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The patent ductus arteriosus (PDA) remains one of the most debated topics within neonatology. Despite thousands of studies, there is significant heterogeneity in management practices. Although pharmacologic therapy results in increased ductal closure, no randomized controlled trial has definitively reported reduced PDA-related morbidities. We will discuss advanced concepts and controversies in the recognition and management of the PDA and highlight nuance frequently missing from interpretations of PDA-focused trials, explore issues which have precluded previous research from establishing a causal link between ductal patency and neonatal morbidity, and suggest directions for future studies investigating the potential merits of targeted ductal closure.
Background: Acute neurosurgical emergencies during pregnancy are rare but pose significant challenges due to the need for simultaneous management of two interdependent patients. Evidence remains limited, and standardized multidisciplinary protocols are lacking. Case Presentation: A 38-year-old woman at 32 + 4 weeks of gestation presented with acute left hemiparesis secondary to right capsulo-insular intracerebral hemorrhage with mass effect. Following initial conservative management, neurological deterioration and hematoma expansion necessitated emergency craniotomy. A structured multidisciplinary approach was implemented involving neurosurgery, anesthesiology, obstetrics, and neonatology, with predefined roles, continuous intraoperative fetal monitoring, and readiness for emergency cesarean delivery. Anesthetic management balanced maternal neuroprotection with preservation of uteroplacental perfusion. Surgery was completed without fetal compromise. The patient demonstrated neurological improvement and was transferred on postoperative day 13. Elective cesarean delivery was performed at 36 weeks. Conclusions: This case illustrates that emergency neurosurgery during pregnancy may be feasible in selected settings when supported by structured multidisciplinary coordination. Key practical elements included continuous fetal monitoring, predefined team roles, and immediate availability of obstetric and neonatal support. In this individual case, these components facilitated intraoperative decision-making and were associated with favorable maternal and fetal outcomes; however, their individual contribution cannot be determined from a single clinical experience. Further evidence is needed to assess the applicability of this approach across different clinical scenarios.
Supplemental oxygen remains the primary treatment for preterm infants with established bronchopulmonary dysplasia (BPD). Although randomized controlled trials have evaluated lower versus higher oxygen saturation targets in preterm infants before 36 weeks postmenstrual age, evidence beyond this age is lacking. The aim of the Supplemental Oxygen Strategies in children with BronchoPulmonary Dysplasia (SOS BPD) study is to evaluate the effect of a higher oxygen saturation lower limit of 95%, compared with a lower limit of 90%, on lung growth by proxy of weight standard deviation score (SDS), at 6 months corrected age in infants with established BPD. This document outlines the statistical analysis plan for the SOS-BPD study. The SOS BPD study is a multicenter, pragmatic, non-blinded, randomized trial in preterm infants with moderate or severe BPD. Eligible infants are randomized between 36 and 38 weeks postmenstrual age to a lower oxygen saturation limit of 95% or 90%, after parental informed consent. The assigned oxygen saturation lower limit is maintained until respiratory support can be discontinued. The primary outcome is weight SDS at 6 months corrected age. Secondary outcomes include anthropometrics measured at 6 and 12 months corrected age, rehospitalizations for respiratory reasons and respiratory complaints. This statistical analysis plan is written and submitted without knowledge of the data. Overview of Medical Research in the Netherlands (OMON), NL-OMON54694. Registered on 09-08-2018, URL: https://onderzoekmetmensen.nl/en/trial/54694.
Nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) are two commonly used modalities of non-invasive respiratory support in neonatal intensive care units. Although both are effective, NIPPV is increasingly preferred because of its additional clinical advantages. However, the comparative hemodynamic effects of these strategies remain uncertain. This randomized controlled trial aimed to compare the hemodynamic effects of NIPPV and NCPAP in preterm infants following extubation. In this single-center randomized controlled trial, preterm neonates (26-36+ 6 weeks), previously intubated and treated with surfactant, were randomized to NIPPV or NCPAP following extubation. Functional echocardiography (FnECHO) was performed at 4-6 h and 18-24 h to assess right and left ventricular output (RVO, LVO) and indices of systolic and diastolic function. Sixty preterm neonates were included in the final analysis (30 in each group). Baseline RVO and LVO on invasive mechanical ventilation were comparable between the groups (p = 0.33, 0.53). Post-extubation, infants on NIPPV demonstrated significantly lower cardiac outputs than those on NCPAP at 4-6 h (RVO, p = 0.006; LVO, p = 0.001) and at 18-24 h (RVO, p < 0.001; LVO, p < 0.001). After adjustment for gestational age and birth weight, these differences remained significant. Sensitivity analysis adjusting for baseline oxygen saturation index attenuated the early differences, whereas those at 18-24 h remained significant (RVO p = 0.030; LVO p = 0.022). Despite statistical significance, all values remained within gestational age-appropriate physiological limits. Mean airway pressure was significantly higher in the NIPPV group at 4-6 h (10.35 ± 1.0 vs. 6.16 ± 1.2 cm H₂O) and 18-24 h (9.72 ± 1.3 vs. 5.71 ± 1.6 cm H₂O; both p < 0.001) and showed a significant inverse correlation with cardiac outputs. Neonates supported with NIPPV in the post-extubation period demonstrated lower cardiac outputs compared with those on NCPAP, and this was associated with higher mean airway pressures. Although within physiological limits, these changes warrant hemodynamic monitoring and further evaluation of their clinical impact. This study was prospectively registered with the Clinical Trials Registry of India (CTRI/2024/04/065278) on 05 April 2024. Trial details are publicly accessible at https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=78,344.
The post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, represent a multifaceted challenge in pediatric populations, characterized by symptoms persisting beyond the acute phase. In Taiwan, where early public health measures initially contained the pandemic, the 2022 Omicron surge prompted focused investigation into pediatric PASC, highlighting the critical need for longitudinal data in this specific demographic. To address this challenge, the Diagnosis and Support for COVID Children to Enhance Recovery (DISCOVER) study was established as a prospective, multidisciplinary cohort. By employing a multimodal approach, this study characterizes the clinical landscape of pediatric PASC in Taiwan through validated screening instruments, AI-driven diagnostics, and pulmonary assessments, while concurrently evaluating immune biomarkers, vaccination protection, and vitamin D intervention. This review synthesizes comprehensive findings from the cohort. While the acute phase of infection was predominantly mild, a substantial proportion of children experienced persistent multisystem symptoms, with fatigue, respiratory issues, and somatic complaints being most prevalent. Vaccination was found to significantly modify the disease trajectory, offering protection against subsequent gastrointestinal sequelae and preserving pulmonary function by mitigating small airway resistance. Furthermore, advanced diagnostic modalities, including impulse oscillometry and deep learning-assisted echocardiography, successfully unmasked subclinical organ dysfunction that conventional methods often failed to detect. Mechanistic investigations revealed that symptom severity was closely linked to elevated anti-nucleocapsid antibody titers, while markers of T-cell exhaustion evidenced persistent immune dysregulation, rather than ongoing viral replication. Notably, a preliminary single-center randomized controlled trial within this cohort provided early evidence that vitamin D supplementation may reduce the overall symptom burden and modulate pro-inflammatory cytokine profiles in children with PASC. Collectively, these findings underscore the multisystem nature and immune-driven mechanism of pediatric PASC, while highlighting the role of vaccination, advanced diagnostics, and targeted nutritional interventions in improving recovery. CLINICAL TRIAL REGISTRATION: NCT05426291 (ClinicalTrials.gov).
Neurally Adjusted Ventilatory Assist is a ventilation mode that allows the patient to control the initiation, size, and termination of each mechanical breath on a breath-by-breath basis. The ventilator uses a neural trigger to detect diaphragmatic electrical activity (Edi) through a specialized nasogastric tube placed at the level of the crural diaphragm. Upon detecting the Edi signal, the ventilator delivers flow to generate a peak pressure proportional to the Edi activity. The breath is terminated when the Edi signal ceases, marking the end of inspiration.
Bronchopulmonary dysplasia (BPD) is a multifactorial disease characterized by disordered angiogenesis and disrupted alveolar development. Stem cell-based therapies, including extracellular vesicles, offer a transformative approach for BPD prevention and treatment. In preclinical studies, cell-based therapies promote lung repair, modulate immune responses, and replenish endogenous progenitor cells. This article critically evaluates the therapeutic potential of stem cell interventions for BPD, while also examining key barriers to clinical translation, including challenges in manufacturing, regulatory oversight, and standardization of cell-based products.
Environmental microorganisms detected in neonatal feeding preparation areas may raise concern for healthcare-associated outbreaks and warrant investigation to identify potential environmental sources of contamination. Between July 2025 and February 2026, repeated bacterial growth was detected during routine microbiological surveillance of formula prepared for neonates. An investigation was conducted, including sampling of powdered formula, prepared formula, and distilled water. Bacterial identification was performed using routine methods, and genetic relatedness among selected Herbaspirillum isolates was evaluated using AP-PCR. Environmental microorganisms were isolated from prepared formula and distilled water, while powdered formula showed no growth. Repeated isolation of Herbaspirillum species demonstrated clonal relatedness, suggesting a common environmental source. No clinical infections associated with these microorganisms were identified among neonates during the study period. This study identified environmental bacterial contamination associated with distilled water used during formula preparation. Molecular typing was valuable in confirming a common environmental source and guiding corrective interventions. Monitoring water sources is critical in neonatal care.
Healthcare professionals who prescribe, prepare, and administer drugs to children must consider age-dependent pharmaceutical aspects. However, information on the age-appropriate use of authorised medicinal products is frequently incomplete within the Summary of Product Characteristics (SmPC). This study aims to improve the quality and completeness of the information provided by the SmPC for products with paediatric authorisation and to create greater awareness from both regulatory authority and market authorisation holders. We created a list of topics that are particularly relevant for safe and effective drug use in paediatrics, but which were identified as either missing or incompletely reported. The list was compiled based on routine experience of clinical pharmacists specialised in paediatrics. Each topic was compared with the reporting obligations imposed by the statutory provisions in Switzerland. The problem of missing information for clinical practice was discussed for selected examples. We identified 16 missing or incompletely reported topics: 1) authorised child ages, 2) posology information, 3) age-specific contraindications, 4) update on change in state-of-the-art, 5) dissolution concentration, 6) solvents / diluents compatibility, 7) administration concentrations, 8) osmolarity / pH, 9) reconstitution / dilution stability, 10) shelf-life, 11) route of administration (central or peripheral vein), 12) infusion rates and administration duration, 13) dosing aids, 14) in-filter compatibility, 15) caution in case of extravasation, and 16) taste. Out of the 16 topics, four (25%) are not subject to any reporting obligations, seven (44%) require further clarification regarding the information to be reported under the statutory provisions, and five (31%) are subject to reporting obligations. We provide a list of topics as a proposal of indispensable paediatric-specific information that should be available for authorised products. Moreover, it is paramount that the safe and effective use of drugs with paediatric authorisation is appropriately described for all age populations within the label.
This investigation reports on a Shwachman-Diamond syndrome (SDS) case arising from compound heterozygous genetic variations affecting the EFL1 locus. A systematic review of published literature was undertaken to compile data on clinical manifestations, management strategies, and prognostic indicators in SDS cases with identified EFL1 genetic alterations. The clinical data of a neonatal SDS patient, whole exome sequencing (WES) results, and the pathogenicity of the variants were analyzed. A comprehensive survey of applicable medical literature published up to March 2025 was executed to identify and synthesize the clinical phenotypes associated with this condition. WES identified compound heterozygous variants within the patient's EFL1 gene: c.2935C>T (p.R979C) and c.3149_3151delCAC (p.P1050del). Bioinformatics analysis indicated these variations were damaging. Seven articles reported a total of 20 cases of this disease, with predominant phenotypes including exocrine pancreatic insufficiency, hematologic abnormalities, and metaphyseal dysplasia. Among the 20 previously reported cases, 16 distinct EFL1 variants were identified, and the current case adds 2 novel variants. SDS caused by EFL1 gene defects primarily presents as bone marrow failure, with treatment mainly focused on symptomatic management. We report a neonatal SDS patient with the earliest onset of symptoms. The c.2935C>T and c.3149_3151delCAC compound heterozygous variants reported in this study expand the mutational spectrum of this disease.
Background The limits of viability, commonly defined by gestational age and/or birth weight thresholds associated with a survival probability exceeding 50 %, have evolved with advances in neonatal care. However, these thresholds vary substantially across countries, reflecting differences in health system capacity rather than fixed biological boundaries. ContentThis review critically examines the definition of the limits of viability as a context-dependent construct shaped by access to perinatal and neonatal care. It analyzes global disparities in survival at the margins of prematurity, with marked differences between high-income (HIC) and low- and middle-income countries (LMIC). These inequities are discussed within the framework of the Sustainable Development Goals (SDG), particularly SDG 3 and SDG 10, and in relation to the child's right to the highest attainable standard of health. The role of global health governance, including the World Health Organization (WHO), and emerging challenges affecting international collaboration are also considered. Current trends in both HIC and LMIC are evaluated to assess alignment between technological progress and global health equity.SummaryThe limits of viability are not fixed biological thresholds but reflect health system capacity. Persistent disparities in periviable survival remain substantial and result in outcomes determined largely by place of birth rather than biological potential.OutlookReducing inequities requires prioritizing equitable implementation of evidence-based interventions, strengthening health systems, and sustaining global collaboration. Aligning advances in neonatal care with global equity is essential to improving outcomes for the most vulnerable newborns.
Hypoplastic left heart syndrome (HLHS) is a critical congenital heart that requires complex surgical and medical management. Despite recent clinical advances, population-level data on infant mortality trends related to HLHS remain limited. This study examines temporal patterns in HLHS-related infant mortality rates (HLHS-IMR), timing of death, interstate variation, and demographic disparities, along with updated prevalence estimates. We analyzed U.S national data from 2007 to 2021 using CDC-WONDER linked births/deaths database. HLHS-related infant mortality rates (HLHS-IMR), identified using ICD-10 code Q23.4, were calculated per 100,000 live births. Bivariate analyses estimated relative risks (RR) by sex, race, gestational age (GA), and state. We used Joinpoint regression to estimate annual percent changes (APC) and average annual percent change (AAPC). We assessed recent state-level prevalence data from the National Birth Defects Prevention Network (NBDPN) for two 5-year periods: 2012-2016 and 2016-2020. Among 59,117,761 live births, 3566 (0.006%) HLHS-related infant deaths were recorded. HLHS-IMR declined by 43% (7.4 to 4.2 per 100,000), with an AAPC of - 3.2% (95% CI, - 5.1, - 1.6; p < .01). Mortality declined more steeply after 2016 (APC - 6.5%; 95% CI, - 21.0, - 3.2). Most deaths (57%) occurred in the neonatal period. Black infants had higher mortality risk (RR 1.15; 95% CI, 1.05, 1.26), while Asian infants had lower risk (RR 0.61; 95% CI, 0.51, 0.73). Recent HLHS prevalence was approximately 1 in 3653 live births.  National HLHS-IMR has declined significantly, likely reflecting improvements in early diagnosis and critical clinical care. However, persistent racial and geographic disparities exist, warranting further investigation. • Hypoplastic left heart syndrome remains a major cause of infant cardiac mortality despite advances in surgical and neonatal care. • Prior studies have reported improving survival, but contemporary national data on mortality trends and geographic disparities remain limited. • This study demonstrates a sustained national decline in HLHS-related infant mortality in the USA over the past 15 years. • Persistent racial and interstate disparities in outcomes remain, with distinct state-level mortality patterns with varied burdens.
To characterize the weight trajectories of infants exposed to opioids and evaluate the association between different exposures and risk of excessive neonatal weight loss. Using mother-baby linked electronic health records, vital records, and claims data, we identified a retrospective cohort of infants exposed to opioids born at a large, academic medical center (2010-2021). We characterized prenatal substance exposures 90 to 2 days before delivery, including medications for opioid use disorder (MOUD), non-MOUD opioids, selective serotonin reuptake inhibitors, benzodiazepines, gabapentin, cigarette smoking, and toxicology evidence of opioids and nonopioid exposures (eg, barbiturates, cannabinoids, amphetamines, cocaine). We parameterized neonatal weight loss as the maximum percentage decrease from birth weight in the first 14 days of life during birth hospitalization. We used multivariable linear regression to compare the association between prenatal exposures and maximum percentage weight loss. Among 868 maternal-infant dyads exposed to opioids that were identified, 622 (71.7%) had prenatal exposure to at least 1 additional substance. Infants with additional prenatal exposures had a greater median weight loss and a later nadir in weight loss compared with those without additional exposures (P < .001). In analyses examining individual substances, MOUD prescriptions (coefficient 0.99; 95% CI 0.50-1.48) and positive toxicology for nonopioid drugs (coefficient 0.53; 95% CI 0.08-0.98) were associated with a greater maximum percentage weight loss. Exposure to MOUD and nonopioid exposures were associated with greater weight loss among infants exposed to opioids during the first 14 days of life. These findings inform the clinical management of infants exposed to opioids to mitigate weight loss during the neonatal hospitalization.
To evaluate the introduction of locally configured standard concentration (StdC) intravenous drug infusions in critically ill children. This two-year quality improvement retrospective cohort study (2018-20) examined post-implementation of 47 StdC drugs configured across three weight bands: <5 kg, 5-20 kg and >20 kg in a 26-bed, multispecialty paediatric intensive care unit. The main outcome measures were (1) adherence to StdC use (non-adherence defined as using a bespoke drug concentration), (2) attempts at dosing above the pre-set infusion rates, known as hard limit events (HLEs), (3) incidents related to infusions and (4) percentage of total fluid allowance available for nutrition. In total, 33 224 infusions were administered, with morphine, clonidine and milrinone representing 61%. Most of them (83.6%) were initiated in children in the lower weight bands. Adherence to StdCs was 96% and was similar across weight bands. A total of 204 498 pump programming events were examined, with 418 (0.2%) being HLEs. Only 21 HLEs (0.01%) were considered potentially clinically significant (defined as programming >2.5 times the maximum dose). Following investigation, 20/21 were found likely to be related to training episodes, rather than true errors. Twenty clinical incidents linked to StdC infusions were reported but none caused harm. The mean fluid allowance available for nutrition after accounting for StdC volumes was 38.8% in the <5 kg weight band, and 71% and 67.4% in the other two bands, respectively. Configured StdCs are effective and safe across all weight bands and allow for partial provision of nutritional needs in fluid-restricted patients. The high adherence rate facilitated pharmacy supplying infusions as Ready-To-Administer (RTA).
Maintaining competency in neonatal resuscitation requires repeated practice. However, equipment costs, space, and instructor availability constrain mannequin-based simulation. Standalone virtual reality (VR) training may improve access. This study aimed to evaluate the feasibility, acceptability, and safety of a standalone VR-based neonatal resuscitation training application (NCPR-VR) focused on positive-pressure ventilation, among already-certified perinatal healthcare professionals. This single-arm exploratory feasibility study involved 32 already-certified perinatal healthcare professionals (11 physicians, 14 nurses, and 7 midwives). Feasibility and acceptability were assessed by session completion, self-reported usefulness/recommendation, System Usability Scale (SUS), User Experience Questionnaire (UEQ), and Igroup Presence Questionnaire (IPQ). Safety was monitored by Simulator Sickness Questionnaire (SSQ) and adverse event reporting. Analyses were limited to descriptive statistics. All 32 participants completed the VR session without adverse event-induced discontinuation (completion rate, 100%). Median perceived usefulness and willingness to recommend the application were both 5 (IQR, 4-5) on a 5-point Likert scale. The median SUS score was 65.0 (IQR, 55.0-73.1), indicating moderate usability. UEQ subscales showed favorable ratings for attractiveness, stimulation, and novelty. IPQ involvement was unsatisfactory and experienced realism only satisfactory; presence and spatial presence were acceptable. Simulator sickness was low (median SSQ, 1.9); three participants reported mild symptoms resolving within 10 min. No serious adverse events occurred. NCPR-VR was feasible and acceptable among already-certified providers, with full session completion and no serious adverse events. Involvement and experienced realism require improvement. Trial registration: UMIN000058975 (University hospital Medical Information Network Clinical Trials Registry; registered September 6, 2025).
Clinical decision-making in periviability, typically between 22 and 25 weeks of gestation, represents one of the most complex intersections of medicine and ethics. Characterised by profound prognostic uncertainty and the absence of clear ethical consensus, this period places neonatologists under significant moral, emotional, and institutional pressure. This study explores how neonatologists in Türkiye experience ethical challenges when making clinical decisions for infants born at the threshold of viability. A qualitative phenomenological design was employed. Between March 2022 and June 2023, in-depth semi-structured interviews were conducted with 15 neonatologists working in tertiary and quaternary neonatal intensive care units across different regions of Türkiye. Data collection continued until data saturation was reached. All interviews were transcribed and analysed using thematic analysis. Five interrelated themes were identified that characterise neonatologists' moral experiences in periviable care: moral decision-making under prognostic uncertainty; moral distress in perceived non-beneficial treatment; moral tensions in clinician-parent interactions; legal and institutional constraints on ethical decision-making; and moral loneliness in periviable care. Together, these themes highlight the ethical complexity of caring for infants at the threshold of viability, where uncertainty, responsibility, relational tensions, and structural pressures intersect. In neonatal intensive care settings in Türkiye, periviable care is experienced as an ethically complex practice shaped by clinical uncertainty and institutional conditions. Strengthening institutional mechanisms for ethical deliberation may help reduce clinicians' experiences of moral loneliness.
The validity of hypertensive disorders of pregnancy (HDP), including preeclampsia, gestational hypertension, and chronic hypertension, is essential for both clinical management and research. The Swedish Pregnancy Register automatically retrieves diagnostic codes based on the Swedish version of the International Classification of Diseases 10th revision (ICD-10), as recorded in antenatal, obstetric, and neonatal electronic medical records. The aim of the study was, for the first time, to assess the validity of HDP diagnoses within the Swedish Pregnancy Register in a contemporary population. A multicenter validation study of women with deliveries from 2021 to 2023 who participated in the prospective Swedish study for Improving Maternal Pregnancy And Child ouTcomes (IMPACT) cohort. Women with a HDP diagnosis in the Swedish Pregnancy Register were retrospectively validated through standardized reviews of electronic medical records. The gold standard for classification followed the Swedish guidelines from the Swedish Society of Obstetrics and Gynecology (SFOG), updated in 2019. Incidence, sensitivity, and positive predictive value (PPV) were calculated and reported with 95% confidence intervals (CIs), using the Wilson score method. In addition, the study includes a descriptive analysis of preeclampsia disease characteristics and clinical diagnostic practices. Among 7443 women included in the validation study, 843 (11.3%, 95% CI 10.6-12.1) had a HDP diagnosis recorded in the Swedish Pregnancy Register and underwent validation. Within the study population, the register-based incidence of preeclampsia was 5.0% (95% CI 4.5-5.5%), while the minimum validated incidence was 5.1% (95% CI 4.6-5.6). The positive predictive value (PPV) of register diagnoses was 79.0% (95% CI 74.5-82.8%) for preeclampsia, 72.8% (95% CI 68.2-76.9%) for gestational hypertension, and 49.3% (95% CI 38.3-60.4%) for chronic hypertension, yielding an overall PPV for any hypertensive disorder of pregnancy diagnosis of 73.4% (95% CI 70.3-76.3%). Among validated cases of preeclampsia, 78% had proteinuria and the remaining cases were classified as preeclampsia based on other organ dysfunctions. In this contemporary Swedish cohort, a diagnosis of preeclampsia recorded in the Swedish Pregnancy Register demonstrated good validity, comparable to that reported in previous Nordic register validation studies.
Background/Objectives: Ventilator-free days (VFDs) are a useful composite measure to assess both survival and duration of mechanical ventilation in critically ill patients. This study aimed to determine the factors associated with (VFDs) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to compare VFDs according to the etiology and severity of PPHN. Methods: We conducted a retrospective cohort study of neonates diagnosed with PPHN between 2013 and 2023. VFDs were defined as days alive and free of mechanical ventilation within the first 28 days. Severe-to-critical PPHN group was defined as an oxygenation index (OI) > 25. Results: Among 175 neonates, the median (interquartile range [IQR]) VFDs were 20 (9-23) days. The factors independently associated with fewer VFDs included maximum OI > 40 (adjusted hazard ratio [aHR] 3.5, 95% confidence interval [CI]: 2.49-4.9), receiving more than two inotropic drugs (aHR 2.27, 95% CI: 1.49-3.45), acute kidney injury (AKI) (aHR 1.54, 95% CI: 1.1-2.17), and ventilator-associated pneumonia (VAP) (aHR 3.42, 95% CI: 1.8-6.48). The median (IQR) number of VFDs in neonates with PPHN secondary to respiratory distress syndrome (RDS), pneumonia/sepsis, meconium aspiration syndrome, and transient tachypnea of the newborn were 16 (0-22), 17 (7-21), 22 (11-24), and 22 (15-24) d, respectively (p = 0.023). Neonates in the severe-to-critical group had markedly fewer VFDs than those in the mild-to-moderate group (8.5 vs. 22 d, p < 0.001). Conclusions: Infants with PPHN from RDS had the fewest VFDs. A maximum OI > 40, use of multiple inotropic agents, AKI, and VAP were associated with a low number of VFDs. Given the retrospective, single-center design, these findings are associative and hypothesis-generating, requiring prospective multi-center validation. Nonetheless, VFDs remain a comprehensive measure of both mortality and respiratory morbidity in this population.
Public health crises like environmental disasters and COVID-19 place psychological burden on affected communities, with pregnant and new mothers disproportionately impacted. With the escalating incidence of such crises, understanding the mechanisms that support maternal resilience is crucial for effective intervention. We investigated partner support as a potential protective factor for mothers' mental health following the Australian 2019-2020 bushfires and COVID-19 pandemic. Data were from 278 mothers living in the ACT and NSW who were pregnant during the bushfires and participants in the Mother and Child 2020 (MC2020) longitudinal cohort study, and 99 of their partners. Moderation analyses tested whether total partner support (dyadic coping) predicted the impact of crises during pregnancy on maternal mental health at 21-38 months postpartum. Secondary analyses examined how mothers' and partners' perceptions of the support provided to mothers contributed to maternal mental health. Mothers with greater crisis impact reported higher depression, anxiety and stress symptoms, and lower wellbeing at 21-38 months postpartum. The effect of crisis impact on mothers' mental health was not moderated by partner support; however, partner support showed the strongest association with maternal mental health, including improvements from the perinatal period to 21-38 months postpartum. Critically, the relationship between partner support and mothers' mental health was primarily driven by mothers' perceptions of the support they received. Strengthening partner support may significantly enhance maternal mental health and resilience surrounding public health crises. Intervention efforts should focus on guiding partners to provide support that aligns with mothers' needs.