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In this open, randomized, multicenter trial involving extremely-low-birth-weight preterm infants, the use of a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity.

In this multicenter, randomized trial involving women at high risk for late preterm delivery, administration of betamethasone significantly reduced the rate of neonatal respiratory complications. Antenatal glucocorticoids are widely used in obstetrics for pregnancies at risk for early preterm delivery. Their use increased especially after a consensus conference held by the National Institutes of Health in 1994, which concluded that there was strong evidence that glucocorticoids reduce adverse neonatal outcomes, including death, the respiratory distress syndrome, and other complications, when administered to women who are likely to deliver before 34 weeks of gestation. 1 – 3 The recommendation was not extended to women at risk for preterm delivery after 34 weeks because of both a lack of data 4 , 5 and the belief that at a threshold of . . .

In extremely preterm infants, the use of cerebral oximetry monitoring to guide treatment for the first 72 hours after birth did not reduce the risk of death or severe brain injury at 36 weeks’ postmenstrual age.

Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks’ gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks’ gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks’ gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks’ gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks’ gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks’ gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks’ gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks’ gestation, but no change was observed at 22-24 weeks’ gestation. At 32-34 weeks’ gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.

The rate of death or major bleeding was significantly higher among preterm infants with severe thrombocytopenia assigned to transfusions at higher platelet-count thresholds (50,000 per cubic millimeter) than among those assigned to lower thresholds (25,000 per cubic millimeter).

In this multicenter, randomized trial involving extremely preterm infants, high-dose erythropoietin administered from 24 hours after birth through 32 weeks of postmenstrual age did not result in a lower risk of severe neurodevelopmental impairment or death at 2 years of age.

In this multicountry, randomized trial involving women in low-resource countries who were at risk for early preterm birth, the risks of neonatal death and stillbirth or neonatal death were significantly lower among women who received antenatal dexamethasone than among those who received placebo, and dexamethasone was noninferior with respect to possible maternal bacterial infection.

This report of the three BOOST II trials, undertaken to examine optimum oxygen saturation in extremely preterm infants, showed that targeting levels below 90% with the use of current oximeter calibrations was associated with increased mortality. The clinically appropriate range for oxygen saturation in preterm infants is unknown. Trials in the 1950s showed that unrestricted oxygen increased the rate of severe retinopathy of prematurity. However, when oxygen was subsequently restricted, increased mortality was observed. 1 The first Benefits of Oxygen Saturation Targeting (BOOST) trial showed that in preterm infants who were still receiving oxygen at 32 weeks' gestation, targeting a higher oxygen-saturation range prolonged oxygen dependence. 2 Observational studies suggested that higher oxygen-saturation levels may increase rates of retinopathy of prematurity. 3 – 5 In five randomized, masked trials with similar protocols conducted in the United States, 6 Australia, New Zealand, . . .

Nirsevimab is a monoclonal antibody to the RSV fusion protein that has an extended half-life. In this clinical trial, a single dose of nirsevimab resulted in a significantly lower incidence of medically attended RSV-associated lower respiratory tract infection than that with placebo.

ObjectivesFor very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care.DesignParallel group randomised (1:1) trial, using sealed opaque numbered envelopes.SettingEight UK tertiary maternity units.Participants261 women expected to have a live birth before 32 weeks, and their 276 babies.InterventionsCord clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and immediate neonatal care after clamping.Main outcome measuresIntraventricular haemorrhage (IVH), death before discharge.Results132 women (137 babies) were allocated clamping ≥2 min and neonatal care cord intact, and 129 (139) clamping ≤20 s and neonatal care after clamping; six mother-infant dyads were excluded (2, 4) as birth was after 35+6 weeks, one withdrew (death data only available) (0, 1). Median gestation was 28.9 weeks for those allocated clamping ≥2 min, and 29.2 for those allocated clamping ≤20 s. Median time to clamping was 120 and 11 s, respectively. 7 of 135 infants (5.2%) allocated clamping ≥2 min died and 15 of 135 (11.1%) allocated clamping ≤20 s; risk difference (RD) −5.9% (95% CI −12.4% to 0.6%). Of live births, 43 of 134 (32%) had IVH vs 47 of 132 (36%), respectively; RD −3.5% (−14.9% to 7.8%). There were no clear differences in other outcomes for infants or mothers.ConclusionsThis is promising evidence that clamping after at least 2 min and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed.Trial registrationISRCTN 21456601.