Submit to Children Review for Children Propose a Special Issue

Journal Menu

Journal Browser

Advances in Neonatal Resuscitation and Intensive Care

Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Related Special Issue
Published Papers

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Emergency Medicine & Intensive Care Medicine".

Deadline for manuscript submissions: closed (5 October 2025) | Viewed by 16205

Share This Special Issue

Special Issue Editors

Dr. Pranav Jani

E-Mail Website
Guest Editor

1. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
2. Department of Neonatology, Westmead Hospital, Westmead, NSW 2145, Australia
Interests: golden-hour practices for preterm infants; preventing brain injury; skin care; thermoregulation; incubator humidity
Special Issues, Collections and Topics in MDPI journals

Dr. Dharmesh Shah

E-Mail Website
Guest Editor

Department of Neonatology, Westmead Hospital, Westmead, NSW 2145, Australia
Interests: neonatal resuscitation; echocardiography; extremely preterm infants
Special Issues, Collections and Topics in MDPI journals

Dr. Rajesh Maheshwari

E-Mail Website
Guest Editor

Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
Interests: infant development; preterm infants; infant nutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Neonatal resuscitation and intensive care are essential for preventing neonatal death and adverse long-term neurodevelopmental impairments. Approximately 85% of full-term neonates initiate spontaneous respirations; <10% require advanced resuscitation measures such as positive-pressure ventilation, intubation and chest compression with or without adrenaline to initiate and support breathing and transition to the extrauterine life. Over the past decades, significant advances in all aspects of neonatal care have led to the improved survival of nonates, especially those born before 28 weeks gestation. There has also been a paradigm shift toward providing active care to neonates born at or below 23 weeks gestation. However, inspite of these advances, clinicians face many challenges when caring for unwell neonates right from resuscitation to hospital admission and follow-up care after discharge.

This Special Issue aims to describe the current advances in research on neonatal resuscitation and intensive care for preterm and full-term neonates. We are inviting research from various backgrounds such as animal studies, bench studies and human research that can contribute to advancing knowledge and/clinical care around neonatal resuscitation and intensive care.

Dr. Pranav Jani
Dr. Dharmesh Shah
Dr. Rajesh Maheshwari
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

neonatal intensive care
resuscitation
infant
premature infant
low-birth-weight infant

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Related Special Issue

Advances in Neonatal Resuscitation and Intensive Care—2nd Edition in Children

Published Papers (11 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Other

12 pages, 1061 KB

Open AccessArticle

The Premature Infants’ Gut Microbiota Assembly and Neurodevelopment (PIGMAN) Cohort Study: Protocol for a Prospective, Longitudinal Cohort Study

by Tingting Li, Liangfeng Fang, Xianhong Chen, Youming He, Xiaoyuan Pang, Ling Lin, Heng Chen, Yajie Su, Yan Huang, Yanping Guo, Tiantian Xiao, Aiping Liu, Yanli Wang, Hanhua Yang, Chuan Nie, Wei Zhou, Guang Yang, Chunquan Cai, Xiaoguang Zhou, Shujuan Zeng, Yongfu Yu, Long Li, Huifeng Zhang, Lijun Yu, Guoqiang Cheng, Wenhao Zhou, Cheng Chen, Zhangbin Yu, Mingbang Wang and Yingmei Xie Show full author list Hide full author list

Children 2025, 12(12), 1644; https://doi.org/10.3390/children12121644 - 3 Dec 2025

Viewed by 318

Abstract

Background: Early-life gut microbiota colonization plays a significant role in the neurodevelopment of infants and young children. However, the causal relationship between early-life gut microbiota colonization and neurodevelopment in preterm infants has not yet been conclusively established. Our research will initiate the PIGMAN (Premature Infants Gut Microbiota Assembly and Neurodevelopment) cohort study to systematically examine the dynamic interplay between gut microbiota developmental trajectories and neurodevelopmental processes in preterm infants. Methods: This study will employ a longitudinal cohort design and utilize data from the PIGMAN cohort, examining the interplay between gut microbiota metabolism and neurodevelopmental outcomes. The study design incorporates longitudinal stool sample collection, which will be analyzed through 16S rRNA gene sequencing and metagenomic shotgun sequencing, enabling comprehensive characterization of microbial community dynamics and functional metabolic pathways. Anticipated Results: Advanced analytical approaches incorporating causal inference methodologies will be implemented to identify significant microbial and metabolic biomarkers associated with neurodevelopmental outcomes in preterm neonates, and to establish causal pathways between these biomarkers and neurodevelopment. These analytical advancements will facilitate the construction of predictive models that utilize temporal microbial signatures and metabolite trajectories as prognostic indicators for neurodevelopmental outcomes. Causal inference method evaluations will further reveal that specific gut-derived metabolites, particularly those involved in cholesterol metabolism and neural signaling pathways—such as bile acids and GABA (gamma-aminobutyric acid)—exhibit superior predictive capacity for cognitive development trajectories. Anticipated Conclusions: The findings will collectively suggest that longitudinal metabolic profiling of the gut ecosystem, when combined with causal network analysis, provides a novel paradigm for developing clinically actionable predictive models of neurodevelopment in vulnerable preterm populations. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

16 pages, 1416 KB

Open AccessArticle

Prospective, Non-Blinded, Randomized Controlled Trial of Pulmonary Surfactant Administration Guided by Lung Ultrasound in Preterm Infants with Gestational Age < 32 Weeks

by Jinghui Zhang, Jinfang Yuan, Jing Xu, Tongyan Han, Yahui Zhang, Huiqiang Liu, Danfang Lu and Yunfeng Liu

Children 2025, 12(12), 1618; https://doi.org/10.3390/children12121618 - 27 Nov 2025

Viewed by 334

Abstract

Objectives: Current guidelines for pulmonary surfactant (PS) administration in preterm infants with respiratory distress rely on clinical signs and FiO₂ thresholds. Lung ultrasound offers a promising alternative for accurately diagnosing neonatal respiratory distress syndrome (NRDS) and assessing its severity. This randomized controlled trial aimed to evaluate whether a lung ultrasound-guided strategy for NRDS diagnosis and lung ultrasound scores (LUS)-guided PS administration could improve respiratory outcomes in preterm infants (<32 weeks’ gestation), compared to conventional methods. Methods: In this non-blinded randomized controlled trial, 89 preterm infants (≤32 weeks’ gestation) with respiratory distress after birth were enrolled. Participants were randomly assigned to either the ultrasound group (PS administration based on ultrasound-confirmed NRDS and LUS criteria) or the control group (PS administration according to standard clinical signs and FiO₂ requirements). Results: The ultrasound group demonstrated a significantly lower rate of invasive mechanical ventilation (p = 0.007) and a shorter duration of ventilation (p = 0.005) compared to the control group. Furthermore, the ultrasound group required less PS (p = 0.03), received their first dose at an earlier time (p = 0.017), and experienced fewer radiation exposures both before surfactant treatment and within the first week after birth (p = 0.023 and p = 0.019, respectively). Conclusions: The integration of lung ultrasound for NRDS diagnosis and LUS-guided surfactant therapy facilitates more precise and timely PS use. This strategy reduces the need for and duration of invasive mechanical ventilation and limits early radiation exposure in very preterm infants. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

14 pages, 2580 KB

Open AccessArticle

Optimal Duration of Umbilical Cord Clamping with Ventilation in a Preterm Asphyxiated Ovine Model

by Mausma Bawa, Sylvia Gugino, Justin Helman, Nicole Bradley, Lori Nielsen, Arun Prasath, Clariss Blanco, Mary Divya Kasu, Hamza Abbasi, Munmun Rawat and Praveen Chandrasekharan

Children 2025, 12(11), 1462; https://doi.org/10.3390/children12111462 - 28 Oct 2025

Viewed by 615

Abstract

Background: There is inadequate evidence to support recommendations for the delayed clamping of umbilical cords in preterm neonates who are born non-vigorous. Objective: In a preterm bradycardic ovine model, our objective was to compare the effects of early cord clamping with ventilation (ECCV) and various time periods of delayed cord clamping with ventilation (DCCV) at 1 min (DCCV1), 2 min (DCCV2), 3 min (DCCV3), 4 min (DCCV4), and 5 min (DCCV5). The primary composite outcome was (i) incidence of achieving a combined heart rate (HR) ≥ 100 bpm and preductal saturation (SpO₂) ≥80% by 5 min, and (ii) time to attain this outcome. Secondary outcomes were to evaluate gas exchange/hemodynamics. Methods: 32 preterm lambs of 126–128-day gestational age were randomized to one of six groups: ECCV (n = 5), DCCV1 (n = 6), DCCV2 (n = 5), DCCV3 (n = 6), DCCV4 (n = 6), and DCCV5 (n = 4). Asphyxia was induced by umbilical cord occlusion to attain a HR ≤ 90 beats per minute (bpm). Results: All lambs in DCCV5 achieved a primary composite outcome by 5 min. The time taken to achieve the primary composite outcome in DCCV5 was significantly lower (p = 0.02). Partial pressure of arterial carbon dioxide (PaCO₂) was significantly lower (p = 0.0001) in DCCV5. Peak pulmonary blood flow (PBF) was significantly higher (p = 0.0001) in DCCV5 while peak carotid blood flow (CBF) was highest in the ECCV (p < 0.0001) compared to other groups. Conclusions: In a preterm ovine model of asphyxia, resuscitation with an intact umbilical cord for 5 min increased the incidence and reduced the time to achieve the primary composite outcome, while also improving gas exchange by enhancing pulmonary blood flow, compared to shorter durations of DCCV and ECCV. These findings suggest that DCCV for 5 min may offer physiological advantages in the resuscitation of non-vigorous preterm neonates, warranting further investigation in clinical settings. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

13 pages, 820 KB

Open AccessArticle

Peripherally Inserted Central Catheters in Newborns: A Seven-Year Single-Center Experience from a Neonatal Intensive Care Unit

by Hasan Avsar, Ali Bulbul, Evrim Kiray Bas, Hasan Sinan Uslu and Ebru Turkoglu Unal

Children 2025, 12(9), 1168; https://doi.org/10.3390/children12091168 - 2 Sep 2025

Viewed by 1589

Abstract

Objectives: To evaluate the clinical characteristics, complication rates, and predictors of adverse outcomes related to peripherally inserted central catheters (PICC) in newborns over a seven-year period in a tertiary neonatal intensive care unit (NICU). Materials and Methods: This retrospective observational study included all neonates who underwent their first PICC placement between January 2017 and January 2024 in a single tertiary NICU. Demographic, clinical, and procedural data were collected, including birth weight, gestational age, catheter type, insertion site, dwell time, and reason for removal. Primary outcomes were PICC-related complications and catheter dwell time. Statistical analyses included chi-square or Fisher’s exact tests, Student’s t-test or ANOVA, and multivariable logistic regression to identify independent predictors of complications. Results: A total of 610 PICCs were evaluated. The mean gestational age was 31.0 ± 4.7 weeks, and the mean birth weight was 1579 ± 870 g. The majority of catheters (96.1%) terminated at the central location, with a mean dwell time of 12.9 ± 9.0 days. The most common removal reason was completion of therapy (60.3%), followed by mechanical complications (36.7%) and suspected infection (14.6%). Overall complication rate was 34.9%. In multivariable analysis, birth weight > 1000 g was associated with a lower risk of complications compared to <1000 g (1000–1500 g: OR 0.35, 95% CI 0.22–0.56; 1500–2000 g: OR 0.29, 0.15–0.54; >2000 g: OR 0.44, 0.21–0.92). Midline (OR 4.16, 1.76–9.83) and peripheral (OR 3.51, 1.82–6.76) terminations carried higher risk compared to central terminations. Use of antimicrobial-impregnated catheters reduced complication risk (OR 0.44, 0.26–0.74), while temporal vein insertion increased it (OR 4.14, 1.23–13.86). Conclusions: Low birth weight (<1000 g) and non-central catheter tip location are significant predictors of PICC-related complications in neonates, while antimicrobial-impregnated catheters have a protective effect. Targeted preventive strategies, strict adherence to insertion and maintenance bundles, and careful patient selection are recommended to improve outcomes in NICU patients. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

14 pages, 1100 KB

Open AccessArticle

Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial

by Siren Rettedal, Amalie Kibsgaard, Frederikke Buskov, Joar Eilevstjønn, Vilde Kolstad, Jan Terje Kvaløy, Peder Aleksander Bjorland, Hanne Pike, Joanna Haynes, Thomas Bailey Tysland, Peter G. Davis and Hege Ersdal

Children 2025, 12(8), 1082; https://doi.org/10.3390/children12081082 - 18 Aug 2025

Viewed by 1095

Abstract

Background/Objectives: Newborn heart rate is an integral part of resuscitation algorithms, but the impact of ECG monitoring on resuscitative interventions and clinical outcomes has been identified as a knowledge gap. The objective was to evaluate the impact of routine use of dry-electrode ECG in all newborns immediately after birth on time to start positive pressure ventilation (PPV) when indicated. Methods: We conducted a randomized clinical trial from June 2019 to November 2021 at Stavanger University Hospital, Norway. Dry-electrode ECG sensors were applied immediately after birth to all newborns ≥ 34 weeks’ gestation. Randomization determined whether the heart rate display was visible or masked. Time of birth was registered in an observation app. Time to start ventilation was calculated from video recordings. Results: In total, 7343 newborns ≥ 34 weeks’ gestation were enrolled, 4284 in the intervention and 3059 in the control group, and 3.7% and 3.8% received ventilation, respectively. In 171/275 (62%) of the newborns the exact time of birth and a video of the resuscitation were available, for 98 in the intervention and 73 in the control group. Ventilation was provided within 60 s to 44/98 (45%) in the intervention and 24/73 (33%) in the control group, p = 0.12. Time from birth to start of PPV was a median of 66 (44, 102) s in the intervention and 84 (49, 148) s in the control group, p = 0.058. Resuscitated newborns were apneic (74%) or breathing ineffectively (26%) at the start of PPV, and only 36% had a heart rate < 100 beats per minute. Conclusions: The use of dry-electrode ECG heart rate monitoring did not change the proportion of newborns that received ventilation within 60 s after birth, but early termination due to employee protests to video recordings rendered the trial inadequately powered to detect a difference. Breathing status was likely a more important determinant of starting ventilation than bradycardia. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

10 pages, 369 KB

Open AccessArticle

Acute Kidney Injury in the Neonatal Period: Retrospective Data and Implications for Clinical Practice

by Meidad Greenberg, Saray Sity-Harel, Sydney Benchetrit, Lewis Reisman, Tali Zitman-Gal, Daniel Erez, Maysam Shehab and Keren Cohen-Hagai

Children 2025, 12(7), 883; https://doi.org/10.3390/children12070883 - 3 Jul 2025

Cited by 1 | Viewed by 965

Abstract

Background: Neonates, particularly those born prematurely or with low birth weight, face an elevated risk of developing Acute Kidney Injury (AKI) due to various factors. Perinatal and maternal considerations, often linked to preterm delivery, contribute to this heightened risk. Methods: A retrospective study of neonates admitted to the intensive care unit at a single Israeli Hospital who were diagnosed as having AKI. The study includes follow-up data on these children. Results: During the study period, 971 neonates were admitted to the Pediatric Intensive Care Unit (PICU), and 47 cases had a documented diagnosis of AKI. Thirty-four of them had available long-term data and were included in this analysis. A total of 13 out of 26 subjects with available blood pressure measurements had high blood pressure for their age percentile compatible with the definition of hypertension, and 6 out of 34 (17.6%) had proteinuria. Conclusions: These findings underscore the importance of increased clinical awareness and structured long-term follow-up for neonates who experience AKI. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

10 pages, 2149 KB

Open AccessArticle

A Prospective Study on the Systematic Application of the Safe Insertion Umbilical Venous Catheter (SIUVeC) Bundle

by Giovanni Barone, Gina Ancora, Mauro Pittiruti, Giorgia Prontera, Giovanni Vento and Vito D’Andrea

Children 2025, 12(7), 819; https://doi.org/10.3390/children12070819 - 21 Jun 2025

Viewed by 1716

Abstract

Background/Objectives: Inserting umbilical venous catheters is a common procedure in neonatal intensive care units. However, this maneuver is potentially associated with early and late complications, some of which can be severe. Several strategies have been described in the literature to minimize the risk of such complications. The recently described SIUVeC (Safe Insertion Umbilical Venous Catheter) protocol incorporates all the innovations suggested by the latest literature, with the intention of reducing the risk associated with this procedure. The purpose of this paper is to report the outcomes of the systematic implementation of this protocol. Methods: Infants were enrolled in this prospective study if they were eligible for umbilical venous catheter placement. Results: A total of 449 infants were enrolled in the study. In total, 407 (90.6%) catheters were successfully placed in the proper position, at the inferior cavo–atrial junction. A total of 89.9% of the catheters were removed electively, without any complications. Conclusions: The SIUVeC protocol demonstrates an effective strategy for the safe elective insertion of umbilical venous catheters. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

15 pages, 1297 KB

Open AccessArticle

Evaluating Novel Chest Compression Technique in Infant CPR: Enhancing Efficacy and Reducing Rescuer Fatigue in Single-Rescuer Scenarios

by Marek Solecki, Monika Tomaszewska, Michal Pruc, Magdalena Myga-Nowak, Wojciech Wieczorek, Burak Katipoglu, Basar Cander and Lukasz Szarpak

Children 2025, 12(3), 346; https://doi.org/10.3390/children12030346 - 10 Mar 2025

Cited by 1 | Viewed by 3123

Abstract

Background/Objectives: Effective infant cardiopulmonary resuscitation (CPR) relies on high-quality chest compressions, yet the optimal technique for single-rescuer scenarios remains debated. Although widely used, the two-finger technique (TFT) is associated with an inadequate compression depth and increased rescuer fatigue. While the two-thumb encircling hands technique (TTHT) provides a superior compression depth, its application in single-rescuer scenarios is impractical. This study evaluates a novel technique (nT) as a potential alternative, aiming to optimize both compression efficacy and rescuer endurance. Methods: This randomized crossover study assessed the efficacy of the TFT, TTHT, and nT in a simulated infant CPR setting. Medical students trained in newborn and infant resuscitation performed all three techniques in a controlled environment using a high-fidelity neonatal simulator. We objectively measured and compared key CPR performance metrics, rescuer fatigue, and hand pain among the techniques. Results: The nT and TTHT outperformed the TFT in compression depth, rescuer endurance, and overall CPR quality. The nT achieved the highest adequate compression rate (92.4% vs. 78.6% for TTHT and 65.2% for TFT) while minimizing fatigue (RPE: 3.1 vs. 4.5 for TTHT and 6.2 for TFT) and hand pain (NRS: 1.8 vs. 3.9 for TTHT and 5.4 for TFT). TTHT produced the deepest compressions (mean: 44.2 mm vs. 42.9 mm for nT and 38.6 mm for TFT, p < 0.001). Rescuer anthropometric factors (sex, weight, and height) affected all techniques similarly, suggesting no inherent advantage based on body characteristics. Conclusions: Both the nT and TTHT outperformed the TFT, with the nT demonstrating superior rescuer endurance while maintaining high-quality compressions. Given its ergonomic benefits and effectiveness, the nT emerges as a promising alternative for single-rescuer infant CPR and warrants consideration for future resuscitation guidelines. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

13 pages, 191 KB

Open AccessArticle

The Experience of Caring for a Medically Complex Child in the Neonatal Intensive Care Unit: A Qualitative Study of Parental Impact

by Natascia Bertoncelli, Martina Buttera, Elisa Nieddu, Alberto Berardi and Licia Lugli

Children 2025, 12(2), 123; https://doi.org/10.3390/children12020123 - 23 Jan 2025

Cited by 1 | Viewed by 1957

Abstract

Background: Parents of children with life-limiting or life-threatening illnesses and/or medical complexity experience intense stress and pain soon after the birth and lifelong. Understanding parents’ experiences and coping strategies is the prerequisite to provide tailored support to families. Aim: To explore the experiences of parents of children with medical complexity (CMCs) during hospitalization in a Family-Centered Care (FCC) neonatal unit and after discharge. Design: Qualitative study. Methods: Semi-structured interviews were administered to the parents of children with medical complexity admitted to the Neonatal Intensive Care Unit (NICU) of Modena between October 2016 and January 2024. The interview was developed based on three time points: birth, hospitalization, and discharge, focusing on parents’ experiences, emotions, and communication with healthcare professionals. The interviews were analyzed using the template analysis. Results: A total of 10 parents were interviewed. Four domains were identified, encompassing eight significant themes in the parents’ experiences and their communication with healthcare professionals. The relevant emotions included anxiety and fear for survival, fatigue, and guilt over the child’s suffering, alongside hope and trust that parents felt entitled to nurture. Relationships with professionals were characterized by expectations and frustrations; mothers and fathers had different perceptions and reactions to the situation they were facing. Conclusions: This qualitative study explores the experiences of parents of CMCs in a neonatal intensive care unit adopting FCC. From admission to discharge, parents’ emotions were influenced by the child’s unique clinical history. Active listening and the humane attitude of healthcare professionals were the aspects most appreciated by parents. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

Other

Jump to: Research

37 pages, 514 KB

Open AccessSystematic Review

Acid–Base Status and Cerebral Oxygenation in Neonates: A Systematic Qualitative Review of the Literature

by Christian Mattersberger, Bernhard Schwaberger, Nariae Baik-Schneditz and Gerhard Pichler

Children 2025, 12(11), 1549; https://doi.org/10.3390/children12111549 - 16 Nov 2025

Viewed by 255

Abstract

Introduction: Blood gas analysis is utilized to assess parameters of oxygenation and ventilation, including acid–base status [pH value, base excess (BE) or base deficit (BD), and bicarbonate (HCO₃)], to evaluate systemic metabolism status. Acid–base imbalances can have complex effects on the organism, potentially impacting oxygen delivery to tissue. Cerebral oximetry is a non-invasive monitoring technique using near-infrared spectroscopy (NIRS) for the continuous measurement of cerebral tissue oxygenation. The relationship between the acid–base status and cerebral tissue oxygenation in neonates remains unclear. This systematic qualitative review aims to analyze current knowledge of the potential correlations between different acid–base status parameters and cerebral tissue oxygenation measured via NIRS in neonates. Methods: A systematic search of PubMed and Ovid Embase was performed, focusing on cerebral oxygenation, neonates, and acid–base status. Risk of bias was assessed using the ‘‘Risk of Bias for Non-randomized Studies of Exposures’’ (ROBINS-E) instrument. Results: Fifty studies that measured parameters of the acid–base status and cerebral tissue oxygenation in the neonatal period were identified. Seven studies demonstrated a correlation between pH and cerebral tissue oxygenation, while eleven studies found no such correlation. Five studies demonstrated a correlation between the BE/BD and cerebral tissue oxygenation, while six studies found no such correlation. Three studies demonstrated a correlation between HCO₃ and cerebral tissue oxygenation, while five studies found no such correlation. Discussion: Associations between acid–base status parameters and cerebral tissue oxygenation remain controversial. However, studies with the lowest risk of bias mainly demonstrated no significant correlation between any of the acid–base status parameters and cerebral tissue oxygenation. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Figure 1

13 pages, 1933 KB

Open AccessSystematic Review

Chest Compression Superimposed with Sustained Inflation or 3:1 Compression/Ventilation Ratio During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: A Systematic Review and Meta-Analysis

by Jenny Koo, Anup C. Katheria, Brenda Law, Anne Lee Solevåg, Gerhard Pichler and Georg M. Schmölzer

Children 2025, 12(2), 230; https://doi.org/10.3390/children12020230 - 13 Feb 2025

Cited by 2 | Viewed by 3387

Abstract

Background: Current resuscitation guidelines recommend a 3:1 chest compression/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI with 3:1 C:V during neonatal cardiopulmonary resuscitation (CPR). Methods: MEDLINE (through PubMed), Google Scholar, EMBASE, and Clinical Trials.gov through June 2024. Randomized controlled trials comparing CC + SI with 3:1 C:V during neonatal CPR in the delivery room were included. Data Analysis included Risk of bias was assessed using the Covidence collaboration tool, and results were pooled into a meta-analysis using a fixed effects model. Main outcomes were In-hospital mortality (primary). Time to return of spontaneous circulation (ROSC) and air leak (secondary). Results: Two studies were included. The pooled data suggests no difference in infant mortality between CC + SI versus 3:1 C:V during neonatal CPR (RR 0.64, 95% CI 0.21,1.7, p = 0.33, I² = 63%). The use of CC + SI during neonatal CPR could result in 182 fewer per 1000 (from 351 fewer to 311 more) infant deaths. The pooled data suggested a significant reduction in time to ROSC with CC + SI versus 3:1 C:V during neonatal CPR (mean difference 115 s (from 184.75 to 45.36 s), p = 0.001, I² = 26%). Air leak was not different between groups. Conclusions: While in-hospital mortality and air leak were not different between groups, time to ROSC was significantly reduced. A large clinical trial is warranted to assess if CC + SI improves outcomes. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

► Show Figures

Journal Menu

Journal Browser

Advances in Neonatal Resuscitation and Intensive Care

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Related Special Issue

Published Papers (11 papers)

Research

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI