Rationale Preterm neonates needing rescue treatments with inotropes and/or inhaled nitric oxide (iNO) (acute critical illnesses, ACIs) in neonatal intensive care units (NICUs) are at high risk of mortality. While targeted neonatal echocardiography consultations (TNE) are increasingly used to guide management, its clinical impact need evaluation. Objectives To investigate clinical outcomes in relation to TNE utilisation during episodes of ACIs among preterm neonates. Methods This retrospective cohort study, conducted at two tertiary NICUs over 10 years, included neonates<37 weeks gestational age (GA) who developed ACIs. Patients receiving TNE-guided care (TNE within 24 hours of treatment initiation) were compared with non-TNE management. Outcomes included predischarge mortality, episode-related mortality (<7 days) and a new diagnosis of intraventricular haemorrhage≥grade 3 (IVH-3). Inverse probability of treatment weighting (IPTW) using propensity score was used to account for confounders, including site, birth years and baseline illness severity. Measurements and main results Of 622 included patients, 297 (48%) had TNE; median (IQR) GA at ACI was 26.4 (25.0–28.4) weeks. TNE group demonstrated higher baseline mean airway pressure, oxygen requirement and heart rate and frequently received both inotrope and iNO during ACI. IPTW analysis revealed TNE was associated with lower mortality (adjusted OR (95% CI) 0.75 (0.59 to 0.95)), episode-related mortality (0.54 (0.40 to 0.72)) and death or IVH-3 (0.78 (0.62 to 0.99)). TNE group received more varied inotropic agents, demonstrated earlier improvements in blood pressures, without increasing overall inotrpoic burden. Conclusions Among preterm neonates requiring rescue treatments with inotropes/iNO, TNE utilisation to guide clinical management may be associated with improved survival.

Background: Caregiver and healthcare provider perspectives of virtual care have not been explored in depth in the literature for neonatal follow-up clinics. Our objective was to evaluate caregivers’ and healthcare providers’ perspectives and compare neurodevelopmental outcomes of preterm neonates before and after implementing virtual care during the SARS-CoV-2 pandemic. Methods: Semi-structured interviews were conducted with families and healthcare providers, designed and analyzed using phenomenological qualitative methods. A retrospective cohort study was conducted to evaluate and compare neurodevelopmental characteristics of two preterm cohorts, one before (“in-person”) and after (“virtual”) virtual care. Results: Three themes were identified: increased confidence in in-person assessments, adequate delivery of information using virtual platforms and a preference for specialized care through the neonatal follow-up clinic. A total of 252 infants born preterm, 104 infants in the in-person group and 148 infants in the virtual group, were included in the study. The adjusted odds ratio (aOR) of cerebral palsy was lower when virtual care was used compared to in-person assessments (aOR = 0.11, 95% CI 0.01–0.98) while the adjusted odds of cognitive delay measured by in-person standardized testing were higher (aOR = 2.78, 95% CI 1.25–6.19). Conclusions: Caregivers and healthcare providers prefer in-person assessments for comprehensive developmental support. It may be more challenging to detect subtle cognitive differences using caregiver-reported measures. Cerebral palsy may be missed when assessments are completed virtually.

Modeling of medical interventions, such as preventive surgeries, on a survival outcome necessitates an accurate and flexible representation of the time‐dependent effect of the intervention. We propose using B‐splines to model the time‐dependent effect of a binary time‐dependent covariate on a survival outcome in the presence of correlated competing risks. The proposed B‐splines can also help choose the best functional form for the time‐dependent effect. Our simulation studies demonstrate that the proposed competing risks model with B‐splines performs well in estimating the time‐dependent effect of the intervention and the penetrance function in all scenarios considered. We applied our proposed method to families carrying a pathogenic variant in BRCA1 recruited through the Breast Cancer Family Registry and evaluated the time‐dependent effects of risk‐reducing salpingo‐oophorectomy on breast cancer risk in the presence of ovarian cancer and death from other causes as competing events. We found that the B‐splines model better captured the changes in the association between the intervention and breast cancer over time and provided better predictive ability than alternative parametric models, such as the permanent exposure model and the Cox and Oakes model. Our results indicate that risk‐reducing salpingo‐oophorectomy has a significant protective effect on breast cancer incidence over the follow‐up period.

Objective: To determine pre‐procedure maternal, pregnancy and fetal factors associated with survival until 6 months of age and evaluate temporal trends in survival outcomes over a 25‐year period following fetoscopic laser ablation (FLA) of placental anastomoses in monochorionic twin pregnancies with twin–twin transfusion syndrome (TTTS). Design: Retrospective observational study. Settings: A tertiary care fetal centre in Canada. Population or Sample: One thousand and five patients undergoing TTTS between 1998 and 2023. Methods: Patient demographics, pregnancy, procedural and outcome details were collected. Predictors for single and dual survival were identified using multivariable logistic regression. Temporal trends in survival outcomes across the study period were also examined. Main Outcome Measures: Fetal/neonatal survival at 6 months and predictors for single and dual survival. Results: Of 915 included fetoscopies, 597 pregnancies (65.2%) achieved dual survival, 217 (23.9%) had a single survivor, and 101 (11%) resulted in dual demise. Survival rates improved significantly over the 25‐year study period for both single and dual survival ( p = 0.03 and p = 0.0004, respectively). Three significant pre‐procedural predictors of dual demise versus one or two survivors were: cervical length ≤ 15 mm (adjusted odds ratio [AOR] 6.1, 95% CI 2.7–14.1), earlier gestational age (GA) at intervention (AOR 1.2 per earlier week, 95% CI 1.1–1.3), and abnormal donor umbilical artery Doppler flow (AOR 5.1, 95% CI 1.7–15.6). A prediction calculator using this model achieved an area under the curve of 0.65. Conclusion: Short cervical length (≤ 15 mm), presence of abnormal donor umbilical artery Doppler waveform, and early GA at time of intervention are significant predictors of fetal/neonatal survival at 6 months following FLA in TTTS and thus, are valuable parameters to consider for pre‐procedural counselling.