Vermont Oxford Network

Protocol available via doi/10.1002/14651858.CD015221.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of respiratory support during ETI in improving the rate of successful intubation in preterm and term neonates undergoing intubation in the NICU, delivery room, or emergency room compared to room air.

ABSTRACTBackgroundAlthough prenatal imaging advancements have increased isolated right aortic arch (iRAA) detection, optimal postnatal vascular ring management remains uncertain. Whereas early postnatal imaging and surgical management may be clinically warranted for some infants, long‐term data are not yet available to justify an identical approach for all prenatal iRAA diagnoses.MethodsChildren with prenatally diagnosed iRAA and left ductus arteriosus were included in a retrospective cohort study at a rural academic center. Fetal echocardiograms (2014–2024) were reviewed to exclude complex congenital heart disease. Joint postnatal cardiopulmonary care was standardized. Clinical data were ascertained using aerodigestive symptom checklists. Fisher's exact test was used to examine associations between symptoms and surgical referral. Growth was assessed by z‐score rates of change from birth weight until last clinic weight.Results3,458 fetal echocardiograms were performed yielding 31 distinct cases meeting inclusion criteria, with postnatal data available for 25. Twenty were managed medically (25% asymptomatic, 75% intermittently symptomatic) with median follow up of 14 (11.5, 17.5) months; five underwent surgery (80% progressively symptomatic) with median follow up of 36 (18, 37) months). Choking/dysphagia (p = 0.04), recurrent emesis (p = 0.03), and the combination of both digestive symptoms and noisy breathing (p = 0.01) were associated with surgical referral. Weight outcomes were similar (p = 0.98) between medical and surgical patients.ConclusionsAlthough aerodigestive symptoms were common, most were not progressive and weight profiles were not adversely affected. Isolated digestive symptoms or in combination with respiratory symptoms may prompt greater concern. A collaborative cardiopulmonary approach to clinical evaluation may help with short‐term risk stratification.

Among extremely low-birth-weight (ELBW; <1000 g) or extremely preterm (EPT; <28 + 0 weeks) infants, we aimed to describe size indicators at 18 to 24 months of corrected age and growth from neonatal intensive care unit (NICU) discharge to follow-up and to examine infant and maternal determinants of those outcomes. We studied 7301 ELBW/EPT children from 77 Vermont Oxford Network member hospitals. Continuous size indicators at 18 to 24 months were z scores of weight, length, head circumference, and body mass index based on World Health Organization standards. We represented growth by z score changes in weight and head circumference from NICU discharge to 18 to 24 months. We estimated associations of infant and maternal factors with indicators of size and growth in multivariate linear and logistic regression. Median gestational age was 26 weeks and birth weight was 800 g. From NICU discharge to 18 to 24 months, weight increased by median 0.74 z scores, but at 18 to 24 months, ELBW/EPT children remained lighter than the reference (median z score -0.26). In adjusted analyses, small-for-gestational-age (SGA) status, NICU weight faltering, and surgical necrotizing enterocolitis all predicted more rapid weight gain after NICU discharge, but infants with those conditions remained smaller at 18 to 24 months. For example, SGA infants gained 0.44 z scores more weight after NICU discharge than non-SGA infants (95% CI, 0.34-0.54) but were nonetheless 0.95 z scores lighter at 18 to 24 months (95% CI, -1.05 to -0.86). Our findings suggest substantial, albeit incomplete, catch-up growth in ELBW/EPT infants after NICU discharge through 18 to 24 months.

This study aimed to describe the epidemiology, pathogens, and outcomes associated with early-onset and late-onset sepsis among newborns admitted to the leading public neonatal hospital in Mexico.We conducted a retrospective cohort study of infants admitted to the neonatal intensive care unit (NICU) at the Instituto Nacional de Perinatología in Mexico City from 2018 to 2023. Early-onset sepsis (EOS) was defined as a culture-confirmed bacterial infection of blood or cerebrospinal fluid within 3 days of birth, and late-onset sepsis (LOS) as culture-confirmed bacterial or fungal infection after day 3. Descriptive statistics and logistic regression were used to compare characteristics and outcomes among infants with and without EOS/LOS.Among 4,381 admitted infants, 23 (0.5%) had EOS (5.2 per 1,000 admissions), and 444 of 3,950 (11.2%) who survived >3 days had LOS (112.4 per 1,000). Prematurity was a major risk factor. Escherichia coli accounted for 70% of EOS, and coagulase-negative staphylococci and Klebsiella spp. were the leading causes of LOS. Infections were associated with higher morbidity, longer hospitalization, and reduced survival, though mortality differences were not statistically significant after adjustment.Neonatal sepsis remains a major burden in this Mexican NICU, with a predominance of gram-negative organisms and incidence rates higher than recent U.S. reports. Continued surveillance and antimicrobial stewardship are warranted to guide empiric therapy and track resistance patterns. · Prematurity was a major risk factor for both early- and late-onset sepsis.. · Gram-negative organisms, especially Escherichia coli and Klebsiella species, were the predominant pathogens.. · Sepsis was associated with increased morbidity, prolonged hospitalization, and lower survival..

This is a protocol for a Cochrane Review (prototype). The objectives are as follows: The aim of this scoping review is to map the quantitative literature about in-hospital motor interventions used to reduce neurodevelopmental impairment in preterm infants. We will collate information about the features, delivery mechanisms, objectives, providers, underlying theoretical frameworks, hypothesized or reported outcomes of these interventions, and equity characteristics of the population. The goal will be to document the breadth and characteristics of available evidence and to identify gaps or areas of knowledge in the field of motor interventions. Subcategories: Identify motor interventions initiated during neonatal intensive care unit stays for preterm infants Identify techniques, elements, and modalities in each intervention Determine the theories underlying these interventions Describe the extent to which the interventions are parent-centered Synthesize and categorize the different motor interventions.