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Objective Acute kidney injury (AKI) in the neonatal period is associated with worst outcomes as increased mortality and increased length of hospital stay. Very low birth weight (VLBW) newborns are at higher risk for developing several other conditions that are associated with worst outcomes. Understanding the risk factors for AKI may help to prevent this condition and improve neonatal care for this population. Methods This retrospective cohort study included 155 very low birth weight newborns admitted between 2015 and 2017. The authors compared the newborns who developed neonatal AKI with the non-AKI group and analyzed the main risk factors for developing AKI in the population. The authors also performed an analysis of the main outcomes defined as the duration of mechanical ventilation, length of stay, and death. Results From the cohort, a total of 61 (39.4%) patients had AKI. The main risk factors associated with Neonatal AKI were necrotizing enterocolitis (aOR 7.61 [1.69 - 34.37]; p = 0.008), neonatal sepsis (aOR 2.91 [1.17 - 7.24], p = 0.021), and hemodynamic instability (aOR 2.99 [1.35 - 6.64]; p = 0.007). Neonatal AKI was also associated with an increase in the duration of mechanical ventilation in 9.4 days (p = 0.026) and in an increase in mortality 4 times (p = 0.009), after adjusting for the other variables. Conclusion The present results highlight the importance of minimizing sepsis and necrotizing enterocolitis, as well as the importance of identifying hemodynamic instability, to prevent AKI and diminish the burden of morbimortality in VLBW newborns.

Background: Human milk for very preterm infants need fortification for optimal growth and development but the optimal fortification product remains to be identified. Aims: To investigate feasibility, safety and preliminary efficacy on growth and blood biochemistry when using intact bovine colostrum (BC) as a fortifier to human milk in very preterm infants. Methods: In an open-label, multicenter, randomized controlled pilot trial (infants 26–31 weeks' gestation), mother's own milk or donor human milk was fortified with powdered BC (n = 115) or a conventional fortifier (CF, bovine-milk-based, n = 117) until 35 weeks’ postmenstrual age. Fortifiers and additional micronutrients were added to human milk according to local guidelines to achieve optimal growth (additional protein up to +1.4 g protein/100 mL human milk). Anthropometry was recorded weekly. Clinical morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) were recorded. Clinical biochemistry included plasma amino acid (AA) levels to assess protein metabolic responses to the new fortifier. Results: A total of 232 infants, gestational age (GA) 28.5 ± 1.4 (weeks + days), fulfilled inclusion criteria. Birthweight, GA and delta Z scores from birth to end of intervention on weight, length or head circumference did not differ between groups, nor between the subgroups of small for gestational age infants. Likewise, incidence of NEC (BC: 3/115 vs. CF: 5/117, p = 0.72, unadjusted values), LOS (BC: 23/113 vs. CF: 14/116, p = 0.08) and other morbidities did not differ. BC infants received more protein than CF infants (+10%, p < 0.05) and showed several elevated AA levels (+10–40%, p < 0.05). Conclusion: Infants fortified with BC showed similar growth but received more protein and showed a moderate increase in plasma AA-levels, compared with CF. Adjustments in protein composition and micronutrients in BC-based fortifiers may be required to fully suit the needs for very preterm infants.

Resumo O presente estudo investigou a experiência da maternidade de mães de bebês nascidos extremamente prematuros durante suas hospitalizações na UTI Neo. Em particular, buscou-se conhecer os sentimentos maternos relacionados a esse contexto. Participaram 18 mães cujos bebês tinham entre 25 e 28 semanas gestacionais e pesavam entre 625g e 1000g. As mães foram entrevistas 15 dias após o parto e as respostas foram examinadas por meio de análise de conteúdo qualitativa. Foram desenvolvidos três eixos, derivados das entrevistas: sentimentos sobre a UTI Neo; sentimentos sobre as manifestações do bebê; e sentimentos sobre a maternidade. Os achados revelaram uma complexidade de sentimentos maternos no contexto da UTI Neo. Porém, destacaram-se nas verbalizações maternas o investimento narcísico das mães nos seus bebês, que as levavam a se comunicar com eles a partir de pequenos gestos e expressões sensoriais, o que oportunizava, simultaneamente, a construção de um lugar simbólico para o bebê. Abstract The present study investigated the motherhood experience of mothers of extremely preterm infants during their hospitalizations in the NICU. In particular, we sought to investigate the maternal feelings related to this context. Participants included 18 mothers whose babies were between 25 and 28 gestational weeks and weighed between 625g and 1000g. Mothers were interviewed 15 days after delivery and the responses were examined using qualitative content analysis. Three axes were developed, derived from the interviews: feelings about the NICU; feelings about the baby’s manifestations; and feelings about motherhood. The findings revealed the complexity of maternal feelings in the context of the NICU. However, the mothers’ narcissistic investment in their babies, which led them to communicate with them using small gestures and sensory expressions, stood out in the maternal verbalizations, which simultaneously made it possible to build a symbolic place for the infant. Resumen El presente estudio investigó la experiencia de maternidad de madres de bebés nacidos extremadamente prematuros durante sus hospitalizaciones en la UCI Neonatal. En particular, se buscó conocer los sentimientos maternos relacionados con este contexto. Participaron 18 madres cuyos bebés tenían entre 25 y 28 semanas de gestación y pesaban entre 625 g y 1000 g. Las madres fueron entrevistadas 15 días después del parto y las respuestas se examinaron mediante análisis de contenido cualitativo. Se desarrollaron tres ejes, derivados de las entrevistas: sentimientos sobre la UCI Neonatal; sentimientos sobre las manifestaciones del bebé; y sentimientos sobre la maternidad. Los hallazgos revelaron una complejidad de los sentimientos maternos en el contexto de la UCI Neonatal. Sin embargo, la inversión narcisista de las madres en sus bebés se evidenció en sus verbalizaciones, que las llevaba a comunicarse con ellos a través de pequeños gestos y expresiones sensoriales que, simultáneamente, permitían la construcción de un lugar simbólico para el bebé.

OBJECTIVES: We sought to investigate how race, ethnicity, and socioeconomic status relate to tracheostomy insertion and post-tracheostomy mortality among infants with bronchopulmonary dysplasia. METHODS: The Vizient Clinical Database/Resource Manager was queried to identify infants born ≤32 weeks with bronchopulmonary dysplasia admitted to United States hospitals from January 2012-December 2020. Markers of socioeconomic status were linked to patient records from the Agency for Healthcare Research and Quality’s Social Determinants of Health Database. Regression models were used to assess trends in annual tracheostomy insertion rate and odds of tracheostomy insertion and post-tracheostomy mortality, adjusting for sociodemographic and clinical factors. RESULTS: There were 40,021 ex-premature infants included in the study, 1,614 (4.0%) of whom received a tracheostomy. Tracheostomy insertion increased from 2012-2017 (3.1% to 4.1%), but decreased from 2018-2020 (3.3% to 1.6%). Non-Hispanic Black infants demonstrated a 25% higher odds (aOR 1.25, 1.09-1.43) and Hispanic infants demonstrated a 20% lower odds (aOR 0.80, 0.65-0.96) of tracheostomy insertion compared to non-Hispanic White infants. Patients receiving public insurance had increased odds of tracheostomy insertion (aOR 1.15, 1.03-1.30), but there was no relation between other metrics of socioeconomic status and tracheostomy insertion within our cohort. In-hospital mortality among the tracheostomy-dependent was 14.1% and was not associated with sociodemographic factors. CONCLUSIONS: Disparities in tracheostomy insertion are not accounted for by differences in socioeconomic status or the presence of additional neonatal morbidities. Post-tracheostomy mortality does not demonstrate the same relationships. Further investigation is needed to explore the source and potential mitigators of the identified disparities.

BackgroundThe first month of life is the most critical in a child’s heath because it is associated with the highest risk of adverse health outcomes. In Tanzania the risk of adverse health outcomes in preterm infants is five times higher compared to term infants.The objective of this study was to assess common adverse health outcomes and compare the risk of such outcomes between preterm and term infants, in Tanzania, within the first 28 days of life.MethodsThis was a case-control study involving preterm (cases) and term (controls) infants delivered at the Muhimbili National Hospital between August and October 2019 . About 222 pairs of cases and controls were reviewed for their medical records. Logistic regression was used to compare the risk of neonatal outcomes between the study groups. Statistical significance was achieved at P-value < 0.05 and 95% confidence interval.ResultsPreterm infants have an increased risk of mortality (OR = 7.2, 95% CI: 3.4-15.1), apnea (OR = 4.7, 95% CI: 3.4-15.1), respiratory distress syndrome (OR = 4.8, 95% CI: 3.2-7.3), necrotizing enterocolitis (OR = 5.5, 95% CI: 1.2-25.3), anemia (OR = 4.3 , 95% CI: 2.8-6.6), pneumonia (OR = 2.7, 95% CI: 1.6-4.6) and sepsis (OR = 2.6, 95% CI: 1.7-3.9) in the first month of life compared to term infants. No differences in the risk of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus and jaundice were observed between preterm and term infants. ConclusionThe findings of this study informs the Tanzanian health sector about the most common and high risk neonatal outcomes in preterm infants. Additionaly, for promoting neonates' health, the health sector needs to consider preventing and treating the most common and high risk adverse neonatal outcomes in preterm infants.

This study investigated the relations between mothers’ and fathers’ controlling behaviors and the executive functioning of children born preterm. Sixty-eight preterm children and their parents were assessed when the children were 3 ½ years old. The executive functioning was measured using the Headto-Toes-Task and controlling parenting behaviors were measured through a standardized observation of a parent-child interaction. Hierarchical regression analysis showed that both mothers’ and fathers’ controlling behaviors were associated with worse child executive functioning performance, after controlling for the child’s cognitive ability. Findings suggest that both mothers and fathers play an important role in the development of executive functioning of children born prematurely, highlighting the need to consider both parents in the study of and intervention with these children. info:eu-repo/semantics/publishedVersion

Amaç: Bronkopulmoner displazi erken doğumun sık görülen uzun vadeli bir komplikasyonudur. Hastaların erken dönemde en yeni radyolojik teknikler kullanılarak değerlendirilmesi, hastalığın şiddetinin değerlendirilmesi ve takip planının yapılması açısından çok önemlidir. İyonize olmayan bir modalite olan manyetik rezonans görüntüleme, bronkopulmoner displazi ile ilgili akciğer patolojilerin radyolojik değerlendirmesi ve izleminde yol gösterici olabilir.Gereç ve Yöntemler: Ağustos 2017-Ağustos 2019 tarihleri arasında bronkopulmoner displazi tanısı ile takip edilen ve akciğer manyetik rezonans görüntülemesi yapılan hastalar retrospektif olarak değerlendirildi. Koronal ve aksiyel T2 ağırlıklı magnetik rezonans görüntüleri incelendi (TR/TE: 4500-5300/90-106 msn). Manyetik rezonans görüntüleme bulguları bir pediatrik radyolog tarafından değerlendirildi. Akciğerlerin yapısal durumu ve patolojik bulguları değerlendirildi (fibrotik bantlar, distrosiyon). Bulgular, BPD hastalarının şiddeti, klinik ve demografik özellikleri ile karşılaştırıldı. Görüntüleme sedasyon yapılmadan veya kloralhidrat verilmeksizin hastanın uyku süresinde yapıldı.Bulgular: Toplamda yedi hasta araştırmaya dahil edildi. Hastaların dördü erkek, üçü kızdı. Bonkopulmoner displazi sınıflamasına göre 1 hastanın hafif, 3 hastanın orta düzeyde ve 4 hastanın şiddetli bronkopulmoner displazisi vardı. Ortalama gebelik haftası 26.2 haftaydı. Hafif bronkopulmoner displazi hastalarında, Objective: Bronchopulmonary dysplasia is a common long-term complication of preterm birth. The evaluation of patients with advanced radiologic methods at early ages is essential in terms of determining the severity of the disease and follow-up. As a non-ionizing modality, magnetic resonance imaging is particularly appropriate for the repeated radiological assessment of pulmonary pathologies associated with bronchopulmonary dysplasia.Material and Methods: Patients who were followed up with the diagnosis of bronchopulmonary dysplasia and underwent lung magnetic resonance imaging between August 2017 and August 2019 were evaluated retrospectively. Coronal and axial T2-weighted magnetic resonance imaging was performed (TR/TE: 4500-5300/90-106 msec). A pediatric radiologist evaluated magnetic resonance imaging findings. Pulmonary structural findings and their distribution were determined (fibrotic bands, distortion). The findings were compared with bronchopulmonary dysplasia patients’ severity, clinical and demographic characteristics. The imaging was performed during the patient’s sleep time without sedation or by giving chlorhydrate.Results: A total of 7 patients were included in the study. Three patients were female, and 4 were male. According to bronchopulmonary dysplasia classification, 1 patient was mild, 3 patients were moderate, and 3 were severe bronchopulmonary dysplasia. The median gestational week was 26.2. In mild bronchopulmonary dysplasia patients, fibrotic bands were seen in

Objectives This study was aimed to investigate the diagnostic values of serum levels of asprosin and neutrophil gelatinase-associated lipocalin (NGAL) in Retinopathy of prematurity (ROP) and to assess the role of these biomarkers on the development and progression of the condition. Methods This study was carried out from April 2020 to February 2021 in the department of ophthalmology of a tertiary hospital in Turkey. Thirty patients diagnosed with ROP and 30 healthy newborns were included the study. Serum NGAL and asprosin levels were determined via ELISA. Results The median serum NGAL levels were found to be similar between the ROP group and the control group (p=0.595). Median asprosin levels were significantly higher in patients diagnosed with ROP [46.58 (12.70–142.28) ng/mL] compared to healthy subjects [13.05 (10.92–17.73) ng/mL] (p=0.001). The optimal cut-off value of asprosin by ROC analysis was 30 ng/mL (AUC: 0.754, p=0.001) for diagnosing ROP. Serum asprosin levels were positively correlated with serum ALP levels and inversely correlated with gestational week, uric acid and AST values (all, p Conclusions Our results demonstrated that asprosin, but not NGAL, could be a biomarker for the diagnosis of ROP.

Introduction: Sensitive mother-infant interactions are important predictors of long-term mother-infant relationship, which is one factor having a positive impact on infant development. Considering preterm infants’ immaturity, mother-infant interactions and maternal sensitivity may not develop optimally. A systematic review showed that current evidence on the effectiveness of parent-infant interventions promoting parental sensitivity in the neonatal intensive care unit (NICU) is of low to very low quality.Objective: The objective of this paper is to report the development process of a novel nursing intervention, using a theory and evidence-based approach, to enhance maternal sensitivity and preterm infant neurodevelopment in the NICU.Methods: The Medical Research Council’s guidance to develop and evaluate complex health interventions, that is an evidence and theory-based approach, was used for this study. Thus, based on the MRC framework, three main steps were conducted: 1- Identifying existing empirical evidence; 2- Identifying and developing theory; 3- Modeling processes and outcomes.Results: We developed a guided participation intervention for mothers to participate in their preterm infant’s care and positioning (‘GP_Posit’). ‘GP_Posit’ is based upon the Attachment theory, the Guided Participation theory as well as the Synactive theory of development.Conclusion: This novel intervention is being tested in a pilot randomized controlled trial (NCT03677752)., Introduction : La relation mère-enfant, dont les interactions empreintes de sensibilité maternelle en sont l’un des principaux prédicteurs, figure parmi les facteurs pouvant améliorer le développement des nouveau-nés prématurés. En raison de l’immaturité des nouveau-nés prématurés, les interactions mère-enfant précoces et la sensibilité maternelle sont à risque de se développer de façon sous-optimale. Les résultats d’une revue systématique ont montré que les données actuelles sur l’efficacité des interventions parent-enfant favorisant la sensibilité parentale dès l’hospitalisation à l’unité de soins intensifs néonatals (USIN) sont de faible à très faible qualité.Objectif : L’objectif de cet article est de rapporter le processus de développement d’une nouvelle intervention infirmière, en utilisant une approche basée sur la théorie et les données empiriques, pour améliorer la sensibilité maternelle et le développement neurologique des nouveau-nés prématurés à l’USIN.Méthodes : Les lignes directrices du Medical Research Council pour le développement et l’évaluation d’interventions complexes en santé ont été utilisées. Ainsi, trois principales étapes ont été suivies : 1- Identification des preuves empiriques existantes ; 2- Identification et développement théorique ; 3- Modélisation des processus et des résultats.Résultats : Nous avons développé une intervention de participation guidée pour que les mères participent aux soins et au positionnement de leur nouveau-né prématuré : GP_Posit (ou Guided Participation of mothers to the Positioning of their preterm infant). GP_Posit est basée sur la théorie de l’attachement, la théorie de la participation guidée ainsi que la théorie synactive du développement.Conclusion : Cette intervention est mise à l’essai dans un essai contrôlé randomisé pilote (NCT03677752).

This review delineates the main pulmonary issues related to preterm birth, perinatal tobacco/nicotine exposure, and its effects on offspring, focusing on respiratory health and its possible transmission to subsequent generations. We review the extent of the problem of preterm birth, prematurity-related pulmonary effects, and the associated increased risk of asthma later in life. We then review the impact of developmental tobacco/nicotine exposure on offspring asthma and the significance of transgenerational pulmonary effects following perinatal tobacco/nicotine exposure, possibly via its effects on germline epigenetics.

Cranial ultrasound is a valuable bedside technique and procedure of choice to image the intraventricular hemorrhage (IVH). Moreover, anatomical variants of the neonatal brain should be known to avoid of misinterpretation. The term of split choroid plexus was described as a cleft in the choroid plexus, which could be partial or complete in the anterior portion, giving a lobular appearance. We presented the case of split choroid plexus in a late premature infant and we aimed draw attention to the fact that it can be confused with IVH.

To determine the impact of maternal coronavirus disease 2019 (COVID-19) on prematurity, birthweight and obstetric complications.Nationwide, population-based retrospective cohort study.National Programme de Médicalisation des Systèmes d'Information database in France.All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID-19 in the mother and/or the newborn.The group with COVID-19 was compared with the group without COVID-19 using the chi-square test or Fisher's exact test, and the Student's t test or Mann-Whitney U test. Logistic regressions were used to study the effect of COVID-19 on the risk of prematurity or macrosomia (birthweight ≥4500 g).Prematurity less than 37, less than 28, 28-31, or 32-36 weeks of gestation; birthweight; obstetric complications.In singleton pregnancies, COVID-19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p 0.01), pre-eclampsia (3.6% versus 2.0%, p 0.01), diabetes (18.8% versus 14.4%, p 0.01) and caesarean delivery (26.8% versus 19.7%, p 0.01). Among pregnant women with COVID-19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small-for-gestational-age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55-2.01) for COVID-19. For macrosomia, COVID-19 resulted in non-significant aOR of 1.38 (95% CI 0.95-2.00).COVID-19 is a risk factor for prematurity, even after adjustment for other risk factors.The risk of prematurity is twice as high in women with COVID-19 after adjustment for factors usually associated with prematurity.

International audience; Aim The aim of this paper was to review the role that donor human milk plays in caring for very low birth weight (VLBW) infants. Methods This review focussed on academic papers and background information published in English and French up to 8 August 2021. Results Donor human milk provides a useful bridge to successful breastfeeding in hospitalised neonates and does not have a negative impact on the use of mother's own milk and breastfeeding rates at discharge. It helps to prevent key complications of prematurity, particularly necrotising enterocolitis up to 36 weeks of postmenstrual age, which is more common in infants fed formulas based on cows' milk. When it is carefully fortified, it supports the postnatal growth of the majority of very preterm infants. Well-organised, accessible human milk banks are required to cover the needs of hospitalised infants, and donor human milk must be prioritised for patients who derive the greatest health benefit from it. These include very preterm infants and those born at term, or near term, with surgical digestive malformations or congenital heart disease. Conclusion Safe, high-quality donor human milk, which is distributed by well-organised human milk banks, is essential for the most vulnerable hospitalised neonates.

In order to develop prognostic criteria for the development of necrotizing enterocolitis, the authors studied clinical and biochemical data of 108 premature infants born and nursed in the departments of the Republican Perinatal Center. The prognostic scale is based on the modification of the probabilistic Bayes method – the method of normalized intensive indicators with the calculation of prognostic, weight indices, normalized intensive and integrated indicators. Individual forecast of the development of necrotizing enterocolitis allows the development of treatment, prevention and rehabilitation measures.

Stress following preterm birth can disrupt the emerging foundation of the neonatal brain. The current study examined how structural brain development is affected by a stressful early environment and whether changes in topological architecture at term-equivalent age could explain the increased vulnerability for behavioral symptoms during early childhood. Longitudinal changes in structural brain connectivity were quantified using diffusion-weighted imaging (DWI) and tractography in preterm born infants (gestational age N= 145, 43.5% female). A global index of postnatal stress was determined based on the number of invasive procedures during hospitalization (e.g., heel lance). Higher stress levels impaired structural connectivity growth in a subnetwork of 48 connections (p= 0.003), including the amygdala, insula, hippocampus, and posterior cingulate cortex. Findings were replicated in an independent validation sample (N= 123, 39.8% female,n= 91 with follow-up). Classifying infants into vulnerable and resilient based on having more or less internalizing symptoms at two to five years of age (n= 71) revealed lower connectivity in the hippocampus and amygdala for vulnerable relative to resilient infants (p< 0.001). Our findings suggest that higher stress exposure during hospital admission is associated with slower growth of structural connectivity. The preservation of global connectivity of the amygdala and hippocampus might reflect a stress-buffering or resilience-enhancing factor against a stressful early environment and early-childhood internalizing symptoms.SIGNIFICANCE STATEMENTThe preterm brain is exposed to various external stimuli following birth. The effects of early chronic stress on neonatal brain networks and the remarkable degree of resilience are not well understood. The current study aims to provide an increased understanding of the impact of postnatal stress on third-trimester brain development and describe the topological architecture of a resilient brain. We observed a sparser neonatal brain network in infants exposed to higher postnatal stress. Limbic regulatory regions, including the hippocampus and amygdala, may play a key role as crucial convergence sites of protective factors. Understanding how stress-induced alterations in early brain development might lead to brain (re)organization may provide essential insights into resilient functioning.

AmaçCiddi ve orta derece preterm bebeklerde kordon kanı nötrofil değerlerinin erken yenidoğan sepsisi (EYS) ve EYS risk etmenleri ile ilişkisinin belirlenmesi amaçlandı. Çalışma planı Geriye dönük çalışmamızda ünitemizde en az yedi gün yatırılan, 28-34 gebelik haftaları arasında doğan olgular değerlendirildi. Göbek kordonundan ya da yaşamın ilk iki saatinde venöz alınan kan sayımları ile kan kültürü sonuçları, CRP değerleri, EYS için risk etmenleri ve klinik özellikler kaydedildi. BulgularHastaların (n=100) ortalama doğum ağırlıkları ve gebelik haftaları sırasıyla 1617±408 gram ve 32,19±1,6 hafta idi. Olguların 33’ünün kordon, 67’sinin doğum sonrası ilk iki saat içinde alınan venöz nötrofil sayıları değerlendirildi. Kordon kanı ve venöz nötrofil değerleri arasında fark saptanmadı (p=0,936). Erken yenidoğan sepsisi ve EYS risk etmeni olanlarla olmayanlar arasında nötrofil değerleri açısından fark saptanmadı (sırasıyla p=0,076, 0,95). Nötrofil düzeyleri gebelik haftası ve doğum ağırlığı ile aynı, CRP değerleri ile zıt yönlü ilişikili saptandı (sırasıyla r, p= 0,282, 0,004; 0,437, 0,0001; -0,209, 0,037). SonuçKordon kanı ve venöz kan nötrofil düzeyleri ile EYS ve EYS risk etmenleri arasında ilişki saptanmadı. Bulgularımız preterm bebeklerde nötrofil değerlerinin gebelik haftası ve doğum ağırlığı göz önüne alınarak değerlendirilmesi gerektiğini düşündürmektedir., IntroductionIt was aimed to determine the relationship between cord blood neutrophil values and early onset neonatal sepsis (ENS) and ENS risk factors in very and moderate preterm infants.MethodsIn our retrospective study, the cases who were born between 28-34 weeks of gestation and hospitalized for at least seven days were evaluated. Blood counts obtained from umbilical cord or in the first two hours of life, blood culture results, CRP values, risk factors for ENS, and clinical features were recorded.ResultsThe mean birth weight and gestational age of patients (n=100) were 1617±408 grams, and 32.19±1.6 weeks, respectively. In the 33 of the cases the cord blood, and in the 67 of the cases venous neutrophil counts taken within the first two hours after delivery were evaluated. There was no difference between cord and venous blood neutrophil values (p= 0.936). There was no difference in terms of neutrophil values between those with/without ENS and with/without ENS risk factors (p = 0.076, 0.95, respectively). Neutrophil levels were positively correlated with gestational week and birth weight, and negatively correlated with CRP values (r, p = 0.282, 0.004; 0.437, 0.0001; -0.209, 0.037, respectively).ConclusionNo relationship was found between cord blood/ venous blood neutrophil levels and ENS/ ENS risk factors. Our findings suggest that neutrophil values should be evaluated by considering gestational age and birth weight in preterm infants.

Peer reviewed: True, In 2023, childhood hypoglycaemia remains a major public health problem and significant risk factor for consequent adverse neurodevelopment. Irrespective of the underlying cause, key elements of clinical management include the detection, prediction and prevention of episodes of hypoglycaemia. These tasks are increasingly served by Continuous Glucose Monitoring (CGM) devices that measure subcutaneous glucose at near-continuous frequency. While the use of CGM in type 1 diabetes is well established, the evidence for widespread use in rare hypoglycaemia disorders is less than convincing. However, in the few years since our last review there have been multiple developments and increased user feedback, requiring a review of clinical application. Despite advances in device technology, point accuracy of CGM remains low for children with non-diabetes hypoglycaemia. Simple provision of CGM devices has not replicated the efficacy seen in those with diabetes and is yet to show benefit. Machine learning techniques for hypoglycaemia prevention have so far failed to demonstrate sufficient prediction accuracy for real world use even in those with diabetes. Furthermore, access to CGM globally is restricted by costs kept high by the commercially-driven speed of technical innovation. Nonetheless, the ability of CGM to digitally phenotype disease groups has led to a better understanding of natural history of disease, facilitated diagnoses and informed changes in clinical management. Large CGM datasets have prompted re-evaluation of hypoglycaemia incidence and facilitated improved trial design. Importantly, an individualised approach and focus on the behavioural determinants of hypoglycaemia has led to real world reduction in hypoglycaemia. In this state of the art review, we critically analyse the updated evidence for use of CGM in non-diabetic childhood hypoglycaemia disorders since 2020 and provide suggestions for qualified use.

© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made., Introduction: According to the World Health Organization, 11% of all children are born prematurely, representing 15 million births annually. An extensive analysis on preterm birth, from extreme to late prematurity and associated deaths, has not been published. The authors characterize premature births in Portugal, between 2010 and 2018, according to gestational age, geographic distribution, month, multiple gestations, comorbidities, and outcomes. Methods: A sequential, cross-sectional, observational epidemiologic study was conducted, and data were collected from the Hospital Morbidity Database, an anonymous administrative database containing information on all hospitalizations in National Health Service hospitals in Portugal, and coded according to the ICD-9-CM (International Classification of Diseases), until 2016, and ICD-10 subsequently. Data from the National Institute of Statistics was utilized to compare the Portuguese population. Data were analyzed using R software. Results: In this 9-year study, 51.316 births were preterm, representing an overall prematurity rate of 7.7%. Under 29 weeks, birth rates varied between 5.5% and 7.6%, while births between 33 and 36 weeks varied between 76.9% and 81.0%. Urban districts presented the highest preterm rates. Multiple births were 8× more likely preterm and accounted for 37%-42% of all preterm births. Preterm birth rates slightly increased in February, July, August, and October. Overall, respiratory distress syndrome (RDS), sepsis, and intraventricular hemorrhage were the most common morbidities. Preterm mortality rates varied significantly with gestational age. Conclusion: In Portugal, 1 in 13 babies was born prematurely. Prematurity was more common in predominantly urban districts, a surprise finding that warrants further studies. Seasonal preterm variation rates also require further analysis and modelling to factor in heat waves and low temperatures. A decrease in the case rate of RDS and sepsis was observed. Compared with previously published results, preterm mortality per gestational age decreased; however, further improvements are attainable in comparison with other countries., The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC, Grant/Award Number: UIDP/04923/2020

This document serves as the preregistration of the protocol of: Benefits of reading to premature newborns in the neonatal intensive care unit Objective: To identify the extent of evidence in relation to benefits of reading to premature newborns in the neonatal intensive care unit. Introduction: Survival rate of premature newborns has increased and the same cannot be said for their long-term quality of life. A focus on the prevention of future complications is recommended. It is believed that reading to premature newborns facilitates language, communication development and bonding. Inclusion criteria: Population: All premature newborns admitted to the NICU will be included. Newborns admitted to the NICU who, at birth, had a gestational age of 37 weeks or more will be excluded; Concept: Reading to premature newborns. Reading is the transmission of written information through voice. It can be performed by mothers/fathers, by health professionals or by volunteers. Other forms of voice exposure will be excluded; Context: Neonatal Intensive Care Units. Methods: This scoping review will be developed in accordance with the JBI methodology for scoping reviews and will survey scientific articles in the online database Pubmed® and EBSCOhost® search engine and grey literature in Google Scholar and Repositórios Científicos de Acesso Aberto de Portugal. It will include literature with full text available, written in Portuguese or English, between 2017 and 2022.

This article describes a case of severe hyperleukocytosis in a preterm infant with fetal inflammatory response syndrome (FIRS) associated with funisitis of umbilical cord and intrauterine inflammation. FIRS is a cause of leukocytosis in newborn, as well as leukemoid reaction in 21 trisomy, congenital leukemia, sepsis, and steroid prophylaxis. Inflammatory response syndrome is associated with high mortality, developmental impairment and complications of prematurity like intraventricular hemorrhage, chronic lung disease, periventricular leukomalacia, and sepsis.

The current study aims to investigate prematurity and socioeconomic status, and their interactive associations to the cortical thickness of language-related brain structures in a large-scale, representative, longitudinal study of adolescents.

Resumen: A pesar de las mejoras en el cuidado neonatal en las últimas décadas, los recién nacidos extremadamente prematuros continúan en alto riesgo de mortalidad y morbilidad, incluyendo discapacidad en el neurodesarrollo. El objetivo de este artículo es revisar la literatura en búsqueda de datos y recomendaciones respecto a este tema de tanta importancia en nuestra práctica clínica neonatal habitual. El establecimiento de un límite de la viabilidad sigue siendo un tema complejo y controvertido, que se debe basar en múltiples factores, no solo en la edad gestacional, y que varía ampliamente en función del entorno y las circunstancias concretas de nacimiento del bebé. La incertidumbre sobre el curso de los bebés extremadamente prematuros hace difícil establecer un pronóstico preciso. En el difícil proceso de toma de decisiones de este contexto, existe acuerdo a nivel internacional acerca de la elaboración de recomendaciones y guías para la asistencia perinatal de estos pacientes, así como la elaboración de registros nacionales de datos y la formación del personal a su cargo. Es una obligación del sistema sanitario poner a disposición de estos recién nacidos el mayor nivel asistencial posible. La participación de las familias, junto con una información bien fundamentada y honesta por parte del personal sanitario, es actualmente el modelo preferido en la toma de decisiones Summary: Despite improvements in neonatal care in recent decades, extremely preterm infants continue to be at high risk for mortality and morbidity, including neurodevelopmental disability. The aim of this article is to review the literature in search of data and recommendations regarding this issue of such importance in our routine neonatal clinical practice. The establishment of a limit of viability remains a complex and controversial issue, which must be based on multiple factors, besides gestational age, and which varies widely depending on the environment and the specific circumstances of the baby's birth. The uncertainty about the course of extremely premature babies makes it difficult to establish an accurate prognosis. In this difficult decision-making context, there is international agreement on the creation of recommendations and guidelines for the perinatal care of these patients, as well as the preparation of national data registries and the training of the health care providers. It is an obligation of the health care system to provide these newborns with the highest available level of care. Family participation, along with well-founded and honest information from healthcare personnel, is currently the preferred model for decision-making.

Introduction Preterm neonates have under-developed immune-regulatory system; consequently, there is a risk for developing chronic inflammation. Necrotizing enterocolitis (NEC) is an acute devastating neonatal intestinal inflammatory disorder. Due to the obscure multifactorial etiology, early diagnosis and effective treatment of NEC are limited. Consequently, effective strategies in the prevention of NEC, including nutritional approaches, are critically needed. The current study was conducted to assess the potential immunomodulatory effect of Docosahexaenoic Acid (DHA) supplementation in preterm neonates at neonatal intensive care unit (NICU) and subsequently its effect on preventing or reducing NEC incidence. Methods This was a prospective randomized controlled study. A total of 67 neonates, with gestational age equal or less than 32 weeks at birth and weight less than or equal 1500 g, were randomly assigned to either DHA group or the control group. Modified Bell’s staging criteria for NEC was used as an objective tool for diagnosis and staging of NEC. Levels of Interleukin 1 beta (IL-1β) were measured at baseline and after 10 days. Mortality and NICU length of stay (LOS) were also monitored. Results Thirty neonates of each group completed the study. A statistically significant difference was observed between the two groups regarding diagnosis and staging of NEC (p = 0.0001). There was also a statistically significant difference between DHA group 22(73.3), 95% CI [55.9, 86.5] and the control group 8 (26.7), 95% CI [13.5, 44.1] in the percentage change in IL-1β levels (p = 0.0001). A statistically significant association was found between IL and 1 β change and NEC diagnosis (p = 0.001). NICU LOS was significantly lower among DHA group 21.63 ± 6.67 compared to the control group 25.07 ± 4.67 (p = 0.025). Mortality n (%) among the control group 4 (11.8) was higher than DHA group 3 (9.1), however, no significant difference was detected (p = 1.0). Conclusion Findings of this study suggest that enteral DHA supplementation can reduce NEC incidence in preterm neonates through its immunoregulatory effect that modulates production of regulatory cytokines. Trial registration: Registered at clinical trials.gov (NCT03700957), 6 October 2018.

Objective The aim of this study was to evaluate infants, born to women with SARS-CoV-2 detected during pregnancy, for evidence of haematological abnormalities or hypercoagulability in umbilical cord blood. Study design This was a prospective observational case-control study of infants born to women who had SARS-CoV-2 RNA detected by PCR at any time during their pregnancy (n = 15). The study was carried out in a Tertiary University Maternity Hospital (8,500 deliveries/year) in Ireland. This study was approved by the Hospital Research Ethics Committee and written consent was obtained. Umbilical cord blood samples were collected at delivery, full blood count and Calibrated Automated Thrombography were performed. Demographics and clinical outcomes were recorded. Healthy term infants, previously recruited as controls to a larger study prior to the outbreak of COVID-19, were the historical control population (n = 10). Results Infants born to women with SARS-CoV-2 had similar growth parameters (birth weight 3600 g v 3680 g, p = 0.83) and clinical outcomes to healthy controls, such as need for resuscitation at birth (2 (13.3%) v 1 (10%), p = 1.0) and NICU admission (1 (6.7%) v 2 (20%), p = 0.54). Haematological parameters (Haemoglobin, platelet, white cell and lymphocyte counts) in the COVID-19 group were all within normal neonatal reference ranges. Calibrated Automated Thrombography revealed no differences in any thrombin generation parameters (lag time (p = 0.92), endogenous thrombin potential (p = 0.24), peak thrombin (p = 0.44), time to peak thrombin (p = 0.94)) between the two groups. Conclusion In this prospective study including eligible cases in a very large population of approximately 1500 women, there was no evidence of derangement of the haematological parameters or hypercoagulability in umbilical cord blood due to COVID-19. Further research is required to investigate the pathological placental changes, particularly COVID-19 placentitis and the impact of different strains of SARS-CoV-2 (particularly the B.1.1.7 and the emerging Delta variant) and the severity and timing of infection on the developing fetus.

Congenital complete heart block (CCHB) is a very rare condition, with high risk of mortality. Prematurity is associated with immaturity of the cardiovascular system. Morbidity related to CCHB and prematurity has never been described. We describe a tertiary perinatal center experience over a 15-year period on CCHB management and complications in preterm infants. This is a single-center observational cohort study. All neonates admitted to neonatal intensive care unit with a diagnosis of isolated CCHB between January 2006 and January 2021 were identified. All preterm neonates (

Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD). Methods Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants’ median gestational age, 25.3 (23.6–28.1) weeks, was compared with 36 historical controls’ median gestational age 25.2 (23.1–29.1) weeks. Results Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0–2] vs. 1 [0–6] p = 0.002), shorter durations of invasive ventilation (median: 30.5, [1–90] vs. 40.5 [11–199] days, p = 0.046), and total duration of invasive and NIV to the point of discharge to the local hospital (median: 80 [57–140] vs. 103.5 [60–246] days, p = 0.026). The overall length of stay (LOS) was lower in NAVA/NIVNAVA group (111.5 [78–183] vs. 140 [82–266] days, p = 0.019). There were no significant differences in BPD (17/18 [94%] vs. 32/36 [89%] p = 0.511) or home oxygen rates (14/18 [78%] vs. 23/36 [64%] p = 0.305). Conclusion The combination of NAVA/NIV-NAVA compared with conventional invasive and NIV modes may be advantageous for preterm infants with evolving/established BPD.

Introduction Studies directly comparing preterm birth rates in women with and without severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are limited. Our objective was to determine whether preterm birth was affected by SARS‐CoV‐2 infection within a large integrated health system in New York with a universal testing protocol. Material and methods This retrospective cohort study evaluated data from seven hospitals in New York City and Long Island between March 2020 and June 2021, incorporating both the first and second waves of the coronavirus disease 2019 (COVID‐19) pandemic in the USA. All patients with live singleton gestations who had SARS‐CoV‐2 polymerase chain reaction (PCR) testing at delivery were included. Deliveries before 20 weeks of gestation were excluded. The rate of preterm birth (before 37 weeks) was compared between patients with positive and negative SARS‐CoV‐2 test results. This analysis was performed separately for resolved prenatal infections and infections at delivery, with the latter group subdivided by symptom status. Multiple logistic regression analysis was used to examine the association between SARS‐CoV‐2 infection and preterm birth, adjusting for maternal age, race‐ethnicity, parity, history of preterm birth, body mass index, marital status, insurance type, medical co‐morbidities, month of delivery, and wave of pandemic. Results A total of 31 550 patients were included and 2473 (7.8%) had laboratory‐confirmed infection. Patients with symptomatic COVID‐19 at delivery were more likely to deliver preterm (19.0%; adjusted odds ratio 2.76, 95% CI 1.92–3.88) compared with women with asymptomatic infection (8.8%) or without infection (7.1%). Among preterm births associated with symptomatic infection, 72.5% were medically indicated compared with 44.1% among women without infection (p

This retrospective cohort study aims to determine the epidemiology of iron deficiency among extreme preterm neonates and the association of iron-deficient status during the NICU stay with neurodevelopmental outcomes at 18–24 months. Neonates ≤29 weeks gestational age (GA) born between June 2016 and December 2019, who received routine iron supplementation were enrolled. Iron deficiency was defined as reticulocyte–hemoglobin (Ret-Hb) levels ≤ 29 pg at 36 weeks corrected age. A subcohort of neonates completed standardized developmental assessment at 18–24 months corrected age. Significant neurodevelopmental impairment (sNDI) was defined as either Bayley Scales of Infant Development score < 70 or cerebral palsy or blindness or hearing aided. Among a cohort of 215 neonates [GA 25.8 (1.7) weeks, birthweight 885 (232) g], prevalence of iron deficiency was 55%, 21%, 26%, and 13%, in neonates

In many countries, preterm birth, defined as birth before 37 completed weeks of gestation, is the primary cause of infant death and morbidity. An increasing body of research suggests that inflammation (both clinical and subclinical) plays a significant role in inducing preterm labor or developing pregnancy problems that lead to premature birth. Consequently, the purpose of this research was to determine the predictive value of the Neutrophil-Lymphocyte Ratio (NLR), derived Neutrophil-Lymphocyte Ratio (dNLR), Monocytes-to-Lymphocyte Ratio (MLR), Platelets-to-Lymphocyte Ratio (PLR), Systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), for premature delivery. A retrospective study analyzed a total of 243 eligible pregnancies that resulted in a preterm birth during 2020 and 2021. A control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio. Although the number of comorbidities was similar among study groups, the body-mass index estimated for the week of gestation was significantly higher among the patients from the prematurity group, as well as the prevalence of urinary tract infections and smoking. Laboratory data showed that patients with a preterm birth had significantly higher white blood cell count and monocytes, but significantly lower lymphocytes, platelets, and hemoglobin. The NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients from the prematurity group, but SII and SIRI were not significantly different between the study groups. It was observed that the AUC values of NLR, dNLR, PLR, and MLR were higher than 0.600, respectively NLR had the highest value among the tested scores (AUC = 0.694) and the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 (p-value = 0.022). PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) (p-value = 0.015). Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility. The significant cut-off values for the inflammatory scores were 9.0 for NLR, 9.8 for dNLR, 250 for PLR, and 4.07 for MLR. After evaluating the importance of these inflammatory scores, further clinical applications should be conducted to confirm the results and improve therapy and care to reduce the burden of premature deliveries.

National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the relationships between admission temperature and outcomes in very low birth weight (VLBW) babies in a unit with low rates of hypothermia and a higher rate of hyperthermia. This was an observational study based on routinely collected data including demographics, admission temperature, survival and major morbidity outcomes. Subjects were 1104 consecutive inborn VLBW babies admitted to a Neonatal Intensive Care Unit in United Kingdom between 2010 and 2017. Results: 155 (14%) of babies were hypothermic (37.5 °C). The rate of major abnormality on cranial ultrasound scan was increased in the hyperthermic babies compared to the normothermic babies (37/239 (15.5%) vs. 54/601 (9%), relative risk (95% CI) 1.723 (1.166 to 2.546), p = 0.006). There was no difference in survival or other major morbidity in the hyperthermic babies compared to the normothermic babies. There was no association between hypothermia and survival or any major morbidity, although this probably reflects the low power of the study given the low rates of significant hypothermia. Higher admission temperature was associated with an increase in the risk of major cranial ultrasound abnormality using multiple logistic regression analysis (p = 0.007) with an increased odds ratio (95% CI) of 1.48 (1.11 to 1.97) for each degree of increase. We conclude that admission hyperthermia is independently associated with an increased risk of preterm brain injury. It is not possible to state whether this is a causative association, or whether the association is a consequence of a shared aetiology of perinatal infection.

Objective Shunt treatment for hydrocephalus in children should aim for sustainable flexibility in regard to optional, perspective pressure level adjustment during advancing physical and mental development. Gravitation-assisted shunt valves are designed to prevent hydrostatic over-drainage frequently observed in the long course of shunt-treated hydrocephalus. We prospectively studied and analyzed the implication, safety, and feasibility for an adjustable gravitational unit combined with a fixed differential-pressure (DP) valve for neonates and infants primary shunted within the first 12 months of life. Methods Clinical course of hydrocephalic neonates and infants who received initial VP-shunt insertion in the early post-natal phase were monitored prospectively on the basis of our digital institutional Hydrocephalus & Shunt Registry. All patients were equipped with a fixed DP valve combined with a programmable gravitational unit activated in upright body position. Patients with a minimum shunt follow-up of 24 months were considered for further statistical analysis regarding hydrocephalus etiology, surgical setting, pre- and post-operative ventricular enlargement, head circumference, valve pressure setting, implication for the adjustment option of the gravitational unit, type and number of shunt complications, and revision-free shunt and valve survival. Results Seventy-eight pediatric patients received primary VP-shunt insertion at a mean age of 10 weeks with age gestationally corrected for preterm neonates. Hydrocephalus was related to perinatal IVH (64%), CNS malformation (11%), spina bifida (9%), congenital aqueductal stenosis (9%), and idiopathic (4%) or post-infectious etiology (3%). Fifty-two patients (70%) presented with history of prematurity (gestational age 23–36 weeks). Regular follow-up carried out for a mean period of 63 months demonstrated that ventricular enlargement decreased significantly after applied treatment and excessive head growth could be counteracted effectively. At least one pressure level adjustment was performed in 31% of all patients after 12 months, in 42% after 24 months, and in 64% at the time of last clinical follow-up since initial shunt insertion. Pressure level adjustments were successful in cases of clinical or radiographic signs of under- or over-drainage for individual patients of various ages during entire clinical course. Mean pressure setting for upright position was 24.1 cm H2O at the time of initial shunt insertion and increased to 26.4 cmH2O at the time of last clinical follow-up. Revision-free shunt-survival rates after 12 and 24 months were 79% and 70% and valve-survival rates 91% and 90%, respectively. Conclusion The combination of a fixed DP valve with an adjustable gravitational unit utilized as first-line shunt regimen was feasible and safe in a highly vulnerable subgroup of hydrocephalic infants. The adjustment option for the gravitational unit showed frequent and increasing implication over time and was beneficial even during the very early developmental stage of limited autonomous mobility. To our knowledge this is the first ever reported long-term investigation of an age-consistent pediatric patient collective primary shunted with an adjustable gravitational valve system.

Rationale: Lung ultrasound is useful in critically ill patients with acute respiratory failure. Given its characteristics, it could also be useful in extremely preterm infants with evolving chronic respiratory failure, as we lack accurate imaging tools to monitor them. Objectives: To verify if lung ultrasound can monitor lung aeration and function and has good reliability to predict bronchopulmonary dysplasia in extremely preterm neonates. Methods: A multicenter, international, prospective, longitudinal, cohort, diagnostic accuracy study consecutively enrolling inborn neonates with gestational age 3016 weeks or younger. Lung ultrasound was performed on the 1, 7, 14, and 28 days of life, and lung ultrasound scores were calculated and correlated with simultaneous blood gases and work of breathing score. Gestational age-adjusted lung ultrasound scores were created, verified in multivariate models, and subjected to receiver operator characteristics (ROC) analyses to predict bronchopulmonary dysplasia at 36 weeks postmenstrual age. Measurements and Main Results: Mean lung ultrasound scores are different between infants developing (n572) or not developing (n575) bronchopulmonary dysplasia (P,0.001 at any time point). Lung ultrasound scores significantly correlate with oxygenation metrics and work of breathing at any time point (P always,0.0001). Gestational age-adjusted lung ultrasound scores significantly predict bronchopulmonary dysplasia at 7 (area under ROC curve, 0.826-0.833; P,0.0001) and 14 (area under ROC curve, 0.834-0.858; P,0.0001) days of life. Bronchopulmonary dysplasia severity and gestational age-adjusted lung ultrasound scores are significantly correlated at 7 and 14 days (P always,0.0001). Conclusions: Lung ultrasound scores allow monitoring of lung aeration and function in extremely preterm infants. Gestational age-adjusted scores significantly predict the occurrence of bronchopulmonary dysplasia, starting from the seventh day of life.

Background Preterm infants are more susceptible to inflammatory complications than term infants. Human milk contains numerous bioactive components protecting the newborn infant. Antisecretory factor, a protein regulating secretory and inflammatory processes by complex binding with complement factors, is present in human milk. Research Aims To describe antisecretory factor (1) in mother’s own milk in term and preterm infants; and (2) in donor milk before and after Holder pasteurization. Methods The study was prospective, longitudinal, explorative, and descriptive. Antisecretory factor-compleasome was determined using sandwich enzyme-linked immunosorbent assay in longitudinal human milk samples over 12 weeks from mothers ( N = 87) of term ( n = 41) and of preterm ( n = 46) infants and 20 anonymized donor human milk samples before and after Holder pasteurization. Results Antisecretory factor-compleasome was overall higher in colostrum versus mature milk ( p < .001) and no difference was found in term or preterm colostrum ( p = .82). In mature milk, compleasome was higher and more variable in the preterm group ( p = .01). After Holder pasteurization, compleasome levels increased ( p < .001). Conclusion Antisecretory factor followed the pattern of other immunological factors with high levels in colostrum. After preterm birth, levels of antisecretory factor were higher and more variable in mature milk. Holder pasteurization did not degrade antisecretory factor, indicating preserved anti-inflammatory properties in donor human milk.

This is the registration of a scoping review about the role of postnatal nutrition in white matter development among preterm infants. The protocol attached is based on the JBI methodology guidance for scoping reviews.

The use of corticosteroids in premature infants with respiratory disease was reviewed and recommendations suggested. The guideline is not considered a standard of care because of individual patient and contextual factors and the presence of new information since the inception of the guideline. Version 1: November 1, 2012 Update: August 18, 2016

In the proposed systematic review, we seek to identify, compile, examine, and synthesize the findings of quantitative and mixed methods research in which both brain imaging techniques and assessments of achievement have been used to evaluate and understand the relationships among developmental programming , neurodevelopment and achievement in reading and mathematics. The principal aims of the present review are to provide an accurate, concise, and accessible overview of the major findings of literature in the field and at the same time address the following research questions: (1) What is the current state of the evidence concerning the relationships among developmental programming, neurodevelopment and achievement in reading and mathematics? (2) What trends can be observed in the extant literature? (3) What gaps exist in the in the extant literature? (4) What are appropriate directions for future research?

Evidence for antenatal corticosteroid use at 23 weeks' gestation is reviewed and guidelines are presented. Use of antenatal corticosteroids at 23 weeks' gestation may vary depending on individual and contextual factors and new evidence since inception of the guideline. Hence, this guideline is not intended as a standard of care. First document: July 2012 Update: August 2018

Evidence for having preterm infants be NPO during PRBC transfusion is reviewed. As patient specific factors, contextual factors and new evidence since the inception of this guideline may exist, the recommendations and/or content may no longer being applicable. Thus, this guideline is not intended to be a standard of care. Version 1: July 14, 2016

Autism, a complex neurodevelopmental disorder, occurs at heightened rates in children born prematurely (

The use of supplemental oxygen in established retinopathy of prematurity (ROP) is reviewed and recommendations offered. The guideline provides for consistency in management of ROP although individual clinical circumstances and evidence available after the review was completed limits the applicability to individual cases. Hence, this serves as a guideline and is not meant to be a standard of care.

Background Although there have been significant improvements in prenatal and neonatal care in recent years, twin pregnancies account for 17-20% of all preterm births and are associated with an increased risk of perinatal mortality and morbidity. Aims To evaluate the contribution of cerclage to the continuation of pregnancy in twin pregnancy cases required cervical cerclage. Methods Cases of twin pregnancies who performed cervical cerclage with follow-up and deliveries between January 2010 and January 2022 in the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine Hospital, were retrospectively analyzed. Obstetric and neonatal outcomes were evaluated. Results A total of 23 women who performed cervical cerclage due to cervical insufficiency in twin pregnancies were evaluated retrospectively. The mean time between cerclage placement and delivery was 12.1 +/- 7 weeks, maximum prolongation was in the obstetric history-indicated cerclage group. The gestational age at delivery was 20-38 (median 30) weeks. The rate of spontaneous preterm birth at < 34, < 32, < 28, and < 24 weeks was higher in the physical examination-indicated cerclage group. Overall neonatal survival was 82.5% (n = 33/40). Conclusion The time between cerclage placement and birth were considered as an important gain for twin pregnancies at the limit of viability. Further studies are needed to better understand the role of cervical cerclage in preventing premature birth and to determine the indications for cerclage.

Retrospective studies indicate that the parenteral provision of calories, proteins, and lipids in the first week of life is associated with improved later neurodevelopment. We aimed to determine whether infants randomized to an enhanced parenteral nutrition protocol had improved developmental outcomes at 4, 12, or 24 months corrected age (CA). In total, 90 preterm infants (

Metabolic bone disease of prematurity (MBD) is a condition of reduced bone mineral content (BMC) compared to that expected for gestational age (GA). Preterm birth interrupts the physiological process of calcium (Ca) and phosphorus (P) deposition that occurs mostly in the third trimester of pregnancy, leading to an inadequate bone mineralization during intrauterine life (IUL). After birth, an insufficient intake of Ca and P carries on this alteration, resulting in overt disease. If MBD is often a self-limited condition, in some cases it could hesitate the permanent alteration of bone structures with growth faltering and failure to wean off mechanical ventilation due to excessive chest wall compliance. Despite advances in neonatal intensive care, MBD is still frequent in preterm infants, with an incidence of 16–23% in very-low-birth-weight (VLBW, birth weight

Background Prematurity is still the leading cause of global neonatal mortality, Rwanda included, even though advanced medical technology has improved survival. Initial hospitalization of premature babies (PBs) is associated with high costs which have an impact on Rwanda’s health budget. In Rwanda, these costs are not known, while knowing them would allow better planning, hence the purpose and motivation for this research. Methods This was a prospective cost of illness study using a prevalence approach conducted in 5 hospitals (University Teaching Hospital of Butare, Gisenyi, Masaka, Muhima, and Ruhengeri). It included PBs admitted from June to July 2021 followed up prospectively to determine the medical direct costs (MDC) by enumerating the cost of all inputs. Descriptive analyses and ordinary least squares regression were used to illustrate factors associated with and predictive of mean cost. The significance level was set at p Results A total of 123 PBs were included. Very preterm and moderate PBs were 36.6% and 23.6% respectively and the average birth weight (BW) was 1724 g (SD: 408.1 g). The overall mean MDC was $237.7 per PB (SD: $294.9) representing 28% of Gross Domestic Product (GDP) per capita per year. Costs per PB varied with weight category, prematurity degree, hospital level, and length of stay (LoS) among other variables. MDC was dominated by drugs and supplies (65%) with oxygen being an influential driver of MDC accounting for 38.4% of total MDC. Birth weight, oxygen therapy, and hospital level were significant MDC predictive factors. Conclusion This study provides an in-depth understanding of MDC of initial hospitalization of PBs in Rwanda. It also indicates predictive factors, including birth weight, which can be managed through measures to prevent or delay preterm birth. Implication for prematurity prevention and management The results suggest a need to revise the benefits and entitlements of insured people to include drugs and interventions not covered that are essential and where there are no alternatives. Having oxygen plants in hospitals may reduce oxygen-related costs. Furthermore, interventions to reduce prematurity should be evaluated using cost-effectiveness analysis since its overall burden is high.

In preterm newborns, secondary hyperparathyroidism (HPTH) is an underdiagnosed and undertreated entity. Its detection in the context of metabolic bone mineral disease (MBD) screening programs may be important to guide nutritional treatment. We designed a retrospective cohort study to determine the incidence of HPTH in very premature infants. As secondary objectives, we studied the risk factors, morbidities, and biochemical alterations associated with HPTH. A total of 154 preterm newborns ≤32 weeks gestational age (GA) were included. Of these, 40.3% (n = 62) presented with HPTH. In the multivariate analysis, independent risk factors for HPTH were cesarean section (OR: 4.00; 95% CI: 1.59–10.06), oxygen during resuscitation (OR: 3.43; 95% CI: 1.09–10.81), invasive mechanical ventilation (OR: 3.56; 95% CI: 1.63–7.77) and anemia requiring transfusion (OR: 2.37; 95% CI: 1.01–5.57). Among the analytical variables, serum calcium (OR: 0.53; 95% CI: 0.29–0.97), serum phosphate (OR: 2.01; 95% CI: 1.39–2.92), vitamin D (OR: 0.96; 95% CI: 0.93–1), and the calcium/creatinine ratio in urine (OR: 0.05; 95% CI: 0.01–0.28) were independently associated with HPTH. The simplified predictive model included GA and calcium/creatinine ratio in urine and demonstrated an AUC of 0.828. We concluded that HPTH is a frequent entity among very premature infants and that further studies are required to determine the role of HPTH in MBD and the clinical applicability of prediction models.

Preterm infants are at risk for adverse neurodevelopmental outcomes, especially language delay. Preterm infants < 29 weeks’ gestational age, cared for in Canadian Neonatal Follow-Up Network affiliated hospitals, were assessed between 18 to 21 months corrected age using the Bayley-III. Bayley-III Language Composite Scores were compared using univariate and multivariate analyses for children in three primary language groups: English, French and other. 6146 children were included. The primary language at home was English, French or another language for 3708 children (60%), 1312 children (21%) and 1126 children (18%), respectively, and overall, 44% were exposed to two or more languages at home. Univariate analysis showed that primary language was associated with lower Bayley-III Language scores; however, multivariate analyses demonstrated that neither primary language nor language of administration were significantly associated with lower language scores when adjusted for gestational age, other developmental delays and sociodemographic factors, but multiple language exposure was. Sociodemographic and other factors are more important in determining language development than primary language at home. Further studies are needed to examine the association between exposure to multiple languages and lower Bayley-III language scores in preterm infants.

In order to assess the immunity indicators of early premature children born in the period from 22 to 27 weeks the researchers conducted a dynamic examination of 24 newborns: 11 children with severe bronchopulmonary dysplasia (Group 1) and 13 children without bronchopulmonary dysplasia (Group 2). They used flow cytometry to determine monocyte counts (CD14+CD64+, CD14+HLA-DR+, CD11b+CD14+). The authors determined the peculiarities of the immune status of children with severe bronchopulmonary dysplasia. They found that the spectrum of monocyte-macrophage protection factors of the children with extremely low body weight was significantly reduced due to a decrease in cell adhesion and migration of the (CD14+CD64+) cells to the inflammation site, as well as the presentation of infectious pathogens – viruses or bacteria (CD14+HLA-DR+), which may be the reason for the development of bacterial complications and prolonged course of the inflammatory process, one of the main factors in the development of severe bronchopulmonary dysplasia. The revealed features of the immune status in infants with bronchopulmonary dysplasia can be used to evaluate the effectiveness of the therapy, which dictates the need for further studies.

Premature birth affects the developmental trajectory of the brain during a period of intense maturation with possible lifelong consequences. To better understand the effect of prematurity on brain structure and function, we performed blood‐oxygen‐level dependent (BOLD) and anatomical magnetic resonance imaging (MRI) at 40 weeks of postmenstrual age on 88 newborns with variable gestational age (GA) at birth and no evident radiological alterations. We extracted measures of resting‐state functional connectivity and activity in a set of 90 cortical and subcortical brain regions through the evaluation of BOLD correlations between regions and of fractional amplitude of low‐frequency fluctuation (fALFF) within regions, respectively. Anatomical information was acquired through the assessment of regional volumes. We performed univariate analyses on each metric to examine the association with GA at birth, the spatial distribution of the effects, and the consistency across metrics. Moreover, a data‐driven multivariate analysis (i.e., Machine Learning) framework exploited the high dimensionality of the data to assess the sensitivity of each metric to the effect of premature birth. Prematurity was associated with bidirectional alterations of functional connectivity and regional volume and, to a lesser extent, of fALFF. Notably, the effects of prematurity on functional connectivity were spatially diffuse, mainly within cortical regions, whereas effects on regional volume and fALFF were more focal, involving subcortical structures. While the two analytical approaches delivered consistent results, the multivariate analysis was more sensitive in capturing the complex pattern of prematurity effects. Future studies might apply multivariate frameworks to identify premature infants at risk of a negative neurodevelopmental outcome., To better understand the effect of prematurity on brain structure and function, we evaluated BOLD and anatomical MRI metrics in a set of 90 cortical and subcortical brain regions of 88 newborns at 40 weeks of postmenstrual age, with no evident radiological alterations and variable gestational age (GA) at birth. Data‐driven multivariate analyses of these measures were in agreement with univariate findings and indicated that GA at birth was associated with bidirectional and diffuse alterations of BOLD functional connectivity and more focal alterations of regional volume and BOLD activity (assessed through the fractional amplitude of low‐frequency fluctuation, fALFF). Future studies might successfully apply multivariate frameworks to identify premature infants at risk of a negative neurodevelopmental outcome.

Background: Percutaneous central venous catheters (PCVCs) are used commonly and widely in the neonatal intensive care unit (NICU). Malposition of PCVCs may cause life-threatening complications and prolong hospitalization. In Taiwan, conventional chest-abdomen radiography (CXR) has been used widely and routinely for assessing tip location of PCVCs. Compared to ultrasonography (US), CXR cannot provide real-time assessment, and patients are exposed to radiation. Therefore, this study aimed to analyze the role of US in detecting PCVC tip location in the lower extremities. Methods: Neonates who received PCVC insertion in the lower extremities in NICU from March 2019 to April 2020 were enrolled in this prospective cohort study. PCVC tip location was confirmed finally by conventional CXR after US examination and patients were included in the sono group; those not assessed by US formed the non-sono group. In addition, PCVCs inserted in 2018 for which tip location was evaluated only by CXR, were reviewed retrospectively and these cases were included in the non-sono group. Withdrawal rates between the two groups were analyzed using Chi-square test. Results: The sono group included 166 neonates with PCVCs and 141 were in the non-sono group. Median gestational age at date of PCVC insertion was 33.21 and 32.71 weeks in sono and non-sono groups, respectively (p = 0.37). Withdrawal rates were 10.84% and 65.95% (p