Anne Lee Solevåg

Aim: In many countries, all newborns undergo a routine clinical newborn examination before discharge. Key aim of this examination is to detect conditions for which early treatment may improve outcomes. This study aimed to describe variation in the timing, content, professional responsibility and follow‐up arrangements for routine clinical newborn examination in Norway, Denmark and Sweden. Methods: April to September 2024, we distributed a survey to Norwegian paediatricians and to representatives of maternity and paediatric departments in Denmark and Sweden. Results: We analysed responses from 45 hospitals: Norway ( N = 20), Denmark ( N = 12) and Sweden ( N = 13). In Norway and Sweden, a more comprehensive examination was generally performed by paediatricians within 72 h after birth. In Denmark, midwives typically performed a simplified examination within 12 h, with paediatric assessment when indicated. Examination content was broadly similar in Norway and Sweden but differed in Denmark. All participating hospitals reported routine pulse oximetry screening, but cardiac auscultation and follow‐up of heart murmurs differed. Conclusion: The organisation of routine clinical newborn examination differs across Scandinavia. These differences in care pathways may influence resource use and clinical decision making. Whether they translate into differences in neonatal morbidity or mortality remains unknown.

Objective To compare mortality and morbidity in extremely preterm (EPT) and/or extremely low birthweight (ELBW) infants receiving or not receiving probiotic supplementation. Design Nationwide, population-based registry study. Setting All neonatal intensive care units (NICUs) in Norway. Participants All EPT (Conclusion Probiotic supplementation to EPT/ELBW infants was associated with lower all-cause mortality and possibly reduced NEC.

Introduction: Regional analgesia is widely used for labour pain relief. The impact on foetal heart rates has been extensively studied, but little is known about its impact on neonatal heart rates. The aim of this study was to assess whether maternal use of epidural, spinal, or pudendal labour analgesia was associated with differences in neonatal heart rates. Methods: This Norwegian observational study included 1,281 singleton cephalic term vaginal deliveries from September 1, 2019, to June 30, 2021. Neonatal heart rates were measured using dry electrode technology. Generalised linear models adjusted for covariates related to the mother, neonate, and labour process were used to estimate neonatal heart rates by methods of maternal analgesia at 30 s, 1, 2, and 3 min after birth. The results were compared to a baseline representing heart rates modelled for infants whose mothers received no analgesia. Results: The median heart rate in all groups, including the epidural (n = 439), spinal (n = 34), pudendal (n = 36), and no analgesia (n = 772) groups, ranged from 147 to 175 beats per minute (bpm) at all time points. Infants whose mother received epidural analgesia had slightly higher mean heart rate compared to the baseline at 2 (167 vs. 164 bpm) and 3 (152 vs. 149 bpm) minutes of life (p < 0.05). No significant association was observed between spinal or pudendal analgesia and neonatal heart rates. Conclusion: Infants whose mothers received epidural labour analgesia had statistically, but not clinically significant, higher heart rates in the first minutes of life.

Background/Objective: Even in the absence of infection, prolonged rupture of membranes (PROM) has been associated with elevated neonatal C-reactive protein (CRP). As both the sensitivity and specificity of CRP in predicting early-onset neonatal sepsis (EOS) may be low, we aimed to describe CRP levels during the first 36 h of life in term infants born after PROM ≥ 24 h. Methods: CRP was measured at 1, 12, and 36 h. Descriptive statistics and correlation analyses were performed, taking gestational age, birth weight, sex, delivery mode, and antibiotic treatment into account. Reference CRP values in healthy neonates without sepsis born after PROM were established. Results: Median (range) CRP was 0 (0–62) mg/L, 0 (0–82) mg/L, and 4 (0–92) mg/L at 1, 12, and 36 h, respectively. CRP at 12 and 36 (p < 0.001) but not 1 h was positively correlated with gestational age and birth weight. There was no difference in CRP after C-section vs. vaginal delivery. Among infants without sepsis, CRP was higher at all time points in infants who did vs. those who did not receive antibiotics (p < 0.001). Conclusions: CRP was low in term infants without sepsis born after PROM but with outliers above 60, 80, and 90 mg/L after 1, 12, and 36 h, respectively. Research is needed on the long-term outcomes of infants with inflammation, as evidenced by an elevated CRP after PROM.

Technological advancements and digital accessibility have increased expectations for flexible learning in higher education, requiring pedagogical approaches that support self-regulation and self-directed learning, which are core principles of self-determination theory. The present study aimed to explore how students experienced courses with flexible learning design within a master's nursing programme. Four focus group interviews were conducted with master`s students in advanced clinical neonatal nursing in spring 2023, and the data were analysed using reflexive thematic analysis. The study adhered to COREQ. Four main themes were identified: “Reflections on Professional Growth”; “Experiences with Flexible Learning Strategies”; “Perceptions of the Learning and Social Environment” and “Balancing Flexibility with Everyday Life”. Flexible learning design supported both autonomy and professional growth. Despite limited face-to-face interaction, students reported a strong sense of relatedness. To meet core psychological needs, a well-structured flexible environment must offer clear communication of structure, expectations and learning opportunities.

Objective: During perinatal transition, compromised cerebral oxygenation may contribute to neonatal morbidity and mortality. Near-infrared spectroscopy measures cerebral regional tissue oxygen saturations (crSO₂) and may guide delivery room respiratory management. This review evaluated whether crSO₂ monitoring in addition to routine assessment (clinical assessment, pulse oximetry +/− ECG) compared with routine assessment alone improves neonatal outcomes. Design: Systematic review and meta-analysis based on Ovid MEDLINE, Embase, and Cochrane CENTRAL searches (16 February and 5 November 2024). Setting: Delivery room. Patients: Newborn infants of all gestations, born via any mode, receiving continuous positive airway pressure and/or intermittent positive pressure ventilation during stabilisation/resuscitation. Intervention: crSO₂ monitoring with a dedicated treatment guideline in addition to routine assessment compared with routine assessment alone. Main outcome measures: Survival without neurodevelopmental impairment, survival, severe intraventricular haemorrhage and periventricular leukomalacia (infants 2 2 for survival (relative risk (RR) 1.02, 95% CI 0.99 to 1.05), severe intraventricular haemorrhage (RR 0.76, 95% CI 0.38 to 1.54), periventricular leukomalacia (RR 1.93, 95% CI 0.66 to 5.70) (n=667; two RCTs) and crSO₂ 2 with a dedicated treatment guideline in preterm infants.

Aim: Our aim was to use electrocardiograms immediately after birth to determine the heart rates of healthy newborn infants by gestational age and mode of delivery. Methods: This prospective observational study was performed in two Norwegian hospitals from March 2019 to June 2021. We included infants with gestational ages of ≥ 28 weeks and no need for positive pressure ventilation. Continuous heart rate data were collected using dry electrode technology and were used to create percentile charts and compare heart rates by groups. Results: We enrolled 214 preterm and 2191 term newborn infants. The median (quartiles) heart rate at 60 s of age was 166 (150–181) beats per minute for preterm infants and 174 (158–187) for term infants ( p < 0.05). Term infants born using vacuum extraction, forceps or emergency Caesarean sections had significantly higher heart rates than term infants born by unassisted vaginal deliveries or planned Caesarean sections. The median heart rates of the groups were all within the normal range. Conclusion: This study provided normative heart rate data for healthy newborn infants, by gestational age and delivery mode. Although the differences between the groups were statistically significant, they were of limited clinical significance and would not support changes in neonatal resuscitation measures.

Background: Current resuscitation guidelines recommend a 3:1 chest compression/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI with 3:1 C:V during neonatal cardiopulmonary resuscitation (CPR). Methods: MEDLINE (through PubMed), Google Scholar, EMBASE, and Clinical Trials.gov through June 2024. Randomized controlled trials comparing CC + SI with 3:1 C:V during neonatal CPR in the delivery room were included. Data Analysis included Risk of bias was assessed using the Covidence collaboration tool, and results were pooled into a meta-analysis using a fixed effects model. Main outcomes were In-hospital mortality (primary). Time to return of spontaneous circulation (ROSC) and air leak (secondary). Results: Two studies were included. The pooled data suggests no difference in infant mortality between CC + SI versus 3:1 C:V during neonatal CPR (RR 0.64, 95% CI 0.21,1.7, p = 0.33, I² = 63%). The use of CC + SI during neonatal CPR could result in 182 fewer per 1000 (from 351 fewer to 311 more) infant deaths. The pooled data suggested a significant reduction in time to ROSC with CC + SI versus 3:1 C:V during neonatal CPR (mean difference 115 s (from 184.75 to 45.36 s), p = 0.001, I² = 26%). Air leak was not different between groups. Conclusions: While in-hospital mortality and air leak were not different between groups, time to ROSC was significantly reduced. A large clinical trial is warranted to assess if CC + SI improves outcomes.

Neonates requiring cardiopulmonary resuscitation (CPR) are at risk of mortality and neurodevelopmental injury. Poor outcomes following the need for chest compressions (CCs) in the delivery room prompt the critical need for improvements in resuscitation strategies. This article explores a technique of CPR which involves CCs with sustained inflation (CC+SI). Unique features of CC+SI include (1) improved tidal volume delivery, (2) passive ventilation during compressions, (3) uninterrupted compressions and (4) improved stability of cerebral blood flow during resuscitation. CC+SI has been shown in animal studies to have improved time to return of spontaneous circulation and reduced mortality without significant increase in markers of inflammation and injury in the lung and brain, compared with standard CPR. The mechanics of CCs, rate of compressions, ventilation strategies and compression-to-ventilation ratios are detailed here. A large randomised controlled trial comparing CC+SI versus the current 3:1 compression-to-ventilation ratio is needed, given the growing evidence of its potential benefits.