Biomedicines

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16 pages, 792 KB

Open AccessArticle

Risks and Benefits of Vesicoamniotic Shunting for Lower Urinary Tract Obstruction (LUTO) After Early, Intermediate and Late Onset of Therapy—A Monocentric Study of 104 Treated Cases

by Nadja Riehle and Thomas Kohl

Biomedicines 2026, 14(1), 182; https://doi.org/10.3390/biomedicines14010182 - 14 Jan 2026

Cited by 1 | Viewed by 1036

Abstract

Background/Objectives: We aimed to assess the risks and benefits of early, intermediate, and late vesicoamniotic shunting (VAS) for lower urinary tract obstruction (LUTO) treated at a single center. Methods: A retrospective analysis of 104 fetuses with LUTO that underwent VAS was [...] Read more.

Background/Objectives: We aimed to assess the risks and benefits of early, intermediate, and late vesicoamniotic shunting (VAS) for lower urinary tract obstruction (LUTO) treated at a single center. Methods: A retrospective analysis of 104 fetuses with LUTO that underwent VAS was carried out. The investigation covered the time between the first VAS and postnatal hospital discharge. The cases were analyzed in three groups: Group I fetuses underwent their first intervention ≤ 16 + 0 weeks; Group II fetuses underwent intervention between 16 + 1 and 24 + 0 weeks; and Group III fetuses underwent intervention > 24 + 0 weeks of gestation. Maternal morbidity, pre- and postnatal complications, fetal and neonatal mortality, and urological and renal outcomes were assessed. Results: All mothers tolerated the procedures well. Mean gestational age at delivery was 35.4 weeks of gestation. In total, 78 of 104 children were born alive (75%). Postnatal survival was 72 of 78 (92.3%). Overall survival was 72 of 104 (69.2%). Overall, 61.2% of children survived from Group I; 69% of children survived from Group II; and 100% of Group III children survived from the first VAS to postnatal hospital discharge. A total of 41 of 72 survivors (56.9%) were discharged with normal renal function. For 80%, normal renal function was highest after early VAS ≤ 16 + 0 weeks of gestation (Group I), whereas 31% of Group II and 61% of Group III survived with normal renal function. Postnatal pulmonary hypoplasia occurred in 13.3% of the cases of Group I, 40% of Group II, and 23.1% of Group III. Conclusions: The findings of this retrospective study confirm that VAS ≤ 16 + 0 weeks of gestation is the best chance for preserved renal function after birth. However, when LUTO is treated later in gestation, fetuses can also benefit from VAS. Pre-interventional sonography may aid in selecting those with the highest chances for a better renal outcome. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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25 pages, 1268 KB

Open AccessArticle

Mathematical Modeling of Obstetric Variables: Influence of COVID-19, Periodontal Disease and Dental Care During Pregnancy

by Juliana Velosa-Porras, Sandra Catalina Correa Herrera, Katherine Lucia Mejía Reyes, Paula Sofía Fuentes Rojas, Laura Daniela Ardila Ortiz, Olga Lucía Ospina, Signed Prieto-Bohórquez, Jairo Javier Jattin Balcázar, Jorge Edgar Guevara Muñoz, Leonardo Bonilla Cortés, Javier M. Mora-Méndez, Catalina Latorre Uriza, Francina María Escobar Arregoces and Nelly S. Roa

Biomedicines 2025, 13(12), 2919; https://doi.org/10.3390/biomedicines13122919 - 28 Nov 2025

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Abstract

Background: Systemic inflammatory factors may be altered by periodontitis and/or COVID-19, potentially increasing the risk of adverse pregnancy outcomes, a relationship that remains unclear. Objective: This study aimed to identify associations between periodontitis and COVID-19 during pregnancy, evaluating the influence of dental care [...] Read more.

Background: Systemic inflammatory factors may be altered by periodontitis and/or COVID-19, potentially increasing the risk of adverse pregnancy outcomes, a relationship that remains unclear. Objective: This study aimed to identify associations between periodontitis and COVID-19 during pregnancy, evaluating the influence of dental care on obstetric variables through set theory and probability. Methods: A quantitative, cross-sectional, and correlational study was conducted in two phases. The first phase analyzed 156 medical records from 5 institutions, including gynecological and periodontal data; the second phase examined 104 records from a single institution selected for data completeness (2020–2021). Descriptive statistics, bivariate analysis, chi-square tests, and odds ratios were applied. Set operations (union, intersection) and relative probabilities were calculated using R and Excel. Sets represented dental care, dental disease, COVID-19 diagnosis, gestational age, neonatal weight, and complications. Results: In Phase 1, 37% of pregnant women were COVID-19-positive, 44% vaccinated, 51.9% underwent cesarean section, and 5.12% had periodontitis. In Phase 2, 76 pregnant women did not receive dental care, while 28 did; among them, 6 were COVID-19-positive. Mean neonatal weight ranged from 2336 g (dental care) to 2271 g (no dental care). COVID-19-positive pregnant women showed fewer complications and a higher proportion of normal-weight neonates. Gingivitis was the most frequent periodontal condition (75%). No statistically significant differences were observed between the analyzed sets. Conclusions: no direct relationship was found between periodontitis and neonatal weight in COVID-19-positive cases. Dental care did not influence maternal–fetal outcomes. The methodology provides an innovative framework for clinical analysis through mathematical abstraction. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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22 pages, 2429 KB

Open AccessArticle

Maternal Dietary Choices Might Impact Intrauterine Healing Processes and Postnatal Phenotype and Function in Human Fetuses with Spina Bifida Aperta—Early Clinical Observations and Implications from a Retrospective Cohort Study

by Thomas Kohl

Biomedicines 2025, 13(11), 2791; https://doi.org/10.3390/biomedicines13112791 - 16 Nov 2025

Viewed by 663

Abstract

Background: The severity of postnatal symptoms in patients with spina bifida aperta (SBA) is also determined by secondary factors that damage the exposed neural tissue throughout gestation. The purpose of this report is to present clinical cases, from 2010 to 2025, and a [...] Read more.

Background: The severity of postnatal symptoms in patients with spina bifida aperta (SBA) is also determined by secondary factors that damage the exposed neural tissue throughout gestation. The purpose of this report is to present clinical cases, from 2010 to 2025, and a new hypothesis for a nonsurgical means of prenatal secondary prophylaxis. Patients: Eight fetuses underwent minimally invasive fetoscopic patch closure of SBA. After delivery, an unusual degree of prenatal patch healing was observed. Furthermore, time to complete postnatal skin closure was shorter (mean ± SD: 22.00 ± 6.53 days) than in 31 contemporary patients without dietary restrictions (Mean ± SD: 44.35 ± 11.91 days; p < 0.001). Four of the eight prenatally operated women reported that they ate plant-based food most of the time but also some meat throughout gestation; the other four were strict vegetarians. Two other fetuses with SBA at the level of the second and third lumbar vertebrae, respectively, had not undergone prenatal surgery. Following delivery, they presented with a markedly preserved surface of the neural cord and exhibited L5 motor function. One mother of the postnatally operated patients was on a vegetarian diet; the other one on a vegan diet. Conclusions: These early clinical observations point to the possibility that maternal plant-based diets might ameliorate the loss of neurological function and facilitate wound healing in human fetuses with SBA. If this impact of maternal dietary habits holds true, it opens the door to a far-reaching, easily available, non-invasive secondary prophylaxis in prenatally operated and unoperated fetuses with SBA and some other malformations. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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14 pages, 690 KB

Open AccessArticle

A Single-Center Clinical Experience with Fully Percutaneous, Minimally Invasive Fetoscopic Surgery for Spina Bifida Aperta

by Robert Brawura Biskupski Samaha, Mirosław Wielgoś, Thomas Kohl, Michal Lipa, Ksawery Goławski, Katarzyna Kosińska-Kaczyńska, Katarzyna Luterek, Przemysław Kosiński and Julia Sienczyk

Biomedicines 2025, 13(11), 2625; https://doi.org/10.3390/biomedicines13112625 - 27 Oct 2025

Cited by 1 | Viewed by 1178

Abstract

Background/Objectives: Following a tailored curriculum, minimally invasive fetoscopic coverage for spina bifida aperta (SBA) was introduced in Poland in 2017. This study aims to present the results of the first patients that underwent this procedure in the 1st Department of Obstetrics and [...] Read more.

Background/Objectives: Following a tailored curriculum, minimally invasive fetoscopic coverage for spina bifida aperta (SBA) was introduced in Poland in 2017. This study aims to present the results of the first patients that underwent this procedure in the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw and compare them with the results obtained in other studies. Methods: We reviewed our data of 38 expectant mothers whose fetuses with SBA and normal karyotype underwent minimally invasive fetoscopic coverage at our center between September 2017 and February 2022. All procedures were carried out between 24 + 4 and 28 + 1 weeks of gestation employing general materno-fetal anesthesia. New methods were implemented with time, moving from the patch technique to the skin-to-skin technique suture. The results of the study were compared with the available literature on fetoscopic and open surgeries. Results: In total, the procedure was attempted 38 times and completed in 34 cases. All lesions were lumbar, and the median width of the lateral ventricle was 12 mm (6–17 mm). The median age at surgery was 26 weeks and the median age at delivery was 32 weeks of gestation (26.1–37.5). The average birth weight was 1870 g (1070–3350g). From 34 patients to 31 at the one year follow-up, 13 out of 31 (41.9%) babies needed a shunt and more than 70% of babies had a functional motor level that was the same or better than the anatomical level. Conclusions: Minimally invasive surgery for SBA could successfully be implemented following a tailored curriculum at our university with encouraging maternal and neonatal outcomes. The fetoscopic approach permits the assessment of various closure approaches. Preterm delivery is common but usually occurs beyond 30 weeks of gestation. At this time relevant complications from prematurity are rare. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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11 pages, 650 KB

Open AccessArticle

Associations of First-Trimester Screening Markers and Hematological Indices with Placenta Accreta Spectrum in Pregnancies Complicated by Placenta Previa

by Volkan Karatasli, Ahkam Goksel Kanmaz, Alaattin Karabulut and Abdurrahman Hamdi Inan

Biomedicines 2025, 13(9), 2082; https://doi.org/10.3390/biomedicines13092082 - 27 Aug 2025

Viewed by 1601

Abstract

Background: Placenta accreta spectrum (PAS) is a serious pregnancy complication associated with significant hemorrhaging and elevated maternal morbidity. Timely prenatal diagnosis is critical for reducing the risk of adverse outcomes. In this study, we aimed to investigate the association between PAS and [...] Read more.

Background: Placenta accreta spectrum (PAS) is a serious pregnancy complication associated with significant hemorrhaging and elevated maternal morbidity. Timely prenatal diagnosis is critical for reducing the risk of adverse outcomes. In this study, we aimed to investigate the association between PAS and first-trimester maternal serum screening markers, as well as selected hematological and inflammatory indices, in pregnancies complicated by placenta previa (PP). Methods: A retrospective study was conducted at a tertiary care center. Pregnant women with singleton pregnancies who had been diagnosed with PP and undergone first-trimester aneuploidy screening and delivered at the same institution were included. The participants were divided into two groups: those diagnosed with PAS (including placenta accreta, increta, and percreta) and those with PP without placental invasion. Data on maternal demographics, the first-trimester serum levels of pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (β-hCG), as well as pre-delivery complete blood count parameters, were collected. Associations between these markers and abnormal placental implantation were analyzed. Results: In total, 181 participants were included in this study, corresponding to 15 cases of PAS and 166 cases of non-invasive PP. The women in the PAS group were significantly younger than those in the non-invasive-PP group (25.3 ± 5.1 vs. 30.0 ± 6.3 years, p < 0.001). The serum levels of PAPP-A and free β-hCG were significantly higher in the PAS cases (p < 0.05). The mean platelet volume (MPV) was significantly lower inF the PAS group (p < 0.05). We did not observe any significant differences in other hematological parameters, including hemoglobin concentration, white blood cell count, neutrophil and lymphocyte counts, platelet count, red cell distribution width, and inflammatory ratios such as the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Conclusions: Elevated first-trimester levels of PAPP-A and β-hCG, along with a reduced MPV, may serve as early indicators of PAS in pregnancies complicated by PP. These biomarkers may assist in early risk stratification and help inform perinatal management strategies. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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15 pages, 1904 KB

Open AccessArticle

The Dynamics of Transaminase and Alkaline Phosphatase Activities in the “Mother–Placenta–Fetus” Functional System

by Elena Kolodkina and Sergey Lytaev

Biomedicines 2025, 13(3), 626; https://doi.org/10.3390/biomedicines13030626 - 4 Mar 2025

Cited by 2 | Viewed by 3684

Abstract

Background: The timing of delivery depends on the condition of the fetus and the mother’s body, which is reflected in both the incretion of enzymes in the pregnant woman’s body and their use by the developing fetus in the anabolic process. The aim: [...] Read more.

Background: The timing of delivery depends on the condition of the fetus and the mother’s body, which is reflected in both the incretion of enzymes in the pregnant woman’s body and their use by the developing fetus in the anabolic process. The aim: This work was aimed to analyze the activities of transaminases (aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) and alkaline phosphatase (AlPh) in liquid media (blood serum, amniotic fluid, umbilical cord blood, and placental homogenate) in pregnant women in each trimester of pregnancy and in the postpartum period, considering the timing and type of delivery (term, premature or late delivery, or cesarean section). Methods: Data from studies in non-pregnant (n = 45) and pregnant (n = 193) women, including women in labor with different delivery timings (term, premature, and late) and types of delivery (natural birth or cesarean section), were analyzed. Amniotic fluid, umbilical cord blood, and the placental homogenate were collected during labor. The de Ritis coefficient (AST/ALT) was calculated. Alkaline phosphatase activity was determined using the standard constant-time method using Lahema diagnosticum biotests, and transaminase activity was determined using the colorimetric dinitrophenylhydrazine method, according to Reitman and Frenkel. Outcomes: The highest alkaline phosphatase activity was recorded in the placenta homogenate (6906.2 ± 208.1 U/mL) in pregnant women who gave birth at term. The highest transaminase activity was found in umbilical cord blood and, in particular, in the placenta in pregnant women with premature and late births. Conclusions: The significant role of transaminases and alkaline phosphatase in the transport functions of the histohematic barriers of the mother and fetus was established, which provides a mechanism for the constancy of enzyme levels in blood plasma. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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Review

Jump to: Research, Other

22 pages, 2073 KB

Open AccessReview

Advances in Fetal Repair of Spina Bifida Integrating Prenatal Surgery, Stem Cells, and Biomaterials

by Aleksandra Evangelista, Luigi Ruccolo, Valeria Friuli, Marco Benazzo, Bice Conti and Silvia Pisani

Biomedicines 2026, 14(1), 136; https://doi.org/10.3390/biomedicines14010136 - 9 Jan 2026

Cited by 1 | Viewed by 2017

Abstract

Spina bifida (SB) is a congenital malformation of the central nervous system (CNS), resulting from incomplete closure of the neural tube (NT) during early embryogenesis. Myelomeningocele (MMC), the most severe form of SB, leads to progressive neurological, orthopedic, and urological dysfunctions due to [...] Read more.

Spina bifida (SB) is a congenital malformation of the central nervous system (CNS), resulting from incomplete closure of the neural tube (NT) during early embryogenesis. Myelomeningocele (MMC), the most severe form of SB, leads to progressive neurological, orthopedic, and urological dysfunctions due to both NT developmental failure and secondary intrauterine injury (“two-hit hypothesis”). Prenatal repair of MMC has progressed considerably since the Management of Myelomeningocele Study (MOMS, 2011) trial, which showed that open fetal surgery can decrease the need for shunting and improve motor function, although it carries significant maternal risks. To address these limitations, minimally invasive techniques have been developed, with the goal of achieving similar benefits for the fetus while reducing maternal morbidity. Recent research has shifted toward regenerative strategies, integrating mesenchymal stem cells (MSCs), bioengineered scaffolds, and cell-derived products to move beyond mere mechanical protection toward true NT repair. Preclinical studies in rodent and ovine models have shown that amniotic- and placenta-derived MSCs exert neuroprotective and immunomodulatory paracrine effects, promoting angiogenesis, modulating inflammation, and supporting tissue regeneration. Minimally invasive, cell-based interventions such as Transamniotic Stem Cell Therapy (TRASCET), in preclinical rodent models, offer the possibility of very early treatment without hysterotomy, although translation remains limited by the lack of large-animal validation and long-term safety data. In parallel, advances in biomaterials, nanostructured scaffolds, and exosome-based therapies reinforce a regenerative paradigm that may improve neurological outcomes and quality of life in affected children. Ongoing translational studies are essential to optimize these approaches and define their safety and efficacy in clinical settings. This review provides an integrated overview of embryological mechanisms, diagnostic strategies, and prenatal therapeutic advances in SB treatment, with emphasis on prenatal repair, fetal surgery and emerging regenerative approaches. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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20 pages, 1204 KB

Open AccessReview

Serum Biomarkers in Patent Ductus Arteriosus in Preterm Infants: A Narrative Review

by Manuela Cucerea, Raluca Marian, Marta Simon, Madalina Anciuc-Crauciuc, Andreea Racean, Andrea Toth, Zsuzsánna Simon-Szabó, Mihaela-Georgiana Fadur, Valeriu Moldovan and Elena Moldovan

Biomedicines 2025, 13(3), 670; https://doi.org/10.3390/biomedicines13030670 - 9 Mar 2025

Cited by 8 | Viewed by 3370

Abstract

Background: Patent ductus arteriosus (PDA) in preterm infants presents a significant challenge in neonatal care, marked by ongoing debates about its definition, diagnosis, treatment options, and effects on patient outcomes. Plasma biomarkers assess mediators involved in PDA closure and hemodynamic responses, assisting [...] Read more.

Background: Patent ductus arteriosus (PDA) in preterm infants presents a significant challenge in neonatal care, marked by ongoing debates about its definition, diagnosis, treatment options, and effects on patient outcomes. Plasma biomarkers assess mediators involved in PDA closure and hemodynamic responses, assisting in identifying newborns at higher risk of developing potentially serious neonatal conditions. The purpose of this review was to investigate the relationship between PDA and various plasma biomarkers used to evaluate and diagnose ductal patency during perinatal life, as outlined in the relevant literature. Methods: We conducted an electronic search of the National Library of Medicine (MEDLINE)/PubMed and Web of Science for relevant studies published up to December 2024, including prospective, retrospective, cohort, and cross-sectional studies, as well as reviews and meta-analyses. The keywords used in the search included “preterm infant”, “persistent ductus arteriosus”, “patent ductus arteriosus”, “PDA”, “neonatal biomarkers”, “cardiac biomarkers”, and “vasoactive biomarkers”. Results: Out of the 813 identified articles, 85 were included in our review of cardiac biomarkers: Natriuretic peptides (NPs), Cardiac troponin T (cTnT), vasoactive biomarkers (Mid-regional pro-adrenomedullin (MR-proADM), Endothelin-1 (ET-1), Copeptin, and Isoprostanes (IPs)), and inflammatory biomarkers (Interleukin-6 (IL-6), IL-8, IL-10, Growth Differentiation Factor 15 (GDF-15), Monocyte Chemoattractant Protein-1 (MCP-1/CCL2), Macrophage Inflammatory Protein-1α (MIP-1α/CCL3)) in relation to PDA. Conclusions: Even if research shows a strong correlation between specific biomarkers and echocardiographic parameters in patients with PDA, clinical judgment must take these evaluations into account, particularly when determining whether to treat a PDA. Future research should focus on investigating new biomarkers associated with the underlying mechanisms of perinatal ductus arteriosus dynamics in preterm infants. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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27 pages, 1771 KB

Open AccessEditor’s ChoiceReview

Impact of Early-Life Microbiota on Immune System Development and Allergic Disorders

by Norbert Dera, Katarzyna Kosińska-Kaczyńska, Natalia Żeber-Lubecka, Robert Brawura-Biskupski-Samaha, Diana Massalska, Iwona Szymusik, Kacper Dera and Michał Ciebiera

Biomedicines 2025, 13(1), 121; https://doi.org/10.3390/biomedicines13010121 - 7 Jan 2025

Cited by 20 | Viewed by 7625

Abstract

Introduction: The shaping of the human intestinal microbiota starts during the intrauterine period and continues through the subsequent stages of extrauterine life. The microbiota plays a significant role in the predisposition and development of immune diseases, as well as various inflammatory processes. Importantly, [...] Read more.

Introduction: The shaping of the human intestinal microbiota starts during the intrauterine period and continues through the subsequent stages of extrauterine life. The microbiota plays a significant role in the predisposition and development of immune diseases, as well as various inflammatory processes. Importantly, the proper colonization of the fetal digestive system is influenced by maternal microbiota, the method of pregnancy completion and the further formation of the microbiota. In the subsequent stages of a child’s life, breastfeeding, diet and the use of antibiotics influence the state of eubiosis, which determines proper growth and development from the neonatal period to adulthood. The literature data suggest that there is evidence to confirm that the intestinal microbiota of the infant plays an important role in regulating the immune response associated with the development of allergic diseases. However, the identification of specific bacterial species in relation to specific types of reactions in allergic diseases is the basic problem. Background: The main aim of the review was to demonstrate the influence of the microbiota of the mother, fetus and newborn on the functioning of the immune system in the context of allergies and asthma. Methods: We reviewed and thoroughly analyzed the content of over 1000 articles and abstracts between the beginning of June and the end of August 2024. Over 150 articles were selected for the detailed study. Results: The selection was based on the PubMed National Library of Medicine search engine, using selected keywords: “the impact of intestinal microbiota on the development of immune diseases and asthma”, “intestinal microbiota and allergic diseases”, “the impact of intrauterine microbiota on the development of asthma”, “intrauterine microbiota and immune diseases”, “intrauterine microbiota and atopic dermatitis”, “intrauterine microbiota and food allergies”, “maternal microbiota”, “fetal microbiota” and “neonatal microbiota”. The above relationships constituted the main criteria for including articles in the analysis. Conclusions: In the present review, we showed a relationship between the proper maternal microbiota and the normal functioning of the fetal and neonatal immune system. The state of eubiosis with an adequate amount and diversity of microbiota is essential in preventing the development of immune and allergic diseases. The way the microbiota is shaped, resulting from the health-promoting behavior of pregnant women, the rational conduct of the medical staff and the proper performance of the diagnostic and therapeutic process, is necessary to maintain the health of the mother and the child. Therefore, an appropriate lifestyle, rational antibiotic therapy as well as the way of completing the pregnancy are indispensable in the prevention of the above conditions. At the same time, considering the intestinal microbiota of the newborn in relation to the genera and phyla of bacteria that have a potentially protective effect, it is worth noting that the use of suitable probiotics and prebiotics seems to contribute to the protective effect. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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24 pages, 4570 KB

Open AccessReview

Current Diagnostic, Counseling, and Treatment Options in Non-Severe and Severe Apparently Isolated Fetal Ventriculomegaly

by Mateusz Zamłyński, Marta Grokhovska, Andrea Surányi and Anita Olejek

Biomedicines 2024, 12(12), 2929; https://doi.org/10.3390/biomedicines12122929 - 23 Dec 2024

Cited by 4 | Viewed by 5473

Abstract

The widening of the vestibular dimension of lateral ventricles > 10 mm should be considered a symptom rather than a definitive diagnosis. In fact, fetal ventriculomegaly (VM) is a defect with ’multifaceted‘ clinical consequences in the child’s further neurodevelopment. Isolated fetal ventriculomegaly can [...] Read more.

The widening of the vestibular dimension of lateral ventricles > 10 mm should be considered a symptom rather than a definitive diagnosis. In fact, fetal ventriculomegaly (VM) is a defect with ’multifaceted‘ clinical consequences in the child’s further neurodevelopment. Isolated fetal ventriculomegaly can cause neurological defects ranging from mild neurodevelopmental delay to severe complications in the form of ongoing palliative care to the death of patients at various developmental periods. The spectrum of compilations often depends on the severity of the ventriculomegaly. In the prenatal period, the combined diagnostic tools include the following: ultrasound/MRI and genetic, infectious tests that form the basis of reliable counseling. We hypothesize that advances in the diagnostic process allow the identification of ‘probably’ isolated forms of severe VM (ISVM). The review authors electronically searched MEDLINE, EMBASE, and the Cochrane Library databases, describing the evidence-based validity and option of prenatal decompression for ISVM. The purpose of this review is to present the evolution of diagnostic techniques and views indicating the possibility and limitations of implementing prenatal decompression in severe ISVM. In conclusion, after reviewing the available data, we want to introduce the idea that perinatal centers are close to or have reached the necessary capability, expertise, and competence to perform ISVM decompression procedures. Endoscopic ventriculostomy of the third ventricle (ETV) appears to be promising, as it seems to be associated with minimal perinatal complications and better neurological outcomes for the newborn. However, long-term follow-up results for the neurodevelopment of patients who underwent ETV have not been reported. Looking ahead, randomized trials with the long-term neurodevelopmental follow-up of children who underwent prenatal decompression due to ISVM are needed. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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Other

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25 pages, 10158 KB

Open AccessSystematic Review

Efficacy of Expressed Breast Milk Versus Sweet Solutions for Neonatal Procedural Pain: A Systematic Review and Meta-Analysis

by Vanessa Espejo-Mansilla, Alessandra Coscia, Héctor Fuentes-Barría, Raúl Aguilera-Eguía, Lisse Angarita-Davila, Cherie Flores-Fernández and Ángel Roco-Videla

Biomedicines 2026, 14(7), 1565; https://doi.org/10.3390/biomedicines14071565 - 13 Jul 2026

Abstract

Objective: To evaluate the efficacy of expressed breast milk in reducing procedural pain in neonates compared with sweet solutions and to assess differences according to type of sweetener and timing of pain assessment. Materials and Methods: A systematic review and meta-analysis of randomized [...] Read more.

Objective: To evaluate the efficacy of expressed breast milk in reducing procedural pain in neonates compared with sweet solutions and to assess differences according to type of sweetener and timing of pain assessment. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA guidelines and registered in PROSPERO (CRD420261418093). PubMed/MEDLINE, Scopus, CINAHL, Cochrane Library, and Google Scholar were searched through May 2026. Random-effects models using standardized mean differences (Hedges’ g) were applied. Heterogeneity was assessed using the I² statistic. Meta-analyses were conducted by pain assessment time point, with subgroup and sensitivity analyses. Risk of bias was assessed using RoB 2 and certainty of evidence (CoE) using GRADE. Results: Seventeen randomized controlled trials were included. No statistically significant differences were observed between expressed breast milk and sweet solutions during the procedure (SMD = 0.15; 95% CI −0.18 to 0.47; I² = 82.6%; Low CoE), at 1 min post-procedure (SMD = 0.40; 95% CI −0.11 to 0.92; I² = 84.5%; Low CoE), or at 2 min post-procedure (SMD = 0.27; 95% CI −0.14 to 0.69; I² = 7.9%; Moderate CoE). Subgroup analyses showed no significant differences or interactions. Egger’s test detected significant funnel plot asymmetry during the procedure (intercept = −3.61; 95% CI −5.53 to −1.69; p = 0.005), but not at 1 min post-procedure (intercept = 1.84; 95% CI −3.53 to 7.20; p = 0.521). Conclusions: Current evidence suggests that expressed breast milk provides analgesia comparable to sweet solutions for neonatal procedural pain, although the certainty of the evidence is limited by substantial heterogeneity. Full article

(This article belongs to the Special Issue Advances in Fetal Medicine and Neonatology)

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