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Background and Objective: This was a nationwide prospective study carried out in Italy between 2005 and 2007, involving 34 centers with a neonatal intensive care unit. The study reports the Italian Neonatal Study charts for weight, length, and head circumference of singletons born between 23 and 42 gestational weeks, comparing them with previous Italian data and with the most recent data from European countries., Patients and Methods: Single live born babies with ultrasound assessment of gestational age within the first trimester, and with both parents of Italian origin. Only fetal hydrops and major congenital anomalies diagnosed at birth were excluded. The reference set consists of 22,087 girls and 23,375 boys., Results: At each gestational age, boys are heavier than girls by about 4%. Later-born neonates are heavier than firstborn neonates by about 3%. The effects of sex and birth order on length and head circumference are milder. No differences were observed between babies born in central-north Italy and southern Italy. A large variability emerged among European neonatal charts, resulting in huge differences in the percentage of Italian Neonatal Study neonates below the 10th centile, which is traditionally used to define small-for-gestational-age babies. In the last 2 decades prominent changes in the distribution of birth weight emerged in Italy and in the rest of Europe, in both term and preterm neonates., Conclusions: The existing European neonatal charts, based on more or less recent data, were found to be inappropriate for Italy. Until an international standard is developed, the use of national updated reference charts is recommended.

Incidence and non-nutritional risk factors were estimated for necrotising enterocolitis in 2035 very low birth weight infants, admitted to 14 tertiary-level neonatal intensive care units in Lombardy, northern Italy. There were 62 necrotising enterocolitis cases, with an overall incidence of 3.1%. After adjustment for gestational age and centre, the risk factors were mechanical ventilation, patent ductus arteriosus, and late-onset sepsis, whereas surfactant treatment was associated with decreased risk. Significant variations in necrotising enterocolitis incidence among hospitals were found.

Mean birth weights and percentile charts are given for 161 singleton infants born between 24 and 30 weeks' gestation at the 2nd School of Medicine of Naples. This chart is the first for a Mediterranean population. Our data are similar to those reported from a United Kingdom population and from Japan, suggesting that ethnic differences in birth weight at this gestational age are unimportant.

Background: The use of vitamin D in premature infants is one of the important preventive factors for osteopenia of prematurity, but there are conflicting results on the appropriate doses, so this study aimed to compare the doses of 400 and 600 units of vitamin D in the prevention of osteopenia of prematurity in infants with a gestational age =32 weeks. Methods: This clinical trial study was conducted on 108 premature infants divided into two groups of 54 with a gestational age of =32 weeks born between 2020 and 2021 in Shahid Beheshti and Al-Zahrai hospitals in Isfahan. In the first group, daily vitamin D was 400 units from the 7th day of birth, and in the second group, it was 600 units. At the age of 5 weeks, levels of calcium, phosphorus, alkaline phosphatase (ALP), and vitamin D were evaluated. If the ALP level was above 1000, wrist radiography was requested. Also, the baby was examined for clinical symptoms of rickets at the age of 5 weeks. The data were analyzed by Statistical Package for the Social Sciences (SPSS) software version 26, and a P value <0.05 was considered significant. Results: In this study, there was no significant difference between the levels of ALP in the two groups (P = 0.596), but the level of vitamin D was significantly higher in the 600 units of vitamin D group (P < 0.001). The level of calcium was higher in the 400 units of vitamin D group, but this difference was slightly significant (P = 0.062). The level of phosphorus in the 600 units of vitamin D group was higher than in the 400 units of vitamin D group, and the difference was slightly significant (P = 0.062). Conclusions: This study showed that daily doses of 600 and 400 units of vitamin D in infants with a gestational age of =32 weeks had no effect on the incidence of clinical symptoms and radiological findings of rickets at the age of 5 weeks. [ABSTRACT FROM AUTHOR]

Objective: Effective oral feeding is one of the critical milestones that must be achieved by preterm infants. While gestational age and birth weight have been recognized as influential factors, recent studies have found additional variables impacting the achievement of full oral feeding (FOF). This study is aimed at describing factors associated with the attainment of FOF in preterm infants. Methods: This retrospective cohort study examines preterm infants born between 28 and 34 weeks' gestation admitted to Dr. Cipto Mangunkusumo General Hospital in Jakarta between July and December 2016. Comparative analysis utilized the Kruskal–Wallis test, while Cox's regression was employed for multivariate analysis to assess factors influencing the achievement of FOF. Results: This study included 87 preterm infants meeting the inclusion criteria. The median gestational age was 33 weeks (IQR: 3). The most common birth weight range was 1500–1999 g (51.7%). Median durations from birth to the first feed, full enteral feed, and FOF were observed to be 1 day (IQR: 1), 6 days (IQR: 10), and 14 days (IQR: 24), respectively. Notably, the duration of oxygen therapy, episodes of sepsis, and frequency of blood transfusions showed significant associations with the time taken to achieve FOF. Conclusion: This study found significant associations between the time to achieve FOF and factors such as oxygen therapy duration, sepsis episodes, and frequency of blood transfusion. These findings highlight the importance of considering these factors in managing preterm infants. However, a further prospective study is warranted to identify additional factors that influence feeding milestones in preterm infants. [ABSTRACT FROM AUTHOR]

The perinatal histories of 27 newborn infants with NEC were compared to those of 54 infants of equivalent birth weight who did not have NEC during an 8-year study period to see if possible predisposing factors were independent of the confounding effect of birth weight. No differences were observed in gestational age, degree of intrauterine growth retardation, premature rupture of membranes, perinatal asphyxia, skin temperature at admission, haematocrit, presence or absence of respiratory distress syndrome, umbilical catheter placement, start and type of feeding or presence of positive blood cultures. Prematurity is the greatest risk factor predisposing to the development of NEC and the perinatal problems which precede the onset of NEC are common among all premature infants. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is necessary to develop healthy lungs and other organs early in life. Most infants born before 28 weeks' gestation have low vitamin D levels at birth and a limited intake during the first month. Enteral vitamin D supplementation is inexpensive and widely used. The appropriate supplementation regimen for extremely preterm infants is controversial, and the effect of different regimens on their blood levels and outcomes is unclear. Methods: Randomized, blinded comparative effectiveness trial to compare two vitamin D supplementation regimens for inborn infants <28 weeks gestation or <1000 g birth weight at a large academic center in the United States. Infants are stratified by birth weight and randomized within 96 h after birth to either routine supplementation (400 IU/day with established feedings) or increased supplementation (800 IU/day with any feedings) during the first 28 days after birth. We hypothesize that the higher and early vitamin D dose (800 IU/day with early feeding) compared to placebo plus routine dose (400 IU/day with established feeding) will substantially increase total 25-hydroxyvitamin D3 levels measured as state-of-art at 1 month, reduce respiratory support at 36 weeks' postmenstrual age (on an ordinal scale predictive of later adverse outcomes), and improve or at least not worsen other important secondary outcomes. The infants in the study will follow up at 22–26 months' corrected age (~2 years) with blinded certified examiners to evaluate neurodevelopmental outcomes. The sample size of a minimum of 180 infants provides >90% power to detect a >95% posterior probability of a 33% increase in serum 25-hydroxy vitamin D3 and >80% power to detect a >80% posterior probability of a relative risk decrease of 20% of reducing respiratory support by intention-to-treat Bayesian analyses using a neutral prior probability. Discussion: Our study will help clarify the uncertain relationship of vitamin D supplementation and its associated serum metabolites to clinical outcomes of extremely preterm infants. Confirmation of our hypotheses would prompt reconsideration of the supplementation regimens used in extremely preterm infants and justify a large multicenter study to verify the generalizability of the results. Trial registration: ClinicalTrials.gov NCT05459298. Registered on July 14, 2022. [ABSTRACT FROM AUTHOR]

Introduction: Children born prematurely (<37 weeks' gestation) are at increased risk of perinatal complications, comorbidities, and iron deficiency. Iron deficiency is associated with restless legs syndrome and periodic limb movement disorder. In this study, we assessed the prevalence of restless sleep disorder (RSD) and elevated periodic limb movements during sleep (PLMS) in children born prematurely who underwent polysomnography. Methods: A retrospective chart review of sleep studies was conducted in children aged 1–18 years (median age 4 years) with a history of premature birth. Children with genetic syndrome, airway surgery, or tracheostomy were excluded. Three groups were compared: children with PLMS index >5, children with RSD, and children with neither elevated PLMS index nor RSD. Results: During the study, 2577 sleep studies were reviewed. Ninety-two studies fit our criteria and were included in the analysis. The median age at birth was 31 weeks, and the interquartile range (IQR) was 27–34 weeks. A total of 32 (34.8%) children were referred for restless sleep and 55 (59.8%) for snoring. After polysomnography, 18% were found to have a PLMS index >5/h, and 14% fit the criteria for restless sleep disorder (RSD). There were no statistically significant differences in PSG parameters among the children with RSD, PLMS, and the remaining group, except for lower obstructive apnea/hypopnea index (Kruskal–Wallis ANOVA 8.621, p = 0.0135) in the RSD group (median 0.7, IQR 0.3–0.9) than in the PLMS (median 1.7, IQR 0.7–3.5) or the non-RSD/non-PLMS (median 2.0, IQR 0.8–4.5) groups. Conclusions: There was an elevated frequency of RSD and elevated PLMS in our cohort of children born prematurely. Children born prematurely are at higher risk of iron deficiency which can be a contributor factor to sleep -related movement disorders. These results add new knowledge regarding the prevalence of RSD and PLMS in these children. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to explore the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan. Study Design Data on live births and fetal deaths in the state of Michigan from March to November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March–November 2020) were compared with the same period (March–November) in the prepandemic years (2017–2019). Results Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with prepandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 (3.1 vs. 4.7 [2017], 5.2 [2018], 4.4 [2019], p -value <0.001). The adjusted risk for fetal death in 2020 was decreased (odds ratio [OR] = 0.64 [95% confidence interval (CI): 0.56–0.74], p <0.0001), compared with prepandemic years. Fetal death was significantly associated with African-American race, pregnancy hypertension and prepregnancy diabetes. No significant difference in the proportion of preterm births (<37 weeks' gestation) was noted between pandemic and prepandemic years (9.9 vs. 10.0%, p = 0.50). There was no significant difference in the risk of preterm birth across gestational age strata (<28, 28–31 6/7 , 32–36 6/7 , 37–41 6/7 , and >42 weeks) between pandemic and prepandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy-induced hypertension, chronic hypertension, prepregnancy diabetes, congenital anomalies, previous preterm birth, and prolonged rupture of membranes >12 hours. Conclusion Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with prepandemic years in the state of Michigan. Key Points A decrease in fetal death rate was noted during SARS CoV-2 pandemic in the State of Michigan. Overall state-wide rates of preterm birth did not change in 2020, compared to previous years. Significant risk factors associated with preterm birth and fetal deaths did not differ between prepandemic and pandemic years. [ABSTRACT FROM AUTHOR]

The threshold for a late-onset sepsis (LOS) evaluation varies considerably across NICUs. This unexplained variability is probably related in part to physician bias regarding when sepsis should be "ruled out". The aim of this study is to determine if physician characteristics (race, gender, immigration status, years of experience and academic rank) effect LOS evaluation in the NICU. This study includes a retrospective chart review of all Level III NICU infants who had a LOS evaluation over 54 months. Physician characteristics were compared between positive and negative blood culture groups and whether CBC and CRP were obtained at LOS evaluations. There were 341 LOS evaluations performed during the study period. Two patients were excluded due to a contaminant. Patients in this study had a birth weight of [median (Q1, Q3)]+ 992 (720, 1820) grams and birth gestation of [median (Q1, Q3)] 276/7 (252/7, 330/7) weeks. There are 10 neonatologists in the group, 5/10 being female and 6/10 being immigrant physicians. Experienced physicians were more likely to obtain a CBC at the time of LOS evaluation. Physician characteristics of race, gender and immigration status impacted whether to include a CRP as part of a LOS evaluation but otherwise did not influence LOS evaluation, including the likelihood of bacteremia. [ABSTRACT FROM AUTHOR]

Vaccination against SARS-CoV-2 has been demonstrated to be safe during gestation. Nevertheless, there are no robust data investigating the entity of maternal antibodies' transmission through the placenta to the newborn and the persistence of the antibodies in babies' serum. The objective of this study is to assess the maternal antibody transmission and kinetics among newborns in the first months of life. Women having received one or two doses of anti-SARS-CoV-2 mRNA-vaccines during pregnancy at any gestational age, and their newborns, were recruited and followed-up over 9 months. Ninety-eight women and 103 babies were included. At birth, we observed a significant positive correlation between maternal and neonatal serum anti-SARS-CoV-2 antibody levels and a significant negative correlation between the time since last dose and antibody levels in mothers with two doses. Over the follow-up, the birth antibody level significantly decreased in time according to the received doses number at 3, 6, and 9 months. During the follow-up, we registered 34 dyad SARS-CoV-2 infection cases. The decreasing trend was slower in the SARS-CoV-2 infection group and among breastfed non-infected babies. Antibodies from maternal anti-SARS-CoV-2 vaccination are efficiently transferred via the placenta and potentially even through breast milk. Among newborns, antibodies show relevant durability in the first months of life. [ABSTRACT FROM AUTHOR]

Background: International studies have reported conflicting data about the effects of COVID-19 pandemic policy measures on maternal and neonatal health. A major impact was reported on stillbirth and prematurity. The published literature suggests that the economic setting influenced the effects of imposed mitigation measures with a more severe effect in low-income countries. Objectives: Our objective is to compare pregnancy outcomes at the only tertiary Maternity Hospital in Bihor County-Romania before and during the COVID-19 pandemic. This study aims to observe and document differences in perinatal outcomes across these periods, without inferring direct causation related to the pandemic or its associated restrictions. Materials and methods: We used data from the registries of Public Health Services Bihor to conduct a retrospective cohort analysis of preterm births and stillbirths during the COVID-19 pandemic in Bihor County, Romania. Pregnancy outcomes were compared between the pandemic period (March 2020-February 2022) to the corresponding historical pre-COVID-19 period (March 2018-February 2020). Maternal socio-demographic variables and neonatal characteristics of these periods were also examined. Results: The COVID-19 pandemic period was associated with an increase in the stillbirth rate (RR: 1.53, 95% CI, 1.05-2.23). Preterm birth was significantly impacted during this period and showed changes when analyzing gestational age (RR: 0.88, 95% CI, 0.79-0.96) or birth weight (RR: 0.91, 95% CI, 0.82-1.00). The main cause of stillbirth was intrauterine asphyxia due to placental causes (67.6%) or cord pathology (12.6%), the most frequently encountered maternal pathology was cardiovascular (28.3%) or infectious (21.7%). Our study revealed no significant changes in terms of maternal and neonatal characteristics during the two-year pandemic period. Conclusions: Lockdown restrictions in Bihor County, Romania were associated with an increase in stillbirths, whilst preterm birth rate decreased. This raises concerns about whether pandemic policy measures may have led to a failure in identifying and offering proper care for pregnant women who were more likely to experience an antepartum loss. Further studies across the globe are needed in order to integrate comparable data that will help develop adequate protocols and policies for protecting maternal and child health during the next pandemic that will follow. [ABSTRACT FROM AUTHOR]

Introduction: It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU. Materials and methods: Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU. Results: For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU. Conclusions: Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy. [ABSTRACT FROM AUTHOR]

Birth weight is one of the determinants of a child's physical growth and future brain development. However, babies with low birth weight (LBW) are at risk of death and other health problems. The purpose of this literature review is to systematically summarize research that analyzes the factors that influence the growth of low birth weight babies. The method used was a literature review using the PRISMA Protocol, with inclusion criteria, namely full text and original research, the research subjects were babies born with low birth weight (<2500g), articles in Indonesian and English, published in the last 5 years (2017-2022). The results showed that there are several factors that influence the growth of infants with a history of low birth weight such as gender (male), lower gestational age, postnatal health problems, nutritional intake, such as exclusive breastfeeding or enteral feeding, and maternal parenting practices such as Kangaroo Mother Care (KMC). Exclusive breastfeeding and maternal parenting practices (Kangaroo Mother Care) have an impact on increasing growth so it is good to apply especially for mothers who have low-birthweight babies to catch up with age-appropriate growth. [ABSTRACT FROM AUTHOR]

Background: Preterm babies are born before completion of 37 weeks of gestational. Compared to term neonates, preterm babies are difficult to adjust to extra uterine life and 15 million babies (11%) born before 37 weeks of gestation. Purpose: This systematic review and meta-analysis aimed to evaluate evidence concerning the efficacy of body position on gastric residual volume among preterm infants. Methods: We conducted a systematic search of studies trials published in PubMed, MEDLINE, CINHAL, Clinical Key, Cochrane Library, and Google scholar. Two authors independently appraised the selected randomized control trials for evaluating the effectiveness of body position on gastric emptying. This systematic review and meta-analysis was conducted based on the Cochrane risk bias assessment tool using Revman 5.3 software. Results: On assessment this systematic review and metaanalysis comprised 289 preterm infants from the included 7 trials, with the sample size ranging from 20–63. The gestational age ranged from 28–37 weeks, with an average gestational age of 31.7 weeks. The age of the participants postnatal ranged from 6.6 days to 33.4 days, with an average age of 18±6 days. The weight of the participants during data collection ranged from 1,272–2,683 g, with an average of 1,795 g. Conclusion: This systematic review and meta-analysis revealed that right lateral and prone position lesser gastric residual volume in comparison to preterm infants placed in supine and left lateral position. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health & Life Sciences / Sağlık ve Yaşam Bilimleri Dergisi is the property of Istanbul Kultur University 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: To generate a reference of length at birth (LB) according to sex and gestational age (GA) of the Chilean population. Methods: This cross‐sectional observational study used public pooled Chilean newborn (NB) population data registered by the Civil Registry and Identification Service in Chile from 2000 to 2016. Multiple births, entries without information for LB, GA, and sex, and birth lengths <−4SD and > 4SD, were excluded. After applying the selection and randomization criteria, the final sample was made up of 5 010 963 NB (2 560 310 boys; 2 450 653 girls). Length at birth centiles by sex and GA (24–42 weeks) were calculated using the GAMLSS method and then compared with the INTERGROWTH‐21st standard. Results: Girls had a lower LB than boys. For most GA and in both sexes, the absolute and percentage differences of percentiles as compared with INTERGROWTH‐21st were lower than 1 cm and 1%, respectively. Conclusions: We present a reference for LB by sex and GA in the Chilean population, developed following updated methodological criteria for neonatal anthropometry, which is acceptably consistent with the INTERGROWTH‐21st standard. The reference we propose may be used in clinical and epidemiological studies to identify either Chilean individuals or populations, respectively, at higher risk of perinatal and infant adverse events related to LB. [ABSTRACT FROM AUTHOR]

Aim: The causative factors of neonatal feeding intolerance are poorly understood. Intrauterine environment and fetal conditions are important factors affecting gastrointestinal perfusion. Our aim was to evaluate whether maternal preeclampsia negatively affects preterm infants' enteral feeding tolerability. Materials and Methods: Eight hundred and twenty preterm infants who were born between January 2015 and December 2016 and were under 1,500 grams and 30 weeks of gestational age were included in this entire cohort of which 701 were retrospectively analyzed because of missing records. Antenatal, perinatal, and neonatal outcome data were retrospectively analyzed. Results: There were statistical differences between infants with maternal preeclampsia (n=128) and without preeclampsia (n=573), in terms of mean birth weight, mean gestational age, grade 3-4 IVH, platelet count, being under 3rd percentile of body weight during discharge from NICU and feeding intolerance. There was no significant difference on the first day of feeding, fully enteral feeding days, and time of catch-up birth weight. After correcting the data with birth weight, gestational age, and SGA as a cofactor; nominal regression revealed that PE strongly may be an independent risk factor for FI in this study group [OR: 5.469 (95%CI 1.099-2.929) p:0.019]. Conclusion: According to this study's results, we could say that preeclampsia is a significant risk factor for feeding intolerance in very low birth-weight preterm babies. For babies of mothers with preeclampsia, a nutrition plan should be made; interventions and treatments to minimize fetal effects should be investigated. [ABSTRACT FROM AUTHOR]

Background: Preterm birth and admission to the neonatal intensive care unit (NICU) could induce post-traumatic stress disorder (PTSD). PTSD is an important factor to focus on, as it is associated with parental mental health difficulties and with changes in caregiving quality such as increased intrusiveness, reduced sensitivity, and increased attachment insecurity for the child. Aims: We aimed to study the main risk factors, in the early life of newborns, and preventive measures for PTSD in parents of neonates hospitalized in the NICU. Methods: We included parents of preterm newborns, consecutively admitted to the NICU of the University La Sapienza of Rome. The presence of PTSD following preterm birth and NICU admission was assessed using the Clinicianadministered PTSD scale (CAPS) at enrollment and at 28-30 days following NICU admission or the moment of discharge. We also evaluated the Family Environment Scale which measures the social environment of all types of families; the Parental Stressor Scale which measures parental anxiety and stress; the Spielberger State-Trait Anxiety Inventory consisting of two parts measuring the State (response to present situation) and Trait (pre-disposition to be anxious) anxieties separately, and the Beck Depression Inventory Second Edition assessing depressive symptoms. Results: We found, in a multivariate analysis, that the gestational age of newborns admitted to NICU significantly (b = 2.678; p = 0.040) influences the occurrence of PTSD. We found that the cases showed significantly (b = 2.443; p = 0.020) more pathological Parental Stressor Scale sights and sounds scores compared to controls. The early Kangaroo-Care (KC) significantly (b = ff2.619; p = 0.015) reduces the occurrence of PTSD. Conclusion: Post-traumatic stress disorder in parents of preterm newborns is a pathological condition that should be properly managed, in the very first days after birth. The NICU environment represents a main risk factor for PTSD, whereas KC has been demonstrated to have a protective role in the occurrence of PTSD. [ABSTRACT FROM AUTHOR]

Trace elements, including zinc (Zn) and copper (Cu), are known to play important roles in human health. The present study aimed to assess the levels of Zn and Cu in cord blood and maternal milk and to analyze their association with maternal and infant characteristics and pregnancy outcomes in a Slovenian study population of mothers and their neonates recruited within the PHIME prospective cohort study. The study included 324 mothers, but the data on Zn and Cu levels in both cord blood and maternal milk was available for 243 mothers. Questionnaires were used to assess the socio-demographic and health status of the mothers, their lifestyle habits (including detailed nutritional habits), and their residential and occupational histories. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used to measure Zn and Cu levels in cord blood and maternal milk. Low Zn levels in cord blood were associated with lower gestational age and birth weight and were correlated with an increased probability of the birth of small for gestational age (SGA) infants. Maternal smoking influenced the Cu levels in both cord blood and maternal milk. Cord blood Cu levels were higher and Cu levels in maternal milk were lower in smoking compared to non-smoking mothers. Most importantly, a decreased Zn/Cu ratio in cord blood was associated with lower gestational age and lower birth weight. This indicates the overall positive effects of Zn and negative effects of Cu on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Preterm and small-for-gestational-age (SGA) infants are more susceptible to vaccine-preventable diseases. To evaluate routine vaccination timeliness in these high-risk groups, a full birth cohort of infants (n = 41,502) born in 2017 and 2018 in Tuscany was retrospectively followed up until 24 months of age. Infants were classified by gestational age (GA) and SGA status. The vaccinations included: hexavalent (HEXA), measles-mumps-rubella, varicella, pneumococcal conjugate (PCV), and meningococcal C conjugate. Time-to-event (Kaplan–Meier) analyses were conducted to evaluate the timing of vaccination according to GA; logistic models were performed to evaluate the associations between GA and SGA with vaccination timeliness. Time-to-event analyses show that the rate of delayed vaccine receipt increased with decreasing GA for all the vaccinations, with a less marked gradient in later vaccine doses. Compared to full-term infants, very preterm infants significantly showed an increased odds ratio (OR) for delayed vaccination in all the vaccinations, while moderate/late preterm infants only showed an increased OR for HEXA-1, HEXA-3, PCV-1, and PCV-3. SGA infants had a significantly higher risk of delayed vaccination only for HEXA-1 and PCV-1 compared to non-SGA infants. In conclusion, vaccinations among preterm and SGA infants showed considerable delay. Tailored public health programs to improve vaccination timeliness are required in these high-risk groups. [ABSTRACT FROM AUTHOR]

Background: Population‐based anthropometric evaluation of malformed newborns is scarce. Objectives: To evaluate malformed newborns' foetal growth using the ICD 10 malformations' classification. Methods: A study including 33,769 newborns (14,857 malformed and 18,912 nonmalformed), selected from 678,840 births from nine South American countries, period 2010–2018, was conducted. Prevalence of severe small and small for gestational age was calculated for malformed and nonmalformed newborns classified by preterm birth categories. Prevalence and relative risk (RR) with its 95% confidence interval (CI) were calculated. The associations between anthropometric phenotypes and congenital malformations were evaluated with generalized linear models. Results: Prevalence of preterm and term severe small and small for gestational age newborns was higher in malformed than that in nonmalformed neonates. For grouped ICD 10 malformations categories, the RR for severe small for gestational age was 2.88 (95% CI 2.51, 3.30) and 2.10 (95% CI 1.92, 2.30) for small for gestational age. For at‐term and preterm malformed newborns, the RR for severe small for gestational age was 2.21 (95% CI 1.87, 2.61) and 3.21 (95% CI 2.52, 4.10), respectively; for small for gestational age, the RR was 2.31 (95% CI 2.11, 2.53) for at‐term newborns and 2.58 (95% CI 2.16, 3.08) for preterm ones. Conclusions: Prevalence and relative risk of severe small and small for gestational age vary according to the group of malformations and gestational age; they increase in congenital malformations of the nervous, respiratory and digestive systems, and in chromosomal abnormalities and are lower for malformations of eye, ear, face and neck and cleft lip and palate. Foetal growth considered together with malformed newborns' gestational age would allow for inferring different risks of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Reports from around the world suggest that rates of preterm birth decreased during COVID‐19 lockdown measures. Aims: To compare the prevalence of preterm birth and stillbirth rates during COVID‐19 restriction measures with infants born at the same maternity centre during the same weeks in 2013–2019. Materials and Methods: Deidentified data were extracted from the Mater Mothers' healthcare records database. This is a supra‐regional tertiary perinatal centre. Logistic regressions were used to examine singleton live preterm birth rates during the beginning of COVID‐19 restrictions (16 March‐17 April; 'early'; 6955 births) and during the strictest part of COVID‐19 restrictions (30 March‐1 May; 'late'; 6953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Singleton stillbirth rates were also examined between 16 March–1 May. Results: Planned moderate/late preterm births declined by more than half during early COVID‐19 restrictions compared with the previous seven years (29 vs an average of 64 per 1000 births; adjusted odds ratio 0.39, 95% CI 0.22–0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two‐week non‐significant spike in spontaneous preterm births from late April to early May, 2020. Conclusions: Together with evidence from other nations, the pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Health & Sport is the property of Turkish Journal of Health & Sport 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.)

Evidences demonstrated that timing of weaning influences long-term growth in full term infants. However, studies on preterm infants are still lacking, and the international guidelines are focused only on healthy full-term newborn, without consensus for preterms. We aimed at evaluating, in a cohort study, the consequences of different timing of weaning on auxological outcomes up to 12 months of corrected age in a population of neonates born with gestational age < 32 weeks or birth weight < 1500 g. We divided the enrolled neonates in two cohorts according to the timing of weaning: (i) Early Weaning: introduction of complementary food before 6 months of corrected age; (ii) Late Weaning: complementary food introduced after 6 months of corrected age. Growth parameters (weight, length, body mass index, and ponderal index) were measured at 12 months of life. The two groups were statistically comparable for baseline clinical characteristics, and differences on growth parameters were not reported between the two study groups. These results were confirmed in linear and binary logistic regression multivariate models. Timing of weaning is not related to growth of preterm newborns in the first 12 months of corrected age. Studies are needed to reach consensus for the appropriate nutritional approach for preterm babies after discharge. [ABSTRACT FROM AUTHOR]

Background: The effects of COVID-19 lockdown measures on maternal and fetal health remain unclear. We examined the associations of COVID-19 lockdown with gestational length and preterm birth (PTB) in a Chinese population.Methods: We obtained medical records of 595,396 singleton live infants born between 2015 and 2020 in 5 cities in Guangdong Province, South China. The exposed group (N = 101,900) included women who experienced the COVID-19 Level I lockdown (1/23-2/24/2020) during pregnancy, while the unexposed group (N = 493,496) included women who were pregnant during the same calendar months in 2015-2019. Cumulative exposure was calculated based on days exposed to different levels of emergency responses with different weighting. Generalized linear regression models were applied to estimate the associations of lockdown exposure with gestational length and risk of PTB (< 37 weeks).Results: The exposed group had a shorter mean gestational length than the unexposed group (38.66 vs 38.74 weeks: adjusted β = - 0.06 week [95%CI, - 0.07, - 0.05 week]). The exposed group also had a higher risk of PTB (5.7% vs 5.3%; adjusted OR = 1.08 [95%CI, 1.05, 1.11]). These associations seemed to be stronger when exposure occurred before or during the 23rd gestational week (GW) than during or after the 24th GW. Similarly, higher cumulative lockdown exposure was associated with a shorter gestational length and a higher risk of PTB.Conclusions: The COVID-19 lockdown measures were associated with a slightly shorter gestational length and a moderately higher risk of PTB. Early and middle pregnancy periods may be a more susceptible exposure window. [ABSTRACT FROM AUTHOR]

Background: Most preterm infants require a continuous glucose infusion in the early postnatal period due to the interruption of the transplacental glucose supply after birth to promote better neurodevelopmental outcomes. Aims: To investigate the glucose infusion rate (GIR) on parenteral nutrition (PN) in the first week of life administered in preterm infants and its effect on neonatal morbidity and mortality. Methods: This study included 97 infants aged < 37 gestational weeks and weighed < 2500 g at birth. Infants recruited in this study were classified into 3 groups based on the GIR usage in parenteral nutrition as follows: GIR usage of 5- < 7 g/kg/day (Group I), GIR usage of 7–13 g/kg/day (Group II), and GIR usage of > 13–15 g/kg/day (Group III). Univariate and multivariate logistic regression analyzes were carried out to investigate whether the GIR usage in the three groups was associated with selected neonatal morbidities and mortality. Neonatal morbidities analyzed included respiratory distress syndrome (RDS), necrotizing enterocolitis, sepsis, retinopathy of prematurity, pulmonary hypertension, hypoglycemia, and hyperglycemia. Result: Of 97 preterm infants included, 51.5% infants had a gestational age of 34- < 37 weeks, and 54.6% infants had a birth weight of 1500- < 2500 g. The multivariate logistic regression analysis showed that the GIR usage of 5- < 7 g/kg/day was an independent variable that significantly increased the risk of hypoglycemia (Adjusted Odds Ratio [AOR] = 4.000, 95% Confidence Interval [CI] = 1.384–11.565, P = 0.010) and reduced the risk of sepsis (AOR = 0.096, 95% CI = 0.012–0.757, P = 0.026). The GIR usage in all three groups did not increase the risk of mortality. For neonatal morbidity analyzed in this study, RDS (AOR = 5.404, 95%CI = 1.421–20.548, P = 0.013) was an independent risk factor of mortality. Conclusion: The GIR usage of < 7 g/kg/day in PN in the first week of life administered to preterm infants was an independent variable in increasing hypoglycemia, but in contrast, reducing the risk of sepsis. [ABSTRACT FROM AUTHOR]

In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration. One of the most vulnerable migrants´ groups is pregnant women. We analyzed the perinatal outcomes of Venezuelan migrants in Colombia and identified if migration was associated with perinatal outcomes. Birth data were obtained from the 2017 Colombian national birth registry (1085 births in migrants and 654,829 in Colombians). Logistic and linear regression models were used to identify the association between the demographic, obstetric and neonatal characteristics with premature birth (PB), low birth weight (LBW), 1-min, and 5-min Apgar score. Venezuelan were more likely to have newborns with LBW, lower Apgar scores at 1-min and 5-min in comparison to Colombians. Furthermore, a difference was observed in the low health insurance coverage and antenatal care visits among Venezuelan in comparison to natives. Access to health care services for the migrants is desirable for the improvement of perinatal health conditions. [ABSTRACT FROM AUTHOR]

(1) Background: Preterm birth exposes the infant to the known risk factors for atopic diseases. We aimed to study the neonatal risk factors and to describe the clinical manifestations of atopy, including the march of symptoms, in a cohort of preschool children born preterm. (2) Methods: We enrolled neonates with gestational age < 32 weeks or birth weight < 1500 g. We classified patients in cases and controls according to the presence of at least one atopic manifestation. (3) Results: We observed 72 cases and 93 controls. Multivariate models showed that the administration of more than one cycle of antibiotics (B 0.902, p = 0.026) and gestational diabetes (B 1.207, p = 0.035) influence the risk of atopy in babies born preterm. In addition, risk of atopic dermatitis was influenced by gestational age < 29 weeks (B −1.710, p = 0.025) and gestational diabetes (B 1.275, p = 0.027). The risk of wheeze was associated with familiarity for asthma (B 1.392, p = 0.022) and the administration of more than one cycle of antibiotics (B 0.969, p = 0.025). We observed a significant reduction in the rate of atopic manifestation after 2 years of life (33.9% vs. 23.8%, p < 0.05). (4) Conclusions: Modifiable (gestational diabetes, antibiotics use) and unmodifiable (familiarity for asthma) conditions influence the risk of atopy in babies born preterm. Extreme prematurity reduces the risk of atopic dermatitis. Preterm babies showed a peculiar atopic march. [ABSTRACT FROM AUTHOR]

Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability. [ABSTRACT FROM AUTHOR]

Objective: To characterise the association between sepsis and postnatal weight growth when accounting for the degree of growth restriction present at birth.Design: Retrospective matched cohort study using data from the Postnatal Growth and Retinopathy of Prematurity study. Participants were born with birth weights of <1500 g or gestational ages of <32 weeks between 2006 and 2011 at 29 neonatal centres in the USA and Canada. Sepsis was defined as a culture-confirmed bacterial or fungal infection of the blood or cerebrospinal fluid before 36 weeks' postmenstrual age (PMA). Growth was assessed as the change in weight z-score between birth and 36 weeks' PMA.Results: Of 4785 eligible infants, 813 (17%) developed sepsis and 693 (85%) were matched 1:1 to controls. Sepsis was associated with a greater decline in weight z-score (mean difference -0.09, 95% CI -0.14 to -0.03). Postnatal weight growth failure (decline in weight z- score>1) was present in 237 (34%) infants with sepsis and 179 (26%) controls (adjusted OR 1.49, 95% CI 1.12 to 1.97). Longitudinal growth trajectories showed similar initial changes in weight z-scores between infants with and without sepsis. By 3 weeks after sepsis onset, there was a greater decline in weight z-scores relative to birth values in those with sepsis than without sepsis (delta z-score -0.89 vs -0.77; mean difference -0.12, 95% CI -0.18 to -0.05). This significant difference persisted until 36 weeks or discharge.Conclusion: Infants with sepsis had similar early weight growth trajectories as infants without sepsis but developed significant deficits in weight that were not apparent until several weeks after the onset of sepsis. [ABSTRACT FROM AUTHOR]

Background: Very preterm birth often results in the development of bronchopulmonary dysplasia (BPD) with an inverse correlation of gestational age and birthweight. This very preterm population is especially exposed to interventions, which affect the development of BPD. Objective: The goal of our review is to summarize the evidence on these daily procedures and provide evidencebased recommendations for the management of BPD. Methods: We conducted a systematic literature research using MEDLINE/PubMed on antenatal corticosteroids, surfactant-replacement therapy, caffeine, ventilation strategies, postnatal corticosteroids, inhaled nitric oxide, inhaled bronchodilators, macrolides, patent ductus arteriosus, fluid management, vitamin A, treatment of pulmonary hypertension and stem cell therapy. Results: Evidence provided by meta-analyses, systematic reviews, randomized controlled trials (RCTs) and large observational studies are summarized as a narrative review. Discussion: There is strong evidence for the use of antenatal corticosteroids, surfactant-replacement therapy, especially in combination with noninvasive ventilation strategies, caffeine and lung-protective ventilation strategies. A more differentiated approach has to be applied to corticosteroid treatment, the management of patent ductus arteriosus (PDA), fluid-intake and vitamin A supplementation, as well as the treatment of BPD-associated pulmonary hypertension. There is no evidence for the routine use of inhaled bronchodilators and prophylactic inhaled nitric oxide. Stem cell therapy is promising, but should be used in RCTs only. [ABSTRACT FROM AUTHOR]

BACKGROUND: Very low birth weight infants born prematurely are at greater risk for growth delays that lead to Ex-utero Growth Restriction (EUGR) during vulnerable periods of organ structural and functional development. There is considerable evidence that early growth failure has adverse effects on long term neurodevelopment in children which often persists into adulthood. METHODS: This is a single-center cross-sectional study on live newborn infants with birth weight ranges from 500 to 1500 grams (VLBW) and gestational age (GA) between 24–32 weeks who were admitted to NICU at KAMC-Jeddah over a 5 year period (2009–2013). This study aims to evaluate predischarge growth pattern of VLBW infants in terms of weight, head circumference (HC) and length and to identify important variables that have influenced such growth pattern. RESULTS: Of the 135 infants included in the final analysis, 68 (50.4%) were male and 67 (49.6%) were female and the mean gestational age was 28.83±2.064 weeks and the mean birth weight 1166.74±256 grams. Ninety-two infants (68%) had discharge weight at ≤10th percentile and forty four (32%) had their weight >10th percentile. HC was the lowest affected among the anthropometric measurements with 42% ≤10th percentile. In terms of linear growth, 62% had their length ≤10th percentile. Amongst infants born ≤750 grams, 71% and 70% had HC and height at ≤10th percentile respectively, at the time of discharge. BPD was significantly associated with EUGR (p = 0.026). CONCLUSIONS: This study demonstrates that almost 2/3rd of VLBW infants born at KAMC-Jeddah with birth weight ≤750 grams were discharged home with EUGR as demonstrated by their weight, length, and HC ≤10th percentile. BPD was found to be significantly associated with EUGR amongst post-natal factors influencing EUGR. [ABSTRACT FROM AUTHOR]

Background: According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks' gestational age (GA); however, some missed cases of culture-positive EOS have also been described. Methods: Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks' GA with birth weight ≤ 1500 g, 34–36 weeks' GA neonates with suspected intraamniotic infection and neonates ≥34 weeks' GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks' GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks' GA newborns (n = 95, group A), ≥ 37 weeks' GA newborns (n = 170, group B), and ≥ 34 weeks' GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar's test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes. Results: 32/265 (12.1%) neonates ≥34 weeks' GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001). Conclusion: Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux may exacerbate chronic lung disease in preterm infants. We evaluated the short-term effects of transpyloric feeding on respiratory status in preterm infants during mechanical ventilation. We retrospectively collected data from the hospital information management system. To evaluate the effect of transpyloric feeding on oxygenation, we compared changes in SpO2/FiO2 ratios before and after commencing transpyloric feeding by a piecewise linear regression model. We examined 33 infants (median gestational age, 25.4 weeks; median birth weight, 656 g) who underwent transpyloric feeding. All tubes were placed at the bedside without fluoroscopy. No cases of unsuccessful placement, gastroduodenal perforation, or tracheal misinsertion occurred. Transpyloric feeding began at a median age of 18 (interquartile range, 15–23) days. Mean SpO2/FiO2 (±SD) ratios were 391 (±49), 371 (±51), 365 (±56), and 366 (±53) 72–96 h before, 0–24 h before, 48–72 h after, and 96–120 h after starting transpyloric feeding, respectively. The rate of change per hour of SpO2/FiO2 ratios increased 48–120 h after compared with 0–96 h before transpyloric feeding (0.03 [95% confidence interval, −0.10 to 0.17] vs. −0.29 [−0.47 to −0.12]) (p=0.007). No apparent changes occurred in the mean airway pressure, amplitude pressure, or pCO2. Transpyloric feeding during mechanical ventilation can prevent the deterioration of oxygenation without major complications at the stage of respiratory exacerbation in preterm infants. [ABSTRACT FROM AUTHOR]

Background: Arachidonic (ARA) and docosahexaenoic acid (DHA) are constitutive to membrane phospholipids, and essential for brain and overall development. ARA/DHA pools in term infants (TI) are built during the third trimester, stored as adipose tissue triglycerides and predominantly distributed via plasma phosphatidylcholine (PC). In preterm infants (PTI), placental ARA/DHA supply is replaced by linoleic-acid (LA)-enriched nutrition. This study aimed to investigate the impact of PTI nutrition, compared to placental supply, on fatty acid composition in adipose tissue and blood. Methods: Prospective observational study (4/2017–3/2019) in 12 PTI and 3 PTI with enterostomy (PTI/E) (gestational age (GA) < 32 weeks) with surgical intervention at term (± 6 weeks) and 14 TI (GA ≥ 34 weeks, surgical intervention < 2 weeks postnatally). PTI/E were analyzed descriptively only. PC and triglyceride fatty acids were analyzed with tandem mass spectrometry and gas chromatography, respectively. Results were compared between TI and PTI with Wilcoxon Test and shown as median [25th percentile–75th percentile] mol%. Results: PTI had less ARA in adipose tissue TG (0.77[0.67–0.87]% vs. 1.04[0.95–1.14]%, p = 0.0003) and plasma PC (20.7[18.7–22.8]% vs. 28.3[22.7–33.5]%, p = 0.011) than TI. PTI also had less DHA in adipose tissue TG (0.6[0.4–0.8]% vs. 1.1[0.8–1.4]%, p = 0.006) and plasma PC (6.4[5.6–7.1]% vs. 8.4[7.8–13.1]%, p = 0.002). LA was increased in PTI's adipose tissue TG (10.0[8.8–12.3]% vs. 3.0[2.5–3.6]%, p < 0.0001) and plasma PC (48.4[44.6–49.6]% vs. 30.6[24.9–35.6]%, p = 0.0002). Similar differences were observed in erythrocyte PC. Conclusion: In PTI, LA is increased and ARA/DHA decreased in adipose tissue, plasma and erythrocyte lipids as proxies for other tissues, likely caused by PTI nutrition. This may contribute to impaired PTI development. [ABSTRACT FROM AUTHOR]

Copyright of Revista Paulista de Pediatria is the property of Assocoacao de Pediatria de Sao Paulo 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: Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available.Methods: Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks.Results: The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks.Conclusion: The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs. [ABSTRACT FROM AUTHOR]

Background: Nutritional supplements may improve short-term growth of infants born small (preterm or small for gestational age), but there are few data on long-term effects and concerns that body composition may be adversely affected. Effects also may differ between girls and boys. Our systematic review and meta-analysis assessed the effects of macronutrient supplements for infants born small on later growth.Methods and Findings: We searched OvidMedline, Embase, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews from inception to January 30, 2020, and controlled-trials.com, clinicaltrials.gov, and anzctr.org.au on January 30, 2020. Randomised or quasirandomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born small and growth was assessed after discharge. Primary outcome was body mass index (BMI) in childhood. Data were pooled using random-effect models. Outcomes were evaluated in toddlers (< 3 years), childhood (3 to 8 years), adolescence (9 to 18 years), and adulthood (>18 years). Forty randomised and 2 quasirandomised trials of variable methodological quality with 4,352 infants were included. Supplementation did not alter BMI in childhood (7 trials, 1,136 children; mean difference [MD] -0.10 kg/m2, [95% confidence interval (CI) -0.37 to 0.16], p = 0.45). In toddlers, supplementation increased weight (31 trials, 2,924 toddlers; MD 0.16 kg, [0.01 to 0.30], p = 0.03) and length/height (30 trials, 2,889 toddlers; MD 0.44 cm, [0.10 to 0.77], p = 0.01), but not head circumference (29 trials, 2,797 toddlers; MD 0.15 cm, [-0.03 to 0.33], p = 0.10). In childhood, there were no significant differences between groups in height (7 trials, 1,136 children; MD 0.22 cm, [-0.48 to 0.92], p = 0.54) or lean mass (3 trials, 354 children; MD -0.07 kg, [-0.98 to 0.85], p = 0.88), although supplemented children appeared to have higher fat mass (2 trials, 201 children; MD 0.79 kg, [0.19 to 1.38], p = 0.01). In adolescence, there were no significant differences between groups in BMI (2 trials, 216 adolescents; MD -0.48 kg/m2, [-2.05 to 1.08], p = 0.60), height (2 trials, 216 adolescents; MD -0.55 cm, [-2.95 to 1.86], p = 0.65), or fat mass (2 trials, 216 adolescents; MD -1.3 5 kg, [-5.76 to 3.06], p = 0.55). In adulthood, there also were no significant differences between groups in weight z-score (2 trials, 199 adults; MD -0.11, [-0.72 to 0.50], p = 0.73) and height z-score (2 trials, 199 adults; MD -0.07, [-0.36 to 0.22], p = 0.62). In subgroup analysis, supplementation was associated with increased length/height in toddler boys (2 trials, 173 boys; MD 1.66 cm, [0.75 to 2.58], p = 0.0003), but not girls (2 trials, 159 girls; MD 0.15 cm, [-0.71 to 1.01], p = 0.74). Limitations include considerable unexplained heterogeneity, low to very low quality of evidence, and possible bias due to low or unbalanced followup.Conclusions: In this systematic review and meta-analysis, we found no evidence that early macronutrient supplementation for infants born small altered BMI in childhood. Although supplements appeared to increase weight and length in toddlers, effects were inconsistent and unlikely to be clinically significant. Limited data suggested that supplementation increased fat mass in childhood, but these effects did not persist in later life. PROSPERO registration: CRD42019126918. [ABSTRACT FROM AUTHOR]

Background: Breast milk is the optimal choice for feeding premature babies. However, the prevalence rate of extrauterine growth restriction in preterm infants remains high. Objectives: The purpose of this study was to analyze the macronutrients present in human milk and the correlation with the growth of in-hospital preterm infants. Methods: This prospective study is based on data from 99 in-hospital preterm infants younger than 37 weeks of gestational age on an exclusively human milk diet. Infants who had previously received parenteral nutrition were eligible, but they had to have reached full enteral feeding at the time that the samples were taken. A total of 3282 samples of raw human milk or donor pasteurized milk were collected. The levels of lactose, protein, fat, and energy in the samples were measured using a Miris human milk analyzer. The primary outcome was weight growth velocity (g/kg/day) which was obtained using two-point approach. Results: The mean (±standard deviation) macronutrient composition per 100 mL of milk was 7.2 (±0.3) g of lactose, 1.1 (±0.2) g of true protein, 3.5 (±0.9) g of fat, and 66.9 (±6.5) kcal of energy. The protein concentration in human milk had a positive, significant correlation with body weight gain, with a coefficient of 0.41 (p < 0.001). After adjusting for gestational age, postmenstrual age, small-for-gestational age, intraventricular hemorrhage, patent ductus arteriosus or congestive heart failure, duration of total parenteral nutrition support, bottle feeding or use of orogastric tube, and ventilator support, total daily protein intake was associated with body weight growth (p < 0.001). Conclusion: Both the protein concentration in human milk and the daily total protein intake had a positive correlation with the body weight gain of premature infants. Routine analysis of breast milk and individualized fortification might be indicated to optimize the growth of preterm infants. [ABSTRACT FROM AUTHOR]

Background: At term-equivalent age, infants born prematurely are shorter, lighter and have more adipose tissue compared to term counterparts. Little is known on whether the differences in body composition persist in later age. Methods: We prospectively recruited 33 preterm infants (<32 weeks gestational age, mean gestational age 28.1 weeks) and 69 term controls. Anthropometry and body composition (air displacement plethysmography) were monitored up to 4 months of age. Nutrient intakes from preterm infants were collected from clinical records. Results: At 4 months of age preterm infants were lighter and shorter than term controls (mean weight-for-age z-score: –0.73 vs. 0.06, p = 0.001; mean length-for-age z-score: –1.31 vs. 0.29, p < 0.0001). The significantly greater percentage of total body fat seen in preterm infants at term-equivalent age (20.2 vs. 11.7%, p < 0.0001) was no longer observed at 4 months. A deficit of fat-free mass persisted until 4 months of age (fat-free mass at term-equivalent age: 2.71 vs. 3.18 kg, p < 0.0001; at 4 months: 4.3 vs. 4.78 kg, p < 0.0001). The fat mass index and fat-free mass index (taking length into account) did not differ between the groups. Nutrition had little effect on body composition. Higher protein intake at week 2 was a negative predictor of fat-free mass at discharge. Conclusions: At 4 months corrected age, preterm infants were both lighter and shorter than term controls and the absolute fat-free mass deficit remained until this age. Little effect of nutrition on body composition was observed. [ABSTRACT FROM AUTHOR]

Background: Extremely premature infants often need invasive respiratory support from birth, but have low nutritional reserves and high metabolic demands. Our aim was to determine if there was a relationship between prolonged ventilation and reduced postnatal growth in such infants. Methods: A retrospective, observational study was undertaken. Data from infants born at less than 28 weeks of gestational age and ventilated for 7 days or more were collected and analysed including gestational age, gender, birth and discharge weight, birth and discharge head circumference, days of invasive mechanical ventilation and use of postnatal corticosteroids. The duration of invasive mechanical ventilation and the differences in weight (ΔWz) and head circumference (ΔHz) z-score from birth to discharge were calculated. Results: Fifty-five infants were studied with a median [interquartile range (IQR)] gestational age at birth of 25.3 (24.3–26.7) weeks and birth weight of 0.73 (0.65–0.87) kg. The median duration of mechanical ventilation was 45 (33–68) days. Both ΔWz and ΔHz were significantly negatively correlated to the number of invasive mechanical ventilation days (P = 0.01 and P = 0.03, respectively), but not to the use of postnatal corticosteroids. Conclusion: Poor postnatal growth is significantly negatively associated with a longer duration of mechanical ventilation in extremely prematurely born infants. [ABSTRACT FROM AUTHOR]

Human growth and development, starting from conception, are characterized by a progressive increase in body and organ dimensions, as well as specific functional maturity, under the influence of genetic as well as environmental and epigenetic determinants. Beyond a possible normal familial trait, increased fetal growth resulting in a large for gestational age newborn, isolated macrosomia or that associated with congenital malformation, can be attributable to both maternal metabolic and genetic pathology. Overgrowth syndromes are a heterogeneous group of diseases characterized by excessive tissue development often concomitant to neurodevelopmental involvement. Recently, an increased risk of fetal overgrowth with Assisted Reproductive Technology has been reported. Thus, in pediatric practice, it is fundamental to monitor any patient who presents with increased growth parameters, variable malformations, neurodevelopmental delay, and distinctive features from birth, aiming to ensure as adequate a medical management as possible, and for some of the disorders, strict tumor monitoring is also necessary. [ABSTRACT FROM AUTHOR]