This meta-analysis assessed short-term outcomes after using human milk-derived fortifiers (HMFs) compared with bovine milk fortifiers (BMFs) in preterm infants fed an exclusive human milk (HM) diet, either mother’s own milk (MOM) or donor human milk (DHM). We searched PubMed, Embase, Google Scholar, CENTRAL and CINHAL between January 2015 and August 2023 for studies reporting outcomes in infants with ≤28 weeks gestation and/or birthweight ≤ 1500 g on an exclusive human milk diet fortified with HMF versus BMF. The primary outcomes were death and NEC (stage ≥ 2). Four studies with a total of 681 infants were included. Mortality was significantly lower in infants fed with an HM-HMFs diet (four studies, 681 infants; RR = 0.50, 95% CI = 0.26–0.94; p = 0.03; I² = 0%), NEC was similar between the two groups (four studies, 681 infants; RR = 0.48, 95% CI = 0.20–1.17; p = 0.11; I²= 39%). BPD was higher in the HM-BMFs group (four studies, 663 infants; RR = 0.83, 95% CI = 0.69–1.000; p = 0.05, I² = 0%), although not statistically significant. No differences were found for sepsis (RR = 0.97, 95% CI = 0.66–1.42; p = 0.96; I² = 26%) or combined ROP (four studies, 671 infants; RR = 0.64, 95% CI = 0.53–1.07; p = 0.28; I² = 69%). An HM-HMFs diet could possibly be associated with decreased mortality with no association with NEC, BPD, sepsis, or ROP. This meta-analysis was limited by the small number of studies included. However, the results should not be refuted for this reason as they provide an impetus for subsequent clinical trials to assess the observed associations.

Background and Objective: The effects of neonatal hypoglycemia on the developing brain are well known, resulting in poor neurological outcomes. We aimed to perform an updated meta-analysis on neonatal hypoglycemia, the severity of hypoglycemia, and the associated neurodevelopmental outcomes from infancy to adulthood. Methods: A systematic literature search was conducted from inception until March 2024, using the PubMed, CINAHL, Embase, and the CENTRAL databases. Randomized/quasi-randomized trials and observational studies that evaluated at least one of the pre-specified outcomes were included. A random-effects model meta-analysis was performed to yield the pooled OR and its 95% CI for each outcome due to the expected heterogeneity in the studies. The study findings were reported as per the PRISMA guidelines. Neurodevelopmental impairment (NDI), cognitive impairment, and visual-motor or visual impairment were the primary outcomes. Results: A total of 17 studies (19 publications) were included in the final analysis. NDI, as defined by authors, was significantly higher in early- (OR = 1.16; 95% CI = 1.11–1.43) and mid-childhood (OR = 3.67; 95%CI = 1.07–12.2) in infants with neonatal hypoglycemia. ‘Any cognitive impairment’ was significantly more common in infants with neonatal hypoglycemia (OR = 2.12; 95%CI = 1.79–2.52). Visual-motor impairment (OR = 3.33; 95%CI = 1.14–9.72) and executive dysfunction (OR = 1.99; 95%CI = 1.36–2.91) were also more common in the hypoglycemic group. No difference in the incidence of epilepsy, motor impairment, emotional-behavioral problems, or hearing impairment were noted. Certainty of evidence was adjudged as ‘low’ to ‘very low’ for most outcomes. The severity of hypoglycemia was studied at different intervals, with NDI more common with a blood glucose interval between 20 and 34 mg/dL (1.1–1.9 mmol/L). Conclusions: Low-quality evidence from large observational studies finds a significant association with hypoglycemia in the early neonatal period and long-term neurodevelopmental problems. Additional studies with long enough follow-up are paramount to determine the cut-off concentration and to quantify the impact beyond the infancy period.

Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes.

Introduction: Surfactant therapy is performed in different ways in respiratory distress syndrome. Surfactant therapy in spontaneously breathing infants <28 weeks′ gestation (LIST/MIST) was compared to intubation with different periods of mechanical ventilation (MV/intubation; INSURE) for efficacy and safety. Methods: This systematic review and meta-analysis followed PRISMA guidelines with PROSPERO registration (CRD42025630748) using GRADE recommendations. Primary outcomes were BPD at 36 weeks′ postmenstrual age, MV in first 72 h; and death before discharge. Secondary outcomes were intraventricular hemorrhage (IVH), necrotizing enterocolitis, retinopathy of prematurity (ROP), periventricular leukomalacia, and pneumothorax. Results: No RCT compared directly LISA/MIST versus INSURE in infants <28 weeks. A total of twenty-six studies were included and 12 studies in quantitative analysis were included. LISA/MIST compared to INSURE was not different in reducing BPD; or death; but reduced MV within 72 h (relative risk [RR], 0.70; 95% confidence interval [CI], 0.55–0.90; events/n = 58/153; INSURE events/n = 82/144). This effect was not detectable when only RCTs were analyzed. Compared to intubation, LISA/MIST reduced BPD (RR, 0.76; 95% CI, 0.59–0.97, n = 6,585), MV (RR, 0.61; 95% CI, 0.45–0.82, n = 6,197), death (RR, 0.63;95% CI, 0.54–0.74, n = 6,597), IVH (RR, 0.62; 95% CI, 0.54–0.73), pneumothorax (RR, 0.58; 95% CI, 0.46–0.73), and ROP (RR, 0.61; 95% CI, 0.50–0.73). Composite outcome analysis BPD/death was not possible due to small numbers. Conclusion: LISA/MIST reduced MV, but not BPD, or separately death when compared with INSURE. The findings should be interpreted cautiously due to limited power and competing risk dynamics in extremely preterm infants.

Background and Objectives: The COVID-19 pandemic profoundly disrupted maternal and newborn healthcare worldwide, necessitating rapid reorganization of healthcare services while maintaining essential care. Evidence from Central, Eastern and Southeastern Europe (CESEE) remains fragmented despite the region’s heterogeneous healthcare systems and variable pandemic responses. This scoping review synthesized the available evidence on maternal and newborn healthcare delivery during the COVID-19 pandemic and proposes a Maternal and Newborn Healthcare Resilience Framework (MNRF) to integrate the findings across key domains of healthcare resilience. Materials and Methods: PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched, with Google Scholar used as a supplementary search source. Eligible publications were published between 1 January 2020 and 31 May 2026. Evidence was synthesized across four predefined MNRF domains: access and continuity of care, healthcare organization and system capacity, quality and family-centered care, and maternal, perinatal, and neonatal outcomes. Results: Twelve publications met the inclusion criteria; several represented analyses derived from shared or partially overlapping datasets, particularly the multinational IMAgiNE EURO project. Across CESEE countries with available evidence, the pandemic disrupted access to antenatal services, accelerated the implementation of telemedicine, and prompted extensive reorganization of maternity and neonatal care. Family-centered practices, including birth companionship, skin-to-skin contact, breastfeeding support, and shared decision-making, were consistently affected. Maternal, perinatal, and neonatal outcomes showed no consistent regional pattern of deterioration in the included evidence; however, data were limited and heterogeneous, and localized increases in stillbirths and changes in neonatal healthcare utilization were reported. Conclusions: The COVID-19 pandemic exposed important vulnerabilities and prompted substantial adaptations in maternal and newborn healthcare delivery in the represented CESEE settings. The MNRF provides a structured, hypothesis-generating conceptual model for organizing these experiences and identifying priorities for preparedness and future research.