An RCT (354 preemies) compared drying before plastic wrapping vs wet-in-bag at birth. Normothermia at NICU admission was similar (45.8% vs 46.3%; RR 0.99). Drying has no added benefit, and over half of infants were still outside the normal range. #Neosky #pedsky pubmed.ncbi.nlm.nih.gov/41774445/

An infant on PGE1 infusion developed severe ethanol toxicity. The low-strength formulation, though similar in ethanol concentration, delivers ~25× more ethanol per dose. Lesson: drugs aren’t interchangeable by active ingredient alone. #Neosky #pedsky pubmed.ncbi.nlm.nih.gov/41401022/

A new retrospective study shows MRI radiomics can accurately predict 18-month developmental outcomes in infants with HIE using only imaging data (R² ~0.87). Despite the objective neuroprognostication, the study still needs external validation. #Neosky #pedsky pubmed.ncbi.nlm.nih.gov/41692231/

In a cohort of 32,634 infants <32 weeks, DCC (≥30 s) was linked to a 24 g higher first-recorded weight, ~ 18 mL/kg extra blood (~21% more volume). Though observational, these data support meaningful placental transfusion in very preterm infants. #Neosky #pedsky pubmed.ncbi.nlm.nih.gov/41720473/

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

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.

A recent meta-analysis of 12 RCTs with 2,428 preterm infants of varying gestational ages, evaluated the effect of budesonide mixed with surfactant on the incidence of BPD. The verdict? Yes, But... pubmed.ncbi.nlm.nih.gov/40995944/ #Neosky

In any given condition, if you elect to treat only babies who are sicker than average and reassess them after treatment, an apparent improvement will almost certainly be observed, even if the treatment has no real effect. Why? To read more, please visit: whatsapp.com/channel/0029... #Neosky

Neonatal World A place to explore the issues that matter most to newborns, their families, and those who care for them. Please visit: whatsapp.com/channel/0029... #Neosky