Somashekhar Marutirao Nimbalkar

Neonatal screening (NBS) enables early detection of treatable congenital disorders, but physiological immaturity in preterm and critically ill neonates may reduce screening accuracy. We conducted a prospective observational study of 8231 neonates screened over three years at a tertiary care centre in Western India for congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), G6PD deficiency, sickle cell disease, and selected amino acidopathy. A total of 70 were confirmed with a screened disorder, yielding an incidence of 8.5 per 1000 live births; G6PD deficiency (1:175) and CH (1:588) were most common.

Background: Alarm fatigue in neonatal intensive care units (NICUs) may affect patient safety, staff well-being, and the developmental care environment. NICU alarm-management interventions have been reported across quality improvement (QI), before-after, randomized crossover, implementation, and observational designs, but outcome definitions, denominators, and safety measures remain heterogeneous. Objective: To map NICU alarm-management interventions and related implementation studies, emphasizing intervention components, outcome metrics, alarm-burden outcomes, clinical safety measures, and implementation lessons. Methods: This scoping review followed PRISMA-ScR guidance. PubMed/MEDLINE, Embase, CINAHL, and Cochrane Library were searched, with an updated search through June 2026. Eligible reports involved neonatal or newborn intensive care settings and addressed alarm fatigue, clinical alarm management, alarm burden, alarm thresholds, alarm delays, alarm routing, or related QI or implementation approaches. Two reviewers screened records and charted data. A protocol was predefined before screening but was not prospectively registered. Full database-specific search strategies are provided in Supplementary Appendix A. Owing to heterogeneity in designs, denominators, and outcome definitions, findings were synthesized descriptively and were not pooled. Results: Sixteen studies/reports met inclusion criteria. The PRISMA-ScR flow diagram shows 20 records identified, 0 duplicates removed, 20 records screened, 3 excluded at title/abstract screening, 17 full texts assessed, 1 full text excluded, and 16 studies included. Included studies addressed alarm-threshold or parameter optimization, oxygen-saturation alarm strategies, staff education, protocol standardization, PDSA-based QI, alarm delay/filtering, handheld-device routing, and single-room NICU alarm workflows. Reported alarm reductions were directionally favorable in many studies, but denominators differed substantially, including total alarms, SpO ₂ alarms, false alarms, non-actionable alarms, and alarms transmitted to handheld devices. Conclusions: The NICU alarm-management literature describes cautiously favorable alarm-burden trends after carefully implemented, patient-tailored, multidisciplinary approaches, while reported monitored safety outcomes were generally maintained in published studies. However, most evidence is observational, before-after, or QI in design; therefore, conclusions should remain descriptive and cautious. Limitations include heterogeneous outcome definitions, English-language full-text restriction, and limited long-term and economic data. The evidence does not support ranking intervention combinations or making causal comparative-effectiveness claims. Future work should use standardized NICU-specific alarm outcomes, predefined balancing safety measures, long-term sustainability assessment, and economic evaluation.

Background/Objectives: Congenital hyperinsulinism (CHI) is the leading cause of persistent hypoglycaemia in infancy and childhood characterized by dysregulated insulin secretion despite low plasma glucose concentrations. Early recognition and treatment are essential to reduce the risk of neurological injury. Advances in molecular genetics have revealed substantial genetic and phenotypic heterogeneity beyond classical K_ATP-channel disorders. This review examines the expanding genetic landscape of CHI and the translation of molecular discoveries into precision clinical care. Methods: This narrative review, based on targeted literature searches of PubMed/MEDLINE, Scopus and Embase and expert selection of key publications, synthesizes current evidence on the genetic mechanisms, genotype–phenotype relationships, molecular diagnosis, and clinical management of CHI, with emphasis on established and emerging genetic subtypes and their implications for therapeutic decision-making. Results: More than 30 disease-associated genes have been identified, involving ion channels, metabolic enzymes, transcription factors, membrane transport proteins, mitochondrial pathways, and developmental mechanisms. Major genetic forms involving ABCC8, KCNJ11, GLUD1, GCK, HK1, HADH, SLC16A1, HNF4A, HNF1A, and FOXA2 illustrate diverse mechanisms of dysregulated β-cell insulin secretion. Recognition of non-coding regulatory variants has further expanded the molecular spectrum and provided new insights into tissue-specific gene regulation. Molecular diagnosis increasingly informs prediction of diazoxide responsiveness, selection for ¹⁸F-DOPA PET/CT, identification of patients at high risk of focal disease, surgical planning, genetic counselling, and long-term surveillance. Conclusions: Precision medicine is increasingly transforming CHI from a predominantly phenotype-based disorder into a genetically informed clinical entity. Integration of genomic testing with clinical phenotyping and functional assessment can improve diagnostic classification and individualize management. Continued genomic discovery, functional validation, and international collaboration will be important for patients who remain without a molecular diagnosis and for developing mechanism-based therapies.

This scoping review maps and compares evidence on enhanced or modified Family‐Centered Care (FCC) models—including Family Integrated Care (FICare) and related variants—against standard FCC/usual neonatal intensive care unit (NICU) care for preterm infants. We aimed to summarize the comparative effects on neonatal growth and development, feeding and hospital utilization metrics, parental engagement, and parental psychosocial outcomes, and to describe program characteristics and contextual factors reported alongside variation in results across settings. We included diverse study designs conducted in NICUs across multiple regions. Growth‐related outcomes were the most commonly reported domain: 30 studies assessed weight gain, growth velocity, feeding progression, discharge weight, or breastfeeding, and 15 studies explicitly reported better growth or feeding‐related outcomes with enhanced FCC/FICare than with standard FCC/usual care. Developmental outcomes were reported in 12 studies, parental psychosocial outcomes in 25 studies, hospital utilization metrics in 28 studies, and parental engagement measures in 22 studies. Benefits were most often described in programs that combined structured parent education with active bedside caregiving, participation in rounds, mentoring, or other implementation supports, although findings varied by program intensity, unit context, and implementation fidelity. Overall, the evidence supports enhanced FCC/FICare as a promising strategy for improving infant–family outcomes in NICUs, while highlighting the need for clearer component definitions, standardized outcome reporting, and longer‐term follow‐up to support scalable, sustainable implementation.

Unplanned extubation (UE) is a common and largely preventable safety event in neonatal intensive care units, with agitation, hand-to-endotracheal tube (ETT) interaction, and subsequent staff intervention frequently preceding events. This study aimed to evaluate the short-term efficacy of the Sunflower Technique (SFT), a non-pharmacological developmental containment intervention, in reducing agitation, behaviors related to self-extubation, and the need for staff intervention in invasively ventilated neonates. In this pilot randomized cross-over trial, intubated neonates of any gestational age underwent two 1-h observation periods on the same day, receiving SFT and conventional care (CC) in randomized order (30 min each during both 1 h periods). Primary outcomes included near-miss self-extubation events (grabbing the ETT), possible self-extubation events (touching the tube), agitation assessed using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and COMFORTneo scales. Secondary outcome included frequency of staff intervention. All observation periods were video-recorded for assessment. Fifty-seven neonates contributed 114 observation periods for each group. Compared with CC, SFT was associated with significantly fewer near-miss and possible self-extubation events (P < .001 for both). Agitation scores were significantly lower during SFT periods on both N-PASS and COMFORTneo scales (P < .001). No UE events occurred during either period. No interventions needed by staff were comparable during SFT and CC periods (72.8% vs. 61.4%, P = .059). The SFT was associated with reduced agitation, fewer behaviors related to self-extubation, and a comparable need for staff intervention in invasively ventilated neonates.

This study aims to map ethical, legal, social, professional, and implementation issues associated with artificial intelligence (AI) in neonatal intensive care units (NICUs). A JBI-informed scoping review using the population-concept-context framework was reported according to PRISMA-ScR. Peer-reviewed English-language articles published from 1 January 2016 to 31 May 2026 were eligible. Because the original exports and screening log were unavailable, a documented updated rerun was completed on 13 July 2026 using public PubMed-indexed bibliographic searching, supplementary publisher and bibliographic web searching, and backward and forward citation chaining. Exact strategies and record-level decisions are provided as online resources. The retrieval log contained 78 record captures. After removal of 21 duplicates, 57 unique records were screened; 45 full texts were assessed, 14 were excluded with documented reasons, and 31 sources were included. Eight recurring domains were identified: data governance; bias and fairness; transparency and explainability; human oversight; accountability and surveillance; parental engagement; professional readiness and workflow; and equitable implementation. Empirical evidence was concentrated on parent and nurse perceptions, pain assessment, counseling, and explainability, whereas consent processes, subgroup fairness, liability, and post-deployment safety remained under-studied. Conclusion: Ethically responsible NICU AI requires secure governance, local and subgroup validation, understandable communication, active clinician oversight, defined accountability, staff and family engagement, and prospective monitoring. Generative AI should remain supervised and should not replace clinician-family communication. What is known: • Artificial intelligence is increasingly being developed for neonatal outcome prediction, monitoring, pain assessment, clinical decision support, documentation, and family communication, but relatively few systems have progressed to validated routine NICU use. • The use of AI in neonatal care raises concerns regarding privacy, algorithmic bias, explainability, accountability, human oversight, parental trust, and equitable access. What is New: • This scoping review identifies eight recurring ethical and implementation domains for NICU AI: data governance, fairness, transparency, human oversight, accountability, parental engagement, professional readiness, and equitable implementation. • Current empirical evidence is concentrated on stakeholder perceptions, pain assessment, counseling, and explainability, while consent processes, subgroup fairness, legal responsibility, and post-deployment safety monitoring remain insufficiently studied.

Objective: To evaluate the effect of a fluid bolus on inferior vena cava dynamics and left ventricular output in newborns. Methods: This prospective, analytical study enrolled newborns in a tertiary neonatal intensive care unit (NICU) who needed a fluid bolus based on clinical assessment. Inferior vena cava (IVC) collapsibility/distensibility and left ventricular output (LVO) were measured using ultrasound before and after a 10 mL/kg normal saline bolus. Results: Sixty newborns were included in the study [room air ( n = 21), continuous positive airway pressure (CPAP) ( n = 12), and ventilated ( n = 27)]. Significant reductions in IVC collapsibility were observed in the room air group ( P < .001), while IVC distensibility significantly decreased in both CPAP ( P = .002) and ventilated ( P < .001) groups. Volume time integral (VTI) and LVO increased significantly following a fluid bolus in all the groups. Clinical parameters showed minimal changes, except for a significant improvement in capillary refill time in the ventilated group. Conclusion: IVC collapsibility/distensibility, VTI, and LVO demonstrate significant improvements after a fluid bolus, suggesting point-of-care ultrasound may be a valuable tool for guiding fluid management in the NICU, although changes in clinical parameters were not always concordant.