Scott O. Guthrie

Objective The Ethiopian Newborn Quality Improvement (EN-QI) Extension for Community Healthcare Outcomes (ECHO) promoted the implementation of Helping Babies Survive training in eight Ethiopian health facilities. The initiative incorporated U.S based Neonatal-Perinatal Medicine (NPM) fellows into the ECHO Expert Hub. This study evaluates the experiences of the NPM fellows. Study design This mixed-methods study incorporated objective data, survey responses, and qualitative focus group analysis from the eight participating fellows. Results Fellows described benefits including mentoring, networking, career development, and quality improvement experience. Their experience would have been improved with more thorough onboarding and clarification of the fellow role at the start of the project. Conclusion This study demonstrates a model for inclusion of fellows in a virtual partnership as a low-cost and high value approach to global health work. This project was well-received and highly valued by fellows as a meaningful training opportunity.

Pulmonary surfactant is a lifesaving treatment for preterm infants with respiratory distress syndrome (RDS). With the advent of less-invasive surfactant delivery techniques that minimize or eliminate exposure to invasive mechanical ventilation, the question of prophylactic surfactant administration has reemerged. This review discusses the evidence for less-invasive surfactant therapy applied prophylactically. In summary, prophylactic surfactant administration by pharyngeal deposition or brief intubation are not recommended. Surfactant delivery via supraglottic airway or by aerosolization have not been investigated as prophylaxis for RDS. Recent evidence suggests that prophylactic surfactant administration via thin catheter is safe and effective. Several ongoing randomized clinical trials are further evaluating the efficacy of prophylactic surfactant administration via thin catheter. Prophylactic surfactant administration via supraglottic airway devices and aerosolization should be evaluated in future studies.

Background/Objectives: Critical congenital heart disease (CCHD) is among the major causes of global neonatal morbidity and mortality. While the incidence of CCHD appears to vary across populations, much of this variation may stem from differences in detection and reporting capabilities rather than true prevalence. In Jordan, recent data revealed a congenital cardiac disease incidence of 17.8/1000 live births, much higher than international averages. Diagnosis is largely dependent upon echocardiography, which is difficult to obtain in low-resource settings where prenatal screening modalities are limited. Screening for CCHD with pulse oximetry offers a potential method to identify patients earlier and contribute to improved outcomes. Methods: This prospective cohort study evaluated 20,482 neonates screened using pulse oximetry at Al-Bashir Hospital between January 2022 and May 2024. Demographic data, pulse oximetry measurements, and echocardiogram findings were collected during the screening process after obtaining ethical approval from the Jordanian Ministry of Health. Results: Pulse oximetry screening identified 752 neonates (3.7%) requiring further evaluation by echocardiography. An abnormality was detected in 240 neonates (31.9%), which included cardiac anomalies and pulmonary hypertension. Screening led to the identification of 138 infants with CCHD, including 80 with a previously unknown diagnosis, and an additional 247 infants with conditions requiring increased monitoring or treatment. Among those with CCHD, hypoplastic left heart syndrome and Tetralogy of Fallot were the most common conditions, 3.1%, and 2.4%, respectively. The overall false positive rate was 1.8% and was higher among those screened at less than 24 h of life compared to those screened at or after 24 h of life (2.3% [95%CI 2.1–2.6] vs. 0.8% [95%CI 0.6–1.0], p < 0.001). Conclusions: Pulse oximetry screening successfully led to the early detection of CCHD among Jordanian neonates. There was a high prevalence of CCHD compared to other reported cohorts. This highlights the importance of implementing national screening protocols to improve early diagnosis and intervention. Future studies will inform the feasibility and cost-effectiveness of national implementation in this setting.

Background Optimal CPAP strategy to prevent CPAP failure defined as need for endotracheal intubation is unknown. Objective To evaluate the risk of CPAP failure in infants treated with high vs low CPAP strategy while receiving aerosolized calfactant in the AERO-02 clinical trial and AERO-03 expanded access program. Methods Infants born between 29 0/7 to 36 6/7 weeks were included. Comparisons were made between low and high CPAP groups (Low, 4–7 cm H₂O; High, 8–10 cm H₂O). Results CPAP failure and pneumothorax were not different between the groups. Odds of CPAP failure were not different after adjustment for baseline characteristics (OR = 0.61; 95% CI: 0.29, 1.24). Conclusion We found no difference in CPAP failure among infants who received aerosolized calfactant that were treated with high vs low CPAP strategy. Efficacy of high CPAP strategy with aerosolized surfactant treatment needs to be evaluated in future studies.

Background Noninvasive respiratory support (NRS) failure is common in preterm infants with respiratory distress syndrome (RDS). We evaluated the utility of Respiratory Severity Score (RSS) and Oxygen Saturation Index (OSI) during the first two hours of life (HOL) as a predictor for NRS failure.Methods We conducted a retrospective cohort study of infants born between 28 0/7 to 33 6/7 weeks with RDS. Univariate and multivariable logistic regression analysis were used to assess whether the RSS and OSI summary measures were associated with NRS failure.Results Among 282 infants included in the study 58 (21%) developed NRS failure. RSS and OSI summary measures in the first 2 HOL were associated with NRS failure within 72 HOL.Conclusion RSS and OSI during the first two HOL can predict NRS failure. Optimal RSS and OSI cutoffs for prediction of NRS failure need to be determined in large cohort studies.

Background. CPAP levels used for respiratory distress syndrome are variable. Optimal CPAP strategy to prevent CPAP failure is unknown. Objective. To evaluate the risk of CPAP failure in infants treated with high vs low CPAP strategy while receiving aerosolized calfactant in the AERO-02 clinical trial and AERO-03 expanded access program. Methods. Comparisons were made between low and high CPAP groups (Low, 4-7 cm H₂0; High, 8-10 cm H₂0). Results. Low and high CPAP groups had 215 and 106 infants respectively. CPAP failure and pneumothorax were not different between the groups. Odds of CPAP failure was not different after adjustment for baseline characteristics (OR = 0.61; 95% CI: 0.29, 1.24). Conclusion. We found no difference in CPAP failure among infants who received aerosolized calfactant that were treated with high vs low CPAP strategy. Efficacy of high CPAP strategy with less invasive surfactant treatment needs to be evaluated in future studies.

Surfactant administration via an endotracheal tube (ETT) has been the standard of care for infants with respiratory distress syndrome for decades. As non-invasive ventilation has become commonplace in the NICU, methods for administering surfactant without use of an ETT have been developed. These methods include thin catheter techniques (LISA, MIST), aerosolization/ nebulization, and surfactant administration through laryngeal (LMA) or supraglottic airways (SALSA). This review will describe these methods and discuss considerations and implementation into clinical practice.

Objective Preterm infants often develop failure of noninvasive respiratory support. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of respiratory severity score (RSS) during the first 3 hours of life (HOL) as a predictor for failure of noninvasive respiratory support. Study Design We conducted a post hoc analysis of infants between 23 and 40 weeks' gestational age who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression analysis were used to assess whether the RSS summary measures were associated with the odds of surfactant administration. Results Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01). Conclusion We demonstrated that RSS during the first 3 HOL can predict failure of noninvasive respiratory support and need for late rescue surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies. Key Points

Background The aerosolized calfactant decreased the need for intubation in neonates with respiratory distress syndrome (AERO-02 trial). Objective To determine the oxygenation response to aerosolized calfactant among infants born 28 0/7–36 6/7 weeks with RDS in the AERO-02 trial. Methods Trends in hourly fraction of oxygen (FiO₂), mean airway pressure (MAP) and respiratory severity score (RSS) were compared between the aerosolized calfactant (AC) and usual care (UC) groups from time of randomization for 72 h. Results A total of 353 subjects were included in the study. FiO₂, MAP, and RSS were lower in the UC group. FiO₂ decrease was seen after the first aerosolized calfactant dose. Conclusion FiO₂, MAP, and RSS were lower in the UC group. This is likely due to early and higher rate of liquid surfactant administration in the UC group. Decrease in FiO₂ was noted in the AC group after the first aerosolization.