Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26–15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

ObjectiveMeasuring exhaled carbon dioxide (ECO2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO2detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: ‘In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO2monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?’.DesignSystematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022.SettingDelivery room.PatientsNewborn infants receiving non-invasive ventilation at birth.InterventionECO2measurement plus routine assessment compared with routine assessment alone.Main outcome measuresEndotracheal intubation in the delivery room, response to resuscitation, survival and morbidity.ResultsAmong 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO2may signify airway obstruction and ECO2detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question.ConclusionsEvidence to support the use of an ECO2monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO2measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed.PROSPERO registration numberCRD42022344849.

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Objective To evaluate students’ qualification after a six-month basic course of Neonatal Performed Echocardiography (NPEcho), adjusted by the motivational profile. Study design Prospective cohort of 16 neonatologists/neonatal fellows who underwent the basic NPEcho course in 2019 (18 h face-to-face theoretical classes; 36 h hands-on training) and 12 in 2020 (18 h online theoretical classes; 36 h hands-on training). Students’ qualification was defined as ≥70% in post-test, video test, and practical evaluation in neonates. Academic Motivation Scale was applied. Results Scores in 2019 vs. 2020 were: pre-test −32% vs. 40% ( p = 0.029), final theoretical score −78% vs. 69% ( p = 0.007), and practical evaluation −88% vs. 65% ( p = 0.003), resulting in 68.8% in 2019 vs. 33.3% in 2020 qualified students. Students’ motivational profile were similar in 2019 and 2020. Conclusion The NPEcho was successful in qualifying students with face-to-face theoretical classes, but the online format was inadequate to achieve the learning goals.

Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7–366/7 weeks gestation without congenital anomalies from 2004–2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7–366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais–Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.