Research ArticleResearchWorkflowQuality Improvement

Intact-cord resuscitation improved a composite neonatal outcome in one very-preterm trial

European journal of pediatrics (PubMed)Aug 12, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a single-center randomized trial of 127 very preterm neonates needing delivery-room resuscitation, intact-cord resuscitation was associated with fewer composite events of in-hospital death, severe intraventricular hemorrhage, or bronchopulmonary dysplasia than conventional clamping.

What NurseJet pulled from the source

The open-label trial compared resuscitation with the cord intact until physiological placental expulsion with clamping within 30 to 60 seconds. The composite outcome occurred in 35.9% versus 60.3% of per-protocol participants, but the small single-center design means the strategy requires confirmation and protocol-level implementation rather than bedside extrapolation.

Why this matters for nurses

Neonatal and pediatric nurses coordinate thermal support, ventilation, oxygenation, monitoring, and team communication during stabilization of very preterm infants. The trial offers a clinically important signal while emphasizing that intact-cord resuscitation depends on a prepared multidisciplinary delivery-room pathway.

Bedside takeaway

Intact-cord resuscitation for very preterm infants requires a coordinated, protocol-defined delivery-room setup and further confirmation of benefit.

How This Applies in Practice

Use this when: Preparing for the delivery-room stabilization of a very preterm infant when an intact-cord resuscitation pathway is available.

On your shift

Confirm the cord-management plan, eligible gestational range, equipment placement, warming strategy, monitoring setup, and assigned obstetric and neonatal roles during the pre-delivery briefing.
Document cord-clamping timing, respiratory support, oxygenation, heart rate, temperature, and transition events using the neonatal resuscitation record.
Escalate equipment, access, maternal, or neonatal concerns that make the planned pathway unsafe or infeasible before or during stabilization.

Keep in mind: The evidence comes from one small center and does not establish a universal cord strategy. Follow the neonatal resuscitation protocol, facility policy, and provider orders.

Key takeaways

The per-protocol analysis included 127 neonates born at 26 weeks 0 days through 31 weeks 6 days who required delivery-room resuscitation.
The composite of in-hospital mortality, severe intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35.9% with intact-cord resuscitation and 60.3% with conventional clamping.
Mortality was 26.6% versus 41.3%, and severe intraventricular hemorrhage was 9.4% versus 20.6%, respectively.
Maternal safety outcomes were comparable between groups in this trial.

Practice implications

For an anticipated very preterm birth, confirm the ordered cord-management and resuscitation plan, equipment position, role assignments, monitoring, and escalation route before delivery. Document timing, respiratory support, oxygenation, temperature, and transition findings according to the neonatal pathway.

Limitations & cautions

This was a single-center, open-label trial with 127 neonates and a per-protocol analysis. The composite combined outcomes of different clinical importance, and the findings may not generalize to centers without the same equipment, staffing, obstetric coordination, or neonatal population.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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European journal of pediatrics (PubMed)

European journal of pediatrics (PubMed). Effect of intact cord resuscitation versus conventional cord clamping on clinical outcomes in very preterm neonates: a randomized controlled trial from Eastern India.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42584505/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Western journal of nursing research (PubMed)Oct 15, 2026Systematic Review

A systematic review and meta-analysis of 38 studies including 19,033 patients identified clinical severity scales—specifically Modified Fisher grade and Fisher grade—and hemodynamic status as the strongest predictors of cerebral vasospasm following subarachnoid hemorrhage.

Emergency ICUAI summaryReview source

Systematic ReviewResearchQuality ImprovementAI summary · original source linked below

Cerebral vasospasm is a severe complication of aneurysmal subarachnoid hemorrhage (SAH) that frequently precipitates delayed cerebral ischemia and increases patient mortality. To clarify clinical predictors and inform intensive care nursing assessments, investigators conducted a systematic review and meta-analysis across eight databases through August 2024, evaluating study quality with the Joanna Briggs Institute checklist and Risk of Bias 2.0 tool. Across 38 included studies (27 in the meta-analysis) encompassing 19,033 patients, clinical severity metrics showed the strongest association with cerebral vasospasm: Modified Fisher grade (odds ratio [OR] 2.88; 95% CI, 2.04–4.07), Fisher grade (OR 2.27; 95% CI, 1.91–2.69), and hemodynamic status (OR 2.56; 95% CI, 1.17–5.59). Aneurysm-related characteristics and comorbid conditions were also linked to increased vasospasm risk, whereas clinical biomarkers and inflammatory markers demonstrated comparatively smaller effect sizes.

Key takeaways

Systematic review and meta-analysis synthesized 38 studies (27 in meta-analysis) encompassing 19,033 patients after subarachnoid hemorrhage.
Radiographic and clinical severity scales showed the strongest association with cerebral vasospasm: Modified Fisher grade (OR 2.88; 95% CI, 2.04–4.07) and Fisher grade (OR 2.27; 95% CI, 1.91–2.69).
Hemodynamic instability was strongly associated with vasospasm risk (OR 2.56; 95% CI, 1.17–5.59).
Aneurysm features and comorbidities also increased risk, while clinical biomarkers and inflammatory markers demonstrated smaller effect sizes.

Why this matters on shift

Neurocritical care nurses are the first line of defense in detecting subtle neurological deterioration and hemodynamic shifts in patients hospitalized for subarachnoid hemorrhage. Understanding that initial Fisher grade and hemodynamic status carry the highest statistical odds for vasospasm reinforces rigorous serial neurological scoring and strict blood pressure monitoring during the peak vasospasm window.

Bedside takeaway

In a meta-analysis of 19,033 SAH patients, Modified Fisher grade (OR 2.88), Fisher grade (OR 2.27), and hemodynamic status (OR 2.56) were the strongest predictors of cerebral vasospasm.

Nursing implications

Identify admission Fisher or Modified Fisher scores during shift handoff, maintain strict hemodynamic parameters per provider orders, and immediately escalate focal neurological deficits, altered sensorium, or transcranial Doppler velocity increases.

Limitations & cautions

Synthesized observational studies with heterogeneous definitions and reporting standards; meta-analysis reflects statistical associations rather than prospective causal prediction models; abstract does not detail specific individual biomarker cutoff values.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Western journal of nursing research (PubMed). Key Predictors of Cerebral Vasospasm Following Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

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Clinical research in cardiology : official journal of the German Cardiac Society (PubMed)Sep 28, 2026Research Article

A prespecified sex-specific secondary analysis of the PUSH-AHF trial in 310 patients found natriuresis-guided diuretic therapy increased 24-hour sodium excretion and reduced 180-day mortality or heart failure readmission in men, but not in women.

Telemetry ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Natriuresis-guided loop diuretic titration uses spot urinary sodium measurements to tailor decongestive therapy in acute heart failure (AHF). In this sex-specific analysis of the randomized PUSH-AHF trial, investigators evaluated 310 patients (45% women) assigned to natriuresis-guided therapy versus standard of care. In men, natriuresis-guided therapy produced significantly greater mean 24-hour total natriuresis compared with standard care (443 vs 354 mmol, p = 0.004), whereas women showed no significant difference between treatment arms (357 vs 336 mmol, p = 0.533; adjusted p-interaction = 0.276). Notably, the median 24-hour natriuretic response per milligram of loop diuretic (bumetanide equivalents) was significantly lower in women receiving natriuresis-guided therapy than standard care (23 vs 52 mmol/mg, p = 0.001), while no difference was observed in men (38 vs 45 mmol/mg, p = 0.337; adjusted p-interaction = 0.009). Clinically, natriuresis guidance was associated with a 49% lower risk of 180-day all-cause mortality or HF rehospitalization in men (adjusted HR 0.51; 95% CI, 0.30–0.86; p = 0.011), but showed no benefit in women (adjusted HR 1.40; 95% CI, 0.67–2.91; p = 0.368; adjusted p-interaction = 0.026).

Key takeaways

Sex-specific analysis of the PUSH-AHF randomized trial evaluated 310 patients (45% women) with acute heart failure.
In men, natriuresis-guided therapy increased 24-hour urinary sodium excretion (443 vs 354 mmol, p = 0.004) and reduced 180-day mortality/rehospitalization by 49% (adjusted HR 0.51, p = 0.011).
In women, natriuresis guidance did not increase total natriuresis (357 vs 336 mmol, p = 0.533) or improve 180-day clinical outcomes (adjusted HR 1.40, p = 0.368; p-interaction = 0.026).
Women in the guided arm exhibited a blunted natriuretic response per milligram of loop diuretic (23 vs 52 mmol/mg bumetanide, p = 0.001).

Why this matters on shift

Cardiology and telemetry nurses frequently manage intensive loop diuretic infusions and collect spot urinary sodium samples during acute decompensated heart failure admissions. These findings demonstrate that diuretic responsiveness and natriuresis-guided protocols may operate differently by biological sex, warning clinicians that intensifying diuretic doses based solely on spot sodium targets may not yield uniform decongestive or prognostic benefits across all patient groups.

Bedside takeaway

In the PUSH-AHF trial (310 patients), natriuresis-guided diuretic therapy reduced 180-day mortality/readmission in men (aHR 0.51) but showed no benefit in women (aHR 1.40; p-interaction=0.026).

Nursing implications

Collect urine samples for spot sodium strictly at ordered intervals during acute decongestion, maintain accurate intake/output records, monitor serum electrolytes and renal function closely during diuretic uptitration, and recognize that blunted urinary sodium output in female patients may reflect altered pharmacodynamics rather than simple noncompliance with fluid restrictions.

Limitations & cautions

Post-hoc subgroup analysis of a randomized trial with limited sample size (n = 310, including 139 women); findings are hypothesis-generating and require prospective validation in sex-stratified clinical trials before modifying clinical guidelines.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Clinical research in cardiology : official journal of the German Cardiac Society (PubMed). Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.

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Pediatrics (PubMed)Oct 1, 2026Clinical Guideline

The American Academy of Pediatrics updated its clinical practice guideline for diagnosing and managing urinary tract infections in infants and children aged 8 days to 5 years with low medical complexity.

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Clinical GuidelineGuidelineQuality ImprovementPatient EducationAI summary · original source linked below

Urinary tract infections (UTIs) occur in approximately 7% of febrile infants and represent one of the most common bacterial infections in pediatric practice. Replacing the 2011 guidance, the American Academy of Pediatrics issued an updated clinical practice guideline with three companion technical reports for children 8 days to 5 years of age with low medical complexity. Developed using the GRADE framework with evidence-to-decision panels, the update provides eight Key Action Statements (two strong and six conditional recommendations ranging from low to very low certainty of evidence) and four Good Practice Statements. Core guidance spans the diagnostic evaluation of suspected UTI, targeted antimicrobial selection and treatment duration, indications for renal and bladder ultrasound and voiding cystourethrography, prevention of structural sequelae including vesicoureteral reflux, and structured screening and treatment for bowel and bladder dysfunction.

Key takeaways

AAP updated its pediatric UTI guideline for children aged 8 days to 5 years with low medical complexity.
Formulates 8 Key Action Statements (2 strong, 6 conditional) and 4 Good Practice Statements using GRADE methodology.
Refines diagnostic sampling criteria, acute antibiotic selection, and targeted duration to minimize antimicrobial resistance.
Updates indications for renal imaging, vesicoureteral reflux evaluation, and systematic management of bowel and bladder dysfunction.

Why this matters on shift

Pediatric and emergency nurses are central to identifying febrile infants at risk for UTI, executing proper catheterized or clean-catch urine specimen collection, and guiding families through antibiotic completion and scheduled follow-up imaging. Standardizing diagnostic thresholds prevents both delayed pyelonephritis treatment and unnecessary antibiotic exposure in young children.

Bedside takeaway

AAP updated its pediatric UTI guideline for children 8 days to 5 years, delivering 8 Key Action Statements on diagnostic sampling, targeted antibiotic therapy, imaging indications, and bowel-bladder dysfunction.

Nursing implications

Collect clean catheterized urine specimens rather than bag samples for culture in non-toilet-trained febrile infants, reinforce completing prescribed antibiotic courses with parents, and assess older toddlers for withholding and bowel/bladder dysfunction during discharge education.

Limitations & cautions

Guideline applies specifically to children with low medical complexity and excludes those with neurogenic bladder, known high-grade anatomical urological anomalies, or immunodeficiency; evidence certainty for several recommendations remains low to very low.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatrics (PubMed). Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age.

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AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 19,033 SAH patients identifies clinical severity and hemodynamics as top predictors of cerebral vasospasm

PUSH-AHF trial analysis finds natriuresis-guided diuretic therapy reduces 180-day events in men but not women with acute heart failure

AAP updates pediatric UTI clinical practice guideline with 8 key action statements for children 8 days to 5 years