Maria Sanchez-Holgado

Aim: Antenatal information is essential for families facing the possibility of an extremely preterm (EPT) birth. Their information needs are not always clear and communication can be challenging during this stressful, uncertain time. We explored parental perceptions about antenatal information provided during perinatal counselling about EPT births. Methods: This Spanish qualitative study comprised parents of infants born between 23 + 0 and 26 + 6 weeks of gestation in 2023–2024, who received antenatal counselling in a tertiary setting. Semi‐structured interviews were conducted with 15 families after their infants were discharged from the neonatal intensive care unit. These were analysed using inductive thematic analysis, in which themes and subthemes were identified. Results: Four main themes emerged. These were: making sense of complex antenatal information, the key roles of context and communication style, emotional journeys around extreme prematurity and supporting better perinatal care. Satisfaction with counselling was generally high, but parents wanted more practical, empathic approaches that respected their individual values and supported their emotional needs. There were wide variations in the level of detail required. Conclusion: Effective antenatal counselling about EPT births should empower parents by respecting their values, supporting their emotional needs and providing resources for informed decision‐making.

Background: Fetus in fetu (FIF) is an exceptionally rare congenital anomaly, often difficult to distinguish from fetiform teratoma. We report a genetically proven retroperitoneal FIF in a neonate and review the literature. Case Presentation: A term female infant presented with a prenatal retroperitoneal cystic mass. Postnatal imaging demonstrated calcifications suggestive of vertebral structures, although teratoma remained in the differential diagnosis. Serum tumor markers showed markedly elevated alpha-fetoprotein (AFP) and normal beta-human chorionic gonadotropin (β-hCG). Complete excision at 2 months revealed a sac containing a fetiform mass with scalp. Histology identified only mature tissues (glial tissue, choroid plexus, retinal pigment epithelium, dental alveoli, lamellar bone with hematopoiesis), without immature elements. Genetic testing by quantitative fluorescent PCR confirmed a diallelic profile identical to the host (46,XX), establishing the diagnosis of FIF. AFP normalized within 6 months, and the infant remained asymptomatic at 18 months. Discussion: Imaging, particularly CT and MRI, is essential for diagnosis and surgical planning, though distinction from teratoma can remain uncertain. Histology may suggest FIF but is not always definitive. Genetic identity between host and mass provides diagnostic certainty, resolving the long-standing controversy with fetiform teratoma. Our review confirms approximately 250 cases reported to date, with ~80% retroperitoneal and excellent outcomes following complete resection. Conclusion: FIF should be considered in neonates with retroperitoneal masses. Genetic analysis is crucial when pathology is inconclusive, ensuring diagnostic accuracy and guiding follow-up.

Background: Hemodynamic insufficiency occurs when tissue oxygen delivery fails to meet demand. Preterm infants are vulnerable to early circulatory failure after birth, impacting mortality and morbidity. Mean arterial pressure is not a reliable indicator of systemic blood flow. Low superior vena cava (SVC) flow, independent of fetal shunts, has been proposed as a robust biomarker of circulatory impairment in this population. Dobutamine, a selective β1 agonist with minimal effect on systemic vascular resistances, is considered the treatment of choice for this condition. However, information about its optimal dosing, efficacy, safety, and pharmacokinetic/pharmacodynamic (PK/PD) profile in preterm infants is limited. Methods: A multicenter, low-intervention, dose-finding trial will be conducted to establish the minimum effective dose of dobutamine to treat hemodynamic insufficiency, defined as SVC flow 55 mL/kg/min). The proportion of patients achieving and maintaining adequate hemodynamic status with dobutamine alone during the first 72 hours (efficacy), side effects, and variables explaining interindividual PK/PD variability will be explored. Discussion: This study aims to define the minimum dose of dobutamine with a relevant PD effect on circulation in infants with hemodynamic insufficiency during transitional circulation. This is the first step towards future randomized clinical trials on efficacy and safety of dobutamine for the proposed indication. Trial registration: EU Clinical trials register, EU CT 2023-504915-34-00, registered 18 April 2023.

Objective To evaluate the therapeutic dose and safety of bemiparin in neonatal thrombosis treatment. Study design A retrospective review was conducted on infants treated with bemiparin between 2018 and 2023 at a tertiary hospital. Results 72 neonates with a mean gestational age of 37 weeks were included. Twenty were preterm, with a median gestational age of 33.5 weeks and a median birth weight of 1847.5 grams. The mean (SD) initial and therapeutic bemiparin doses were 170.5 (31) and 200 (37.2) IU/kg/day, respectively. Only 32% of patients reached the therapeutic target range (TTR) with the initial dose. Preterm infants required higher doses to reach TTR (215 vs 194.7 IU/kg/day, p = 0.05). Adverse events were minimal (1.4%) and unrelated to the starting dose or prematurity. Conclusion Bemiparin appears to be a potential therapeutic option for anticoagulation in neonates; however, targeted anti-Xa levels were rarely achieved with the initial dose and most patients required uptitration.

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants.

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight <1000g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomised to AF group and 23 to TF group. AF was based on BUN concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day).No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge nor during intervention. Protein intake was significantly higher in AF group (5.02 g/kg/day vs 4.48 g/kg/day, p= 0.001). No differences were found in lipids, carbohydrates and energy intake; neither in weight z score change between the different time points; nor in length and head circumference growth. Both AF and TF are comparable methods of fortification and provide appropriate growth rate in ELBW infants.