Search Results (263)

Background/Objectives: Survival of infants born very preterm or with very low birth weight has improved without a comparable reduction in neurodevelopmental morbidity, and the exposures acting during neonatal intensive care are usually studied in isolation. We aimed to identify which prenatal, perinatal and postnatal factors are independently associated, domain by domain, with neurodevelopment at 24 months’ corrected age (CA) and with the composite outcome of neurodevelopment and survival. Methods: Single-centre prospective cohort of 146 infants (135 assessed at 24 months’ CA and 11 who died between day 8 of life and the assessment) with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g admitted to a level III unit (2018–2022). Neurodevelopment was assessed with the Bayley-III; a score < 85, rather than the conventional <70 being taken as pathological, was used, with the third edition yielding systematically higher scores. Eighty-one candidate exposures were screened; for each domain a primary composite outcome (score < 85 or death) and a secondary survivors-only outcome were analysed by exploratory multivariable logistic regression. Results: Twenty-nine of 164 eligible survivors (17.68%) were lost to follow-up and did not differ appreciably from the analysed cohort (all standardised differences ≤ 0.10). Severe intraventricular haemorrhage was associated with language, sepsis and anaemia requiring transfusion with motor, and male sex and sepsis with socio-emotional development, whereas no covariate was associated with cognition. No nutritional, metabolic or postnatal-growth variable was independently associated with any domain, and no association survived Benjamini–Hochberg control of the false discovery rate (optimism-corrected c-statistics 0.598–0.739). Conclusions: These findings are associations rather than evidence of causality; they are hypothesis-generating and warrant multicentre external validation and longer follow-up. Full article

Background: Polyhydramnios is associated with adverse perinatal outcomes and is commonly assessed using either the amniotic fluid index (AFI) or the maximal vertical pocket (MVP). Although both methods are accepted in clinical practice, they frequently classify the same pregnancy differently, and their relative ability to predict adverse neonatal outcomes remains uncertain. Methods: We conducted a retrospective cohort study of pregnancies delivered at a tertiary university medical center between 2010 and 2025. Pregnancies with an AFI or MVP measurement within two weeks before delivery were eligible. Pregnancies complicated by diabetes mellitus or major fetal anomalies were excluded. Polyhydramnios severity was classified separately according to AFI and MVP criteria. The primary outcome was a composite of severe neonatal morbidity including neonatal intensive care unit admission, umbilical artery pH < 7.1, 5 min Apgar score < 7, or perinatal death. Separate multivariable logistic regression models were constructed for AFI- and MVP-based severity classifications. Results: Among 32,928 pregnancies, 3146 (9.6%) had polyhydramnios. Moderate-to-severe polyhydramnios defined by MVP was independently associated with severe neonatal morbidity (adjusted odds ratio [aOR] 2.47, 95% confidence interval [CI] 1.57–3.90; p < 0.001), whereas AFI-based severity classification was not (aOR 1.44, 95% CI 0.98–2.12; p = 0.07). Severe neonatal morbidity increased progressively with increasing MVP measurements. Mild polyhydramnios, regardless of the measurement method, was not associated with increased neonatal morbidity. Similar findings were observed in sensitivity analyses. Conclusions: MVP-based severity classification identified pregnancies at increased risk of severe neonatal morbidity, whereas AFI-based classification did not, at their conventional thresholds. These findings suggest that MVP may provide better risk stratification in pregnancies complicated by polyhydramnios and support prospective studies to validate its role in clinical management. Full article

Hepatitis B virus (HBV) infection is a worldwide health concern that infects nearly 254 million people globally and causes more than 1 million deaths annually. The highest prevalence is seen in sub-Saharan Africa and the Western Pacific region. Cirrhosis, liver failure, and hepatocellular carcinoma (HCC) are reported as leading complications of chronic HBV. The route of transmission of this infection is mainly by exposure to infected blood and bodily fluids. Transmission from mother-to-child remains the predominant route in highly endemic areas. Vaccination has significantly reduced HBV seroprevalence and complications. However, incomplete vaccination of newborns continues to be a major obstacle to elimination of the disease. Current prevention strategies include universal vaccination, perinatal prophylaxis with hepatitis B immune globulin, and maternal antiviral therapy in pregnant women with high viral load. The management of chronic hepatitis B virus infection predominantly depends on nucleoside analogs, including entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide, as well as pegylated interferon alfa. These therapies effectively suppress viral replication and reduce the risks of cirrhosis, HCC, and liver-related mortality, but they rarely achieve functional cure characterized by hepatitis B surface antigen loss. The persistence of covalently closed circular DNA (cccDNA) remains a major hindrance in HBV eradication. Therefore, novel therapeutic strategies targeting different stages of the viral life cycle, including capsid assembly modulators, small interfering RNAs, nucleic acid polymers, and cccDNA-directed approaches, are under active investigation. This review summarizes the epidemiology, prevention, current therapies, clinical outcomes, and emerging therapeutic advances in HBV infection, highlighting ongoing efforts toward achieving a functional cure and global HBV elimination. Full article

Background/Objectives: Perinatal mortality causes substantial economic losses in dairy and beef suckler industries, yet diagnosis remains challenging as post-mortem autolysis can mask lesions and hinder definitive diagnosis. To establish a standardized tool for objectively quantifying carcass decomposition and aiding in the categorization of perinatal timing of death, this study developed a simple, visual 3-point scoring scale based on the macroscopic evaluation of nine parameters. Methods: Retrospective scoring was performed using necropsy findings and high-resolution photography from 127 calves, including a Reference group (n = 32; comprising 26 perinatal mortality cases which breathed and six live-born control calves with normal vitality that were euthanized), and a test group (n = 95; perinatal mortality calves which did not breathe). Hierarchical clustering was performed on the total autolysis score, calculated as the sum of points across all evaluated parameters, using Ward’s linkage method with Euclidean distance. Results: Calves in the test group were clustered into three distinct decomposition profiles, with total autolysis scores differing highly significantly across all study groups (H(3) = 111.71, p ≤ 0.0001). Cluster 1 represented an early decomposition stage where most organs showed no macroscopically detectable autolysis; Cluster 2 exhibited advanced but variable autolysis with intermediate tissue decay and the absence of rigor mortis; and Cluster 3 was marked by advanced, uniform decomposition across all features. Neither the calving/death-to-necropsy interval (p = 0.09) nor season (p = 0.43) significantly affected the severity of autolysis. The Kruskal–Wallis test confirmed highly significant differences (p ≤ 0.001) for all nine individual parameters, demonstrating a stepwise progression of post-mortem changes. Conclusions: This novel visual scoring scale provides an objective numerical proxy for carcass decomposition, offering a practical tool for categorizing general perinatal death timing rather than precise chronological dating. Full article

Background and Objectives: Twin pregnancies carry a high risk of preterm birth, and cerclage for a short or dilated cervix is typically placed before 24 weeks. Its use at or after 24 weeks is less well characterized in twins. Materials and Methods: We describe the perinatal course of twin pregnancies that underwent cervical cerclage at 24–32+0 weeks at three university hospitals in South Korea between 2015 and 2024, with pregnancies treated before 24 weeks as a descriptive reference. Entry into the late group required remaining undelivered at 24 weeks without prior cerclage, so the groups do not share a common baseline and were not compared. Results: Eighteen pregnancies received cerclage at 24–32+0 weeks (median 26.3 weeks), and 25 received it before 24 weeks. In the late group, delivery occurred at a median of 34.1 weeks (IQR 31.7–35.4) after a mean cerclage-to-delivery interval of 45.8 days (95% CI 34.7–56.9). No fetal, neonatal, or perinatal death occurred (0 of 36 fetuses in 18 pregnancies; 95% CI 0.0–17.6%, calculated on the 18 pregnancies). NICU admission was 83.3% (95% CI 62.3–93.8), and adverse neonatal morbidity was 55.6% (95% CI 34.2–75.0). Conclusions: No perinatal death was recorded in this descriptive series. Because no untreated control group was available, these findings do not establish efficacy but provide a real-world basis for future prospective controlled trials. Full article

Background: Congenital tracheal stenosis (CTS) caused by complete tracheal rings and absence of the pars membranacea is rare and potentially lethal in infancy. Agenesis or hypoplasia of the medullary arcuate nucleus (ARC), a chemosensitive component of the ventral medullary surface, has been implicated in disordered respiratory control in sudden perinatal and infant deaths. The coexistence of these two abnormalities is uncommon. Case: A 2-month-old male infant, apparently healthy, was found unresponsive on his parents’ bed in the early morning. The pregnancy was uncomplicated, aside from maternal obesity and tobacco use. Given a context compatible with either sudden natural death or accidental overlay/suffocation, a full forensic autopsy was ordered. An external examination showed diffuse cyanosis and minor superficial abrasions without significant trauma. An internal examination revealed heavy, congested lungs with petechiae and cerebral edema. The heart and great vessels were anatomically normal, and the ductus arteriosus was closed. Histological examination demonstrated congenital tracheal stenosis characterized by complete cartilaginous rings with absent pars membranacea and bilateral agenesis of the medullary arcuate nucleus. The overall findings supported an acute hypoxic–ischemic event during sleep. Conclusions: This case documents a rare, isolated CTS with complete rings and absent pars membranacea coexisting with bilateral ARC agenesis, providing a plausible organic substrate (“cum materia”) for sudden unexpected death in infancy (SUDI). It underscores the importance of standardized neuropathological examination with serial brainstem sections in SUDI investigations and of distinguishing explained SUDI from sudden infant death syndrome (SIDS), which remains unexplained after complete investigation (“sine materia”). Full article

The purpose of this perspective paper is to present a translational approach aimed at identifying the critical periods in brain development during which to provide neuroprotective and neurorestorative strategies, followed by prehensile training, to minimize hemiparesis and foster skill acquisition after asymmetrical perinatal brain injury (APBI). We contend that hemiparesis could be minimized after APBI through a multimodal sequential approach based on timely implementation of evidence-based intervention strategies. If APBI is identified early, neuroprotective techniques can be used in the first 10 days of life to minimize cell death. This can be followed in the next 3 months by the provision of timely neurorestorative strategies to enhance neuron survival and promote brain growth. Ideally these strategies will prime the system for targeted prehensile training from 3 months and beyond. Building on animal work, scientifically sound pilot work in human infants is needed to determine the best timing and therapy dose verified with sensitive outcome measures available before widespread implementation. Strategic planning among a multidisciplinary group working in basic science, medicine, and rehabilitation will inform efforts to bring this translational approach to clinical fruition. Full article

Background/Objectives: Hypoxic–ischemic encephalopathy (HIE) remains a leading cause of neonatal death and long-term neurodisability. Cardiovascular dysfunction commonly accompanies HIE and influences neurological recovery, yet it is difficult to recognize because conventional clinical signs correlate poorly with the myocardial function. This review summarizes the current evidence on cardiac dysfunction in neonates with HIE, with particular attention to the diagnostic tools used to evaluate cardiovascular function and the clinical outcomes associated with myocardial injury. Methods: We conducted a narrative review informed by a systematic, reproducible search of four databases (PubMed, Embase, Cochrane Library, and Web of Science) from 2000 to 2026, using a Population–Concept–Context framework to identify studies of term and near-term neonates (≥35 weeks gestation) with HIE or perinatal asphyxia reporting a measure of cardiac dysfunction (electrocardiographic, biomarker, echocardiographic, or clinical hemodynamic). Records were screened and selected using Covidence systematic review software; eligible studies were original, primary-data reports with a minimum sample size of 20 neonates. Findings were synthesized narratively and grouped thematically by diagnostic modality and clinical outcome. Results: Eighty-one studies met the pre-specified eligibility criteria following a systematic multi-database search and structured screening process. As a subset of included studies are secondary analyses or overlapping cohorts, an aggregate patient count is not reported. Reported prevalence of cardiac dysfunction varied widely with the definition applied, reaching 70–90% when multimodal assessment was used. Blood pressure, heart rate, urine output, and lactate were inconsistently reliable indicators of myocardial function, and ejection fraction and fractional shortening often remained normal despite injury. Tissue Doppler imaging and speckle-tracking strain appeared to be more sensitive, with impaired left ventricular global longitudinal strain associated with brain injury. The right ventricle was more commonly and severely affected, with reduced TAPSE, RV fractional area change, and RV strain associated with death or MRI-defined injury. Each additional 24 h of inotropic support was associated with increased odds of adverse short- and long-term outcomes by 14% and 12%, respectively. Conclusions: Cardiac dysfunction is common and prognostically important but remains underrecognized by the routine clinical assessment and cardiovascular monitoring. Multimodal monitoring centered on TnECHO, near infra-red spectroscopy, and specific biomarkers may enable earlier, physiology-based management. Full article

Background/Objectives: Maternal, perinatal, and neonatal mortality remain major global health challenges, causing approximately 2.5 million neonatal deaths annually, particularly in low- and middle-income countries (LMICs). Although Artificial Intelligence (AI), including Machine Learning (ML) and Deep Learning (DL), is increasingly used to support healthcare decision-making, a comprehensive synthesis of its application to prevent prenatal, preterm birth, and neonatal deaths is lacking. This study systematically reviews the current state of research in this field. Methods: A Structured Literature Review (SLR) was conducted following a combined methodological framework integrating Massaro’s protocol and PRISMA 2020 guidelines. Searches were performed in Scopus, IEEE Xplore, and Google Scholar using domain-specific keywords. From 459 identified publications, 46 peer-reviewed studies published between 2018 and 2024 were selected through a four-step filtering and quality assessment process. Bibliometric and thematic analyses were performed. Results: ML techniques accounted for 71.7% of the selected studies, whereas DL approaches represented 28.3%. Neonatal death prediction was the most frequently investigated outcome (34.7% of publications). Most studies originated from Europe (39.1%) and North America (30.4%), while research from Latin America and Sub-Saharan Africa was scarce despite the high mortality burden in these regions. Key barriers included non-standardized clinical records, limited interoperability of health information systems, and the underrepresentation of LMIC populations in training datasets. Conclusions: AI shows significant potential for reducing maternal and neonatal mortality through predictive analytics. However, important geographical and methodological gaps remain. Future research should prioritize inclusive datasets and predictive frameworks adapted to resource-constrained healthcare settings. Full article

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder unique to pregnancy, closely associated with severe adverse maternal and fetal outcomes such as preterm birth and intrauterine fetal death. Its pathogenesis involves a complex interplay of genetic, hormonal, metabolic, and environmental factors, with a higher risk observed in southern China and among individuals co-infected with hepatitis B virus. Substantial evidence demonstrates a significant dose–response relationship between serum total bile acid (TBA) levels and perinatal outcomes, with TBA ≥ 40 μmol/L commonly used as a criterion for severe ICP. However, most existing prediction models are based on single-center, retrospective studies with small sample sizes and insufficient external validation, limiting their clinical generalizability. In recent years, nomograms and machine learning methods have demonstrated advantages in the early prediction and risk stratification of ICP. Deep learning models and multi-omics integration strategies have further enhanced predictive accuracy. Nevertheless, challenges remain regarding model interpretability, data standardization, and cross-population applicability. Future research should leverage large-scale, multi-center prospective cohorts, integrating multi-omics technologies, including genomics, metabolomics, gut microbiome profiling with artificial intelligence to develop clinically actionable and interpretable risk prediction tools. Integrating these tools into electronic health record systems and mobile platforms may facilitate the early identification and individualized management of ICP, ultimately improving maternal and neonatal outcomes. Full article

Background: Perinatal deaths remain a major public health concern and present unique medico-legal challenges. Forensic autopsy plays a crucial role in determining the cause of death, distinguishing live birth from stillbirth, assessing fetal viability, and identifying traumatic or non-natural causes of death. Methods: This retrospective study included all perinatal cases referred to the Gaziantep Forensic Medicine Group Presidency between 2021 and 2024. Demographic characteristics, gestational age, autopsy findings, histopathological and toxicological examinations, hydrostatic lung test results, and final forensic diagnoses were evaluated. Results: Seventeen of 339 infant forensic cases met the inclusion criteria. Fourteen underwent complete forensic autopsy, whereas three were evaluated by external postmortem examination and medical records. Despite a multidisciplinary forensic investigation that included external examination, complete forensic autopsy, systematic macroscopic organ evaluation, routine histopathological examination, hydrostatic lung flotation testing, toxicological analysis when indicated, review of maternal medical and obstetric records, judicial investigation records, and placental and umbilical cord histopathology whenever available, no definitive cause of death could be established in six cases. Advanced decomposition prevented determination in two cases. One case was classified as an undiagnosed natural death, whereas no specific cause of death could be assigned in the remaining three cases. Placental examination was available in only a minority of cases, whereas umbilical cord histopathology was performed in nearly all autopsied cases. Causes of death included traumatic injury, pulmonary immaturity, intrauterine infection, congenital anomalies, maternal drug exposure, placental abruption, maternal disease, and umbilical cord pathology. Conclusions: Perinatal death investigations require a multidisciplinary forensic approach integrating autopsy, histopathology, toxicology, placental examination, and clinical information. Beyond determining the cause of death, forensic evaluation is essential for assessing live birth, fetal viability, suspected abuse, maternal violence, medical malpractice, and criminal investigations. Full article

Background/Objectives: Caffeine citrate is widely used in very preterm infants, but whether initiation during the first postnatal hours is independently associated with respiratory outcomes remains uncertain. We evaluated the association between caffeine initiation within versus after the first 2 h of life and respiratory outcomes in infants born at <32 weeks’ gestation. Methods: This single-center observational cohort study included 84 infants born at <32 weeks’ gestation and with a birth weight of ≤1500 g who received caffeine citrate within the first 24 h of life. The 2 h threshold represented the unit’s protocol-defined target for caffeine loading rather than a biologically validated cutoff. The primary outcome was bronchopulmonary dysplasia (BPD) at 36 weeks’ postmenstrual age. Secondary outcomes included BPD or death, moderate/severe BPD or death, respiratory support requirements, and neonatal morbidities. Conventional multivariable logistic regression and expanded gestational age- and birth weight-based propensity score models with stabilized inverse probability of treatment weighting (IPTW) were used. The expanded propensity score models incorporated maternal, placental, perinatal, and early respiratory variables, including first-hour invasive mechanical ventilation and surfactant administration within the first hour. Results: Caffeine was initiated within the first 2 h in 41 infants and after the first 2 h in 43 infants. BPD occurred in 10/41 (24.4%) and 24/40 (60.0%) infants, respectively, while BPD or death occurred in 10/41 (24.4%) and 27/43 (62.8%), respectively. In expanded IPTW analyses, caffeine initiation after the first 2 h remained associated with BPD in both the gestational age-based model (OR 3.40, 95% CI 1.22–9.48) and the birth weight-based model (OR 3.23, 95% CI 1.16–9.00). Corresponding ORs for BPD or death were 3.89 (95% CI 1.41–10.71) and 3.68 (95% CI 1.34–10.12). Additional adjustment for residual imbalance in pretreatment respiratory support produced similar estimates. Conclusions: Caffeine initiation after the first 2 h of life was associated with higher odds of BPD and BPD or death. These findings support further investigation of very early caffeine timing but do not establish a causal effect because of the observational design, modest sample size, and potential residual confounding. Full article

Background/Objectives: Perinatal loss is a profoundly distressing life event associated with grief, depression, anxiety, post-traumatic stress symptoms, and long-term psychosocial challenges among bereaved parents who experience miscarriage, stillbirth, or neonatal death. Although psychotherapeutic interventions are increasingly used to address these adverse outcomes, there is limited synthesis on how characteristics consistent with a patient-centered care perspective are reflected in such interventions and how they may relate to psychosocial well-being. This umbrella review aimed to synthesize evidence on psychotherapeutic interventions following perinatal loss and to examine patient-centered care–related dimensions reported across the included reviews, including therapeutic communication, patient engagement, therapeutic relationships, emotional validation, and meaning-making processes. Methods: An umbrella review was conducted in accordance with the Joanna Briggs Institute methodological guidance. Systematic reviews and meta-analyses published between 2019 and 2025 were identified through searches of PubMed, CINAHL, PsycINFO, and the Cochrane Library from database inception to 31 May 2026. Eligible reviews examined psychotherapeutic, psychosocial, and psychological support interventions designed to improve grief, depression, anxiety, post-traumatic stress symptoms, psychological distress, coping, and psychosocial well-being among bereaved parents following perinatal loss. In accordance with the predefined secondary exploratory objective, a secondary interpretive synthesis examined patient-centered care–related dimensions described within the included reviews. Results: Five systematic reviews and meta-analyses met the inclusion criteria. Interventions included cognitive behavioral therapy, mindfulness-based approaches, bereavement counseling, psychosocial support programs, narrative interventions, supportive counseling, and digitally delivered psychological therapies. Across reviews, psychotherapeutic interventions were generally associated with beneficial effects on grief, depression, anxiety, post-traumatic stress symptoms, and broader indicators of psychosocial well-being. Communication-, support-, and engagement-related characteristics consistent with a patient-centered care perspective, including empathy, therapeutic alliance, individualized support, emotional validation, and continuity of communication, were identified through secondary interpretive synthesis as recurring features of beneficial interventions. Digital modalities, such as internet-based cognitive behavioral therapy and telephone-delivered counseling, were consistently described as supporting accessibility, engagement, and continuity of care. Conclusions: Psychotherapeutic interventions following perinatal loss appear to improve a range of psychosocial outcomes. A patient-centered care perspective may help interpret how communication, emotional validation, patient engagement, and supportive therapeutic relationships are described in relation to psychological adaptation after loss. These dimensions should be understood as interpretive characteristics identified across the included reviews rather than as directly measured mechanisms of intervention effectiveness. Future research should examine communication processes, therapeutic alliance, and patient engagement using validated measures, assess how these factors relate to intervention effectiveness, and support the development of integrated, patient-centered models of perinatal bereavement care. Full article

Background: Prematurity remains a major global health challenge and is a leading cause of neonatal morbidity and mortality worldwide. The risk of adverse outcomes is inversely associated with gestational age and birth weight. Although advances in neonatal intensive care have improved survival rates over recent decades, very-low-birth-weight (VLBW) preterm neonates continue to experience substantial morbidity and remain vulnerable to long-term complications. Objective: This study aimed to evaluate the morbidity and mortality of very-low-birth-weight preterm neonates (<1500 g) admitted to the Neonatal Intensive Care Unit (NICU) of the Hospital Regional de Alta Especialidad de Ciudad Victoria (HRAEV), Mexico. Materials and Methods: A retrospective observational cohort study was conducted through a review of medical records of VLBW preterm neonates admitted to the NICU between January 2019 and December 2023. Demographic, perinatal, clinical, and outcome-related data were collected and analyzed. Results: A total of 58 VLBW preterm neonates were included. Mean gestational age was 29.8 ± 2.7 weeks, and mean birth weight was 1109 ± 238 g. The most common morbidities were respiratory distress syndrome (81.0%), apnea of prematurity (72.4%), hyperbilirubinemia (68.9%), pneumonia (34.5%), sepsis (32.7%), patent ductus arteriosus (25.8%), bronchopulmonary dysplasia (26.9% among infants who survived to 36 weeks’ PMA), necrotizing enterocolitis (15.5%), and intraventricular hemorrhage (12.0%) and retinopathy of prematurity (8.6%). Overall mortality was 10.3%. Conclusions: VLBW preterm neonates remain at high risk for significant morbidity despite relatively favorable survival rates. Respiratory distress syndrome, apnea of prematurity, hyperbilirubinemia, and sepsis were the most frequent complications, whereas deaths occurred mainly in the context of severe respiratory and systemic complications, including neonatal asphyxia, pulmonary hypertension, sepsis, shock, and multiple organ failure. Survival outcomes should be interpreted cautiously because of differences in study populations, referral patterns, local viability practices, and study design across neonatal settings. Full article

This study introduces and provides an initial validation of the Metaphorical Anchor Model, a framework in which metaphors function as cognitive tools that transform affective overload into structured professional meaning in the context of death and end-of-life care. A mixed-methods design was used to test whether professional background moderates the anchoring process. Study 1 involved a qualitative analysis of 61 metaphorical expressions produced by 14 multidisciplinary professionals, using thematic analysis within a discourse-based interpretative framework grounded in cognitive linguistics. Study 2 provided quantitative validation through Fisher’s Exact Test to examine whether professional training influences the selection of metaphor types. Qualitative findings identified six cognitive domains grouped into two macro-clusters: Symbolic & Relational Anchors (symbolic, affective, relational) and Functional & Cognitive Analogies (embodied, spatial, cognitive). Quantitative results supported the model, showing professional role as a significant moderator (p = 0.008): science-based professionals predominantly used Functional & Cognitive Analogies (54.3%), whereas humanistic-psychosocial professionals relied mainly on Symbolic & Relational Metaphor Anchors (80.8%). These findings suggest that metaphor use offers insight into how professional roles shape representations of death and care and may represent a relevant resource for emotional processing. Beyond its theoretical contribution, the model has potential implications for clinical communication training, supporting healthcare professionals in managing emotionally demanding interactions and improving reflective practice in end-of-life care. Full article