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Item Brain oxygenation monitoring during neonatal stabilization and resuscitation and its potential for improving preterm infant outcomes: a systematic review and meta-analysis with bayesian analysis(Springer Science and Business Media Deutschland GmbH, 2025) Bruckner, Marlies; Suppan, Thomas; Suppan, Ena; Schwaberger, Bernhard; Urlesberger, Berndt; Goeral, Katharina; Hammerl, Marlene; Perme, Tina; Dempsey, Eugene M.; Springer, Laila; Lista, Gianluca; Szczapa, Tomasz; Fuchs, Hans; Karpinski, Lukasz; Bua, Jenny; Law, Brenda; Buchmayer, Julia; Kiechl-Kohlendorfer, Ursula; Cerar, Lilijana Kornhauser; Schwarz, Christoph E.; Gründler, Kerstin; Stucchi, Ilaria; Klebermass-Schrehof, Katrin; Schmölzer, Georg M.; Pichler, GerhardNeonatal stabilization and resuscitation in preterm infants are critical interventions. Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy monitoring offers potential benefits by providing real-time information on brain oxygenation. This systematic review aimed to determine if CrSO2-monitoring to guide neonatal resuscitation after birth can improve survival without cerebral injury. A systematic search of MEDLINE, Google Scholar, EMBASE, the Cumulative Index of Nursing and Allied Health Literature, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials was performed through December 2024. We included only human studies that investigated CrSO2-guided interventions during neonatal resuscitation after birth in preterm infants. A meta-analysis was performed using individual patient data and the Bayesian method. The main outcome assessed was survival without cerebral injury (Study registration:PROSPERO CRD42024512148). Two studies were identified, including a total of 667 preterm infants with less than 34 weeks of gestation, describing CrSO2-guided interventions during neonatal resuscitation. The meta-analysis revealed a high probability of treatment superiority for NIRS-guided interventions that demonstrated improved outcomes compared to standard care, with a 4.5% increase in the rate of survival without cerebral injury (93% probability) and 4.2% reduction of IVH of any grade (94% probability). The risk of bias can be described as low. Conclusion:This meta-analysis suggests that CrSO2-guided interventions may offer a meaningful advantage in preterm infant resuscitation after birth, improving survival without brain injury. The analysis indicates a high probability of a clinically important benefit. This warrants consideration in clinical practice.Item Addressing the humans in the delivery room—optimising neonatal monitoring and decision-making in transition(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Schwarz, Christoph E.; Schwaberger, Bernhard; Flore, Alice Iride; Joyce, Robert; Woodworth, Simon; Adam, Frederic; Dempsey, Eugene M.During the first minutes of life, complex dynamic processes occur, facilitating a normal transition to ex utero life. In healthy term infants, these processes typically occur with minimal intervention required but are often more challenging for the preterm infant. These challenges involve not only the physiological processes encountered but also an organizational process: that of a team of healthcare providers led by a neonatologist, establishing a diagnosis based on clinical and technical information and initiating time-critical and potentially life-altering interventions. In this narrative review, we highlight the challenges of both processes. We explore the role and limitations of well-established and newer potential monitoring modalities, in particular respiratory function monitoring and cerebral near-infrared spectroscopy, to optimally inform the team in regards to physiological processes. We also evaluate the important role that human factors play in the process of decision-making. Both are important for optimal performance to enable successful transition and thereby reduce short- and long-term problems. We identify research goals to inform future studies to further optimize technological and human aspects in the first minutes of life.Item The association between threatened miscarriage in early pregnancy and depression or anxiety in offspring in late adolescence(Elsevier B.V., 2025) Kidd, Ciara; O'Driscoll, David; O'Byrne, Laura J.; O'Keeffe, Gerard W.; Khashan, Ali S.; Maher, Gillian M.; INFANT Research Centre, University College CorkBackground: Adolescent mental health is a known determinant of health across the lifespan underscoring the importance of identifying determining factors. Threatened miscarriage is a common pregnancy complication, yet its influence on child mental health outcomes is unclear. Here we examined the association between pregnancies complicated by threatened miscarriage and the risk of offspring depression or anxiety in late adolescence using the representative longitudinal UK Millennium Cohort Study. Methods: Maternal reported data on threatened miscarriage and potential confounders were collected at 9-months postpartum. Data on depression and anxiety were collected as one variable when children were aged 17 years using self-reported doctor diagnosis. Multivariable logistic regression adjusted for several maternal and sociodemographic factors. We examined separate interaction effects for threatened miscarriage and hypertensive disorders of pregnancy, small for gestational age (SGA) and preterm birth. Results: N = 9521 mother-child dyads were included in the analyses, with n = 574 (6 %) women experiencing a threatened miscarriage, and 978 (10.3 %) children reported depression or anxiety diagnosis. Adjusted results suggested that threatened miscarriage was associated with a 34 % increase in the odds of depression or anxiety (OR: 1.34, 95 % CI 1.03, 1.73). An interaction effect was observed for threatened miscarriage and SGA (OR: 2.09, 95 % CI: 1.01, 4.36) and threatened miscarriage and preterm birth (OR:2.23, 95 % CI: 1.26, 3.95). Conclusion: Threatened miscarriage was associated with an increased odds of depression or anxiety in offspring by age 17 years, albeit residual and unmeasured confounding cannot be ruled out. Future research should examine the potential biological mechanisms mediating this association. © 2025 The AuthorsItem The effect of maternal position on cerebral oxygenation in premature infants during Kangaroo care: a randomised controlled trial(Springer Nature, 2025-04-05) Stapleton, Iyshwarya; Murphy, Sarah; Vaughan, Susan; Walsh, Brian Henry; Natchimuthu, Kannan; Livingstone, Vicki; Dempsey, EugeneObjective: To assess whether there was an optimal maternal position (30° versus 60° incline) for kangaroo mother care. Design: Single centre cross-over randomised controlled trial. Mothers were randomly assigned to start at either a 30° or 60° angle. Primary outcomes were the mean cerebral near-infrared spectroscopy (NIRS) values. Secondary outcomes included median peripheral saturations and heart rates. Results: Twenty infants were included in the final analysis: median gestational age at birth was 28+1 weeks and median birth weight was 985 g. No significant differences were observed in the primary outcomes or the secondary outcomes at either angle. Conclusions: Maternal positioning at a 30° or 60° incline did not impact on cerebral oxygenation values in very preterm infants. Either position was associated with clinical stability. Trial Registration Number: ClinicalTrials.gov ID NCT05686252Item Conflicts of interest in public health research and publications(Oxford University Press, 2025-02-07) Thomas, Samantha; Hennessy, Marita; Frazer, Kate; Wild, Cervantée; Haynes, Ashleigh; Kavanagh, Shane; Okan, Orkan; Daube, Mike
