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Background: Preterm infants (i.e., those born before 37 completed weeks of pregnancy) often require additional care and are admitted to neonatal units soon after birth. Readiness for discharge home typically requires a level of physiological maturity such that an infant is able to: 1) breathe spontaneously without additional support; 2) maintain their own body temperature; 3) take all their nutritional requirements orally; 4) weighs ≥ 1700g and is gaining weight. Longer hospital stays than necessary can be detrimental to infants, stressful for families, and costly. Currently, little is known about whether, how long and why preterm infants stay in hospital beyond physiological readiness for discharge., Materials and Methods: We will conduct a retrospective cohort study using data from the National Neonatal Research Database on all infants born at < 37 weeks' gestational age (GA) admitted to neonatal units in England and Wales from 2016-2022. The day of life and postmenstrual age infants reach each physiological milestone, and the final barrier to discharge, will be identified. We will assess whether the final barrier differs by GA and between neonatal Operational Delivery Networks and summarise the number of days infants remain in hospital after surpassing all physiological milestones. We will explore the characteristics of infants, mothers and neonatal units associated with extended hospital stays beyond physiological readiness for discharge., Discussion: The results of this study will allow identification of areas to target to help achieve a safe reduction in length of hospital stay and will support the development of evidence-based recommendations to guide optimal discharge practices., Trial Registration: ClinicalTrials.gov NCT06284044., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Szatkowski et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Mature oral feeding is a complex function involving numerous muscles and nerves, typically developing between the postmenstrual age of 34-36 weeks in newborn infants. The objective of this study was to analyze the oral feeding skills of healthy late preterm, early term, and full-term infants using a neonatal oral feeding monitor., Methods: We used the oral feeding parameters reported by NeoSAFE which is a certified medical device, to assess the swallowing and swallow-respiration coordination in newborn infants. Oral feeding parameters were recorded over a 2-minutes long bottle-feeding session. The total swallow count, swallow time, maximum rhythmic swallows, resting interval duration, time between rhythmic swallows and inspiration after swallow count were recorded by NeoSAFE. We planned to examine the relationship of oral feeding parameters according to the gestational age. We also investigated whether the coordination of swallowing and respiration changes with respect to gestational age in newborn infants., Results: A total of 88 infants were included; 34 late preterm, 34 early term, and 20 full term. The gestational age was found to have significant negative correlation with the average time between rhythmic swallows and positive correlation with the swallow time. Feeding volume was found to have a negative correlation with the resting interval duration and average time between rhythmic swallows. It was also found that the feeding volume has a positive correlation with total swallow count, swallow time, maximum rhythmic swallow and inspirium after swallow count., Conclusion: Although the oral feeding skills of infants at 34 weeks gestation are still developing, this study identified differences in oral feeding skills among late preterm, early term, and full-term infants when assessed using a neonatal swallow and respiration detection system. However, conducting larger cohort studies using NeoSAFE would be beneficial for guiding oral feeding approaches in infants., Trial Registration: Not applicable., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board (IRB) and Ethics Committee at Baskent University (Project number: KA23/183) and a written consent was obtained from a parent of each newborn infant. A statement to confirm that all methods were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication: Written informed consent for publication was obtained. Informed consent: A written consent was obtained from a parent of each newborn infant. Competing interests: AE works at Baskent University, is a founding member of KuartisMED and serves on the advisory board of KuartisMED. BE is working at KuartisMED. AS is a founding member of KuartisMED, AT is a founding member of KuartisMED and serves on the advisory board of KuartisMED. Other authors have no conflict of interest., (© 2025. The Author(s).)

Background: Preterm infants face challenges in their suck-swallow-breathe coordination leading to an increased risk of aspiration. Key components of the swallowing process are present around 34 to 35 weeks postmenstrual age (PMA), but preterm infants fatigue early affecting timing, quality and efficiency in swallowing and prolonging breathing pauses. Feeding strategies need to address these specific challenges in suck-swallow-breathe coordination., Aim: To objectively measure the effect of positioning and applying "paced bottle feeding" on swallowing and breathing function in preterm infants., Methods: Two separate groups of each 20 preterm infants were measured during a single bottle feed at the age of 34 to 35 weeks PMA using a noninvasive measuring device combining bioimpedance, surface electromyography as well as a breathing belt. In the first study (S1) feeding in elevated side-lying was compared to elevated supine position for 2 min each. In the second study (S2) 2 min of paced bottle feeding was compared to 2 min without paced bottle feeding., Results: (S1): Feeding in elevated side-lying led to significantly fewer episodes of choking and coughing, significantly shorter breathing pauses and significantly less variation in swallowing movements than in elevated supine. Pharyngeal closure was significantly greater in supine at the start of the feed. (S2): The application of paced bottle feeding significantly reduced the length of breathing pauses., Conclusions: Feeding in elevated side-lying position and applying paced bottle feeding may support improved swallow-breathe coordination in healthy preterm infants at 34 to 35 weeks PMA., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims: To retrospectively evaluate the effect of a sequential swallow training programme (SSTP) consisting of nonnutritive sucking (NNS), modified feeding posture, oral sensory-motor intervention and breath exercise on the independent oral feeding transition and coordination of suck-swallow-breath (SSB) functions in preterm infants., Methods: Sixty preterm infants received SSTP intervention and sixty infants receiving NNS were set as control. The feeding performance and SSB coordination were assessed using POFRAS and NOMAS scales., Results: The transition interval were 8.42 ± 4.49 and 10.27 ± 5.05 days for SSTP and NNS group, respectively (P = 0.022). SSTP group had substantially more weight gains and shorter in-hospital stay than NNS. Two groups had comparable POFRAS and NOMAS scores before interventions, which were significantly increased after treatments in the two groups (P < 0.05). SSTP groups exhibited higher POFRAS scores, and better NOMAS performance reflected by the movement and coordination of jaw and tongue, especially in the normal sucking domain than the NNS group (P < 0.05). Both interventions significantly reduced the episodes of desaturation, apnea, and bradycardia, while no priority was shown for SSTP comparing with NNS. Multivariate linear regression analysis revealed that SSTP intervention was independently associated with decreased full oral feeding transition days, more weight gain during intervention and higher POFRAS score after intervention., Conclusion: SSTP intervention shorten the transition days to full oral feeding and efficiently improved oral movement and coordination of SSB pattern when feeding., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yanxia Huang reports financial support was provided by Science and Technology Department, Shaanxi Province. Yanxia Huang reports a relationship with Science and Technology Department, Shaanxi Province that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Neural development leads to the evolution of electroencephalographic (EEG) characteristics during the third trimester of gestation. Theta activity in coalescence with slow waves (TA-SW) and delta brushes (DB) are key clinical neurobiomarkers in the evaluation of neurodevelopment in infants prior to full-term gestation. Both neurobiomarkers exhibit nested oscillations, a key feature of intrinsic spontaneous oscillatory activity, allowing the investigation of neural interaction development in the underlying circuits. In the present study, we propose an automatic approach for the detection and characterization of neurobiomarkers that (1) leverages high-density EEG (HD-EEG), (2) incorporates temporal dynamics and spatial distributions, and (3) evaluates the characteristics of nested oscillations. This method evaluates both slow and rapid neural activity, along with their cross-frequency coupling. Our results are in good agreement with those of clinical experts, achieving ROC performances and overall accuracies of 91 %/84 % and 83 %/75 % for TA-SW/DB events, respectively. Following detection and validation, we characterized and compared these two neurobiomarkers. Correlation-based spatial clustering showed that DB patterns were more symmetric and diffuse, whereas TA-SW patterns were more localized in the right and left temporal areas. Comparisons revealed (1) greater variability in spatial patterns for DB than for TA-SW, and that (2) while slow-wave coupling to fast oscillations showed similar characteristics for both neurobiomarkers, differences emerged in the amplitude and descending slope of the underlying slow waves. These findings suggested potential differences in the mechanisms underlying their generation, particularly in the modulation of slow oscillations. This approach represents a promising avenue for the quantitative evaluation of EEG signatures pertinent to early neural development in premature neonates., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To systematically review the literature on the associations between electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) measures in preterm infants (gestational age < 37 weeks)., Methods: A comprehensive search was performed in PubMed and EMBASE databases up to February 12th, 2024. Non-relevant studies were eliminated following the PRISMA guidelines., Results: Ten out of 991 identified studies were included. Brain MRI metrics used in these studies include volumes, cortical features, microstructural integrity, visual assessments, and cerebral linear measurements. EEG parameters were classified as qualitative (Burdjalov maturity score, seizure burden, and background activity) or quantitative (discontinuity, spectral content, amplitude, and connectivity). Among them, discontinuity and the Burdjalov score were most frequently examined. Higher discontinuity was associated with reduced brain volume, cortical surface, microstructural integrity, and linear measurements. The Burdjalov score related to brain maturation qualitatively assessed on MRI. No other consistent correlations could be established due to the variability across studies., Conclusions: The reviewed studies utilized a variety of EEG and MRI measurements, while discontinuity and the Burdjalov score stood out as significant indicators of structural brain development., Significance: This review, for the first time, provides an extensive overview of EEG-MRI associations in preterm infants, potentially facilitating their clinical application., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Aim: To evaluate the effect of a parent-administered sensorimotor intervention (PASI) program on developmental outcomes of infants born preterm during their stay in the neonatal intensive care unit (NICU)., Method: A randomized clinical study was conducted with 94 infants (mean gestational age 31 weeks [SD 2.2 weeks]; 1658 g [SD 478 g]; 49 males, 45 females) initially enrolled and randomly assigned to an experimental or a control group. Infants in the experimental group received a PASI, consisting of tactile input to oral structures, trunk/limbs, and non-nutritive sucking for 15 minutes, once a day, for 10 days. Infants in the control group received standard care. Outcomes included attainment of complete oral feeds, occurrence of direct breastfeeding at hospital discharge, and motor function assessed using the Test of Infant Motor Performance (TIMP)., Results: A total of 80 infants completed the study. Infants in the experimental group achieved complete oral feeds sooner (11.9 [SD 4.3] vs 15.3 [SD 6.5] days, p = 0.013), and a greater number of them received direct breastfeeds (22 vs 12, p = 0.010) than controls. Infants in both groups had equivalent motor functions scores on the TIMP (46.9 [SD 4.8], 46.8 [SD 8.4], p = 0.961)., Interpretation: A PASI program may enhance an infant's oral feeding skills. These findings provide evidence to advocate for the institution of PASI in NICUs., (© 2024 Mac Keith Press.)

This observational study investigated the effects of sleep position and sleep state on short apneas and periodic breathing in hospitalized preterm infants longitudinally, in relation to postmenstrual age. Preterm infants (25-31 weeks gestation, n = 29) were studied fortnightly after birth until discharge, in prone and supine positions, and in quiet sleep and active sleep. The percentage of time spent in each sleep state (percentage of time in quiet sleep and percentage of time in active sleep), percentage of total sleep time spent in short apneas and periodic breathing, respectively, the percentage of falls from baseline in heart rate, arterial oxygen saturation and cerebral tissue oxygenation index during short apneas and periodic breathing, and the associated percentage of total sleep time with systemic (arterial oxygen saturation < 90%) and cerebral hypoxia (cerebral tissue oxygenation index < 55%) were analysed using a linear mixed model. Results showed that the prone position decreased (improved) the percentage of falls from baseline in arterial oxygen saturation during both short apneas and periodic breathing, decreased the proportion of infants with periodic breathing and the periodic breathing-associated percentage of total sleep time with cerebral hypoxia. The percentage of time in quiet sleep was higher in the prone position. Quiet sleep decreased the percentage of total sleep time spent in short apneas, the short apneas-associated percentage of falls from baseline in heart rate, arterial oxygen saturation, and proportion of infants with systemic hypoxia. Quiet sleep also decreased the proportion of infants with periodic breathing and percentage of total sleep time with cerebral hypoxia. The effects of sleep position and sleep state were not related to postmenstrual age. In summary, when sleep state is controlled for, the prone sleeping position has some benefits during both short apneas and periodic breathing. Quiet sleep improves cardiorespiratory stability and is increased in the prone position at the expense of active sleep, which is critical for brain maturation. This evidence should be considered in positioning preterm infants., (© 2024 The Author(s). Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Objective: This review aims to examine the impact of early introduction of oral feeding, compared with standard care, on the duration of achieving full oral feeding, postmenstrual ages at full oral feeding and discharge, and weight gain in preterm infants., Introduction: Because of their immature oral function, preterm infants are prone to feeding difficulties during hospitalization and after hospital discharge. Early introduction of oral feeding helps infants to coordinate sucking, swallowing, and respiration, thereby improving their oral feeding skills. However, early introduction of oral feeding may also contribute to respiratory adverse events; therefore, safety verification is necessary., Inclusion Criteria: Early introduction of oral feeding is defined as beginning oral feeding at < 33 weeks' postmenstrual age and transitioning from tube feeding to oral feeding. The primary outcomes are the duration from the initial oral feeding to full oral feeding; postmenstrual age at full oral feeding and discharge; and weight gain. The secondary outcomes are oxygen desaturation and bradycardia., Methods: Eight databases, including MEDLINE (Ovid), CINAHL (EBSCOhost), and the Cochrane Central Register of Controlled Trials, will be used with no restrictions on language or publication year. Study selection, critical appraisal, data extraction, and data synthesis will be conducted by 2 independent reviewers according to the JBI methodology for systematic reviews. Quantitative data will be extracted and pooled in a statistical meta-analysis, if possible. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to assess the certainty of evidence., Review Registration: PROSPERO CRD42024530910., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 JBI.)

In very preterm-born infants, nutritional intake is important to reduce the risk of severe metabolic bone disease including the risk of a lower bone mineral density (BMD). The aim of this study was to evaluate bone mineral content (BMC) and BMD (measured as BMC per bone area (BA)) at six years of age in very preterm-born infants fed different diets post-discharge. Data on this topic so far is insufficient, and with this study we aim to supply more useful data. A prospective follow-up study of 281 children born very preterm (gestational age ≤ 32 + 0 weeks) and enrolled in a multicentre RCT on post-discharge nutrition. Infants fed human milk (HM) were randomised respectively to be fed unfortified HM (UHM) or fortified human milk (FHM) from hospital discharge to four months' corrected age. Those not fed HM received a preterm formula (PF). At six years of age, BMD and BMC in all the children were established by means of a dual-energy X-ray absorptiometry (DXA) scan (Lunar Prodigy) and adjusted for sex, age, and anthropometrics. A total of 192 very preterm-born children (59 fed UHM, 67 FHM and 66 PF) had a DXA scan performed at median 6 (5.8-8.3) years of age. No significant difference was found comparing UHM and FHM according to height, weight, BA, BMC, and BMD at six years of age. However, a multiple regression analysis showed significantly improved BMD in breastfed children compared to PF-fed children., Conclusions: Fortified compared to non-fortified human milk post-discharge did not have an impact on BMD at 6 years of age in very preterm-born infants. Breastfed children demonstrated higher BMD than formula-fed children., What Is Known: • Adequate nutritional intake is important to improve growth and to reduce the risk of severe bone disease in very preterm born infants. • Bone mineralization is attained later in preterm born infants compared to term born infants., What Is New: • Feeding human milk with fortification compared to non-fortified human milk did not improve bone mineral density in children born very preterm in this follow-up study at six years of age. • Feeding human milk compared to formula was associated with increased BMD at six years of age among very preterm born infants., Competing Interests: Declarations. Financial disclosure: The authors have no financial relationships relevant to this article to disclose. Ethics approval: According to the Declaration of Helsinki the original RCT and the follow-up was approved by the Danish National Committee on Biomedical Research Ethics (no. VF20030208), and handling of data were approved by the Danish Data Protection Agency (no. 2016–41-4921). The study was registered at www.Clinicaltrials.gov (SDU-2014-LHT-NCT02078687). Consent to participate: Written informed consent was obtained from the parent. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s).)

It has been widely assessed that very preterm children (<32 weeks gestational age) present language and memory impairments compared with full-term children. However, differences in their underlying semantic memory structure have not been studied yet. Nevertheless, the way concepts are learned and organized across development relates to children's capacities in retrieving and using information later. Therefore, the semantic memory organization could underlie several cognitive deficits existing in very preterm children. Computational mathematical models offer the possibility to characterize semantic networks through three coefficients calculated on spoken language: average shortest path length (i.e., distance between concepts), clustering (i.e., local interconnectivity), and modularity (i.e., compartmentalization into small sub-networks). Here we assessed these coefficients in 38 very preterm schoolchildren (aged 8-10 years) compared with 38 full-term schoolchildren (aged 7-10 years) based on a verbal fluency task. Using semantic network analysis, very preterm children showed a longer distance between concepts and a lower interconnectivity at a local level than full-term children. In addition, we found a trend for a higher modularity at a global in very preterm children compared with full-term children. These findings provide preliminary evidence that very preterm children demonstrate subtle impairments in the organization of their semantic network, encouraging the adaptation of the support and education they receive., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Décaillet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Previous studies have documented the effectiveness of music therapy in improving adverse neonatal outcomes in premature infants. However, this review aims to address the question of how long listening to music can enhance these neonatal outcomes., Methods: To conduct this dose-response meta-analysis, we searched the PubMed, Scopus, Web of Science, and Cochrane Library databases. The inclusion criteria comprised randomized clinical trials that investigated the effects of music therapy on improving adverse neonatal outcomes. Preterm infants were defined as those born between 27 and 37 weeks of gestation, as fetuses are known to respond to auditory stimuli starting at the 27th week of pregnancy. The initial search was performed on January 28, 2024, and there were no restrictions on the time frame for the search. Ultimately, we employed a two-stage random effects model using the "drmeta" package in Stata software to perform this dose-response meta-analysis., Results: In total, 30 articles (1855 participants) were identified for inclusion in our meta-analysis. According to pooled analysis with each minute increase in music therapy, the means of respiratory rate, pain score, SBP, DBP, behavioral score, and body temperature decrease by 35.3 beats per minutes, 15.3 VAS, 30.7 mmHg, 8.9 mmHg, 2.7, and 0.27°C. On the other hand, with each minute increase in listening to the music, the mean of O2 saturation, heart rate and sleep duration increase 1.7%, 89.2 beats per minutes and 5.081 minutes per day, respectively., Conclusion: Music therapy improves the neonatal outcomes of O2 saturation, heart rate, respiratory rate, sleep duration, body temperature and systolic and diastolic blood pressures. Therefore, the existence of a dose-response relationship can indicate a causal relationship between music therapy and the improvement of neonatal outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Shahbazi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Physical activity (PA) is beneficial for several health outcomes. Adults born with very low birth weight (VLBW<1500g) undertake less PA than those born at term, have poorer motor abilities and may serve as a model on early life origins of PA. We therefore examined whether motor abilities mediate the association between being born with VLBW and device-measured PA. In a joint assessment of two longitudinal birth cohorts from Finland and Norway, PA was measured by two tri-axial accelerometers in 87 adults born preterm with VLBW and 109 controls born at term. We explored the mediating role of motor abilities assessed by standardized tests on the association between VLBW and device-measured PA. To do this, we examined group differences in metabolic equivalent of task (MET) min/day of moderate to vigorous PA (MVPA), light PA and sedentary. Analyses were adjusted for cohort, age and sex. MVPA was 40.4 (95% confidence interval [CI]: 13.3 to 69.4) MET min/day lower in the VLBW group than the control group. This was in part mediated through gross motor abilities, indicated by the indirect effect on the association between VLBW and MVPA being -15.6 (95% CI: -28.5 to -5.4) MET min/day. In conclusion, adults born preterm with VLBW undertake less MVPA than controls born at term, and gross motor abilities mediate this association. Interventions targeting motor abilities should be examined as potential ways to increase PA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Benum et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU., Design, Setting and Patients: We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI's BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US)., Results: 191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio., Conclusions: Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge., Competing Interests: Competing interests: There are no competing interests., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Computational analysis of infant movement has significant potential to reveal markers of developmental health. We report two studies employing dynamic analyses of motor kinematics and motor behaviours, which characterise movement at two levels, in 9-month-old infants. We investigate the effect of preterm birth (< 33 weeks of gestation) and the effect of changing emotional and social-interactive contexts in the still-face paradigm. First, multiscale permutation entropy was employed to analyse acceleration kinematic timeseries data collected from Inertial Measurement Unit (IMU) sensors on infants' torso, wrists, and ankles (N = 32: 10 term; 22 preterm). Second, Recurrence Quantification Analysis was used to characterise patterns of second-to-second behavioural changes, from observationally coded behavioural timeseries on infants' emotional self-regulation (N = 111: 61 term; 50 preterm). We found frequency-specific effects of context on permutation entropy. Relative to infants born at term (> 37 weeks of gestation), infants born preterm showed greater permutation entropy in their left ankle and torso movements, but not in right ankle or wrist movements. We did not find effects of preterm birth or emotional context on micro-level behavioural dynamics. Our methodology and findings inform future work using multiscale entropy to study infant development. Dynamic analysis of behaviour is a relatively young field, and applications to emotional self-regulation requires further methodological development., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This pilot clinical trial aimed to evaluate the effects of vestibular stimulation, through Hammock-positioning therapy (HPT) or by multidirectional balancing, administered during physical therapy, on movement repertoire, sleep-wakefulness state, and pain in late preterm infants. The newborns were randomly allocated into two groups: 1) vestibular sensory stimulation by HPT (HG) and 2) conventional vestibular stimulation (CG). Movement repertoire was evaluated using the General Movement Assessment (GMA), sleep-wakefulness state was evaluated using the Adapted Brazelton Scale, finally pain was evaluated by the Neonatal Facial Activity Coding System (NFCS). An increase in normal GMAs and a reduction in abnormal GMAs was observed in the HG group after intervention. An Improvement in the sleep-wakefulness state scores was observed in the HG group. In the CG group, same improvements were seen. In conclusion, HPT has a positive effect on the sleep-wakefulness state and movement repertoire in late preterm infants similar to the conventional group.

When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500-750 mL by Day 14 after birth, as this is considered a 'critical window' to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a 'gold standard' outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24-h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post-menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3-4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3-5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Although recent studies have consistently reported the emergence of resting-state networks in early infancy, the changes in inter-network functional connectivity with age are controversial and the alterations in its dynamics remain unclear at this stage. This study aimed to investigate dynamic functional network connectivity (dFNC) using resting-state functional MRI in 244 full-term (age: 37-44 weeks) and 36 preterm infants (age: 37-43 weeks) from the dHCP dataset. We evaluated whether early dFNC exhibits age-dependent changes and is influenced by preterm birth. Gestational age (GA) and postnatal age (PNA) showed different effects on variance of FNC change over time during fMRI scan in resting-state networks, especially among high-order association networks. These variances were significantly reduced by preterm birth. Moreover, two states of weakly-connected (State Ⅰ) and strongly-connected (State Ⅱ) FNC were identified. The fraction window and dwell time in State Ⅰ, and the transition from State Ⅱ to State Ⅰ, all showed significantly negative correlations with both GA and PNA. Preterm-born infants spent a longer time in the weakly-connected state compared to term-born infants. These findings suggest a state-dependent development of dynamic FNC across brain networks in the early stages, gradually reconfiguring towards a more flexible and dynamic system with stronger connections., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This comprehensive longitudinal study explored for the first time the interrelations between neonatal brainstem abnormalities, focused attention (FA), and learning-following a preterm cohort (N = 175; 46.3% female; predominantly White) from birth (2003-2006) to 17 years. The findings indicated that FA during early childhood was associated with language outcomes in toddlerhood (n = 131) and academic and attention self-report indices in late adolescence (n = 44). Pilot assessments indicated that FA at 17 years (n = 25) was also associated with concurrent academic and attention functioning. Structural equation modeling analyses revealed that neonatal brainstem functioning, manifested in auditory brainstem response patterns, was associated with early-life FA competence, which affected learning development. Implications underscore the essential role of early brainstem function and FA in shaping childhood learning trajectories., (© 2024 The Author(s). Child Development published by Wiley Periodicals LLC on behalf of Society for Research in Child Development.)

Premature infants, born before 37 weeks of gestation can have alterations in neurodevelopment and cognition, even when no anatomical lesions are evident. Resting-state functional neuroimaging of naturally sleeping babies has shown altered connectivity patterns, but there is limited evidence on the developmental trajectories of functional organization in preterm neonates. By using a large dataset from the developing Human Connectome Project, we explored the differences in graph theory properties between at-term (n = 332) and preterm (n = 115) neonates at term-equivalent age, considering the age subgroups proposed by the World Health Organization for premature birth. Leveraging the longitudinal follow-up for some preterm participants, we characterized the developmental trajectories for preterm and at-term neonates, for this purpose linear, quadratic, and log-linear mixed models were constructed with gestational age at scan as an independent fixed-effect variable and random effects were added for the intercept and subject ID. Significance was defined at p < 0.05, and the model with the lowest Akaike Information Criterion (AIC) was selected as the best model. We found significant differences between groups in connectivity strength, clustering coefficient, characteristic path length and global efficiency. Specifically, at term-equivalent ages, higher connectivity, clustering coefficient and efficiency are identified for neonates born at later postmenstrual ages. Similarly, the characteristic path length showed the inverse pattern. These results were consistent for a variety of connectivity thresholds at both the global (whole brain) and local level (brain regions). The brain regions with the greatest differences between groups include primary sensory and motor regions and the precuneus which may relate to the risk factors for sensorimotor and behavioral deficits associated with premature birth. Our results also show non-linear developmental trajectories for premature neonates, but decreased integration and segregation even at term-equivalent age. Overall, our results confirm altered functional connectivity, integration and segregation properties of the premature brain despite showing rapid maturation after birth., (© 2025 The Author(s). Human Brain Mapping published by Wiley Periodicals LLC.)

Preterm birth poses a major public health challenge, with significant and heterogeneous developmental impacts. Latent profile analysis was applied to the National Institutes of Health Toolbox performance of 1891 healthy prematurely born children from the Adolescent Brain and Cognitive Development study (970 boys, 921 girls; 10.00 ± 0.61 years; 1.3% Asian, 13.7% Black, 17.5% Hispanic, 57.0% White, 10.4% Other). Three distinct neurocognitive profiles emerged: consistently performing above the norm (19.7%), mixed scores (41.0%), and consistently performing below the norm (39.3%). These profiles were associated with lasting cognitive, neural, behavioral, and academic differences. These findings underscore the importance of recognizing diverse developmental trajectories in prematurely born children, advocating for personalized diagnosis and intervention to enhance care strategies and long-term outcomes for this heterogeneous population., (© 2024 The Author(s). Child Development © 2024 Society for Research in Child Development.)

The human brain connectome is characterized by the duality of highly modular structure and efficient integration, supporting information processing. Newborns with congenital heart disease (CHD), prematurity, or spina bifida aperta (SBA) constitute a population at risk for altered brain development and developmental delay (DD). We hypothesize that, independent of etiology, alterations of connectomic organization reflect neural circuitry impairments in cognitive DD. Our study aim is to address this knowledge gap by using a multi-etiologic neonatal dataset to reveal potential commonalities and distinctions in the structural brain connectome and their associations with DD. We used diffusion tensor imaging of 187 newborns (42 controls, 51 with CHD, 51 with prematurity, and 43 with SBA). Structural weighted connectomes were constructed using constrained spherical deconvolution-based probabilistic tractography and the Edinburgh Neonatal Atlas. Assessment of brain network topology encompassed the analysis of global graph features, network-based statistics, and low-dimensional representation of global and local graph features. The Cognitive Composite Score of the Bayley scales of Infant and Toddler Development 3rd edition was used as outcome measure at corrected 2 years for the preterm born individuals and SBA patients, and at 1 year for the healthy controls and CHD. We detected differences in the connectomic structure of newborns across the four groups after visualizing the connectomes in a two-dimensional space defined by network integration and segregation. Further, analysis of covariance analyses revealed differences in global efficiency (p < 0.0001), modularity (p < 0.0001), mean rich club coefficient (p = 0.017), and small-worldness (p = 0.016) between groups after adjustment for postmenstrual age at scan and gestational age at birth. Moreover, small-worldness was significantly associated with poorer cognitive outcome, specifically in the CHD cohort (r = -0.41, p = 0.005). Our cross-etiologic study identified divergent structural brain connectome profiles linked to deviations from optimal network integration and segregation in newborns at risk for DD. Small-worldness emerges as a key feature, associating with early cognitive outcomes, especially within the CHD cohort, emphasizing small-worldness' crucial role in shaping neurodevelopmental trajectories. Neonatal connectomic alterations associated with DD may serve as a marker identifying newborns at-risk for DD and provide early therapeutic interventions. Trial Registration: ClinicalTrials.gov identifier: NCT00313946., (© 2025 The Author(s). Human Brain Mapping published by Wiley Periodicals LLC.)

Little is known about language development after late-to-moderate premature birth, the most significant part of prematurity worldwide. We examined minimal-pair word-learning skills in 18 eighteen-month-old healthy full-term (mean gestational age [GA] at birth = 39.6 weeks; 7 males; 100% Caucasian) and 18 healthy late-to-moderate preterm infants (mean GA at birth 33.7 weeks; 11 males; 100% Caucasian). Data were collected in the local urban area of Barcelona city from May 2015 to August 2016. Toddlers first associated two pseudo-words, forming a minimal pair based on a voice onset time distinction of the initial consonant, with two unfamiliar objects during a habituation phase. A visual choice test assessed their recognition of the two novel word-object associations and some familiar word-object pairs. While full-terms successfully mapped the similar sounding pair of novel words (d = 1.57), preterms could not (d = 0.17). These results suggest that late to moderate preterm birth can hinder basic associative learning mechanisms relying on fine temporal speech features., (© 2024 The Author(s). Child Development © 2024 Society for Research in Child Development.)

Objective: This study aimed to prove the effectiveness of physiological flexion swaddling and oromotor interventions in terms of the duration needed to achieve the oral feeding ability of preterm infants in the NICU., Methods: A randomized clinical trial in five Neonatal intensive care units (NICU) was performed involving 70 preterm infants born at 28-34 weeks gestational age. Participants were allocated to 1) the experimental group (n = 39) received physiological flexion swaddling and oromotor interventions, and 2) the control group (n = 31) received conventional swaddling and oromotor interventions. Mann-Whitney U analysis was used to determine the effectiveness of each group according to the duration needed to achieve oral feeding ability, while Kaplan-Meier survival analysis was applied to compare the duration of both groups., Results: The experimental group had a significantly shorter duration in achieving oral feeding ability [4 (1-15) vs. 7 (2-22) days; p = 0.02]. The Kaplan-Meier survival curve analysis showed that infants in the experimental group achieved full oral feeding ability earlier than those in the control group (15 vs. 22 days)., Conclusions: Physiological flexion swaddling and oromotor interventions have been proven to be effective in shortening the number of days needed to achieve the oral feeding ability of preterm infants in the NICU., Competing Interests: Conflicts of interest The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript., (Copyright © 2024. Published by Elsevier Editora Ltda.)

Study Objectives: The brains of preterm infants exhibit altered functional connectivity (FC) networks, but the potential variation in sleep states and the impact of breathing patterns on FC networks are unclear. This study explores the evolution of resting-state FC from preterm to term, focusing on breathing patterns and distinguishing between active sleep (AS) and quiet sleep (QS)., Methods: We recruited 63 preterm infants and 44 healthy-term infants and performed simultaneous electroencephalography and functional near-infrared spectroscopy. FC was calculated using oxy- and deoxyhemoglobin signals across eight channels. First, FC was compared between periodic breathing (PB) and non-PB segments. Then sleep state-dependent FC development was explored. FC was compared between AS and QS segments and between preterm infants at term and term-born infants in each sleep state. Finally, associations between FC at term, clinical characteristics, and neurodevelopmental outcomes in late infancy were assessed in preterm infants., Results: In total, 148 records from preterm infants and 44 from term-born infants were analyzed. PB inflated FC values. After excluding PB segments, FC was found to be elevated during AS compared to QS, particularly in connections involving occipital regions. Preterm infants had significantly higher FC in both sleep states compared to term-born infants. Furthermore, stronger FC in specific connections during AS at term was associated with unfavorable neurodevelopment in preterm infants., Conclusions: Sleep states play a critical role in FC development and preterm infants show observable changes in FC., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

A growing body of literature suggests that power spectral density (PSD) slope, measured using electroencephalography (EEG), might reflect synaptic activity and be a useful marker of early brain development. The objective of this article is to identify differences between preterm and full-term infants in PSD slope in active and quiet sleep. This is a secondary analysis of two studies, including premature (N = 33) (30 0/7 and 36 0/7 weeks' gestation) and full-term infants (N = 22). EEG was performed at near term-equivalent age in premature infants and within 36 h after birth in full-term infants. The natural log of the EEG power spectrum was plotted versus the natural log of the frequency spectrum. To estimate PSD slope, the power law exponent derived from the slope of the log(power) versus log(frequency) was calculated for the 1-20 Hz range and the 21-40 Hz range. Linear regression models were fit for each region in active and quiet sleep to examine the association between the PSD slope and infant age group. Preterm versus full-term infants demonstrated a less negative slope across multiple brain regions in active and quiet sleep. PSD slope may be an early measure of altered brain development in premature infants., (© 2024 Wiley Periodicals LLC.)

Prenatal listening experience reportedly modulates how humans process speech at birth, but little is known about how speech perception develops throughout the perinatal period. The present experiment assessed the neural event-related potentials (ERP) and mismatch responses (MMR) to native vowels in 99 neonates born between 32 and 42 weeks of gestation. The vowels elicited reliable ERPs in newborns whose gestational age at time of experiment was at least 36 weeks and 1 day (36 + 1). The ERPs reflected spectral distinctions between vowel onsets from age 36 weeks + 6 days and durational distinctions at vowel offsets from age 37 weeks + 6 days. Starting at age 40 + 4, there was evidence of neural discrimination of vowel length, indexed by a negative MMR response. The present findings extend our understanding of the earliest stages of speech perception development in that they pinpoint the ages at which the cortex reliably responds to the phonetic characteristics of individual speech sounds and discriminates a native phoneme contrast. The age at which the brain reliably differentiates vowel onsets coincides with what is considered term age in many countries (37 weeks + 0 days of gestational age). Future studies should investigate to what extent the perinatal maturation of the cortical responses to speech sounds is modulated by the ambient language., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: Preterm infants need nutritional support due to their premature digestive system, undeveloped anatomy and functional limitations. Neonatal positioning in the proper position is one of the nurses' main principles that affect the residual volume. We performed our systematic review and network meta-analysis to determine the best feeding position for preterm infants in reducing gastric residual volume and increasing the rate of gastric emptying., Methods: We systematically searched PubMed, Cochrane, CINHAL, Scopus and Web of Science from their inception to August 2023. We included studies that assess the effect of different feeding positions for preterm infants on gastric residuals. The Cochrane risk of bias tool (ROB2) appraised the included clinical trials. Cohort studies were assessed by the NIH tool and quasi-experimental studies by the relevant items from (Downs and Black) checklist. RevMan Version 5.4 was used for analysing the pooled data. Our study included a frequentist network meta-analysis of the aggregate data to obtain network estimates for the outcomes of interest. Network meta-analysis was done using R software., Results: We included 16 studies with 1139 premature infants, comparing six preterm feeding positions. The pooled MD and 95% CI for GRV at 30 min for right lateral, prone, right anterior oblique and left lateral compared to supine position were as follows: (-12.08 [-20.09, -4.07]), (-11.14 [-18.26, -4.01]), (-9.02 [-21.66, 3.61]) and (-0.18 [-7.87, 7.5]), respectively. Moreover, the pooled MD and 95% CI for GRV at 180 min for right lateral, prone and left lateral compared to supine position were as follows: (-0.69 [-1.29, -0.09]), (-0.56 [-1.22, 0.1]) and (0.09 [-0.63, 0.81]), respectively. Nevertheless, the pooled MD and 95% CI for GRV at 120 min for right anterior oblique, prone, right lateral and left lateral compared to supine position were as follows: (-6.09 [-11.33, -0.86]), (-5.07 [-7.71, -2.43]), (-3.08 [-5.89, -0.27]) and (-0.44 [-3.41, 2.53]), respectively., Conclusion: We concluded that the best nursing position after preterm infants feeding for lower gastric residuals and higher gastric emptying rate is the right lateral position after 30 and 180 min post-feeding. Also, the right anterior oblique was the best after 120 min. Although the prone position can lower the GRV better than the left lateral and supine positions, it is not advisable to use this position because it raises the SIDS risk. Our results could help healthcare professionals to provide the appropriate positioning of preterm infants., (© 2024 John Wiley & Sons Australia, Ltd.)

There is ample research discussing the benefits of a pacifier-activated music system with preterm and high-risk infants. Benefits include improving the quality of nonnutritive sucking (NNS) and increased feeding volume/attempts/endurance, which lead to decreased time to full oral feedings and shortened hospital stays. The use of pacifier-activated music systems supports a faster transition to oral feeding in preterm infants while learning to breastfeed or bottle feed in the NICU. When coupling pacifier-activated music systems with the NNS of a pacifier, the preterm infant gains efficacy in feeding strength and endurance. Benefits also include faster nipple feeding success, mother/infant stress reduction, fewer rehospitalizations, diminished length of stay, and other long-term benefits. This article will discuss how the benefits of using music in the NICU are widespread and should be implemented as a multidisciplinary approach in a variety of NICU settings. Several NICU patient populations can benefit from music using a music pacifier system dependent on the modes used., (© 2024 Springer Publishing Company, LLC.)

Background: Stress exposure, operationalized as a count of painful or skin-breaking breaking procedures, is an important concept for inclusion in studies of preterm infants. The Neonatal Infant Stressor Scale (NISS) was developed to also account for nonpainful and environmental stressors; however, validity of this measure is unknown., Aims: The purpose of this review was to define the breadth of use of the NISS in neonatal research studies and determine its predictive and concurrent validity., Methods: Using the methods for integrative review, a systematic search of the literature was conducted using PubMed, CINAHL, PsycINFO, and Embase with keywords "NISS" OR "Neonatal Infant Stressor Scale". Study findings were narratively synthesized., Results: Twenty-nine articles were retained for the review and included two cross-sectional studies describing development or adaptation of the measure, two protocols for empirical studies, and 25 empirical studies of preterm infants. Modifications to the original NISS were common and included addition or exclusion of specific stressors and use of unweighted scores. Although findings were inconsistent across studies, limited data support the predictive validity of the NISS, as higher NISS scores have been associated with abnormal brain development and cognitive, motor, and behavioral deficits. Two studies found concurrent associations between NISS scores and cortisol., Conclusion: The NISS may be a useful tool to quantify stressors experienced by preterm infants; however, there are only limited data to support its predictive or concurrent validity. The NISS may be particularly useful as a method to bring awareness to the infant's stress burden in clinical practice. Additional research is needed to validate inclusion of specific stressors in the NISS., Competing Interests: Declaration of competing interest Thao Griffith reports financial support was provided by National Institute of Nursing Research. Marliese Nist reports a relationship with National Association of Neonatal Nurses that includes: travel reimbursement. Marliese Nist reports a relationship with National Institute of Child Health and Human Development that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Approximately 15 million babies are born preterm (<37 weeks of completed gestation) worldwide annually. Although neonatal and perinatal medicine have contributed to the increased survival rate of preterm newborn infants, premature infants are at increased risk of mortality in the first years of life. Infants born preterm are at four times the risk of Sudden Infant Death Syndrome (SIDS) compared to infants born at term. SIDS is believed to be multifactorial in origin. The Triple Risk hypothesis has been proposed to explain this. The model suggests that when a vulnerable infant, such as one born preterm, is at a critical but unstable developmental period in homeostatic control, death may occur if exposed to an exogenous stressor, such as being placed prone for sleep. The highest risk period is at ages 2-4 months, with 90 % of deaths occurring before 6 months. The final pathway to SIDS is widely believed to involve some combination of immature cardiorespiratory control and a failure of arousal from sleep. This review will focus on the physiological factors which increase the risk for SIDS in preterm infants and how these factors may be identified and potentially lead to effective preventative strategies., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

As a NICU parent, I was always wondering how my daughter could sleep through all of the noise in the NICU what with her very early birth. I was already concerned about her developmental outcomes due to the birth itself, but the alarms and noise in the NICU gave me incredible pause. So when I found about DREAMIES, a product that helps muffle the noise not only in the NICU but during transport and during an MRI, I was amazed., (© 2024 Springer Publishing Company, LLC.)

The way in which a mother and her preterm baby interact, especially in moments preceding or following stressful events, is fundamental in shaping the infant's autoregulation. Patterns of mutual sequential coordination constitute stress regulation competences and provide foundation for later socio-emotional development. Maternal affective touch has been postulated as an essential regulatory factor in early social exchange. In this study we aimed to better understand the interplay between maternal affective tactile behaviors and physiological synchrony between mother and child, with possible implications for early bonding processes. Fifteen mother-premature infant dyads were video-recorded during a free interaction and directly after a skin-interrupting medical procedure (vaccination or blood sampling) in the Neonatal Intensive Care Unit. The proportion of maternal affective touch was coded both in free and post-stress interactions. Parasympathetic response was assessed simultaneously in mothers and neonates in order to observe physiological synchrony in dyads. Finally, interactional misattunement during mothers' comforting actions and infant behavior after stress was evaluated as a potential indicator of risk in early bonding processes. Results indicated a positive association between the duration of maternal affective touch and adaptive autonomic synchrony patterns in dyads. Correlations were found between maternal affective touch both before and after stress-inducing procedure and several synchrony measures from free interaction phase (Spearman ρ = -0,57 do 0,72, p < 0,05) Additionally, the study revealed a positive correlation between the level of interactional misattunement and the duration of maternal affective touch after stress (ρ = 0,47, p < 0,05). The quality of synchrony was better in free interactions than during post-stress kangaroo care phase (p < 0,05)., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Researchers have hypothesized that infant language learning starts from the third trimester of pregnancy. This is supported by studies with fetuses and newborns showing discrimination/preference for their native language. Jointly with empirical research, initial computational modeling studies have investigated whether learning language patterns from speech input benefits from auditory prenatal language exposure (PLE), showing some advantages for prior adaptation to speech-like patterns. However, these modeling studies have not modeled prenatal speech input in an ecologically representative manner regarding quality or quantity. This study describes an ecologically representative framework for modeling PLE for full-term and preterm infants. The approach is based on empirical estimates of the amount of prenatal speech input together with a model of speech signal attenuation from the external air to the fetus' auditory system. Using this framework, we conduct language learning simulations with computational models that learn from acoustic speech input in an unsupervised manner. We compare the effects of PLE to standard learning from only postnatal input on various early language phenomena. The results show how incorporating PLE can affect models' learning outcomes, including differences between full-term and preterm conditions. Moreover, PLE duration might influence model behavior, depending on the linguistic capability being tested. While the inclusion of PLE did not improve the compatibility of the tested models with empirical infant data, our study highlights the relevance of PLE as a factor in modeling studies. Moreover, it provides a basic framework for modeling the prenatal period in future computational studies., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Newborns are able to neurally discriminate between speech and nonspeech right after birth. To date it remains unknown whether this early speech discrimination and the underlying neural language network is associated with later language development. Preterm-born children are an interesting cohort to investigate this relationship, as previous studies have shown that preterm-born neonates exhibit alterations of speech processing and have a greater risk of later language deficits. This investigation also holds clinical importance, as differences in neonatal speech discrimination and its functional networks may serve as predictors of later language outcomes. We therefore investigated neural speech discrimination using functional near-infrared spectroscopy in 92 preterm- and term-born neonates and its predictive value for language development in 45 of them. Three to five years later, preterm-born and term-born children did not significantly differ in language comprehension, sentence production, the use of morphological rules, or phonological short-term memory. In addition, the gestational age at birth was not a significant predictor of language development. Neural speech discrimination, in contrast, was strongly correlated with later phonological short-term memory. However, not the extent of speech discrimination, but rather its lateralization, was a predictor of language development. Children with less right hemisphere involvement-and therefore more left-lateralized speech discrimination at birth-showed better development of phonological short-term memory three to five years later. These findings suggest that the ability of fetuses to form memory traces is reflected by neonatal abilities to neurally discriminate speech, which in turn is a predictor for later phonological short-term memory., (© 2025 The Author(s). Developmental Science published by John Wiley & Sons Ltd.)

Structural and functional connectomes undergo rapid changes during the third trimester and the first month of postnatal life. Despite progress, our understanding of the developmental trajectories of the connectome in the perinatal period remains incomplete. Brain age prediction uses machine learning to estimate the brain's maturity relative to normative data. The difference between the individual's predicted and chronological age-or brain age gap (BAG)-represents the deviation from these normative trajectories. Here, we assess brain age prediction and BAGs using structural and functional connectomes for infants in the first month of life. We use resting-state fMRI and DTI data from 611 infants (174 preterm; 437 term) from the Developing Human Connectome Project (dHCP) and connectome-based predictive modeling to predict postmenstrual age (PMA). Structural and functional connectomes accurately predict PMA for term and preterm infants. Predicted ages from each modality are correlated. At the network level, nearly all canonical brain networks-even putatively later developing ones-generate accurate PMA prediction. Additionally, BAGs are associated with perinatal exposures and toddler behavioral outcomes. Overall, our results underscore the importance of normative modeling and deviations from these models during the perinatal period., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Continuous positive airway pressure (CPAP) is a recommended first-line therapy for infants with respiratory distress at birth. Resuscitation devices incorporating CPAP delivery can have significantly different imposed resistances affecting airway pressure stability and work of breathing., Aim: To compare CPAP performance of two resuscitation devices (Neopuff T-piece resuscitator and rPAP) in a neonatal lung model simulating spontaneous breathing effort at birth., Methods: The parameters assessed were variation in delivered pressures (∆P), tidal volume (VT), inspiratory effort (model pressure respiratory muscle (PRM)) and work of breathing (WOB). Two data sequences were required with Neopuff and one with rPAP: (1) set PRM with changes in VT and (2) constant VT (preterm 6 mL, term 22 mL) with increased effort. Data were collected at CPAP settings of 5, 7 and 9 cmH 2 O using a 1 kg preterm (Compliance: 0.5 mL/cmH 2 O) and 3.5 kg term (1.0 mL/cmH 2 O) model., Results: 2298 breaths were analysed (760 rPAP, 795 Neopuff constant VT, 743 Neopuff constant PRM). With CPAP at 9 cmH 2 O and set VT the mean ∆P (cmH 2 O) rPAP vs Neopuff 1.1 vs 5.6 (preterm) and 1.9 vs 13.4 (term), WOB (mJ) 4.6 vs 6.1 (preterm) and 35.3 vs 44.5 (term), and with set PRM mean VT (ml) decreased to 6.2 vs 5.2 (preterm) and 22.3 vs 17.5 (term) p<0.001. Similar results were found at pressures of 5 and 7 cmH 2 O., Conclusion: rPAP had smaller pressure swings than Neopuff at all CPAP levels and was thus more pressure stable. WOB was higher with Neopuff when VT was held constant. VT reduced with Neopuff when respiratory effort was constant., Competing Interests: Competing interests: T Drevhammar is one of the inventors of rPAP., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The first 1000 days of life are of paramount importance for neonatal development. Premature newborns are exposed early to the external environment, modifying the fetal exposome and leading to overexposure in some sensory domains and deprivation in others. The resulting neurodevelopmental effects may persist throughout the individual's lifetime. Several neonatal neuromonitoring techniques can be used to investigate neural mechanisms in early postnatal development. EEG is the most widely used, as it is easy to perform, even at the patient's bedside. It is not expensive and provides information with a high temporal resolution and relatively good spatial resolution when performed in high-density mode. Functional near-infrared spectroscopy (fNIRS), a technique for monitoring vascular network dynamics, can also be used at the patient's bedside. It is not expensive and has a good spatial resolution at the cortical surface. These two techniques can be combined for simultaneous monitoring of the neuronal and vascular networks in premature newborns, providing insight into neurodevelopment before term. However, the extent to which more general conclusions about fetal development can be drawn from findings for premature neonates remains unclear due to considerable differences in environmental and medical situations. Fetal MEG (fMEG, as an alternative to EEG for preterm infants) and fMRI (as an alternative to fNIRS for preterm infants) can also be used to investigate fetal neurodevelopment on a trimester-specific basis. These techniques should be used for validation purposes as they are the only tools available for evaluating neuronal dysfunction in the fetus at the time of the gene-environment interactions influencing transient neuronal progenitor populations in brain structures. But what do these techniques tell us about early neurodevelopment? We address this question here, from two points of view. We first discuss spontaneous neural activity and its electromagnetic and hemodynamic correlates. We then explore the effects of stimulating the immature developing brain with information from exogenous sources, reviewing the available evidence concerning the characteristics of electromagnetic and hemodynamic responses. Once the characteristics of the correlates of neural dynamics have been determined, it will be essential to evaluate their possible modulation in the context of disease and in at-risk populations. Evidence can be collected with various neuroimaging techniques targeting both spontaneous and exogenously driven neural activity. A multimodal approach combining the neuromonitoring of different functional compartments (neuronal and vascular) is required to improve our understanding of the normal functioning and dysfunction of the brain and to identify neurobiomarkers for predicting the neurodevelopmental outcome of premature neonate and fetus. Such an approach would provide a framework for exploring early neurodevelopment, paving the way for the development of tools for earlier diagnosis in these vulnerable populations, thereby facilitating preventive, rescue and reparative neurotherapeutic interventions., (Copyright © 2024. Published by Elsevier Ltd.)

Background: One criterion for infant NICU discharge is the ability to meet all nutritional needs by mouth, therefore, it is important to understand interventions that can improve the trajectory to full oral feeding. While many oral motor and feeding interventions are used in clinical practice, it remains unclear which are supported by the literature., Aim: The aim of this integrative review was to identify and understand what oral motor interventions are defined in the literature to support positive outcomes for preterm infants and their parents., Methods: An integrative review of studies published from 2002 to 2022 focusing on applied oral motor interventions and their impact on feeding-related outcomes was completed. The systematic search used databases including PubMed, Cochrane, CINAHL, Scopus, and Google Scholar. Studies were included if they used a study population of preterm infants born

Objective: To investigate the effect of computer-based early intervention with a playpen to enhance standing and walking, and to examine the relationship between changes in gross motor percentile and segmental trunk control in preterm infants nine months corrected age., Methods: Forty infants born before 37 weeks of gestation were randomly assigned to either the experimental or control group. The Alberta Infant Motor Scale (AIMS) and the Segmental Assessment of Trunk Control (SATCo) were administered before and after the intervention. The experimental group, consisting of twenty preterm infants, participated in a computer-based early intervention involving 45 min of play in standing and walking positions, five times a week for 4 weeks., Results: There were significant between-group differences in the gross motor percentiles of the AIMS (p-value <0.001). In addition, there was a significant difference in all conditions of the SATCo scores (p-value <0.05) compared with baseline score. The change in percentiles of gross motor development was significantly correlated (r s  = 0.643; p-value <0.001) with reactive SATCo during walking in infants in the experimental group., Conclusion: Early intervention with a playpen in a standing and walking position can be applied to improve changes in gross motor percentiles and segmental trunk control in preterm infants., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Noppharath Sangkarit reports financial support was provided by University of Phayao. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

When exposed to rhythmic patterns with temporal regularity, adults exhibit an inherent ability to extract and anticipate an underlying sequence of regularly spaced beats, which is internally constructed, as beats are experienced even when no events occur at beat positions (e.g., in the case of rests). Perception of rhythm and synchronization to periodicity is indispensable for development of cognitive functions, social interaction, and adaptive behavior. We evaluated neural oscillatory activity in premature newborns (n = 19, mean age, 32 ± 2.59 weeks gestational age) during exposure to an auditory rhythmic sequence, aiming to identify early traces of periodicity encoding and rhythm processing through entrainment of neural oscillations at this stage of neurodevelopment. The rhythmic sequence elicited a systematic modulation of alpha power, synchronized to expected beat locations coinciding with both tones and rests, and independent of whether the beat was preceded by tone or rest. In addition, the periodic alpha-band fluctuations reached maximal power slightly before the corresponding beat onset times. Together, our results show neural encoding of periodicity in the premature brain involving neural oscillations in the alpha range that are much faster than the beat tempo, through alignment of alpha power to the beat tempo, consistent with observations in adults on predictive processing of temporal regularities in auditory rhythms. RESEARCH HIGHLIGHTS: In response to the presented rhythmic pattern, systematic modulations of alpha power showed that the premature brain extracted the temporal regularity of the underlying beat. In contrast to evoked potentials, which are greatly reduced when there is no sounds event, the modulation of alpha power occurred for beats coinciding with both tones and rests in a predictive way. The findings provide the first evidence for the neural coding of periodicity in auditory rhythm perception before the age of term., (© 2024 The Author(s). Developmental Science published by John Wiley & Sons Ltd.)

It is well recognized that children born preterm have specific learning difficulties. The objective of this study is to carry out a systematic review and meta-analysis on preterm children's reading ability performance. Of the 486 studies identified, 53 met the inclusion criteria, resulting in 143 effect sizes. 33,500 children between 5 and 18 years were included of whom 13,765 were preterm infants and 19,735 were full-term infants. Among preterm-born children without neurodevelopmental disorders significant differences and larger effect sizes were found in the reading subcategories, letter-word knowledge, reading comprehension, and spelling, whereas no significant differences were found in phonological awareness and rapid automatized naming. Extremely preterm children showed larger effect size. The present meta-analysis, which includes a much larger number of studies, shows that preterm children have lower performance than full-term children in reading and spelling. This fact underlines the need to design, develop and implement neuroeducational programs that take into account the characteristics of preterm born students., (© 2024. The Author(s), under exclusive licence to Marta Olivetti Belardinelli.)

Objective: To systematically review nonpharmaceutical interventions aiming to enhance neurodevelopment in preterm children and adolescents (aged 4-18 years)., Method: A systematic review of the literature was conducted for all studies published up to May 1, 2022, across Medline, Web of Science, and PsycINFO databases. Studies were evaluated for inclusion by 2 independent reviewers using predetermined inclusion criteria. The Risk of Bias In Non-randomized Studies of Interventions and the Cochrane risk-of-bias tool for randomized trials (RoB 2) tools were used to assess bias in the selected studies., Results: Of the 1778 articles identified, 23 were included. Quality assessment revealed moderate bias in 52.2%, low bias in 21.7%, and serious bias in 26.1%. The selected studies comprised 60.9% randomized controlled trials and 21.7% pre- versus postdesigns. Interventions included Cogmed Working Memory Training® (43.5%), BrainGame Brian (13%), physiotherapy (13%), and others (30.4%). Qualitative analysis showed the limited impact of interventions on neurodevelopmental outcomes in preterm children aged 4-18 years., Conclusion: Despite recent efforts to use more rigorous methodologies, current research on school-age interventions for preterm neurodevelopment exhibits methodological limitations. There is a pressing need for well-designed, large-scale clinical trials to evaluate the efficacy of nonpharmaceutical interventions in this vulnerable population., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Sleep, notably active sleep (AS) and quiet sleep (QS), plays a pivotal role in the brain development and gradual maturation of (pre) term infants. Monitoring their sleep patterns is imperative, as it can serve as a tool in promoting neurological maturation and well-being, particularly important in preterm infants who are at an increased risk of immature brain development. An accurate classification of neonatal sleep states can contribute to optimizing treatments for high-risk infants, with respiratory rate (RR) and heart rate (HR) serving as key components in sleep assessment systems for neonates. Recent studies have demonstrated the feasibility of extracting both RR and HR using near-infrared spectroscopy (NIRS) in neonates. This study introduces a comprehensive sleep classification approach leveraging high-frequency NIRS signals recorded at a sampling rate of 100 Hz from a cohort of nine preterm infants admitted to a neonatal intensive care unit. Eight distinct features were extracted from the raw NIRS signals, including HR, RR, motion-related parameters, and proxies for neural activity. These features served as inputs for a deep convolutional neural network (CNN) model designed for the classification of AS and QS sleep states. The performance of the proposed CNN model was evaluated using two cross-validation approaches: ten-fold cross-validation of data pooling and five-fold cross-validation, where each fold contains two independently recorded NIRS data. The accuracy, balanced accuracy, F1-score, Kappa, and AUC-ROC (Area Under the Curve of the Receiver Operating Characteristic) were employed to assess the classifier performance. In addition, comparative analyses against six benchmark classifiers, comprising K-Nearest Neighbors, Naive Bayes, Support Vector Machines, Random Forest (RF), AdaBoost, and XGBoost (XGB), were conducted. Our results reveal the CNN model's superior performance, achieving an average accuracy of 88%, a balanced accuracy of 94%, an F1-score of 91%, Kappa of 95%, and an AUC-ROC of 96% in data pooling cross-validation. Furthermore, in both cross-validation methods, RF and XGB demonstrated accuracy levels closely comparable to the CNN classifier. These findings underscore the feasibility of leveraging high-frequency NIRS data, coupled with NIRS-based HR and RR extraction, for assessing sleep states in neonates, even in an intensive care setting. The user-friendliness, portability, and reduced sensor complexity of the approach suggest its potential applications in various less-demanding settings. This research thus presents a promising avenue for advancing neonatal sleep assessment and its implications for infant health and development.

Objectives: To evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing., Study Design: Prospective quasi-experimental observational study., Setting: Tertiary perinatal neonatal unit., Patients: 50 very preterm infants being managed with nasal continuous positive airway pressure., Interventions: Continuous high-resolution preductal pulse-oximetry recordings using Masimo Radical-7 oximeter for 1 hour (incubator care) followed by 1 hour during KMC performed on the same day., Main Outcome Measures: Measures of cardiorespiratory stability (dips in oxygen saturations (SpO 2 )) of ≥5% less than baseline, % time spent with oxygen saturations <90%, SpO 2 variability and heart rate fluctuation and incidence of bradycardias., Results: The gestational age and birth weight of the cohort were 28.4±2.1 weeks and 1137±301 g, respectively. Dips in SpO 2 of ≥5% less than baseline were significantly fewer with KMC, median (IQR) 24 (12 to 42) vs 13 (3 to 25), p=0.001. SpO 2 variability (Delta 12 s and 2 s), (1.24±0.6 vs 0.9±0.4, p=0.005 and 4.1±1.7 vs 2.8±1.2, p<0.0001) and rapid resaturation and desaturation indices were significantly lower during KMC, compared with incubator care. Percentage time spent in oxygen saturations <90% was less with KMC (7.5% vs 2.7%, p=0.04). Mean heart rate was comparable although fluctuations in heart rate (rise by >8 bpm) were lower with KMC (43±22 vs 33±20, p=0.03). Seven (14%) infants had bradycardias during incubator care and none during KMC, p=0.012., Conclusions: KMC improves cardiorespiratory stability in ventilated preterm infants. Regular KMC has the potential to improve clinical outcomes in this vulnerable cohort., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Immature lung development and respiratory morbidity place preterm-born children at high risk of long-term pulmonary sequelae. This systematic review and meta-analysis aims to quantify lung function in preterm-born children and identify risk factors for a compromised lung function., Methods: We searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus for relevant studies published on preterm cohorts born since 1990. Studies comparing forced expiratory volume in 1 s (FEV 1 ) in preterm-born children aged ≥5 years to term-born controls or normative data were included. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Standardised mean differences in FEV 1 and secondary spirometry outcomes per study were pooled using meta-analysis. The impact of different demographic and neonatal variables on studies' FEV 1 effect sizes was investigated by meta-regression analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework., Results: We identified 42 studies with unique cohorts including 4743 preterm children and 9843 controls. Median gestational age in the studies was 28.0 weeks and age at assessment ranged from 6.7 to 16.7 years. Preterm children had lower FEV 1 than controls (-0.58 sd, 95% CI -0.69- -0.47 sd, p<0.001) resulting in a relative risk of 2.9 (95% CI 2.4-3.4) for abnormal outcome, with high certainty of evidence. FEV 1 was significantly associated with gestational age, birthweight, bronchopulmonary dysplasia and invasive mechanical ventilation in univariate meta-regression analyses (R 2 =36-96%)., Conclusion: This systematic review shows robust evidence of impaired lung function in preterm-born children with a high certainty of evidence., Competing Interests: Conflict of interest: M. Königs reports grants from GSK, KNVB and Daan Theeuwes Center for Intensive Neurorehabilitation, payment or honoraria for lectures, presentations, manuscript writing or educational events from Vrije Universiteit Amsterdam and Applied University for Physiotherapy SOMT, and their partner has stock options in Open Up BV, a psychological care provider. All other authors have nothing to disclose., (Copyright ©The authors 2024.)

Preterm birth causes alterations in structural and functional cerebral development that are not fully understood. Here, we investigate whether basic characteristics of BOLD signal itself might differ across preterm, term equivalent, and term infants. Anatomical, fMRI, and diffusion weighted imaging data from 716 neonates born at 23-43 weeks gestational age were obtained from the Developing Human Connectome Project. Hurst exponent (H; a measure of temporal complexity of a time-series) was computed from the power spectral density of the BOLD signal within 13 resting state networks. Using linear mixed effects models to account for scan age and birth age, we found that H increased with age, that earlier birth age contributed to lower H values, and that H increased most in motor and sensory networks. We then tested for a relationship between temporal complexity and structural development using H and DTI-based estimates of myelination and found moderate but significant correlations. These findings suggest that the temporal complexity of BOLD signal in neonates relates to age and tracks with known developmental trajectories in the brain. Elucidating how these signal-based differences might relate to maturing hemodynamics in the preterm brain could yield new information about neurophysiological vulnerabilities during this crucial developmental period., (© The Author(s) 2024. Published by Oxford University Press.)

Background: Nasal continuous positive airway pressure (NCPAP) is a common mode of respiratory support in neonatal intensive care units. Our objective was to compare whether NCPAP given with nasal prongs compared with a nasal mask reduces the pain scores in preterm infants with respiratory distress., Methods: Preterm infants on NCPAP due to respiratory distress were included in the study. All infants received NCPAP via the Infant Flow SiPAP. The COVERS pain scale was used to score the infants' pain. Each infant was studied alternating between nasal prongs and a nasal mask. Heart rate, respiratory rate, oxygen saturation, and transcutaneous CO 2 (tcCO 2 ) were monitored. Blood pressure and the infants' pain scores were determined every 30 minutes and the average of measurements was taken., Results: The median (interquartile range) values of pain scores, respiratory rates, oxygen saturations, tcCO 2 levels, and systolic blood pressures differed significantly and favored the nasal mask., Conclusions: This study demonstrates that continuous positive airway pressure via a nasal mask leads to a significant reduction in pain scores without altering the respiratory parameters of babies. On the basis of this study, it is possible to conclude that NCPAP applied via nasal mask may be a good alternative to NCPAP applied via nasal prongs., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings.