Journal of Neonatal-Perinatal Medicine

Premature neonates are at risk for feeding difficulties, and despite early feeding therapy, some neonates require gastrostomy tube (GT) placement. This study aims to determine rates of GT placement in infants born at 22- and 23-weeks of gestation at our institution and to identify demographic and clinical risk factors associated with this outcome.

Institutional Review Board approval and de-identified data from January 1, 2018 to December 31, 2021 were analyzed in a REDCap database.

GT was placed for 33 of the 72 neonates (45.8%). GT neonates had lower gestational ages (23.1 vs 23.4 weeks; P = 0.004), birth weights (532.5 vs 596.7 g; P = 0.003), and APGAR scores at 1 min (2 vs 3; P = 0.020) and 5 min (5 vs 7; P = 0.009). They also had a higher incidence of intraventricular hemorrhage (IVH) diagnosed in the first week of life (45.5% vs 30.8%; P = 0.041) than those without a GT.

Despite feeding therapy, a substantial proportion of 22- and 23-week neonates require alternative feeding methods at NICU discharge. Further research is needed to determine additional risk factors and interventions in this population.

To evaluate temporal trends in heart rate variability as defined by the Heart Rate Characteristic index (HRCi) preceding necrotizing enterocolitis (NEC) in preterm infants.

Retrospective cohort study of neonates with NEC (Bell Stage II/III) at a tertiary NICU from 2020 to 2024. Continuous HRCi data were extracted for 15 days before and 4 days after NEC diagnosis. HRCi trajectories were analyzed using generalized additive models, Wilcoxon signed-rank tests, and linear regression. Logistic regression models were fit to daily HRCi with NEC diagnosis day (Day 0) as the binary outcome, adjusting for gestational age, small for gestational age (SGA) status, and birth weight Z-scores. Model discrimination was assessed using receiver operating characteristic curves and area under the curve (AUC).

Among 51 infants with NEC, median birth weight was 900 g and gestational age 27.7 weeks. HRCi rose progressively 2 weeks before onset of NEC, with a significant increase 3 days before diagnosis (median difference 0.31; p = 0.031). Logistic regression showed HRCi remained independently associated with NEC diagnosis day (OR = 1.28; 95% CI: 1.12–1.45; p < 0.001), while gestational age and birth weight Z-score were not. Within-patient AUCs were modest (0.65–0.66); exploratory comparison to the broader NICU population yielded higher discrimination (AUC = 0.84).

Rising HRCi preceded NEC diagnosis, with significant elevation 3 days before onset. HRCi demonstrated independent temporal association with NEC, though modest discrimination reflects the exploratory design. Prospective validation with matched controls and confounder adjustment is required to establish clinical utility.

Extremely preterm neonates undergo significant serum sodium (Na) changes in the first few days after birth. The objectives of this study were to describe the epidemiology of early onset hyponatremia, examine the investigations and interventions chosen, and assess the association of early onset hyponatremia with sodium and fluid intake in extremely preterm neonates.

Retrospective study of 100 extremely preterm neonates admitted between 2018 and 2019; data was collected 1-14 days post-birth. Early onset hyponatremia was defined as: hyponatremia within first 14 days, with mild (serum Na 130-134), moderate (Na 126-129), and severe (Na ≤125 mmol/L).

Early onset hyponatremia prevalence was 85%. Amongst mild hyponatremia, 23% progressed to moderate, 21% to severe hyponatremia. Repeat Na was ordered in 84%, Na intake increased in 57%, fluid intake reduced in 7% in the 24-h following hyponatremia. Higher cumulative weight gain and fluid intake >171 ml/kg/day had higher moderate/severe hyponatremia after 7 days. Na intake higher than 5 mmol/L (OR = 1.03) and increased fluid intake (OR = 1.00) did not reduce hyponatremia risk.

Early onset hyponatremia is common in extremely preterm neonates. Early recognition of mild hyponatremia is critical in preventing progression to moderate-severe hyponatremia. Fluid management in the early days of life of extremely preterm neonates should prioritize weight loss and Na balance while providing adequate nutrition.

Traditional diagnostic criteria for hypoxic-ischemic encephalopathy (HIE) rely heavily on documented fetal acidemia, which may be missing or unavailable in resource-limited settings. This study evaluated the diagnostic utility of multi-organ biomarkers in identifying neonates with HIE who do not meet classic acidemic criteria (“non-classic HIE”).

This clinical population study analyzed 416 full-term and late-preterm neonates over 3 years at a tertiary neonatal intensive care unit (NICU). Participants were categorized into “classic HIE” (acidemia present) and “non-classic HIE” (no acidemia but presenting with clinical encephalopathy). Cardiac (Troponin-I), renal (urea/creatinine), hepatic (ALT/AST), and hematological (neutrophil-to-lymphocyte ratio [NLR]) biomarkers were evaluated to predict HIE severity and short-term outcomes.

Of the cohort, 54.8% (n = 228) were classified into the non-classic HIE group. Within this group, 49.1% presented with mild, 43.4% with moderate, and 7.5% with severe clinical features, confirming systemic hypoxia despite “normal or near-normal” initial blood gases. Significant elevations in cardiac Troponin-I and AST were observed in the mild-to-severe classic HIE groups compared to the non-classic cohort (p < 0.001). Troponin-I showed high performance (AUC = 0.711) in predicting moderate-to-severe HIE across both cohorts. The NLR was significantly higher in all infants with clinical evidence of moderate-to-severe hypoxic insult.

Multi-organ biomarkers, particularly Troponin-I and NLR, offer valuable adjunctive metrics reflecting the severity of systemic hypoxic insults. They assist in identifying asphyxiated neonates when early blood gases are inconsistently captured or fail to show fetal acidemia.

Red blood cell (RBC) transfusion in very preterm infants has been linked to transfusion-related necrotizing enterocolitis (TR-NEC), and peri-transfusion feeding practices vary. We examined whether three different feeding strategies affect cerebral and splanchnic oxygenation.

In this single-center randomized pilot trial, infants <32 weeks’ gestation requiring RBC transfusion were allocated to feeds withheld, feeds reduced by 50%, or feeds continued during transfusion. Near-infrared spectroscopy measured cerebral and splanchnic rSO₂ from 2 h before transfusion start through 42 h after completion (covering the remainder of the 48-h post-initiation window used to define TR-NEC). FTOE and SCOR were calculated. Prespecified primary endpoints were between-group differences in changes in CrSO₂, SrSO₂, and corresponding FTOE across pre-specified epochs; secondary endpoints were feeding intolerance and TR-NEC (Bell stage ≥II within 48 h).

Forty-five infants were enrolled (14, 14, and 17 per group). Splanchnic rSO₂ increased and splanchnic FTOE decreased during and after transfusion; cerebral rSO₂ increased after transfusion with decreased cerebral FTOE. No statistically significant differences in, FTOE, or SCOR were detected between feeding groups. TR-NEC occurred in eight infants (2, 1, and 5 per group). In exploratory analyses, infants who developed TR-NEC had lower splanchnic rSO₂ and higher splanchnic FTOE before and during transfusion.

No statistically significant differences were demonstrated in cerebral or splanchnic oxygenation among three feeding strategies during RBC transfusion. As a pilot, hypothesis-generating study, these findings should not be interpreted as equivalence between strategies and require confirmation in larger trials.

Meta-analyses of observational studies evaluating association between blood transfusion and necrotizing enterocolitis (NEC) have shown mixed results and an independent association between anemia and NEC requires further evaluation.

To investigate the association of NEC with anemia in preterm infants via meta-analysis of (1) randomized controlled trials (RCTs) evaluating transfusion thresholds and recombinant erythropoietin (rEpo)/darbepoetin and (2) case–control studies comparing hematocrit levels between NEC cases and controls.

PubMed, Embase, Scopus, and the Cochrane Database were searched in August 2025, and the results were supplemented by other sources.

(1) Transfusion threshold and rEpo RCTs evaluating NEC rates in preterm infants with lower hemoglobin (Hb) levels compared with higher Hb levels. (2) Case–control studies comparing hematocrit levels between NEC cases and controls.

The incidence of any stage NEC in infants with low versus high Hb group.

RCTs evaluating transfusion threshold (n = 4, 3307 participants) showed no difference in NEC incidence between the low versus high Hb group [OR: 1.14 (CI: 0.89, 1.46), p 0.647]. RCTs evaluating rEPO versus placebo (n = 11, 4173 participants) showed higher incidence of NEC in the low versus high Hb group [OR: 1.43 (CI: 1.13, 1.80), p 0.003]. Meta-analysis of case–control studies (n = 3, 1016 participants) showed association of lower hematocrit levels in NEC cases compared with controls (standardized mean difference −0.28; CI −0.56, −0.002; p 0.048).

Our analysis suggests an association between NEC and lower hemoglobin levels. Well-designed and adequately powered prospective studies are required to confirm our findings.

Mechanical ventilation is an essential component of the management of respiratory failure in newborn infants in the neonatal intensive care unit (NICU). The effects of invasive and noninvasive ventilation strategies on the Cerebral Blood Flow Velocity (CBFV) have not been fully studied. The objective was to assess the influence of the mode of respiratory support, invasive or noninvasive, on CBFV in newborn infants admitted to the NICU.

This is a prospective observational study of 90 neonates. Participants were allocated into three groups according to the need for respiratory support: invasive ventilation, noninvasive ventilation, and a control group. Doppler ultrasonography of the middle cerebral artery was performed at the first hour and on the third day of respiratory support.

There were no statistically significant differences between the Doppler indices at the first hour of starting respiratory support between the studied groups. However, the Vmax of the middle cerebral artery was decreased significantly in the invasive mechanical ventilation group on the 3rd day of ventilation compared to the noninvasive group. Preterm infants exhibited a significant decrease in the mean values of Vmax, compared to full-term infants in the invasive group. Reduction of CBFV was reported in relation to seizures and sepsis. The cutoff value of CBFV for mortality has 100% sensitivity and 94.74% specificity.

In this observational study, Lower Vmax was observed among infants receiving invasive ventilation, a group that was also more premature and clinically unstable. Noninvasive ventilation was associated with stable cerebral hemodynamics.

Bronchopulmonary dysplasia (BPD) remains one of the most common and serious complications of premature birth, often leading to long-term morbidities. It affects approximately 40–50% of infants born before 29 weeks of gestation.

Our study was designed to validate the useful predictive value of serum NT-proBNP for BPD/Death in preterm neonates born <32 weeks of gestation with patent ductus arteriosus (PDA), in an Egyptian dual-center NICU setting.

Preterm neonates (<32 weeks, <72 h of age), regardless of PDA status, were prospectively enrolled. Echocardiographic assessment of PDA, including ductal diameter, was performed. NT-proBNP levels were measured twice during the first 10 days of life (within 72 hours and on days 8–9). At 36 weeks postmenstrual age, infants were classified into BPD/death (n = 44) or survival without BPD (n = 36).

NT-proBNP levels measured within 72 hours and on days 8–9 showed a moderate predictive value for BPD/death in infants with PDA diameter >1.5 mm. At <72 hours, the sensitivity was 62.8% and the specificity was 83.3%. At days 8–9, the sensitivity increased to 72.7% and the specificity to 88.9%.

Serum NT-proBNP concentrations showed a moderate predictive value, with superior performance at days 8–9 of life for the development of BPD/death in preterm infants, regardless of persistence of PDA.

The effectiveness of phototherapy for neonatal hyperbilirubinemia depends on irradiance and exposed body surface area. In resource-limited settings, suboptimal light delivery may reduce treatment efficiency. Reflective materials such as aluminium foil may improve light utilization during phototherapy.

To evaluate the efficacy and safety of aluminium foil reflector-assisted phototherapy compared with standard LED phototherapy in term neonates with hyperbilirubinemia.

In this randomized controlled trial conducted between August 2024 and August 2025 at a tertiary neonatal unit, 90 term neonates requiring phototherapy were randomized to receive either aluminium foil reflector-assisted phototherapy (n = 45) or standard LED phototherapy (n = 45). Total serum bilirubin (TSB) was measured at baseline and at 24-h intervals during phototherapy. Primary outcomes were rate of bilirubin reduction at 24 h and total duration of phototherapy. Secondary outcomes included physiological parameters, weight change, and adverse effects. Analysis of covariance was performed to adjust for baseline covariates.

Baseline TSB levels were similar between groups (15.43 ± 1.77 vs 15.85 ± 1.97 mg/dL; p = 0.111). After 24 h, the mean reduction in TSB was greater in the reflector group (3.91 ± 1.96 vs 2.76 ± 1.40 mg/dL; mean difference 1.15 mg/dL; p = 0.006). The total duration of phototherapy was shorter in the reflector group (32.62 ± 7.89 vs 39.04 ± 6.69 h; mean difference 6.42 h; p < 0.0001). The treatment effect remained significant after adjustment for gestational age and postnatal age using ANCOVA. No significant differences in adverse events were observed.

Aluminium foil reflector-assisted phototherapy was associated with faster bilirubin reduction and shorter treatment duration without increased adverse effects. This low-cost modification may improve phototherapy efficiency in resource-limited neonatal care settings.

Climate change is increasing the frequency and intensity of heatwaves globally, with potential implications for maternal and neonatal health. While associations between heat exposure and preterm birth (PTB) and low birth weight (LBW) have been documented, the broader spectrum of neonatal morbidities remains incompletely characterized. This scoping review systematically maps the evidence on heatwaves and neonatal outcomes beyond PTB and LBW.

To identify and synthesize evidence on (1) which neonatal morbidities beyond PTB and LBW are studied in relation to heat exposure; (2) exposure windows examined (preconception, trimester-specific, peripartum); and (3) heat metrics employed in the literature.

Following PRISMA-ScR guidelines and the JBI Population-Concept-Context (PCC) framework, we searched PubMed, Embase, Web of Science, and Scopus for peer-reviewed studies examining maternal heat exposure during pregnancy and neonatal outcomes in the first 28 days of life other than PTB and LBW. Because this was a scoping review of a heterogeneous literature, we retained variation in study design, exposure metrics, and outcome definitions rather than attempting quantitative pooling. Two reviewers independently screened titles, abstracts, and full texts. Data were extracted on study characteristics, neonatal outcomes, exposure windows, and heat metrics. Risk of bias was assessed using design-appropriate tools.

From 165 initial records, 15 records informed the review. The evidence base was heterogeneous in design, exposure assessment, and outcome definition, and represented 62,986,500 participants across nine countries (primary study publication period: 2012-2020). Eight neonatal outcome categories were identified: mortality (n = 7 evidence sources), NICU admissions (n = 5), thermoregulation disorders (n = 4), metabolic complications (n = 4), respiratory morbidity (n = 3), clinical assessment/Apgar scores (n = 3), congenital anomalies (n = 3), and infectious complications (n = 2). Third-trimester exposure was most frequently studied (n = 9), followed by peripartum (n = 3), second trimester (n = 2), and first trimester (n = 2). Heat metrics included maximum temperature (n = 5), heat index (n = 4), heatwave definitions (n = 4), mean temperature (n = 4), apparent temperature (n = 2), humidex (n = 1), and WBGT (n = 1). Seven studies (47%) were rated as low risk of bias. Across outcome groups, the literature generally suggested adverse associations with heat exposure, but the magnitude, statistical significance, and certainty varied across designs and metrics.

This scoping review reveals a growing, yet heterogeneous, body of evidence linking heat exposure to diverse neonatal morbidities beyond PTB and LBW. Third-trimester and peripartum exposures appear especially relevant, but conclusions should remain cautious because the included evidence varies in design, exposure metrics, outcome definitions, and confounder control. Standardization of heat metrics and exposure assessment is needed. Gaps include limited research on preconception and first-trimester exposures, metabolic and infectious complications, and research from low- and middle-income countries. Future research should employ consistent methodologies and examine vulnerable populations to inform climate adaptation strategies for maternal-neonatal health.

Acute kidney injury (AKI) is a serious complication in early preterm neonates with severe birth asphyxia, yet its incidence and predictors in this specific population remain incompletely characterised. The effect of caffeine initiation timing on AKI outcomes has not been prospectively examined.

This prospective observational cohort study enrolled 112 neonates of 28–32 weeks gestational age with severe birth asphyxia admitted to a level III neonatal intensive care unit (NICU) in South India (February–August 2025). AKI was defined by neonatal KDIGO (nKDIGO) criteria. Neonates were categorised according to early (≤6 h) or delayed (>6 h) caffeine initiation; delayed initiation was primarily associated with outborn status and haemodynamic instability at admission. Independent predictors of AKI were identified by multivariate logistic regression with bootstrap confidence intervals.

AKI was diagnosed in 48 of 112 neonates (42.9%; 95% CI 34.1–52.1%). Stage 1 disease predominated (47.9% of AKI cases), with onset in the first 48 h in the majority. On multivariate analysis, early caffeine initiation was independently associated with reduced odds of AKI (aOR 0.22; 95% CI 0.11–0.43; p < 0.001), and cumulative fluid balance at 48 h was associated with increased odds (aOR 6.30 per SD [21.8 ml/kg]; 95% CI 4.27–13.05; p < 0.001). AKI incidence was 24.1% in the early caffeine group versus 60.3% in the delayed group (p < 0.001), with an observed difference in AKI incidence of 36.2%. In-hospital mortality was higher in the AKI group (10.4% vs 0%; p = 0.013).

AKI occurred in 42.9% of early preterm neonates with severe birth asphyxia. Early caffeine initiation (≤6 h) was associated with reduced AKI incidence. Positive fluid balance at 48 h was an independent predictor. These findings suggest early caffeine initiation as a potentially modifiable factor associated with reduced AKI risk and identify fluid balance as a clinically relevant early marker in this high-risk population.

Neonatal priapism is a rare and typically benign condition characterized by a persistent penile erection unrelated to stimulation. Unlike priapism beyond the neonatal period, which is more frequently ischemic, most neonatal cases are non-ischemic and idiopathic, although associations with polycythemia have been reported.

We report the case of a male neonate born at 37 + 3 weeks of gestation who developed painless priapism on the first day of life, persisting for approximately 48 h. Clinical examination showed no penile discoloration or distress. Color Doppler ultrasound demonstrated preserved arterial and venous flow consistent with high-flow, non-ischemic priapism. A simple therapeutic phlebotomy was performed, resulting in complete detumescence within 24 h and normalization of hematologic parameters. The infant remained clinically stable, and 3-month follow-up showed no recurrence or complications.

This case highlights the importance of considering polycythemia in the etiological assessment of neonatal priapism and supports a conservative approach when vascular flow is preserved. Early recognition and appropriate management can lead to favorable outcomes without long-term sequelae.

Neonatal jaundice is a leading cause of newborn hospitalization in low- and middle-income countries (LMICs), yet factors influencing length of hospital stay (LOS) in non-infectious cases remain poorly characterized.

We retrospectively analyzed 1262 neonates with confirmed non-infectious jaundice admitted to a tertiary referral hospital in southern Vietnam between January 2024 and June 2025. Demographic characteristics, admission bilirubin levels, complete blood count (CBC) parameters, and derived inflammatory indices were evaluated. LOS was analyzed primarily as a continuous outcome, with prolonged hospitalization (≥3 days) assessed as a secondary outcome. Robust OLS, Poisson, and logistic regression models identified independent predictors after adjustment for age, sex, and ethnicity.

Higher total and indirect bilirubin levels were associated with longer LOS in univariable analyses. Across all multivariable models, total bilirubin independently predicted longer hospitalization and increased odds of prolonged stay. Higher monocyte count showed a modest inverse association with LOS, although this finding should be considered exploratory. Other CBC-derived inflammatory indices (NLR, MLR, PLR, SII, and SIRI) and demographic factors, including ethnicity, were not independently associated with LOS.

Bilirubin burden was the dominant determinant of hospitalization duration in neonates with non-infectious jaundice. Routine CBC-derived inflammatory indices provided little incremental prognostic value beyond bilirubin concentration. The modest association between monocyte count and shorter LOS warrants prospective validation, while additional clinical and health-system factors not captured in this study are also likely to influence hospitalization duration.

To assess the feasibility and efficacy of Vayu continuous positive airway pressure (vCPAP) for preterm and term infants with respiratory distress in the delivery room.

Feasibility study of infants of any gestational age presenting with respiratory distress defined as a Silverman–Anderson Score (SAS) ≥4 in the delivery room, who were started on vCPAP prior to transfer to the NICU and maintained during transport. Efficacy was assessed by comparing SAS, FiO₂, and SpO₂ before initiation of vCPAP, 1 min after initiation, and at the time of NICU admission. Secondary outcomes were feasibility accessed by a survey applied to all health care professionals (HCP), and safety (pneumothorax or clinical deterioration). Descriptive analysis and parametric and non-parametric tests were applied (alpha of 5%).

10 preterm and 10 term infants were initially enrolled, but one term was excluded because of a protocol deviation. The median gestational age was 37.6 ± 1.1 weeks for preterm and 34.2 ± 1.6 weeks for term infants. A significant improvement in SAS from five prior to vCPAP initiation (IQR 4–6) to three 1 min after initiation (IQR 2–4, p < 0.01), to two on NICU admission (IQR 1–3, p < 0.001). No significant differences in FiO₂, SpO₂, or CPAP pressure over these time periods were identified. Among HCP, ease of use and satisfaction were highlighted. No complications were observed.

In neonates with respiratory distress after birth, a clinical improvement was noted after initiation of vCPAP in the DR and during transport to the NICU.

Coronary artery dilatation (CAD) in neonates is an uncommon but clinically important finding on echocardiography. Reported associations include multisystem inflammatory syndrome in the newborn (MIS-N) following COVID-19 infection, congenital cardiac malformations, and perinatal inflammatory states. In the post-COVID era, CAD has been reported more frequently.

This retrospective, record-based case series conducted at a Government Medical College in South India describes the clinical profile of neonates with CAD who were admitted between January 2023 and December 2024.

A total of 24 neonates with CAD were identified during the study period. They were admitted in NICU for different conditions like respiratory distress syndrome, congenital pneumonia, sepsis, or perinatal asphyxia. The mean (SD) gestational age was 35.5 (2.2) weeks, and the mean birth weight was 2557 (646) g. Respiratory distress was the most common presenting feature (95.8%) followed by shock (75%). CAD was detected incidentally during echocardiography which was performed to evaluate persistent pulmonary hypertension of the newborn (PPHN), assess ventricular dysfunction during shock, and exclude congenital heart disease, particularly in those with an unexpected clinical course. One-third of the neonates (n = 8) met the diagnostic criteria for MIS-N and all of them responded to intravenous immunoglobulin therapy, with no mortality. Mortality was 31.25% (n = 5) among the others. Complete resolution of coronary dilatation was observed in all infants within 3–6 months.

Assessment of coronary arteries for dilatation should be considered in any sick neonate with an inadequate response to conventional management. It may be a pointer for MIS-N.

Hyperoxia-induced lung injury is a key contributor to the development of bronchopulmonary dysplasia in preterm infants, primarily through oxidative stress and impaired antioxidant defense mechanisms.

To evaluate the protective effects of N-acetylcysteine (NAC) and combined vitamin E and C therapy on oxidative stress, antioxidant capacity, and lung histopathology in a neonatal rat model of hyperoxia-induced lung injury.

A total of 36 neonatal rats were randomly assigned to four groups: control (room air, n = 9), hyperoxia (n = 9), hyperoxia + NAC (n = 8), and hyperoxia + vitamin E + C (n = 10). Hyperoxia exposure (90% ± 10% O₂) was maintained from postnatal days 3–14. Treatments were administered intraperitoneally (NAC 150 mg/kg/day, vitamin E 25 IU/day, vitamin C 1 mg/kg/day). Oxidative stress parameters (TOS, OSI, and LOOH), antioxidant markers (TAS, paraoxonase, and arylesterase), and histopathological findings were evaluated in serum and lung tissue.

Hyperoxia significantly increased oxidative stress markers, with higher TOS levels observed in both serum and lung tissue compared to the control group (p < 0.001). NAC and vitamin E + C treatments significantly increased TAS levels compared to the hyperoxia group (p < 0.05). Serum OSI levels were significantly reduced in both treatment groups (p = 0.002 and p = 0.032). Additionally, arylesterase levels were significantly higher in the vitamin group compared to all other groups (p < 0.001). Histopathological evaluation demonstrated reduced inflammatory cell infiltration and lower fibrosis scores in the treatment groups.

N-acetylcysteine and combined vitamin E and C therapy attenuate hyperoxia-induced lung injury by reducing oxidative stress and improving lung histopathology in neonatal rats. These findings support antioxidant strategies as adjunctive approaches for BPD-related lung injury.

Maternal mirror syndrome is a rare pregnancy complication causing maternal edema that mirrors that of a hydropic fetus. Isolated fetal ascites is also uncommon and has multiple possible etiologies, and has not traditionally been associated with maternal mirror syndrome.

We present a case of “atypical maternal mirror syndrome” in a fetus with isolated abdominal ascites to illustrate the possibility of mirror syndrome without fetal hydrops. A 32-year-old G1P0 had an ultrasound revealing significant fetal abdominal ascites with incompletely visualized fetal bladder dome. The patient developed pulmonary edema with oxygen requirements and underwent preterm delivery due to concern for mirror syndrome. The neonatal ascites was suspected to be secondary to bladder outlet obstruction due to hydrometrocolpos from an imperforate hymen. Although the fetus was not hydropic, our patient developed pulmonary edema, hemodilution, and maternal weight gain, and recovered quickly after delivery, many features of maternal mirror syndrome.

This case illustrates an atypical presentation of maternal mirror syndrome in the setting of isolated fetal ascites rather than fetal hydrops. With the significant maternal and fetal morbidity associated with maternal mirror syndrome, clinicians should consider maternal mirror syndrome as a possible diagnosis even in the absence of fetal hydrops.

Umbilical venous catheterization provides essential vascular access in neonates, particularly in premature and low-birth-weight neonates. Conventional confirmation using radiography may delay accurate placement and increase radiation exposure.

To compare catheter placement confirmation using conventional radiography versus real-time bedside ultrasonography, while evaluating diagnostic performance, procedural efficiency, radiation exposure, and short-term complications.

A prospective cohort study was conducted on 270 neonates (150 with ultrasound guidance and 120 without) who required umbilical venous catheterization in the neonatal intensive care unit at Children’s Hospital, Ain Shams University, from June 2022 to July 2024.

Standard catheter positioning (T7–T9) was achieved in 97.9% of ultrasound-guided cases compared with 70.4% in the non-guided group (p < 0.001). Procedure time until suturing and radiographic confirmation was significantly shorter in the ultrasound group (5.87 ± 1.37 and 14.14 ± 2.15 min) than in the non-ultrasound group (6.90 ± 1.99 and 16.90 ± 3.46 min) (p < 0.001). Ultrasound guidance reduced catheter manipulations and the number of radiographs required. Diagnostic performance of ultrasound showed high sensitivity (95.2%) and accuracy (94.0%). One-month follow-up demonstrated minimal complications.

Ultrasound-guided umbilical venous catheter insertion provides accurate and efficient catheter localization, reduces procedure time and radiation exposure, and offers reliable diagnostic performance. These findings support its routine use in neonatal intensive care units.