搜索结果：Archives of disease in childhood. Fetal and neonatal edition

To assess the predictive accuracy of early neurophysiological and neuroimaging biomarkers, alone and in combination, for adverse neurodevelopmental disorders in term-born infants with neonatal encephalopathy (NE). Systematic review and meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines. Eligible studies included infants born at term with NE who underwent amplitude-integrated EEG (aEEG) or EEG and MRI of the brain within the first month of life. Adverse outcomes, assessed at 18-36 months of age, were defined as cerebral palsy, postneonatal epilepsy, severe hearing or visual impairment, moderate-to-severe developmental delay, or death attributable to NE. Searches were conducted in MEDLINE, CINAHL, Embase and Web of Science from database inception to 10 June 2025; risk of bias of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool. Sensitivity, specificity and diagnostic odds ratio (DOR) of abnormal aEEG background, EEG background, EEG seizures and MRI injury, individually and in combination, for predicting adverse outcomes, pooled using Bayesian bivariate random effects meta-analyses. 27 studies including 1843 infants were analysed. MRI injury was the individual predictor with higher DOR estimate (31.01, 95% CI 15.07 to 72.82), followed by abnormal EEG background (16.84, 95% CI 5.88 to 50.59), while abnormal aEEG background and EEG seizures performed less well (7.99, 95% CI 2.40 to 33.00; 4.46, 95% CI 1.86 to 11.42). Combining EEG background with MRI injury improved DOR (78.59, 95% CI 19.72 to 321.36) and specificity (93.8%, 95% CI 85.2% to 97.9%) compared with MRI alone. MRI is a strong individual predictor of adverse outcomes in NE. Combining it with early EEG improves prognostic accuracy and may better support clinical decision-making. CRD42024585816.

To determine the impact of early rapid saline bolus during resuscitation on (1) time to achieve return of spontaneous circulation (ROSC), and (2) systemic haemodynamics, oxygenation, myocardial stress markers and pulmonary oedema. Randomised controlled trial. Lamb delivery suite. Term lambs in haemorrhagic, asphyxial cardiac arrest. Fetal lambs were exsanguinated (~45 mL/kg) followed by umbilical cord occlusion to arrest. After 5 min of asystole, ventilation was followed by coordinated chest compressions. Asystolic lambs were randomised to epi-first (intravenous epinephrine, 0.02 mg/kg and if no ROSC, a 10 mL/kg saline bolus over 5 min), or bolus-first (10 mL/kg saline bolus over 2 min and if no ROSC, followed by intravenous epinephrine). Haemodynamics and blood gases were monitored. In the epi-first group, none of the lambs achieved ROSC after epinephrine; ROSC occurred in 11/11 lambs during or immediately after saline bolus. In the bolus-first group, none of the lambs achieved ROSC with bolus alone and 8/9 lambs had ROSC after epinephrine. Mean time to ROSC from start of resuscitation was shorter in epi-first (4.9±1.3 vs 6.6±0.9 min, p=0.004), but time to ROSC from the time of epinephrine administration was shorter with bolus-first (86±43 vs 40±21 s, p=0.004). The fetal heart rate did not change significantly despite fetal blood loss. Our findings support current neonatal resuscitation guidelines of intravenous epinephrine followed by a bolus in neonates with suspected hypovolaemic arrest. Early saline bolus delays epinephrine and ROSC. Careful clinical assessment of haemodynamics in the post-resuscitation phase is critical.

Assess the incidence, presentation, management and short-term outcomes of neonatal stroke in the UK and Ireland (ROI). Active surveillance (British Paediatric Surveillance Unit) study and meta-analysis of national surveillance studies. UK and ROI. Neonatal stroke presenting <90&#x2009;days old in term and preterm infants between March 2022 and April 2023. Reporting clinicians completed questionnaires and uploaded de-identified neuroimages via a purpose-built data platform. 68 neonatal stroke cases were reported in the UK and ROI. UK incidence was 9.0 per 100&#x2009;000 live births (95%&#x2009;CI 6.9 to 11.6). Three-quarters were arterial ischaemic and unilateral. Arterial ischaemic and cerebral venous sinus thrombosis (CVST) strokes commonly presented with seizures at 2-3&#x2009;days of age, while haemorrhagic stroke commonly presented with encephalopathy in the first ten days of age. Neonatal stroke was associated with fetal distress in utero. 61% of infants had an umbilical pH <7.25 and 28% required significant resuscitation at birth, respectively. A meta-analysis of 3&#x2009;607&#x2009;864 infants found our reported incidence and associated conditions were similar to surveillance studies in Germany and Australia.Guidelines were available in a quarter of reporting hospitals. 87% of infants with arterial ischaemic and CVST stroke received antiseizure medications. 82% of infants were discharged home at 12 days old (median) with antiseizure medications (42%) alongside paediatric/neonatal (91%), physiotherapy (77%) and paediatric neurology (63%) follow-up. Neonatal stroke is rare, with distinct subtypes associated with different presentations, timings and management strategies, highlighting the need to better understand this condition.

A wide range of neonatal-specific video laryngoscopes (VLs) are now available, each offering unique design features. Understanding these differences is essential to support training and optimise clinical use in neonatal airway management. To compare the physical and functional characteristics of four commonly used neonatal VLs and assess user experience. In this observational study, four VL systems-C-MAC, GlideScope, InfantView and NeoView were evaluated. A technical comparison of blade design and dimensions was performed across available blade sizes, alongside a conventional Miller blade. Medical professionals attending a neonatal airway workshop then used each device on neonatal manikins and rated their experience using a 4-point scale across six domains: ease of use, airway visualisation, ease of intubation, image quality, blade size and blade design. A total of 23 participants with varied clinical backgrounds completed the evaluation. While 65% routinely performed neonatal intubations, 80% reported fewer than 10 intubations annually and 65% preferred conventional laryngoscopy. Following the trial, most participants favoured the C-MAC and NeoView VLs, and GlideScope was perceived to mimic conventional laryngoscope. The NeoView and C-MAC devices had the shortest distance between the camera and the distal blade tip. All VLs supported video and image capture. NeoView and GlideScope used disposable blades, while others employed reusable blades. This study provides a systematic comparison of the physical features and user preferences for commonly available neonatal VLs. These insights can guide equipment selection, inform training programmes and promote safer neonatal airway management.

To characterise aetiologies and prenatal neuroimaging findings in fetuses with intracranial haemorrhage (ICH), and evaluate the ability of imaging to suggest underlying causes. We retrospectively reviewed fetuses with ICH diagnosed prenatally at a single tertiary fetal centre between 2015 and 2025. Cases with a known mechanism at presentation were excluded. Ultrasound (US) and MRI images were reassessed by fetal medicine and neuroradiology specialists blinded to aetiology. Clinical, laboratory, genetic, autopsy and placental findings were integrated to determine underlying causes and assess imaging patterns. Sixty-seven fetuses were included; a definitive aetiology was identified in 38.8% (26/67). Genetic aetiologies were detected in 27.7% (13/47) of cases with advanced genetic testing, most commonly associated with cerebral small vessel disease (CSVD). Other causes included infection (5/67, 7.5%), fetal anaemia (6/67, 9%), and coagulopathy (3/67, 4.5%, of which one was genetic). Twenty-one cases (31.3%) remained unexplained despite comprehensive investigation, and 20 (29.9%) had incomplete investigations. Intraventricular haemorrhage (IVH) was present in 91% (61/67), with periventricular haemorrhagic infarction (PVHI) in 55.2% (37/67). CSVD was associated with multifocal PVHI, porencephaly, white matter injury and frequent brainstem involvement. In fetal anaemia, cerebellar haemorrhage was common, with brainstem and vermian involvement predominantly in non-parvovirus cases. Intraparenchymal haemorrhage without IVH occurred mainly with coagulopathy or infection. Although some phenotypic clustering was observed, there was substantial overlap among aetiologic groups. Genetic disorders, particularly CSVD, account for a significant proportion of prenatal ICH, supporting routine genomic testing. Imaging can suggest probable causes, but overlap limits its diagnostic specificity.

Management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Randomised controlled trials (RCTs) have shown that administering pharmacotherapy, predominantly ibuprofen, a cyclooxygenase (COX) inhibitor, to infants selected based on the standard echocardiography approach to diagnosis (eg, duct diameter and shunt direction), does not improve outcomes and may lead to harm. It remains uncertain, however, whether eliminating or reducing PDA shunt volume using an intervention with higher efficacy and fewer adverse effects, or in a more selective population, would show different results. It is possible that an imprecise approach to patient selection exposes low-risk infants to the adverse effects of pharmacotherapy without benefit and high-risk infants to the synergistic adverse effects of pharmacotherapy and persistent high volume pathological shunt when treatment fails. Whether targeted management of moderate-high volume PDA shunts, informed by comprehensive echocardiography adjudication, in the highest risk infants is beneficial remains untested in an RCT setting. Furthermore, both pharmacological and non-pharmacological interventions warrant further investigation. High quality practice changing research requires a collaborative approach between haemodynamic specialists, epidemiologists and trial methodologists to (1) define the study population based on phenotypic profiles of high-risk infants; (2) enhance the choice and timing of intervention; and (3) identify outcome measures that are relevant and clinically meaningful to families. In this review, we summarise evidence from RCTs and observational studies by discerning discrepancies and exploring potential explanations. Such an approach is essential to establish whether active PDA treatment confers any measurable benefit for high-risk preterm infants.

To study the effect of early-onset neonatal infection on long-term cognitive impairment including intellectual disability and special educational needs. A nationwide register-based cohort study was conducted including near-term to term children born between 1997 and 2013 with follow-up until 2021. Early-onset infection was defined as an invasive bacterial infection within the first week after birth defined by either physician-assigned diagnoses or bacterial pathogens cultured from blood or cerebrospinal fluid. Outcomes included diagnoses of intellectual disability and special educational needs. Associations were estimated by adjusted HRs (aHR) or unadjusted incidence rate ratios (IRR), when exposures and outcomes were rare. Additional analyses were conducted, including sibling-matched analyses and subgroup analyses considering only children with culture-positive infection. Among 993&#x2009;363 children, 8267 (0.8%) had sepsis and 152 (<0.1%) had meningitis. Of these, 260 had culture-positive sepsis and 31 had culture-positive meningitis. Early-onset sepsis was associated with an increased risk of intellectual disability (aHR: 2.24, 95%&#x2009;CI 1.93 to 2.59) and special educational needs (aHR: 1.49, 95% CI 1.40 to 1.59). Early-onset meningitis was associated with higher risks of both intellectual disability (IRR: 7.75, 95%&#x2009;CI 3.34 to 15.27) and special educational needs (aHR: 2.95, 95% CI 2.06 to 4.22). The associations remained consistent across multiple additional analyses, including sibling-matched analyses and subgroup analyses limited to culture-positive infections. Early-onset neonatal infection in near-term to term children was associated with an increased risk of long-term cognitive impairment including both intellectual disability and special educational needs.

Decision-making in the neonatal intensive care unit (NICU) is complex. In grey zones (where there are multiple morally acceptable pathways), families and clinicians may disagree about the best plan. While negative moral phenomena (NMP) such as moral distress are well recognised within clinicians, little is known about parental experiences. We sought to understand parental experiences of decision-making, particularly if parents experienced NMP. This was a mixed-methodology phenomenological study, using surveys. Statistical analysis was used for categorical data and thematic analysis for textual data. Four tertiary or quaternary NICUs in Australia and Canada. Parents of infants admitted to NICUs between July 2018 and August 2022 who engaged in decision-making in grey zones. 71 parents (80% mothers) completed the survey. 80% were bereaved.Thematic analysis revealed five themes: (1) decision burdens, (2) internal tensions, (3) actualising beliefs and values through decision-making, (4) inauthentic shared decision-making (SDM) and (5) external factors that shaped decision-making.Parents reported variable experiences of SDM. Despite decisions being described as burdensome, 89% wanted to be very involved in SDM, while 63% felt included. Actualisation of beliefs and values was important. Time pressures, competing interests and environmental factors influenced internal tensions experienced. Despite framing as SDM, some parents reported feeling coerced and experiences consistent with NMP. Some parents do experience significant NMP during SDM in the grey zones of the NICU. Clinician awareness of NMP and their antecedents may enhance communication and the SDM process in this challenging setting.

Multiple births are common in randomised trials targeting preterm populations. Clustering due to multiple births is often overlooked in individual trials and may impact the results of meta-analyses that pool their results. We aimed to assess how multiple births have been handled in the reporting and meta-analyses of recent systematic reviews. We conducted a methodological systematic review of Cochrane and non-Cochrane systematic reviews. The search was conducted on 10 September 2024 in the Cochrane Database of Systematic Reviews and PubMed for articles published in the previous 12 months. Reviews were eligible if they involved randomised trials of interventions delivered in pregnancy or infancy, included multiple births and reported results of at least one aggregate data meta-analysis for an infant outcome. After screening 222 articles, 39 had unclear eligibility due to making no mention of multiple births and nine met the eligibility criteria (five Cochrane and four non-Cochrane reviews). Multiple births were inconsistently handled across included reviews. The degree of clustering due to multiple births was poorly described and meta-analyses accounting for clustering were rarely reported (2/9 reviews; 22%). CIs around pooled treatment effect estimates were wider after accounting for clustering. Clustering due to multiple births is a poorly recognised issue in systematic reviews and meta-analyses. Given the potential for this clustering to alter conclusions about the effectiveness of interventions, we recommend accounting for clustering due to multiple births in future meta-analyses.

Developmental follow-up is a necessary part of neonatal care to identify additional support needs but also to allow national surveillance and research. Follow-up at 4 years of age enables assessment before school entry, allowing schools to be ready for and support children and their families. This is not currently routine across the UK despite the National Institute for Health and Care Excellence recommendations in 2017. This best practice guide was developed by the British Association for Neonatal Neurodevelopmental Follow-Up, a special interest group of the British Association of Perinatal Medicine.This framework supports clinicians developing and delivering a 4-year developmental follow-up service for children whose neonatal experiences put them at risk of developmental conditions or additional learning needs. This should include as a minimum those born before 28 weeks' gestation and infants with moderate to severe neonatal encephalopathy. Infants with risk factors for developmental problems should also be considered.This framework recommends assessment of developmental domains including physical development and growth, cognitive development, emotional and behavioural development, sensory needs, speech, language and communication skills, social skills and relationships. A summary report should be shared with caregivers and key individuals in health, education and social care. This should describe the child's strengths and needs to support transition into and throughout education.Specific service arrangements will vary depending on local resources and existing services. This framework provides guidance for clinical teams to enhance follow-up for children whose early experiences put them at risk of challenges, facilitating lifelong learning, participation and well-being.

Maternal immunity is modulated during pregnancy at the placental interface to prevent alloreactivity with the developing fetus. Importantly, however, maternal immunoglobulin G (IgG) freely crosses the placenta, and the presence of pre-existing alloreactive antibodies can lead to injury of fetal tissues and/or cells. Because maternal IgG continues to circulate up to 6 months after birth, these antibodies can also continue to affect the newborn, causing a variety of disease conditions including haemolytic disease of the newborn, neonatal alloimmune thrombocytopenia, neonatal lupus, neonatal Graves' disease, gestational alloimmune liver disease and others. Ig therapy, most typically in the form of intravenous Ig, is indicated in these disorders, as pooled IgG molecules can interfere with the circulating maternal IgG, lessening the interactions with the fetal or neonatal binding targets. Ig is an increasingly used therapy in this population; however, most fetal and neonatal providers do not receive comprehensive training in its development or use. Here, we review the formulation, mechanisms of action, therapeutic indications and administration of intravenous Ig in the context of fetal and neonatal medicine.

Investigate whether enteral supplementation with arachidonic acid (AA) and docosahexaenoic acid (DHA), from birth to term-equivalent age (TEA), promotes brain maturation as a prespecified secondary outcome of a multicentre randomised controlled trial. 206 infants born at 22-28 weeks gestational age (GA) were randomised into intervention or control groups from three university hospitals in Sweden. The intervention group received an oil with AA (100&#x2009;mg/kg/d) and DHA (50&#x2009;mg/kg/d) starting at birth until 40 weeks postmenstrual age (PMA) in addition to standard nutrition. Standard-of-care infants received standard nutrition according to national guidelines. MRI volumetrics were defined a priori as a secondary outcome of the trial and included total brain, white and cortical grey matter, central structures and cerebellum. Univariable and multivariable linear regression models were used for comparisons. MRI data in 117 infants had sufficient quality for inclusion (n=58 intervention). Birth weight, GA at birth, sex distribution, and PMA at MRI were similar in the groups. Infants receiving intervention had significantly larger white-matter volume at TEA, as compared with standard of care, in models adjusted for GA at birth, sex, study centre and PMA at MRI (&#x3b2;=6.8 cm3, 95% CI 0.7 to 12.9, p=0.028). The contribution of the intervention to white-matter volume corresponded to 10 days of prolonged gestation. Our findings in this hypothesis-generating study suggest that AA+DHA promotes white matter growth, which may protect the developing brain in this vulnerable population. NCT03201588.

To describe changes in early respiratory support for infants born at <30 weeks' gestational age (GA) in England and Wales. Retrospective cohort study using data from the National Neonatal Research Database of all infants born at <30 weeks GA, admitted to neonatal units in England and Wales from 2016 to 2021. Methods of respiratory support used in the delivery room and days 1 and 7 of care were determined. Success of the initial non-invasive respiratory support strategy was assessed by any use of mechanical ventilation in the first 7&#x2009;days of care. 24&#x2009;107 babies were included. Use of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) as the highest method of respiratory support for stabilisation increased during the study period (CPAP: 17.3% to 28.8%; HFNC: 0% (first recorded in 2016) to 0.7%). CPAP use increased in the most preterm (<25 weeks GA; 0.7% to 4.8%), the extremely preterm (<28 weeks GA; 7.2% to 17.5%) and the very preterm (28-29 weeks GA; 29.3% to 44.1%) cohorts. Among those initially stabilised with non-invasive ventilation in this study, 2763 (48.0%) infants required mechanical ventilation in the first week. In England and Wales, use of non-invasive respiratory support for initial stabilisation has increased among babies born at <30 weeks GA. 48% of those stabilised with non-invasive ventilation required mechanical ventilation in the first week. A higher quality evidence base for interventions that reduce mechanical ventilation could improve respiratory management in this population.

Neonatal clinical trials frequently encounter low enrolment rates, challenges obtaining consent and biased research populations. Alternative approaches to consent have been proposed to address these concerns but introduce complex ethical trade-offs. Using a modified Delphi approach with diverse stakeholders, we aimed to create recommendations for the use of alternative methods of consent in neonatal clinical trials. Our process resulted in 21 recommendations within three categories. In 'deciding whether to use alternative methods of consent', we present five statements to guide whether alternative methods are appropriate. For example, heightened justification may be required for early phase research or allocation arms that are highly preference-sensitive for families. In 'preallocation information and ability to opt-out', we present 11 statements related to information sharing with families of potential participants. These include guidance on researcher communication and guidance for passive information sharing such as via flyers. In 'postallocation information and decision to continue participation', we present five statements to guide later information sharing. These focus on best practices for researcher communication postallocation. For two items, our Working Group could not reach consensus. These items were not included in our recommendations. Our recommendations may guide researchers, clinicians, regulators and funders in the consideration and conduct of alternative methods of consent for neonatal clinical trials. Future work must evaluate these recommendations within neonatal clinical trials and the areas of lack of consensus among our Working Group.

To assess feasibility of recruitment and compare clinical outcomes in a trial of early selective treatment of a moderate-severe patent ductus arteriosus (PDA) or no intervention in the first 7 postnatal days in extremely preterm infants. Multicentre, open-label, parallel-design pilot randomised controlled trial SETTING: Seven tertiary/quaternary neonatal intensive care units. Infants <26 weeks gestational age (GA) with a PDA diagnosed within 72 hours after birth. Participants were randomised to an early echocardiographic screening within the first 72 hours followed by selective medical treatment (SMART) strategy of a moderate-severe PDA shunt or no intervention in the first 7&#x2009;days. The primary feasibility outcome was the proportion of eligible infants enrolled. Important secondary outcomes included a composite clinical endpoint of survival without major morbidity. 116 of 185 eligible infants were enrolled (63%, 95%&#x2009;CI 56% to 70%; SMART, n=51, Control, n=53). Of them, 104/116 (90%) (mean GA 24.3 weeks, birth weight 714&#x2009;g) were randomised. Protocol deviation was 1.9%. Based on the treatment algorithm, 24% infants randomised to SMART never required treatment. Median treatment initiation age in the SMART arm was 2&#x2009;days (IQR 1-2.5&#x2009;days). The SMART strategy demonstrated an 85% probability of a better Win ratio (1.34, 95% CrIs 0.73 to 2.5) compared with control. A trial of selective early PDA pharmacotherapy based on clinical and echocardiography grading of PDA shunt volume in the smallest infants is feasible with minimal protocol deviation. Early echocardiography screening and selective pharmacotherapy using the SMART-PDA algorithm may enhance the probability of survival with less morbidities in infants born <26 weeks GA. NCT05011149.

To evaluate enteral feeding practices in preterm infants in neonatal intensive care units (NICUs) in high-income countries across three continents, and compare results with a similar survey 13 years earlier. Web-based survey distributed to neonatologists at 258 NICUs across 15 countries in Europe, Australia, New Zealand and Canada, October 2023 and February 2024. Survey domains focused on availability of human milk, onset of enteral feeding, breast milk fortification (BMF), cytomegalovirus (CMV) screening and enteral supplements including probiotics. Results were compared with a similar survey performed in 2010. Replies were received from 185 (72%) NICUs. Access to donor human milk (DHM) was high (91%). Across all NICUs, feeds were started on day 1 in 64%, 73% and 85% among infants born <25, 25-27 and 28-31 weeks' gestation, respectively. Bovine milk-based BMF was routinely used in 88% of NICUs, with large variation in when it was commenced and discontinued. Routine use of human milk-based BMF was uncommon (4%). Maternal CMV status was routinely determined in 33% of all NICUs who then pasteurised or froze milk if the mother was CMV-seropositive. Probiotics were provided in 66% of the NICUs, with large variations in products and birth weight/gestational age criteria. Compared with our survey from 2010, more NICUs now start feeding preterm infants on day 1, and DHM availability has increased in some countries. Substantial variation remains in the use of BMF, probiotics and CMV screening. A stronger evidence base is needed to update guidelines, aiming ultimately to improve growth and long-term neurodevelopment.

To evaluate whether combining abdominal ultrasound with radiography improves diagnostic accuracy and surgical risk stratification in neonates with suspected necrotising enterocolitis (NEC) compared with radiography alone. Prospective cohort pilot study conducted in two tertiary neonatal intensive care units. Sixty-seven neonates with suspected NEC underwent concurrent abdominal radiography and ultrasound assessments. Imaging studies were independently reviewed by masked investigators using pre-specified criteria to classify each study as reassuring or non-reassuring. The main outcome measure was the need for surgical intervention. Imaging data were analysed using unsupervised k-means clustering (k=2): logistic regression-testing associations with surgery and principal component analysis (PCA)-to identify imaging features most contributing to group separation. Ultrasounds were reassuring in all cases subsequently diagnosed with non-NEC, that is, feeding intolerance, whereas most radiographs in this group were non-reassuring. Clustering based on radiographs alone did not significantly discriminate surgical risk (58.8% vs 39.4%; p=0.11). Combined model (radiograph+ultrasound) produced two distinct clusters with significantly different surgical rates (78.3% vs 34.1%; OR 6.96, 95% CI 2.29 to 24.58). PCA highlighted complex ascites, absent peristalsis and abnormal bowel perfusion as key discriminating features. Combining abdominal ultrasound with radiography improved the identification of neonates at high surgical risk from NEC, in our pilot study. A reassuring ultrasound reliably identified infants with feeding intolerance, suggesting potential to reduce unnecessary transfers and treatments. Larger multicentre studies are needed to validate these findings and inform development of a unified multimodal imaging score for NEC diagnosis.

Information on lung volume characteristics in infants with clinical signs of respiratory distress immediately after birth is limited. To assess changes in respiratory dynamics and physiological parameters in infants with and without respiratory distress in the delivery room and to determine the effect of continuous positive airway pressure (CPAP) support. Electrical impedance tomography data were obtained from late preterm and term infants, born via caesarean section in a tertiary referral centre. Changes in the ratio of inspiratory to expiratory time (Ti/Te-ratio), end-expiratory lung impedance (&#x2206;EELI), oxygen saturation (SpO2) and heart rate (HR) over the first 10 min as well as corresponding changes after CPAP application were assessed. Of 73 infants, 18 (25%) received CPAP after birth (11 not admitted (CPAP group) and 7 admitted to the neonatal intensive care unit (CPAP/NICU)). Ti/Te ratio differed significantly between groups with the highest values in the CPAP/NICU group, mostly due to a reduced Te. There was no difference in &#x2206;EELI. Similarly, infants in the CPAP/NICU group had lower SpO2 and HR trajectories over time than the other two groups. After CPAP application, &#x394;EELI increased significantly. There were no changes in Ti/Te ratio, SpO2 and HR after CPAP initiation. In infants with more severe respiratory distress, Ti/Te ratio was increased, and SpO2 and HR were reduced, suggesting that these parameters may serve as early predictors of respiratory failure. Application of CPAP resulted in an immediate increase in EELI, highlighting the importance of early CPAP initiation for infants with respiratory distress.

Postmortem (PM) examination can be valuable after a baby's death, providing information about the cause of death and support for families. However, worldwide trends indicate declining neonatal PM rates. We aimed to analyse trends in PM offer and completion after deaths in neonatal units. We used data from the National Neonatal Research Database on deaths in neonatal units in England, Wales and the Isle of Man (2017-2022). We used regression models to estimate rates of PM offer and completion and their association with selected clinical, socio-demographic and service-related variables. We report the relative risk (RR), with a p value <0.05 considered statistically significant. PM offer and completion rates ranged from 56% to 62%&#x2009;and 15% to 18%, respectively. Compared with extremely preterm infants, term infants had higher PM completion rates (RR 2.25, 95% CI 1.94 to 2.62, p<0.001). PM completion was less likely for babies of Asian (RR 0.58, 95% CI 0.46 to 0.72, p<0.001) or black mothers (RR 0.78, 95% CI 0.60 to 0.99, p=0.04) when compared with babies of white mothers. Babies of mothers in the country's least deprived decile were more likely to have a PM completed (RR 1.38, 95% CI 1.04 to 2.48, p=0.04), in comparison with the most deprived centile. This national study provides a near-contemporaneous perspective on neonatal PM and adds to existing evidence of low rates. These data indicate the need to address the root causes of variation in PM completion to ensure equity in the care of families after a neonatal death.