Managing Post-Haemorrhagic Hydrocephalus PHH, as I will call it, is an extremely important determinant of outcomes in a small subgroup of preterm infants. Infants with severe IVH who don't develop PHH have outcomes that are little affected. As our group reviewed, even grade 4 IVH, if unilateral,…

Give your opinion: what should we call the most immature babies? There is an upcoming workshop, sponsored by the AAP, and other groups, that is investigating what shared language should be used for the babies of less than 25 weeks gestation. At present there are not as many responses as they would…

Automated oxygen control; is it worth it? The history of automated controls of inspired oxygen goes back many decades, to before the invention of pulse oximetry. The first studies I remember used transcutaneous PO2 as the target variable, which had major limitations, as well as the advantage of…

Prophylactic acetaminophen in the preterm In a newly published trial (Roze JC, et al. Prophylactic Treatment of Patent Ductus Arteriosus With Acetaminophen: A Randomized Clinical Trial. JAMA Pediatr. 2026) nearly 800 infants of 23 to

Not just neonatology, trip to Rwanda I was very fortunate to be able to take a trip to Rwanda to participate in their neonatal training scheme, in what was termed a "respiratory bootcamp". Rwanda is a small country of 23000 km2, with a young population of over 14 million, and 400,000 births…

How much oxygen for the resuscitation of the preterm? I like a good acronym, so my initial response to the new TORPIDO trial was very positive! TORPIDO 30/60 was a large multicentre RCT comparing initial FiO2 concentrations for resuscitation of the preterm infant (Oei JL, et al. Targeted Oxygen…

Universal Neonatal Genome sequencing? It is over 2 years since I posted about this issue, in the meantime there have been a number of new initiatives, and several review articles and opinion pieces. Including a JAMA, "research of the year" article". I was triggered to return to this issue by a…

Why doesn’t closing the PDA help preterm infants? I have been continuing to think about this issue, so will subject you all to some of my thoughts. The large RCTs of medication for closure of the PDA show no benefit, and some evidence of harms, but we all know that the PDA usually closes shortly…

Should we ever close the PDA? The latest large multicentre RCT has just been published. Laughon MM, et al. Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants. JAMA. 2025. In this trial, infants of 22 to 28 weeks GA were randomized at between 48 hours and 21 days of…

Is this article trustworthy? There are many ways that an article in the medical literature may not be worthy of trust, and whose results may be unreliable. I remember one of my own trials, LACUNA, which was a pilot RCT of lactoferrin supplementation to prevent late-onset sepsis (LOS). As a pilot.…

Hope for HIE I was struck this morning by a new article in Pediatric Research a "Family Perspectives" written by the founder of the organisation that has the same name as the title of this post, "Hope for HIE", Betsy Pilon (Pilon B. Family reflections: what’s next for hypoxic-ischemic…

Longer term outcomes after cooling One of the numerous major advances in neonatology during my career has been the introduction of therapeutic hypothermia for infants with Hypoxic Ischemic Encephalopathy (HIE). Mortality is decreased, by about 25%, and long term morbidity among survivors is also…

Face masks for resuscitation? Blank DA, et al. Face mask versus nasal mask device use for initial resuscitation in extremely and very preterm infants (FONDUE): an open-label, single-centre, randomised, controlled trial. Lancet Child Adolesc Health. 2025;9(10):715–23. An excellent acronym for this…

Beware articles written by AI I subscribe to Google alerts, which sends me an email whenever the phrase "neonatal research" appears on a new website or a new post. I was interested, therefore to receive an alert about an article which, according the blog "Bioengineer.org", showed a major genetic…

Neonatal Research Shorts : November 2025 Ybarra M, et al. Low-Grade Germinal Matrix Hemorrhage-Intraventricular Hemorrhage and Concomitant Preterm Brain Injuries: Neurodevelopmental Outcomes at 3 Years of Age. J Pediatr. 2025:114713. Previous studies of the long term outcome of infants with…

Clinical examination and treatment of septic shock. Not neonatology. Andromeda-Shock-2 Investigators for the Andromeda Research Network SSoAR, et al. Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial. JAMA.…

Lactoferrin supplementation does not prevent late-onset sepsis in the preterm… or is it more complicated that that? Many of my readers will remember the impressive results of the high-quality study by Paolo Manzoni, Manzoni P, et al. Bovine lactoferrin supplementation for prevention of late-onset…

Return to the Regression to the Mean After my post on regression to the mean, and its importance in studies of apnoea therapy, I was thinking of other examples. Some which have been most evident to me are those which impact on areas of medicine that I have researched myself. One example, from many…

Beware of meta-analysis factories I mentioned in my previous post, an issue with meta-analyses; there have been several I have read recently which are very problematic. They seem to be produced by groups that have little concern for the quality of their product. This recent meta-analysis, for…

Do blood transfusions treat apnoea of prematurity? There has for a long time been a thought that anemic babies with many apnoeas could benefit from a blood transfusion which would decrease their apnoeic spells. This idea has never been directly tested by an RCT. That is, a trial in which infants…

Non-invasive high-frequency oscillation; worth the hassle? Non-invasive HFOV can be delivered by a variety of different equipment and interfaces. The high flows and upper airway turbulence probably have an impact on gas exchange; It appears that the effective dead space of the oro-nasopharynx is…

Avoiding IVs in moderately preterm babies A new very large (for neonatology) RCT has just been published. Ojha S, et al. Full exclusively enteral fluids from day 1 versus gradual feeding in preterm infants (FEED1): a open-label, parallel-group, multicentre, randomised, superiority trial. Lancet…

Bob Bartlett RIP I just learned of the very recent death of Dr Robert Hawkes Bartlett, May 8, 1939 – October 20, 2025. He was a surgeon who had been developing extracorporeal oxygenation systems for cardiothoracic surgery who realised that extracorporeal circulation could be used for prolonged…

Neonatal Research Shorts : October 2025 Afifi J, et al. Atropine Versus Placebo for Neonatal Nonemergent Intubation: A Randomized Clinical Trial. J Pediatr. 2025;286:114719 I had thought this was a settled issue, Neil Finer showed many years ago that atropine alone decreased bradycardias during…

Predicting neurological and developmental outcomes. Why? How? There are a huge number of publications correlating medium term outcomes (by which I mean outcomes around 1 to 2 years of age) with findings in the neonatal period. Most have concerned various approaches to brain imaging, although other…

Caffeine is good for the preterm brain; might more caffeine be even better? One of the pivotal RCTs in neonatology was the CAP study (Schmidt B, et al. Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med. 2007;357(19):1893–902). We performed that study because there was no…

Unethical research practice, fraud and abuse of trust. One of the worst kinds of unethical research practice is to fail to publish results after a prospective study. Parents consent to research for altruistic motives, in the belief that their baby's participation will help the care of other,…

Sooooooo…the MAHA report was written by AI and had all sorts of insane hallucinations, including completely fabricated studies and data?!!! And NO ONE FACTCHECKED ANYTHING???? This is apparently the ‘good science’ we were promised. Made up bullshit that is used to form batshit crazy policy.

Caring for the most extremely immature infants There have been multiple publications concerning this issue recently, many from the tiny baby collaborative. The first 2 publications are about the overall approach to providing intensive care at extremely low GA: Bernardini LB, et al. It's the little…

Hypotension and Shock. Optimising treatments A new single centre RCT of permissive hypotension (PH) compared to "standard treatment" (ST) of very preterm infants 24 to

Supporting Breast Milk production in the NICU A recent confluence of 3 reviews, one on breastfeeding specifically in the NICU (Hilditch C, et al. Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of Systematic Reviews. Neonatology.…

NEC awareness day, 17 May 2025. What is new in NEC prevention? I thought, as today is NEC awareness day, I would give an overview of recent research about NEC prevention strategies. Probiotics. I am sure my readers are aware of the major problems in the USA which have followed the occurrence of an…

Should we be giving erythropoietin, or analogues, to preterm infants? In some pre-clinical models, erythropoietin acts as a neuroprotective agent, which led to the performance of clinical trials to determine whether there was a positive impact on outcomes of the preterm. The latest study has just…

Neonatal Research Shorts : May 2025 Dutta S, et al. Seven-day versus 14-day antibiotic course for culture-proven neonatal sepsis: a multicentre randomised non-inferiority trial in a low and middle-income country. Arch Dis Child Fetal Neonatal Ed. 2025. This is a multicentre trial from India of…

Research has found that privatisation of health services reduces quality of care. @franbaum.bsky.social‬ and colleagues look at how the concept of "enshittification" applies to health services and their decline with privatisation www.bmj.com/content/389/...

Therapeutic Hypothermia at 35 weeks In response to a couple of thoughtful comments to my previous post, I thought I would try to address the specific issue of the infant of 35 weeks. (Faix RG, et al. Whole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A…

Therapeutic Hypothermia in the Late Preterm Infant Current guidelines support the use of therapeutic hypothermia for term infants with hypoxic ischaemic encephalopathy. Both the Canadian and the US guidelines include infants born at 35 weeks gestation. However, the data supporting efficacy for…

Prolonging CPAP in the preterm to improve pulmonary outcomes I wrote about this trial after last year's PAS meeting, mentioning that it looked like a potential significant improvement in respiratory care of the preterm The full publication confirms that is a real possibility. McEvoy CT, et al.…

Neonatal Research Shorts : April 2025 I used to do a series of shorter posts called "weekly updates" but I ran out of steam and have concentrated on longer posts in recent years. The last couple of weeks, with clinical service, I have had less time for a longer post, but a few things piqued my…

Neonatal Research Shorts : April 2025 I used to do a series of shorter posts called "weekly updates" but I ran out of steam and have concentrated on longer posts in recent years. The last couple of weeks, with clinical service, I have had less time for a longer post, but a few things piqued my…

Neonatal Research Shorts : April 2025 I used to do a series of shorter posts called "weekly updates" but I ran out of steam and have concentrated on longer posts in recent years. The last couple of weeks, with clinical service, I have had less time for a longer post, but a few things piqued my…

Neonatal Research Shorts : April 2025 I used to do a series of shorter posts called "weekly updates" but I ran out of steam and have concentrated on longer posts in recent years. The last couple of weeks, with clinical service, I have had less time for a longer post, but a few things piqued my…

Early hydrocortisone in shock? A few years ago, we published our experience with the use of hydrocortisone in newborn infants in septic shock (Altit G, et al. Corticosteroid Therapy in Neonatal Septic Shock-Do We Prevent Death? Am J Perinatol. 2018;35(2):146-51), like many such studies the numbers…

Is it a duck? Is it a mole? Platipus and Trial Design Innovations. When the platypus was first captured, killed, skinned and the pelt sent to a zoologist in London, George Shaw in 1799, he thought he was being scammed. He tried to find the stitches that had been used to cobble together the…

Annual EPIQ conference in Montréal. Many great presentations improving quality of care in the NICU. New family engagement group: focusing on skin-to-skin care for their 1st projects. We have a long way to go. Telephone survey of Canadian NICUs, most babies in the units didn't get cuddled that day.

A lower limit for restrictive transfusion strategies? Not directly neonatology… Several trials of liberal versus more restrictive transfusion practices have been published, and overall, it seems that being very restrictive in transfusions has no negative impacts on clinical outcomes, and depending…

Bilirubin is Bad for the Brain! Who knew? We have known for a very long time that bilirubin can cause an encephalopathy leading to acute and chronic clinical impacts, the most severe chronic impacts being kernicterus, a disabling movement disorder and nerve deafness. What seems to be the case is…

Breast is Best; is Fresher Better? A recurrent problem in the NICU is "bandwagon-jumping". An intervention with some preliminary positive data, and a possible physiologic rationale is widely adopted and made part of QI bundles with little or no reliable evidence that it is either effective or…

Neurodevelopmental Impairment, who decides what it is? I have written frequently about my concerns with "NDI" as an important measure of neonatal outcomes, indeed, it seems to be often thought of as if it were the only important measure. It has very often been included as part of a composite…

On my other blog, a photo diary of my trip to Panama, mostly bird photos. keithbarrington.com