane Oxygenation on Antiepileptic Drug Serum Concentrations in Pediatric Patients.

Objectives: Patients supported on extracorporeal membrane oxygenation (ECMO) have an increased incidence of seizures. Phenobarbital (PB) and fosphenytoin (fos-PHT) are common antiepileptic drugs (AEDs) used to manage seizures in the pediatric population; however, it is unknown what effect ECMO has on the serum concentrations of AEDs. The purpose of this study is to evaluate the effect of ECMO on AED serum concentrations.

Bleeding Complications and Mortality in Neonates Receiving Therapeutic Hypothermia and Extracorporeal Membrane Oxygenation.

Objective:  The objective of this study was to compare complications and mortality in neonates with hypoxic ischemic encephalopathy (HIE) on extracorporeal membrane oxygenation (ECMO) who did and did not receive therapeutic hypothermia (TH).

Study Design:  The Extracorporeal Life Support Organization registry was queried from 2005 to 2013 to identified infants with HIE. Infants ≤30 days of age with HIE on respiratory ECMO were included.

Structural and transcriptomic response to antenatal corticosteroids in an Erk3-null mouse model of respiratory distress.

Background: Neonatal respiratory distress syndrome in preterm infants is a leading cause of neonatal death. Pulmonary insufficiency-related infant mortality rates have improved with antenatal glucocorticoid treatment and neonatal surfactant replacement. However, the mechanism of glucocorticoid-promoted fetal lung maturation is not understood fully, despite decades of clinical use.

Point Prevalence, Clinical Characteristics, and Treatment Variation for Infants with Severe Bronchopulmonary Dysplasia.

Objectives: Despite improvements in survival of preterm infants, bronchopulmonary dysplasia (BPD) remains a persistent morbidity. The incidence, clinical course, and current management of severe BPD (sBPD) remain to be defined. To address these knowledge gaps, a multicenter collaborative was formed to improve outcomes in this population.

Administration of antenatal glucocorticoids and postnatal surfactant ameliorates respiratory distress syndrome-associated neonatal lethality in Erk3(-/-) mouse pups.

Background: Respiratory distress syndrome (RDS) persists as a prevalent cause of infant morbidity and mortality. We have previously demonstrated that deletion of Erk3 results in pulmonary immaturity and neonatal lethality. Using RNA sequencing, we identified corticotrophin releasing hormone (CRH) and surfactant protein B (SFTPB) as potential molecular mediators of Erk3-dependent lung maturation.