Neonatal respiratory diseases are a major cause of neonatal morbidity and mortality, posing substantial challenges in clinical practice. Despite recent advances, existing Multimodal Large Language Models (MLLMs) face two key limitations in neonatal diagnosis: (1) domain gap arising from predominantly adult training data; (2) insufficient integration of multidimensional clinical context for accurate diagnosis. To address these challenges, we collect two real-world clinical datasets (NeoCXR and NeoCXR-EV) and propose NeoRed, to the best of our knowledge, the first MLLM tailored for neonatal respiratory disease, filling the gap in neonatal diagnostic reports generation. To enhance joint diagnosis from heterogeneous clinical context and chest X-rays, we design a novel Knowledge-Logic-Alignment (KLA) framework which constrains model behavior from three perspectives: 1) Knowledge Prior Injection (KPI) incorporates neonatologist-inspired diagnostic priors into multimodal representations, guiding disease-specific attention across modalities; 2) Diagnostic Logic Constraint (DLC) aligns the semantics of generated reports with multimodal diagnostic logic; and 3) Visual Semantic Alignment (VSA) establishes semantic correspondence between visual features and imaging conclusions. Extensive experiments demonstrate that NeoRed enables accurate neonatal diagnostic reports generation, achieving ROUGE-L of 53.29% and Clinical Efficacy F1 score of 65.19% on NeoCXR, outperforming existing MLLMs. NeoRed also preserves competitive report generation performance on adult benchmarks (MIMIC-CXR and IU-Xray). Datasets will be available upon application.
Qixiang Zhang, Yi Li, Tianqi Xiang +4eess.IV cs.CV q-bio.QM
Whole slide image analysis is commonly formulated as multiple instance learning (MIL), where instance features are contextually updated and aggregated into a slide representation, a process we term slide encoding dynamics. Recently, selective state-space models (SSM) have emerged as promising MIL architectures due to their long-sequence modeling capability and linear complexity. However, existing SSM-based MIL methods rely solely on visual features during MIL. Meanwhile, in large-scale WSIs, where sparse diagnostically decisive regions are surrounded by abundant irrelevant information, such purely vision-driven selective dynamics can misallocate state updates and readouts, causing the evolving SSM state to accumulate task-irrelevant evidence and dilute critical diagnostic cues over long scan trajectories. In this work, we propose the Knowledge-Aware Hidden-State Modulation architecture (KHiM-Mamba), which innovatively regulates Mamba's core selective state-space mechanism with explicit knowledge priors, steering slide encoding dynamics toward diagnostically meaningful evidence accumulation. Specifically, we redesign the original SSM layer to perform knowledge modulation operations during the evolution of hidden states, thereby guiding what visual evidence is accumulated and retrieved from the hidden state at each encoding step. Furthermore, we additionally introduce a local-adaptive vocabulary retrieval module that uses large language models to assign each patch fine-grained, tissue-specific semantic descriptions, enabling precise modulation across diverse tasks. Experiments on 11 public benchmarks across 4 tasks show that KHiM-Mamba consistently achieves state-of-the-art performance.