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Background and Objectives: Although considerable research has been devoted to examining the distinctions between fresh and frozen embryo transfer regarding obstetric outcomes and rates of pregnancy success, there is still a scarcity of thorough analyses that specifically examine neonatal outcomes. The objective of our study was to provide an in-depth analysis of neonatal outcomes that occur after the transfer of fresh and frozen embryos (ET vs. FET) in IVF/ICSI cycles. Materials and Methods: Multiple databases (PubMed/MEDLINE, Cochrane Library, Web of Science, Wiley, Scopus, Ovid and Science Direct) were searched from January 1980 to February 2024. Two reviewers conducted the article identification and data extraction, meeting inclusion and exclusion criteria. The methodological quality was evaluated using the Newcastle–Ottawa Scale (NOS) or the revised Cochrane Risk of Bias Tool. The meta-analysis was performed using RevMan 5.4. Results: Twenty studies, including 171,481 participants in total, were subjected to qualitative and quantitative analyses. A significant increase in preterm birth rates was noted with fresh embryo transfer compared to FET in the overall IVF/ICSI population (OR 1.26, 95% CI 1.18–1.35, p < 0.00001), as well as greater odds of a low birth weight (OR 1.37, 95% CI 1.27–1.48, p < 0.00001) and small-for-gestational-age infants in this group (OR 1.81, 95% CI 1.63–2.00, p < 0.00001). In contrast, frozen embryo transfer can result in macrosomic (OR 0.59, 95% CI 0.54–0.65, p < 0.00001) or large-for-gestational-age infants (OR 0.64, 95% CI 0.60–0.69, p < 0.00001). No significant difference was observed regarding congenital malformations or neonatal death rates. Conclusions: This systematic review confirmed that singleton babies conceived by frozen embryo transfer are at lower risk of preterm delivery, low birthweight and being small for gestational age than their counterparts conceived by fresh embryo transfer. The data support embryo cryopreservation but suggest that elective freezing should be limited to cases with a proven indication or within the framework of a clinical study. [ABSTRACT FROM AUTHOR]

Aim: Parents of children born preterm have identified outcomes to be measured for audit and research at 18-24 months of age: child well-being, quality of life/function, socio-emotional/behavioural outcomes, respiratory, feeding, sleeping, and caregiver mental health. The aim was to identify the best tools to measure these seven domains. Methods: Seven working groups completed literature reviews and evaluated potential tools to measure these outcomes in children aged 18-24 months. A group of experts and parents voted on the preferred tools in a workshop and by questionnaire. Consensus was 80% agreement. Results: Consensus was obtained for seven brief, inexpensive, parent friendly valid measures available in English or French for use in a minimum dataset and potential alternative measures for use in funded research. Conclusion: Valid questionnaires and tools to measure parent-identified outcomes in young preterm children exist. This study will facilitate research and collection of data important to families. [ABSTRACT FROM AUTHOR]

Neonatal osteopenia (KB 61.3 (ICD-11)) – violation of mineral exchange of bone tissue (BT) of premature babies (PB). Predicting and detection of osteopenia is the key to its successful control. Aim. The aim of the article was to determine risk factors influencing the formation of neonatal osteopenia of PB and during the term of intensive care / postintensive nursing. Materials and methods. Ultrasound densitometer Sunlight Omnisense 9000 was used to measure the ultrasound speed in BT (SOS, m/s) with estimation Z-score (SD) according to gestational age of 56 PB and 20 mature babies (control group) in the early neonatal age. Verification of osteopenia was carried out under the WHO guidelines for radiation methods by Z-score indicator less than SD by -1.0. Estimation of Z-score -2.0 SD and less was attributed to ultra-low indicators. The characteristics of obstetric and gynecological, somatic anamnesis and pregnancy course of premature babies’ mothers, factors of PB postnatal development that influence the formation of BT were studied. Results. Children born at 33 weeks or earlier are 3.23 times more likely (OR = 3.23; CI 95 % [1.08; 9.70]) to develop BT demineralization by the corresponding term of birth than other PB. The chances of ultra-low SOS by Z-score are 14.22 times higher (OR = 14.22; CI 95 % [3.29; 61.57]) in PB born at 32 weeks of gestation and earlier. Extragenital diseases, clinical signs of calcium deficiency in mothers, and women’s intake of calcium and vitamin D3 during pregnancy did not have a statistically significant difference (p > 0.05) in the studied PB and control group. The mother’s preeclampsia increases the chances of insufficient BT mineralization by 5.47 times (OR = 5.47; CI 95 % [1.07; 27.93]), second parity pregnancy (and subsequent ones) – by 4.51 times (OR = 4.51, CI 95 % [1.38; 14.80]). The factors of the ratio of the duration of mechanical ventilation relative to the total time of PB treatment, the duration of parenteral feeding have an inverse correlation (moderate (r = -0.42, р < 0.05) and significant (r = -0.51, р < 0.05) respectively) with a decrease in SOS to low Z-score. Conclusions. In PB born at 32 weeks of gestation and earlier, the chances of ultra-low SOS indicators by Z-score are 14.22 times higher (OR = 14.22; CI 95 % [3.29; 61.57]). The following factors predicts insufficient mineralization of BT according to SOS indicators according to the Z-score: mother’s second parity pregnancy (and subsequent ones), preeclampsia, parenteral feeding of PB for more than 8 days (Se = 75.00 %, Sp = 71.87 %, p < 0.0001), duration of mechanical ventilation, which is more than 6.48 % of the total time of PB treatment (Se = 86.67 %, Sp = 59.38 %, p < 0.046).

Background and Objectives: Although considerable research has been devoted to examining the distinctions between fresh and frozen embryo transfer regarding obstetric outcomes and rates of pregnancy success, there is still a scarcity of thorough analyses that specifically examine neonatal outcomes. The objective of our study was to provide an in-depth analysis of neonatal outcomes that occur after the transfer of fresh and frozen embryos (ET vs. FET) in IVF/ICSI cycles. Materials and Methods: Multiple databases (PubMed/MEDLINE, Cochrane Library, Web of Science, Wiley, Scopus, Ovid and Science Direct) were searched from January 1980 to February 2024. Two reviewers conducted the article identification and data extraction, meeting inclusion and exclusion criteria. The methodological quality was evaluated using the Newcastle–Ottawa Scale (NOS) or the revised Cochrane Risk of Bias Tool. The meta-analysis was performed using RevMan 5.4. Results: Twenty studies, including 171,481 participants in total, were subjected to qualitative and quantitative analyses. A significant increase in preterm birth rates was noted with fresh embryo transfer compared to FET in the overall IVF/ICSI population (OR 1.26, 95% CI 1.18–1.35, p < 0.00001), as well as greater odds of a low birth weight (OR 1.37, 95% CI 1.27–1.48, p < 0.00001) and small-for-gestational-age infants in this group (OR 1.81, 95% CI 1.63–2.00, p < 0.00001). In contrast, frozen embryo transfer can result in macrosomic (OR 0.59, 95% CI 0.54–0.65, p < 0.00001) or large-for-gestational-age infants (OR 0.64, 95% CI 0.60–0.69, p < 0.00001). No significant difference was observed regarding congenital malformations or neonatal death rates. Conclusions: This systematic review confirmed that singleton babies conceived by frozen embryo transfer are at lower risk of preterm delivery, low birthweight and being small for gestational age than their counterparts conceived by fresh embryo transfer. The data support embryo cryopreservation but suggest that elective freezing should be limited to cases with a proven indication or within the framework of a clinical study.

All premature babies lack the intrauterine phase of active mineralization of the bones, osteogenesis changes, speed of ultrasound propagation in bone tissue changes. Aim. The purpose of the article was to determine osteopenia in premature babies (PB) based on ultrasound densitometry at birth and during the period of intensive care. Materials and methods. 70 premature babies and 20 full-term newborns were studied. The authors determined the bone ultrasound speed (SOS, m/s) and its comparative evaluation (Z-score) with the representative base of the ultrasound sonometer "Sunlight Omnisense 9000" (Israel). SOS was defined as average at Z ≥-1.0 SD, as low - at Z from -1.1 to -2.0 SD, and as significantly low - Z ≤-2.0 SD. Results. 54.3 % of PB had osteopenia at birth: low indicators in 28.6 %, significantly low in 25.7 %. Postnatally, an increase in bone tissue deficiency of PB was observed - osteopenia with a low Z was diagnosed in 41.1 %, with a significantly low - in 37.5 % of PB. Conclusions. The number of PB with osteopenia increased 1.4 times, during the first 4 weeks of life. An increase in bone tissue deficiency was most often (p < 0.05) observed among children (52.0 %) with normal / average Z-score SOS indicators. Z-score SOS indicators in children with osteopenia were stable during the first month of life. The odds ratio of having osteopenia were 3.37 times higher for those born in GA of 33 weeks or less (OR = 3.37; CI 95 % [1.25, 9.09], p < 0.05), and 7.50 times higher odds of having significantly low Z-scores (OR = 7.50; CI 95 % [1.60, 34.59], p < 0.05),), and 8.15 times higher odds of having significantly low Z-scores after 1 month of life (OR = 8.15; CI 95 % [2.23; 29.70], р < 0.05), than in children with greater GA. Indicators of physical development of premature newborns do not allow assessing the state of bone mineral velocity and require dynamic ultrasonic densitometry, despite the presence of correlations of SOS with indicators of the mass or length of infants depending on the gestational timing of birth. [ABSTRACT FROM AUTHOR]

Abstract Intoduction Childhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities. Objectives The purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children. Methods We designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated. Results Stepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4. Conclusion Sociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored.

Background: About 55% of extremely-low-birth-weight (birth weight < 1000 g) and 23% of very low-birth-weight infants (birth weight < 1500 g) suffer from metabolic bone disease (MBD). There are limited data on the use of calcitriol (1, 25-dihydroxycholecalciferol) to prevent or treat MBD in preterm infants. Therefore, this study aimed to compare the preventive effect of calcitriol and cholecalciferol on the biochemical markers of MBD in preterm infants. Methods: This study was a pilot randomized controlled trial conducted in the Alzahra teaching hospital of Tabriz University of Medical Sciences. we randomized 72 very-low-birth-weight infants in two groups of calcitriol 0.25 μg/day and cholecalciferol 400 IU/day. Biochemical markers, including serum 25-hydroxyvitamin D, alkaline phosphatase (ALP), phosphorus (P),calcium (Ca), parathyroid hormone (PTH), and tubular reabsorption of phosphate (TRP) levels were checked at baseline, three, and five weeks after medication, consecutively. Results: After three weeks of supplementation, infants in the cholecalciferol group had higher levels of serum 25-hydroxyvitamin D (P=0.001) and lower levels of urine phosphate (P=0.009); There were no significant differences in other biochemical markers. At the end of the fifth week, there was no significant difference between the two groups in terms of biochemical markers. Conclusion: The study indicated that the use of cholecalciferol caused a lower urinary loss of phosphate in very-low birth-weight infants at a short time; however, these findings were not sustained during the study period.

Resumen: La historia de los inicios en Chile de la implementación nacional de las unidades de cuidados intensivos neonatales, y por ende de los inicios de la neonatología moderna en Chile, es de visionarios motivados exclusivamente por el profundo deseo de mejorar la sobrevida y calidad de vida de pequeños que nacían, muy a su pesar, antes de tiempo. Es una historia que, como muchas otras del desarrollo de la medicina, vale la pena relatar no solo por los logros que alcanzó, sino que también por el proceso de gestación y desarrollo en sí. Recordaremos para ello primero la historia de los orígenes y desarrollo del cuidado de los recién nacidos en el mundo, su avance gradual en el siglo XIX y principios del siglo XX, su consolidación a partir de la década de los 60, y finalmente su impulso en Chile con especial mención de la gestación del programa nacional de cuidados intensivos de prematuros en la década de los 80. Summary: The story of the onset of nationwide implementation of neonatal intensive care units in Chile, and therefore the beginnings of modern neonatology in Chile, is a story of visionaries motivated exclusively by a deep desire to improve the survival rate and quality of life of the little ones who were born, much to their regret, before their time. It is a story that, like many others of advances in medicine, is worth telling not only for the achievements acomplished but also for the gestation and development process itself. We’ll begin this story by recalling the history of the origins and development of newborn care in the world, its gradual growth in the 19th and early 20th centuries, its consolidation from the 1960s onward and finally its development in Chile, with special focus on the gestation of the national program of intensive care for premature infants in the 1980s.

We performed a quality improvement project to necrotizing enterocolitis (NEC) and published our results about the initiative in 2021. However, aspects on the safety of the cooling and how to do therapeutic hypothermia with low technology to preterm infants are not described in this previous reporter. Thus, we aim to describe the steps and management to apply hypothermia in preterm infants using low technology and present the safety aspects regarding the initiative. We performed a quality improvement project to NEC in a reference hospital for neonatology (intensive care unit). Forty-three preterm infants with NEC (modified Bell's stage II/III) were included: 19 in the control group (2015-2018) and 24 in the hypothermic group (2018-2020). The control group received standard treatments. The hypothermia group received standard treatment and underwent passive cooling (35.5 °C, used for 48 h after NEC diagnosis). We reported cooling safety to NEC, assessing hematological and gasometrical parameters, coagulation disorders, clinical instability, and neurological disorders. We described how to perform cooling to preterm infants using incubators' servo-control and the occurrence and management of dysthermia during the cooling. We turn-off the incubator and used the esophageal probe to monitor the temperature every 15 min; if the temperature dropped, the incubator was turned on with a rewarming speed of 0.5 °C/h. The participants' average weights and gestational ages were 1186 g and 32 weeks, respectively. There were no differences among hematological indices, serum parameters (sodium, potassium, creatinine, lactate, and bicarbonate), pH, pCO2, and pO2/FiO2 between the groups during treatment and after rewarming. We did not observe dysthermia, bradycardia, hemodynamic instability, apnea, seizure, bleeding, peri-intraventricular hemorrhage, or any alterations in ventilatory parameters due to the cooling technique in preterm babies. This simple technique was performed without intercurrences through a rigorous team evaluation, with a target cooling speed of 0.5 °C/h. The target temperature was successfully reached between the second and third hours of life with the incubator control in 21 children; ice bags were used in only three cases. The temperature was maintained at the expected level during the programmed cooling period.Conclusion: Mild controlled hypothermia for preterm infants with NEC is safe. The cooling of preterm infants could be performed through passive methods, using the servo-control of the incubators for temperature management.What Is Known: • Mild controlled hypothermia to NEC treatment is feasible and associated with a decrease in NEC surgery, short bowel, and death. • Mild controlled hypothermia to preterm is feasible and can be performed through low technology and passive cooling.What Is New: • Mild controlled hypothermia to preterm is safe and does not associate with safety adverse effects during and after the cooling. • Preterm infants can be cooled through passive methods by just using the servo control of the incubator, presenting acceptable temperature variance, without dysthermia, achieving and remaining at the target temperature with a proper cooling speed. Mild controlled temperature for preterm infants does not need an additional cooling device. [ABSTRACT FROM AUTHOR]

Generalized arterial calcification of infancy (GACI) is an extremely rare autosomal recessive condition characterized by the storage of calcium at the level of internal elastic membrane of arteries. The main consequences are intimal fibrous thickening and arterial occlusion. We present the case of a preterm male infant, born from an improperly dispensed pregnancy. At birth, the newborn presented generalized edema and hypotonia, and abolished heart sounds, without response to stimulation. Despite the mechanical ventilation, the infant died 2 h after birth. The death was clinically presumed to be related to the maternal infection with cytomegalovirus (CMV) and Toxoplasma gondii. The infant's mother affirmed the history of 6 previous miscarriages and a non-consanguineous marriage. At autopsy, microscopic examination showed generalized vasculitis secondary to minimal calcification of the large and medium-sized vessels of the lungs, liver, and tongue. These findings supported the diagnosis of GACI. Hydrothorax, non-infective ascites, and necrosis of the brain parenchyma were also associated. The premature infant died due to tonsillar herniation associated with decreased vessel compliance and refractory pulmonary hypertension thus leading to congestive cardiac failure. CMV was not detected on histopathological assessment nor were signs of any other infections. To the best of our knowledge, this is the first case of GACI occurring in a baby from a mother co-infected with CMV and T. gondii.

Human milk is the food of choice for low birth weight preterms, but its processing and administration lead to nutritional losses. Studies have been proposing human milk additives, and the challenge is to seek techniques for effective lipid supplementation, with emphasis on omega-3, due to its importance in neurological development and cell integrity. The objective was to develop and test emulsions containing omega-3 source oil to microcapsules manufacture for addition to human milk. The experimental study used fish oil, soy lecithin as emulsifier, and starch and maltodextrin as wall materials with subsequent lyophilization for the production of powders from the microcapsules. The stability and characteristics analyzes of the product showed positive results, being a viable alternative for the addition of lipids to human milk. Future analyzes will allow the study of the behavior of the product added to human milk and will subsidize research on human milk additives for vulnerable children. [ABSTRACT FROM AUTHOR]

Abstract Background Langerhans cell histiocytosis (LCH) is a rare disorder in which Langerhans cells (LC) accumulate in the skin or other organs and cause tumor formation or organ damage. Cutaneous lesions can vary widely and do not predict extent of systemic disease or prognosis. Case We present a premature infant with skin findings, multisystem involvement, and immunohistochemical markers consistent with multisystem LCH. Conclusion Limited data from preterm neonates with LCH suggest that prognosis is particularly poor, with even limited cutaneous disease often rapidly progressing to become fatal, although diagnosis is not always prompt. Early diagnosis and treatment may affect prognosis.

Intoduction: Childhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities.Objectives: The purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children.Methods: We designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated.Results: Stepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4.Conclusion: Sociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored. [ABSTRACT FROM AUTHOR]

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Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece. [ABSTRACT FROM AUTHOR]

Rationale: The contribution of ventilatory control to the pathogenesis of obstructive sleep apnea (OSA) in preterm-born children is unknown.Objectives: To characterize phenotypes of ventilatory control that are associated with the presence of OSA in preterm-born children during early childhood.Methods: Preterm- and term-born children without comorbid conditions were enrolled. They were categorized into an OSA group and a non-OSA group on the basis of polysomnography.Measurements and Main Results: Loop gain, controller gain, and plant gain, reflecting ventilatory instability, chemoreceptor sensitivity, and blood gas response to a change in ventilation, respectively, were estimated from spontaneous sighs identified during polysomnography. Cardiorespiratory coupling, a measure of brainstem maturation, was estimated by measuring the interval between inspiration and the preceding electrocardiogram R-wave. Cluster analysis was performed to develop phenotypes based on controller gain, plant gain, cardiorespiratory coupling, and gestational age. The study included 92 children, 63 of whom were born preterm (41% OSA) and 29 of whom were born at term (48% OSA). Three phenotypes of ventilatory control were derived with risks for OSA being 8%, 47%, and 77% in clusters 1, 2, and 3, respectively. There was a stepwise decrease in controller gain and an increase in plant gain from clusters 1 to 3. Children in cluster 1 had significantly higher cardiorespiratory coupling and gestational age than clusters 2 and 3. No difference in loop gain was found between clusters.Conclusions: The risk for OSA could be stratified according to controller gain, plant gain, cardiorespiratory coupling, and gestational age. These findings could guide personalized care for children at risk for OSA. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Neonatal mortality is defined as the newborn children's number who die before they reach 28 days of life. Infant mortality rate in Mexico is 41% in the total deaths of under-five children. OBJECTIVE: To determinate the characteristics of neonatal mortality in an institutional hospital. SUBJECTS AND METHODS: A descriptive, retrospective and longitudinal study, of neonate's deaths from years 2008 to 2012 at our institution. We identified neonatal deaths by means of pediatrician's department records and we collected data from clinical files. We included only clinical records of neonates whose death occurred within the first 28 days of life and were attended at our institution. We excluded incomplete or lost clinical records. We studied gender, birth weight, gestational age, cause of death, co morbidity, prenatal care, history of neonatal death and gestational pathology. We carried descriptive statistics. RESULTS: Three-hundred and eight neonates' deaths total were studied; the age of gestation at birth was 30 ± 5 weeks (average and standard deviation), birth weight 1944 ± 990 g. The main cause of death was extreme immaturity 19% (58), followed by perinatal asphyxia with 13% (41). CONCLUSIONS: The main characteristics of neonatal mortality found in this study are similar to those reported in the literature, considering that extreme immaturity and prematurity are the characteristics in which higher mortality was present, we must have an appropriate prenatal control. [ABSTRACT FROM AUTHOR]

Background To evaluate peritoneal drainage (PD) and laparotomy ± resection/ostomy (LAP) as initial approaches to the surgical management of necrotizing enterocolitis (NEC) in premature, extremely low birth weight (ELBW) infants. Methods Kids' Inpatient Database (2003-2012) was searched for cases of NEC ( International Classification of Diseases, ninth revision, Clinical Modification [ICD-9-CM] 777.5x) in premature (<37 weeks), extremely low birth weight (<1000 g) infants. Infants were admitted at <28 days of life. Propensity score (PS)-matched analyses were performed, using end points of hospital mortality, length of stay (LOS), and cost of hospitalization. Cases were matched 1:1 on 48 confounding variables (demographic, clinical, and hospital characteristics and 39 comorbidities). Results On PS-matched comparison, PD had higher survival versus LAP, P = 0.0009. LOS and cost were higher for PD versus LAP, P < 0.003. Survival rates did not differ between PD + LAP and PD-only treatments. LOS and cost were higher for PD + LAP versus PD-only, P < 0.02. PD + LAP infants had higher survival versus LAP, P = 0.0193. LOS and cost were higher for PD + LAP, P < 0.005. Conclusions A risk-adjusted PS-matched analysis of operative management in premature, ELBW infants with NEC found higher survival rates associated with PD placement versus LAP, whether PD was used as definitive treatment or with subsequent LAP even after controlling for potential contributors to selection bias (i.e., stability influencing management preference). [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the relationships between serum cytokine concentrations and chorioamnionitis (CAM) and CAM-related bronchopulmonary dysplasia (BPD) in premature infants. METHODS: Serum was collected at 0 and 7 days after birth from 36 premature infants born at <32 weeks of gestation. We examined the relationships between 30 cytokine concentrations and CAM, BPD, and other perinatal factors. RESULTS: On day 0, GM-CSF, IL-15, IL-17, IL-2, IL-2R, VEGF, and MIG concentrations were significantly higher in the CAM group (n = 17) than in the non-CAM group (n = 19). These concentrations had decreased by day 7 and were similar in both groups. The IL-12p70 concentration on day 0 was significantly lower in the BPD group (n = 16) than in the non-BPD group (n = 15). BPD incidence was similar between the CAM and non-CAM groups. CONCLUSIONS: These data support the hypothesis that intrauterine inflammation is not a primary risk factor for BPD. The immunological environment at birth or soon after, rather than intrauterine fetal inflammation (e.g., CAM), is a primary risk factor for BPD onset in preterm infants. Decreased inflammatory responses are particularly relevant, as indicated by the relationship between BPD and low serum IL-12p70 concentrations on day 0. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the disease patterns and outcome of patients admitted to the neonatal unit of a secondary care hospital in Pakistan from January to December 2009. Methods: Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analysed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome. Trends were examined to identify the indicators of inpatient neonatal deaths. Results: The total number of neonates admitted during the study period was 1,554; 979 were male (63%), and 575 were female (37%). A total of 891 patients (57.3%) were born in the hospital while 663 (42.7%) were born elsewhere. The majority were admitted during the first 24 hours of life (51.3%). A total of 13 patients (0.8%) weighed

Objectives: A limited body of research is available on the relationships between multiplicity of birth and neuropsychological functioning in preterm children who were conceived in the age of assisted reproductive technology and served by the modern neonatal intensive care unit. Our chief objective was to evaluate whether, after adjustment for sociodemographic factors and perinatal complications, twin birth accounted for a unique portion of developmental outcome variance in children born at-risk in the surfactant era. Methods: We compared the neuropsychological functioning of 77 twins and 144 singletons born preterm (<34 gestational weeks) and served by William Beaumont Hospital, Royal Oak, MI. Children were evaluated at preschool age, using standardized tests of memory, language, perceptual, and motor abilities. Results: Multiple regression analyses, adjusting for sociodemographic and perinatal variables, revealed no differences on memory or motor indices between preterm twins and their singleton counterparts. In contrast, performance of language and visual processing tasks was significantly lower in twins despite reduced perinatal risk in comparison to singletons. Effect sizes ranged from .33 to .38 standard deviations for global language and visual processing ability indices, respectively. No significant group by sex interactions were observed, and comparison of first-, or second-born twins with singletons yielded medium effect sizes (Cohen’s d=.56 and .40, respectively). Conclusions: The modest twin disadvantage on language and visual processing tasks at preschool-age could not be readily attributable to socioeconomic or perinatal variables. The possibility of biological or social twinning-related phenomena as mechanisms underlying the observed performance gaps are discussed. (JINS, 2016, 22, 865–877) [ABSTRACT FROM AUTHOR]

Purpose We sought to investigate the association between blood transfusions (BT), rates of necrotizing enterocolitis requiring surgical intervention (SNEC), and survival. Methods Blood transfusions in premature infants were identified in the Kids' Inpatient Database (2003-2009). Propensity score-matched analysis compared SNEC outcomes in BT vs. non-BT groups. Multivariate analyses were performed to determine independent predictors of outcome. Results Overall, 663 740 cases were identified and 4.9% received BT. Surgical necrotizing enterocolitis occurred in 493 cases in the BT group, while SNEC occurred in 1049 cases in the non-BT group. Propensity score analysis of 20 991 BT and 20 988 non-BT cases demonstrated higher SNEC rates with BT (odds ratio [OR], 1.21) vs non-BT. Surgical necrotizing enterocolitis with BT had lower survival rates (58%) vs non-BT (67%). Surgical necrotizing enterocolitis with BT had lower length of stay and total charges vs non-BT. On multivariate analyses, SNEC mortality with BT increased for lower gestational age, males (OR, 45.7), African Americans (OR, 64.4), and infants with cardiac anomalies (OR, 50.8) or bronchopulmonary dysplasia (OR, 177). Non-BT SNEC demonstrated higher mortality with lower gestational age and infants with bronchopulmonary dysplasia (OR, 6.56) or sepsis (OR, 3.66). Conclusion On propensity score-matched analysis, SNEC occurs at higher rates after BT and is associated with lower survival and lower resource utilization vs SNEC without BT. [ABSTRACT FROM AUTHOR]

Background There is a paucity of published clinical data to guide obstetric decision-making regarding mode of birth at extreme prematurity. Aims To evaluate whether neonatal survival or maternal outcomes were affected by the decision to perform a caesarean section ( CS) between 23 + 0 and 26 + 6 weeks' gestation. Materials and Methods A single-centre retrospective cohort study of all liveborn infants born with a plan for active resuscitation at 23-26 weeks' gestation was performed. Descriptive and multivariate logistic regression analyses compared outcomes after vaginal birth and CS. Subgroup analyses of nonfootling breech presentations, multiple pregnancies and singleton pregnancies in spontaneous preterm labour were performed. Results Outcomes for 625 neonates delivered by 540 mothers were analysed. A total of 300 (48%) neonates were born vaginally and 325 (52%) by CS. Mode of birth was not associated independently with survival for any multivariate analysis; gestational age at birth was an independent predictor across all analyses. Adverse maternal outcomes were documented in 112 (21%) pregnancies; the rate of severe maternal complications was low. Maternal morbidity was not affected by mode of birth. Conclusions Mode of birth did not affect neonatal survival or the rate of maternal morbidity for deliveries at 23-26 completed weeks' gestation. [ABSTRACT FROM AUTHOR]

Skin is a multifunctional human organ. It has a protective, regulatory and sensory function. Skin of the very premature newborn is underdeveloped with deficient functionality and has to be observed and treated as an immature organ in need of special care and interventions. Appropriate prevention and compensation of water and heat losses is obligatory as preserving the integrity of the skin and therefore of the entire body. [ABSTRACT FROM AUTHOR]

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Objective: Antenatal corticosteroids (ACSs) are administered to pregnant individuals at high risk of preterm delivery to reduce neonatal morbidity and mortality. ACSs have a limited timeframe of effectiveness, and timing of administration can be difficult because of uncertainty surrounding the likelihood of preterm delivery. The objective of the current study was to design a decision analysis model to optimize the timing of ACS administration and identify important model variables that impact administration timing preference., Methods: We created a Markov decision analysis model with a base case of a patient at 24 0 weeks gestation with antepartum hemorrhage. Decision strategies included immediate, delayed, and no ACS administration. Outcomes were based on the neonatal perspective and consisted of lifetime quality adjusted life years (QALYs). Data for model inputs were derived from current literature and clinical recommendations., Results: Our base case analysis revealed a preferred strategy of delaying ACSs for 2 weeks, which maximized QALYs (39.18 lifetime discounted), driven by reduced neonatal morbidity at the expense of 0.1% more neonatal deaths, when compared with immediate ACS administration. Sensitivity analyses identified that, if the probability of delivery within the next week was >6.19%, then immediate steroids were preferred. Other important variables included gestational age, ACS effectiveness, and ACS adverse effects., Conclusion: ACS timing involves a trade-off between morbidity and mortality, and optimal timing depends on probability of delivery, gestational age, and risks and benefits of ACSs. Clinicians should carefully consider these factors prior to ACS administration., (Copyright © 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Objective: Determine whether higher targeted oxygen levels are associated with reduced incidence of pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) in extremely premature infants., Study Design: Retrospective chart review of 252 extremely preterm infants (<29 weeks), who underwent echocardiogram prior to discharge. PH rates were compared during periods (June 2012-May 2015 and June 2015-April 2016) when lower (88-92%) or higher (90-95%) oxygen saturation targets were used. PH was determined on echocardiography. The ratio of pulmonary artery acceleration time to right ventricular ejection time was computed, with values <0.31 indicative of elevated PVR. Survival analysis compared the effects of oxygen saturation group on development/resolution of PH and elevated PVR., Results: The higher saturation group had significantly lower risk of developing PH (hazard ratio (HR) = 0.50, 95%CI 0.26-0.95; P = 0.03) or elevated PVR (HR = 0.55, 95%CI 0.38-0.81; P = 0.002), compared to the lower oxygen saturation group. Median time to PH development was significantly shorter in the lower saturation group than in the higher saturation group (5 days vs 12 days; P = 0.02), as was time to development of elevated PVR (4 days vs 6 days; P < 0.001). Duration of PH (P = 0.12) and elevated PVR (P = 0.86) did not differ significantly between groups. Cumulative incidence of PH (P = 0.04) and elevated PVR (P = 0.01) at 36 weeks post-menstrual age was significantly lower in the high saturation group compared to the lower saturation group., Conclusion: Higher targeted oxygen saturation was associated with reduced risk of PH or elevated PVR in extremely preterm infants compared to lower oxygen saturation target., (© 2018 Wiley Periodicals, Inc.)

Rationale: The contribution of ventilatory control to the pathogenesis of obstructive sleep apnea (OSA) in preterm-born children is unknown., Objectives: To characterize phenotypes of ventilatory control that are associated with the presence of OSA in preterm-born children during early childhood., Methods: Preterm- and term-born children without comorbid conditions were enrolled. They were categorized into an OSA group and a non-OSA group on the basis of polysomnography., Measurements and Main Results: Loop gain, controller gain, and plant gain, reflecting ventilatory instability, chemoreceptor sensitivity, and blood gas response to a change in ventilation, respectively, were estimated from spontaneous sighs identified during polysomnography. Cardiorespiratory coupling, a measure of brainstem maturation, was estimated by measuring the interval between inspiration and the preceding electrocardiogram R-wave. Cluster analysis was performed to develop phenotypes based on controller gain, plant gain, cardiorespiratory coupling, and gestational age. The study included 92 children, 63 of whom were born preterm (41% OSA) and 29 of whom were born at term (48% OSA). Three phenotypes of ventilatory control were derived with risks for OSA being 8%, 47%, and 77% in clusters 1, 2, and 3, respectively. There was a stepwise decrease in controller gain and an increase in plant gain from clusters 1 to 3. Children in cluster 1 had significantly higher cardiorespiratory coupling and gestational age than clusters 2 and 3. No difference in loop gain was found between clusters., Conclusions: The risk for OSA could be stratified according to controller gain, plant gain, cardiorespiratory coupling, and gestational age. These findings could guide personalized care for children at risk for OSA.

Abstract: A 5 month old male infant was transferred to a children's general hospital with an 11-centimeter rectal prolapse, which had not been reduced for four months. He had been born at 24 weeks gestation with a normal perineum and had recovered from sepsis and respiratory failure. At the time of arrival, he was tolerating feeds and having normal bowel movements. He had a normal neurologic exam and spinal x-rays. We performed a laparoscopic reduction with digital pressure from below to successfully address the prolapse. Hypertonic saline was additionally used as a sclerosant. There is no current consensus on the timeframe for addressing rectal prolapse, though a case that remains unreduced for four months in a neurologically normal newborn is exceedingly rare. To minimize potential complications, expeditious reduction and repair, as necessary, is recommended. [Copyright &y& Elsevier]

Unlabelled: Many preterm infants with bronchopulmonary dysplasia (BPD) demonstrate impaired lung function and respiratory symptoms during infancy. The relationships between initial BPD severity, lung function and respiratory morbidity are not fully understood. We aimed to investigate the association between BPD severity and subsequent lung function and whether lung function impairment is related to respiratory morbidity., Study Design and Methods: In this longitudinal cohort study, 55 infants born preterm (23-30 weeks of gestation) with mild or moderate/severe BPD, based on oxygen requirement at 36 gestational weeks, were followed up at 6 and 18 months postnatal age. Respiratory symptoms, such as recurrent or chronic chough and wheeze, were noted and patient records were scrutinized. Lung function was assessed by passive lung mechanics, whole body plethysmography, and tidal and raised volume rapid thoraco-abdominal compression techniques. Results were related to published normative values., Results: Besides residual functional capacity (FRC) and respiratory system compliance (Cso ) assessed at 18 months, all measures of lung function were significantly below normative values. Moderate/severe BPD differed significantly from mild BPD only with respect to reduced Cso . At follow-up at 6 and 18 months, participants with respiratory symptoms showed lower; maximal forced expiratory flow at FRC (V'maxFRC) (P = 0.006, P = 0.001), forced mid-expiratory flows (MEF50 ) (P = 0.006, P = 0.048), and Cso (P = 0.004, P = 0.015) as compared to participants without symptoms., Conclusions: In the present study BPD severity did not predict lung function, but may be associated with impaired alveolarization, indicated by reduced Cso . Respiratory morbidity was associated with reduced airway function and respiratory compliance in infancy after preterm birth., (© 2014 Wiley Periodicals, Inc.)

Objectives: The study objective was to assess the gaps in current hospital health management information systems (ie. paper based records of prenatal, delivery, neonatal, discharge data) for environmental studies. This study also considers the feasibility of linking patient-level hospital data with ambient air pollution data recorded in real time by air quality monitoring stations., Methods: This retrospective hospital based cohort study used a semi-ecologic design to explore the association of air pollution with a neonate's birth weight and gestational age. Maternal and neonatal data from 2007-2012 were encoded and linked with air pollution data based on distance to the nearest air quality monitoring station. Completeness and accuracy of neonatal anthropometric measures, maternal demographic information, nutritional status and maternal risk factors (gestational diabetes, anaemia, hypertension, etc.) were assessed., Results: The records of 10,565 births in Sir Ganga Ram hospital in New Delhi were encoded and linked with real time air quality data. These were records of women who reported a New Delhi address during the time of delivery. The distance of each address to all the monitoring stations were recorded. Birth records were assigned pollution exposure levels averaged across records from monitoring stations within 10 kilometers of the address during the pregnancy period., Conclusion: This pilot study will highlight the potential of hospital management information system in linking administrative hospital record data with information on environmental exposure. The linked health-exposure dataset can then be used for studying the impact of various environmental exposures on health outcomes. Mother's educational attainment, occupation, residential history, nutritional status, tobacco and alcohol use during pregnancy need to be documented for better health risk assessments or case management. Health institutions can provide data for public health researchers and environmental scientists and can serve as the backbone of an environmental public health tracking system.

Objectives: This study aimed to determine the disease patterns and outcome of patients admitted to the neonatal unit of a secondary care hospital in Pakistan from January to December 2009., Methods: Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analysed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome. Trends were examined to identify the indicators of inpatient neonatal deaths., Results: The total number of neonates admitted during the study period was 1,554; 979 were male (63%), and 575 were female (37%). A total of 891 patients (57.3%) were born in the hospital while 663 (42.7%) were born elsewhere. The majority were admitted during the first 24 hours of life (51.3%). A total of 13 patients (0.8%) weighed <1 Kg; 85 (5.4%) weighed 1-1.49 Kg, and 587 (37.7%) between 1.5-2.5 Kg. Prematurity and infection were the main reasons for admission (27.9% and 20.33%, respectively), followed by birth asphyxia (13%) and neonatal jaundice (11.3%). A total of 1,287 patients (82.8%) were discharged, 41 left against medical advice (2.6%), 59 were referred to tertiary care hospitals (3.79%) and 106 (6.8%) died., Conclusion: Prematurity, low birth weight, birth asphyxia and neonatal jaundice were the major causes of neonatal admissions. This could be reduced by appropriate antenatal care, timely intervention, and in-time referral to tertiary care centres for the deliveries of all high-risk pregnancies. The major cause of neonatal mortality was prematurity.

Objectives: To compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM)., Methods: Women with PPROM occurring between 24+0 and 36+6 weeks of gestation were identified from a provincial population-based perinatal database in Nova Scotia. The primary outcomes included composite variables for serious maternal and neonatal infectious morbidity and neonatal prematurity-related morbidity. Logistic regression was used to quantify the relationship between latency period (< 24 hours, 24 hours to < 48 hours, 48 hours to < 7 days, and ≥ 7 days) and maternal and neonatal outcomes. Separate analyses were conducted for gestational age groups 24+0 to 33+6 weeks and 34+0 to 36+6 weeks., Results: There were 4329 women included in the cohort. The composite variables representing serious maternal or neonatal infectious morbidity were not significantly associated with latency for either gestational age group. For PPROM occurring at gestational ages of 24+0 to 33+6 weeks, the odds of neonatal prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with < 24 hours latency. For PPROM at 34+0 to 36+6 weeks of gestation, the odds of prematurity-related morbidity at 48 hours to < 7 days latency was decreased compared with latencies < 24 hours (OR 0.4; 95% CI 0.2 to 0.8)., Conclusion: Postponing delivery following PPROM may contribute to less prematurity-related morbidity, even close to term, without putting mother or neonate at substantial risk for serious infectious morbidity. Generalization of these findings to other obstetric populations should be informed by the underlying risk of infection.