Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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European journal of pediatrics
Associations of socioeconomic status and nurturing environment with developmental outcomes in very preterm children without sensorimotor impairment: a secondary analysis of the INTACT study
UNLABELLED: The objective of this study is to retrospectively evaluate the associations between socioeconomic status (SES), including nurturing environment, and developmental quotients (DQ) at age 3 in children born very preterm with birth weight ≤ 1500 g. This secondary analysis used follow-up data from the Improvement of NICU Practices and Team Approach Cluster Randomized Controlled Trial. Participants born < 32 weeks' gestation without major sensorimotor impairments were stratified into three groups: 22-24, 25-27, and 28-31 weeks. Multiple linear regression evaluated the associations between prenatal SES and DQ scores of the Kyoto Scale of Psychological Development (KSPD), adjusted for sex, parity, gestational age, small for gestational age, multiple births, and facilities. Post-discharge SES variables were subsequently added to assess associations with nurturing environment. Of 2148 eligible survivors, 1978 underwent KSPD testing and 1846 caregivers completed SES questionnaires. Higher parental education was positively associated with total DQ across all groups: 22-24 weeks (β = 2.246, 95% CI 0.015-4.477), 25-27 weeks (β = 1.589, 95% CI 0.408-2.770), and 28-31 weeks (β = 1.299, 95% CI 0.315-2.282). Group childcare utilization was associated with higher total DQ: 22-24 weeks (β = 3.397, 95% CI 0.893-5.901), 25-27 weeks (β = 1.851, 95% CI 0.591-3.111), and 28-31 weeks (β = 2.617, 95% CI 1.613-3.620). These associations remained after adjustments for postnatal morbidities. CONCLUSION: Among children born very preterm without major sensorimotor impairments, parental education and group childcare utilization were independently associated with more favorable cognitive outcomes at age 3. These results suggest the importance of socioeconomic and environmental support in optimizing developmental outcomes for this vulnerable population. WHAT IS KNOWN: • Prenatal and postnatal SES are associated with developmental outcomes in both preterm and term children. In addition, daily group childcare environments influence child development in the general population. WHAT IS NEW: • Among very preterm children without major sensorimotor impairments, including those born at 22-24 weeks' gestation, parental education and group childcare utilization are independently associated with more favorable cognitive and language outcomes at age 3.
25 May 2026
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Multi-directional phototherapy vs. unidirectional phototherapy from below for severe neonatal jaundice: a randomized pilot trial in home phototherapy
UNLABELLED: Severe neonatal jaundice is a common problem, carrying a risk of neurologic toxicity. Phototherapy has become the standard treatment for jaundiced infants, eliminating the need for exchange transfusion and the risk of neurotoxicity. We hypothesized that treatment with multi-directional phototherapy would be more rapid than with single-direction, high-intensity treatment from below (unidirectional) in the home setting. We performed a prospective, randomized, pilot trial comparing high-intensity multi-directional phototherapy to high-intensity unidirectional treatment in the home setting. Treatment time was determined from device timers. Serum bilirubin levels were obtained daily and as ordered by the pediatrician, serving as a basis for estimating the bilirubin reduction rates. Eight infants were treated with multi-directional phototherapy; nine were treated with unidirectional phototherapy. Multi-directional treatment was more rapid with treatment time of 15.1 ± 6.4 h vs. 25.1 ± 11.8 h; p = 0.05. The estimated rate of bilirubin reduction was more rapid with multi-directional phototherapy 0.40 ± 0.21 vs. 0.14 ± 0.10 mg/dL/h; p < 0.02. CONCLUSION: Multi-directional phototherapy was more rapid than treatment with unidirectional phototherapy in the home setting. TRIAL REGISTRATION: ISRCTN88608924 29 January 2026, retrospectively registered. WHAT IS KNOWN: •Home phototherapy for hyperbilirubinemia is safe and effective. •Treatment times with fiberoptic and wearable devices in the home setting can be lengthy and complicated by overheating and readmission. WHAT IS NEW: •Home phototherapy with multidirectional illumination is more effective than unidirectional undersurface phototherapy. •Multidirectional home phototherapy can lower bilirubin levels at a rate comparable to hospital devices.
15 Apr 2026
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