Summary Background Extremely preterm infants often develop anemia of prematurity, partly caused by blood losses for laboratory diagnostic tests during their stay in the neonatal intensive care unit (NICU). However, international quantitative data on diagnostic blood loss in extremely preterm infants are limited. Methods We performed an international, prospective, observational study across 64 NICUs across 22 European countries (ISRCTN17267090) to describe diagnostic blood losses during the first 28 days after birth in extremely preterm infants born below 28 weeks. Data collected between September 1st, 2022 and August 31st, 2023 (6-weeks per center). Findings We included 320 extremely preterm infants (46% female; median gestational age at birth 26 + 1 weeks; median birthweight 800 g). Median estimated cumulative diagnostic blood loss at day 28 in infants born at 24, 25, 26, 27 weeks’ gestation was 49.6%, 25.9%, 19.7%, 11.5% of calculated initial blood volume (assuming 70 mL/kg birthweight), respectively. Median number of laboratory tests ranged from 6.5 to 25 per center after birth (postnatal day 1–2), and median associated diagnostic blood loss on day 1 and 2 combined ranged from 1.6 to 26.7 mL/kg. There was considerable variation between centers in minimum blood volumes required for laboratory testing. Infants admitted to centers with small-volume analyzers experienced half the cumulative diagnostic blood loss by day 28 (8.2 mL/kg), compared to those admitted to centers with medium- and large-volume analyzers (17.3 and 19.9 mL/kg, respectively). Interpretation In this cohort study of extremely preterm infants, we found significant diagnostic blood losses, particularly in the first week, resulting in an estimated cumulative loss of half of the initial blood volume in infants born at 24 weeks. Our findings highlight considerable variations between European centers, underlining the need to understand these differences and minimize diagnostic blood losses whenever possible in this vulnerable patient population. Funding Sanquin, ESPR, EBA.

Introduction: Cesarean delivery (CS) has been associated with altered neonatal physiological transition due to the absence of labor-related hormonal and mechanical stimuli, which are essential for effective cardiopulmonary and metabolic adaptation after birth. Aim: To evaluate the association between cesarean delivery and early neonatal transition disorders in term and late preterm newborns. Methods: This prospective observational study included 230 newborns ≥ 35 weeks of gestation over a 12-month period. Infants were divided into CS (n = 100) and vaginal delivery (VD) groups (n = 130). Outcomes included respiratory disorders (TTN, RDS), need for respiratory support (CPAP/HFNC, oxygen therapy), NICU admission, as well as metabolic disturbances such as hypoglycemia. Results: Cesarean delivery was associated with significantly higher rates of TTN (28% vs 9%, p < 0.001) and RDS (12% vs 4%, p = 0.02). Infants in the CS group more frequently required CPAP/HFNC (22% vs 7%, p < 0.001), oxygen therapy (34% vs 12%, p < 0.001), and NICU admission (26% vs 10%, p < 0.001). Hypoglycemia was also more common following CS (18% vs 7%, p = 0.01). Conclusion: Cesarean delivery is associated with an increased risk of early neonatal transition disorders, particularly respiratory and metabolic complications. Optimizing the timing and indications for CS, along with structured postnatal monitoring, may reduce neonatal morbidity.

Background: Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and long-term neurodevelopmental impairment, particularly in preterm infants. Early diagnosis remains challenging, and there is growing interest in biomarkers that reflect underlying mechanisms such as neuroinflammation and blood-brain barrier disruption. Objective: To evaluate the diagnostic and prognostic value of selected circulating biomarkers in preterm infants with HIE, with emphasis on a multimarker approach. Methods: This prospective cohort study included 120 preterm infants (gestational age 28-36 weeks), divided into HIE (n = 90) and control (n = 30) groups. Serum levels of NR2 antibodies, endothelin-1, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) were measured at 24-48 hours, day 5-7, and day 14. Statistical analysis included t-test, ANOVA, correlation analysis, logistic regression, and ROC curve analysis. Results: Biomarker levels were significantly higher in the HIE group (p < 0.001). GFAP and NfL showed the highest diagnostic performance (AUC 0.86 and 0.88). The combined model achieved the best accuracy (AUC = 0.89). Biomarker levels correlated with disease severity. Conclusion: A multimarker approach improves diagnostic accuracy and may support early risk stratification and individualized management in preterm infants with HIE.

Objective Despite lack of evidence supporting efficacy, prophylactic fresh frozen plasma and Octaplas transfusions may be administered to very preterm infants to reduce bleeding risk. International variation in plasma transfusion practices in neonatal intensive care units (NICUs) is poorly understood, therefore, we aimed to describe neonatal plasma transfusion practice in Europe. Design Prospective observational study. Setting 64 NICUs in 22 European countries, with a 6-week study period per centre between September 2022 and August 2023. Patients Preterm infants born below 32 weeks of gestational age. Interventions Admission to the NICU. Main outcome measures Plasma transfusion prevalence, cumulative incidence, indications, transfusion volumes and infusion rates and adverse effects. Results A total of 92 of 1143 infants included (8.0%) received plasma during the study period, collectively receiving 177 transfusions. Overall prevalence was 0.3 plasma transfusion days per 100 admission days, and rates varied substantially across Europe. By day 28 of life, 13.5% (95% CI 10.0% to 16.9%) of infants received at least one plasma transfusion, accounted for competing risks of death or discharge. Transfusions were given for a broad range of indications, including active bleeding (29.4%), abnormal coagulation screen results (23.7%) and volume replacement/hypotension (21.5%). Transfusion volumes and infusion rates varied significantly; the most common volume was 15 mL/kg (range: 5–30 mL/kg) and the most common duration was 2 hours (range: 30 min to 6 hours). Conclusions We found wide variation in plasma transfusion practices in Europe, highlighting the need for evidence to inform neonatologists in daily practice and guidelines, in particular for non-bleeding indications. Trial registration number ISRCTN17267090.

Summary Background Platelet transfusions are given to preterm infants with severe thrombocytopenia aiming to prevent haemorrhage. The PlaNeT2/MATISSE trial revealed higher rates of mortality and/or major bleeding in preterm infants receiving prophylactic platelet transfusions at a platelet count threshold of 50 × 109/L compared to 25 × 109/L. The extent to which this evidence has been incorporated into clinical practice is unknown, thus we aimed to describe current neonatal platelet transfusion practices in Europe. Methods We performed a prospective observational study in 64 neonatal intensive care units across 22 European countries between September 2022 and August 2023. Outcome measures included observed transfusion prevalence rates (per country and overall, pooled using a random effects Poisson model), expected rates based on patient-mix (per country, estimated using logistic regression), cumulative incidence of receiving a transfusion by day 28 (with death and discharge considered as competing events), transfusion indications, volumes and infusion rates, platelet count triggers and increment, and adverse effects. Findings We included 1143 preterm infants, of whom 71 (6.2%, [71/1143]) collectively received 217 transfusions. Overall observed prevalence rate was 0.3 platelet transfusion days per 100 admission days. By day 28, 8.3% (95% CI: 5.5–11.1) of infants received a transfusion. Most transfusions were indicated for threshold (74.2%, [161/217]). Pre-transfusion platelet counts were above 25 × 109/L in 33.1% [53/160] of these transfusions. There was significant variability in volume and duration. Interpretation The restrictive threshold of 25 × 109/L is being integrated into clinical practice. Research is needed to explore existing variation and generate evidence for various aspects including optimal volumes and infusion rates. Funding Sanquin, EBA, and 10.13039/501100008873ESPR.

Key Points Question What is the current red blood cell (RBC) transfusion practice for preterm infants born before 32 weeks’ gestation in Europe? Findings This cohort study included 1143 infants from 64 neonatal intensive care units across 22 European countries. By day 28 of life, 36.5% of infants had received an RBC transfusion, and most transfusions based on hemoglobin threshold were given above restrictive thresholds tested in recent trials. Meaning These findings suggest that there is a need to address the gap between evidence and practice and to understand factors influencing ongoing variable practices of RBC transfusions among preterm infants.

Key Points Question What is the current red blood cell (RBC) transfusion practice for preterm infants born before 32 weeks’ gestation in Europe? Findings This cohort study included 1143 infants from 64 neonatal intensive care units across 22 European countries. By day 28 of life, 36.5% of infants had received an RBC transfusion, and most transfusions based on hemoglobin threshold were given above restrictive thresholds tested in recent trials. Meaning These findings suggest that there is a need to address the gap between evidence and practice and to understand factors influencing ongoing variable practices of RBC transfusions among preterm infants.

AIM To estimate prevalence of respiratory distress syndrome in preterm twins compared to preterm singletons. METHODS This is a retrospective observational point prevalence study conducted at the level of three neonatal intensive care units. Medical records of all preterm newborns (<37 weeks of gestation) with respiratory distress syndrome treated in a two-year period were reviewed. The birth order of twins, gestational age and mortality were analysed. RESULTS Out of 809 preterm newborns, 104 (12.9%) were twins. Median gestational age at birth was 30.3 (IQR 31.4-34.2) weeks. Respiratory distress syndrome was diagnosed in 525 (64.9 %) preterm newborns, of which 441 singletons and 84 twins. Prevalence of respiratory distress syndrome in first-born twins was not significantly higher compared with singletons, 67.3% (35/52) vs. 62.6 % (441/705), respectively (p=0.06). Prevalence of respiratory distress syndrome in second-born twins was 94.2 % (49/52), which was significantly higher compared with both singletons and first-born twins (p<0.001). The mortality rate of preterm newborns was significantly higher in second-born twins compared with singletons and first-born twins, 15.4 % vs. 6.8 % (p<0.001) and 15.4 % vs. 5.5% (p<0.001), respectively. CONCLUSION There was a higher risk of respiratory distress syndrome and higher mortality rate in twins compared with singletons, but only in second-born twins the difference was statistically significant.

Bronchiolitis is a relatively common respiratory condition, usually presenting in the first two years of life. It is followed by audible phenomena, due to inflammatory airway obstruction. Common symptoms are nasal discharge, cough, tachypnoea, fever, and cyanosis. The cause is viral, most commonly respiratory syncytial virus. Bronchitis leads to respiratory acidosis and leads to accumulation of carbon dioxide. We analyzed 83 patients with a diagnosis of bronchiolitis at the discharge from the Pediatric clinic of the Clinical Center of the University of Sarajevo. We observed the relationships between acid-base status parameters, blood work parameters, age, and weight and placed them into groups based on whether they had any co¬morbidities or not. Patients without comorbidities showed significant differences in age, body temperature, and leukocyte count compared to patients with comorbidities. We also noted significant correlations be¬tween age, weight, hemoglobin level, hematocrit, erythrocyte count, pCO2, pH, and HCO3 which led to a conclusion that it is likely that in young children with bronchiolitis, the issue is not in the elimination of CO2 through lungs. Rather, it is the transport of CO2 to the lungs due to reduced erythrocyte count and so we believe, that if proven feasible, bronchiolitis could be treated with pure erythrocyte trans.

The psychophysical preparation program for pregnant women includes physical exercises and theoretical lectures aimed at preparing the pregnant woman for childbirth and that the benefits far outweigh the risks. Exercise is an essential element of pregnancy, and OB-GYNs and other obstetric care providers should encourage their patients to continue or begin exercise. The aim of this work is to understand the impact of psychophysical preparation of pregnant women on health during and after pregnancy, birth outcomes and postpartum recovery. Twenty scientific research papers/articles including 5517 respondents were reviewed, based on databases: Web of Science, EBSCO, Scopus, Medline, PubMed, ScienceDirect, Google Scholar, and others. Works published from 2017-2022 were reviewed. The results of this study show that pregnant women who attended the program of psychophysical preparation for childbirth had a chance to experience childbirth in a more beautiful light, to be prepared, so that they would go to the maternity hospital with less fear, how to use breathing techniques during childbirth, and how to have the easiest and most beautiful childbirth without the use of drugs and interventions. Pregnant women had significantly more positive outcomes of childbirth as well as postpartum recovery and mental health. Psychological support and education have positive outcomes on the mental health of pregnant women because they reduce fear of the unknown and reduce the risk of postpartum depression. Higher rates of intact perineum, reduction of episiotomy and less damage of perineal tears are recorded. The preparation itself significantly affects the outcome of the test subjects’ births, where vaginal births are much more common, and the rate of instrumental methods of birth and caesarean section is reduced. A positive outcome was recorded during postpartum recovery.