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A new standard for NOWS Neonatal Opioid Withdrawal is a major public health problem in the world. Large numbers of infants born after fetal exposure to opioids experience unpleasant symptoms, requiring non-pharmacologic and pharmacologic intervention. Studies of different approaches for symptom…

Neonatal Research Shorts : March 2026 Pineda R, et al. Language and sound exposure across neonatal intensive care hospitalization and relationships with early outcome. J Perinatol 2026. In this short term outcome study, 64 very preterm infants

Steroids and BPD, what do we really know? My first foray into systematic review and meta-analysis was about 25 years ago with this article Barrington KJ. The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs. BMC Pediatr. 2001;1:1. As you…

Registration of clinical trials. Since 2005 the International Committee of Medical Journal Editors has required that a condition of publication of a prospective controlled trial is that it should be registered in an accessible database prior to starting the trial. It is understandable that for a…

Neonatal Acute Respiratory Distress Syndrome, what is it and how should we treat it? ARDS is a fairly common problem in the adult and the paediatric ICU; following trauma, or systemic sepsis, or other extrapulmonary insults, usually inflammatory in nature, or as a complication of direct pulmonary…

Neonatal Research Shorts : February 2026 Dereymaeker A, et al. Neonatal sleep physiology and early executive functioning in preterm children. Pediatr Res. 2026. In this observational study, the authors recorded sleep architecture overnight shortly prior to discharge of 76 preterm infants,…

Optimizing ventilation in established BPD Babies with established BPD (I won't worry about the exact diagnostic criteria here, but very preterm infants who are still ventilated as they approach term are the group I am talking about) have somewhat reduced compliance, increased airways resistance,…

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…

Neonatal Opioid Withdrawal is a major public health problem in the world. Large numbers of infants born after fetal exposure to opioids experience unpleasant symptoms, requiring non-pharmacologic and pharmacologic intervention. Studies of different approaches for symptom control have the potential to improve outcomes for this fragile population. To go back in the history a bit, the Finnegan scale was developed as a research tool, it is fairly cumbersome, with 21 items, several of which are rather subjective, and some are frequent in babies without opioid exposure. The threshold for treatment, of a score of 8, was entirely arbitrary, and has never been adequately tested or compared to other thresholds.

Pineda R, et al. Language and sound exposure across neonatal intensive care hospitalization and relationships with early outcome. J Perinatol 2026. In this short term outcome study, 64 very preterm infants <29 weeks GA were evaluated at near-term age with the Neonatal Neurobehavioural Score (NNNS). They had previously had a recording of the ambient noise for 4 separate 16 hour periods during their NICU stay, which was analysed to determine the exposure to any noise, including electronic sounds (which I guess means alarms, and monitors beeping), or meaningful language or distant voices.

My first foray into systematic review and meta-analysis was about 25 years ago with this article Barrington KJ. The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs. BMC Pediatr. 2001;1:1. As you can see it was the very first article in the new journal BMC Pediatrics, I had submitted to BioMed Central, BMC, because it was a new open access model of publishing, (which authors didn't have to pay for!) and then they asked me if I minded them transferring it to BMC Pediatrics.

Since 2005 the International Committee of Medical Journal Editors has required that a condition of publication of a prospective controlled trial is that it should be registered in an accessible database prior to starting the trial. It is understandable that for a few years afterwards, trials that had been commenced prior to this standard might not have been pre-registered. I don't think there is any reasonable excuse for not pre-registering prospective trials in more recent years. Since 2013, the World Medical Association's declaration of Helsinki has also clearly stated "Every research study involving human subjects must be registered in a publicly accessible database before recruitment of the first subject".

ARDS is a fairly common problem in the adult and the paediatric ICU; following trauma, or systemic sepsis, or other extrapulmonary insults, usually inflammatory in nature, or as a complication of direct pulmonary insults, such as pneumonia or aspiration of gastric contents. It is characterised by acute respiratory distress, diffuse pulmonary infiltrates on the x-ray, without signs of cardiac compromise, an oxygenation defect, and a major decrease in lung compliance. Various definitions have been proposed, none of which are entirely satisfactory, but many cases in the PICU are fairly clear.

Dereymaeker A, et al. Neonatal sleep physiology and early executive functioning in preterm children. Pediatr Res. 2026. In this observational study, the authors recorded sleep architecture overnight shortly prior to discharge of 76 preterm infants, averaging 30 weeks GA. The main finding was that infants with less sleep time (as a percentage of the recording) had more executive function problems. This was a single recording prior to discharge, and might not reflect total sleep problems during the hospitalisation, but is certainly suggestive that preterms need their sleep. Take Home Message…

Babies with established BPD (I won't worry about the exact diagnostic criteria here, but very preterm infants who are still ventilated as they approach term are the group I am talking about) have somewhat reduced compliance, increased airways resistance, leading to long time constants, and rather heterogeneous lungs, often with apical emphysema and basal atelectasis. Ventilatory requirements are different to infants with, for example, HMD, who have predominately atelectatic lung disease, very low compliance, and airways resistance which is largely normal, apart from the resistance due to the endotracheal tube; such infants have very short time constants, so can be ventilated with very short expiratory times, and respond to increased PEEP with improving oxygenation.

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, and affecting 1 or 2 of the Bassan zones, has little impact on motor or cognitive outcomes unless complicated by PHH. Andrew Whitelaw died recently (a touching eulogy is on the site of the Newborn Brain Society), I knew him personally, having worked as his resident during a summer in Jersey (Channel Isles, UK), when he covered for my consultant during their vacation.

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 like from families, or from former preterm infants. I would encourage any readers of the blog, and especially those from the 2 groups I just mentioned, a few of whom, I know, follow this blog, to participate.

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 being better at detecting hyperoxia, at least when it was working well. There are numerous recent publications about automated FiO2 control, at the end of this post I have put a list of a selection of publications from the last 8 years or so.