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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]

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]

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]

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6–8% of extremely low birth weight (ELBW) infants. SIP has lower mortality than NEC, but with similar short-term morbidity in length of stay, growth failure, and supplemental oxygen requirements. Comparative long-term neurodevelopmental outcomes have not been clarified. Data were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401–1000 g or 22–27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16–26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated. Of 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09–1.86), rehospitalization (ARR 1.46; 1.17–1.82), and post-discharge surgery (ARR 1.82; 1.48–2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34–2.00) compared to infants without NEC or SIP. ELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs. Level II. • What is currently known about this topic? SIP has decreased risk of mortality compared to NEC, with similar short-term morbidity. NEC has increased risk of long-term morbidity. Limited data exists in SIP. • What new information is contained in this article? ELBW NEC infants had increased risk of neurodevelopmental disability and post-discharge healthcare needs. SIP infants also have increased healthcare needs. [ABSTRACT FROM AUTHOR]

[Display omitted] • Innovative amplitude and frequency modulation for EEG analysis in preterm infants. • AM-FM features of EEG promising for intraventricular haemorrhage prediction. • Intraventricular haemorrhage prediction 24-hours prior to detection on ultrasound. • Personalized information of AM-FM EEG evaluated for clinical decision making. Intraventricular hemorrhage (IVH) is a common and significant complication in premature infants. While cranial ultrasound is the golden standard for IVH detection, it may not identify lesions until hours or days after occurring, which limits early intervention. Predicting IVH in premature infants would be highly advantageous. Recent studies have shown that EEG data's amplitude and frequency modulation features could offer predictive insights for neurological diseases in adults. To investigate the association between IVH and EEG monitoring, a retrospective case-control study was conducted in preterm infants. All infants underwent amplitude integrated EEG monitoring for at least 3 days after birth. The study included 20 cases who had an IVH diagnosed on cranial ultrasound and had a negative ultrasound 24 h earlier, and 20 matched controls without IVH. Amplitude and frequency modulation features were extracted from single-channel EEG data, and various machine learning algorithms were evaluated to create a predictive model. Cases had an average gestational age and birth weight of 26.4 weeks and 965 g, respectively. The best-performing algorithm was adaptive boosting. EEG data from 24 h before IVH detection proved predictive with an area under the receiver operating characteristic curve of 93 %, an accuracy of 91 %, and a Kappa value of 0.85. The most informative features were the slow varying instantaneous frequency and amplitude in the Delta frequency band. Amplitude and frequency modulation features obtained from single-channel EEG signals in extremely preterm infants show promise for predicting IVH occurrence within 24 h before detection on cranial ultrasound. [ABSTRACT FROM AUTHOR]

Transcatheter ductal closure has proven to be safe and effective to occlude the patent ductus arteriosus (PDA) in premature infants. We have developed a robust multidisciplinary PDA program. After gaining experience performing transcatheter ductal closure in the cardiac catheterization laboratory, we transitioned to performing the procedure at the patient's bedside in the neonatal intensive care unit using echocardiographic guidance. The bedside approach has the potential to expand this therapy to patients who currently undergo expectant PDA management because of lack of availability of this therapy, and allow for earlier referral, which will reduce time of exposure to this pathologic shunt. [ABSTRACT FROM AUTHOR]

To investigate potential differences in discharge time, feeding methods and amounts, daily weight gain, vital signs, pain, and comfort levels among preterm infants born at 28–32 weeks' gestation who were hospitalized in the neonatal intensive care unit during long-term follow-up while implementing a light-dark cycle. This is a randomized controlled study conducted with the support of a day-night cycle in premature infants born at 28–32 weeks' gestation and admitted to the neonatal intensive care unit of a teaching and research hospital affiliated with the Ministry of Health. The study compared the follow-up results from hospitalization to discharge over a period of 8 weeks. 50% of premature infants admitted to the unit are multiple pregnancies. There was no significant difference in discharge weight, comfort level, pain level, vital signs of the infants included in the study (p > 0.05). The optimal development of infant feeding patterns was examinedand it was observed that the study group had significantly improved before the control group in terms of the time to switch to full enteral feeding and oral feeding (p < 0,05). The daily weight gain of the babies was examined, it was seen that the weight gain was higher in the study group compared to the control group (p < 0,05). The mean duration of hospitalization was compared, it was seen that the babies in the study group were discharged significantly earlier (p < 0,05). The study compared the long-term outcomes of premature babies hospitalized in neonatal intensive care and babies exposed to a light-dark cycle and regularly monitored in standard care. The results showed that the babies in the study group had higher daily weight gain and were discharged earlier than the control group. There were also no statistically significant differences in comfort and pain scores, vital signs or oxygen saturation between the study and control groups. A light-dark cycle was found to be a feasible and promising intervention for infants at 28–32 weeks' gestation. It was a nurse-led management of care that could be integrated into the usual care of 28–32-week-old babies in neonatal units. [ABSTRACT FROM AUTHOR]

Does our time inside the womb predict our future? Evidence suggests that the environment in the womb plays a powerful role in predicting specific adult diseases. The fetus is constantly responding and adapting to the intrauterine environment by a process called programming. Toxic exposures, such as nutritional deficits and hypoxia, can affect fetal development and increase the risk for specific diseases that manifest later in our adult life. Preeclampsia (PE) is one disorder that results in a less-than-optimal environment for the growing fetus. It is pregnancy-specific and defined as new-onset hypertension after 20 weeks' gestation in the presence of maternal multiorgan dysfunction. To the best of our understanding, the pathogenesis is multifactorial and involves dysfunction of the placenta and the vascular, renal, and immunological systems. Treatment options are limited and may result in adverse outcomes for the fetus and newborn. Preeclampsia is a major contributor to perinatal and maternal morbidity and mortality worldwide, thus generating a significant healthcare burden. Research continues to demonstrate that mothers and infants affected by PE are at increased susceptibility to chronic conditions such as cardiovascular, renal, metabolic, and neurological diseases. More efforts are needed to further understand this disease. Efforts to increase awareness will help improve clinical outcomes for both mothers and infants. [ABSTRACT FROM AUTHOR]

• Infants with BPD receiving higher levels of respiratory support on discharge from hospital is associated with poorer NDI. • Understanding the relative risks of NDI may facilitate better-informed counselling of parents regarding outcomes at age 3 years. • Subclassifying BPD infants based on levels of respiratory support received at home is a pragmatic way to predict outcome. The reader will come to appreciate that: • The likelihood of infants with BPD developing poorer childhood neurodevelopmental outcomes is associated with the level of respiratory support provided on discharge from hospital. • Understanding the relative risks of neurodevelopmental impairment may facilitate better-informed counselling of parents regarding clinical outcomes at age 3 years. To investigate the neurodevelopmental outcomes for preterm infants born < 29 weeks gestation with/without bronchopulmonary dysplasia (BPD). Preterm infants < 29 weeks' gestation born 2007–2018 in New South Wales and the Australian Capital Territory, Australia, were included. Infants who died < 36 weeks' postmenstrual age and those with major congenital anomalies were excluded. Subjects were assessed at 18–42 months corrected age using the Bayley Scales of Infant Development, 3rd edition. 1436 infants without BPD (non-BPD) and 1189 infants with BPD were followed. The BPD group, 69 % infants were discharged without respiratory support (BPD1), 29 % on oxygen (BPD2) and 2 % on pressure support/tracheostomy (BPD3). Moderate neurodevelopmental impairment (NDI) was evident in 5.7 % of non-BPD infants, 11 % BPD1, 15 % BPD2, 15 % BPD3 infants. Severe NDI was seen in 1.7 % non-BPD infants, 3.4 % BPD1, 7.3 % BPD2, 35 % BPD3 infants. After adjusting for confounders, infants with BPD2 (OR 2.24, 99.9 % CI 1.25 to 5.77) or BPD3 (OR 5.99, 99.9 % CI 1.27 to 46.77) were more likely to have moderate-severe NDI compared to non-BPD infants. The majority of infants with BPD were discharged home without respiratory support and had better neurocognitive outcomes in early childhood compared to those that required home-based oxygen or respiratory support. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude est d'investiguer le niveau de stress parental durant l'hospitalisation de leur nouveau-né prématuré au service de néonatologie pendant le premier confinement (de mars à mai 2020) et d'explorer son association avec la construction du lien parent-nouveau-né. Cinquante-deux parents, soit 20 pères et 32 mères du service de néonatologie de quatre centres hospitaliers universtaires – CHU (Toulouse, Nantes, Tours et Paris), ont complété en ligne une série d'échelles : l'échelle de stress parental : unité de néonatologie (PSS-NICU), le Questionnaire Périnatal de l'état de stress Post-traumatique (PPQ) ainsi que l'échelle Mother-to-Infant Bonding (MIBS). Nos résultats saillants ont mis en évidence des niveaux de stress modérés pour les mères mais aussi pour les pères, avec une prédominance de l'altération du rôle parental. Les mères présentaient de premiers signes de stress post-traumatique et une difficulté plus marquée dans l'établissement du premier lien par rapport aux pères. Ces résultats sont discutés à la lumière de la littérature existante et des perspectives cliniques sont proposées afin de palier à ces difficultés. The aim of this study is to examine the perceived parental stress levels during the NICU hospitalization of the premature infant during the first lockdown and to analyze its relationship with the construction of the first bond. Fifty-two parents, that is 20 fathers and 32 mothers completed online the following scales: the Parental Stress Scale: Neonatal Intensive Care Unit (PSS-NICU), the Perinatal Questionnaire of Post-Traumatic Stress Disorder (PPQ) along with the Mother-to-Infant Bonding (MIBS). Main results showed that stress levels are moderate both for mothers and fathers, with a predominance of the parental role alteration; mothers exhibit post-traumatic symptoms by as well as a more complicated construction of the first bond. These findings are discussed as per to existing literature and clinical interventions are recommended. [ABSTRACT FROM AUTHOR]

To review the outcomes of premature patients with type C esophageal atresia (EA). In this retrospective cohort study, charts of patients of type C EA patients were reviewed from 1992 to 2022. Outcomes of premature patients were compared to term patients. Preterm patients were analyzed to compare outcomes of infants with very low birth weights (VLBW) to patients >1,500 g as well as primary versus delayed anastomosis. Among 192 type C EA, 67 were premature. Median and interquartile range (IQR) gestational age and birth weight of preterm patients were 34 [33–36] weeks and 1965 [1740–2290] g. Delayed anastomosis was performed in 12 (18%) preterm vs. 3 (2%) term patients (p = 0.0003). Short-term postoperative outcomes were similar between preterm and term patients, except for recurrent fistula (16% vs. 6%, p = 0.01). Prematurity was associated with an increased need for long-term enteral tube feeding (56% vs. 10%, p = 0.0001) and parenteral nutrition (10 days vs. 0 days, p = 0.0004). The length of stay was 3 times longer when patients were premature (50 days vs. 17 days, p = 0.002). Delayed surgery in preterm patients was associated with post-operative leaks, strictures, recurrent fistula, prolonged enteral tube feeding, and gastrostomy insertion. Patients with very low birth weight (VLBW) were compared to other preterm patients and showed no difference in terms of rate of delayed surgery, and post-operative outcomes. Despite increased prematurity-related comorbidities and low birth weight, premature infants with type C EA/TEF have similar post-operative outcomes to term patients though recurrent fistula was more frequent with prematurity. Retrospective cohort study. III. • Indications for delayed esophageal atresia repair include patients who are at high operative risk for neonatal surgery due to very low birth weight, prematurity, or significant cardiac anomalies. • The question of whether primary or delayed anastomosis should be performed in premature infants with EA/TEF has been overlooked. • This study highlights the feasibility of performing primary anastomosis in premature patients with type C EA-TEF. [ABSTRACT FROM AUTHOR]

In a sixty-eight-bed level-IV NICU, an increased incidence of hospital-acquired pressure injuries (HAPIs) from noninvasive ventilation (NIV) devices was identified. The aim of this quality improvement project was to decrease HAPIs from NIV by 10%. A literature review and the Plan–Do–Study–Act were implemented. The intervention included a customized silicone foam dressing under NIV, an NIV skincare bundle, and multidisciplinary support. Hospital-acquired pressure injury rates were tracked over 3 years postinterventions. The incidence of HAPIs declined by 20% from 0.2 per 1,000 patient days to 0.05 per 1,000 patient days. Relative risk was 4.6 times greater prior to intervention (p =.04). Continuous positive airway pressure (CPAP) failure was not noted and measured by the percentage of patients on ventilators pre- and postintervention. Customized silicone foam dressings under NIV, NIV skincare bundle, and multidisciplinary team support may decrease HAPIs in neonates without CPAP failure. [ABSTRACT FROM AUTHOR]

The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst mothers towards DBM seem to persist. A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open-ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to determine differences in variables and to understand associations related to knowledge was conducted. A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60–68.40; p < 0.001). Negative attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor mothers and fears of HIV transmission when using DBM. Lack of awareness concerning DBM was associated with poor knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could address the poor uptake of DBM. [ABSTRACT FROM AUTHOR]

Antenatal steroid therapy is increasingly central to the obstetrical management of women at imminent risk of preterm birth. For women likely to deliver between 24 and 34 weeks' gestation, antenatal steroid therapy is the standard of care, conferring sizable benefits and few risks in high-resource environments when appropriately targeted. Recent studies have focused on antenatal steroid use in periviable and late preterm populations, and in term cesarean deliveries. As a result, antenatal steroid therapy has now been applied from 22 to 39+6 weeks of estimated gestational age. There is also an increased appreciation that the vast majority of randomized control data informing the use of antenatal steroids are derived from predominantly high-resource, White populations. Accordingly, a sizable amount of work has recently been undertaken to test how to safely use antenatal steroids in low- and middle-resource environments, wherein the often high rates of preterm birth make these low-cost, easily administered interventions an attractive proposition. It is likely underappreciated by the obstetrical and neonatal communities that the overall efficacy of antenatal steroid therapy is highly variable (including when preterm risk is accurately assessed), the treatment regimens used are largely arbitrary, dosing is suprapharmacologic for effect, and the benefit–risk balance is significantly and differentially modified by gestation. It is also very likely that the patients consenting to receive these treatments are similarly unaware of the complex balance of potential benefits and harms. Although a small number of follow-up studies present a generally benign picture of long-term antenatal steroid risk, several large, population-based retrospective studies have identified associations between antenatal steroid use, childhood mental disease, and newborn infections that warrant urgent attention. Of particular contemporary importance are emergent efforts to optimize antenatal steroid regimens on the basis of the pharmacokinetics and pharmacodynamics of the agents themselves, the need for better targeting of these potent drugs, and clear articulation of the potential benefits and harms of antenatal steroid use at differing stages of pregnancy and in different delivery contexts. [ABSTRACT FROM AUTHOR]

Purpose: Maternal concerns for health and growth in prematurely born infants affect the breastfeeding duration. Method: This prospective observational study evaluated whether maternal concerns regarding insufficient milk supply were supported by inadequate nutrients in human milk or low infant growth. The study followed mothers of 211 premature born infants for 6 months after delivery. Results: Of the 211 infants, 156 were not exclusively breastfed for the recommended 6 months after delivery. For 79 of these 156 infants, termination was due to maternal concerns regarding insufficient milk supply. There was no difference in human milk nutrients or infant growth when comparing infants who were exclusively breastfed with those who were not. Conclusion: Maternal concern regarding insufficient milk supply was the primary explanation for termination of exclusive breastfeeding after premature delivery. Concerns regarding insufficient milk supply were not found associated with inadequate nutrients in the human milk, nor with low infant growth. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine early clinical and laboratory findings in infants born to mothers who had organ transplants and received immunosuppressive treatment. Methods: Between 2016 and 2023, the study examined infants of mothers who underwent organ transplantation and were receiving immunosuppressive treatment, and followed at the Department of Neonatology at Akdeniz University. Demographic, clinical, and laboratory characteristics of mothers and infants were recorded. On the first day of life, complete blood count values were examined, as well as potassium levels on the first, third, and seventh days, and creatinine levels on the third and seventh days. The tacrolimus blood level was calculated by taking the average of the tacrolimus blood values of the mother measured during the pregnancy. The infants were evaluated for any potential morbidities caused by intrauterine immunosuppressive drug exposure. Results: The study included 21 mothers (some with multiple pregnancies) and 27 infants. According to the findings of this study, 74% of these infants were born premature, 67% had low birth weight, and all were delivered via cesarean section. Prematurity was associated with the morbidities found in the infants. In the early period, lymphopenia was detected in 37%, neutropenia in 25.9%, thrombocytopenia in 11.1%, hyperkalemia in 18.5%, and creatinine elevation in 7.4%, all of which returned to normal within a few days. There was no significant relationship between maternal tacrolimus blood levels and infant potassium and creatinine levels. Conclusion: Apart from an increased risk of prematurity, low birth weight, and cesarean delivery, no effects were observed in these infants during the early period. However, long-term follow-up is necessary to monitor for any potential morbidities. [ABSTRACT FROM AUTHOR]

Preterm birth remains one of the most urgent unresolved medical problems in obstetrics, yet only 2 therapeutics for preventing preterm birth have ever been approved by the United States Food and Drug Administration, and neither remains on the market. The recent withdrawal of 17-hydroxyprogesterone caproate (17-OHPC, Makena) marks a new but familiar era for obstetrics with no Food and Drug Administration–approved pharmaceuticals to address preterm birth. The lack of pharmaceuticals reflects a broad and ineffective pipeline hindered by extensive regulatory hurdles, soaring costs of performing drug research, and concerns regarding adverse effects among a particularly vulnerable population. The pharmaceutical industry has historically limited investments in research for diseases with similarly small markets, such as cystic fibrosis, given their rarity and diminished projected financial return. The Orphan Drug Act, however, incentivizes drug development for "orphan diseases", defined as affecting <200,000 people in the United States annually. Although the total number of preterm births in the United States exceeds this threshold annually, the early subset of preterm birth (<34 weeks' gestation) would qualify, which is predominantly caused by inflammation and infection. The scientific rationale for classifying preterm birth into early and late subsets is strong given that their etiologies differ, and therapeutics that may be efficacious for one subset may not work for the other. For example, antiinflammatory therapeutics would be expected to be highly effective for early but not late preterm birth. A robust therapeutic pipeline of antiinflammatory drugs already exists, which could be used to target spontaneous early preterm birth, in combination with antibiotics shown to sterilize the amniotic cavity. New applications for therapeutics targeting spontaneous early preterm birth could categorize as orphan disease drugs, which could revitalize the preterm birth therapeutic pipeline. Herein, we describe why drugs targeting early preterm birth should qualify for orphan status, which may increase pharmaceutical interest for this vitally important obstetrical condition. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Children born premature are more likely to be from minoritized racial and ethnic groups and face chronic health and developmental problems. The medical home aims to comprehensively address health and social needs of all families. This study evaluates racial and ethnic disparities in the prevalence of a medical home among children born premature compared to children born full-term. METHODS: A 2017--18 National Survey of Children's Health data set was used to calculate the medical home performance measure and subcomponents for children aged 0 to 17 born premature (n = 5633) or full-term (n = 45,819). Chi square and logistic regression assessed magnitude and significance of variations by race and ethnicity and prematurity status. RESULTS: Prematurity prevalence differed by race and ethnicity (12.0% non-Hispanic Black [NHB], 12.8% Hispanic, 11.1% Multiracial/Other, 11.0% non-Hispanic White [NHW]). Minoritized children born premature had lower adjusted odds of receiving care in a medical home compared to NHW peers eg, NHB adjusted odds ratio [aOR] 0.54 [95% confidence interval {CI}: 0.38--0.76] and Hispanic aOR 0.56 [95% CI: 0.40--0.79]). Differences were greater in magnitude among children born premature compared to full-term peers (eg, NHB premature aOR 0.54 [95% CI: 0.38--0.76] vs NHB full-term aOR 0.67 [95% CI: 0.58--0.78]), with similar results for "personal doctor/nurse" and "usual sick care." CONCLUSIONS: Racial and ethnic disparities exist in the medical home among children born premature, some more pronounced than full-term peers. To deliver equitable care for all children, efforts are needed to expand access to and improve the medical home, including reliable routine and sick care and stronger family-provider relationships. [ABSTRACT FROM AUTHOR]

Intra-amniotic inflammation leading to preterm birth is one of the leading causes of neonatal morbidity and mortality. We recently reported that the mitochondrial levels of MNRR1 (Mitochondrial Nuclear Retrograde, Regulator 1; also called CHCHD2, AAG10, or PARK22), an important bi-organellar regulator of cellular function, are reduced in the context of inflammation and that genetic and pharmacological increases in MNRR1 levels can counter the inflammatory profile. Herein, we show that nitazoxanide, a clinically approved drug, is an activator of MNRR1 and abrogates preterm birth in a well-characterized murine model caused by intra-amniotic lipopolysaccharide (LPS) injection. • Nitazoxanide exerts anti-inflammatory functions via activation of MNRR1. • Oral administration of nitazoxanide prevents preterm birth in a mouse model of LPS-induced intra-amniotic inflammation. • Nitrazoxanide administration reduces LPS-induced inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Preterm birth remains the leading cause of neonatal morbidity and mortality worldwide. A substantial number of spontaneous preterm births occur in the context of sterile intra-amniotic inflammation, a condition that has been mechanistically proven to be triggered by alarmins. However, sterile intra-amniotic inflammation still lacks treatment. The NLRP3 inflammasome has been implicated in sterile intra-amniotic inflammation; yet, its underlying mechanisms, as well as the maternal and fetal contributions to this signaling pathway, are unclear. Herein, by utilizing a translational and clinically relevant model of alarmin-induced preterm labor and birth in Nlrp3−/− mice, we investigated the role of NLRP3 signaling by using imaging and molecular biology approaches. Nlrp3 deficiency abrogated preterm birth and the resulting neonatal mortality induced by the alarmin S100B by impeding the premature activation of the common pathway of labor as well as by dampening intra-amniotic and fetal inflammation. Moreover, Nlrp3 deficiency altered leukocyte infiltration and functionality in the uterus and decidua. Last, embryo transfer revealed that maternal and fetal Nlrp3 signaling contribute to alarmin-induced preterm birth and neonatal mortality, further strengthening the concept that both individuals participate in the complex process of preterm parturition. These findings provide novel insights into sterile intra-amniotic inflammation, a common etiology of preterm labor and birth, suggesting that the adverse perinatal outcomes resulting from prematurity can be prevented by targeting NLRP3 signaling. [ABSTRACT FROM AUTHOR]

Medical interventions have improved the lives and wellbeing of prematurely born infants and their families,however, mental health interventions among these families have yet to become more widely implemented. Approximately 10 % of the population in the United States is born prematurely, with a higher incidence among families of color. Parents of premature babies face several challenges that negatively influence their mental health, their ability to bond with their babies, and ultimately their children's development. In addition to the biological impairment that certain premature babies face, their experience of medical interventions at such a young age increases their caregiving needs. This paper aims to review the literature about caregivers' attachment representation and sensitivity and its impact on caregivers' behaviors and infant attachment. It also overviews effective early interventions emphasizing the caregiver--infant relationship treatment guided by the principles of Infant and Early Childhood Mental Health due to the reverberating influence of prematurity in the whole family. [ABSTRACT FROM AUTHOR]

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

Natural language processing—the branch of artificial intelligence concerned with the interaction between computers and human language—has advanced markedly in recent years with the introduction of sophisticated deep-learning models. Improved performance in natural language processing tasks, such as text and speech processing, have fueled impressive demonstrations of these models' capabilities. Perhaps no demonstration has been more impactful to date than the introduction of the publicly available online chatbot ChatGPT in November 2022 by OpenAI, which is based on a natural language processing model known as a Generative Pretrained Transformer. Through a series of questions posed by the authors about obstetrics and gynecology to ChatGPT as prompts, we evaluated the model's ability to handle clinical-related queries. Its answers demonstrated that in its current form, ChatGPT can be valuable for users who want preliminary information about virtually any topic in the field. Because its educational role is still being defined, we must recognize its limitations. Although answers were generally eloquent, informed, and lacked a significant degree of mistakes or misinformation, we also observed evidence of its weaknesses. A significant drawback is that the data on which the model has been trained are apparently not readily updated. The specific model that was assessed here, seems to not reliably (if at all) source data from after 2021. Users of ChatGPT who expect data to be more up to date need to be aware of this drawback. An inability to cite sources or to truly understand what the user is asking suggests that it has the capability to mislead. Responsible use of models like ChatGPT will be important for ensuring that they work to help but not harm users seeking information on obstetrics and gynecology. [ABSTRACT FROM AUTHOR]

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

Aminophylline use and the association between clinical outcomes and therapy timing have been less investigated. The objective of this study was to determine the efficacy of early aminophylline use (within the first two days of life) in premature infants. A retrospective observational cohort of infants weighing <1500 g and <30 weeks of gestational age at Kaohsiung Veterans General Hospital received aminophylline either within the first two days of life (EA, early aminophylline group), after the third day of life (LA, late aminophylline group), or without aminophylline during the first month of life (WA, without aminophylline group). Demographic data and neonatal clinical outcomes were compared among the three groups. This study included 89 preterm infants (EA = 33, LA = 38, WA = 18). The EA group had a lower incidence of bronchopulmonary dysplasia (BPD) than the WA group (adjusted odds ratio [aOR] = 8.86(1.56–59.32); P = 0.024). Although there was no significant difference in BPD incidence between the EA and LA groups (aOR = 2.66(0.51–13.81), P = 0.244), a trend remained. Birth body weight less than 1000 g was also a significant risk factor for BPD (aOR = 8.86(1.32–47.41), P = 0.014). The duration of mechanical ventilation was shorter in the infants in the EA group compared to the WA group (estimated beta = −11.344(-19.57–3.12); P = 0.008). Early aminophylline administration may be associated with a decreased incidence of BPD in preterm infants. However, the clinical benefits of aminophylline treatment require further investigation. In addition, a birth body weight of less than 1000 g was a crucial risk factor for BPD. [ABSTRACT FROM AUTHOR]

Prematurity, prenatal growth restriction, and retinopathy of prematurity (ROP) are associated with altered ocular geometry, such as a steeper corneal shape in childhood, but it is unclear whether perinatal history affects corneal thickness development, so this study investigated whether corneal thickness in adulthood is affected by perinatal history. The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. The corneal thickness was measured by Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany), and the relationship between perinatal parameters respective birth weight percentile and corneal thickness at different locations was assessed using uni- and multivariable linear regression models. Covariates included age, sex, mean corneal radius, white-to-white distance, gestational age, birth weight percentile, ROP occurrence, and treatment. The main outcome measures were corneal thickness at the apex, the pupil center, and the corneal periphery. The corneal thickness was measured in 390 participants (754 eyes, mean age 29.7+/-8.7 years, 224 females). In multivariable analyses, a lower birth weight percentile was associated with a lower corneal thickness at the apex (B = 0.20, p = 0.003) and the pupil (B = 0.19, p = 0.007). These effects diminished towards the corneal periphery and were not observed beyond the 4-mm diameter circle around the thinnest corneal position. Neither gestational age, ROP occurrence, or ROP treatment affected the corneal thickness. A lower birth weight percentile in subjects born preterm as a proxy for restricted fetal growth is associated with corneal thickness thinning in adults aged 18 to 52 years, indicating that corneal thickness development, particularly in the corneal center, may originate in the fetal stage. [ABSTRACT FROM AUTHOR]

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

Background: Premature infants experience alterations in maternal stimulation (including auditory sensory alteration such as talking or singing to the infant in the neonatal intensive care unit) due to admission to the neonatal intensive care unit. Because of their physiological and neurobehavioral immaturity, infants are at an increased risk of delays in reaching feeding milestones (a key developmental milestone), which often need to be achieved before discharge. Purpose: This systematic review evaluated the literature regarding the effect of maternal speech on achievement of feeding milestones in premature infants. Data Sources: A systematic search of CINAHL, PubMed, Web of Science, and Google Scholar from 2010 to 2021. Study Selection: Studies were selected if they examined the effect of maternal voice interventions on premature infants' feeding milestones. Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Results: Six studies were identified. This systematic review of the literature on the effects of maternal voice on feeding milestones in premature infants found equivocal results. Implications for Practice: Given the inconsistent results, this systematic review does not support a change in clinical practice. However, encouragement of maternal visits is highly recommended as the additional benefits of the mother's presence may extend beyond exposure to maternal voice. Implications for Research: More research is needed including use of more homogenous samples, application of recommended decibel levels, and utilization of an adequately powered randomized controlled trial to further examine the effects of maternal voice on feeding milestones. [ABSTRACT FROM AUTHOR]

In 2015, a protocol including early laparoscopy-assisted surgery in the treatment of necrotizing enterocolitis (NEC) was implemented at our institution. Carbon dioxide insufflation during laparoscopy may have an anti-inflammatory effect. We aimed to compare post-operative outcome after early laparoscopy-assisted surgery and classical laparotomy for NEC. Charts of premature infants undergoing surgery for NEC (2012–2021) were reviewed. Cases operated by early laparoscopy-assisted surgery (2015–2021) were compared to infants operated for NEC between 2012 and 2015 (laparotomy-NEC). Outcomes were post-operative CRP, need for reintervention, mortality, and the occurrence of post-NEC intestinal strictures. CRP was measured on the day of surgery (POD-0), 2 days (POD-2), and 7 days after surgery (POD-7). Data were compared using contingency tables for categorical variables and Student t-test or Mann–Whitney test for continuous variables. Infants with NEC operated by early laparoscopy (n = 48) and laparotomy (n = 29) were similar in terms of perforation (60% vs 58%, p = 0.99) and POD-0 CRP (139 vs 124 mg/L, p = 0.94). Delay between first signs of NEC and surgery was shorter in the laparoscopy group (3 vs 6 days, p = 0.004). Early laparoscopy was associated with a lower CRP on POD-2 (108 vs 170, p = 0.005) and POD-7 (37 vs 68, p = 0.002), as well as a lower rate of post-operative intestinal stricture (34% vs 61%, p = 0.04). In addition to being safe and feasible in premature infants, early laparoscopic-assisted surgery was associated with decreased NEC-related post-operative inflammation and strictures. A prospective, randomized study is needed in order to evaluate short and long-term effects of laparoscopy in infants with NEC. Level III. [ABSTRACT FROM AUTHOR]

Preterm birth (<37 weeks gestation) affects over 10% of live births. The last two to three decades have seen an improvement in survival of preterm infants, especially those born at extremes of viability. Preterm birth results in interruption of organ development and maturation that occurs in the last trimester of pregnancy. This increases the risk of short term mortality and morbidity. As an incremental improvement in survival of preterm neonates into adulthood is seen, this has brought to light the long term health needs of this subgroup of the population. Adolescents and adults born preterm are at increased risk of chronic respiratory, cardiovascular, renal, endocrine, visual and hearing problems and adverse neurodevelopmental and mental health outcomes. Better awareness amongst clinicians, targeted follow-up, and screening, would help in early detection and timely intervention to optimize their long term health outcomes and survival. [ABSTRACT FROM AUTHOR]

Premature birth is a risk factor for bronchopulmonary dysplasia (BPD); both of which are associated with obstructive airway disease throughout childhood. Impulse oscillometry (IOS) is an effort-independent, passive measure of tidal breathing, which could have benefits in assessing lung function amongst younger patients unable to perform valid spirometry. A literature search was conducted to investigate the use of IOS in prematurely born children and young people. IOS results correlate with those of spirometry. Reversibility of airway obstruction in children with BPD is variable. IOS could have benefits in assessing individual patient response and suitability for bronchodilator therapy. More work, however, is required to establish multi-ethnic reference ranges and standardise commercially available devices prior to its routine incorporation into clinical practice. [ABSTRACT FROM AUTHOR]

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

• What is currently known about this topic? Timing of inguinal hernia repair in premature infants is variable. Early repair, during admission in the neonatal intensive care unit (NICU) may be encouraged owing to concerns about hernia incarceration, strangulation, or loss to follow up. On the other hand, delayed repair might be encouraged owing to concerns about increased perioperative risk in premature infants. • What new information is contained in this article? In premature infants, inguinal hernia repair that is performed during initial hospitalization in the NICU is associated with lower cost, but higher recurrence rates, when compared to delayed repair. Timing of inguinal hernia repair (IHR) in premature infants remains variable, yet the impact of IHR timing on procedure costs and recurrence is unclear. We sought to compare cost and recurrence rates of IHR in premature infants based on timing of repair. We performed a retrospective cohort study using MarketScan insurance claims data from 2007 to 2018 to evaluate IHR occurring within 365 days of birth in preterm infants (gestational age [GA]<37 weeks at birth). Patients were stratified based on timing of IHR: those occurring during and after neonatal discharge. Hernia recurrences within one year following IHR were identified. Patient demographic characteristics and costs were compared between groups. Time to recurrence and cumulative recurrence hazards were estimated using Kaplan Meier analysis and Cox proportional hazards regression. We identified 3,662 preterm infants with IHR within 365 days of birth; 1,054(28.8%) occurred early. Infants with IHR during NICU stay were more likely to have GA at birth≤32 weeks (74.7% vs. 37.2%; p <0.01) and birthweight<1500 g (83.0% vs. 40.3%; p <0.01) compared to post-NICU IHR. The hernia recurrence rate was higher and total procedure costs lower in early IHR. Early IHR (HR:1.86, 95% CI: 1.56–2.22), incarcerated/strangulated hernia (HR:1.86, 95% CI:1.49–2.32), GA≤32 weeks (HR: 1.40, 95% CI: 1.19–1.65), and congenital anomalies (HR: 1.32, 95% CI: 1.12–1.57) were predictors of hernia recurrence. Using insurance claims data, IHR performed during initial neonatal admission was associated with lower cost, but higher recurrence rate, when compared to delayed repairs in preterm infants. Retrospective study Level III [ABSTRACT FROM AUTHOR]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infants exposed prenatally to drugs of substance use are at increased risk for seizures, strabismus, feeding difficulty, and neurodevelopmental delays. Exposed preterm infants may have additional morbidities related to prematurity. There is limited literature on national outcomes of preterm infants exposed to drugs of substance use. We aimed to evaluate the trends and neonatal outcomes of preterm infants born in the USA who were exposed in-utero to drugs of substance use. Retrospective cohort study of preterm live born (<37 weeks gestation) exposed in-utero to opioids, hallucinogens, or cocaine in the Healthcare Cost and Utilization Project database from 2002 to 2017. Neonatal outcomes were identified using international classification of diseases 9&10 codes. Of the 54,469,720 live-born infants, 7.7% (4,194,816) were preterm, and 58 679 (1.4%) were exposed in-utero to maternal opioids/hallucinogens (n = 39,335) or cocaine (n = 19,344). There was a trend for increased exposure to opioids/hallucinogens (Z score = 76.14, p < 0.001) during the study period. Exposed preterm infants had significantly more neurological anomalies, intra-ventricular hemorrhage and periventricular leukomalacia (p < 0.001). There was a trend for increased in-utero exposure to opioids and hallucinogens in the preterm infants in the USA. Exposed preterm infants had more neurological morbidities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe parent-reported barriers and facilitators to reading to preterm-born infants, both in the neonatal intensive care unit (NICU) and at home. We hypothesized that families of preterm infants face unique barriers previously not described in the literature, and that understanding barriers from the parent perspective will uncover strategies for improving the NICU environment and cognitive home environment and allow refinement of current reading programs. METHODS:We performed a qualitative study of parents of 0 to 12 month corrected age infants presenting to neonatal follow-up clinic. Infants were born <33 weeks gestational age or with birth weight ≤1500 grams. Parents completed a semistructured interview about reading practices. Answers to open-ended questions were coded to highlight key themes. RESULTS: We reached thematic saturation after interviewing 23 parents of 28 infants. Parent-generated items about barriers and facilitators to reading in the NICU and at home were each coded into 4 themes. Competing responsibilities and believing that reading was developmentally inappropriate were 2 shared themes for barriers to reading in both the NICU and home environment. Support people and understanding developmental impact were 2 shared themes for facilitators to reading in both the NICU and home environment. CONCLUSIONS: This qualitative work elucidates new targets for novel programs intended to support cognitive development of high-risk preterm infants. Addressing the unique, parent-reported barriers that we have identified and supporting adoption of the facilitators could increase word exposure for preterm infants, starting in the NICU and continuing at home. [ABSTRACT FROM AUTHOR]

Background: Development of necrotizing enterocolitis is multifactorial, with contributing factors that are unique to the preterm infant in the neonatal intensive care unit (NICU). The use of probiotics may reduce these risk factors.Purpose: To evaluate evidence of biologic plausibility for probiotic supplementation to mitigate key risk factors implicated in the development of disease and show recent evidence of safety and effectiveness.Data Sources: A literature survey of electronic databases, including PubMed, Cochrane Database of Systematic Reviews, and CINAHL, was conducted.Study Selection: Selection terms included "necrotizing enterocolitis," "probiotics," and "prematurity." Reviews that were included were full text, in English, and published in the last 5 years. Ten systematic reviews of randomized controlled trials were extracted from 749 records. Excluded were studies that used adjuncts to probiotics, such as lactoferrin or prebiotics, and studies of probiotics given antenatally.Data Extraction: Two independent reviewers extracted data to AMSTAR 2, a critical appraisal tool for systematic reviews of randomized or nonrandomized studies of healthcare interventions.Results: All the reviews found statistically significant reductions in necrotizing enterocolitis rates after supplementation with probiotics. None of the reviews reported adverse effects.Implication For Practice and Research: Probiotic supplementation with specific strains reduces risk for necrotizing enterocolitis. To advance probiotic use in the NICU, additional high-quality trials are needed to focus on specific strains or combinations of strains and to evaluate dosing and duration of treatment.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx . [ABSTRACT FROM AUTHOR]

• What is currently known about this topic? Concerns have been addressed about a higher risk of anastomotic leak and mediastinitis in neonates operated on for EA/TEF who required non-invasive ventilation after extubation in previous studies, with contrasting results. • What new information is contained in this article? Post-operative non-invasive respiratory support could be safely used in EA/TEF infants without a significant increase in risk of anastomotic leak. This should be considered especially in preterm infants in which a prolonged invasive ventilation contribute to the development of bronchopulmonary dysplasia and therefore it should be carefully shifted to non-invasive ventilation as soon as possible, using low pressures and, if necessary, a mild sedation. Infants affected by Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) may require non-invasive ventilation (NIV) in the post-operative period after elective extubation, especially if born preterm. The aim of the paper is to evaluate the role of different ventilation strategies on anastomotic complications, specifically on anastomotic leak (AL). Retrospective single Institution study, including all consecutive neonates affected by EA with or without TEF in a 5-year period study (from 2014 to 2018). Only infants with a primary anastomosis were included in the study. All infants were mechanically ventilated after surgery and electively extubated after 6–7 days. The duration of invasive ventilation was decided on a case-by-case basis after surgery, based on the pre-operative esophageal gap and intraoperative findings. The need for non-invasive ventilation (NCPAP, NIPPV, and HHHFNC) after extubation and extubation failure with the need for mechanical ventilation in the post-operative period were assessed. The primary outcome evaluated was the rate of anastomotic leak. 102 EA/TEF infants were managed in the study period. Sixty-seven underwent primary anastomosis. Of these, 29 (43.3%) were born preterm. Patients who required ventilation (n = 32) had a significantly lower gestational age as well as birthweight (respectively p = 0.007 and p = 0.041). 4/67 patients had an AL after surgical repair, with no statistical differences among post-operative ventilation strategies. We found no significant differences in the rate of anastomotic leak (AL) according to post-operative ventilation strategies in neonates operated on for EA/TEF. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals. We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model. On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family. Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family. Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways. • Prematurity represents the leading cause of death in first weeks of life. • Parents face hard-hitting challenges and NICU may represent a place where their expectations are dashed. • Literature on prematurity is limited to distinct perspectives, leaving out the involved actors' process. • A Grounded Theory has been conceptualized to explain the parents and professionals' process around prematurity. • This study may improve perinatal care by suggesting integrating professionals into the family systems. [ABSTRACT FROM AUTHOR]