The study, published in Frontiers in Developmental Psychology, is, according to its authors, the first to examine the relationship between screen exposure and psychomotor, communicative, socio-emotional, and tactile competencies in very preterm infants at 12 months corrected age. Its findings arrive amid a striking shift in the digital environments surrounding infants: television running in the background, parents’ smartphones perpetually within reach, and content that is rarely designed for babies at all.

Recruitment drew on the routine follow-up program that all very preterm survivors in the region attend after hospital discharge. Of 147 children born very preterm who survived, the researchers excluded those with major congenital malformations, severe brain injury, or parents insufficiently fluent in French to complete the questionnaires. After accounting for refusals, families lost to follow-up, and incomplete questionnaires, 64 infants entered the analysis—38 boys and 26 girls, with a mean gestational age of 28.9 weeks and a mean birth weight of just 1,162 grams. Fifty-nine percent had bronchopulmonary dysplasia, and nearly one in five had experienced neonatal sepsis, underscoring how medically fragile this cohort was from the start.

Parents completed the Family Media Use questionnaire, which catalogued the household’s electronic devices and asked them to estimate, for weekdays and weekends alike, how much time their child spent watching television or using tablets and smartphones. The answers revealed a household landscape saturated with screens: an average of seven devices per home, with parents spending nearly six hours a day on screens for work and about five hours a day for personal use. Seventy-two percent of parents reported using screens while their child was in the room, averaging one hour daily. Twenty-three percent said the television was often on in the background, and roughly one in five systematically watched television during family meals.

Direct exposure among the infants themselves was less universal but still substantial. Thirty-nine percent of the babies—25 of the 64—were directly exposed to screens, averaging about four hours per week, with individual exposure ranging from half an hour to 14 hours weekly. That figure exceeds the roughly 1.75 hours per week reported for infants under one year in earlier research, and the authors note that screen time typically climbs with age: data from the French Elfe cohort show average daily viewing rising from 52 minutes at age two to one hour and 40 minutes by age 5.5.

Each child underwent a battery of assessments during the routine follow-up consultation. Child psychologists, psychomotor therapists, and physiotherapists administered the Bayley Scales of Infant Development III, a standardized instrument measuring cognitive, language, and motor development. Parents completed the Ages and Stages Questionnaire: Social-Emotional, a screening tool covering self-regulation, compliance, autonomy, affect, and interaction with others. The team also designed experimental tasks: one tested whether the infant preferred a helpful puppet over one that withheld a ball; another observed whether the child, after watching one experimenter help another build a tower, would hand over blocks themselves; a third counted gaze alternations and pointing gestures to quantify joint attention. Finally, a tactile exploration task video-recorded each child playing with a textured plastic cube and three different toys, coding the duration of active exploration and the variety of strategies used—pressing, shaking, stroking, mouthing, rotating, throwing. Crucially, the single trained rater who coded all the videos did so before ever seeing the screen-time questionnaires, guarding against bias.

The statistical picture that emerged was nuanced. When the researchers simply compared screen-exposed infants with unexposed ones, no significant differences appeared on any Bayley scale, the social-emotional questionnaire, or any of the experimental tasks. Nor did correlations across the entire cohort reach significance. But when the analysis narrowed to the 25 directly exposed infants, a clear dose-response pattern surfaced: greater screen time correlated negatively with cognitive scores (ρ = −0.34, p = 0.048) and, more strongly, with language scores (ρ = −0.56, p = 0.002). Higher exposure also predicted fewer exploration strategies during the tactile task (ρ = −0.39, p = 0.02), an association that actually strengthened after adjustment for gestational age and socio-economic status. Notably, motor scores showed no relationship with screen time, and neither did prosocial behavior, joint attention, or the parent-rated social-emotional total.

That last null result surprised the team, given how much prior research links early screen exposure to poorer social and emotional outcomes. The authors offer several explanations. Socio-emotional skills may evolve on a different timetable and only become measurable later in development. Pointing, in particular, emerges late in preterm children—studies have shown that extremely preterm infants produce significantly fewer pointing gestures at 18 months than full-term peers, a deficit linked to later language delay—so the rarity of pointing in this 12-month sample may have limited the task’s sensitivity. Previous work has also found that gaze-based joint attention behaviors are more affected by screens than gesture-based ones, and only a subset of infants in this cohort had begun pointing at all.

The findings align with a substantial literature. A longitudinal study of 2,441 children found that heavier screen use at 24, 36, and 60 months predicted poorer performance on developmental screening questionnaires at subsequent ages. A meta-analysis of language outcomes reported negative correlations between children’s language skills and both daily screen duration and background television, and found that later first exposure was associated with better language skills. Research on the mechanisms is equally telling: when a television is on, parents speak less and infants vocalize less, eroding the dyadic exchanges on which early language depends. The displacement theory offers a complementary frame—every hour in front of a screen is an hour not spent in interactive play, physical exploration, or social engagement, experiences that are especially critical for very preterm infants whose brains are already maturing atypically.

The study also uncovered a social gradient: within the exposed subgroup, lower family socio-economic status was associated with greater screen exposure, echoing earlier findings that parents of lower socio-economic status adhere less strictly to screen-time guidelines for toddlers. The authors are careful to frame their work as a pilot. Parent-reported screen time is vulnerable to recall and social-desirability bias; the questionnaire captured quantity but not content quality, co-viewing, or background exposure; the observational design precludes causal inference; and the small, attrition-prone sample limits statistical power. Still, the message for families is concrete. The researchers argue that awareness campaigns alone are insufficient, and that parents need practical guidance—skills for reading their infant’s cues, and alternatives to screens that foster meaningful interaction from birth. For a population already navigating elevated neurodevelopmental risk, the first year may be precisely the wrong time to hand over a screen.

Subject of Research: Associations between early screen exposure and cognitive, language, socio-emotional, and tactile development in very preterm infants at 12 months corrected age

Article Title: Screen exposure and reduced cognitive abilities, language development, and tactile exploration in very preterm infants aged 12 months—A pilot study

Article References: Liverani, M. C., Lordier, L., Durand-Ruel, M., Gillioz, E., Ha-Vinh Leuchter, R., Gentaz, E., Lejeune, F., & Borradori-Tolsa, C. (2026). Screen exposure and reduced cognitive abilities, language development, and tactile exploration in very preterm infants aged 12 months—A pilot study. Frontiers in Developmental Psychology, 4, Article 1875016. https://doi.org/10.3389/fdpys.2026.1875016

Image Credits: AI Generated

DOI: 10.3389/fdpys.2026.1875016

Keywords: very preterm infants, screen exposure, cognitive development, language development, tactile exploration, Bayley Scales, joint attention, prosocial behavior, socio-economic status, infant development, pilot study, digital media

The ductus arteriosus is a normal feature of fetal circulation, a short muscular vessel that shunts blood away from the lungs while the baby is still in the womb and oxygen comes from the placenta. In most newborns, the vessel closes within hours or days of birth. In babies born before 32 weeks of gestation, however, closure often fails or is delayed. The resulting patent ductus arteriosus, or PDA, creates a left-to-right shunt: oxygenated blood leaving the heart is diverted back toward the lungs, increasing pulmonary blood flow and pressure. When that shunt becomes hemodynamically significant, meaning it is large enough to disturb circulatory function, the flooded, immature lung capillaries are thought to become vulnerable to rupture, particularly in lungs already injured by prematurity and mechanical ventilation.

The research team, led by Li Yang and colleagues in the Department of Neonatology at Guangyuan Central Hospital in Sichuan, China, set out to quantify this relationship. They reviewed the records of 482 very preterm infants, all born at less than 32 weeks of gestation, who were admitted to their neonatal intensive care unit between January 2019 and October 2025. Because the study was retrospective, the investigators worked backward from outcomes that had already occurred, using univariate and multivariate logistic regression to separate factors genuinely associated with pulmonary hemorrhage from those that merely appeared linked because of confounding. For infants diagnosed with a patent ductus arteriosus, the team calculated the Patent Ductus Arteriosus Severity Score, a composite measure that grades the clinical and hemodynamic weight of the defect.

The headline finding is stark. Of the 482 infants in the cohort, 93, or 19.3 percent, developed neonatal pulmonary hemorrhage. Among those who bled, 42 died before discharge, a post-hemorrhage mortality rate of 45.2 percent. Those numbers underline why the condition commands such dread in neonatology: nearly one in five very preterm infants in this cohort experienced a lung hemorrhage, and nearly half of the affected babies did not survive it. Preventing even a fraction of these events, or identifying them earlier, could translate into a meaningful survival gain for this population.

When the researchers ran their multivariate analysis across the entire cohort, five factors remained independently associated with pulmonary hemorrhage: lower gestational age, lower birth weight, a lower five-minute Apgar score, premature rupture of membranes, and hemodynamically significant PDA. Each of these tells a clinically coherent story. Earlier gestational age and lower birth weight reflect pulmonary immaturity and fragile capillary networks. A depressed five-minute Apgar score signals birth depression and possible hypoxic stress on vascular integrity. Premature rupture of membranes is associated with intrauterine inflammation and infection, which can precondition the fetal lung for injury. And hemodynamically significant PDA supplies the mechanical mechanism, the excessive pulmonary blood flow, that pushes those weakened capillaries over the edge.

To make these findings more usable at the bedside, the team built nomograms, graphical scoring tools that allow clinicians to total up a patient’s individual risk factors and read off an estimated probability of the outcome. They internally validated these tools using the bootstrap method, a resampling technique that estimates how much a model’s apparent performance is inflated by overfitting to the original dataset. In the subgroup of infants with PDA, the nomogram for predicting pulmonary hemorrhage achieved an area under the receiver operating characteristic curve, or AUC, of 0.858, with a 95 percent confidence interval of 0.812 to 0.904. After bootstrap correction, the value settled at 0.837, still comfortably in the range considered good discrimination for a clinical prediction tool.

One of the more contemporary aspects of the study is its use of SHAP analysis, short for SHapley additive explanations, a machine learning interpretation method borrowed from game theory that quantifies how much each individual predictor contributes to a model’s output. Applied here, SHAP revealed that gestational age contributed most to the risk assessment of pulmonary hemorrhage, followed by hemodynamically significant PDA and then birth weight. In practical terms, this means the single strongest signal of danger remains how early the baby was born, but the severity of the ductal shunt carries weight nearly comparable to birth weight. The approach gives clinicians an intuitive visualization of why the model flags a particular infant, addressing a common criticism that statistical prediction tools operate as unexplained black boxes.

The second half of the analysis focused on the sickest subgroup: the 81 infants who had both a patent ductus arteriosus and a pulmonary hemorrhage. Here the question shifted from who bleeds to who dies after bleeding. In multivariate analysis, a higher Patent Ductus Arteriosus Severity Score was independently associated with in-hospital mortality, with an odds ratio of 3.614 and a 95 percent confidence interval of 1.918 to 6.812. In plain language, each step up in severity score roughly tripled or more the odds of dying, a strong and statistically robust association whose confidence interval lies well above the null. This suggests the score, which aggregates indicators of ductal hemodynamic burden, may function as an early warning marker for the babies least likely to survive a hemorrhagic event.

The clinical implications are considerable. If hemodynamically significant PDA is independently linked to pulmonary hemorrhage, then the intensity of monitoring and treatment of the ductus in very preterm infants, whether through fluid restriction, pharmacologic closure, or other strategies, may matter not only for classic ductal outcomes but for lung bleeding itself. Meanwhile, the severity score’s association with mortality offers a way to stratify infants with PDA who do hemorrhage, helping clinicians and families calibrate expectations and direct intensive resources toward those at highest risk. The nomograms, once validated, could become routine bedside calculators in neonatal units caring for extremely premature babies.

The authors themselves are careful about the limits of what they can claim. As a single-center retrospective cohort, the study cannot establish that treating the ductus prevents hemorrhage; association is not causation, and unmeasured variables may still influence both conditions. The internal bootstrap validation, while methodologically sound, does not substitute for external validation in larger, independent cohorts, which the researchers explicitly identify as the necessary next step before the tools enter routine practice. Still, by combining a large consecutive cohort, adjusted regression modeling, machine learning interpretability, and validated risk scores, the study offers one of the clearest quantitative portraits to date of how a simple failure of fetal circulation to close can help push a preterm lung into its most dangerous complication, and how a structured score may tell clinicians, early, which of these babies are in the gravest danger.

Subject of Research: Association between patent ductus arteriosus and neonatal pulmonary hemorrhage and mortality in very preterm infants

Article Title: Association of patent ductus arteriosus and severity score with neonatal pulmonary hemorrhage and mortality in very preterm infants: a retrospective cohort study

Article References: Yang, L., Han, X., Xu, X., Bai, L., Li, Y., Zhao, Z., & Duan, Y. (2026). Association of patent ductus arteriosus and severity score with neonatal pulmonary hemorrhage and mortality in very preterm infants: a retrospective cohort study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07663-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07663-z

Keywords: patent ductus arteriosus, very preterm infants, neonatal pulmonary hemorrhage, PDA severity score, mortality, nomogram, SHAP analysis, logistic regression, neonatology, risk factors, retrospective cohort study, BMC Pediatrics

Bronchopulmonary dysplasia, or BPD, is a chronic lung disease that develops when the fragile, immature lungs of very preterm infants are damaged by mechanical ventilation, oxygen therapy, and inflammation during the first weeks of life. Infants who develop BPD often require prolonged respiratory support and hospitalization, and they face elevated risks of rehospitalization, neurodevelopmental impairment, and long-term respiratory problems such as asthma-like symptoms and reduced lung function well into childhood and adulthood. Because survival rates for extremely preterm infants have climbed steadily over recent decades, BPD has become one of the most common long-term consequences of prematurity, making effective prevention strategies a major priority for neonatal medicine.

Caffeine is already a workhorse of neonatal care. A methylxanthine compound that crosses the blood-brain barrier readily, caffeine acts primarily as a respiratory stimulant by antagonizing adenosine receptors in the brainstem, increasing the drive to breathe and improving diaphragmatic contractility. Since a landmark 2006 international trial demonstrated that caffeine therapy shortened the duration of mechanical ventilation and reduced the rate of BPD among extremely low-birth-weight infants, caffeine citrate has become standard treatment for apnea of prematurity in neonatal intensive care units worldwide. However, that trial initiated caffeine only once apnea developed or clinicians judged treatment necessary—what neonatologists call therapeutic administration. Whether giving the drug prophylactically, within hours of birth to all very preterm infants regardless of symptoms, could prevent BPD more effectively remained unresolved, and prior smaller studies had produced mixed and inconclusive results.

To address this gap, researchers led by Fangfang Tao and Jiang-Qin Liu of Shanghai First Maternity and Infant Hospital, together with colleagues at Children’s Hospital of Fudan University and the University of Alberta, enrolled 372 very preterm neonates born before 32 weeks and 0 days of gestation between September 2016 and January 2024. In this single-center, randomized clinical trial, infants were assigned to one of two strategies. The prophylactic caffeine administration group received caffeine citrate shortly after birth, beginning with a loading dose of 20 milligrams per kilogram of body weight followed by a daily maintenance dose of 10 milligrams per kilogram. The comparison group received therapeutic caffeine administration, meaning the same drug at the same doses, but only after a diagnosis of apnea was made. The primary endpoint was the composite of BPD at 36 weeks postmenstrual age and/or death before hospital discharge.

The results favored early treatment. BPD or death occurred in 37.1 percent of infants in the prophylactic group—69 of 186 infants—compared with 47.3 percent in the therapeutic group, or 88 of 186. That difference corresponds to a relative risk of 0.77 with a 95 percent confidence interval of 0.62 to 0.95, and a P value of 0.013, meaning the reduction was statistically significant and unlikely to be due to chance alone. In practical terms, for roughly every ten very preterm infants treated prophylactically rather than reactively, one fewer infant would be expected to die before discharge or leave the hospital requiring oxygen for chronic lung disease.

The effect proved robust across five different sensitivity analysis models designed to test whether the finding depended on particular statistical assumptions. Notably, the benefit appeared more pronounced in several clinically meaningful subgroups: female infants, infants whose mothers had received antenatal corticosteroids to accelerate fetal lung maturation, infants who were not intubated in the delivery room, and infants who required only noninvasive ventilation after birth. This pattern is biologically plausible, since these are infants whose lungs were less severely compromised at the outset and who therefore stood to gain the most from protecting the airways and respiratory drive before injury could accumulate.

Caffeine’s protective mechanism in the context of BPD is thought to extend beyond simple respiratory stimulation. Experimental work suggests that caffeine exerts anti-inflammatory effects, modulates cytokine responses, improves diaphragmatic and intercostal muscle function, and enhances respiratory pattern stability, all of which can reduce the need for invasive mechanical ventilation and high oxygen concentrations—the principal drivers of lung injury in preterm infants. By stabilizing breathing from the first hours of life, prophylactic caffeine may prevent the cascade of apnea episodes, desaturations, and escalation of ventilatory support that culminates in chronic lung disease.

The trial was not without signals of potential harm, and the authors were careful to report them. Infants in the prophylactic group received a higher number of blood transfusions than those in the therapeutic group, with a mean difference of 0.42 transfusions (95 percent confidence interval, 0.05 to 0.79; P = 0.027). The clinical significance of this small increase is uncertain, but it aligns with earlier observations that early caffeine use has been associated with more frequent phlebotomy-related blood sampling and transfusion in previous trials. Importantly, no significant differences were observed between the two groups in the incidence of other serious complications of prematurity, including necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and late-onset sepsis, nor in the duration of mechanical or noninvasive ventilation, oxygen exposure, length of hospital stay, or medical costs.

The researchers emphasized that the study had limitations inherent to its design. As a single-center trial, its findings may reflect the specific practices and patient population of one institution, and confirmation in multicenter settings is needed before the results can be generalized universally. The trial was registered retrospectively in the Chinese Clinical Trial Registry, a point the authors acknowledged transparently. In addition, the composite primary outcome of BPD or death, while standard in neonatal trials, combines two distinct events, and a larger sample would be required to separately power each component. Still, the trial’s seven-and-a-half-year enrollment window, its randomized design, and the consistency of the effect across sensitivity analyses lend considerable weight to the conclusion.

For neonatologists, the study raises the prospect of shifting practice: rather than waiting for apnea to declare itself, starting caffeine citrate routinely within the first hours of life in infants born before 32 weeks could prevent a substantial share of BPD cases and deaths. Prophylactic caffeine is already inexpensive, well tolerated, and familiar to every neonatal unit, which means that if the findings are confirmed, implementation barriers would be minimal compared with entirely new therapies. As BPD continues to burden a growing population of preterm survivors, an intervention this simple—administering earlier a drug already sitting in the NICU pharmacy—represents exactly the kind of low-cost, high-reach strategy that could reshape outcomes for the most vulnerable newborns. The study was funded through the CHINA-CANADA Clinical Research program, and the full open-access article is available in BMC Pediatrics.

Subject of Research: Prophylactic caffeine administration to prevent bronchopulmonary dysplasia in very preterm infants

Article Title: Prophylactic administration of caffeine reduces bronchopulmonary dysplasia in very preterm infants: a single center, randomized controlled trial

Article References: Tao, F., Zhou, M., Fu, Y., Zhou, J., Wang, M., Duan, Y., Li, M., Hua, J., Wang, Y., Chen, C., Cheung, P.-Y., Yuan, L., Yan, W., & Liu, J.-Q. (2026). Prophylactic administration of caffeine reduces bronchopulmonary dysplasia in very preterm infants: a single center, randomized controlled trial. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07625-5

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07625-5

Keywords: caffeine, bronchopulmonary dysplasia, very preterm infants, prophylactic administration, randomized controlled trial, apnea of prematurity, neonatal intensive care, caffeine citrate, chronic lung disease, mechanical ventilation, Prophylactic, administration