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Premature life exposure, meaning an immature central nervous system, presents a significant challenge for the development of postural control and, in turn, overall motor development. Preventing motor delay thus requires identifying, characterizing, and quantifying deficit in postural control as early as possible. In our study, we reviewed the procedures used in past studies to assess postural control among individuals born preterm, specifically the characterization of participants, the instruments and motor tasks involved, the types of data collected and analyzed, and the outcomes. To that end, we performed a literature search on PubMed, Wiley Online Library, Web of Science, and Scopus using Boolean logic and assessed the quality of the studies with a standardized assessment based on the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Of 35 potential studies, 24 were included; all evaluated infants born preterm, but six did not include a control group of full-term infants. Although the heterogeneity of measurements, variability of instruments, and divergence in motor tasks examined limit definitive conclusions based on quantitative synthesis and the generalization of the results, most studies revealed dysfunctional postural control among individuals born preterm. [ABSTRACT FROM AUTHOR]

In neonatal, symptomatic tetralogy of Fallot (sTOF), data are lacking on whether high-risk groups would benefit from staged (SR) or complete repair (CR). We studied the association of gestational age (GA) at birth and z-score for birth weight (BWz), with management strategy and outcomes in sTOF. California population-based cohort study (2011-2017) of infants with sTOF (defined as catheter or surgical intervention prior to 44 weeks corrected GA) was performed, comparing management strategy and timing by GA and BWz categories. Multivariable models evaluated composite outcomes and days alive and out of hospital (DAOOH) in the first year of life. Among 345 patients (SR = 194; CR = 151), management strategy did not differ by GA or BWz with complete repair defined as prior to 44 weeks corrected gestational age; however, did differ by GA with regard to complete/timely repair (defined as complete repair within first 30 days of life). Full-term and early-term neonates underwent CR 20 (95%CI: - 27.1, - 14.1; p

Aim Methods Results Conclusion To describe the concept of preterm birth in the history of medicine in France, from the 17th century up until the end of the 20th century, on the basis of old medical textbooks.Historical manuscripts and books held in medical libraries and from our personal collection were examined. Digital copies of medical textbooks online were also studied.Premature deliveries were often referred to as spontaneous abortions or miscarriages, irrespective of the infant's condition at birth. The difference between growth restriction and prematurity was not known. At the end of the 18th century, care for newborn infants entered the age of modern medicine, with observations of the newborn infant and its illnesses and experiments concerning nutrition and thermoregulation treatments. The responsibility for newborn infants, long allocated to midwives and obstetricians, was passed to neonatologists and paediatricians in the 1960s, thanks to developments in our knowledge of neonatal physiology in general and respiration, nutrition and thermoregulation in particular.This article delays the history of medicine concerned the care of preterm infants by obstetricians and then neonatologists, from the 17th century to modern period. [ABSTRACT FROM AUTHOR]

This study examined the links between maternal self‐criticism, maternal postpartum emotional distress (PPED), and maternal non‐hostility among Arab‐Bedouin mothers living in southern Israel. We proposed a moderated mediation model in which self‐criticism would be related to PPED, which, in turn would be related to maternal non‐hostility. One hundred five Arab‐Bedouin mothers and their preterm (n = 48) and full‐term (n = 57) infants were recruited shortly after birth and were followed up when infants were 6 months old (corrected for prematurity). The self‐report measures were done shortly after birth, and, the measurement of observation was done at the 6‐month visit. Findings demonstrated evidence for a moderated mediation model in which higher levels of maternal self‐criticism correlated over time with higher levels of maternal PPED, and this, in turn, predicted lower levels of maternal non‐hostility. This model was found only among the preterm group. [ABSTRACT FROM AUTHOR]

Background: Assisted reproductive technology (ART) nowadays plays a major role in the treatment of infertility, with the most frequently used techniques being in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The objective of this study is to analyze pregnancies achieved using these ART techniques and their correlations with the prematurity and congenital malformations rates. Methods: This is an observational retrospective longitudinal study that includes 814 newborns conceived through an ART, namely IVF or ICSI. Results: Using a multivariate logistic regression analysis mode, there is a higher prematurity rate in twin pregnancies OR 16 (95% CI 10.7, 23.8), donor conception OR 1.8 (95% CI 1.1, 3.3) and PIH pregnancy OR 2.6 (95% CI 1.5, 4.5). The odds of malformations in these ART pregnancies are increased by the stage of the embryo (day 3) OR 2.6 (95% CI 1.3, 5.2), fresh embryo transfer OR 2 (95% CI 1.2, 3.4) and donor conception OR 2.3 (95% CI 1.2, 4.4). The ART used (IVF/ICSI) does not influence the prematurity or birth defects rate. Conclusions: Donor conception is found to increase the odds of both prematurity and congenital malformations. The ART used (IVF/ICSI) does not influence the prematurity or birth defects rate. [ABSTRACT FROM AUTHOR]

Introduction: Myelomeningocele (MMC) is the most common neural tube defect, but rarely seen in premature infants. Most centers advocate for closure of MMC within 24 h of birth. However, this is not always possible in severely premature infants. Given the rarity of this patient population, we aimed to share our institutional experience and outcomes of severely premature infants with MMC. Methods: We performed a retrospective, observational review of premature infants (≤ 32 weeks gestational age) identified through our multidisciplinary spina bifida clinic (1995–2021) and surgical logs. Descriptive statistics were compiled about this sample including timing of MMC closure and incidence of adverse events such as sepsis, CSF diversion, meningitis, and death. Results: Eight patients were identified (50% male) with MMC who were born ≤ 32 weeks gestational age. Mean gestational age of the population was 27.3 weeks (SD 3.5). Median time to MMC closure was 1.5 days (IQR = 1—80.8). Five patients were taken for surgery within the recommended 48 h of birth; 2 patients underwent significantly delayed closure (107 and 139 days); and one patient's defect epithelized without surgical intervention. Six of eight patients required permanent cerebrospinal fluid (CSF) diversion (2 patients were treated with ventriculoperitoneal shunting (VPS), three were treated with endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) and 1 patient treated with ETV; mean of 3 years after birth, ranging from 1 day to 16 years). Two patients required more than one permanent CSF diversion procedure. Two patients developed sepsis (defined as meeting at least 2/4 SIRS criteria). In both cases of sepsis, patients developed signs and symptoms more than 72 h after birth. Notably, both instances of sepsis occurred unrelated to operative intervention as they occurred before permanent MMC closure. Two patients had intraventricular hemorrhage (both grade III). No patients developed meningitis (defined as positive CSF cultures) prior to MMC closure. Median follow up duration was 9.7 years. During this time epoch, 3 patients died: Two before 2 years of age of causes unrelated to surgical intervention. One of the two patients with grade III IVH died within 24 h of MMC closure. Conclusions: In our institutional experience with premature infants with MMC, some patients underwent delayed MMC closure. The overall rate of meningitis, sepsis, and mortality for preterm children with MMC was similar to MMC patients born at term. [ABSTRACT FROM AUTHOR]

Pre‐term birth is associated with physiological sequelae that persist into adulthood. In particular, modulated ventilatory responsiveness to hypoxia and hypercapnia has been observed in this population. Whether pre‐term birth per se causes these effects remains unclear. Therefore, we aimed to assess pulmonary ventilation and blood gases under various environmental conditions, comparing 17 healthy prematurely born individuals (mean ± SD; gestational age, 28 ± 2 weeks; age, 21 ± 4 years; peak oxygen uptake, 48.1 ± 11.2 ml kg−1 min−1) with 16 well‐matched adults born at term (gestational age, 40 ± 1 weeks; age, 22 ± 2 years; peak oxygen uptake, 51.2 ± 7.7 ml kg−1 min−1). Participants were exposed to seven combinations of hypoxia/hypobaria (equivalent to ∼3375 m) and/or hypercapnia (3% CO2), at rest for 6 min. Pulmonary ventilation, pulse oxygen saturation and the arterial partial pressures of O2 and CO2 were similar in pre‐term and full‐term individuals under all conditions. Higher ventilation in hypoxia compared to normoxia was only observed at terrestrial altitude, despite an equivalent (normobaric) hypoxic stimulus administered at sea level (0.138 FiO2${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$). Assessment of oscillations in key variables revealed that combined hypoxic hypercapnia induced greater underlying fluctuations in ventilation in pre‐term individuals only. In general, higher pulse oxygen saturation fluctuations were observed with hypoxia, and lower fluctuations in end‐tidal CO2 with hypercapnia, despite similar ventilatory oscillations observed between conditions. These findings suggest that healthy prematurely born adults display similar overall ventilation to their term‐born counterparts under various environmental stressors, but that combined ventilatory stimuli could induce an irregular underlying ventilatory pattern. Moreover, barometric pressure may be an important factor when assessing ventilatory responsiveness to moderate hypoxic stimuli. Key points: Evidence exists for unique pulmonary and respiratory function under hypoxic conditions in adult survivors of pre‐term birth. Whether pre‐term birth per se causes these differences requires a comparison of conventionally healthy prematurely born adults with an appropriately matched sample of term‐born individuals.According to the present data, there is no difference between healthy pre‐term and well‐matched term‐born individuals in the magnitude of pulmonary ventilation or arterial blood gases during independent and combined hypobaria, hypoxia and hypercapnia.Terrestrial altitude (hypobaria) was necessary to induce differences in ventilation between normoxia and a hypoxic stimulus equivalent to ∼3375 m of altitude. Furthermore, peak power in pulse oxygen saturation was similar between hypobaric normoxia and normobaric hypoxia.The observed similarities between groups suggest that ventilatory regulation under various environmental stimuli is not impaired by pre‐term birth per se. Instead, an integrated combination of neonatal treatment strategies and cardiorespiratory fitness/disease status might underlie previously observed chemosensitivity impairments. [ABSTRACT FROM AUTHOR]

Introduction: To compare neonatal, obstetrical, and maternal outcomes associated with outpatient vs inpatient management of pregnancies with preterm prelabor rupture of membranes (PPROM). Material and Methods: A search of MEDLINE, EMBASE, the Cochrane Database and Central Register from January 1, 1990 to July 31, 2023 identified randomized controlled trials (RCTs) and cohort studies comparing outpatient with inpatient management for pregnant persons diagnosed with PPROM before 37 weeks' gestation. No language restriction was applied. We applied a random effects model for meta‐analysis. Trustworthiness was assessed using recently published guidance and Risk of bias using the RoB 2.0 tool for RCTs and ROBINS‐I tool for cohort studies. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the certainty of evidence (COE). Outcomes of interest included perinatal mortality, neonatal morbidities, latency and gestational age at delivery, and maternal morbidities. RCTs and cohort studies were analyzed separately. This study was registered in the International Prospective Register of Systematic Reviewsr: CRD42022295275. Results: From 2825 records, two RCTs and 10 cohort studies involving 1876 patients were included in the review and meta‐analysis. Outpatient management protocols varied but generally included brief initial hospitalization, strict eligibility criteria, and surveillance with laboratory and ultrasound investigations. Outpatient management showed lower rates of neonatal respiratory distress syndrome (cohort: RR 0.63 [0.52–0.77, very low COE]), longer latency to delivery (RCT: MD 7.43 days [1.14–13.72 days, moderate COE], cohort: MD 8.78 days [2.29–15.26 days, low COE]), higher gestational age at birth (cohort: MD 7.70 days [2.02–13.38 days, low COE]), lower rates of Apgar scores <7 at 5 min of life (cohort: RR 0.66 [0.50–0.89, very low COE]), and lower rates of histological chorioamnionitis (cohort: RR 0.74 [0.62–0.89, low COE]) without increased risks of adverse neonatal, obstetrical, or maternal outcomes. Conclusions: Meta‐analysis of data from RCTs and cohort studies with very low‐to‐moderate certainty of evidence indicates that further high‐quality research is needed to evaluate the safety and potential benefits of outpatient management for selected PPROM cases, given the moderate‐to‐high risk of bias in the included studies. [ABSTRACT FROM AUTHOR]

• Cervical length, advanced cervical dilatation and in vitro fertilization are predictors of cerclage failure. • Similar outcomes were registered for patients who underwent cervical cerclage before and after 24 weeks. • A positive vaginal swab before cerclage exposed patients to higher risks of preterm premature rupture of membranes and chorioamnionitis. • Pre-operative assessment of a local infectious/inflammatory process may provide further insights into the pathophysiological mechanisms behind cerclage failure. We aimed to retrospectively evaluate obstetric and neonatal outcomes in patients who underwent ultrasound-indicated and rescue cervical cerclage and to identify predictors for cerclage failure and consequent preterm birth (PTB). We conducted a retrospective analysis on singleton pregnancies between 16 and 27 weeks of gestation who presented with a transvaginal sonographic cervical length (TVS-CL) <25 mm and a previous PTB/second-trimester miscarriage or prolapsed amniotic membranes and/or a TVS-CL <15 mm and underwent cervical cerclage at Mangiagalli Center, Milan, between September 2011 and December 2021. Univariate and multivariate logistic regression analyses were used to identify possible predictive factors of cerclage failure. During the study period, a total of 136 singletons met the inclusion criteria. Overall, 3 % of pregnancies did not reach fetal viability, mostly due to post-cerclage preterm premature rupture of membranes and/or chorioamnionitis. The mean gestational age at delivery was 35.9 ± 4.5 weeks. Neonates were delivered beyond 37 weeks in 63.2 % of cases, between 28 and 37 weeks in 26.5 %, and less than 28 gestational weeks in 10.3 %. At the multivariate analysis, independent risk factors for miscarriage or PTB were cervical length <10 mm (odds ratio, OR 3.44), advanced cervical dilatation (OR 4.76), and in vitro fertilization (OR 4.66). A history of previous miscarriage, premature delivery, and uterine malformations did not increase the risk of post-cerclage delivery before 37 weeks. In the preterm delivery group, 14 % of patients experienced preterm premature rupture of membranes (pPROM) and 10 % had chorioamnionitis, while no case was registered in the term delivery group. A positive vaginal swab at the time of cervical cerclage was not significantly associated with PTB at the multivariate analysis but it emerged as a significant risk factor for both chorioamnionitis (OR 11.03) and pPROM (OR 5.28). Ultrasound-indicated and rescue cervical cerclage were effective in prolonging pregnancy, even when placed beyond 24 weeks of gestation. Preoperative cervical length of less than 10 mm, advanced dilatation, and in vitro fertilization are associated with an increased risk of cerclage failure. A positive vaginal swab before cerclage is associated with increased rates of intrauterine infectious-inflammatory processes. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) poses a significant challenge as the most common late morbidity of preterm infants. This study aimed to evaluate airway abnormalities in infants with BPD who underwent flexible bronchoscopy (FB) to gain insights into the prevalence of upper airway obstruction and associated complications. A retrospective case–control study was conducted on BPD patients who underwent FB at a tertiary center between 2013 and 2023. BPD patients were matched (1:3) with a reference group based on age, gender, and ethnicity, who also had undergone FB. Demographic data, comorbidities, indications for FB, findings, and complications during and after FB were collected. The study included 50 BPD patients (mean age 1.26 ± 0.9 years, 58% males), and 150 controls. As expected, BPD patients had a lower gestational age, lower birth weight, and longer hospitalizations and were treated with more medications. Abnormal bronchoscopy findings were significantly more common in the BPD group compared to the reference group, with an increased rate of turbinate hypertrophy (OR [95% CI]: 3.44 [1.27–9.37], P = 0.014), adenoid hypertrophy (OR: 2.7 [1.38–5.29], P = 0.004), lingual tonsils (OR: 5.44 [1.29–27.4], P = 0.0024), subglottic stenosis (OR: 6.95 [2.08–27.1], P = 0.002), and tracheomalacia (OR: 2.98 [1.06–8.19], P = 0.034). Complications including desaturation (OR: 3.89 [1.32–11.7], P = 0.013) and PICU admission (OR: 16.6 [2.58–322], P = 0.011) were more frequent in the BPD than in the reference group. Conclusion: The study revealed a high prevalence of structural anomalies leading to upper airway obstruction and complications in infants with BPD undergoing FB. These findings emphasize the importance of careful consideration and preparation for bronchoscopic procedures in this vulnerable population. What is known: • Bronchopulmonary dysplasia (BPD) represents the most prevalent late morbidity among preterm infants. • Preterm infants diagnosed with BPD frequently undergo diagnostic procedures, including flexible and rigid bronchoscopies, to identify structural pathologies within the respiratory tract. What is new: • A significantly higher prevalence of structural anomalies leading to upper airway obstruction was observed in the BPD group compared to controls. • The incidence of complications during flexible bronchoscopy was higher in the BPD group than in controls. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Early induction of labor (37+0–38+6 gestational weeks) in large‐for‐gestational‐age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long‐term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large‐for‐gestational‐age children born early term versus full term (combined or independent exposures).The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large‐for‐gestational‐age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double‐checked the data. The risk of bias was assessed using the Newcastle‐Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta‐analyses were conducted where possible.Of the 2505 identified articles, no study investigated early‐term delivery in large‐for‐gestational‐age babies. Seventy‐six studies involving 11 460 016 children investigated the effects of either early‐term delivery or large‐for‐gestational‐age. Children born at 37 weeks of gestation (standard mean difference, −0.13; 95% confidence interval, −0.21 to −0.05), but not at 38 weeks (standard mean difference, −0.04; 95% confidence interval, −0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large‐for‐gestational‐age children had slightly higher cognitive scores than appropriate‐for‐gestational‐age children (standard mean difference, 0.06; 95% confidence interval, 0.01–0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance.No study has investigated the combined effect of early‐term delivery on cognitive scores in large‐for‐gestational‐age babies. Early‐term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required. [ABSTRACT FROM AUTHOR]

We investigated the relationship between the degree of alveolarization and ultrasound-assessed lung aeration in a validated preterm rabbit model of experimental bronchopulmonary dysplasia (BPD). Lung ultrasound findings were heterogeneously abnormal and consisted of zones with interstitial, interstitial-alveolar or consolidated patterns. The median radial alveolar count was 10.1 [8.4–11.5], 7.8 [6.1–9] and 7.3 [1.8–10.1] in rabbits with interstitial, interstitial-alveolar or consolidated ultrasound pattern, respectively (overall p = 0.036). Alveolar count and lung ultrasound score were significantly correlated (ρ = − 0.044 (95%CI: − 1; − 0.143), p = 0.009; τ-b = − 0.362 (95%CI: − 0.6; − 0.1), p = 0.017). [ABSTRACT FROM AUTHOR]

Introduction: Premature and low-birthweight infants are at especially high risk of perinatal complications, including impaired thermoregulation, infections and respiratory distress. Such adverse effects and the need for invasive procedures are associated with high mortality among preterms. This study focused on the influence of the innate immune system and tested the levels of collectins, collectin-10 (CL-10), collectin-11 (CL-11) and mannose-binding lectin (MBL) in preterm neonates. Methods: Cord blood was collected from 535 preterms (born at gestational age ≤37 weeks). COLEC10 and COLEC11 polymorphisms were analyzed by real-time PCR and those of MBL2 by PCR/PCR-RFLP. The concentrations of collectins in sera from cord blood were determined with ELISA. Findings: Low concentrations of CL-10 in cord sera (<462 ng/ml corresponding to the 10th percentile) were significantly associated with births at GA =32 weeks. Median levels of both CL-10 and CL-11 were significantly lower in preterms with very low birthweight (<1500 g), low Apgar 1' score and those who needed prolonged hospitalisation. Lower median CL-10 was also observed in fetal growth restriction cases. An important finding was the decreased concentrations of CL-10, CL-11 and MBL in respiratory distress syndrome (RDS). For CL-10 and CL-11, that relationship was confined to infants born at GA ≥33 weeks and/or with body mass at birth =1500 g. Only CL-10 was found to influence susceptibility to early-onset infections. COLEC11 heterozygosity for the activity-decreasing polymorphism (rs7567833, +39618 A>G, His219Arg) was more common in preterm premature rupture of membranes (pPROM) cases, compared with corresponding reference groups. Furthermore, C/T or T/T genotypes at COLEC11 at rs3820897 (-9570 C>T) as well as MBL deficiency-associated MBL2 gene variants were more common in preterms diagnosed with RDS than among unaffected newborns. Conclusion: The complement-activating collectins investigated here could be important for maintaining homeostasis in preterm neonates. Despite similar structure and specificity, MBL, CL-10 and CL-11 manifest a different spectrum of clinical associations. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Maternal health and gestational control are crucial to improving the newborn's prognosis. This study analyses demographic and obstetric factors at the beginning of pregnancy related to neonatal health, assessing their impact on the risk of hospital admission and prematurity.Observational retrospective study conducted in Northeast Spain with data of 9560 newborns between February 2017 and February 2022. The following have been evaluated as risk factors for hospital admission: nulliparity, multiple gestation, fertilisation techniques, foreign maternal origin, maternal age, smoking and residential location, dividing the sample according to gestational age. Hypothesis testing and logistic regression were performed.Nulliparity, fertilisation techniques and multiple gestation represent a risk factor for neonatal admission (OR 22.48, 4.04 and 3.34, respectively), especially in premature newborns <32 weeks of GA (OR: 30.71, 10.71 and 22.76, respectively). Foreign maternal origin also adds risk of admission, both in term newborns (OR 1.26; CI: 1.10–1.43) and in premature babies <32 weeks of GA (OR 1.61; CI: 1.09–2.38). Tobacco does not present a significant risk of neonatal admission. The multivariate analysis model confirms the influence of the following factors in all the studied groups: nulliparity, multiple gestation and foreign maternal origin.Nulliparity and multiple pregnancies are both main risk factors for neonatal admission and premature delivery. The use of fertilisation techniques and the foreign origin of the mother significantly associate increased risk of admission and neonatal prematurity. These findings underscore the need for a comprehensive approach to prenatal care to improve neonatal prognosis and promote long‐term health in risk populations. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested an increasing prevalence of intellectual disability diagnoses in some countries. Our aim was to describe the trend in the prevalence of intellectual disability diagnoses in Sweden and explore whether associated sociodemographic and perinatal factors can explain changes in the prevalence. Methods: We used a register-based nationwide cohort of residents in Sweden born between 2001 and 2011. We calculated the prevalence of intellectual disability diagnoses by age 10 for each birth cohort and the prevalence ratios in relation to the baseline year 2011, overall and by severity of intellectual disability, and comorbidity of autism and attention-deficit/hyperactivity disorder. The prevalence ratios were stratified and adjusted for associated sociodemographic and perinatal factors. Results: Among 1,096,800 individuals, 8,577 were diagnosed with intellectual disability by age 10. Among these, 3,949 (46%) and 2,768 (32%) were also diagnosed with autism and attention-deficit/hyperactivity disorder, respectively, and 4% were diagnosed with profound, 8% severe, 20% moderate, 52% mild, and 16% other/unspecific intellectual disability. The recorded age-10 prevalence of intellectual disability diagnoses increased from 0.64% (95% confidence interval 0.59–0.69%) in 2011 to 1.00% (0.94–1.06%) in 2021, corresponding to an annual prevalence ratio of 1.04 (1.04–1.05). The increase was, however, restricted to mild, moderate, and other/unspecific intellectual disability diagnoses, while the trends for profound and severe intellectual disability diagnoses were stable. The increasing trend was perhaps less pronounced among females and children with diagnosed attention-deficit/hyperactivity disorder, but independent of the co-occurrence of autism. The prevalence ratios did not change with stratification or adjustment for other associated demographic and perinatal factors. Conclusion: The recorded prevalence of diagnosed mild and moderate intellectual disability among 10-year-olds in Sweden has increased over the recent decade. This increase could not be explained by changes in associated sociodemographic or perinatal factors, including birth weight, gestational age, and parental age, migration status, and education at the child's birth. The increase instead may be due to changes in diagnostic practices in Sweden over time. [ABSTRACT FROM AUTHOR]

To compare neonatal morbidity in late preterm pregnancies with small-for-gestational-age fetuses, between those exposed and not exposed to antenatal corticosteroids (ACS).A retrospective study which included growth-restricted fetuses delivered at gestational week 34+0 to 36+6 weeks at a tertiary university-affiliated hospital, from March 2016 to March 2022. The primary composite outcome included the need for oxygen therapy or ventilation, respiratory distress syndrome, transient tachypnea of the newborn, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade III/IV and neonatal mortality.The primary composite outcome was comparable between those who did and did not receive ACS (26.1 vs. 20.8 %, p=0.512). Neonatal morbidity rates did not differ significantly between the groups, except for hypoglycemia, which was more common among neonates from ACS-exposed mothers (37.0 vs. 19.5 %, p=0.037). Multivariate analysis, adjusted for gestational diabetes and the mode of delivery showed no significant difference in the composite outcome between the groups (OR=2.03, 95 % CI 0.79–5.20, p=0.142). Cesarean delivery was associated with a higher risk of the primary outcome (OR=2.13, 95 % CI 1.17–3.85, p=0.013). After excluding those who did not receive the initial betamethasone dose within 2–7 days before delivery, the primary composite outcome remained similar between the groups. The primary composite outcome was similar among severely growth-restricted fetuses (<5th percentile) exposed and not exposed to ACS (29.2 vs. 22.0 %, p=0.560).Among preterm pregnancies complicated by small-for-gestational-age fetuses, ACS did not lower the rate of neonatal morbidity. [ABSTRACT FROM AUTHOR]

Prematurity-associated lung disease (PLD) is a long-term consequence of preterm-birth. Since the underlying mechanisms of PLD remain poorly characterised, we compared the urinary metabolome between recently described spirometry phenotypes of PLD. Preterm- and term-born children aged 7–12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) cohort, underwent spirometry and urine collection. The urinary metabolome was analysed by gas chromatography time-of-flight mass spectrometry. Preterm-born children were classified into phenotypes of prematurity-associated obstructive lung disease (POLD, Forced expiratory volume in 1 s (FEV1) < lower limit of normal (LLN), FEV1/Forced Vital Capacity (FVC) < LLN), prematurity-associated preserved ratio impaired spirometry (pPRISm, FEV1 < LLN, FEV1/FVC ≥ LLN) and Preterm/Term controls (FEV1 ≥ LLN). Metabolite set enrichment analysis was used to link significantly altered metabolites between the groups with metabolic pathways. Univariable and multivariable linear regression models examined associations between early and current life factors and significantly altered metabolites of interest. Urine from 197 preterm- and 94 term-born children was analysed. 23 and 25 were classified into POLD and pPRISm groups respectively. Of 242 identified metabolites, 49 metabolites were significantly altered in the POLD group compared with Preterm controls. Decreased capric acid (log2 fold change − 0.23; p = 0.003), caprylic acid (− 0.18; 0.003) and ceratinic acid (− 0.64; 0.014) in the POLD group, when compared to preterm controls, were linked with reduced β-oxidation of very long chain fatty acids (p = 0.004). Reduced alanine (log2 fold change − 0.21; p = 0.046), glutamic acid (− 0.24; 0.023), and pyroglutamic acid (− 0.17; 0.035) were linked with decreased glutathione metabolism (p = 0.008). These metabolites remained significantly associated with POLD in multivariable models adjusting for early/current life factors. The pPRISm urinary metabolome was minimally changed when compared with preterm-born controls. When compared to term-born subjects, alterations in tryptophan metabolism were implicated (p = 0.01). The urinary metabolome in POLD showed significantly altered β-oxidation of fatty acids and glutathione metabolism, implying alterations in cellular metabolism and oxidative stress. Similar findings have been noted in adults with chronic obstructive pulmonary disease. Given the similarity of findings between the POLD group and those reported for COPD, the POLD group should be considered at future risk of developing COPD. [ABSTRACT FROM AUTHOR]

Background: Gastroschisis is a rare congenital anomaly in which abdominal organs herniate through a defect in the abdominal wall. Managing gastroschisis in extremely low birth weight (ELBW) infants presents significant challenges because of their immature physiologies and increased risk of complications. Case presentation: This report discusses the case of a female ELBW infant born via an emergency cesarean section at 29 weeks of gestation, weighing 768 g, who had a prenatal diagnosis of gastroschisis. Postnatal management included immediate surgical intervention using a hand-made silo manufactured from expanded polytetrafluoroethylene (ePTFE) sheets that were sutured to the patient's abdominal wall to accommodate her small abdominal cavity and preserve mesenteric blood flow. Necrotizing enterocolitis with bowel perforation emerged as a complication, which led to the excision of a 10 cm segment of the ileum and the creation of an ileostomy. The infant experienced insufficient weight gain and liver dysfunction. However, she was eventually discharged on day 142 of life, weighing 2774 g, on oral feeding, without significant complications. Conclusions: This case emphasizes how prematurity significantly affected the patient's clinical outcomes, and highlights the importance of individualized management strategies. Our experience demonstrates that custom silo placement allows for the size to be adapted to the abdominal defect, and highlights the critical need to prioritize postnatal bowel perfusion in ELBW infants with gastroschisis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the frequency of ROP development in premature infants hospitalized in the neonatal intensive care unit and/or referred to the ROP Diagnostic Unit of our hospital and to emphasize the importance of cooperation between ophthalmologists and neonatologists in the treatment and follow-up of infants with ROP. Materials and Methods: The findings of 287 premature infants who were followed and treated in the neonatal intensive care unit between January 2017 and November 2022 and then referred to the ROP Diagnostic Unit were retrospectively analyzed. They were classified according to birth weight and gestational age. They were divided into 4 groups according to birth weight (under 1000 g, between 1000-1250 g, between 1250-1500 g and over 1500 g) and 3 groups according to gestational age (under 28 weeks, between 29-32 weeks and over 33 weeks). ROP development rates were determined in these groups. Those who developed retinopathy of prematurity were classified according to their stages. Results: A total of 287 premature infants (141 boys and 146 girls) were included in the study. Twenty-eight of the premature babies were Syrian (9.8%). Mean gestational age at birth was 32.34 weeks (min. 24, max. 37) and mean birth weight was 1830.12 g (min. 750 g, max. 4000 g). 34 babies (11.8%) had stage 1 ROP and 12 babies (4.1%) had stage 2 ROP. 14 babies (4.9%) had plus. Due to the rapid progression of the clinic, 20 patients (7%) with stage 2 or higher ROP and plus were referred to an advanced center with ROP treatment center certification. Conclusion: Premature babies born under 34 weeks of gestation should be examined for retinopathy of prematurity. Early diagnosis of retinopathy of prematurity is very important to prevent blindness due to ROP, even if treatment is not possible according to local conditions. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the feasibility of implementing telescreening for retinopathy of prematurity (ROP) using the ICON GO® widefield camera operated by a non-physician healthcare professional (NPHP). We hypothesized that images captured by an NPHP are adequate to evaluate ROP changes without further examinations. Secondly, the level of agreement between independent ROP graders were evaluated based on the fundus photographs. Methods: National ROP screening criteria were gestational age (GA) < 32 weeks or birthweight (BW) < 1500 g. Exclusion criteria were children hospitalized and born outside the Capital Region and examinations not performed by an NPHP. The screenings were performed using the ICON GO®. The NPHP selected the best images for evaluation by an on-site ophthalmologist, regarding whether re-examination was necessary and if so, whether the re-examination was beneficial. Lastly, the images were re-evaluated by an independent off-site ophthalmologist. Results: A total of 415 screening sessions on 165 patients performed by an NPHP were included. Re-examination was necessary in three screening sessions and beneficial in two. The level of agreement between the on-site and off-site ophthalmologists regarding ROP screening outcome was k = 0.82, ROP stage k = 0.69, plus disease k = 0.69, and lastly ROP zone k = 0.37. Of the screened children, ninety-seven (58.8%) had no ROP at any time points, sixty-two (37.6%) had some stage of ROP not requiring treatment, and six (3.6%) received ROP treatment. Conclusions: Telemedicine screening for ROP with the ICON GO® camera performed by an NPHP was feasible with an almost-perfect agreement and negligible need for re-examinations. The approach effectively identified children needing treatment, supporting the use of telescreening in ROP management. [ABSTRACT FROM AUTHOR]

A 31‐week gestation male infant with respiratory distress since day of delivery had lobectomy at 8 weeks of age for symptomatic, suspected congenital pulmonary airway malformation (CPAM). Histology of resected lung showed cytomegalovirus (CMV) inclusion bodies and emphysematous changes. The infant was treated with antiviral therapy with improvement in symptoms. CMV infection of the lung should be considered in any neonate presenting with lung cysts. [ABSTRACT FROM AUTHOR]

Aim: The effect of COVID‐19 vaccine given during pregnancy on premature infants is unknown. This study aims to determine the association between maternal COVID‐19 vaccine with postnatal outcome in premature infants. Methods: This is a single‐centre retrospective case–control study of infants born before 35 weeks gestation to mothers who received SARS‐CoV‐2 vaccine during pregnancy compared with infant born to non‐vaccinated mothers. Results: A total of 78 infants in each group were included. Infants in the vaccinated group had less respiratory distress syndrome (RDS) (p = 0.02) and less need for respiratory support (p = 0.002), and maternal vaccine had a protective effect on RDS [adjustable OR 0.38 (0.17–0.85)]. Vaccination during the first compared to the second trimester was associated with earlier gestational age (32.3 ± 2.1 vs. 33.3 ± 1.1 weeks, p = 0.03). Conclusion: We demonstrated that maternal SARS‐CoV‐2 vaccine is not associated with postnatal adverse effect in premature infants and potentially has a protective effect on RDS. Earlier gestational age among the infants born to mothers who received COVID‐19 vaccine during the first trimester did not translate to higher rate of postnatal complications. These findings might suggest that COVID‐19 vaccine is safe in high‐risk pregnancies, but timing of administration should be considered. Further studies are needed to confirm our findings and the biological mechanism. [ABSTRACT FROM AUTHOR]

Intraventricular hemorrhage (IVH) in preterm neonates presents a high risk for developing posthemorrhagic ventricular dilatation (PHVD), a severe complication that can impact survival and long-term outcomes. Early detection of PHVD before clinical onset is crucial for optimizing therapeutic interventions and providing accurate parental counseling. This study explores the potential of explainable machine learning models based on targeted liquid biopsy proteomics data to predict outcomes in preterm neonates with IVH. In recent years, research has focused on leveraging advanced proteomic technologies and machine learning to improve prediction of neonatal complications, particularly in relation to neurological outcomes. Machine learning (ML) approaches, combined with proteomics, offer a powerful tool to identify biomarkers and predict patient-specific risks. However, challenges remain in integrating large-scale, multiomic datasets and translating these findings into actionable clinical tools. Identifying reliable, disease-specific biomarkers and developing explainable ML models that clinicians can trust and understand are key barriers to widespread clinical adoption. In this prospective longitudinal cohort study, we analyzed 1109 liquid biopsy samples from 99 preterm neonates with IVH, collected at up to six timepoints over 13 years. Various explainable ML techniques—including statistical, regularization, deep learning, decision trees, and Bayesian methods—were employed to predict PHVD development and survival and to discover disease-specific protein biomarkers. Targeted proteomic analyses were conducted using serum and urine samples through a proximity extension assay capable of detecting low-concentration proteins in complex biofluids. The study identified 41 significant independent protein markers in the 1600 calculated ML models that surpassed our rigorous threshold (AUC-ROC of ≥0.7, sensitivity ≥ 0.6, and selectivity ≥ 0.6), alongside gestational age at birth, as predictive of PHVD development and survival. Both known biomarkers, such as neurofilament light chain (NEFL), and novel biomarkers were revealed. These findings underscore the potential of targeted proteomics combined with ML to enhance clinical decision-making and parental counseling, though further validation is required before clinical implementation. [ABSTRACT FROM AUTHOR]

To conduct a systematic review and meta-analysis of the association between chorioamnionitis and respiratory outcomes of prematurely born children. Pubmed, Medline and Embase were searched for relevant studies. Studies were included if they assessed prematurely born children, who had been exposed to chorioamnionitis and had either lung function testing or assessment of wheeze or asthma following NICU discharge. Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality. One reviewer extracted the data and these were checked by a second reviewer. A total of 1,237 studies were identified, but only eight which included 35,000 infants, fulfilled the inclusion criteria. One study looked at both lung function results and wheeze or asthma in childhood. Four of five studies found an association between wheeze/asthma in childhood and exposure to chorioamnionitis: the overall Odds Ratio (OR) for developing wheeze/asthma in childhood was OR 1.71 (95 % CI: 1.55–1.89). Four studies looked at lung function in childhood, three of which showed no statistically significant association between chorioamnionitis exposure and altered lung function. One study found lower lung function in those exposed to chorioamnionitis and lower expiratory flows with increasing levels of chorioamnionitis (forced expiratory flow at 50 % of exhaled forced vital capacity (=FEF50) p=0.012, forced expiratory flow at 25–75 % of the forced vital capacity is exhaled (=FEF25–75) p=0.014). There was a significant association between chorioamnionitis and the development of wheeze or asthma in childhood, but overall not in impairment of lung function. [ABSTRACT FROM AUTHOR]

Aim: We aimed to determine whether the effect of antenatal corticosteroids (ANS) differs in male and female fetuses without anomalies born before 32 weeks in terms of mortality and short‐term morbidity. Methods: This single‐center retrospective study included infants born before 32 weeks' gestation and admitted to the neonatal intensive care unit between January 1, 2018, and December 31, 2020. Results: The study included 210 infants with a median gestational age of 28.6 weeks (24–31.6), a birth weight of 1065 g (445–2165), and an ANS use rate of 80%. Compared to female fetuses exposed to ANS, male fetuses exposed to ANS had a lower mortality rate (23% and 11%, respectively, p = 0.038), but there were no differences in intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, respiratory distress syndrome, and APGAR scores of 1st and 5th but an increased rate of bronchopulmonary dysplasia (moderate/severe) (p = 0.008). In addition, the mortality rate was similar in exposed and unexposed female fetuses (p = 0.850). Enzyme activities and steroid levels in the placenta might be different in male and female fetuses, which could explain the results of ANS administration. Conclusions: In our study, we have shown that ANS has no effect on mortality in female fetuses younger than 32 weeks. Future studies may focus on adjusting the administration of ANS based on fetal sex, altering the dose or taking fetal sex into account when performing ANS. [ABSTRACT FROM AUTHOR]

Objective Studies have suggested an association between prenatal care (PNC) and preterm birth (PTB). We evaluated trends in PTB and association of PNC and PTB. Study Design This was a retrospective cohort study of singleton, viable nonanomalous deliveries from 1991 to 2018. PNC utilization was defined by World Health Organization using number of visits: adequate (≥8), suboptimal (5–7), and inadequate (<5). Primary outcome was PTB. Tests of trend were used to assess changes in PTB over time. Baseline characteristics and outcomes were compared. Logistic regression estimated the association of PNC and PTB. We evaluated for effect modification by year of birth. Results Of 92,294 patients, 14,057 (15%) had PTB. Inadequate and suboptimal PNC were associated with higher odds of PTB compared to adequate PNC (adjusted odds ratios = [aOR 6.21], 95% confidence interval [CI]: 5.84–6.60; aOR = 3.57, 95% CI: 3.36–3.79). Inadequate PNC was associated with higher odds of PTB over time (effect modification p < 0.0001). Inadequate PNC was associated with 5.4 times higher odds of PTB in 1998, 7.0 times in 2008, and 9.1 times in 2018. Conclusion Despite an increase in adequate PNC, there was a rise in PTB associated with inadequate and suboptimal PNC. PNC utilization was a stronger risk factor in recent years with higher PTB in patients who attended more than five PNC visits. Key Points PNC utilization is associated with the risk of PTB. Despite an increase in PNC utilization, PTB rates have increased. There is an even stronger association between PNC utilization and PTB over time. [ABSTRACT FROM AUTHOR]

Pregnant women considered at risk for coronavirus disease (COVID-19), the virus can cause some pregnancy complications such as miscarriages, intrauterine growth restrictions and even lead to a premature birth. The objective of this study was to characterize the newborns of mothers with a hypothesis or confirmed case of COVID 19 who were admitted to a neonatal isolation unit. The research was carried out through the analysis of the records of neonates, of both genders, admitted to the COVID unit between 2020 and 2021, regardless of their length of stay in the unit and their clinical situation. Most mothers were from Fortaleza, gestational age ranged between 28 and 41 weeks, the presence of neonatal infection was not relevant compared to maternal swab and cesarean delivery was the most practiced. Regarding the possible consequences generated for the newborn due to maternal COVID 19, we can conclude that COVID 19 does not have relevant repercussions for the newborns in the sample, as well as we cannot identify the presence of vertical transmission from mother to baby within the sample. [ABSTRACT FROM AUTHOR]

Background: Endotracheal suctioning (ES) is a painful procedure frequently performed in the neonatal intensive care unit. This procedure negatively affects the comfort level of premature neonates. Purpose: To determine the effect of 2 nonpharmacologic methods, swaddling and the administration of oropharyngeal colostrum, on the pain and comfort levels of preterm neonates during ES. Methods: This randomized controlled experimental study comprised 48 intubated premature neonates (swaddling group n = 16; oropharyngeal colostrum group n = 16; and control group n = 16) at 26 to 37 weeks of gestation. The neonates were swaddled with a white soft cotton cloth or administered 0.4 mL of oropharyngeal colostrum 2 minutes before ES, according to the group in which they were included. Two observers evaluated the pain levels (Premature Infant Pain Profile-Revize [PIPP-R]) and comfort (Newborn Comfort Behavior Scale [COMFORTneo]) of the infants by observing video recordings of before, during, and after the procedure. Findings/Results: A significantly lower mean PIPP-R score was found in the swaddling group during ES compared with the control group (P = .002). The mean COMFORTneo scores of the swaddling and oropharyngeal colostrum groups during ES (P < .01, P = .002) and the mean PIPP-R and COMFORTneo scores immediately after ES and 5, 10, and 15 minutes later were significantly lower than the control group (P < .005). Implications for Practice and Research: Swaddling was effective both during and after the procedure, while oropharyngeal colostrum was effective only after the procedure in reducing ES-related pain in premature neonates. Swaddling and oropharyngeal colostrum were effective in increasing comfort both during and after the procedure. [ABSTRACT FROM AUTHOR]

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Objective This systematic review, performed in accordance with the PRISMA guidelines, seeks to summarize the interventions that have been developed in order to improve executive functioning and attention in children born prematurely. Methods The PICOS framework helped guide the structure and relevant terms selected for the study. Electronic systematic searches of the databases PubMed (NLM), Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and Ovid PsycINFO were completed in March 2022. This review focuses on interventions that target attention and executive functioning in prematurely born children between birth and 12 years old, with outcome measures assessed between 3 and 12 years old, even if the age range in the study can exceed our own parameters. Data extraction included sample characteristics, country of recruitment, type of intervention, description of the intervention group and control group, outcome measures, and overall results. An assessment of the quality of methodology of studies was performed through an adaptation of the Downs and Black checklist for both randomized and nonrandomized studies in healthcare interventions. An assessment of the risk of bias was also presented using the Cochrane risk of bias tool for randomized trials 2.0. Results A total of 517 premature children received an intervention at some point between birth and early adolescence. Eleven different interventions were assessed in 17 studies, with rating of the quality of methodology and outcomes ranging from lower quality studies (44% quality rating) to robust studies (96% quality rating) in terms of reporting standards, external and internal validity, and power. Five of those studies focused on interventions administered in the neonatal intensive care unit or shortly postdischarge (e.g. the Mother–Infant Transaction Program and the Newborn Individualized Developmental Care and Assessment Program, documented in two articles each [11%] or the Infant Behavioral Assessment and Intervention Program assessed in one study [about 5%]), while 12 articles reported on interventions administered between the ages of 1.5–12 years old [mostly computerized cognitive training programs such as Cogmed (23%) and BrainGame Brian (17%)]. Of the 17 articles examined, 12 (70%) showed positive short-term outcomes postintervention and 3 (17%) demonstrated positive long-term results with small to large effect sizes (0.23–2.3). Among included studies, 50% showed an overall high risk of bias, 21.4% showed some concerns, and 28.6% were low risk of bias. Conclusions Due to the heterogeneity of the programs reviewed, the presented findings should be interpreted as descriptive results. A careful and individualized selection from the various available interventions should be made based on the target population (i.e. age at intervention administration and outcome testing) before implementing these program protocols in clinical settings. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis (C. trachomatis) screening and treatment in pregnancy allows the opportunity to reduce adverse pregnancy and neonatal outcomes worldwide. Although C. trachomatis infection is easily treated and cured with antibiotics, only some countries have routine pregnancy screening and treatment programs. We therefore evaluated whether just one maternal screening for C. trachomatis is enough to prevent adverse pregnancy and negative neonatal outcomes. Among the 4087 first-time gynecological–obstetric consultations granted at the National Institute of Perinatology in 2018, we selected the study population according to a case–cohort design. Antenatal C. trachomatis screening and treatment interventions were performed on 628 pregnant women using COBAS® TaqMan CT. C. trachomatis DNA was also detected in samples from 157 infants of these mothers. In the maternal cohort, incidence of C. trachomatis infection was 10.5%. The vertical transmission rate was 1.5% for the cohort of mothers who tested positive for C. trachomatis and received treatment, and 29.7% for those with a negative test. By evaluating symptomatic neonatal infection, the hazard rate of perinatal pneumonia was 3.6 times higher in C. trachomatis-positive babies than in C. trachomatis-negative babies. Despite the low rate of mother-to-child transmission in women positive for C. trachomatis, possible maternal infection that is not detected in pregnancy significantly increases the risk of neonatal infection with consequent perinatal pneumonia. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is characterized by impaired lung alveolar and vascular growth. We investigated the hypothesis that neonatal exposure to hyperoxia leads to persistent BPD phenotype caused by decreased expression of liver kinase B1 (LKB1), a key regulator of mitochondrial function. We exposed mouse pups from Postnatal Day (P)1 through P10 to 21% or 75% oxygen. Half of the pups in each group received metformin or saline intraperitoneally from P1 to P10. Pups were killed at P4 or P10 or recovered in 21% O2 until euthanasia at P21. Lung histology and morphometry, immunofluorescence, and immunoblots were performed to detect changes in lung structure and expression of LKB1; downstream targets AMPK, PGC-1α, and electron transport chain (ETC) complexes; and Notch ligands Jagged 1 and delta-like 4. LKB1 signaling and in vitro angiogenesis were assessed in human pulmonary artery endothelial cells (exposed to 21% or 95% O2 for 36 hours. Levels of LKB1, phosphorylated AMPK, PGC-1α, and ETC complexes were decreased in lungs at P10 and P21 in hyperoxia. Metformin increased LKB1, phosphorylated AMPK, PGC-1α, and ETC complexes at P10 and P21 in pups exposed to hyperoxia. Radial alveolar count was decreased, and mean linear intercept increased in pups exposed to hyperoxia at P10 and P21; these were improved by metformin. Lung capillary density was decreased in hyperoxia at P10 and P21 and was increased by metformin. In vitro angiogenesis was decreased in human pulmonary artery endothelial cells by 95% O2 and was improved by metformin. Decreased LKB1 signaling may contribute to decreased alveolar and vascular growth in a mouse model of BPD. [ABSTRACT FROM AUTHOR]

Prematurity can disrupt the psychological transition to parenthood, with the unfamiliar environment of the Neonatal Intensive Care Unit (NICU) often exacerbating parental concerns about their baby’s health and survival. This study explores factors influencing parental coping mechanisms during their NICU stay, focusing on gender differences and parental perceptions of staff support. Sixteen Italian parents of preterm infants (born before 37 weeks of gestation and hospitalized for at least 10 days) participated in remote narrative interviews. Thematic analysis revealed key differences in the emotional experiences and care participation between mothers and fathers, shaped by traditional Italian gender norms and further impacted by COVID-19 restrictions limiting fathers’ access to the NICU. Additionally, parents who were more involved in their infant’s recovery through interactions with doctors reported higher levels of personal well-being. These findings highlight the importance of fostering parent-staff communication and support, particularly during times of crisis, to promote positive outcomes in the parent-infant relationship and enhance parental well-being. Recommendations include tailored interventions to ensure mothers and fathers are actively engaged in their infant’s care. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To compare trajectories of social functioning in peer problems and prosocial behavior from 5 to 13 years between individuals born very preterm (VPT) and full‐term (FT).Participants were from the Victorian Infant Brain Study (VIBeS) longitudinal cohort, consisting of 224 individuals born VPT and 77 born FT recruited at birth. Social functioning was measured using the parent‐rated Strengths and Difficulties Questionnaire (SDQ) peer problems and prosocial behavior subscales at 5, 7, and 13 years' corrected age. Multilevel mixed effects models were fitted.Peer problems increased with age (adjusted mean difference per year = 0.04, 95% confidence interval [CI] = 0.01, 0.07, p = 0.02), with higher peer problems in the VPT compared with the FT group (adjusted mean difference between groups = 0.46, 95% CI = 0.06, 0.86, p = 0.02). Prosocial behavior increased from early to middle childhood and decreased approaching adolescence, but was similar between VPT and FT groups (adjusted mean difference between groups = −0.05, 95% CI = −0.50, 0.40, p = 0.82).Children born VPT are at greater risk for peer problems than FT peers and may benefit from receiving greater early social support. [ABSTRACT FROM AUTHOR]

This article uses machine learning techniques as fuzzy and neuro-fuzzy ANFISs, to develop and compare prediction models capable of relating pregnant women's exposure to air pollutants, such as Nitrogen Dioxide and Particulate Matter, the mother's age, and the number of prenatal consultations to the incidence of premature birth. In the current literature, studies can be found that relate prematurity to the exposure of pregnant women to NO2, O3, and PM10; to Toluene and benzene, mainly in the window 5 to 10 days before birth; and to PM10 in the week before birth. Both models used logistic regression to quantify the effects of pollutants as a result of premature birth. Datasets from Brazil—Departamento de Informatica do Sistema Único de Saúde (DATASUS) and Companhia Ambiental do Estado de São Paulo (CETESB)—were used, covering the period from 2016 to 2018 and comprising women living in the city of São José dos Campos (SP), Brazil. In order to evaluate and compare the different techniques used, evaluation metrics were calculated, such as correlation (r), coefficient of determination (R2), Root Mean Square Error (RMSE), Mean Absolute Percentage Error (MAPE), Mean Square Error (MSE), and Mean Absolute Error (MAE). These metrics are widely used in the literature due to their ability to evaluate the robustness and efficiency of prediction models. For the RMSE, MAPE, MSE, and MAE metrics, lower values indicate that prediction errors are smaller, demonstrating better model accuracy and confidence. In the case of (r) and R2, a positive and strong result indicates alignment and better performance between the real and predicted data. The neuro-fuzzy ANFIS model showed superior performance, with a correlation (r) of 0.59, R2 = 0.35, RMSE = 2.83, MAPE = 5.35%, MSE = 8.00, and MAE = 1.70, while the fuzzy model returned results of r = 0.20, R2 = 0.04, RMSE = 3.29, MSE = 10.81, MAPE = 6.67%, and MAE = 2.01. Therefore, the results from the ANFIS neuro-fuzzy system indicate greater prediction capacity and precision in relation to the fuzzy system. This superiority can be explained by integration with neural networks, allowing data learning and, consequently, more efficient modeling. In addition, the findings obtained in this study have potential for the formulation of public health policies aimed at reducing the number of premature births and promoting improvements in maternal and neonatal health. [ABSTRACT FROM AUTHOR]

Background: Prematurity remains one of the main causes of neonatal morbidity and mortality. Approximately two thirds of preterm births are spontaneous, i.e. secondary to preterm labour, preterm prelabour rupture of membranes (PPROM) or cervical insufficiency. Etiologically, the vaginal microbiome plays an important role in spontaneous preterm birth (sPTB). Vaginal dysbiosis and bacterial vaginosis are well-known risk factors for ascending lower genital tract infections and sPTB, while a Lactobacillus crispatus-dominated vaginal microbiome is associated with term deliveries. Synbiotics may help to achieve and/or maintain a normal, Lactobacillus-dominated vaginal microbiome. Methods: We will perform a multi-centre, double-blind, randomised, placebo-controlled trial. Women aged 18 years or older with a singleton pregnancy are eligible for inclusion at 80/7–106/7 weeks gestational age if they have one or more of the following risk factors for sPTB: previous sPTB at 240/7–356/7 weeks, prior PPROM before 360/7 weeks, or spontaneous pregnancy loss at 140/7–236/7 weeks of gestation. Exclusion criteria are multiple gestation, cervix conisation, inflammatory bowel disease, uterine anomaly, and the use of pro-/pre-/synbiotics. Patients will be randomised to oral synbiotics or placebo, starting before 11 weeks of gestation until delivery. The oral synbiotic consists of eight Lactobacillus species (including L. crispatus) and prebiotics. The primary outcome is the gestational age at delivery. Vaginal microbiome analysis once per trimester (at approximately 9, 20, and 30 weeks) and delivery will be performed using metataxonomic sequencing (16S rRNA gene) and microbial culture. Secondary outcomes include PPROM, the use of antibiotics, antenatal admission information, and neonatal outcomes. Discussion: This study will evaluate the effect of oral synbiotics on the vaginal microbiome during pregnancy in a high-risk population and correlate the microbial changes with the gestational age at delivery and relevant pregnancy outcomes. Trial registration: ClinicalTrials.gov, NCT05966649. Registered on April 5, 2024. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the current neonatal nutritional practices in Taiwan and promote consensus on standardized protocols. Methods: An online questionnaire comprising 95 items on parenteral nutrition (PN) and enteral nutrition (EN) practices was distributed to neonatal care units across Taiwan via email between August and December 2022. The responses were compared with the recommendations from the European Society for Pediatric Gastroenterology Hepatology and Nutrition for preterm infant care. Results: Most of the 35 neonatal units, comprising 17 level III and 18 level II units, that participated in this study adhered to standard PN protocols; however, only 30% of units used protein-containing solutions as the initial fluid. Over half of the neonatal units provided calcium, phosphate, and magnesium at less than the recommended dosage. Trophic feeding commenced within 48 h in 88% of the units, with the mother's milk used as the first choice. All the units preferred commencing advanced feeding at <25 mL/kg/day. Conclusions: Most nutrient protocols for preterm infants in neonatal units in Taiwan meet recent guidelines, but discrepancies such as lower mineral supplements in PN and a slower advancement of enteral feeding increase nutritional risk. These issues warrant further research. [ABSTRACT FROM AUTHOR]

Prematurity is associated with lower exercise capacity, which relies on the integrity of the cardiovascular, pulmonary, and skeletal muscle systems. Our animal model mimicking prematurity-associated conditions showed altered muscle composition and atrophy in adulthood. This study aimed to compare muscle composition and strength in adults born preterm versus full-term controls. This observational cohort study recruited 55 adults born preterm, ≤ 29 weeks’ of gestation and 53 full-term controls who underwent musculoskeletal ultrasound imaging to assess morphology of the rectus femoris at rest and during a maximal voluntary contraction. Maximal voluntary contraction of the hands and legs were measured by manual dynamometry. In adults born preterm, there was lower muscle strength (handgrip: − 4.8 kg, 95% CI − 9.1, − 0.6; knee extensor: − 44.6 N/m, 95% CI − 63.4, − 25.8) and smaller muscle area (− 130 mm2, 95% CI − 207, − 53), which was more pronounced with a history of bronchopulmonary dysplasia. Muscle stiffness was increased in the preterm versus term group (0.4 m/s, 95% CI 0.04, 0.7). Prematurity is associated with alterations in skeletal muscle composition, area, and function in adulthood. These findings highlight the necessity to implement preventive and/or curative approaches to improve muscle development and function following preterm birth to enhance overall health in this population. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Prematurity is a risk factor for strabismus, but the roles of intermediate factors like retinopathy of prematurity (ROP) and neurological lesions are less understood. We aimed to identify neonatal risk factors for strabismus at age 5.5 in preterm children.Data were extracted from the étude épidémiologique sur les petits âges gestationnels 2 cohort, a French prospective population‐based study of preterm children born in 2011 with gestational age of 34 weeks or less. Strabismus was recorded during a medical interview at 5.5 years. Using a directed acyclic graph, intermediate and confounding factors were identified. Total and direct effects of gestational age on strabismus risk were analysed using generalised estimating equation.Among 2419 children assessed, 274 (52.6% male) presented strabismus at 5.5 years. The direct effect of gestational age remained significant after adjustment (p < 0.001). In the complete imputed model: maternal smoking during pregnancy (odds ratio, OR 1.8; 95% confident interval, 95% CI 1.3–2.6), neonatal severe cerebral lesions (OR 2.9, 95% CI 1.8–4.6) and severe ROP (OR 4.2, 95% CI 1.9–9.0) were independent risk factors.Special attention is needed regarding strabismus screening at age 5.5 in preterm children, even without severe cerebral lesions and ROP. Smoking cessation during pregnancy should be encouraged. [ABSTRACT FROM AUTHOR]

Background: Prehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes. Aims: The study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital. Methods and materials: Between September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment. Results: Composite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118). Conclusion and recommendations: Prehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women. [ABSTRACT FROM AUTHOR]

The congenital condition gastroschisis is associated with delayed villous development and placental malperfusion, suggesting placental involvement. This study uses RNA sequencing to compare the placental transcriptome in pregnancies with and without gastroschisis. 180 coding genes were differentially expressed, mapping to multiple gene ontology pathways. Altered placental gene expression may represent fetal signalling to the placenta, and these changes could contribute to the pathogenesis of gastroschisis and associated morbidities, including fetal growth restriction. • Gastroschisis is a congenital condition where the infant's intestines extend outside the abdomen. • Developmental and vascular defects are associated with Gastroschisis. • Gastroschisis associated changes in the placental transcriptome were observed. • These changes may reflect altered fetal to placental signalling. [ABSTRACT FROM AUTHOR]

Introduction: Brain injury patterns of preterm infants with perinatal asphyxia (PA) are underreported. We aimed to explore brain magnetic resonance imaging (MRI) findings and associated neurodevelopmental outcomes in these newborns. Methods: Retrospective multicenter study included infants with gestational age (GA) 24.0–36.0 weeks and PA, defined as ≥2 of the following: (1) umbilical cord pH ≤7.0, (2) 5-min Apgar score ≤5, and (3) fetal distress or systemic effects of PA. Findings were compared between GA <28.0 (group 1), 28.0–31.9 (group 2), and 32.0–36.0 weeks (group 3). Early MRI (<36 weeks postmenstrual age or <10 postnatal days) was categorized according to predominant injury pattern, and MRI around term-equivalent age (TEA, 36.0–44.0 weeks and ≥10 postnatal days) using the Kidokoro score. Adverse outcomes included death, cerebral palsy, epilepsy, severe hearing/visual impairment, or neurodevelopment <-1 SD at 18–24 months corrected age. Results: One hundred nineteen infants with early MRI (n = 94) and/or MRI around TEA (n = 66) were included. Early MRI showed predominantly hemorrhagic injury in groups 1 (56%) and 2 (45%), and white matter (WM)/watershed injury in group 3 (43%). Around TEA, WM scores were highest in groups 2 and 3. Deep gray matter (DGM) (aOR 15.0, 95% CI: 3.8–58.9) and hemorrhagic injury on early MRI (aOR 2.5, 95% CI: 1.3–4.6) and Kidokoro WM (aOR 1.3, 95% CI: 1.0–1.6) and DGM sub-scores (aOR 4.8, 95% CI: 1.1–21.7) around TEA were associated with adverse neurodevelopmental outcomes. Conclusion: The brain injury patterns following PA in preterm infants differ across GA. Particularly DGM abnormalities are associated with adverse neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

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

Need for admission to the neonatal intensive care unit (NICU) confers an increased risk of hearing loss in the newborn and of later neurodevelopmental impairment. In this retrospective longitudinal case-controlled study, we assess how the degree of prematurity, measured via gestational age, birth weight, and z-scores, in 138 infants admitted to the NICU are associated with permanent childhood hearing loss (PCHI) and 2-year developmental outcomes. Logistic regression analyses, Kruskal–Wallis analysis of variance, and Chi-squared tests were used. Independent of prematurity, PCHI and NICU admission were predictive of poor developmental outcomes. Twenty-one (47%) children with PCHI had a moderate-to-severe developmental delay, compared to three (7%) matched controls. Days in the NICU but not z-scores predicted PCHI. Z-score was not prognostic of moderate or severe developmental impairment in children with PCHI. The odds ratio of moderate-to-severe neurodevelopmental impairment with PCHI was high, at 12.48 [95% CI = 3.37–46.40]. Children with PCHI were significantly more likely to have cerebral palsy than their matched counterparts (30% vs. 2%). These findings challenge the conventional focus on gestational age and birth weight on neurodevelopmental outcomes for children with PCHI and NICU admission. A more nuanced approach to monitoring and intervention is needed. [ABSTRACT FROM AUTHOR]

Objective: Bronchopulmonary dysplasia (BPD) is among the most common complications of prematurity and is associated with high morbidity and mortality rates. Acute kidney injury (AKI) is also commonly observed in premature infants and significantly increases morbidity and mortality. Studies have shown that systemic changes in AKI may also trigger lung damage. Methods: This study aimed to determine the effects of AKI on the development of BPD in preterm infants with a postconceptional age of ≤32 weeks and/or birth weight of ≤1500 grams. The relationship between demographic features and accompanying perinatal and postnatal morbidities among the patients was investigated. Results: The incidence of BPD in infants with AKI was 52.6% (10 of 19 infants) and 38.3% (61 of 140 infants) in infants without AKI. In infants who developed BPD, the rate of AKI did not vary notably between babies born at ≤28 weeks and those born at >28 weeks [n=9, 17.3% (9 of 52 infants) and n= 1, 5.3%, (1 of 19 infants) respectively] of gestation (p>0.05). Conclusions: AKI was associated with a greater need for resuscitation at birth, a greater need for invasive mechanical ventilation, fewer ventilator-free days, and a higher incidence of sepsis, patent ductus arteriosus, and necrotizing enterocolitis in premature infants. It was also more frequently associated with fluid-electrolyte imbalance, blood pressure, and hemodynamic disorders in the first postnatal week. The rate of BPD development was higher in infants with AKI, but this disparity was not statistically notable (p>0.05). [ABSTRACT FROM AUTHOR]

Zinc (Zn) is a vital trace element that plays a pivotal role in protein synthesis, cellular growth, and differentiation and is involved as a cofactor of metalloenzymes, performing a wide variety of metabolic, immune, and synthesis roles. Zn is required at all stages of an infant's and child's development, and severe Zn deficiency has been reported to lead to slower physical, cognitive, and sexual growth. Preterm neonates are at a higher risk of developing zinc deficiency for a variety of reasons, including low Zn intake from enteral feeds containing breast milk, relative malabsorption due to immaturity of the gastrointestinal tract with limited absorptive capacity, increased urinary loss of zinc, and increased demand during the early developmental stages. Moreover, premature infants are at risk of gastrointestinal diseases like necrotizing enterocolitis (NEC), which can limit absorption capacity and potentially lead to malabsorption. TPN is frequently used in preterm infants to provide them with sufficient nutrients and calories. However, it has its own complications, including cholestasis, especially if used for prolonged periods. In this case report, we are presenting the case of a male preterm infant who was delivered by caesarean section at 26 weeks' gestation. The baby developed an intestinal perforation due to NEC, for which he underwent surgery for resection of the necrotic bowel and the creation of a high ileal stoma and was put on prolonged total parenteral nutrition (TPN), which led to the development of zinc deficiency. [ABSTRACT FROM AUTHOR]

Traditionally, gestational age <34 wk and weight <2 kg are considered relative contraindications to extracorporeal membrane oxygenation (ECMO). There is a paucity of information that explains the outcomes in this unique population of premature neonates. The purpose of this study is to examine outcomes of patients who undergo ECMO at <34 wk at a single institution. A single-center retrospective review was performed for neonates managed with ECMO in the neonatal intensive care unit from January 2012 to April 2022. Characteristics and outcome data were collected. The primary outcome studied was survival at discharge. Secondary outcomes were intraventricular hemorrhage, ischemic brain injury, and thrombosis. Data were analyzed with descriptive statistics. Following exclusion, 107 patients were included with eight having initiating ECMO at <34 wk. Three (38%) patients, who received ECMO at <34 wk, incurred intraventricular hemorrhages compared to 14 (14%) in the ≥34-wk cohort. Two (25%), who underwent ECMO at <34 wk, exhibited signs of brain ischemia on imaging compared to 9 (9%) in those ≥34 wk, and 3 (38%) patients <34 wk experienced thrombosis compared to 31 (31%) in the ≥34-wk cohort. Five (63%) of those in the <34-wk cohort survived to discharge, similar to 61 (61%) in the ≥34 wk cohort. Our data suggest that EGA <34 wk may not be a contraindication for ECMO, with appropriate counseling of potential risks. • ECMO at <34 wk cohort experienced IVH and thrombosis. • Survival after ECMO at <34 wk was similar to survival at >34 wk. • Gestational age of <34 wk may not be a contraindication to ECMO. [ABSTRACT FROM AUTHOR]

We aimed to perform a systematic review and network meta-analysis to evaluate the preventive strategies for preterm birth in twin-to-twin transfusion syndrome. PubMed, Embase and Cochrane Central were searched from inception to December 2023 with no filters. Additionally, the reference lists of the included studies were manually examined to identify any supplementary studies. We selected randomized controlled trials and cohorts comparing interventions to prevent preterm birth in twin pregnancies complicated by twin-to-twin transfusion syndrome. A random-effects frequentist network meta-analysis was performed using RStudio version 4.3.1. Randomized controlled trials and cohorts were assessed respectively using the Risk of Bias in Non-randomized Studies of interventions tool and Cochrane Collaboration's tool for assessing risk of bias in randomized trials. In this systematic review and meta-analysis, we included eight studies comprising a total of 719 patients. Compared with expectant management, cerclage stood out as the only intervention associated with an increase in the survival of at least one twin (risk ratio 1.12; 95 % confidence interval 1.01–1.23). Our subgroup analysis based on different thresholds for short cervix demonstrated a significant reduction in the risk of preterm birth before 32 weeks with ultrasound-indicated cerclage using a 15 mm criterion (risk ratio 0.65; 95 % confidence interval 0.47–0.92). Our study suggests the potential benefit of cerclage as a preventive strategy for preterm birth in pregnancies complicated by twin-to-twin transfusion syndrome. These findings highlight the necessity for further investigation to corroborate our results and address the optimal threshold for ultrasound-indicated cerclage. [ABSTRACT FROM AUTHOR]

Introduction: Reactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI. Methods: This study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards. Results: A total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3. Conclusion: RI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker. [ABSTRACT FROM AUTHOR]