Search Results (36)

Background/Objectives: Probiotic supplementation has been actively investigated in preterm populations to reduce the risk of necrotizing enterocolitis (NEC) and late-onset sepsis. Despite this, few studies have focused on clinically relevant feeding tolerance and growth outcomes, and there is an alarming lack of evidence surrounding extremely preterm infants (defined as birth before 28 weeks gestational age), those most at risk of severe comorbidities. We aimed to investigate whether probiotics improve feeding tolerance, neonatal growth and neonatal morbidity among extremely preterm infants. Methods: A literature search was conducted in Medline, Embase, Cochrane CENTRAL, Web of Science, and clinicaltrials.gov for ongoing trials. We included extremely preterm infants from randomized controlled trials and non-randomized trials with a concurrent control group. Two authors independently performed screening, data extraction and risk of bias assessment using the Risk of Bias 2 tool from Cochrane. The certainty of the evidence was assessed using GRADE. Results: Eleven RCTs and three non-randomized studies with a concurrent control group were included, analyzing a total of 14,888 extremely preterm infants. Meta-analyses revealed lower mean days to full enteral feeds (mean difference 1.1 days lower; 95% CI, 7.83 lower to 5.56 higher) and lower duration of parenteral nutrition (mean difference 2.4 days lower; 95% CI, 7.44 lower to 2.58 higher) in infants treated with probiotics; however, this was not statistically significant. There was a significant reduction in NEC (RR; 0.80, 95% CI; 0.68, 0.93) and all-cause mortality (RR; 0.56, 95% CI; 0.33, 0.93) in the probiotic group. All outcomes were graded at low or very low certainty of evidence. Conclusions: The findings indicate a trend towards a potential beneficial effect of probiotic supplementation in reducing feeding intolerance and a notable reduction of risk of NEC and all-cause mortality in infants receiving probiotics. Future RCTs will focus on feeding intolerance, and growth outcomes are warranted. Full article

Background: Sodium regulation is critical in extremely low-birth-weight (ELBW, <1000 g) infants. In a recent systematic review, a sodium pattern over postnatal age and its variables (care factors, fluid regimens, and maturational factors) has been summarized. However, this systematic review also illustrated the shortages and limitations of reported cohorts, and the need to report on additional datasets. This study therefore aims to describe the postnatal sodium patterns and their variables in a cohort of ELBW neonates in the first 10 days of postnatal life. Methods: Data on 1704 serum sodium observations in the first 10 days of life from 211 ELBW infants hospitalized in a single neonatal intensive care unit were available to explore associations between serum sodium and perinatal variables. Multivariate linear models with sodium as a response variable and postnatal day as a factor were hereby applied. Baseline and treatment characteristics were included as variables, applying an unstructured covariance matrix to account for the longitudinal data. Results: Gestational age, birth weight, and length showed variable correlations with serum sodium concentrations over postnatal age. Interestingly, the analysis of sodium patterns in this ELBW cohort also revealed significant associations between prenatal betamethasone use, delivery mode, ibuprofen, or the use of inotropes and the postnatal serum sodium concentrations patterns. Multivariate analyses confirmed that gestational age and birth weight independently impacted sodium concentration patterns, and that ibuprofen use remained a significant variable after adjusting for these variables. Conclusions: Gestational age and birth weight complexities emphasize the need for nuanced understanding and standardized methodologies. Sodium patterns in the current ELBW cohort provide support for previously published sodium reference patterns in this population. New variables associated with sodium levels include ibuprofen administration and the use of inotropic agents. Full article

Background/Objectives: The numerical risk of bronchopulmonary dysplasia (BPD) and/or death could be estimated using the National Institute of Child Health and Human Development (NICHD) BPD outcome estimator 2022 in extremely low gestational age (ELGA) infants during the first 4 weeks of life to facilitate prognostication, and center-specific targeted improvement interventions. However, the 2022 NICHD BPD outcome estimator’s performance in the Canadian setting has not been validated. Our objective is to validate the NICHD BPD outcome estimator 2022 in predicting death and or moderate to severe BPD at 36 weeks in infants less than 29 weeks admitted to NICU. Methods: A retrospective observational study (March 2022–August 2023) was conducted on both inborn and outborn preterm infants excluding neonates with major congenital anomalies. Infants were classified into six groups based on the predicted risk of death or Grade 2 or 3 BPD (<10%, 10–20%, 20–30%, 30–40%, 50–59%, ≥60%) followed by noting observed outcomes from the unit’s database. A receiver operating characteristics (ROC) curve was used to assess the accuracy of the NICHD BPD outcome estimator 2022, with an area under curve (AUC) > 0.7 defined a priori as an acceptable predictive accuracy for local use. Results: Among 99 infants included, 13 (13.1%) died, and 40 (40.4%) developed BPD. Median gestational age was 26 weeks, and median birth weight was 914 g. Twenty-three infants (23.2%) received postnatal steroids. The AUC values for death or moderate to severe BPD on days 1, 3, 7, 14, and 28 were 0.803, 0.806, 0.837, 0.832, and 0.843, respectively. The AUC values for moderate to severe BPD alone on those days were 0.766, 0.746, 0.785, 0.807, and 0.818 respectively. Conclusions: The 2022 BPD estimator adequately predicted the death and/or moderate to severe BPD on days 1, 3, 7, 14, and 28 of life. This tool could serve as a valid adjunct to facilitate discussion between clinicians and families on initiating time-sensitive targeted interventions to prevent or alter the course of BPD. Full article

Background/Objectives: To obtain bioelectrical data to assess nutritional status for extremely low-birth-weight (ELBW) infants upon reaching term-corrected age. Methods: A descriptive, observational, prospective, and single-center study, which included ELBW preterm infants was performed. The study variables collected were gestational age, sex, and anthropometry at birth and at term-corrected age. Bioelectrical impedance vector analysis (BIVA) was performed by a phase-sensitive device (BIA 101 BIVA PRO AKERN srl, Pisa, Italy). The components of the impedance vector—resistance (R) and reactance (Xc)—were normalized for body height (H). For each subject, the measurement was taken between the 36th and 44th weeks of postmenstrual age (PMA). A semi-quantitative analysis of body composition was performed using the vector modality of the BIA. Using the RXc graph method, the bivariate 95% confidence intervals of the mean vectors were constructed. From the bivariate normal distribution of R/H and Xc/H, the bivariate 95%, 75%, and 50% tolerance intervals for this cohort were drawn. The individual impedance vectors were compared with the distribution of the vectors from other populations. Results: 85 ELBW infants (40 male, 45 female) were included, with a mean gestational age at birth of 26 + 6 weeks (±1.76). Mean R/H was 870.33 (±143.21) Ohm/m and Xc/H was 86.84 (±19.05) Ohm/m. We found differences in the bioelectrical data with regard to gender, with resistance values being significantly higher in females. Our ellipses align closely with those from other term neonatal cohorts. Conclusions: Bioelectrical data and the confidence and tolerance ellipses of an ELBW infant cohort are presented and can be used as a reference standard for nutritional assessment at discharge. Full article

Background/Objectives: This study identified early neonatal factors predicting pre-discharge mortality among extremely preterm infants (EPIs) or extremely low birth weight infants (ELBWIs) in China, where data are scarce. Methods: We conducted a retrospective analysis of 211 (92 deaths) neonates born <28 weeks of gestation or with a birth weight <1000 g, admitted to University Affiliated Hospitals from 2013 to 2024 in Guangzhou, China. Data on 26 neonatal factors before the first 24 h of life and pre-discharge mortality were collected. LASSO–Cox regression was employed to screen predictive factors, followed by stepwise Cox regression to develop the final mortality prediction model. The model’s performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic, calibration curves, and decision curve analysis. Results: The LASSO–Cox model identified 13 predictors that showed strong predictive accuracy (AUC: 0.806/0.864 in the training/validation sets), with sensitivity and specificity rates above 70%. Among them, six predictors remained significant in the final stepwise Cox model and generated similar predictive accuracy (AUC: 0.830; 95% CI: 0.775–0.885). Besides the well-established predictors (e.g., gestational age, 5 min Apgar scores, and multiplicity), this study highlights the predictive value of the maximum FiO₂. It emphasizes the significance of the early use of additional doses of surfactant and umbilical vein catheterization (UVC) in reducing mortality. Conclusions: We identified six significant predictors for pre-discharge mortality. The findings highlighted the modifiable factors (FiO₂, surfactant, and UVC) as crucial neonatal factors for predicting mortality risk in EPIs or ELBWIs, and offer valuable guidance for early clinical management. Full article

Background/Objectives: While neonatal morbidities associated with early preterm birth are known, the risks of maternal morbidities in these births remain unclear. Thus, we set out to assess the risk of maternal morbidities associated with early preterm births. Methods: Retrospective cohort study utilizing the United States (US) Natality Live Birth database from the Centers for Disease Control and Prevention (2016–2021). Low-risk singleton pregnancies were included. High-risk conditions such as out-of-hospital births, fetal anomalies, pregestational and gestational diabetes, and hypertensive disorders of pregnancy were excluded. The rates of several maternal morbidities were compared among three gestational age at birth groups: 23 0/7–27 6/7 (i.e., extreme preterm), 28 0/7–33 6/7 (i.e., early preterm), and 37 0/7–41 6/7 (i.e., term, reference group) weeks. Multivariable logistic regression was used to adjust outcomes for potential confounders. Data were presented as adjusted odds ratios (aORs) with a 95% confidence interval (CI). Results: 18,797,394 live births were analyzed. Extreme and early preterm birth were associated with increased odds of maternal transfusion (aOR 3.32, 95% CI 3.13–3.53 and aOR 2.96, 95% CI 2.86–3.07), uterine rupture (aOR 3.75, 95% CI 3.14–4.48 and aOR 4.13, 95% CI 3.76–4.54), unplanned hysterectomy (aOR 5.60, 95% CI 4.85–6.48 and aOR 5.92, 95% CI 5.47–6.40), and maternal admission to the intensive care unit (ICU, aOR 10.58, 95% CI 9.97–11.54 and aOR 10.13, 95% CI 9.77–10.50) compared to term birth. The odds of third- or fourth-degree perineal lacerations were decreased in both preterm birth groups compared to term birth. Conclusions: In addition to the known prematurity-related neonatal morbidities, extreme and early preterm births also impose a risk for maternal morbidities. Higher odds of maternal transfusion, uterine rupture, unplanned hysterectomy, and maternal admission to the ICU were detected in our cohort. These data should be taken into consideration when caring for patients with preterm births. Full article

Objective: The aim of this study was to evaluate high-frequency percussive ventilation (HFPV) as a rescue strategy for extremely low gestational age neonates (ELGANs) with severe lung disease. Methods: This is a retrospective review of 16 ELGANs with severe lung disease who were placed on HFPV following a lack of improvement on other modes of conventional and high-frequency ventilation. Results: The gestational age of these 16 infants was 25 (24, 26) weeks and their birth weight was 640 (535, 773) grams [median (IQR)], with the survivors being more immature compared to those who died [24 (23, 26) and 26 (25, 28) weeks, respectively; (p = 0.04)]; and with an overall mortality of 31% (N = 5). Of those who died, 60% were SGA (p = 0.02). Following placement on HFPV, the survivors had a statistically significant decrease in their respiratory severity scores (RSSs) [11 (9, 14) to 6 (5, 13), p = 0.03] compared to those who did not survive [15 (11, 16) to 11 (6.8, 14.5), p = 0.32] due to an improvement in their oxygenation [FiO₂: 0.95 (0.85, 1) to 0.6 (0.4, 0.9), p = 0.01; compared to 1 (1, 1) to 1 (0.7, 1); survivors and non-survivors, respectively; p = 0.32]. Chest X-rays also showed significantly improved aeration due to decreased areas of atelectasis in those who survived. Conclusions: HFPV may be an appropriate rescue mode of high-frequency ventilation in the ELGAN population with severe lung disease, particularly for patients with impaired oxygenation and ventilation difficulties due to shifting atelectasis and mucous plugging. Full article

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality data to understand causes and risk factors, helping in prevention efforts. This study includes 140 cases collected during 2018–2022. Demographic, maternal, and thanatogenetic data were statistically analyzed. We observed an upward slope of stillborn babies. In the case of live-born premature, the average survival was 301.76 h. The multivariate analysis noted that extremely low birth weight (HR = 5.141) and very low birth weight (HR = 4.177) are risk factors involved in mortality. Increased parity was associated with premature births with low and very low birth weight (p = 0.019). We observed that a mother’s age of over 30 years is predictable for the development of pregnancy-induced hypertension. Cerebral and pulmonary hemorrhages were the most common intermediate morbid conditions, with prematurity and plurivisceral hemorrhages serving as their root causes. We have identified that anthropometric measurements have a high predictability on malformed babies. The identified associations indicate a shared mechanism for certain lesion processes, which can help optimize resources for predicting and preventing preterm neonatal issues. Full article

Advances in perinatal intensive care have significantly enhanced the survival rates of extremely low gestation-al-age neonates but with continued high rates of bronchopulmonary dysplasia (BPD). Nevertheless, as the survival of these infants improves, there is a growing awareness of associated abnormalities in pulmonary vascular development and hemodynamics within the pulmonary circulation. Premature infants, now born as early as 22 weeks, face heightened risks of adverse development in both pulmonary arterial and venous systems. This risk is compounded by parenchymal and airway abnormalities, as well as factors such as inflammation, fibrosis, and adverse growth trajectory. The presence of pulmonary hypertension in bronchopulmonary dysplasia (BPD-PH) has been linked to an increased mortality and substantial morbidities, including a greater susceptibility to later neurodevelopmental challenges. BPD-PH is now recognized to be a spectrum of disease, with a multifactorial pathophysiology. This review discusses the challenges associated with the identification and management of BPD-PH, both of which are important in minimizing further disease progression and improving cardiopulmonary morbidity in the BPD infant. Full article

Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother’s age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62–7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46–0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67–8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24–8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32–0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions. Full article

Introduction: Prophylactic paracetamol for extremely low gestation age neonates (ELGAN, <27 weeks’ gestation) with symptomatic patent ductus arteriosus (sPDA) in high-income countries (HIC) reduces medical and surgical interventions. Its effectiveness in low-to-middle-income countries (LMIC) remains uncertain. This study assesses prophylactic paracetamol’s impact on sPDA interventions in ELGANs in an LMIC. Methods: This is a retrospective cohort study that compared a historical cohort of ELGANs that were treated with oral ibuprofen or intravenous paracetamol after diagnosis of sPDA (n = 104) with infants (n = 76) treated with prophylactic paracetamol (20 mg/kg loading, 7.5 mg/kg qid for 4 days), in a tertiary neonatal intensive care unit (NICU) in Vietnam. Oral ibuprofen or intravenous therapeutic paracetamol were administered if prophylactic paracetamol failed to close sPDA. Surgical ligation was conducted if targeted medical intervention failed, or the infant deteriorated from conditions attributable to sPDA. Results: In the historical cohort, 57 (55%) infants died within 7 days of life compared to 18 (24%) from the prophylactic cohort (p < 0.01). Of the survivors, 21 (45%) of the historical and 23 (39.7%) of the prophylactic cohort required surgical ligation (p = 0.6). Duration of hospitalization for survivors was lower in the prophylactic cohort (mean 74 vs. 97 days, p = 0.01). In the prophylactic cohort, 24 (41%) infants did not need further treatment while 34 (59%) required further treatment including ibuprofen and/or paracetamol 28 (48%) and surgical ligation 22 (38%). Conclusions: Prophylactic paracetamol for ELGAN in LMIC does not reduce the need for surgical ligation, sPDA rates, and other PDA-related morbidities in infants who survive beyond 7 days of age. It may reduce the risk of death and the duration of hospitalization but further study into the reasons behind this need to be determined with larger studies. Full article

Maturational changes in the gut start in utero and rapidly progress after birth, with some functions becoming fully developed several months or years post birth including the acquisition of a full gut microbiome, which is made up of trillions of bacteria of thousands of species. Many factors influence the normal development of the neonatal and infantile microbiome, resulting in dysbiosis, which is associated with various interventions used for neonatal morbidities and survival. Extremely low gestational age neonates (<28 weeks’ gestation) frequently experience recurring arterial oxygen desaturations, or apneas, during the first few weeks of life. Apnea, or the cessation of breathing lasting 15–20 s or more, occurs due to immature respiratory control and is commonly associated with intermittent hypoxia (IH). Chronic IH induces oxygen radical diseases of the neonate, including necrotizing enterocolitis (NEC), the most common and devastating gastrointestinal disease in preterm infants. NEC is associated with an immature intestinal structure and function and involves dysbiosis of the gut microbiome, inflammation, and necrosis of the intestinal mucosal layer. This review describes the factors that influence the neonatal gut microbiome and dysbiosis, which predispose preterm infants to NEC. Current and future management and therapies, including the avoidance of dysbiosis, the use of a human milk diet, probiotics, prebiotics, synbiotics, restricted antibiotics, and fecal transplantation, for the prevention of NEC and the promotion of a healthy gut microbiome are also reviewed. Interventions directed at boosting endogenous and/or exogenous antioxidant supplementation may not only help with prevention, but may also lessen the severity or shorten the course of the disease. Full article

Prenatal exposure to toxic metals is associated with altered placental function and adverse infant and child health outcomes. Adverse outcomes include those that are observed at the time of birth, such as low birthweight, as well as those that arise later in life, such as neurological impairment. It is often the case that these adverse outcomes show sex-specific responses in relation to toxicant exposures. While the precise molecular mechanisms linking in utero toxic metal exposures with later-in-life health are unknown, placental inflammation is posited to play a critical role. Here, we sought to understand whether in utero metal exposure is associated with alterations in the expression of the placental proteome by identifying metal associated proteins (MAPs). Within the Extremely Low Gestational Age Newborns (ELGAN) cohort (n = 230), placental and umbilical cord tissue samples were collected at birth. Arsenic (As), cadmium (Cd), lead (Pb), selenium (Se), and manganese (Mn) concentrations were measured in umbilical cord tissue samples via ICP-MS/MS. Protein expression was examined in placental samples using an LC-MS/MS-based, global, untargeted proteomics analysis measuring more than 3400 proteins. MAPs were then evaluated for associations with pregnancy and neonatal outcomes, including placental weight and gestational age. We hypothesized that metal levels would be positively associated with the altered expression of inflammation/immune-associated pathways and that sex-specific patterns of metal-associated placental protein expression would be observed. Sex-specific analyses identified 89 unique MAPs expressed in female placentas and 41 unique MAPs expressed in male placentas. Notably, many of the female-associated MAPs are known to be involved in immune-related processes, while the male-associated MAPs are associated with intracellular transport and cell localization. Further, several MAPs were significantly associated with gestational age in males and females and placental weight in males. These data highlight the linkage between prenatal metal exposure and an altered placental proteome, with implications for altering the trajectory of fetal development. Full article

(1) Background: This study aimed to evaluate whether the implementation of a modified blood-sampling protocol, which focused on need-based laboratory testing and minimized venous sampling by replacing it with point-of-care testing (POCT) via capillary puncture, successfully reduced iatrogenic blood loss, incidence of anemia, and the frequency of blood transfusion among extremely low-birth-weight infants (ELBWIs) without negatively affecting neonatal outcomes. (2) Methods: A retrospective analysis was conducted on 313 ELBWIs with a gestational age (GA) of between 23 and 28 weeks and born between 2013 and 2019. The infants were divided into two groups corresponding to the periods before (period I) and after (period II) the implementation of the modified blood-sampling protocol in January 2016. Propensity score matching was conducted to minimize selection bias. Clinical data, including the frequency and amount of blood sampling, the frequency and volume of blood transfusion, and clinical characteristics, such as gestational age, birth weight, and neonatal outcome data, were collected and compared between the two groups. (3) Results: No significant differences in GA or birth weight between the two periods were observed. The total sampling volume a month after birth (16.7 ± 4.1 mL vs. 15.6 ± 4.4 mL, p = 0.03) and the total sampling volume during hospitalization days (51.4 ± 29.7 mL vs. 44.3 ± 27.5 mL, p = 0.04) in period II were significantly lower than those in period I. There were no differences in terms of anemia (hemoglobin 10.8 ± 2.2 vs. 11.0 ± 1.9, p = 0.43) and mortality or morbidity, such as intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis, between the two periods. Although the transfusion frequency and amount did not present significant differences between the periods, we observed a positive correlation between the transfusion frequency and sampling volume (coefficient: 0.09, 95% CI: 0.08–0.11). (4) Conclusions: The modified blood-sampling protocol effectively reduced the level of iatrogenic blood loss without negatively affecting the neonatal outcomes. Full article

Background: Premature infants are born with immature cerebral autoregulation function and are vulnerable to pressure passive cerebral circulation and subsequent brain injury. Measurements derived from near-infrared spectroscopy (NIRS) have enabled continuous assessment of cerebral vasoreactivity. Although NIRS has enabled a growing field of research, the lack of clear standardization in the field remains problematic. A major limitation of current literature is the absence of a comparative analysis of the different methodologies. Objectives: To determine the relationship between NIRS-derived continuous indices of cerebral autoregulation in a cohort of extremely low birth weight (ELBW) infants. Methods: Premature infants of birth weight 401–1000 g were studied during the first 72 h of life. The cerebral oximetry index (COx), hemoglobin volume index (HVx), and tissue oxygenation heart rate reactivity index (TOHRx) were simultaneously calculated. The relationship between each of the indices was assessed with Pearson correlation. Results: Fifty-eight infants with a median gestational age of 25.8 weeks and a median birth weight of 738 g were included. Intraventricular hemorrhage (IVH) was detected in 33% of individuals. COx and HVx demonstrated the highest degree of correlation, although the relationship was moderate at best (r = 0.543, p < 0.001). No correlation was found either between COx and TOHRx (r = 0.318, p < 0.015) or between HVx and TOHRx (r = 0.287, p < 0.029). No significant differences in these relationships were found with respect to IVH and no IVH in subgroup analysis. Conclusions: COx, HVx, and TOHRx are not numerically equivalent. Caution must be applied when interpreting or comparing results based on different methodologies for measuring cerebral autoregulation. Uniformity regarding data acquisition and analytical methodology are needed to firmly establish a gold standard for neonatal cerebral autoregulation monitoring. Full article