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.

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.

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.

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.

This article reported two cases of axillary artery thrombosis in extremely low/very low birth weight infants following the placement of a local arterial catheter, who hospitalized in Shengjing Hospital of China Medical Universityin in April 2023 and August 2022, respectively. Case 1: Before surgery for necrotizing enterocolitis, an arterial catheter was placed in the left axilla of the infant. On the same day, the infant developed cyanosis of the left upper limb and weakened radial artery pulse. Ultrasound examination confirmed the presence of left axillary artery thrombosis. Despite subcutaneous injection of low molecular weight heparin (LMWH) and plasma infusion, there was no improvement in blood circulation. The infant also exhibited reduced movement in the left upper limb and loss of radial artery pulse. Thrombolytic therapy with recombinant tissue-type plasminogen activator was administered. Six hours after the treatment, the radial artery pulse became palpable. Thrombolysis was then terminated, and anticoagulation with LMWH was supplied for two weeks. At one year and eight months of age, the infant had a weaker left-hand grip strength compared to the right, but the overall functionality was largely preserved. Case 2: The infant developed late-onset sepsis at 17 days old and had an arterial catheter placed in the axilla. Pale left upper limb was observed in the following day, and the brachial and radial artery pulses were absent. Vascular ultrasound indicated the presence of left axillary artery thrombosis. Anticoagulation therapy with subcutaneous injection of LMWH was provided, along with thrombolysis using urokinase. On the sixth day after thrombolysis, an ultrasound examination showed no thrombus-like echoes. At one year and eight months of age, the development and movement of the affected upper limb became normal.

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.