Search

This study aims to analyze the main risk factors for acute kidney injury in the subgroup of very-low birth weight newborns, using the diagnosing criteria of the Kidney Disease Improving Global Outcomes (KDIGO) or the Acute Kidney Injury Network (AKIN). A systematic review of the literature was performed on the EMBASE® and PubMed® platforms. Studies that evaluated the risk factors for developing AKI in VLBW newborns were included. For the meta-analysis, we only included the risk factors that were associated with AKI in the univariate analysis of at least two studies. After an initial screening, abstract readings, and full-text readings, 10 articles were included in the systematic review and 9 in the meta-analysis. The incidence of AKI varied from 11.6 to 55.8%. All the studies have performed multivariate analysis, and the risk factors that appeared most were PDA and hemodynamic instability (use of inotropes or hypotension), sepsis, and invasive mechanical ventilation. After the meta-analysis, only cesarian delivery did not show an increased risk of AKI, all the other variables remained as important risk factors. Moreover, in our meta-analysis, we found a pooled increased risk of death in newborns with AKI almost 7 times. Conclusion: AKI in VLBW has several risk factors and must be seen as a multifactorial disease. The most common risk factors were PDA, hemodynamic instability, sepsis, and invasive mechanical ventilation. What is known: • Acute kidney injury is associated with worst outcomes in all ages. It´s prevention can help diminish mortality. What is new: • A synthesis of the main risk factors associated with AKI in very low birth weight newborns. [ABSTRACT FROM AUTHOR]

Aim: To describe sodium and potassium intake, their sources and plasma concentrations, and the association between intake and morbidity in very‐low‐birthweight (VLBW, <1500 g) infants during the first week of life. Methods: This retrospective cohort study comprised 951 VLBW infants born at <32 weeks. Infants were divided into three groups according to gestational age: 23–26 (n = 275), 27–29 (n = 433) and 30–31 (n = 243) weeks. Data on fluid management and laboratory findings were acquired from an electronic patient information system. Results: The median sodium intake was highest in the 23–26 week group, peaking at 6.4 mmol/kg/day. A significant proportion of sodium derived from intravascular flushes; it reached 27% on day 1 in the 23–26 week group. High cumulative sodium intake in the first postnatal week was associated with weight gain from birth to day 8 in the 23–26 week group. High intake of sodium associated with an increased risk of surgically ligated patent ductus arteriosus (PDA), bronchopulmonary dysplasia and intraventricular haemorrhage, whereas low intake of potassium associated with an increased risk of PDA. Conclusion: Sodium intake in the most premature infants exceeded recommendations during the first postnatal week. Saline flushes accounted for a significant proportion of the sodium load. [ABSTRACT FROM AUTHOR]

Aim: To present the rare localization of haemangioma in a premature child and to point out the importance of early treatment to prevent possible complications. Case report: A female prematurely born child was referred for a consultative examination by an ophthalmologist due to oedema of the upper eyelid of the left eye and bulbous protrusion lasting three weeks. Physical examination revealed mild axial, painless left bulbar proptosis, palpebral oedema and slower pupillary response. Native and postcontrast MR and UTZ B scan of the bulbus and retroorbital space were performed. MR showed protrusion of the left bulb caused by haemangioma along the lateral contour and the orbital roof, which impregnates the surrounding muscles and with localized signs of intraconal spread in the area of the posterior part of the orbit. Expansion was also observed through the upper orbital fissure to the level of the cavernous sinus region. Propranolol therapy was started. After three months after the start of therapy, UTZ and MRI showed a complete retreat of tumour formation. Conclusion: Because of their localization, retrobulbar haemangiomas can cause numerous serious complications, which, in order to prevent them, require early diagnosis and the start of treatment. Due to the limited therapeutic options, the drug of first choice is oral propranolol. [ABSTRACT FROM AUTHOR]

Purpose Bronchopulmonary dysplasia (BPD) is a chronic lung disease that primarily affects premature infants receiving mechanical ventilation and oxygen therapy. Severe BPD leads to long-term respiratory complications, including lung tissue damage, vascular abnormalities, and airway diseases. This study aimed to investigate bronchoscopy findings and characteristics in patients with moderate-to-severe BPD, and to investigate BPD-associated airway diseases. Methods A retrospective study of preterm infants diagnosed with moderate-to-severe BPD who underwent bronchoscopic evaluation in the neonatal intensive care unit at Seoul National University Bundang Hospital between 2004 and December 2022 was conducted. Results Nineteen patients with a mean gestational age of 28.0±1.6 weeks and mean birth weight of 960.5±271.0 g were included in the study. Among these 19 patients, 18 were diagnosed with severe BPD. Tracheobronchomalacia, laryngomalacia, and subglottic stenosis were observed in 63.2%, 52.6%, and 36.8% of patients, respectively. Tracheostomy was performed in nine of the 19 patients (47.4%); five were discharged without requiring tracheostomy following surgical or medical interventions. Conclusion Tracheobronchomalacia, laryngomalacia, and subglottic stenosis were common in patients with moderate or severe BPD who underwent bronchoscopic evaluations, of which 50% required tracheostomy. Our study findings provide valuable insights into the pathophysiology of BPD-associated airway diseases and may inform future clinical management strategies for patients with BPD.

Purpose Despite advances in neonatal care, extrauterine growth restriction (EUGR) remains common in preterm infants. This retrospective single-center study aimed to determine the incidence and risk factors of EUGR in very low birth weight (VLBW) infants. Methods Data were collected concerning VLBW infants with gestational age (GA) 1.2 from birth to discharge, using Fenton growth charts. Results Among 331 eligible preterm infants, the prevalence of EUGR at discharge was 71.6%. Infants with EUGR had lower GA and birth weight than those without EUGR. They also underwent prolonged durations of parenteral nutrition, invasive ventilation, and hospitalization. Neonatal morbidities, such as bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, gastrointestinal surgery, sepsis, and parenteral nutrition-associated cholestasis were more prevalent in the EUGR group. Multivariate analysis identified lower GA and longer time to reach full enteral feeding as independent risk factors, whereas maternal use of antenatal steroids and history of gestational diabetes mellitus were independent protective factors for EUGR. Conclusion As VLBW infants are at a high risk of EUGR, continuous attention and efforts to achieve early full enteral nutrition are required to decrease the incidence of EUGR.

Objective To investigate the characteristics of thyroid function and its influencing factors in preterm infants born to mothers with preeclampsia. Methods A total of 222 preterm infants, who were admitted to the neonatal intensive care unit of our hospital from January to December 2019, were enrolled, and according to the presence or absence of preeclampsia in the mother, they were divided into experimental group with 120 infants and control group with 102 infants. Basic clinical data were collected from the preterm infants and their mothers, as well as the results of thyroid function test using peripheral venous blood of preterm infants at 10-14 d after birth. The Student’s t-test, a one-way analysis of variance, and the multiple stepwise regression analysis were used to investigate the influencing factors for thyroid function in preterm infants. Results There was no significant difference in maternal thyroid function between the two groups (P>0.05). The experimental group had a significantly higher se-rum level of thyroid stimulating hormone (TSH) than the control group (t=-2.76,P

Purpose This study aimed to examine the health concerns of parents regarding their premature infants and to identify changes in these concerns during perinatal period and after discharge. Methods This was a retrospective study performed at a single tertiary center that enrolled 119 premature infants who were discharged from the neonatal intensive care unit (NICU) and visited the outpatient pediatrics department between December 2018 and October 2021. Data on the concerns of 176 parents regarding enrolled premature infants’ health from before birth to 1 week after NICU discharge were obtained from outpatient records. The t test and with the chi-squared test were used to analyze the data for this study. Results The consistently greatest focus of parents' health concerns was the respiratory system. The second focus of parents' health concerns before discharge was the central nervous system. However, during the first week after NICU discharge, the gastrointestinal system was the second-most frequent focus of parents’ health concerns among parents of infants without diseases related to prematurity and infants with older gestational ages. Conclusion The results of this study offer insights into the health concerns among parents of premature infants. Parental health concerns about premature infants vary over time, from before birth to post-discharge, necessitating supportive interventions to enhance parental understanding of their child's health status.

Bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are potentially fatal complications in prematurely born infants. Extracorporeal membrane oxygenation (ECMO) may be a life-saving option for managing infants with BPD and PH. We present 2 patients who were successfully weaned off mechanical ventilators (MVs) through the application of ECMO. The patients were transferred to our institution after receiving MV care for 8 and 10 months, respectively, for BPD and PH. We were able to remove the patients from MVs after a period of ECMO-mediated lung rest. Although more research is required to determine specific criteria for ECMO use in patients with BPD and PH, our clinical experiences may contribute to the early application of ECMO in MV-dependent patients.

Objective To investigate the nutritional status of hyperemesis gravidarum (HG) patients and its influence on pregnancy outcome. Methods A total of 153 cases of HG and their newborns were taken as the observation group, and 350 cases of healthy women and their newborns were used as the control group. The characteristics of pregnant women and pregnancy outcomes were compared between the two groups. In patients with HG, 7 newborns were in the low birth weight group and 146 cases in the normal birth weight group. The levels of fast reaction protein, vitamin and trace element were analyzed in the two groups. Results Compared with the control group, the mean birth weight of newborns was lower, the preterm birth rate was higher, the proportion of low birth weight was higher and the probability of female birth was higher in the observation group (P＜0.05). Micronutrient deficiency was common in the observation group, especially vitamin D, serum manganese and zinc deficiency. Compared with the normal body weight group, more weight loss and lower levels of zinc, iron and vitamin C during pregnancy in the low birth weight group (P＜0.05). Conclusion HG patients should pay attention to the supplementation of vitamin D, manganese, and zinc. Low birth weight of newborns is associated with a higher level of decline in pregnancy body weight and lower levels of zinc, iron, and vitamin C during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that primarily affects premature infants receiving mechanical ventilation and oxygen therapy. Severe BPD leads to long-term respiratory complications, including lung tissue damage, vascular abnormalities, and airway diseases. This study aimed to investigate bronchoscopy findings and characteristics in patients with moderate-to-severe BPD, and to investigate BPD-associated airway diseases. Methods: A retrospective study of preterm infants diagnosed with moderate-to-severe BPD who underwent bronchoscopic evaluation in the neonatal intensive care unit at Seoul National University Bundang Hospital between 2004 and December 2022 was conducted. Results: Nineteen patients with a mean gestational age of 28.0±1.6 weeks and mean birth weight of 960.5±271.0 g were included in the study. Among these 19 patients, 18 were diagnosed with severe BPD. Tracheobronchomalacia, laryngomalacia, and subglottic stenosis were observed in 63.2%, 52.6%, and 36.8% of patients, respectively. Tracheostomy was performed in nine of the 19 patients (47.4%); five were discharged without requiring tracheostomy following surgical or medical interventions. Conclusion: Tracheobronchomalacia, laryngomalacia, and subglottic stenosis were common in patients with moderate or severe BPD who underwent bronchoscopic evaluations, of which 50% required tracheostomy. Our study findings provide valuable insights into the pathophysiology of BPD-associated airway diseases and may inform future clinical management strategies for patients with BPD. [ABSTRACT FROM AUTHOR]

Purpose: Despite advances in neonatal care, extrauterine growth restriction (EUGR) remains common in preterm infants. This retrospective single-center study aimed to determine the incidence and risk factors of EUGR in very low birth weight (VLBW) infants. Methods: Data were collected concerning VLBW infants with gestational age (GA) <32 weeks between 2011 and 2020. EUGR was defined as a decline in weight z-score >1.2 from birth to discharge, using Fenton growth charts. Results: Among 331 eligible preterm infants, the prevalence of EUGR at discharge was 71.6%. Infants with EUGR had lower GA and birth weight than those without EUGR. They also underwent prolonged durations of parenteral nutrition, invasive ventilation, and hospitalization. Neonatal morbidities, such as bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, gastrointestinal surgery, sepsis, and parenteral nutrition-associated cholestasis were more prevalent in the EUGR group. Multivariate analysis identified lower GA and longer time to reach full enteral feeding as independent risk factors, whereas maternal use of antenatal steroids and history of gestational diabetes mellitus were independent protective factors for EUGR. Conclusion: As VLBW infants are at a high risk of EUGR, continuous attention and efforts to achieve early full enteral nutrition are required to decrease the incidence of EUGR. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the health concerns of parents regarding their premature infants and to identify changes in these concerns during perinatal period and after discharge. Methods: This was a retrospective study performed at a single tertiary center that enrolled 119 premature infants who were discharged from the neonatal intensive care unit (NICU) and visited the outpatient pediatrics department between December 2018 and October 2021. Data on the concerns of 176 parents regarding enrolled premature infants' health from before birth to 1 week after NICU discharge were obtained from outpatient records. The t test and with the chi-squared test were used to analyze the data for this study. Results: The consistently greatest focus of parents' health concerns was the respiratory system. The second focus of parents' health concerns before discharge was the central nervous system. However, during the first week after NICU discharge, the gastrointestinal system was the second-most frequent focus of parents' health concerns among parents of infants without diseases related to prematurity and infants with older gestational ages. Conclusion: The results of this study offer insights into the health concerns among parents of premature infants. Parental health concerns about premature infants vary over time, from before birth to post-discharge, necessitating supportive interventions to enhance parental understanding of their child's health status. [ABSTRACT FROM AUTHOR]

Introduction: Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants. Methods: An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023. Results: We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively). Conclusion: Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.

Anemia is frequent in preterm infants. Red blood cell transfusion practices vary between different centers. The objective of this study was to review red blood cell transfusion practices in preterm infants between 2020 and 2021. This was a narrative review that included studies published on PubMed (Medline) and Web of Science between October 2020 and October 2021. Ten studies were included finally. Red blood cell transfusion frequency was variable. Some neonatal units did not report transfusion protocols. Most studies reported volumes of 10-15 ml/kg per transfusion. The implementation of an anemia care bundle and adoption of restrictive transfusion resulted in a reduction in the number of transfusions, the volume transfused, and a reduction in the rate of multiple transfusions. We suggest that neonatal units that care for preterm infants should have a transfusion protocol based on the best evidence available and this issue may improve.

Introduction. Metabolic bone disease of premature infants is a rare complication characterized by a lower mineral content in bone tissue. Objective. To establish the incidence of metabolic bone disease in premature infants and to determine associated risk factors. Materials and method. We conducted a descriptive prospective cohort study for one year in all newborns under 32 gestational weeks, or 1,500 g, at the Hospital Universitario de Santander to determine the incidence of metabolic bone disease. We collected demographic data and prenatal histories of the selected patients, and later, we measured serum alkaline phosphatase and serum phosphorus at the third week of birth, having as reference values for diagnosis less than 5.6 mg/dl for the first one and more than 500 UI/L for the second one. We applied statistical tools for data analysis, such as average proportions, dispersion, distribution and association measures, and binomial regression. Results. From a total of 58 patients, 7 had a diagnosis of metabolic bone disease, with an incidence of 12%. The weight was reported as an independent variable for the development of the disease, being significant in children under 1,160 g, as well as prolonged parenteral nutrition for more than 24 days. When performing the multivariate analysis, low weight and short time of parenteral nutrition appeared as risk factors; in the same way, maternal age below 22 years is associated with a higher relative risk, even more than a newborn weight inferior to 1,160 g. Conclusion. Establishing an early intervention in patients with metabolic bone disease enhancing risk factors, such as low weight and prolonged parenteral nutrition, is critical to prevent severe complications.

Introduction. Coronavirus disease 2019 (COVID-19) pneumonia is a potentially life-threatening condition that can require the use of mechanical ventilation (MV) and is rare in the neonatal population. Giant pneumatocele is an extremely rare complication of MV, which is practically unknown in neonates. Case report. We report a case of a two-week-old premature infant who developed severe acute respiratory distress syndrome (ARDS) due to COVID-19 and pneumatocele as a complication of MV. The newborn was admitted in a life-threatening condition with persistent hypercapnia, which, therefore, required prolonged MV. Chest computed tomography (CT) was done to assess the degree of fibrosis caused by COVID-19, and as an accidental finding, a pneumatocele was observed. The patient was immediately started on high-frequency oscillatory ventilation as a way of conservative treatment. After prolonged duration and gradual separation from MV, the patient was extubated, and oxygen therapy was gradually discontinued. The patient was discharged in good condition, and the follow-up chest CT showed complete regression of pneumatocele. Conclusion. Optimization of MV parameters and adequate treatment of complications such as ARDS or giant pneumatocele in neonates is an area that still requires further research, primarily due to the specificity of the neonatal age compared to adult patients. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the pattern of eye-gaze of preterm (PT), autism spectrum disorder (ASD) and neurotypical (Ty) children. Methods: A cross-sectional study with eight preterm (born with ≤2000 g weight), nine ASD and five Ty male children, between six and nine years old, was performed. The eye gaze was evaluated presenting a board with a couple in social interaction, and a video with four children playing with blocks, projected in a screen computer, successively, evaluating the time that the children looked at each stimulus. Results: Although all the groups focus on the central social figure with no significant differences, ASD presented significant differences in time fixation of the objects (p=0.021), while premature children fixated more time in the central social interaction than in the whole scene than typical children. Conclusions: Although this study found noteworthy differences in the eye-gaze patterns among the three groups, additional research with a more extensive participant pool is necessary to validate these preliminary results. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization, tuberculosis (TB) ranks among the top 10 causes of death worldwide. The significance of TB during pregnancy lies in its symptoms, which can be mistaken for physiological changes associated with pregnancy. This confusion can lead to maternal-perinatal complications. Objective: To evaluate the association between pulmonary TB in pregnancy and adverse neonatal outcomes in two Peruvian hospitals. Methods: This is a retrospective cohort study. The target population consisted of pregnant women with and without pulmonary TB whose deliveries were attended at two public hospitals, located in Lima, Peru. The adverse neonatal outcomes were prematurity, low birth weight (LBW), and being small for gestational age (SGA). Crude and adjusted relative risks (RRa) were calculated with their respective 95% confidence intervals (95%CI). Results: Information from 212 patients was analyzed; 48.1% had TB during pregnancy, and 23.1% had adverse neonatal outcomes (8%, 11.3%, and 12.3% for LBW, prematurity, and SGA, respectively). In the adjusted model, pregnant women with pulmonary TB had a 3.52 times higher risk of having a newborn with at least one of the adverse outcomes than those who were not exposed (aRR, 3.52; 95%CI: 1.93–6.68). Conclusion: Pulmonary TB in pregnancy was jointly and independently associated with adverse neonatal outcomes, including LBW, prematurity, and being SGA.

ABSTRACT Objective This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. Methods This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. Results A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Conclusion Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

Introduction: Maternal recognition of special health needs of premature babies is essential, given the importance of early stimuli after discharge to strengthen child development. Objective: To identify premature newborns with potential factors for the development of special health needs and describe maternal recognition of these factors. Materials and methods: Qualitative and quantitative study, performed using a triangulation method, with concomitant incorporation of data, included to analysis Chi-square test (p

Abstract Objectives: to evaluate the association between the time to initiate the first skin-to-skin contact (SSC) and the daily practice time with the rates of late-onset sepsis in newborns ≤1,800g. Methods: a multicentric cohort study was carried out at the neonatal units located in three Brazilian geographic regions. The SSC time was recorded in individual files by the hospital staff and the newborn’s parents. Maternal and neonatal data were obtained from medical records and through questionnaires applied to the mothers. Data analysis was carried out using a tree algorithm classification, which divided the data set into mutually exclusive subsets that best described the variable response. Results: 405 newborns participated in the study, with an average of 31.3 ± 2.7 weeks and 1,412g (QR=1,164-1,605g) as a median birth weight. The first SSC was carried out within 137 hours of life (≤5.7 days) was associated with a lower rate of late sepsis (p=0.02) for newborns who underwent daily SSC of 112.5 to 174.7 min/day (1.9 to 2.9h/day), with a reduction in the sepsis rate from 39.3% to 27.5%. Furthermore, the duration of SSC >174.7min/day (>2.9h/day) was relevant (p1,344g, with a reduction in this rate from 24.1% to 6%. Conclusions: SSP has been proven to be significant in reducing late-onset sepsis rates in preterm newborns, especially when carried out in a timely manner (≤5.7 days) and prolonged (>2.9h/day).

ABSTRACT Objective: To evaluate the pattern of eye-gaze of preterm (PT), autism spectrum disorder (ASD) and neurotypical (Ty) children. Methods: A cross-sectional study with eight preterm (born with ≤2000 g weight), nine ASD and five Ty male children, between six and nine years old, was performed. The eye gaze was evaluated presenting a board with a couple in social interaction, and a video with four children playing with blocks, projected in a screen computer, successively, evaluating the time that the children looked at each stimulus. Results: Although all the groups focus on the central social figure with no significant differences, ASD presented significant differences in time fixation of the objects (p=0.021), while premature children fixated more time in the central social interaction than in the whole scene than typical children. Conclusions: Although this study found noteworthy differences in the eye-gaze patterns among the three groups, additional research with a more extensive participant pool is necessary to validate these preliminary results.

Abstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

Background Respiratory distress syndrome (RDS) is an important cause of death in preterm infants, which needs to be constantly strengthened in clinical prevention and treatment, but the relationship of umbilical cord blood vitamin A and E levels with the development of RDS in preterm infants has been rarely reported. Objective To investigate the relationship of vitamin A and E levels in umbilical cord blood with RDS in preterm infants. Methods A total of 304 preterm infants in the Fourth Hospital of Shijiazhuang from January 2021 to January 2022 were selected and divided into the RDS group (n=120) and non-RDS group (n=184) according to the incidence of RDS. Clinical features that may be related to the occurrence of RDS in preterm infants were collected, vitamin A and E levels in umbilical cord blood were detected. Multivariate Logistic regression analysis was used to analyze the influencing factors of the occurrence and severity of RDS in preterm infants. Results The gestational age, birth weight, vitamin A and E levels in umbilical cord blood of preterm infants in the RDS group were lower than those in the non-RDS group, the proportions of newborn's Apgar score in one-minute≤7, newborn's Apgar score in five-minute≤7, and incidence of vitamin A deficiency were higher in the RDS group than those in the non-RDS group (P