About

Sara Bonamo DeMauro, MD, MSCE, is a Professor of Pediatrics specializing in Neonatology and Newborn Services at the Children's Hospital of Philadelphia. She holds the Harriet & Ronald Lassin Endowed Chair in Pediatric Neonatology and serves as an Attending Physician in Neonatology at the same hospital. Dr. DeMauro is also an Associate Scholar at the University of Pennsylvania School of Medicine, within the Center for Clinical Epidemiology and Biostatistics, and functions as the Program Director for Neonatal Follow-up Programs at the Children's Hospital of Philadelphia. Her educational background includes a BS in Molecular Biophysics and Biochemistry from Yale University, an MD from UMDNJ - Robert Wood Johnson Medical School, and an MSCE in Clinical Epidemiology from the University of Pennsylvania School of Medicine. Her professional focus encompasses neonatal clinical and epidemiological research, contributing to advancements in pediatric neonatology through her leadership and research activities.

Research topics

• Medicine
• Pediatrics
• Internal medicine
• Demography
• Surgery
• Bioinformatics
• Physical therapy
• Biology
• Emergency medicine
• Genetics
• Anesthesia
• Intensive care medicine
• Psychiatry
• Radiology

Selected publications

• Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants

  UNC Libraries · 2026-03-18

  articleOpen access

  Importance: The management of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). Design, Setting, and Participants: A randomized clinical trial including infants born at 22 to 28 weeks' gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Interventions: Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. Main Outcomes and Measures: The primary outcome was death or BPD at 36 weeks' postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. Results: A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P = .73). The incidence of death before 36 weeks' postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P = .01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. Conclusions and Relevance: In extremely preterm infants with a protocol-defined PDA, death or BPD did not differ between the expectant management group and the active treatment group. Survival was substantially higher with expectant management. Trial Registration: ClinicalTrials.gov Identifier: NCT03456336.

  PublisherDOI

• Symptom-Based Dosing for Neonatal Opioid Withdrawal

  JAMA · 2026-04-25 · 1 citations

  articleOpen access

  Importance: Infants with neonatal opioid withdrawal syndrome (NOWS) who receive pharmacologic treatment are traditionally treated with a scheduled opioid taper. An alternate approach, symptom-based dosing, may better align treatment with withdrawal severity. Objective: To compare time from birth to medical readiness for discharge for infants with moderate to severe withdrawal treated with either a symptom-based dosing or scheduled opioid taper approach. Design, Setting, and Participants: In this cluster, crossover randomized clinical trial with run-in period, 23 US hospitals cared for infants using the Eat, Sleep, Console approach (ESC) or Finnegan-based care (a comprehensive scoring system to quantify severity of symptoms; 15 ESC and 8 Finnegan hospitals) and their preferred primary opioid. Opioid dosing was guided by study-approved, site-specific algorithms. Infants with NOWS with a gestational age at birth of at least 36 weeks and at risk for pharmacologic treatment were enrolled between March 25, 2024, and April 9, 2025, with the last 3-month assessment on July 15, 2025. Sample size analyses were conducted between August 1, 2024, and September 23, 2024. Intervention: Sites were randomized to 1 of 2 sequences: (1) symptom-based dosing followed by scheduled opioid taper or (2) scheduled opioid taper followed by symptom-based dosing. Main Outcome and Measure: Time from birth to medical readiness for discharge. Results: Of the 626 enrolled infants (mean [SD] gestational age, 38 [1] weeks; 49% male), 383 were cared for with ESC (primary outcome cohort). The mean time to medical readiness for discharge was significantly shorter in the symptom-based dosing group compared with the scheduled opioid taper group (9.18 vs 11.61 days; adjusted mean ratio [aMR], 0.79 [95% CI, 0.65-0.96]). There was no difference in the risk for initiation of pharmacologic treatment (0.4 vs 0.41; adjusted risk ratio, 0.99 [95% CI, 0.77-1.27]) or length of stay (10.91 vs 12.09 days; aMR, 0.9 [95% CI, 0.72-1.13]) between groups. For infants in the symptom-based group, 35% (95% CI, 25%-45%) required scheduled opioid dosing due to withdrawal severity that was not controlled with intermittent dosing. In the Finnegan cohort (n = 243; planned secondary outcome), there were no significant differences in time to medical readiness for discharge (15.99 vs 17.56 days; aMR, 0.91 [95% CI, 0.72-1.15]) or length of stay (17.38 vs 19.39 days; aMR, 0.9 [95% CI, 0.69-1.16]). The inpatient composite safety outcome occurred rarely (in the ESC cohort, 3 of 188 in the symptom-based dosing vs 2 of 195 in the scheduled opioid taper groups). Conclusions and Relevance: Symptom-based dosing decreased time to medical readiness for discharge compared with a scheduled opioid taper approach among infants cared for with ESC. Trial Registration: ClinicalTrials.gov Identifier: NCT05980260.

  PublisherOA PDFDOI

• Temporal trends in outcomes for infants with neonatal opioid withdrawal managed with the Finnegan scoring tool: Insights from the INFORM NOW Study

  Journal of Perinatology · 2026-04-16

  articleOpen access

  OBJECTIVE: To evaluate changes in hospital outcomes for infants with neonatal opioid withdrawal syndrome (NOWS) assessed by the Finnegan Tool before (10/1/2019 to 12/31/2019;pre-epoch) and after (7/1/2021 to 3/31/2022;post-epoch) publication of the 2020 AAP NOWS clinical report. STUDY DESIGN: This subgroup analysis included infants with NOWS assessed with the Finnegan Tool and enrolled in the INFORM NOW study (pre- and post-epoch 183 and 267 infants respectively). RESULTS: No differences were found between epochs in initiation or length of pharmacologic treatment(LOT), or length of stay(LOS). Outcomes were modified by opioid type: LOT was 20% shorter (aMR=0.80; 95%CI:[0.69,0.93]) and LOS was 16% shorter (aMR=0.84; 95%CI:[0.73,0.96]) for buprenorphine treated infants post- compared to pre-epoch, while LOT and LOS were longer in the post-epoch for those treated with methadone. CONCLUSION: There was no difference in outcomes before and after publication of the AAP report. However, the type of postnatal opioid did modify study results.

  PublisherOA PDFDOI

• Discrepancy between airwave and impulse oscillometry measurements of impedance in healthy children

  2025-08-18

  articleOpen access

  Introduction: Respiratory oscillometry (OSC) is a pulmonary function test that measures respiratory system impedance and is well-suited for young children. Previous studies have suggested that there may be differences between impedance values obtained on different instruments, however, no studies comparing instruments have been done in healthy children. Methods : We performed both impulse oscillometry (IOS) and airwave oscillometry (AOS), in random order, in a cohort of healthy children with no history of cardiopulmonary disease or recent illness. We used linear regression analysis and Bland Altman plots to compare results. Results : Eighty children ages 4 – 18 years completed study visits. Compared with AOS, the IOS mean and median values for resistance at 5 Hz (R5) were higher (p < 0.001), reactance at 5 Hz (X5) mean and median values were less negative (p < 0.001), and both the area under the reactance curve (AX) and resonant frequency (Fres) were lower (p < 0.001). Bland Altman analysis revealed proportional bias between the two systems. Conclusions : Our results in healthy children show differences between results obtained on different OSC instruments. This may be due to differences in the type of pressure signal produced by the instrument, or, in the case of IOS, may be related to a stress-relaxation response. Our results suggest that normal values obtained on one instrument may not be comparable to results obtained on another.

  PublisherOA PDFDOI

• Conditional-longitudinal brain growth charts detect MRI changes with birth weight and psychopathology

  bioRxiv (Cold Spring Harbor Laboratory) · 2025-12-26

  articleOpen access

  Abstract Importance Brain maturation varies between individuals, particularly during dynamic developmental periods like adolescence. Directly assessing differences in longitudinal trajectories can reveal deviations from normative patterns. Objective We present novel conditional-longitudinal normative models that characterize variability in brain maturation. We utilize these models to examine whether differences in longitudinal trajectories are associated with birth weight (BW), gestational age (GA), and longitudinal psychopathology derived from behavioral assessments. Design Cross-sectional and conditional-longitudinal normative models were developed for brain volumes derived from the first two neuroimaging timepoints from the Adolescent Brain Cognitive Development (ABCD) Study. Conditional-longitudinal models index an individual’s expected brain volume at follow-up conditioned on their baseline measurement. Models were fit with split-half cross-validation on demographically matched samples. Setting The ABCD Study is a multi-site, population-based study Participants Participants were excluded based on imaging quality flags and missing data, leaving 10,830 at baseline and 7,262 at follow-up. Exposures BW and GA were derived from parent-report questionnaires. General psychopathology scores were calculated using a bifactor model. Main Outcomes and Measures We calculated cross-sectional and conditional-longitudinal centiles, respectively quantifying individual deviations in size and change between timepoints. Sensitivity analyses included covariates for parental income and education as well as current weight and height. Results The sample was 10,830 at baseline (48.2% F,age 9-10y) and 7,262 at follow-up (46.6% F,age 11-13y). Conditional-longitudinal centiles were sensitive to individual differences in brain change between timepoints. Lower BW was associated with lower conditional-longitudinal centiles, suggesting larger decreases in brain volumes over time (27 regions p fdr <0.05, β max =0.08). Lower conditional-longitudinal centiles were associated with greater increases in psychopathology scores, suggesting with increased psychopathology brain volumes show greater decrease (37 regions p fdr <0.05, β max =0.06). Notably, changes in psychopathology were not related to brain size at either timepoint, indexed by cross-sectional centiles. Conclusions and Relevance Models that capture individual-level deviations from expected growth trajectories, rather than static positions on a growth curve, are particularly informative for assessing developmental change. Novel conditional-longitudinal models address this gap in lifespan brain imaging. Using this framework, we demonstrate robust associations between individual trajectory deviations, perinatal adversity, and longitudinally assessed mental health symptoms. Condition-longitudinal models hold promise for applications across psychiatric neuroscience, from development to aging. Key Points Question How do differences in brain maturation trajectories, quantified by novel conditional-longitudinal models, relate to perinatal factors and mental health in adolescence? Findings In this longitudinal analysis of neuroimaging data from the Adolescent Brain Cognitive Development (ABCD) Study, conditional-longitudinal normative models revealed that trajectories of brain maturation in adolescence are associated with birth weight, and with longitudinal changes in mental health. Meaning Conditional longitudinal models detect inter-individual variability in brain maturation, which is related to both perinatal factors and concurrent changes in psychopathology.

  PublisherDOI

• Antenatal Prediction of Early Cord Clamping among Infants Born Extremely Preterm

  The Journal of Pediatrics · 2025-10-31

  articleOpen access
  PublisherOA PDFDOI

• Disrupted Brain Connectivity in Newborns Following Antenatal Opioid Exposure

  Biological Psychiatry Cognitive Neuroscience and Neuroimaging · 2025-09-23

  articleOpen access

  BACKGROUND: The neural bases of adverse neurodevelopmental outcomes in antenatal opioid exposure are poorly understood. Very limited in vivo human newborn imaging studies have reported disrupted functional connectivity (FC) in limbic and reward-related brain regions, but these studies used small samples and lacked matched controls. Our objective was to compare brain FC in antenatal opioid-exposed and unexposed newborns to study the impact of opioid exposure on early brain development. METHODS: Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected using 3T MRI at 4 centers as part of the prospective, observational OBOE (Outcomes of Babies with Opioid Exposure) study. We used seed-based correlation analysis to estimate the FC of 93 brain regions. Voxelwise linear regression with covariate adjustment and correction for multiple comparisons was used to determine significant between-group differences. FC differences based on opioid type were also investigated. RESULTS: We evaluated 248 rs-fMRI scans (158 opioid-exposed/90 unexposed). Canonical sensorimotor and higher-order resting-state network maps in exposed newborns (mean ± SD postmenstrual age at MRI = 42.80 ± 2.2 weeks, 53 male) were comparable to control newborns (42.82 ± 1.9 weeks, 88 male; Dice indices > 0.9 across 7 networks). Exposed newborns showed decreased FC from seeds in bilateral pre- and left postcentral gyri, bilateral orbitofrontal regions, and cerebellum and increased FC from seeds in peri-opercular, subcortical (e.g., amygdala, hippocampus, and putamen), and mid-to-superior occipital regions (familywise error rate, α < 0.05). Connectivity from 23 of 93 (24.7%) seeds differed between groups. Methadone- and buprenorphine-exposed newborns showed disrupted regional FC compared with control newborns, but there were no FC differences between them. CONCLUSIONS: In a large sample of antenatally opioid-exposed newborns, we found altered organization of brain functional networks, particularly in integrative sensorimotor-affective circuits.

  PublisherDOI

• Optimizing pharmacologic treatment for neonatal opioid withdrawal syndrome (OPTimize NOW): a symptom-based dosing approach study protocol for a multi-center, cluster crossover design randomized controlled trial

  Trials · 2025-08-27 · 2 citations

  articleOpen access

  BACKGROUND: Opioid use and misuse during pregnancy rose from 1.5 to 6.5 per 1000 deliveries between 1999 and 2014 and continues as a significant public health concern. A fivefold increase in neonatal opioid withdrawal syndrome (NOWS) has accompanied the increase in opioid use. The Eating, Sleeping, Consoling care approach (ESC) has been shown to improve outcomes for infants with NOWS and is quickly becoming the standard of care for infants affected by opioid use disorder. Quality improvement initiatives following the implementation of ESC provide some evidence to suggest that symptom-based (i.e., as needed, PRN, just in time) dosing of opioid medications for infants with significant withdrawal may be an effective alternative to using a traditional scheduled opioid taper approach. These initiatives have shown reduced length of hospital stay and decreased postnatal opioid exposure when compared to scheduled opioid dosing for infants with NOWS who receive pharmacologic treatment. It is unknown if the findings from these quality improvement initiatives are generalizable, and little is known about the safety of this approach in a diverse population. The purpose of this manuscript is to describe the design and rationale for an ongoing study to evaluate the effect of symptom-based opioid dosing compared to traditional scheduled opioid taper on short-term outcomes for infants with NOWS. METHODS/DESIGN: In this ongoing multi-center two-period cluster crossover randomized controlled trial, 24 sites within the USA were randomized at the site level into one of two sequences. Prior to randomization, sites were stratified by care approach used (ESC vs. usual care) and these strata were independently randomized. All study sites will provide care based on their random allocation. Data will be collected under waiver of consent for in-hospital and short-term outcomes for eligible infants. A minimum of 480 infants will be enrolled. We hypothesize that use of symptom-based dosing will safely reduce the length of time until infants with NOWS and at risk for pharmacological treatment are medically ready for discharge when compared to infants treated with a scheduled opioid taper. DISCUSSION: This trial is uniquely and efficiently designed to establish the efficacy, safety, and generalizability of the symptom-based dosing approach to opioid treatment for NOWS. TRIAL REGISTRATION: NCT05980260 ; registered July 27, 2023.

  PublisherOA PDFDOI

• Hydrocortisone in Preterm Infants and School-Age Functional Outcomes

  JAMA Pediatrics · 2025-12-08

  articleOpen access1st authorCorresponding

  Importance: Bronchopulmonary dysplasia (BPD) is the most common in-hospital morbidity of prematurity, associated with significant long-term medical and neurodevelopmental sequelae and health resource utilization. The Neonatal Research Network (NRN) Hydrocortisone for BPD Trial evaluated the efficacy and safety of hydrocortisone to prevent BPD in high-risk very preterm infants; the impact of hydrocortisone on school-age outcomes in this trial cohort is previously unreported. Objective: To evaluate the impact of neonatal hydrocortisone treatment on early school-age functional motor, cognitive, academic, and pulmonary outcomes among children who participated in the Hydrocortisone for BPD Trial. Design, Setting, and Participants: This prospective long-term cohort study is a follow-up of a randomized clinical trial, the Hydrocortisone for BPD Trial, conducted at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development NRN. Participants, enrolled from August 2011 to February 2018, included intubated infants who had been born before 30 weeks' gestational age and had been mechanically ventilated for at least 7 days by postnatal day 14 to 28. They were eligible for a single, in-person, early school-age visit between corrected age 5 years 0 months and 7 years 11 months, conducted from September 2017 to July 2024. Data analysis was performed from July 2024 to September 2025. Intervention: Participants were randomized to a 10-day tapering course of hydrocortisone or placebo beginning at 14 to 28 postnatal days. Main Outcomes and Measures: Early school-age study visits were performed by certified, masked assessors. The primary outcome of functional impairment was defined as any of the following: cognitive delay, motor delay, academic delay, or poor functional exercise capacity. Results: The primary outcome was available for 545 of 674 eligible children (80.9%), including 272 children in the hydrocortisone group (152 [55.9%] female; mean [SD] gestational age, 24.9 [1.5] weeks; mean [SD] age at visit, 5.3 [0.6] years) and 273 in the placebo group (108 [39.6%] female; mean [SD] gestational age, 24.8 [1.5] weeks; mean [SD] age at visit, 5.4 [0.6] years). There was no difference in the rate of functional impairment between the hydrocortisone group (194 of 272 children [71.3%]) and the placebo group (200 of 273 children [73.3%]) (adjusted relative risk, 0.99; 95% CI, 0.89-1.10), nor were there differences in the rates of the individual components. Motor delay was the most common impairment (308 of 510 children [60.4%]), followed by poor functional exercise capacity (175 of 484 children [36.2%]). Conclusions and Relevance: In this study, neonatal hydrocortisone treatment of preterm infants with high risk for BPD did not impact functional impairment or its components; nearly three-quarters of the children demonstrated functional impairment at school age. Trial Registration: ClinicalTrials.gov Identifier: NCT01353313.

  PublisherOA PDFDOI

• Associations of Early Life Ambient PM _2.5 Exposure With Asthma Risk in a Cohort of Preterm Infants With Bronchopulmonary Dysplasia

  Pediatric Pulmonology · 2025-12-01

  articleOpen access

  ABSTRACT Objective To examine whether exposure to fine particulate matter (PM 2.5 ) during the first year after neonatal intensive care unit (NICU) discharge is associated with asthma by age 5 among infants with bronchopulmonary dysplasia (BPD). Methods We conducted a retrospective cohort study of 337 infants with BPD, born between 2010 and 2019, who survived to discharge with clinical follow‐up in the Children's Hospital of Philadelphia Care Network through age 5. Daily residential census block group PM 2.5 exposures were estimated using a spatiotemporal machine‐learning model and averaged over the first year after NICU discharge. Modified Poisson regression models with robust standard errors quantified associations of PM2.5 with asthma by age 5, adjusting for neonatal clinical factors, insurance, neighborhood deprivation, and race/ethnicity. Results By age 5 years, 169 (50.1%) infants had an asthma diagnosis. Mean annual PM 2.5 exposure was 8.8 µg/m 3 (SD 1.1). Each 1 µg/m 3 increment of PM 2.5 was associated with higher asthma risk (unadjusted RR 1.14, 95% CI: 1.03–1.25; fully adjusted aRR 1.19, 95% CI: 1.03–1.37). Compared to the lowest exposure tertile (mean 7.6 µg/m 3 ), adjusted rates of asthma tended to be higher as exposure increased: Tertile 2 (mean 8.7 µg/m 3 , aRR 1.31; 95% CI: 0.98–1.74), Tertile 3 (mean 10.0 µg/m 3 , aRR 1.68, 95% CI: 1.17–2.4). Conclusions Exposure to higher ambient PM 2.5 in the year after NICU discharge was associated with asthma by age 5 among children with BPD. These findings highlight early‐life air quality as a modifiable determinant of long‐term respiratory outcomes in infants with BPD.

  PublisherOA PDFDOI

Recent grants

• Clinical Center for NICHD/Neonatal Research Network

  NIH · $3.6M · 2011–2030

• 3/24 Healthy Brain and Child Development National Consortium

  NIH · $7.7M · 2021–2026

Frequent coauthors

• Brenda B. Poindexter

  329 shared

• Michele C. Walsh

  Case Western Reserve University

  245 shared

• Abbot R. Laptook

  Women & Infants Hospital of Rhode Island

  177 shared

• Rosemary D. Higgins

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  174 shared

• Carla Bann

  160 shared

• Barbara J. Stoll

  Children's Nutrition Research Center at Baylor College of Medicine

  158 shared

• Namasivayam Ambalavanan

  University of Alabama at Birmingham

  154 shared

• Scott A. Lorch

  146 shared

Education

• MSCE, Center for Clinical Epidemiology and Biostatistics

  University of Pennsylvania Perelman School of Medicine

  2011

• MD

  Robert Wood Johnson Medical School

  2004

• BS, Molecular Biophysics and Biochemistry

  Yale University

  2000

Awards & honors

• Harriet & Ronald Lassin Endowed Chair in Pediatric Neonatolo…