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Background: Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates. Objectives: This study's main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants. Methods: This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1) discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile. Results: The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant. Conclusion: The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2. [ABSTRACT FROM AUTHOR]

Antenatal administration of magnesium sulfate (MgSO 4) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO 4 exposure with neonatal respiratory outcomes. Very low birth weight (VLBW) infants exposed to antenatal MgSO 4 were included. Infants who were intubated anytime during the first three days of life were compared to those who were not intubated regarding their demographic and clinical characteristics, MgSO 4 therapy, immediate respiratory outcomes, and occurrence of intraventricular hemorrhage (IVH) using student t-test, chi square testing and logistic regression analysis to control for confounding variables. Correlation coefficient of MgSO 4 cumulative dose given and duration of infusion with delivery room resuscitation and need for mechanical ventilation in the first 3 days of life were also calculated. Multilinear regression analysis was used to control for confounding factors. Intubated group included 96 infants while non-intubated group included 171 infants. Although, intubated group has younger gestational age (26 vs. 29 weeks, p < 0.01) and lower birth weight (786 vs. 1115 g (g), p < 0.01), there were no significant differences between groups in regard to MgSO 4 cumulative dose (24 vs. 27 g, p = 0.29), infusion time (14.6 vs. 18 h, p = 0.19) or infants' serum magnesium level (2.6 vs. 2.8 milliequivalents (mEq)/L p = 0.86). There was no correlation between cumulative MgSO4 dose with endotracheal intubation or cardiac resuscitation in the delivery room (cc: −0.03, p = 0.66; and 0.02, p = 0.79, respectively) or the need for mechanical ventilation in the first 3 days of life (cc: −0.04 to −0.07, p = 0.21–0.51). In addition, there was no relationship between MgSO 4 dose, duration of infusion, or infant's serum magnesium level and occurrence of IVH. Regardless of dose or duration of infusion, antenatal MgSO 4 exposure is not associated with increased intubation or mechanical ventilation early in life. [ABSTRACT FROM AUTHOR]

To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants and examine whether delivery at different levels of hospital affects neonatal and infant mortality. This population-based cohort study was retrieved from Taiwan Maternal and Child Health Database. Livebirth singleton VLBW infants born between 2011 and 2014, with BW between 500 and 1499 g and gestational age ≥22 weeks were enrolled. The main outcomes were risk-adjusted odds ratios (aOR) of neonatal and infant mortality by birthplace, which was categorized as medical center (MC), regional hospital (RH), district hospital (DH), and clinic (C) based on Taiwan's hospital accreditation system. Of 4560 VLBW infants enrolled, 3005 (66%) were born in MCs, 1181 (26%) in RHs, 213 (5%) in DHs, and 161 (4%) in Cs. Neonatal mortality rates were 10%, 15%, 16%, 17%, and infant mortality rates were 13%, 17%, 18%, 21%, if born in MCs, RHs, DHs and Cs, respectively. The aORs for neonatal and infant mortality were 1.94 (95% CI 1.53–2.48) and 1.67 (1.34–2.08) for those born in RHs, 2.26 (1.38–3.70) and 1.82 (1.16–2.86) for infants born in DHs/Cs, as compared to those born in MCs. For VLBW infants born in RHs, DHs, and Cs and postnatally transferred to MCs, the aORs of neonatal and infant mortality were lower than those who were not transferred. VLBW infants born outside of MCs had higher neonatal and infant mortality and a two-fold higher risk of mortality than those born in MCs. When possible, VLBW infants should be born in MCs. [ABSTRACT FROM AUTHOR]

Survival rate for preterm infants has improved significantly in the last decade because of advancements in care provided by NICUs. Yet, a large proportion of extremely low birth weight (ELBW) infants continue to be at risk of being discharged home from NICUs with long-term co-morbidities. Several centers have introduced and described the concept of a focused program on the care of micro-preemies and demonstrated improved processes as well as outcomes utilizing a continuous improvement approach with adoption of standardized guidelines, checklists, and shared team values. The journey and effort that it takes to develop and sustain such a program have been described less. This article discusses the process of building a Small Baby Program using a change model framework, how the organization and staff bought into the concept, as well as the accomplishments and challenges experienced during the last 3 years as the program continues to evolve and grow. [ABSTRACT FROM AUTHOR]

Objective Some previous studies have reported the improved survival of very-low-birth-weight (VLBW) neonates with no disabilities. However, 16% of these neonates have developmental disorders. Considering the lack of research on the developmental status of five-year-old VLBW children and the importance of early detection and treatment, in this study, we aimed to assess the developmental status of five-year-old VLBW children. Materials & Methods This historical cohort study was conducted on five-year-old children. The participants were divided into VLBW and normal-birth-weight (NBW) groups. Data were gathered using the Ages and Stages Questionnaire (ASQ). This questionnaire consisted of five developmental domains, including communication, gross motor, fine motor, problem-solving, and personal/social skills. Data were reported by measuring descriptive statistics, including mean, standard deviation, number, and percentage, and analyzed by Mann-Whitney U test and independent t-test in SPSS version 22. Results A total of 106 five-year-old children, including two groups of VLBW and NBW, participated in this study. The results of Mann-Whitney U test showed a significant difference between the groups regarding the scores of communication (P=0.002), gross motor (P<0.001), fine motor (P<0.001), and problem-solving (P<0.001) skills. However, no significant difference was found between the groups regarding the personal/social developmental status (P=0.559). Conclusion According to the results, a higher risk of developmental delay was observed in VLBW infants as compared to NBW neonates; therefore, it is recommended to perform developmental screening tests for timely detection of high-risk children and early diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited.Purpose: Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants.Methods: A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay.Findings: Neonatal intensive care unit-specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables.Implication For Practice: Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population.Implication For Research: Prospective studies regarding NICU-specific lactation support with larger samples are warranted. [ABSTRACT FROM AUTHOR]

Objective: To examine the change in breastfeeding behaviors over time, among low birth weight (LBW), very low birth weight (VLBW), and normal birth weight (NBW) infants using nationally representative US data.Study Design: Univariate statistics and bivariate logistic models were examined using the Early Child Longitudinal Study-Birth Cohort (2001) and National Study of Children's Health (2007 and 2011/2012).Results: Breastfeeding behaviors improved for infants of all birth weights from 2007 to 2011/2012. In 2011/2012, a higher percentage of VLBW infants were ever breastfed compared with LBW and NBW infants. In 2011/2012, LBW infants had a 28% lower odds (95% CI, 0.57-0.92) of ever breastfeeding and a 52% lower odds (95% CI, 0.38-0.61) of breastfeeding for ≥6 months compared with NBW infants. Among black infants, a larger percentage of VLBW infants were breastfed for ≥6 months (26.2%) compared with LBW infants (14.9%).Conclusions: Breastfeeding rates for VLBW and NBW infants have improved over time. Both VLBW and NBW infants are close to meeting the Healthy People 2020 ever breastfeeding goal of 81.9%. LBW infants are farther from this goal than VLBW infants. The results suggest a need for policies that encourage breastfeeding specifically among LBW infants. [ABSTRACT FROM AUTHOR]

Background: Mother's own milk (MOM) provides significant health benefits to very low birth-weight infants (VLBW, ≤1500 g). However, 60% of African American (AA) women initiate lactation, and less than 35% provide MOM 6 months following the birth of their infant. Previous research focuses on term infants and is not specific to AA mothers of VLBW infants.Purpose: To qualitatively describe supports and barriers experienced by AA mothers while providing MOM for their VLBW infants.Methods: In this qualitative, descriptive study, we conducted semistructured interviews with AA mothers who provided MOM for their VLBW infant. Interviews were transcribed and manually coded concurrently with enrollment until theoretical saturation was achieved. Infant charts were reviewed for demographics, and triangulation with notes from the medical record by bedside nurse lactation consultants and other providers was performed to increase validity. Member checks were completed to ensure true meaning of responses.Results: Theoretical saturation was achieved after 9 interviews. Themes perceived to support provision of MOM included (1) Being a Mother; (2) Neonatal intensive care unit environment; (3) Community support; and (4) Useful resources. Themes that emerged as barriers to the provision of MOM were: (1) Maternal illness; (2) Milk expression; (3) Challenging home environment; and (4) Emotional distress.Implications For Practice: African American mothers report supports similar to published data but faced challenges not previously reported. These factors warrant attention by professionals who support lactation in this population.Implications For Research: Future research will address perceived barriers to improve provision of MOM and the quality of the lactation journey of AA mothers of preterm infants. [ABSTRACT FROM AUTHOR]

Background For infants with very low birth weights (VLBW), their neurodevelopmental outcomes are thought to be associated with extra-uterine growth retardation (EUGR). In this study, based on a single institute, we analyzed the association between different levels or severity of EUGR of VLBW infants and their neurodevelopmental outcomes later at a corrected age of 24 months. Methods This is a hospital-based retrospective cohort study. The severity of EUGR was classified into three categories according to the z-score of discharge weight: z < −2.0, <−2.5, and <−3.0. The outcomes were assessed using the Bayley Scales of Infant Development-II (BSID-II) at a corrected age of 24 months. We then estimated the association of EUGR with low mental developmental index (MDI) or low psychomotor developmental index (PDI). Multiple logistic regression and stratified analyses were used to adjust for the possible confounding factors. Results In total, 224 VLBW infants were enrolled in this study from 1997 to 2006. In the univariate analysis, EUGR for weight at discharge from hospital was associated with MDI <85 at the corrected age of 24 months, and this association was related to the severity of EUGR (z < −2.5, OR: 1.92 (1.04–3.53); z < −3.0, OR: 2.83 (1.26–6.36)). In addition, the relationship was not confounded by gender nor small for gestational age. The stratified analysis against hemodynamic significant patent ductus arteriosus also revealed that EUGR was an independent predictor for neurodevelopmental outcomes. Conclusion In VLBW preterm infants, EUGR was significantly associated with low MDI scores assessed at a corrected age of 24 months. Early evaluation and recognition of EUGR should be emphasized when caring for preterm infants. [ABSTRACT FROM AUTHOR]

Lower testosterone during the transition to new parenthood is considered beneficial to help parents better engage with their infants. No data currently exist studying salivary testosterone of parents with infants in neonatal intensive care units (NICUs) during the transition to home. We examine testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes overtime. Testosterone salivary samples were assayed after self-collection by 86 parents (43 fathers and 43 mothers) with NICU infants at wakeup and bedtime prior to discharge and at 3 additional times at home. Self-reported survey measures, including psychosocial reports, were also collected at these times. Using multilevel modeling approaches, we report significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode (P < .05). Results were significant after accounting for covariates. Our study is the first to examine the time course of diurnal testosterone for parents of premature infants over the transition home; as such, we suggest further research into better understanding parental physiology in this vulnerable parent population. [ABSTRACT FROM AUTHOR]

Purpose The objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality. Methods Mortality among 4328 VLBW neonates with surgical NEC born 2009-2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants). Results Mortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)). Conclusion Transfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted. [ABSTRACT FROM AUTHOR]

Background: Children born small for gestational age (SGA) are at risk for the metabolic syndrome (MetS) as adults. We examined whether indicators of MetS could be identified in pre-pubertal children born very preterm. Methods: Parameters associated with MetS were studied in 141 pre-pubertal schoolchildren with either very low birth weight (VLBW) or GA <32 weeks (SGA: n=43). Results: At 8.3±0.8 years, 36 children (SGA: n=15) were classified short. There were no differences between the SGA and appropriate for age (AGA) groups; nor were dissimilarities observed between short children and those with normal height for parameters such as body mass index (BMI), serum levels of hormones, HDL cholesterol, triglycerides, glucose, insulin, HOMA-IR, body composition, resting energy expenditure, grip strength and jump force. Conclusions: Neither SGA at birth nor short stature at follow-up (irrespective of size at birth), could be associated with parameters that indicate an increased risk for the MetS during childhood. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of Bifidobacteriumlongum subsp. infantis EVC001 (Binfantis EVC001) administration on the incidence of necrotizing enterocolitis (NEC) in preterm infants in a single level IV neonatal intensive care unit (NICU).Study Design: Nonconcurrent retrospective analysis of 2 cohorts of very low birth weight (VLBW) infants not exposed and exposed to Binfantis EVC001 probiotic at Oregon Health & Science University from 2014 to 2020. Outcomes included NEC incidence and NEC-associated mortality, including subgroup analysis of extremely low birth weight (ELBW) infants. Log-binomial regression models were used to compare the incidence and risk of NEC-associated outcomes between the unexposed and exposed cohorts.Results: The cumulative incidence of NEC diagnoses decreased from 11.0% (n = 301) in the no EVC001 (unexposed) cohort to 2.7% (n = 182) in the EVC001 (exposed) cohort (P < .01). The EVC001 cohort had a 73% risk reduction of NEC compared with the no EVC001 cohort (adjusted risk ratio, 0.27; 95% CI, 0.094-0.614; P < .01) resulting in an adjusted number needed to treat of 13 (95% CI, 10.0-23.5) for Binfantis EVC001. NEC-associated mortality decreased from 2.7% in the no EVC001 cohort to 0% in the EVC001 cohort (P = .03). There were similar reductions in NEC incidence and risk for ELBW infants (19.2% vs 5.3% [P < .01]; adjusted risk ratio, 0.28; 95% CI, 0.085-0.698 [P = .02]) and mortality (5.6% vs 0%; P < .05) in the 2 cohorts.Conclusions: In this observational study of 483 VLBW infants, Binfantis EVC001 administration was associated with significant reductions in the risk of NEC and NEC-related mortality. Binfantis EVC001 supplementation may be considered safe and effective for reducing morbidity and mortality in the NICU. [ABSTRACT FROM AUTHOR]

Objectives: To examine the characteristics of safety net (sn) and non-sn neonatal intensive care units (NICUs) in California and evaluate whether the site of care is associated with clinical outcomes.Study Design: This population-based retrospective cohort study of 34 snNICUs and 104 non-snNICUs included 22 081 infants born between 2014 and 2018 with a birth weight of 401-1500 g or gestational age of 22-29 weeks. Quality of care as measured by the Baby-MONITOR score and rates of survival without major morbidity were compared between snNICUs and non-snNICUs.Results: Black and Hispanic infants were cared for disproportionately in snNICUs, where care and outcomes varied widely. We found no significant differences in Baby-Measure Of Neonatal InTensive care Outcomes Research (MONITOR) scores (z-score [SD]: snNICUs, -0.31 [1.3]; non-snNICUs, 0.03 [1.1]; P = .1). Among individual components, infants in snNICUs exhibited lower rates of human milk nutrition at discharge (-0.64 [1.0] vs 0.27 [0.9]), lower rates of no health care-associated infection (-0.27 [1.1] vs 0.14 [0.9]), and higher rates of no hypothermia on admission (0.39 [0.7] vs -0.25 [1.1]). We found small but significant differences in survival without major morbidity (adjusted rate, 65.9% [95% CI, 63.9%-67.9%] for snNICUs vs 68.3% [95% CI, 67.0%-69.6%] for non-snNICUs; P = .02) and in some of its components; snNICUs had higher rates of necrotizing enterocolitis (3.8% [3.4%-4.3%] vs 3.1% [95% CI, 2.8%-3.4%]) and mortality (95% CI, 7.1% [6.5%-7.7%] vs 6.6% [6.2%-7.0%]).Conclusions: snNICUs achieved similar performance as non-snNICUs in quality of care except for small but significant differences in any human milk at discharge, infection, hypothermia, necrotizing enterocolitis, and mortality. [ABSTRACT FROM AUTHOR]

Abstract: Background: High prevalence of abnormal cerebral MRI findings as well as major and minor motor, perceptual and cognitive impairments has been reported in very low birth weight (VLBW) children. Aim: To investigate whether cerebral MRI pathology relates to different types of neuroimpairments in adolescents with VLBW. Methods: At age 15, 55 adolescents with birth weight ⩽1500g (VLBW) were examined. Motor function was evaluated by Movement Assessment Battery for Children (ABC) and the Grooved Pegboard (GP) test, cognitive function by Wechsler Intelligence Scales, and visuo-motor and visual perceptual function by The Developmental Test of Visual-Motor Integration (VMI) with the supplementary tests of Visual Perception (VP), and Motor Coordination (MC). Executive functions were assessed by Wisconsin Card Sorting Test (WCST) and the Stroop test. Cerebral MRI was assessed semi-quantitatively for ventricular, white and grey matter pathology. Results: There was a rather weak relationship between MRI pathology and neuroimpairments. Poor performance on the WCST was related with ventricular dilatation (VD), white matter reduction and corpus callosum thinning. There was a correlation between results on the VMI test and the Movement ABC test and MRI pathology, but the correlation became much weaker when children with cerebral palsy were excluded. There was no relationship between MRI findings and estimated intelligence quotient (IQ) scores. Normal MRI predicted normal or near normal neuropsychological functioning. Conclusion: Cerebral MRI pathology suggestive of perinatal white matter injury was related to disadvantages in performances on executive functions, to a lesser degree to motor and visual perceptual problems, but not to cognitive impairments in VLBW adolescents. [Copyright &y& Elsevier]

Providing optimal nutrition to satisfy the growth needs of very low birth weight infants is critical. The available preterm formulas and fortified human milk diets provide protein intakes of approximately 3.5 to 3.6 g/kg/d when volumes sufficient to provide 120 kcal/kg/d are fed to these infants. These intakes support growth and protein accretion at about or slightly greater than intrauterine rate and lead to relatively increased fat deposition. However, most very low birth infants fed these diets remain below the 10th percentile of the intrauterine growth standards at discharge. There is clear evidence that, with respect to growth, very low birth infants are likely to benefit from a higher protein intake; however, there is no clear evidence that energy intakes greater than 120 kcal/kg/d are needed. Although the upper limit of protein intake and the ideal protein:energy ratio remain controversial, there is enough evidence to support the beneficial and safe use of formulas providing protein:energy ratio of 3.2 to 3.3 g/100 kcal. [Copyright &y& Elsevier]

Very low birth weight baby (VLBW) the limit for intact survival 15 years ago, has been replaced with extremely low birh weight babies (ELBW) as the neonatal intensive care unit(NICU) responds to these challenges. There are several risk factors associated with VLBW babies and the goal of management is to reduce mortality as well as the long term morbidity. The outcome varies depending on the level of care provided in the perinatal period. On comparative analysis we found that small babies in developing countries were more mature as compared to a similar birth weight baby in western countries. Hence, we see lower incidence of respiratory distress syndrome and associated complications. We can expect a reasonable outcome in babies >800 g birth weight and 28 weeks gestation and therefore all efforts should be made for providing adequate care to this group of VLBW neonates. [Copyright &y& Elsevier]

Objectives: To determine the incidence, timing, progression, and risk factors for intracranial hemorrhage (ICH) in infants 240/7 to 276/7 weeks of gestational age and to characterize the association between ICH and death or neurodevelopmental impairment (NDI) at 2 years of corrected age.Study Design: Infants enrolled in the Preterm Erythropoietin Neuroprotection Trial had serial cranial ultrasound scans performed on day 1, day 7-9, and 36 weeks of postmenstrual age to evaluate ICH. Potential risk factors for development of ICH were examined. Outcomes included death or severe NDI as well as Bayley Scales of Infant and Toddler Development, 3rd Edition, at 2 years of corrected age.Results: ICH was identified in 38% (n = 339) of 883 enrolled infants. Multiple gestation and cesarean delivery reduced the risk of any ICH on day 1. Risk factors for development of bilateral Grade 2, Grade 3, or Grade 4 ICH at day 7-9 included any ICH at day 1; 2 or more doses of prenatal steroids decreased risk. Bilateral Grade 2, Grade 3, or Grade 4 ICH at 36 weeks were associated with previous ICH at day 7-9. Bilateral Grade 2, any Grade 3, and any Grade 4 ICH at 7-9 days or 36 weeks of postmenstrual age were associated with increased risk of death or severe NDI and lower Bayley Scales of Infant and Toddler Development, 3rd Edition, scores.Conclusions: Risk factors for ICH varied by timing of bleed. Bilateral and increasing grade of ICH were associated with death or NDI in infants born extremely preterm. [ABSTRACT FROM AUTHOR]

Preterm birth research is poised to explore the mental health of adults born very preterm(VP; <32+0 weeks gestational age) and/or very low birth weight(VLBW; <1500g) through individual participant data meta-analyses, but first the previous evidence needs to be understood. We systematically reviewed and assessed the quality of the evidence from VP/VLBW studies with mental health symptoms or disorders appearing in adulthood, excluding childhood onset disorders. Participants (≥18 years, born >1970) included VP/VLBW individuals with controls born at term(≥37+0 weeks) or with normal birth weight(NBW; ≥2500g). Thirteen studies were included. Studies consistently showed an increased risk for psychotropic medication use for VP/VLBW adults in comparison to NBW/term controls, but whether VP/VLBW adults have an increased risk for mental health disorders or symptoms appearing in adulthood remains uncertain. The quality of the evidence was moderate (65.8%) to high (34.2%). Further research in larger samples is needed. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with prolonged maternal breast milk (BM) provision in very low birth weight (VLBW) infants.Study Design: This was a cohort study of VLBW infants who initially received maternal BM and were born at one of 197 neonatal intensive care units managed by the Pediatrix Medical Group from 2010 to 2012. We used multivariable logistic regression to identify demographic, clinical, and maternal factors associated with provision of maternal BM on day of life (DOL) 30 and at discharge.Results: Median gestational age for all infants was 28 weeks (25th, 75th percentiles: 26, 30), and median maternal age was 28 years (23, 33). Of 8806 infants, 6261 (71%) received maternal BM on DOL 30, and 4003 of 8097 (49%) received maternal BM at discharge to home. Predictors of maternal BM provision at DOL 30 included increased maternal age, white maternal race, absence of history of necrotizing enterocolitis or late-onset sepsis, higher household income, lower education level, lack of donor BM exposure, and lower gestational age.Conclusions: Our results suggest that maternal-infant demographic and clinical factors and household neighborhood socioeconomic characteristics were associated with provision of maternal BM at 30 postnatal days to VLBW infants. Identification of these factors allows providers to anticipate mothers' needs and develop tailored interventions designed to improve rates of prolonged maternal BM provision and infant outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of major neonatal morbidities on the risks for rehospitalization in children and adolescents born of very low birth weight.Study Design: An observational study was performed on data of the Israel Neonatal Network linked together with the Maccabi Healthcare Services medical records. After discharge from the neonatal intensive care unit, 6385 infants of very low birth weight born from 1995 to 2012 were registered with Maccabi Healthcare Services and formed the study cohort. Multivariable negative binomial regression models were calculated to estimate the adjusted relative risk (aRR) and 95% CI for hospitalization.Results: Up to 18 years following discharge, 3956 infants were hospitalized at least once. The median age of follow-up was 10.7 years with total of follow-up of 67 454 patient years and 10 895 hospitalizations. The risks for rehospitalization were increased significantly for each of the neonatal morbidities: surgical necrotizing enterocolitis (NEC), aRR 2.71 (95% CI 2.08-3.53), intraventricular hemorrhage grades 3-4, 2.13 (1.85-2.46), periventricular leukomalacia (PVL), 1.83 (1.58-2.13), bronchopulmonary dysplasia, 1.94 (1.72-2.17), and retinopathy of prematurity stages 3-4, 1.59 (1.36-1.85). During the first 4 years, children with surgically treated NEC, intraventricular hemorrhage, PVL, or bronchopulmonary dysplasia had 1.5- to 2.5-fold greater risks for hospitalization compared with those without the specific morbidity. In the 11th-14th and 15th-18th years, respectively, surgically treated NEC was associated with a 3.05 (1.32-7.04) and 3.26 (0.99-10.7) aRR for hospitalization, and PVL was associated with a 2.67 (1.79-3.97) and 3.47 (2.03-5.92) aRR for hospitalization.Conclusions: Specific major neonatal morbidities as well as the number of morbidities were associated with excess risks of rehospitalization through childhood and adolescence. [ABSTRACT FROM AUTHOR]