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Purpose To compare the effectiveness of sunflower oil and silicone-based spray used to remove medical adhesives from the orogastric catheter in preventing the skin injury of premature infants in the neonatal intensive care unit. This randomized controlled experimental study was conducted on premature infants, born between 32 and 36 weeks, hospitalized in the Neonatal Intensive Care Unit located in the city center of the Black Sea region. There were 86 participants in the study; 43 were in the control group (silicone-based spray), and 43 were in the intervention group (sunflower oil). The "Neonatal Skin Condition Score Scale" evaluated premature infants' skin. Mean skin condition score of premature infants for whom silicone-based adhesive remover spray was applied was 3.63 ± 0.78, whereas the mean skin condition score measured three hours later was 3.17 ± 0.37. Mean skin condition score of premature infants for whom sunflower oil was applied as a medical adhesive remover was 3.40 ± 0.62, whereas the mean skin condition score measured three hours later was 3.07 ± 0.25. No statistically significant difference was determined between the mean skin condition scores of premature infants in both groups evaluated immediately after removing the medical adhesive and 3 h there after (p > 0.05). There is no difference between the skin condition of premature infants for whom silicone-based medical adhesive remover spray is used and the skin condition of premature infants for whom sunflower oil is used to remove the orogastric tube adhesive. Pediatric nurses should use medical supplies suitable for the skin condition of premature infants and should frequently evaluate the baby's skin condition. Since silicone-based adhesive remover sprays have a risk of toxicity by being absorbed by the skin, it is recommended to use herbal, cost-effective, non-toxic products. Clinical Trial Number: NCT06280326 • Premature babies hospitalized in neonatal intensive care need many medical devices to maintain their vital functions. • The skin of a premature baby is physiologically and developmentally different compared to term babies. • Medical adhesive removers are used to remove the adhesive and protective film residues and minimize the pain and skin injury. • Pediatric nurses should use different materials to remove medical devices for protecting premature baby's skin. [ABSTRACT FROM AUTHOR]

We aimed to compare the prevalence of modifiable and non-modifiable coronary heart disease (CHD) risk factors among those with premature CHD and healthy individuals. PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol is registered in PROSPERO CRD42020173216). The quality of studies was assessed using the National Heart, Lung and Blood Institute tool for cross-sectional, cohort and case-control studies. Meta-analyses were performed using Review Manager 5.3. Effect sizes for categorical and continuous variables, odds ratio (OR) and mean differences (MD)/standardised mean differences (SMD) with 95% confidence intervals (CI) were reported. A total of n=208 primary studies were included in this review. Individuals presenting with premature CHD (PCHD, age ≤65 years) had higher mean body mass index (MD 0.54 kg/m2, 95% CI 0.24, 0.83), total cholesterol (SMD 0.27, 95% CI 0.17, 0.38), triglycerides (SMD 0.50, 95% CI 0.41, 0.60) and lower high-density lipoprotein cholesterol (SMD 0.79, 95% CI: −0.91, −0.68) compared with healthy individuals. Individuals presenting with PCHD were more likely to be smokers (OR 2.88, 95% CI 2.51, 3.31), consumed excessive alcohol (OR 1.40, 95% CI 1.05, 1.86), had higher mean lipoprotein (a) levels (SMD 0.41, 95% CI 0.28, 0.54), and had a positive family history of CHD (OR 3.65, 95% CI 2.87, 4.66) compared with healthy individuals. Also, they were more likely to be obese (OR 1.59, 95% CI 1.32, 1.91), and to have had dyslipidaemia (OR 2.74, 95% CI 2.18, 3.45), hypertension (OR 2.80, 95% CI 2.28, 3.45), and type 2 diabetes mellitus (OR 2.93, 95% CI 2.50, 3.45) compared with healthy individuals. This meta-analysis confirms current knowledge of risk factors for PCHD, and identifying these early may reduce CHD in young adults. [ABSTRACT FROM AUTHOR]

Despite recognizing high seizure risk, the current consensus guidelines on evaluating seizures in preterm neonates are based on limited data. We chose to investigate the seizure risk in high-risk preterm (<30 weeks gestation) asymptomatic (without a clinical concern for seizures) infants with high-grade intraventricular hemorrhage who underwent long-term video electroencephalographic monitoring. We performed a comprehensive retrospective review on all infants of <30-week gestational age admitted to the University of Alabama at Birmingham Regional Neonatal Intensive Care Unit from June 2018 to October 2022. We selected those patients who underwent electroencephalographic monitoring without a prior clinical concern for seizures. We recorded gender, gestational age, APGAR scores (one and five minutes), intraventricular hemorrhage (grade, age at diagnosis), and electroencephalographic monitoring (timing and duration) data. Among 37 premature infants, six had seizures detected on electroencephalographic monitoring. All six infants had subclinical seizures. Only two of six patients had a clinical correlation (although not identified by the providers) with some of their seizures. Patients with seizures were significantly younger in chronological age (median age 6.5 days vs 9 days, P value 0.009) at the time of the electroencephalographic monitoring initiation and were more likely to have subsequent monitoring studies (P value 0.0418). Long-term video electroencephalographic monitoring performed after the diagnosis of high-grade intraventricular hemorrhage captured seizures in ∼16% of asymptomatic premature neonates of <30 weeks' gestation. Patients identified to have seizures were significantly younger (chronological age) at the time of the electroencephalographic monitoring initiation and were more likely to be remonitored. [ABSTRACT FROM AUTHOR]

Cryptorchidism is commonly treated with orchiopexy at 6–12 months of age, often allowing time for undescended testicle(s) (UT) to descend spontaneously. However, when an inguinal hernia (IH) is also present, some surgeons perform orchiopexy and inguinal hernia repair (IHR) immediately rather than delaying surgery. We hypothesize that early surgical intervention provides no benefit for newborns with both IH and UT. The Nationwide Readmissions Database was used to identify newborns with diagnoses of both IH and UT from 2010 to 2014. Patients were stratified by management: IHR performed on initial admission (Repair) or not (Deferral). Demographics, outcomes, and complications were compared. Results were weighted for national estimates. We analyzed 1306 newborns (64% premature) diagnosed with both IH and UT. IHR was performed at index admission in 30%. Repair was more common in premature babies (43% vs. 8% full-term, p < 0.001) and patients with congenital anomalies (33% vs. 27% without congenital anomaly, p = 0.012). There was no difference in readmission rates. Repair patients had higher rates of orchiectomy than did Deferral. No Deferral patients were readmitted for bowel resection, and <1% were readmitted for orchiectomy or hernia incarceration. In newborns with UT and IH, immediate repair is not associated with improved outcomes. Even with incarceration on initial presentation, rates of readmission with incarceration or bowel compromise for patients who undergo Deferral of surgery are minimal. Moreover, Repair newborns have higher rates of orchiectomy. We found no benefit to early operative intervention; thus, we recommend waiting until 6–12 months of age to reassess for surgery. Level III Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy (CEA) aims to reduce the risk of stroke in patients with atherosclerotic carotid disease. Preoperative risk assessments that predict complications are needed to optimize the care in this patient group. The current approach, namely relying solely on symptomatology and degree of stenosis, is outdated and calls for innovation. The Agatston calcium score was applied in several vascular specialties to assess cardiovascular risk profile but has been little studied in carotid surgery. It is hypothesized that a higher calcium burden at initial presentation equates to a worse prognosis attributable to an increased cerebrovascular and cardiovascular risk profile. The aim was to investigate the association between preoperative ipsilateral calcium score and postoperative all-cause mortality in patients undergoing CEA. This single-center retrospective cohort study included 89 patients who underwent CEA at a tertiary referral center between 2010 and 2018. Preoperative calcium scores were measured on contrast-enhanced computed tomography images with patient-specific Hounsfield thresholds at the level of the carotid bifurcation. The association between these calcium scores and all-cause mortality was analyzed using multivariable adjusted Cox proportional hazard analysis. Cox proportional hazard analysis demonstrated a significant association between preoperative ipsilateral carotid calcium score and all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03-1.16; P =.003). After adjusting for age, preoperative estimated glomerular filtration rate, and diabetes mellitus, a significant association remained (hazard ratio, 1.07; 95% confidence interval, 1.00-1.15; P =.05). A higher calcium burden was predictive of worse outcome, which might be explained by an overall poorer health status. These results highlight the potential of calcium measurements in combination with other traditional risk factors, for preoperative risk assessment and thus for improved patient education and care. [ABSTRACT FROM AUTHOR]

The purpose of this scoping review was to map and organize the previous studies conducted among fathers whose infants experienced admission to neonatal intensive care units (NICUs) in South Korea. A scoping review was conducted based on Arksey and O'Malley using the JBI template. The review was described by PRISMA-ScR. The studies were reviewed through five electronic databases (PubMed, CINAHL, Web of Science, RISS and KMbase) since 1996. Each study was analyzed, extracted, and summarized into the following domains: general characteristics (language, design, data collection methods, intervention, data collection site, and time) and fathers' characteristics (types of fathers, mean age, variables related to the fathers, and measurements). A total of 290 studies were identified after screening titles and abstracts, and 32 full-text articles were retrieved for eligibility. Finally, 15 articles were included in the review. Four themes were derived after review: paternal stress, paternal attachment, fathers' adaptation, and fathers' support needs. Infants' hospitalization in NICUs causes stress for fathers but they overcome difficulties and play multiple roles as guardians, caregivers, and decision-makers of their spouses and infants over time. Paternal attachment increases significantly after participating in tactile and educational interventions. Fathers rely on nurses and they want to receive support from nurses. It is necessary for NICU nurses to understand and support fathers whose infants are hospitalized in NICUs. Medical institutions should provide nursing interventions and education for fathers to relieve their stress, help their adaptation, and improve attachment. • When infants were hospitalized in the NICU, fathers experienced a high level of stress. • Fathers have difficulty forming attachments and showed low attachment in visual perception to their infants. • Fathers in this study felt a role burden as they were given multiple new roles when their infants were hospitalized in NICU. • Fathers recognized NICU nurses as their supporters. [ABSTRACT FROM AUTHOR]

Children born preterm are at risk of developing neurodevelopmental, cognitive and mental health needs. There is an inverse correlation between gestational age and those needs. Difficulties with communication and language, executive function, learning, coordination, behaviour, and mental health tend to become more obvious as the social and academic demand increases in later childhood. By school age, children born preterm without severe neurodisability have often been discharged from neonatal follow-up programmes and opportunities for early recognition are missed. Long term follow-up with enhanced developmental surveillance as well as raising awareness of the consequences of prematurity in school are essential in identifying the needs of children born preterm, so that timely interventions can be implemented. In this article, we draw attention to the school-age developmental needs of children born preterm and the implications for clinical care for this population. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate gestational age (GA) and small-for-gestational age (SGA) as continuums and gender on the incidences of autism spectrum disorder (ASD) and co-occurring intellectual disability (ID).Methods: This is a population-based cohort study using the 2004-2008 Taiwan Maternal and Child Health Database. The diagnosis of ASD was determined by International Classification of Diseases, 9th Revision (ICD-9). Generalized estimating equations models were fit to evaluate associations between perinatal variables and ASD.Results: This study included 916,315 individuals. A total of 9474 (1.0%) children were diagnosed with ASD, among whom 1594 (16.8%) had co-occurring ID. Lower GA carried higher odds of ASD with ID (GA < 28 weeks, aOR: 4.26, 95% CI: 2.13, 8.50; GA 28-30 weeks, aOR: 2.80, 95% CI: 1.57, 4.97; GA 31-33 weeks, aOR: 1.63, 95% CI: 1.05, 2.55; GA 34-36 weeks, aOR: 1.39, 95% CI: 1.16, 1.67) and ASD without ID (GA < 28 weeks, aOR:2.05, 95% CI: 1.25, 3.36; GA 28-30 weeks, aOR: 2.02, 95% CI: 1.46, 2.79; GA 31-33 weeks, aOR: 1.42, 95% CI: 1.13, 1.77; GA 34-36 weeks, aOR: 1.18, 95% CI: 1.08, 1.29). Male preterm infants had ASD risks negatively correlated to GA, while ASD risks were significantly increased only among female infants born late preterm. The degree of SGA showed a stepwise increased risk for ASD with and without ID in both male and female infants.Conclusion: Lower GA and the degree of SGA are both associated with ASD susceptibility, either with or without co-occurring ID, and remarkably increased the risk of ID. [ABSTRACT FROM AUTHOR]

Background: As compared to full-term infants (39-41 weeks of gestation), early-term infants (37-38 wk) are at increased risk of adverse outcomes, including shorter exclusive breastfeeding (EB) duration and continued breastfeeding. Objectives: To compare early-term with full- and late-term infants regarding the prevalence of EB at 3 mo and any breastfeeding at 12 mo. Methods: Data sets from two population-based birth cohorts conducted in the city of Pelotas, Brazil, were combined. Only term infants (37 0/7 through 41 6/7 weeks of gestation) were included in the analyses. Early-term infants (37 0/7 through 38 6/7 wk) were compared to the remaining term infants (39 0/7 through 41 6/7 wk). Information on breastfeeding was gathered through maternal interviews at the 3-mo and 12-mo follow-ups. The prevalence of EB at 3 mo and any breastfeeding at 12 mo with 95% CIs were calculated. Crude and adjusted prevalence ratios (PRs) were obtained through Poisson regression. Results: A total of 6395 infants with information on gestational age and EB at 3 mo and 6401 infants with information on gestational age and any breastfeeding at 12 mo were analyzed. There was no difference between early-term infants and the remaining term infants regarding the prevalence of EB at 3 mo (29.2% and 27.9%, respectively) (P = 0.248). Prevalence of any breastfeeding at 12 mo was lower in early-term infants than among those born between 39 0/7 and 41 6/7 weeks of gestation (38.2% compared with 42.4%) (P = 0.001). In the adjusted analysis, the PR for any breastfeeding at 12 mo was 15% lower in the early-term group than in the remaining term infants (PR = 0.85; 95% CI: 0.76-0.95) (P = 0.004). Conclusions: The prevalence of EB at 3 mo was similar among term infants. Nonetheless, in comparison with the remaining infants born at term, early-term infants were at increased risk of having been weaned before reaching 12 mo of age. Curr Dev Nutr 2023;xx:xx. [ABSTRACT FROM AUTHOR]

Mothers of premature infants are in the risk group for having psychological symptoms and attachment-interaction difficulties. Preventing these maternal risks is essential for providing optimal care and health opportunities for infants, consequently improving developmental outcomes. In this study, we aimed to understand how mothers experienced prematurity within four processes retrospectively: (a) the mother's hospitalization after birth, (b) the infant's hospitalization in the Neonatal Intensive Care Unit (NICU), (c) after discharge, and (d) in early childhood. We adopted Max van Manen's phenomenology of practice and interviewed nine mothers whose children were born premature and reached early childhood. The themes were as follows: (a) incomplete mother ; (b) facing prematurity, uncertainty, natural touch barrier, facing reductive social response, and NICU friendship; (c) being on the alert, a period of complete closure, and fighting with the reductive social response; (d) association to prematurity and (cannot) overcome the difficulties. We expressed the mothers' overall experiences through the metaphor " living with a birthmark." This metaphor represents the longitudinal effects of prematurity. As much as it is apparent and painful at first, it fades over time, and the pain lessens, but the effects of the birthmark remain in early childhood. The birthmark becomes a part of the mother-baby relationship. Our study contributes to premature infant care and health literature by highlighting the longitudinal experiences of mothers on prematurity. • When mothers cannot get appropriate support cumulatively, prematurity might occur as a traumatic experience longitudinally. • The most intense process for mothers is the infant's hospitalization in the NICU. • Premature infants' mothers should be supported longitudinally starting from the NICU process towards early childhood. • Fathers, other premature infants' mothers, and close family members should be considered in support practices. • Comprehensive early intervention practices are essential to benefit mothers' and their infants' well-being. [ABSTRACT FROM AUTHOR]

Les infections sont une pathologie fréquente de la période néonatale, touchant entre 1 et 5 % des nouveau-nés. La mortalité de ces infections néonatales reste préoccupante malgré les progrès en néonatologie. Les conséquences des infections sont possibles à court terme mais aussi à long terme, avec notamment des troubles du neurodéveloppement. Les caractéristiques et les conséquences des infections néonatales varient selon leur caractère précoce (dans les 3 premiers jours de vie) ou tardif (entre le 3e et le 28e jour de vie) et selon le terrain sur lequel elles surviennent (nouveau-né à terme ou prématuré notamment). Le diagnostic des infections néonatales est difficile en raison des signes cliniques aspécifiques. L'identification d'une bactérie dans le sang ou le liquide cérébrospinal permet d'affirmer le diagnostic. Les infections néonatales bactériennes précoces sont majoritairement liées au streptocoque du groupe B et à Escherichia coli. Les infections néonatales bactériennes tardives sont à distinguer selon deux cadres nosologiques : les infections communautaires et les infections associées aux soins, fréquentes chez les nouveau-nés prématurés. [ABSTRACT FROM AUTHOR]

Objectives: To identify short-term repeatability of forced oscillation technique (FOT) measurement of lung function, assess the lung function response to bronchodilators (BDs) by FOT, and prove the concept that only some very preterm infants manifest a change in lung mechanics in response to BD.Study Design: We retrospectively analyzed respiratory system resistance and respiratory system reactance measured by FOT (Fabian HFOi). The measurement short-term repeatability was assessed in 43 patients on 60 occasions; BD responsiveness was assessed using a different data set, including 38 measurements in 18 infants. The coefficient of repeatability was calculated as twice the SD of differences between measurements performed 15 minutes apart. We assessed BD responsiveness by measuring respiratory system resistance and respiratory system reactance before and 15 minutes after administering 200 mcg/kg of nebulized salbutamol. A positive response was defined as an improvement in respiratory system resistance or respiratory system reactance greater than the identified coefficient of repeatability.Results: The coefficient of repeatability was 7.5 cmH2O∗s/L (21%) for respiratory system resistance and 6.3 cmH2O∗s/L (21%) for respiratory system reactance. On average, respiratory system resistance did not change significantly following BD administration, though respiratory system reactance increased significantly (from -32.0 [-50.2, -24.4] to -27.9 [-38.1, -22.0] cmH2O∗s/L, P < .001). Changes in respiratory system resistance or respiratory system reactance after BD were greater than the identified coefficient of repeatability in 8 infants (44%) on 13 (34%) occasions.Conclusions: We identified a threshold to assess BD responsiveness by FOT in preterm infants. We speculate that FOT could be used to assess and personalize treatment with BD. [ABSTRACT FROM AUTHOR]

South Asians account for around 25% of the global population and are the fastest-growing ethnicity in the US. This population has an increasing burden of atherosclerotic cardiovascular disease (ASCVD) which is also seen in the diaspora. Current risk prediction equations underestimate this risk and consider the South Asian ethnicity as a risk-enhancer among those with borderline-intermediate risk. In this review, we discuss why the South Asian population is at a higher risk of ASCVD and strategies to mitigate this increased risk. [ABSTRACT FROM AUTHOR]

Seizures are the most common sign of neurologic dysfunction, reflecting a wide variety of central nervous system disorders. A retrospective cross-sectional study of neonates with a clinical diagnosis of seizures was conducted in order to verify relationships between clinical aspects and EEG findings. Patients were divided into 3 groups according to the EEG recording available as: 1) with confirmatory ictal EEG; 2) with altered but non-ictal EEG; and 3) without any EEG recording. Variables related to pregnancy and birth history, neonatal complications, and seizure semiology (by video or clinical description) were compared to EEG findings. 97 neonates were included (39.1% preterm, 54.6% male), 71 with available EEG data (56.3% with ictal EEG). The group without EEG presented clinical characteristics significantly different from the others such as extreme prematurity, low birth weight, and higher neonatal mortality (P = 0.002, 0.001, and 0.003, respectively). The most common etiology was hypoxic-ischemic encephalopathy (HIE) (46.4%) followed by vascular disorders, which predominated in extremely preterm neonates (P = 0.006). Sequential seizure was the most common type (44.6%) and was more frequently identified in term neonates (46%). In 51.2% of the ictal recordings the main finding was electrographic seizure without clinical manifestation. Discharge using antiseizure medication was higher among those with ictal or altered non-ictal EEG (P < 0.001). HIE is still a frequently etiology for neonatal seizures. Even if the patients in the sample were not under continuous EEG, the substantial proportion of electrographic seizures without clinical manifestations detected suggests the importance of continuous EEG monitoring in neonates at increased risk of seizures. [ABSTRACT FROM AUTHOR]

To evaluate the clinical outcomes of herniotomy in preterm infants undergoing early versus delayed repair, the risk factors for complications, and to identify best timing of surgery. Medline, Embase and Central databases were searched from inception until 25 Jan 2021 to identify publications comparing the timing of neonatal inguinal hernia repair between early intervention (before discharge from first hospitalization) and delayed (after first hospitalisation discharge) intervention. Inclusion criteria was preterm infants diagnosed with inguinal hernia during neonatal intensive care unit admission. Results were analyzed using fixed and random effects meta-analysis (RevManv5.4). Out of 721 articles found, six studies were included in the meta-analysis. Patients in the early group had lower odds of developing incarceration [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.34–0.55, I2 = 0%, p < 0.001]; but higher risk of post-operative respiratory complications (OR 4.36, 95% CI 2.13–8.94, I2 = 40%, p < 0.001). No significant differences were reported in recurrence rate (OR 3.10, 95% CI 0.90–10.64, I2 = 0%, p = 0.07) and surgical complication rate (OR 0.94, 95% CI 0.18–4.83, I2 = 0%, p = 0.94) between early and delayed groups. While early inguinal hernia repair in preterm infants reduces the risk of incarceration, it increases the risk of post-operative respiratory complications compared to delayed repair. Surgeons should discuss the risks and benefits of delaying inguinal hernia repair with the caregivers to make an informed decision best suited to the patient physiology and circumstances. Treatment study, level 3. [ABSTRACT FROM AUTHOR]

Objectives: Since late preterm neonates are physiologically less mature than term neonates, the use of antenatal corticosteroids in the late preterm period has been recommended. The use of tocolytics can also be considered to gain valuable time for using antenatal corticosteroids in the late preterm period. In this study, we examined the efficacy of tocolytics on prolonging pregnancy in the late preterm period, by comparing women who received tocolytics with those who received none.Study Design: This retrospective cohort study included women who were admitted due to preterm labor after 34 weeks of gestation and delivered in the late preterm period. Primary outcome was time from admission to delivery (days). Secondary outcomes were the proportion of preterm births within 2 days, and within 7 days, completed cycles of antenatal corticosteroids, and the neonatal outcomes. Primary and secondary outcomes were compared according to the use of tocolytics. Propensity score matching was performed to create comparable groups. The maternal age, pre-pregnancy body mass index, nulliparity, history of preterm birth, hypertensive disease during pregnancy, gestational diabetes mellitus, history of preterm labor, gestational age at admission, cervical length, and the number of contractions were the baseline characteristics included in the propensity score.Results: Of 275 women, 44 women received tocolytics (tocolytics group) and 231 women did not (no tocolytics group). We matched 44 women who received tocolytics and 44 women who didn't. The tocolytics group was shown to exhibit a longer time from admission to delivery than the no tocolytics group, with a hazard ratio for tocolytics of 0.4 (95 % confidence interval, 0.2-0.6). In addition, the proportion of preterm births occurring within 2 days and 7 days were lower in those receiving tocolytics compared to those that didn't.Conclusion: In this propensity score matched-study, the use of tocolytics had a significant effect on pregnancy prolongation, which allows more time for use of corticosteroids in women with preterm labor after 34 weeks of gestation. [ABSTRACT FROM AUTHOR]

Transcutaneous bilirubin (TCB) monitoring is widely used for jaundice screening in the newborn period. Limited data exists on adjusting TCB for bias in late preterm infants. The objective of this study was to determine the median bias between transcutaneous bilirubin and total serum bilirubin levels in newborns born at 35–36 weeks' gestation. This was a retrospective cohort study of late preterm infants born at 35–0/7 to 36–6/7 weeks' gestation who were admitted to a level III neonatal intensive care unit from May 2018 to February 2020. Transcutaneous and total serum bilirubin levels were assessed within 2 h of each other during the first 60 h of life. Bland–Altman plots were used to evaluate transcutaneous bilirubin bias. Bilirubin risk stratification based on age (in hours) was done using an adaptation of the Bhutani nomogram for transcutaneous, adjusted transcutaneous, and total serum bilirubin measurements. The median bias between transcutaneous and total serum bilirubin bias was 2.4 mg/dL (IQR 1.7–3.4, 95% CI 2.2–2.7). The kappa statistic demonstrated slight agreement between the unadjusted transcutaneous bilirubin and total serum bilirubin (k = 0.033, p = 0.194. The kappa statistic demonstrated fair agreement between an adjusted transcutaneous bilirubin (subtract 1 mg/dL) and total serum bilirubin (k = 0.298, p < 0.0001) and moderate agreement between another adjusted transcutaneous bilirubin (subtract 2 mg/dL) and total serum bilirubin (k = 0.430, p < 0.0001). In a single center study of late preterm infants, transcutaneous bilirubin systematically overestimated the total serum bilirubin level. Subtracting 1 mg/dL from the transcutaneous bilirubin identified infants with total serum bilirubin levels in the high or high intermediate risk range. Adjusting the transcutaneous bilirubin prior to risk stratification may reduce unnecessary blood draws for total serum bilirubin. Studies of racially and ethnically diverse newborns using various transcutaneous bilirubin meters are needed prior to broad application of the adjusted transcutaneous bilirubin approach. [ABSTRACT FROM AUTHOR]

Objective: Very preterm born children are at risk for impairments in multiple neurodevelopmental domains, but outcomes vary between individuals. The present study aimed to distinguish subgroups with distinct profiles of functioning across motor, cognitive, behavioral, and psychosocial domains. These profiles were related to neonatal and social/environmental factors.Method: The sample included 1977 children born very preterm (<32 weeks' gestation) in 2011 from the French population-based EPIPAGE-2 cohort. Using latent profile analysis, subgroups of children were distinguished based on their functioning at 5.5 years. The relation between outcome profiles and neonatal and social/environmental factors was tested using multivariable multinomial logistic regression analysis.Results: Four subgroups with distinct outcome profiles were distinguished: no deficit in any domain (45%); motor and cognitive deficits without behavioral/psychosocial deficits (31%); primarily behavioral and psychosocial deficits (16%); and deficits in multiple domains (8%). Male sex (odds ratio [OR] = 2.1-2.7), bronchopulmonary dysplasia (OR = 2.1-2.8), low parental education level (OR = 1.8-2.1), and parental non-European immigrant status (OR = 2.3-3.0) were independently associated with higher odds for all suboptimal outcome profiles compared to the favorable outcome profile.Conclusion: Among 5.5-year-old very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits. This information is important for the development of interventions that are tailored to the needs of large subgroups of children across multiple domains of functioning. General neonatal and social/environmental factors may be useful for early identification of very preterm born children at risk for general rather than domain-specific impairments. [ABSTRACT FROM AUTHOR]

Early-onset neonatal sepsis (EOS) is difficult to diagnose clinically because the semiology of premature newborns is poor during the first days of life. This study aimed to identify predictive factors of EOS in neonates less than 37 weeks' gestational age in neonatal care at Louis Mourier Hospital, France. This was a case–control study of all newborns less than 37 weeks of gestational age diagnosed and managed for EOS from January 1 to December 31, 2019. The main parameters studied were demographic characteristics, risk factors, laboratory, and bacteriological characteristics. At the benchmarking level, the statistical tests used were the McNemar test for qualitative variables and the paired Student's t -test for quantitative variables. A total of 50 mother–child pairs were included in this study (25 cases and 25 matched controls). The results showed a statistically significant relationship between the birth of a child with EOS and between a premature rupture of membranes of > 18 h (68% of cases vs. 36% of controls; p = 0.042); a positive culture of the placenta (p = 0.0002); C-reactive protein levels of > 6 mg/L (88% of cases vs. 20% of controls; p = 0.001); a procalcitonin level of > 0.6 ng/mL (72% of cases vs. 16% of controls; p = 0.001). Gram-negative bacteria including Escherichia coli (44.5%) and Haemophilus influenzae (14.8%) were the most common pathogens found. The search for risk factors must be systematic and the clinic must remain at the center of the diagnostic approach. [ABSTRACT FROM AUTHOR]

Preterm birth is one of the most frequent complications of pregnancy in women with systemic lupus erythematosus. The high indicated preterm birth proportion due to hypertensive disorders of pregnancy and/or fetal growth restriction is well known, and preventive measures and screening for early detection are performed. The risk of spontaneous preterm birth is less well recognized. This study aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus. A systematic literature search using Pubmed, Embase, Web of Science, and Google Scholar was performed in June 2021. Studies in pregnant women with systemic lupus erythematosus reporting spontaneous and indicated preterm birth rates were selected. Original research articles published from 1995 to June 2021 were included. Quality and risk of bias of the included studies were assessed using the Newcastle–Ottawa quality assessment scale. To estimate the pooled event rates and 95% confidence intervals, meta-analysis of single proportions with a random-effects model was performed. We included 21 articles, containing data of 8157 pregnancies in women with systemic lupus erythematosus. On average, 31% (95% prediction interval, 0.14–0.50) of the pregnancies resulted in preterm birth, including 14% (95% prediction interval, 0.04–0.27) spontaneous and 16% (95% prediction interval, 0.03–0.35) indicated preterm birth. In pregnant women with systemic lupus erythematosus, spontaneous and indicated preterm birth proportions are high. This information should be applied in (prepregnancy) counseling and management in pregnancy. The knowledge obtained by this meta-analysis paves the way for further research of associated risk factors and development of interventions to reduce spontaneous preterm birth in systemic lupus erythematosus pregnancies. [Display omitted] [ABSTRACT FROM AUTHOR]

To measure the effects kangaroo mother care (KMC) on the regional cerebral oxygen saturation (rSO 2) measured with near-infrared spectroscopy (NIRS) in premature infants and to study the physiological stability and comfort of the infants during such interventions. This was a prospective, single-centered, single-blind, 2-arm, parallel-group randomized controlled trial conducted. The study was carried out in a tertiary neonatal intensive care unit in Medical Faculty Hospital in Konya/Turkey. Premature infants born between 24 and 36+6 weeks. Participants were randomly assigned to one of two groups: kangaroo care (n = 20) and control groups (n = 20). The rSO 2 , oxygen saturation (%SpO 2), heart rate (HR), respiratory rate, body temperature, and comfort levels of the infants were evaluated in three stages. In the 60th min measurement of the intervention group, rSO 2 , body temperature, heart rate, respiratory rate, and, comfort level, the comfort level was found to be higher and significant in the 30th and 60th min measurements (p < 0.001). In the intervention group, the rSO 2 (p < 0.001), body temperature (p < 0.001), HR (p < 0.001), SpO 2 (p < 0.001), respiratory rate (p < 0.001), and comfort levels (p < 0.001) scores with the control group and the group × time interaction was significant. KMC moderately increased the rSO 2 levels and also created a moderate effect size on the physiological parameters and comfort levels of the newborns, which implicates its short-term benefits for premature infants. KMC may be beneficial in stabilizing rSO 2 and physiological parameters and increasing comfort in premature infants. The trial was registered in ClinicalTrials.gov (identifier: NCT04725435). [ABSTRACT FROM AUTHOR]

L'entérocolite ulcéro-nécrosante (ECUN) est la plus fréquente des urgences digestives touchant principalement les prématurés. Localement n'ayant aucune étude, il convenait de mener une étude dont l'objectif était de déterminer les facteurs de risque de l'ECUN dans un pays aux ressources limitées. Étude rétrospective cas témoins réalisée à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé de janvier 2013 à décembre 2018 visant les prématurés ayant une ECUN pendant leur hospitalisation appariés à deux témoins également hospitalisés. Parmi les 2181 admissions, nous retrouvions 35 cas d'ECUN appariés à 70 témoins donnant une prévalence de 1,6 % avec une mortalité de 79,4 %. L'âge moyen de survenue était de 7,7 ± 5,9 jours, 62 % des cas était au stade II, 38 % au stade III. Les principaux signes cliniques étaient l'hypotonie (74,3 %), l'instabilité thermique (45,7 %), la distension abdominale (100 %), les résidus gastriques (94,2 %), les rectorragies (40 %), les vomissements (31,4 %). Les facteurs associés retrouvés étaient : l'âge maternel ≤ 20 ans, paludisme sur grossesse, le transfert postnatal, l'alimentation avec substitut de lait maternel, l'ictère, l'anémie, la transfusion sanguine, le sepsis, et la réanimation néonatale ; Ces deux derniers étaient des facteurs indépendants. Comme facteurs protecteurs, nous avions le début de l'alimentation dans les premières 48 heures de vie avec du lait maternel. Dans notre contexte, l'ECUN pourrait être prévenu en agissant d'une part sur les complications de la prématurité et le bon suivi de grossesse et d'autre part en privilégiant une alimentation précoce et au lait de mère. Necrotizing enterocolitis is the most common digestive emergency affecting mainly preterm infants. As no local studies were available, a study was needed to determine the risk factors for ECUN in a country with limited resources. Retrospective case-control study carried out at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital from January 2013 to December 2018 targeting premature infants with ECUN during their hospitalization matched with two controls also hospitalized. Among the 2181 admissions, we found 35 cases of ECUN matched to 70 controls giving a prevalence of 1.6% with a mortality of 79.4%. The mean age of onset was 7.7 ± 5.9 days, 62% of cases were stage II, 38% stage III. The main clinical signs were hypotonia (74.3%), thermal instability (45.7%), abdominal distension (100%), gastric residue (94.2%), rectorrhagia (40%), vomiting (31.4%). The associated factors found were maternal age ≤ 20 years, malaria in pregnancy, postnatal transfer, feeding with breast milk substitute, jaundice, anemia, blood transfusion, sepsis, and neonatal resuscitation; these last two were independent factors. As protective factors, we had the start of feeding in the first 48 hours of life with breast milk. In our context, ECUN could be prevented by acting on the one hand on the complications of prematurity and good pregnancy follow-up and on the other hand by favoring early feeding with mother's milk. [ABSTRACT FROM AUTHOR]

• PCV7/13 introduction reduced alveolar pneumonia (CAAP) in young children in Israel. • The extent of the decline in children born prematurely in unknown. • PCV7/PCV13 impacted CAAP rates in both term and preterm children. • Pre-PCV in Israel, CAAP rates in preterm children was higher than in term children. • Post PCV7/13 CAAP rates in term and preterm children were similar, closing gaps. Preterm-born children are prone to respiratory infections and complications during infancy and early childhood. In Israel, pneumococcal conjugated vaccines (PCVs) were introduced in 2009–2010, with high vaccination coverage. We assessed the impact of PCV implementation on community-acquired alveolar pneumonia (CAAP) in children < 2 years old born prematurely, in comparison with term born infants. We conducted a prospective, active, population-based surveillance of children < 2 years old with radiologically-proven CAAP, visiting the only regional medical center. CAAP incidence in the pre-PCV and post-PCV eras were compared in early premature (29–32 weeks gestational age [WGA]), late premature (33–36 WGA) and term-born infants (>36 WGA). Of 214,947 births during the study period, 6'791 CAAP episodes were diagnosed; 211, 653 and 5,806 were in early premature, late premature and term infants, respectively. After PCV implementation, overall CAAP visits were reduced by 44% (95% CI 36–51): 60%, 21% and 45% among those born early preterm, late preterm and at term, respectively (statistically significant for children born early preterm and at term). For outpatients, the respective rate reductions were 79%, 40% and 65% (statistically significant for the children born at term). Importantly, the mean annual rates in the post-PCV period became similar in all 3 groups. The rate reductions among the hospitalized children were lower those that among the non-hospitalized children, with reductions of 56%, 16% and 33% for the three groups, respectively (statistically significant for early preterm and at term children). CAAP reduction trends after PCV implementation for preterm-born infants were similar to those for term-born infants. Whether this was because of similar direct PCV- protection, because of indirect (herd) protection or both, is unclear. Post-PCV implementation, the gaps in CAAP rates between infants born prematurely and at term were reduced. [ABSTRACT FROM AUTHOR]

Objectives: Psychosocial and educational interventions based on standardized needs assessment can help alleviate distress among parents of premature infants. This study aims to (1) provide an overview of standardized instruments used to assess parental needs in neonatal intensive care units (NICUs) and (2) discuss their potential to facilitate the provision of appropriate support to parents of premature babies.Methods: A systematic literature review was conducted. PubMed, CiNAHL, PsychARTICLES, PsychINFO, and Medline were searched for studies reporting on the use of validated parental needs assessment instruments in the NICU.Results: Following the analysis of 33 publications, 6 instruments designed to assess the needs of premature infants' parents were identified. Based on their good psychometric properties and practicality, the NICU Family Needs Inventory, the Critical Care Maternal Needs Inventory, and the Nurse Parent Support Tool were considered particularly relevant for use in clinical and research settings.Conclusions: Validated parent needs assessment instruments are available for use in the NICU setting. Further research evaluating the benefits and usability of standardized parental needs assessment in the NICU is needed.Practice Implications: Validated needs assessment instruments should be consistently used to facilitate the development of targeted psychosocial and educational interventions for parents in the NICU. [ABSTRACT FROM AUTHOR]

Background: Preterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm. Methods: Eleven young adults and 17 adolescents born preterm (< 32 weeks of gestation and < 1500 g birth weight) were compared to 11 young adult and 18 adolescent age-matched controls born at term. Stroke volume, cardiac output, and flow in the main pulmonary artery were quantified with 4D flow CMR. Kinetic energy and vorticity were measured in the right ventricle. All parameters were measured at rest and during exercise at a power corresponding to 70% VO2max for each subject. Multivariate linear regression was used to perform age-adjusted term-preterm comparisons. Results: With exercise, stroke volume increased 10 ± 21% in term controls and decreased 4 ± 18% in preterm born subjects (p = 0.007). This resulted in significantly reduced capacity to increase cardiac output in response to exercise stress for the preterm group (58 ± 26% increase in controls, 36 ± 27% increase in preterm, p = 0.004). Elevated kinetic energy (KEterm = 71 ± 22 nJ, KEpreterm = 87 ± 38 nJ, p = 0.03) and vorticity (ωterm = 79 ± 16 s−1, ωpreterm = 94 ± 32 s−1, p = 0.01) during diastole in the right ventricle (RV) suggested altered RV flow dynamics in the preterm subjects. Streamline visualizations showed altered structure to the diastolic filling vortices in those born preterm. Conclusions: For the participants examined here, preterm birth appeared to result in altered right-heart flow dynamics as early as adolescence, especially during diastole. Future studies should evaluate whether the altered dynamics identified here evolves into cardiopulmonary disease later in life. Trial registration None [ABSTRACT FROM AUTHOR]

Postnatal metabolism depends on maturation of key metabolic pathways around birth. In this regard, endogenous glucose production is impaired in calves born preterm. Concerning protein metabolism, the rates of protein turnover are greater during the neonatal period than at any other period of postnatal life. The mammalian target of rapamycin (mTOR) and the ubiquitin-proteasome system (UPS) are considered as the major regulators of cellular protein turnover. The objectives of this study were to investigate (1) the changes in plasma AA profiles, (2) the mRNA abundance of mTOR signaling and UPS-related genes in skeletal muscle, and (3) the mRNA abundance of branched-chain AA (BCAA) catabolic enzymes in skeletal muscle and adipose tissue in neonatal calves with different degree of maturation during the transition to extrauterine life. Calves (n = 7/treatment) were born either preterm (PT; delivered by cesarean section 9 d before term) or at term (T; spontaneous vaginal delivery) and were left unfed for 1 d. Calves in treatment TC were also spontaneously born but were fed colostrum and transition milk for 4 d. Blood samples were collected from all calves at birth and at 24 h of life. Additional blood samples were taken 2 h after feeding (26 h of life) for PT and T calves, and on d 4 of life for TC, to determine plasma glucose, urea, and AA. Tissue samples from 3 muscles [M. longissimus dorsi (MLD), M. semitendinosus (MST), and M. masseter (MM)], and kidney fat were collected following euthanasia at 26 h after birth (PT, T) or on d 4 of life (TC) at 2 h after feeding. The concentrations of the majority of plasma AA (Ala, Gln, Asn, Cit, Lys, Orn, Thr, and Tyr), nonessential AA, and total AA were greater during the first 24 h and also before and 2 h after feeding in PT than in T. The ratio of plasma BCAA to the aromatic AA (Tyr and Phe) was greatest in TC, followed by T, and least in PT. The mRNA abundance of mTOR and ribosomal protein S6 kinase 1 (S6K1) in MLD and MM was greater in PT and T than in TC. The mRNA abundance of muscle-specific ligases FBXO32 (F-box only protein 32) in the 3 different skeletal muscles and TRIM63 (tripartite motif containing 63) in MLD was greater in PT and T than in TC; in MM, TRIM63 mRNA was greatest in PT. The mRNA for BCKDHA and BCKDHB (the α and β polypeptide of branched-chain α-keto acid dehydrogenase) in kidney fat was elevated in PT and T compared with TC, suggesting a possible enhancement of BCAA oxidation as energy source to cover the energetic and nutritional postnatal demands in PT and T in a starved state. The increased abundances of mTOR-associated signaling factors and muscle-specific ligase mRNA indicate a greater rate of protein turnover in muscles of PT and T in a starved state. Elevated plasma concentrations of several AA may result from enhanced muscle proteolysis and impaired conversion to glucose in the liver of PT calves. [ABSTRACT FROM AUTHOR]

Prolonged monitoring of cardiac rhythm has been used to screen for subclinical atrial fibrillation (AF); little is known about other arrhythmias in the general population, especially in the elderly, who are at higher risk of arrhythmias. We evaluated the frequency of arrhythmias in the tri-ethnic (white, Black, Hispanic), community-based Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study using a patch-based recorder for up to 14 days in 527 participants free of AF, congestive heart failure (CHF) or history of stroke. Differences according to gender, age, ethnicity and presence of hypertension, diabetes and pertinent ECG and echocardiographic variables were examined. Mean age was 77.2 ± 6.8 years (37.2% men, 62.8% women). AF was present in 10 participants (1.9%), only 2 of them symptomatic. Supraventricular tachycardia (SVT) and ventricular tachycardia (VT) episodes were observed in 84.4% and 25.0% but only 13.5% and 10.6% of participants reported symptoms, respectively. Severe bradycardia (<40 bpm) was present in 12.5%. Sinus pauses and high-degree atrioventricular blocks were infrequent (2.1% and 1.5%, respectively). Most arrhythmias were more frequent in participants > 75 years; ventricular arrhythmias and severe bradycardia were more common in men. Whites had significantly more episodes of AF than Hispanics, SVT than Blacks and VT ≥ 10 beats than Hispanics and Blacks. Hypertensives had more episodes of severe bradycardia. LV hypertrophy or LVEF <55% were associated with more frequent ventricular and supraventricular arrhythmias. Prolonged cardiac rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing arrhythmias. Ventricular arrhythmias were relatively frequent, whereas severe bradyarrhythmias were infrequent. • Older adults free of AF, stroke or HF completed 14-days of cardiac monitoring. • AF was present in 1.9%, of whom only 30% had symptoms. • AF-predisposing arrhythmias were frequent, 25% had ventricular arrhythmias. • Age, gender, ethnicity differences exist. • Prolonged monitoring identifies subgroups that benefit from additional monitoring. [ABSTRACT FROM AUTHOR]

The composition and enzymology of human milk changes throughout the lactation period, and differ for mothers who give birth prematurely compared to those who deliver at full-term. Understanding the composition of milk from mothers of very low birth weight premature infants is of great significance, and the objective of this study was to evaluate the composition, protein profile and plasmin activity of milk from mothers who delivered infants at different gestational ages. Samples of human milk were donated by women (n = 74) in the Cork, Ireland, area who gave birth to full-term (>37 weeks gestation, FT), pre-term (32–37 weeks, PT) and very pre-term (≤32 weeks, VPT) infants. FT milk was collected at 1, 3, 6 and 10 weeks post-partum (PP), while PT and VPT milk was collected weekly until the FT due date of the infant and subsequently followed the FT protocol. Gestational age did not significantly affect lactose or fat content or total energy content of milk. However, protein content, and levels of some individual proteins, were significantly affected by both gestational age at birth and duration of lactation, with significantly higher protein levels in PT or VPT milk samples at 0–7 days and 1–2 months, respectively. Plasmin activity was significantly higher in VPT milk, indicating differences in proteolytic processing in milk. Compositional differences between the milk of mothers of term and pre-term infants were greatest in terms of the protein profile, which showed both qualitative and quantitative differences, as well as difference in proteolytic activity. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair (IHR) is a common operation in preterm and term infants. Recently, spinal anesthesia (SA) has been proposed as an alternative to avoid exposure to general anesthesia (GA) during early life. The aim of this study was to compare surgical outcomes of open IHR performed under SA versus GA in neonates and infants, and to detect criteria to predict the success or failure of SA. This is a 6-year, single center, nonrandomized interventional study (2013–2019). SA was performed with 0.5% bupivacaine. GA was given using propofol, fentanyl, sevoflurane, and laryngeal mask. Patient demographics, operative time, intraoperative events related to surgery or anesthesia, and complications were analyzed at short and long-term follow-up. 68 infants (78 IHR) and 37 infants (44 IHR) received SA and GA at the discretion of the anesthesiologist, respectively. SA failure rate was 9%, and positively correlated with weight at surgery (p = 0.001; r p = 0.38). Conversion from SA to GA occurred in 4 (6%) patients owing to prolonged operative time (43.75 ± 4.8 vs 23.02 ± 11.3 min; p = 0.0006). There were no differences regarding operative time and intra- and postoperative complications among the two groups at mean follow-up of 18.53 ± 21.9 months. This pilot study confirms that SA is safe, effective and not detrimental to surgical outcome of neonates and infants undergoing IHR. Additionally, it may help further define what patients may have a successful SA. Our experience suggests that SA is especially suitable in infants weighing < 4000 g, and conversion to GA correlates with prolonged operative time. Level II. [ABSTRACT FROM AUTHOR]

Preterm infants are at risk of developing both intraventricular hemorrhage (IVH) and anemia of prematurity. Several studies reported an association between early postnatal red blood cell (RBC) transfusion and IVH, however the timing and causality between these two remains unclear. To describe the temporal sequence between administration of early RBC transfusion (within the first week of life) and diagnosis of IVH in very preterm infants. Retrospective single center case-series. 132 very preterm infants (<32 weeks' gestation), admitted to a level III neonatal intensive care unit, studied with serial cranial ultrasound (CUS), and diagnosed with any grade of IVH. Number and timing of early RBC transfusions in relation to the timing of IVH. Median time of IVH diagnosis was 20.5 h after birth (interquartile range [IQR], 6.25–49.00 h). Of those who received an early RBC transfusion (36 %, 47/132), only 15 % (20/132) received it before the IVH diagnosis. Infants with RBC transfusion before IVH more frequently had lower birth weight, received less fequently antenatal steroids, required more often invasive mechanical ventilation and surfactant administration, had more often hypo- and hypercapnia, and received more fluid boluses, NaHCO3, and inotropes compared to the rest. In the majority of infants, IVH was already present at the time of the first RBC transfusion. Studies including pre- and post RBC transfusion CUS are needed to assess the effect of early RBC transfusions on the development of IVH in preterm neonates. • An association between RBC transfusion and preterm IVH was reported previously. • With serial CUS we show that IVH was often already present before the transfusion. • Infants with transfusion before IVH diagnosis often had additional risk factors. • Therefore, the causal relation between RBC transfusion and IVH remains unclear. [ABSTRACT FROM AUTHOR]

Background: Women with threatened preterm labor (TPTL) resting at home face several life challenges, but their psychological well-being has been ignored. This study aimed to explore the status and related factors of the psychological status of women with TPTL resting at home, and to compare the psychological status differences between TPTL and healthy pregnant women.Methods: A cross-sectional, multiple time-point study was conducted to repeatedly assess depression, perceived stress, and distress in 49 TPTL women and 62 healthy pregnant women during pregnancy in Taiwan. Mann-Whitney U tests were used to compare the psychological status differences between these women and the generalized estimating equation was used to identify the factors related to their psychological status.Results: The TPTL women's perceived stress at 24-27 weeks (p=0.047) and 32-35 weeks (p=0.04) and distress at each time point was significantly greater than that of healthy pregnant women (p<0.001). The common distress experienced by TPTL women was the inability to provide self-care and family care, the baby's health and safety, and to request leave from work for bed rest. Positive personalities, gestational age, preterm birth history, follow-up status and employment have been shown to be related to the psychological status of TPTL women.Limitations: The major limitation of this study is the small sample size.Conclusion: This study contributed to a better understanding of the emotional burdens of women with TPTL resting at home. Such findings highlight the need for constructing effective interventions to alleviate the psychological burden of these women. [ABSTRACT FROM AUTHOR]

Objective: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units.Study Design: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records.Results: There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation.Conclusions: MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation. [ABSTRACT FROM AUTHOR]

Objectives: Sleep disorders are common problems among all age groups. If sleep problems detected in childhood are not resolved successfully, they become sleep disorders and a chronic state. In this study, we aimed to compare sleep problems between preterm-born and term-born preschool-age children.Methods: In the cross-sectional study, children were grouped according to whether they were born preterm or at term. The preterm group included 137 children aged four to six years. The control group comprised 145 age-matched term-born preschool children. The prenatal, natal, demographical, and clinical characteristics of preterm- and term-born preschool-age children were compared. The Children's Sleep Habits Questionnaire (CSHQ) was used to identify sleep problems. The total score and subscores of the CSHQ were compared between the groups.Results: The percentage of gastroesophageal reflux (GER) symptoms and obstructive sleep apnea (OSA) symptoms were significantly higher in the preterm group. According to the cutoff point of the CSHQ, 97 children in the preterm group (70.8%) and 88 children in the control group (60.7%) had a sleep disorder. The total score of the CSHQ was significantly higher in the preterm group compared with the control group; however, the scores of the subscales were similar between the groups. In the regression analysis, a significant association was found between being born preterm and having sleep disorder (β = 0.308, OR = 1.36, p = 0.04).Conclusions: Our study reported a high percentage of sleep problems in preterm-born preschool children. We suggest that prematurity is associated with sleep problems even if the etiology of sleep problems is heterogeneous. Symptoms regarding GER and OAS should be investigated, and precautions, such as prohibiting maternal cigarette smoking, should be taken in preterm infants. [ABSTRACT FROM AUTHOR]

La prématurité et le poids de naissance ne constituent pas des facteurs limitant au calendrier vaccinal. Les vaccins doivent être administrés selon l'âge chronologique et non selon l'âge corrigé de l'enfant. Les décrets de la pratique du BCG ne mentionnent pas la prématurité parmi les contre-indications. Il s'agit d'une étude rétrospective, auprès de 51 nouveau-nés prématurés vivants, menée au service de néonatologie et de réanimation néonatale, s'étalant sur une durée de 28 mois, allant du 01/2017 au 04/2019. Notre objectif est d'attirer l'attention sur les causes du retard de la vaccination chez les prématurés et de comparer nos données avec les résultats de la littérature. L'âge gestationnel moyen des nouveau-nés prématurés est de 33,4 SA. Le poids moyen était de 2 kg. L'âge moyen de la réalisation du 1er vaccin était de 62,56 jours. Les causes du retard de la vaccination reviennent, en premier lieu, au refus du personnel des centres de santé devant le faible poids de naissance, la fièvre et l'ictère néonatal ainsi que la longue durée d'hospitalisation et le manque d'éducation des parents. À travers cette étude, on constate que la vaccination des nouveau-nés prématurés est retardée par rapport au nouveau-né à terme, ce retard revient principalement à la réticence du personnel de soin vis-à-vis de la vaccination des prématurés et des faibles poids de naissance puis à la longue durée d'hospitalisation. Ceci constitue un problème majeur vu la fréquence élevée des infections chez cette population. De ce fait, il est nécessaire d'actualiser les connaissances chez le personnel soignant et d'établir des recommandations claires concernant la vaccination des nouveau-nés prématurés et de faible poids de naissance. Prematurity and birth weight are not limiting factors in the immunization schedule. Vaccines should be given according to chronological age and not according to the child's corrected age. The BCG practice decrees do not mention prematurity as a contraindication. This is a retrospective study of 51 live premature newborns hospitalized in the neonatology and neonatal resuscitation department, spanning 28 months from 01/2017 to 04/2019. Our aim is to draw attention to the causes of delayed vaccination in premature babies and to compare our results with those in the literature. The average gestational age of preterm infants is 33.4 weeks. The average weight was 2 kg. The average age of the first vaccine was 62.56 days. The main reasons for delayed vaccination are primarily due to the refusal of health center staff to deal with the low birth weight, fever and jaundice, as well as prolonged hospitalization and insufficient information given to parents. Through this study, it can be seen that the vaccination of premature newborns is delayed compared to the term newborn, the main reasons for delayed vaccination may include insufficient information given to parents as well as prolonged hospitalization. This is a major problem given the high frequency of infections in this population. As a result, there is a need to update knowledge among health care workers and to establish clear recommendations for the vaccination of premature and low birth weight infants. [ABSTRACT FROM AUTHOR]

• Nosocomial viral infections are frequently overlooked in neonatology units. • Nosocomial respiratory syncytial virus infection resulted in longer hospitalizations. • Health-care interventions increased in infants with nosocomial infection. • Hospital costs were higher in infants with respiratory syncytial virus infection. • Interventions to reduce nosocomial respiratory syncytial virus infections are needed. Nosocomial infections are a leading cause of morbidity, costs, and mortality in preterm newborns. Most reports regarding nosocomial infections in neonatal intensive care units (NICU) are focused on bacterial infections and there is limited information regarding the impact of nosocomial viruses. The objective of this study was to assess the impact of nosocomial respiratory syncytial virus (RSV) infections in a NICU. This was a retrospective cohort design from a NICU in a general hospital in Mexico. We included 24 newborn infants with nosocomial RSV infection and 24 infants without RSV matched by gestational age, birth weight, and the period of time of hospitalization. Infants with nosocomial RSV infection had longer hospitalization duration (median 24 days vs. 13 days; P =.05), increased antibiotic use (45.8% vs. 8.3%; P =.003), more mechanical ventilation requirement (54.2% vs. 0.4%; P <.001), more frequent nosocomial infections (45.8% vs. 0%; P <.001), and higher hospitalization direct costs (median 3,587.20 USD vs. 1,123.60 USD; P =.001) after nosocomial RSV detection. Nosocomial RSV infections are associated to a significant increase of costs in infants hospitalized in the NICU. Evaluation of interventions that may reduce the incidence of nosocomial RSV infections in this setting is warranted. [ABSTRACT FROM AUTHOR]

La détermination de l'âge gestationnel (AG) repose sur la date des dernières règles (DDR), l'échographie précoce avant 12e semaine d'aménorrhée, l'électroencéphalogramme (EEG) ou les scores cliniques morphologiques ou neuro-morphologiques. Ces scores sont importants dans les pays sous-développés où la DDR est très souvent méconnue par la mère, le suivi obstétrical et l'échographie précoce non faits. Ainsi, l'utilisation de score comme le FINNSTROM semblerait plus accessible pour les professionnels de santé exerçant en salle de naissance. L'objectif général était d'évaluer la pertinence de ce score pour déterminer l'AG. Il s'agit d'une étude multicentrique (Dakar et Ouagadougou) incluant les nouveau-nés de moins de 3 jours de vie issus d'une grossesse avec DDR connue et/ou échographie précoce réalisée. Le score a été réalisé par deux examinateurs différents à savoir un pédiatre et un étudiant en spécialisation en pédiatrie. En cas de discordance, un 3e examinateur intervenait. La pertinence du score a été évaluée en déterminant la corrélation avec l'échographie et la DDR par le calcul du coefficient de corrélation (r) significatif avec un p < 0,05. Notre étude a porté sur un total de 95 nouveau-nés dont 19 recrutés à Ouagadougou et 76 à Dakar. Nous avons trouvé une corrélation satisfaisante pour la DDR (r = 0,798 ; p < 0,001) et pour l'échographie de datation (r = 0,869 ; p < 0,001). Au terme de notre étude nous pouvons affirmer que le score de FINNSTRÖM est pertinent pour déterminer l'AG. Ainsi, nous recommandons son utilisation en l'absence d'EEG, d'échographie précoce ou de méconnaissance de la DDR au niveau des différentes structures sanitaires périphériques. The determination of gestational age (GA) is based on the date of the last menstrual period, the early ultrasound before the 12th week of amenorrhea, or the clinical morphological scores. These scores are important in underdeveloped countries where the date of the last menstrual period is very often unknown by the mother, obstetric follow-up and early ultrasound not done. Thus, the use of score like FINNSTROM would seem more accessible for medical and paramedical practitioners exercising in a birth room. The general objective was to assess the relevance of this score to determine GA. This is a multicenter study (Dakar and Ouagadougou) including newborns less than 3 days of life stemming from a pregnancy with known date of the last menstrual period and/or early echography performed. The score was made by two different examiners namely a pediatrician and a pediatric specialist student. In case of discrepancy, a third examiner intervened. The relevance of the score was assessed by determining the correlation with ultrasound and the date of the last menstrual period by calculating the significant correlation coefficient (r) with P < 0.05. Our study included a total of 95 newborns, 19 recruited from Ouagadougou and 76 from Dakar. We found a good correlation for the date of the last menstrual period (r = 0.798, P < 0.001) and for dating ultrasound (r = 0.869, P < 0.001). At the end of our study we can say that the FINNSTRÖM score is relevant for determining GA. Thus, we recommend it use in the absence of early ultrasound or lack of knowledge of the date of the last menstrual period at the different peripheral health structures. [ABSTRACT FROM AUTHOR]

The purpose of this article is to explain the impact of secondary musculoskeletal problems in cerebral palsy and the impact with growth on body posture and how postural care and use of sleep systems can help protect and preserve body shape. Successful postural care relies on a family's engagement of the programme. To engage them education staff and health care workers require the awareness of the impact of body shape distortion and the fact it can be reduced or avoided through good postural care. A failure to provide good postural care increases the risks of physical changes in the bones and muscles and joints, which can lead to severe issues on an individual's respiration, circulation and their digestion. This can lead to compromising the internal organs and has the potential to lead to premature death. It is important for everyone involved in the care of children with CP to have knowledge and understanding of the importance of postural care. The child needs a team around them empowering the family through education and support. All clinicians should be able to identify who will need it, know how they can refer on to access assessment of the child and training for the family and be aware off the postural care plan as it is developed to get the right equipment in place. The benefits of an improved posture can result in reduced muscle tone, increased comfort, improved functioning and participation, and better sleeping patterns. This leads to an improved quality of life for the child and the family. [ABSTRACT FROM AUTHOR]

Preterm children display only slightly lower exercise capacity than term children do during their development, despite their previous cardiopulmonary impairments. This raises doubts about the role of the respiratory muscles' influence on exercise capacity. This study aimed to compare respiratory muscle activity in preterm and term children using an exercise test. This cross-sectional study involved comparison of 35 term children and 39 matched preterm children aged 6–9 years, who were born prematurely with a birth weight <1500 g. An adapted treadmill incremental test was utilized and surface electromyography of the sternocleidomastoid (SCM), upper trapezius (UT), and rectus abdominis (RA) muscles was performed. The root mean square was calculated every minute and compared between and within groups. A Monte Carlo simulation was also applied, and the area under the curve was calculated to evaluate the differences between groups. During the entire exercise, the SCM muscle activity was higher in preterm children with a larger area under the curve than in the term children. There was no difference in the RA and UT muscle activity between groups throughout the test. The results suggest a greater contribution of the SCM muscle sin preterm children's performance than in term children's performance during high-intensity exercises. Brazilian Clinical Trial Registry (ReBec) - RBR-89hr2h. [ABSTRACT FROM AUTHOR]

Background: Despite the greater prevalence of familial hypercholesterolemia (FH) in subjects with ischemic heart disease (IHD), premature IHD, and severe hypercholesterolemia (low-density lipoprotein ≥190 mg/dl), overall prevalence estimates are not available.Objectives: The aim of this study was to provide worldwide estimates of FH prevalence in subjects with IHD, premature IHD, and severe hypercholesterolemia compared with those in the general population.Methods: In this systematic review and meta-analyses, Embase, PubMed, and the Web of Science were searched until June 3, 2019, for peer-reviewed papers and conference abstracts reporting heterozygous FH prevalence in nonfounder populations, revealing 104 studies eligible for inclusion.Results: Estimates of FH prevalence were pooled using random-effects meta-analyses and were 0.32% (95% confidence interval [CI]: 0.26% to 0.39% [corresponding to 1:313]) among 10,921,310 unique subjects in the general population (33,036 patients with FH) on the basis of 44 studies, 3.2% (95% CI: 2.2% to 4.3% [1:31]) among 84,479 unique subjects with IHD (2,103 patients with FH) on the basis of 28 studies, 6.7% (95% CI: 4.9% to 8.7% [1:15]) among 31,316 unique subjects with premature IHD (1,471 patients with FH) on the basis of 32 studies, and 7.2% (95% CI: 4.6% to 10.8% [1:14]) among 17,728 unique subjects with severe hypercholesterolemia (920 patients with FH) on the basis of 7 studies. FH prevalence in the general population was similar using genetic versus clinical diagnoses. Seventeen of 195 countries (9%) in the world have reported FH prevalence for the general population, leaving 178 (91%) countries in the world with unknown prevalence.Conclusions: Compared with 1:313 among subjects in the general population, FH prevalence is 10-fold higher among those with IHD, 20-fold higher among those with premature IHD, and 23-fold higher among those with severe hypercholesterolemia. The prevalence of FH is unknown in 90% of countries in the world. [ABSTRACT FROM AUTHOR]

Background: Diffuse white matter abnormality (diffuse excessive high signal intensity) is the most common finding on structural brain magnetic resonance imaging (MRI) at term-equivalent age in very preterm infants. Yet, there remains a large gap in our understanding of the etiology of diffuse white matter abnormality. Our objective was to evaluate perinatal and neonatal inflammation-associated antecedents of diffuse white matter abnormality on MRI.Methods: We prospectively enrolled 110 very preterm infants born at ≤31 weeks gestational age and collected data on multiple perinatal/neonatal exposures, especially inflammation initiating-illnesses. We performed structural MRI at term-equivalent age and quantified the volume of diffuse white matter abnormality objectively. Multivariable regression was used to identify clinical antecedents of diffuse white matter abnormality.Results: The mean (S.D.) birth gestational age of the final study sample of 98 very preterm infants was 28.3 (2.5) weeks. Multiple inflammation initiating-illnesses were associated with diffuse white matter abnormality in univariate analyses. In multivariable linear regression analyses controlling for gestational age, severe retinopathy of prematurity (P < 0.001) and bronchopulmonary dysplasia (P = 0.006) were independent risk factors, whereas maternal treatment with 17-hydroxyprogesterone (P < 0.001) was protective of later development of objectively quantified diffuse white matter abnormality.Conclusions: We identified several perinatal and neonatal antecedent clinical factors associated with diffuse white matter abnormality. Although we found some support for inflammation as a common underlying mechanism, larger studies are needed to validate inflammation as a potential common pathway to the development of diffuse white matter abnormality in very preterm infants. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association of gestational age groups (VP: <32 weeks, MP: 32-33 weeks, LP: 34-36 weeks and FT: ≥37 weeks of gestation) and club sport participation in childhood on body mass index (BMI), fat free mass index (FFMI) and fat mass index (FMI).Design: Longitudinal, cross sectional.Methods: BMI (age 3, 5, 7, 11 and 14 years; N=10581-14702) and FFMI/FMI (age 7, 11 and 14 years; N=10446-12996) and consistent club sport participation at age 5, 7 and 11 years (ranging from never participating to participating at all three ages) were assessed prospectively. These were compared by gestational age and their associations with BMI and FMI were investigated, while controlling for confounders (socio-economic, maternal obesity, child related, diet).Results: BMI and FFMI was lower in VP or MP until age 7, but no differences were found in BMI, FFMI or FMI after age 11 with regard to gestational age. Consistent club sport participation from age 5-11 was unrelated to BMI at ages 3-7. However, FT children with club sport participation had lower BMI and FMI at ages 11 and 14; but this association was not found in VP or MP.Conclusions: During adolescence body composition of VP and MP become similar to FT born peers. Consistent sport participation reduces BMI and FMI in FT only. In VP or MP children modifying effects of sport on body composition might not be detected due to the catch-up growth in weight, height and fat mass at the same time. [ABSTRACT FROM AUTHOR]

Background: Intraventricular hemorrhage is a serious neonatal complication associated with neurodevelopmental disorders, but the relationship with other childhood morbidities is unclear. We sought to assess the association of neonatal intraventricular hemorrhage with the risk of morbidity up to 12 years of age.Methods: We analyzed a cohort of 794,384 infants born between 2006 and 2016 in Quebec, Canada, with 4,269,579 person-years of follow-up. The exposure was grade I to IV intraventricular hemorrhage in the neonatal period. The main outcome measure was childhood hospitalization by cause of admission. In adjusted Cox regression models, we estimated hazard ratios and 95% confidence intervals for the association of intraventricular hemorrhage with future childhood hospitalization.Results: Infants with intraventricular hemorrhage had a higher incidence of childhood hospitalization than infants without hemorrhage (23.8 vs. 5.7 per 100 person-years). Compared with those with no hemorrhage, infants with intraventricular hemorrhage had 1.56 times the risk of hospitalization (95% confidence interval, 1.43-1.70). The risk was 2.81 times higher for grade III/IV hemorrhage (95% confidence interval, 2.23-3.53). Intraventricular hemorrhage at term was associated with 3.19 times the risk of hospitalization (95% confidence interval, 2.55-4.00), whereas preterm intraventricular hemorrhage was associated with 2.06 times the risk before 28 weeks (95% confidence interval, 1.75-2.42) and 1.87 times the risk between 28 and 36 weeks (95% confidence interval, 1.68-2.08), compared with no hemorrhage at term. Primary reasons for hospitalizations included central nervous system, ophthalmologic, musculoskeletal, and cardiovascular disorders.Conclusions: Intraventricular hemorrhage, especially of higher grades and in term neonates, is a predictor of future risk of hospitalization in childhood. [ABSTRACT FROM AUTHOR]

Genetic partial lipodystrophies are rare heterogeneous disorders characterized by abnormalities of fat distribution and associated metabolic complications including a predisposition for atherosclerotic cardiovascular disease. We hypothesized that the milder forms of these diseases might be underdiagnosed and might result in early acute coronary syndrome (ACS) as the first sign of the pathology. We performed targeted sequencing on a panel of 8 genes involved in genetic lipodystrophy for 62 patients with premature ACS, and selected heterozygous missense variations with low frequency. To confirm those results, we analyzed a second independent group of 60 additional patients through Sanger sequencing, and compared to a control group of 120 healthy patients. In the first cohort, only PLIN1 exhibited variants in more than 1 patient. In PLIN1 , 3 different variants were found in 6 patients. We then analyzed PLIN1 sequence in the second cohort with premature ACS and found 2 other patients. Altogether, 8 patients were carriers of 4 different mutations in PLIN1. The variant frequencies in the total cohort of 122 patients were compared to frequencies observed in a local control cohort and in 2 different public databases showing a significant difference between patient vs control group frequencies for two mutations out of 4 (c.245C > T p = 10−4; c.839G > A p = 0.014). This is the first study that identifies a high frequency of potential pathogenic mutations in PLIN1 related to early onset ACS. These findings could contribute to the prevention and care of precocious ACS in families carrying those mutations. Image 1 • High throughput sequencing revealed mutations in PLIN1 in patients with premature acute coronary syndrome (ACS). • Two mutations in PLIN1 close to phosphorylation sites are strongly correlated to precocious ACS. • We observed no correlation between the presence of a mutation and a recurrent event of ACS. [ABSTRACT FROM AUTHOR]

Few data are available to substantiate the dogma commonly held by pediatric surgeons and pediatric pathologists that rectal biopsies may be inaccurate or risky in preterm neonates. We aimed to address these concerns. We performed a single-institution retrospective review of patients who underwent suction rectal biopsies at < 37 weeks corrected age from 2009 to 2018. The primary outcomes were accuracy of biopsy results and procedural complications. Forty-nine patients underwent suction rectal biopsy at < 37 weeks corrected age. Mean gestational age at biopsy was 35.2 weeks (range 32.1–36.9) and mean weight was 2126 g (range 1590–3100). Five (10%) infants had biopsies positive for Hirschsprung Disease. All 5 later underwent pull-through operations and had pathologic confirmation of an aganglionic segment. The remaining 44 (90%) had biopsies showing ganglion cells. None were later found to have HD during the follow up period. Those who underwent biopsy at < 2000 g (16/44) had 100% sensitivity [95% CI 48, 100] and specificity [95% CI 92, 100] (2 true positives, 14 true negatives). There were no complications identified. Suction rectal biopsy can be performed safely in preterm infants as small as 1590–2000 g with high accuracy. Clinicians should not hesitate to perform a biopsy for a premature infant when clinically appropriate. Study of a diagnostic test. Level IV. [ABSTRACT FROM AUTHOR]

Very-low-birth-weight (VLBW) infants have a high risk of postdischarge growth retardation (GR). Continued GR might exert negative long-term effects on their health. This study examined the prevalence and the risk factors for postdischarge GR among VLBW infants in Taiwan. Nationwide data from the Taiwan Premature Infant Follow-up Network between 2007 and 2011 were analyzed. Infants with a gestational age (GA) < 37 weeks and birth body weight (BBW) < 1500 g were enrolled. They were followed up after discharge at the corrected ages of 6, 12, and 24 months. Associations between postdischarge GR at the follow-ups and possible risk factors were analyzed. The prevalence of postdischarge GR among 2124 VLBW infants was 17.3%, 19.4%, and 13.8% at the corrected age (CA) of 6, 12, and 24 months, respectively. The significant perinatal factors of postdischarge GR were being small for gestational age (SGA) and extremely low birth weight (ELBW). ELBW infant with extra-uterine growth retardation (EUGR) at discharge or longer length of hospital stay (LOS) had poorer growth outcomes. Among non-ELBW infants, EUGR at discharge and surgical necrotizing enterocolitis (NEC) were the main influencing factors of unfavorable growth outcomes. RDS with surfactant therapy had a positive effect of postdischarge growth outcomes in ELBW infants. Postdischarge GR is still a serious problem in Taiwan. Being SGA and ELBW and EUGR were significant risk factors for postdischarge GR throughout the first two years of life in VLBW infants. An integrated and organized team for postdischarge care as well as scheduled follow-ups, detailed nutritional education, and thorough inspection are necessary. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD), also known as Chronic Lung Disease (CLD), is a chronic respiratory condition of prematurity with potential life-long consequences for respiratory well-being. BPD was first described by Northway in 1967, when the mean gestation of preterm infants with BPD was 34 weeks' postmenstrual age (PMA). Survival of preterm infants at lower gestational ages has increased steadily since 1967 associated with marked improvements in respiratory management of respiratory distress syndrome. Currently, BPD develops in approximately 45 % of all infants born extremely preterm (Stoll et al., 2015). These smaller and more immature babies are born during the late canalicular or early saccular period of lung development. Not surprisingly, the pathophysiology of BPD also evolved since classical BPD was described. As the nature and our understanding of BPD evolved, so too the definitions and classification of BPD changed over time. These differing and ever-changing definitions hamper clinical benchmarking as they are interpreted and applied inconsistently, and define BPD and its severity by non-standardised treatments rather than independent evaluations of structure or function. A standardised, unambiguous definition and classification of BPD is essential for evaluation and improvement in clinical practice, both within an individual unit, as well as across and between neonatal networks. The determination and implementation of diagnostic criteria and severity classification that is standardised, globally applicable, and that has prognostic utility for clinical outcomes and guidance of ongoing respiratory management remain of utmost importance. This review describes the evolution of BPD definitions, evaluates the benefits and limitations of each approach, and discusses alternative approaches that may improve the functional assessment of BPD severity. [ABSTRACT FROM AUTHOR]

Antenatal factors play an important role in NEC. This study aimed to identify antenatal risk factors associated with the development of NEC, the role of the placental alterations, and the presence of prenatal signs predisposing to a severe NEC. Data of NEC patients including antenatal findings [preeclampsia, diabetes, cholestasis, abnormal antenatal umbilical artery flow (AAUF), clinical chorioamnionitis (CC), and histology of placentas] were compared to unaffected cases between 2002 and 2016 in a single center. Unaffected infants were matched for gestational age. Newborns with cardiovascular diseases were excluded. Bivariate and multivariate analyses were performed. We identified 136 cases and 134 controls. The group of mothers of NEC-neonates had a higher prevalence of preeclampsia, CC, and AAUF. Histology of Placentas from 123/136 cases and 126/133 unaffected newborns was available. Chorioamnionitis was significantly more present in NEC cases vs controls. There weren't differences in vascular anomalies and necrotic alterations. Multivariate analysis identified AAUF, CC and histological chorioamnionitis (HC) as predictors of NEC. Bivariate tests show that preeclampsia and HC occurred more often in severe cases of NEC. This study suggests that AAUF, CC, and HC can independently predict the risk of NEC. Preeclampsia and HC seem associated to more severe cases. IIIA. [ABSTRACT FROM AUTHOR]

Kawasaki disease and the associated complication of Ventricular Septal Rupture are extremely rare in neonates, particularly among premature infants. We report a case of a premature infant who was diagnosed with incomplete Kawasaki disease after an echocardiogram incidentally demonstrated a coronary artery aneurysm. The patient developed Ventricular Septal Rupture secondary to myocardial infarction seven months after the onset of the disease. This case highlighted the importance of coronary artery screening in a febrile neonatal patient who did not respond to multiple courses of antibiotics. Due to the rarity of the disease in neonates and the complications, the management of Ventricular Septal Rupture postneonatal Kawasaki disease is challenging as there is no consensus regarding treatment. • Neonates with a fever should be evaluated for Kawasaki disease. • Early detection of coronary artery abnormality is crucial for preventing complications. • Ventricular septal rupture is a rare complication of neonatal kawasaki disease. [ABSTRACT FROM AUTHOR]