The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking. In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis. A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups. In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).

Background Bronchopulmonary dysplasia (BPD) is a common cause of morbidity in preterm infants, leading to long-term respiratory complications and risk of neurodevelopmental impairment. Although it has a multifactorial etiology, local inflammation may play a major role. Objectives. We aimed to analyze the relationship between nasopharyngeal aspirate (NA) interleukin 6 (IL6) levels and clinical and imaging findings of BPD. Methods: Pilot study in preterm infants < 30 weeks. NA was collected at 7 days of life (DOL) and serial lung ultrasounds (LUS) were performed during admission. NA-IL6 levels were measured using an automated electrochemiluminescence immune-analyzer Cobas-e602 and an IL6 ELISA method. Results. Forty-two patients were studied. Infants with BPD had significantly lower gestational age and higher levels of NA-IL6 at DOL 7. Both methods showed good agreement: ICC = 0.937 (95%CI 0.908-0.957); p < 0.001) and Passing-Bablok Regression (R² = 0.961). LUS score (AUC = 0.83) and NA-IL6 (AUC = 0.81) at DOL 7 predicted BPD. The AUC of NA-IL6 as a stand-alone marker of BPD was 0.808 (95% CI 0.67 – 0.94); p = 0.002, with 24 pg/ml being the best cutoff with a sensitivity and specificity of 83.3%. A model including birth weight, LUS score at DOL7, NA-IL6 at DOL7, and days of mechanical ventilation predicted BPD with R² = 0.600 (p < 0.001). Conclusions. Point-of-care assessment of NA-IL6 is feasible and reliable compared with a reference method and can be useful in managing BPD. Predictive models of BPD in the first week of life, including clinical, biological, and imaging biomarkers must be tested in larger cohorts.

Background/Objectives: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI). Methods: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive care units (1995–2019) were included. Risk factors and outcomes were assessed by logistic regression and adjusted for gestational age (GA). Results: In total, 4271 VPI with a mean GA of 28.7 ± 2.3 weeks were evaluated. Pneumothorax was diagnosed in 174 patients (4.1%, 95% Confidence Interval (CI) 3.5–4.7) with its incidence inversely proportional to GA: 9.9% in 23–25 w and 2.1% in 30–31 w (p < 0.001), but stable over the years 1995–1999 (5.2%) and 2015–2019 (4.2%) (p = 0.309). Patients with pneumothorax exhibited higher rates of severe intraventricular hemorrhage (IVH) (Odds Ratio (OR) = 2.0 (95%CI 1.3–3.1), p = 0.003), bronchopulmonary dysplasia (OR = 2.7 (95%CI 1.7–4.4), p < 0.001), and death (OR = 8.5 (95%CI 6.2–11.6), p < 0.001). Independent risk factors for pneumothorax were GA, prolonged premature rupture of membranes, and intubation in the delivery room. The composite outcome of death or severe IVH was higher in patients with pneumothorax with an adjusted OR = 6.7 (95%CI 4.7–9.6), p < 0.001. Although VPI mortality has significantly decreased over the years (20.3% 1995–1999 and 11.7% 2015–2019, p < 0.001), we found no significant difference in pneumothorax-related deaths. Conclusion: Pneumothorax remains a serious threat to VPI, leading to a higher incidence of morbidity, and mortality attributable to this complication has not decreased. Preventive strategies and early recognition are essential for improving disability-free survival in VPI.

Anti-Kell alloimmunisation is a potentially severe minor blood group type incompatibility, not only as a cause of haemolytic disease of the foetus and newborn, but also due to the destruction of red blood cells (RBC) and mature form in the bone marrow with the subsequent hyporegenerative anaemia. In severe cases and when the foetus shows signs of anaemia, an intrauterine transfusion (IUT) may be necessary. When repeated, this treatment can suppress erythropoiesis and worsen the anaemia. We report the case of a newborn who required four IUTs plus an additional RBC transfusion at one month of life due to late onset anaemia. The identification of an adult haemoglobin profile with a complete absence of foetal haemoglobin in the patient’s newborn screening samples at 2 and 10 days of life warned us of a possible late anaemia. The newborn was successfully treated with transfusion, oral supplements and subcutaneous erythropoietin. A blood sample taken at 4 months of life showed the expected haemoglobin profile for that age with a foetal haemoglobin of 17.7%. This case illustrates the importance of a close follow-up of these patients, as well as the usefulness of the haemoglobin profile screening as a tool for anaemia assessment.

Cutis verticis gyrata (CVG) is a very rare benign disorder characterised by convoluted folds and deep furrows of the scalp that mimic cerebral sulci and gyri. Associations with other pathologies as neuropsychiatric and/or ophthalmologic disorders, secondary cases to inflammatory or neoplastic processes, as well as cases associated to genetic disorders as Turner’s syndrome have been reported, but there is no literature describing an association with a congenital structural heart defect and no other underlying condition. We report a case of primary CVG in a 3-week-old female infant associated with an echocardiographic diagnosis of cor triatriatum. Other systemic examination findings and investigations were unremarkable, and the patient has normal neurodevelopment at 1 year old. Aside from the neuropsychiatric and ophthalmologic pathologies commonly associated with primary non-essential CVG, it should be noted that isolated congenital cardiac lesions are also possible, so as to increase our index of suspicion in patients with the disorder.