Umbilical cord management in neonates requiring resuscitation remains a critical yet debated topic in perinatal medicine. While deferred cord clamping (DCC) is widely adopted for non-resuscitated infants, its application during resuscitation is contentious. Emerging strategies—including physiologically-based cord clamping (PBCC), intact cord resuscitation (ICR), and umbilical cord milking (UCM)—aim to balance placental transfusion with timely resuscitation. Current evidence suggests DCC enhances blood volume and iron stores but may delay critical interventions. PBCC and ICR optimize hemodynamics by synchronizing respiration with placental transfusion, though they demand advanced technical expertise. UCM rapidly augments blood volume but raises concerns about intraventricular hemorrhage in extremely preterm infants. Further studies are needed to validate the long-term safety and efficacy of these approaches, particularly in infants <35 weeks' gestation and through combined protocol optimization. Future research should prioritize standardized guidelines to improve outcomes for neonates requiring resuscitation.

Neurovascular coupling (NVC) is a fundamental mechanism that maintains the dynamic balance between cerebral metabolic demands and stable blood supply, playing a crucial role in supporting brain development and basic functions. Impaired NVC may lead to local cerebral ischemia and hypoxia, consequently affecting neural signal transmission and indirectly reflecting alterations in brain function. In recent years, various non-invasive imaging technologies based on NVC have been applied for brain function assessment. However, the application of these techniques in neonates remains limited. The neonatal period represents a critical phase for brain development and maturation, during which the brain is highly vulnerable to various injurious factors. Therefore, there is an urgent need for non-invasive, high-resolution, and highly sensitive brain function assessment methods to facilitate timely clinical diagnosis, treatment, and nursing strategy formulation. This review aims to summarize the structural basis of NVC and its current applications in neonatal brain function evaluation.

Objective:To investigate the clinical utility of functional near-infrared spectroscopy (fNIRS) in evaluating cerebral function in neonates with hypoxic-ischemic encephalopathy (HIE).Methods:This was a case-control study. Fifteen neonates with moderate to severe HIE who were admitted to the Department of Neonatal Medical Center, Children's Hospital of Fudan University from March 2023 to August 2024 and completed fNIRS testing were selected as the HIE group, and 15 full-term infants without neurological diseases and completed fNIRS testing were selected as the control group during the same period. Resting-state fNIRS data were acquired to construct cerebral functional connectivity networks and topological properties were analyzed. Statistical analyses included independent t-tests, Mann-Whitney U tests, analysis of variance, and Chi-square tests. Results:Compared with controls, the HIE group exhibited significantly reduced global functional connectivity strength [0.15 (0.05-0.26) vs. 0.24 (0.13-0.35), Z=－7.66, P<0.001]. Both groups demonstrated small-world network properties, with no intergroup difference (1.17±0.05 vs. 1.14±0.05, t=2.02, P=0.050). The HIE group showed decreased shortest path length (6.22±0.52 vs. 13.74±0.49, t=48.18, P<0.001), global efficiency (0.26±0.04 vs. 0.30±0.05, t=2.50, P=0.018) and normalized shortest path length (1.50±0.07 vs. 1.62±0.22, t=2.43, P=0.020). No differences were observed in the clustering coefficient or local efficiency between the two groups. Regional analysis revealed reduced nodal efficiency in both left (0.30±0.06 vs. 0.35±0.05, t=2.47, P=0.021) and right hemispheres (0.30±0.06 vs. 0.37±0.06, t=2.68, P=0.013) in HIE neonates compared with that of the corresponding hemispheres in the control group. The intra-group comparison showed no statistical significance in node efficiency between the left and right hemispheres (both P>0.05). Conclusion:fNIRS captures functional network signatures in HIE, demonstrating clinical potential for early detection of cerebral dysfunction in neonates with hypoxic-ischemic injury.

Air leak syndrome is a common and critical respiratory issue in neonates. Air leak syndrome not only affects pulmonary gas exchange but also leads to unstable hemodynamics, severe pulmonary hypertension, and other life-threatening conditions. In recent years, despite significant improvements in respiratory support concepts, equipment, and techniques, air leak syndrome remains a prevalent clinical problem, impacting neonatal prognosis and quality of life. This article summarizes the research progress on high-risk factors, early diagnosis, prevention, and treatment of air leak syndrome.

Objective:To investigate the clinical utility of functional near-infrared spectroscopy (fNIRS) in evaluating cerebral function in neonates with hypoxic-ischemic encephalopathy (HIE).Methods:This was a case-control study. Fifteen neonates with moderate to severe HIE who were admitted to the Department of Neonatal Medical Center, Children's Hospital of Fudan University from March 2023 to August 2024 and completed fNIRS testing were selected as the HIE group, and 15 full-term infants without neurological diseases and completed fNIRS testing were selected as the control group during the same period. Resting-state fNIRS data were acquired to construct cerebral functional connectivity networks and topological properties were analyzed. Statistical analyses included independent t-tests, Mann-Whitney U tests, analysis of variance, and Chi-square tests. Results:Compared with controls, the HIE group exhibited significantly reduced global functional connectivity strength [0.15 (0.05-0.26) vs. 0.24 (0.13-0.35), Z=－7.66, P<0.001]. Both groups demonstrated small-world network properties, with no intergroup difference (1.17±0.05 vs. 1.14±0.05, t=2.02, P=0.050). The HIE group showed decreased shortest path length (6.22±0.52 vs. 13.74±0.49, t=48.18, P<0.001), global efficiency (0.26±0.04 vs. 0.30±0.05, t=2.50, P=0.018) and normalized shortest path length (1.50±0.07 vs. 1.62±0.22, t=2.43, P=0.020). No differences were observed in the clustering coefficient or local efficiency between the two groups. Regional analysis revealed reduced nodal efficiency in both left (0.30±0.06 vs. 0.35±0.05, t=2.47, P=0.021) and right hemispheres (0.30±0.06 vs. 0.37±0.06, t=2.68, P=0.013) in HIE neonates compared with that of the corresponding hemispheres in the control group. The intra-group comparison showed no statistical significance in node efficiency between the left and right hemispheres (both P>0.05). Conclusion:fNIRS captures functional network signatures in HIE, demonstrating clinical potential for early detection of cerebral dysfunction in neonates with hypoxic-ischemic injury.

Air leak syndrome is a common and critical respiratory issue in neonates. Air leak syndrome not only affects pulmonary gas exchange but also leads to unstable hemodynamics, severe pulmonary hypertension, and other life-threatening conditions. In recent years, despite significant improvements in respiratory support concepts, equipment, and techniques, air leak syndrome remains a prevalent clinical problem, impacting neonatal prognosis and quality of life. This article summarizes the research progress on high-risk factors, early diagnosis, prevention, and treatment of air leak syndrome.

Umbilical cord management in neonates requiring resuscitation remains a critical yet debated topic in perinatal medicine. While deferred cord clamping (DCC) is widely adopted for non-resuscitated infants, its application during resuscitation is contentious. Emerging strategies—including physiologically-based cord clamping (PBCC), intact cord resuscitation (ICR), and umbilical cord milking (UCM)—aim to balance placental transfusion with timely resuscitation. Current evidence suggests DCC enhances blood volume and iron stores but may delay critical interventions. PBCC and ICR optimize hemodynamics by synchronizing respiration with placental transfusion, though they demand advanced technical expertise. UCM rapidly augments blood volume but raises concerns about intraventricular hemorrhage in extremely preterm infants. Further studies are needed to validate the long-term safety and efficacy of these approaches, particularly in infants <35 weeks' gestation and through combined protocol optimization. Future research should prioritize standardized guidelines to improve outcomes for neonates requiring resuscitation.

Neurovascular coupling (NVC) is a fundamental mechanism that maintains the dynamic balance between cerebral metabolic demands and stable blood supply, playing a crucial role in supporting brain development and basic functions. Impaired NVC may lead to local cerebral ischemia and hypoxia, consequently affecting neural signal transmission and indirectly reflecting alterations in brain function. In recent years, various non-invasive imaging technologies based on NVC have been applied for brain function assessment. However, the application of these techniques in neonates remains limited. The neonatal period represents a critical phase for brain development and maturation, during which the brain is highly vulnerable to various injurious factors. Therefore, there is an urgent need for non-invasive, high-resolution, and highly sensitive brain function assessment methods to facilitate timely clinical diagnosis, treatment, and nursing strategy formulation. This review aims to summarize the structural basis of NVC and its current applications in neonatal brain function evaluation.

Over the past two decades,therapeutic hypothermia has been the most important treatment for moderate to severe neonatal hypoxic-ischemic encephalopathy (HIE).However,due to the lack of uniformity in the grading assessment methods for HIE and the willingness of clinicians to actively treat,therapeutic hypothermia is now being increasingly implemented in infants with mild HIE.At the same time,owing to the insufficient knowledge regarding the effectiveness and safety of treatment beyond the established indications,concerns about this situation have been arisen.The ongoing large-scale multi-center randomized controlled trial may change this situation in the future.

Objective:To investigate the predictive value of the expression of CD14+CD277+monocyte macrophage and pro-grammed death receptor-1(PD-1)on T cells in clinical outcome of children with acute respiratory distress syndrome(ARDS).Meth-ods:The clinical data of 130 children with ARDS in 3201 hospital from April 2014 to March 2020 were respectively analyzed.After 28 days of treatment,the children were divided into survival group and death group according to their survival status.The levels of PD-1 on CD14+CD277+monocyte macrophages and T cells in survival group and death group were compared.The independent risk factors af-fecting the outcome of the children and the value of PD-1 levels on CD14+CD277+monocyte-macrophages and T cells in predicting the death of the children were analyzed.Results:The proportion of CD14+CD277+monocyte-macrophages and MFI in the death group were higher than those in the survival group(P<0.05).Multivariate Logistic regression analysis showed that gestational age,Apgar score at 5 min after birth,hypoalbuminemia,CD14+CD277+monocyte macrophage and PD-1 on T cells were independent risk factors for death(P<0.05).The area under the ROC curve of CD14+CD277+monocyte macrophage was 0.777(95%CI:0.698～0.855,P=0.000),the cut-off value was 0.105%,the corresponding sensitivity was 81.96%,and the specificity was 55.67%.The area under ROC curve of PD-1 on T cells was 0.756(95%CI:0.674～0.838,P=0.000),and the cutoff value for predicting death was 114 MFI.The sensitivity and specificity were 80.45%and 58.23%.Conclusion:The level of PD-1 on CD14+CD277+monocyte-macrophages and T cells is relat-ed to the prognosis of neonates with ARDS,and its higher level indicates poor prognosis and a higher risk of death.