To establish reference ranges for regional brain volumes in normally developing very preterm infants without brain injury at term-equivalent age, using automated brain segmentation, and to explore associations with sex and gestational age. This was a cross-sectional study of very preterm infants (gestational age <32 weeks) with structurally normal magnetic resonance imaging at term-equivalent age and normal neurodevelopmental outcomes up to 2 years of age. 3-Tesla MRI scans were processed using Infant Free Surfer, a fully automated segmentation tool, yielding 26 regional brain structures. MRIs were acquired on the same scanner. Only scans of highest quality, confirmed by expert consensus, were included. Associations between regional brain volumes and gestational age, as well as sex differences were assessed using Pearson correlations and Mann-Whitney U tests. The final cohort included 55 infants (24 male) with a median gestational age of 29.4 (interquartile range: 27.6-31.0) weeks. Reference volumes and sex-stratified centiles (3rd-97th) are provided. Male infants had significantly larger volumes of the putamen (p=0.031) and the hippocampus (p=0.003). Gestational age showed weak or no correlations with regional brain volumes. This study establishes normative data on regional brain volumes in a well-defined cohort of normally developing very preterm infants without brain injury at term-equivalent age. These data provide a reference for future research on early brain development and may support studies investigating whether deviations from typical brain development can be detected and inform early interventions.

The article "Seizure Burden before and after Lidocaine as Add-On Therapy in (Amplitude-Integrated) Electroencephalography-Confirmed Neonatal Seizures" [Neonatology. 2025; https://doi.org/10.1159/000549690] by Rondagh et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been updated.

Introduction The Bilistick is a handheld point-of-care device for measuring total bilirubin levels in small blood volumes. We assessed its diagnostic accuracy and user convenience in near-term neonates cared for at home. Methods A prospective cohort study was conducted in nine Dutch community midwifery practices. Neonates ≥35 weeks' gestation were eligible if they were at home between postnatal days 2-8 and had not received phototherapy. A Bilistick version 2.0 was used in parallel to laboratory-based bilirubin (LBB) quantification when significant visible jaundice was observed or the transcutaneous bilirubin reading was elevated. Results 2314 neonates were included in the study, with 423 blood samples analyzed across 13 laboratories. On 203 occasions, the Bilistick was not used. Among the remaining 220 Bilistick readings, 104 failed, and two lacked corresponding LBB results. A Bland-Altman plot of 114 paired measurements of Bilistick and LBB showed a mean difference of +9.7 µmol/L (0.57 mg/dL) with corresponding 95% limits of agreement of -179.7 to +199.2 µmol/L (-10.5 to 11.7 mg/dL). The positive predictive value of a Bilistick reading for having a TSB level above the phototherapy threshold was 36.4%. The negative predictive value was 90.1%, sensitivity 60% and specificity 77.6%. Hemolysis (24%) contributed to overestimations by the Bilistick. Community midwives expressed multiple barriers related to user convenience. Conclusion Diagnostic accuracy of the Bilistick when used in the home setting was limited. Its use was further hindered by a significant proportion of failed readings and low user-convenience when operated by midwives.

Introduction: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions. Methods: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation “Train the Trainers” course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites. Results: The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas. Conclusions: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.

Introduction: The aim of the study was to analyze for which reasons the certainty of evidence was downgraded in neonatal Cochrane reviews. Methods: We performed a systematic meta-epidemiological review for Cochrane Neonatal reviews published in 2022–2024. The search was performed in January 2025, and all reviews were screened by two authors. We extracted the information from the summary of findings tables. As the main outcome, we compared the reasons for downgrading across evidence-certainty categories. Secondary outcomes included the analysis of null effects and comparison of confidence interval width. Chi2 was used to analyze the categorized variables. Results: We included 54 reviews with 467 outcomes of which evidence certainty was rated very low (35%), low (43%), moderate (20%), and high (2%). Imprecision and risk of bias were the most frequent reasons for downgrading certainty of evidence (p < 0.001). Outcomes with effect estimates including the null were more often downgraded for imprecision, whereas outcomes without null effects were more often downgraded for risk of bias. A strong association was observed between certainty level and null effects: very low certainty evidence most often included the null effect, followed sequentially by low, moderate, and high certainty evidence (p < 0.001). Among dichotomous outcomes, wide confidence intervals were the predominant driver of imprecision, with CI width clearly associated both with certainty categories and with the frequency of downgrading due to imprecision. Discussion: The neonatal evidence was mainly limited due to imprecision and risk of bias. This indicates that larger scale high-quality studies in various neonatal topics are still greatly warranted.

Introduction: Spontaneous ductal closure is common in preterm populations; however, a subset of infants develops a hemodynamically significant PDA (hsPDA), which has been associated with adverse outcomes. The objective was to develop and internally validate a predictive model for hsPDA in preterm infants using a machine learning approach. Methods: A prospective cohort study including infants born at <33 weeks of gestation. B-type natriuretic peptide (BNP) levels within the first 120 h, gestational age, birth weight, and surfactant use were used to train a random forest classifier. The outcome was hsPDA diagnosed by standardized echocardiography. Model performance was assessed using stratified 5-fold cross-validation. Results: Sixty-seven infants were included; 46.3% had hsPDA. The random forest model achieved an area under the receiver operating characteristic curve (AUC) of 0.86, outperforming logistic regression using BNP alone (AUC 0.82). BNP was the strongest predictor (48% importance), followed by gestational age, birth weight, and surfactant use. Conclusion: A machine learning-based model combining BNP with clinical variables showed high accuracy in predicting hsPDA. The accompanying calculator may assist clinicians in early risk stratification, though external validation is required before clinical implementation.

Introduction: The use of reliable, validated, and multidimensional tools for pain evaluation has been recommended to manage neonatal pain. However, these tools have limited use in Japan due to their complexity, which involves numerous evaluation and observation items, making thorough observation challenging. Methods: We developed a new method based on the Premature Infant Pain Profile-Revised (PIPP-R), a multidimensional evaluation tool that includes physiological and behavioral indicators, to simplify the evaluation of facial expressions. Instead of assessing three facial expressions individually, we evaluate them in four categories. We also created a system that automatically records changes in vital signs and calculates scores. In this study, we determined if the facial expression score aligns with the conventional PIPP-R-based facial expression score. The scoring methods were categorized into three types: (1) a real-time new method, where facial expressions were evaluated concurrently with the puncture procedure using a new method; (2) an individual assessment method using recorded videos from the puncture sessions with facial expressions scored later using the PIPP-R; and (3) a new video-based method, in which facial expressions were evaluated using the new method while watching recorded videos. Results: The study included 63 healthy neonates (born at ≥37 weeks’ gestation) delivered at our hospital. The degree of agreement among the methods and the inter-rater agreement showed high levels of consistency. Conclusion: The new facial expression assessment method based on the PIPP-R demonstrated equivalence to conventional scoring in full-term neonates. Further validation, particularly in preterm infants and diverse clinical settings, is needed.

Introduction: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment. Methods: Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support. Results: We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34–35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs. Conclusion: Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.

Introduction: Skin care for very and extremely preterm infant is an important and previously underappreciated topic. Coconut oil skin care for preterm infants is a promising option, but several important questions remain including the theoretical potential for allergic sensitization. Methods: This prospective study conducted skin prick testing and allergy questionnaires in a cohort of very preterm infants who received routine skin care with virgin coconut oil during their neonatal admission. Results: Ninety infants (median GA 28.2 weeks, median BW 1,048 g) were assessed at corrected age 15 months. A total of 8 children had positive skin prick tests to 1 or more of the most common allergens (egg, peanut, cashew, dust mite). No child was sensitized to coconut oil or extract. Conclusions: We did not find evidence of allergic sensitization following neonatal skin care with coconut oil in children born preterm.