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Background: Guidelines recommend non-invasive ventilatory (NIV) support as first-line respiratory support mode in preterm infants as NIV is superior to intubation and mechanical ventilation in preventing death or bronchopulmonary dysplasia. However, with an ever-expanding variety of NIV modes available, there is much debate about which NIV modality should ideally be used, how, and when. The aims of this work were to summarise the evidence on different NIV modalities for both primary and secondary respiratory support: nCPAP, nasal high-flow therapy (nHFT), and nasal intermittent positive airway pressure ventilation (nIPPV), bi-level positive airway pressure (BiPAP), nasal high-frequency oscillatory ventilation (nHFOV), and nasally applied, non-invasive neurally adjusted ventilatory assist (NIV-NAVA) modes, with particular focus on their use in preterm infants. Summary: This is a narrative review with reference to published guidelines by European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. nCPAP is currently the most commonly used primary and secondary NIV modality for premature infants. However, there is increasing evidence on the superiority of nIPPV over nCPAP. No beneficial effect was found for BiPAP over nCPAP. For the use of nHFT, nHFOV, and NIV-NAVA, more studies are needed to establish their place in neonatal respiratory care. Key Messages: The superiority of nIPPV over nCPAP needs to be confirmed by contemporaneous trials comparing nCPAP to nIPPV at comparable mean airway pressures. Future trials should study NIV modalities in preterm infants with comparable respiratory pathology and indications, at comparable pressure settings and with different modes of synchronisation. Importantly, future trials should not exclude infants of the smallest gestational ages. [ABSTRACT FROM AUTHOR]

Background: Milk bank is one of the most important emerging issues in neonatal health. The present study aimed toimprove the attitude and inclination of mothers with premature neonates to feed their suckling with milk donatedfrom the milk bank by comparing the effect of face-to-face training and an educational package. Methods: In this randomized clinical trial, 66 mothers of premature neonates hospitalized in the neonatal intensivecare unit were included and assigned to two groups of 33 mothers. The samples completed the demographicinformation questionnaire and questionnaire of attitude and inclination toward feeding with milk donated from themilk bank. The first group received direct face-to-face training, and the second received an educational package. Thedata was statistically analyzed with SPSS 22.Results: The attitude and inclination scores increased significantly in face-to-face and educational package groups. Theattitude score in the face-to-face group was higher after the intervention compared to the educational package group(P=0.003). Besides, the inclination score in the face-to-face group was higher than that in the educational packagegroup, which was statistically significant (P

OBJECTIVE Inhaled nitric oxide (iNO) is a mainstay of treatment for infants with persistent pulmonary hypertension. However, abrupt discontinuation of inhaled nitric oxide can result in rebound pulmonary hypertension. The objective of this analysis is to describe the use of sildenafil to facilitate the weaning from iNO in preterm neonates. METHODS This retrospective chart review identified all infants who were receiving iNO and subsequently received sildenafil between 2017 and 2021. Neonates were included if they met the following criteria: gestational age at birth less than 34 weeks, receiving iNO, and started on sildenafil with the indication to facilitate weaning or discontinuation of iNO. Patients were excluded if they had major congenital anomalies, including congenital heart disease or congenital diaphragmatic hernia. RESULTS We identified 7 neonates with a gestational age range of 22 5/7 weeks to 31 0/7 weeks and birth weight range of 545 to 910 g with previously failed attempts at iNO weaning. The most common starting dose for sildenafil was 0.125 mg/kg intravenously every 8 hours or 0.25 mg/kg enterally every 8 hours. Four infants were able to discontinue iNO within 48 hours of sildenafil initiation, 1 patient discontinued iNO within 5 days, and 1 patient within 10 days of sildenafil initiation. One patient experienced weaning failure from iNO despite initiation of sildenafil. No adverse events, such as hypotension or deaths, were reported in any of the 7 infants. CONCLUSIONS Sildenafil facilitated weaning off iNO in most preterm neonates evaluated without adverse side effects. [ABSTRACT FROM AUTHOR]

Background: Milk bank is one of the most important emerging issues in neonatal health. The present study aimed to improve the attitude and inclination of mothers with premature neonates to feed their suckling with milk donated from the milk bank by comparing the effect of face-to-face training and an educational package. Methods: In this randomized clinical trial, 66 mothers of premature neonates hospitalized in the neonatal intensive care unit were included and assigned to two groups of 33 mothers. The samples completed the demographic information questionnaire and questionnaire of attitude and inclination toward feeding with milk donated from the milk bank. The first group received direct face-to-face training, and the second received an educational package. The data was statistically analyzed with SPSS 22. Results: The attitude and inclination scores increased significantly in face-to-face and educational package groups. The attitude score in the face-to-face group was higher after the intervention compared to the educational package group (P=0.003). Besides, the inclination score in the face-to-face group was higher than that in the educational package group, which was statistically significant (P<0.001). Conclusion: Both face-to-face training and educational packages effectively improved the inclination and attitude of mothers with premature neonates to feed neonates with donated milk. Considering the more significant impact of faceto-face training compared to the educational package, it is suggested that this accessible and affordable method be applied along with other training to increase the effectiveness of the training [ABSTRACT FROM AUTHOR]

Abstract Background Respiratory distress syndrome (RDS) is one of the most important and common disorders among premature infants. Objective This study aimed to compare the effect of the combination of surfactant and budesonide with surfactant alone on Bronchopulmonary dysplasia (BPD) and mortality rate among premature infants with RDS. Method An outcome assessor-blind randomized clinical trial was conducted on 134 premature infants with RDS who were born in Ayatollah Mousavi Hospital, Zanjan, Iran in 2021. The covariate adaptive randomization method was utilized to allocate participants into two groups (surfactant alone and a combination of surfactant and budesonide). The primary outcomes were BPD and Mortality rate from admission to hospital discharge. The data in this study were analyzed using SPSS software version 18. Results Overall the comparison of mortality rate and BPD between the two groups did not show a significant difference(p > 0.05). The subgroup results showed that administering surfactant with budesonide to infants under 30 weeks of age significantly reduced the number of deaths compared to using surfactant alone (5 vs. 17). Similar positive effects were observed for the occurrence of Pulmonary Hemorrhage, the need for a second dose of surfactant, oxygen index, mean blood pressure and mean arterial pressure (MAP) in infants under 34 weeks of age compared to more than 34 weeks (p

Background: Respiratory distress syndrome (RDS) is one of the most important and common disorders among premature infants. Objective: This study aimed to compare the effect of the combination of surfactant and budesonide with surfactant alone on Bronchopulmonary dysplasia (BPD) and mortality rate among premature infants with RDS. Method: An outcome assessor-blind randomized clinical trial was conducted on 134 premature infants with RDS who were born in Ayatollah Mousavi Hospital, Zanjan, Iran in 2021. The covariate adaptive randomization method was utilized to allocate participants into two groups (surfactant alone and a combination of surfactant and budesonide). The primary outcomes were BPD and Mortality rate from admission to hospital discharge. The data in this study were analyzed using SPSS software version 18. Results: Overall the comparison of mortality rate and BPD between the two groups did not show a significant difference(p > 0.05). The subgroup results showed that administering surfactant with budesonide to infants under 30 weeks of age significantly reduced the number of deaths compared to using surfactant alone (5 vs. 17). Similar positive effects were observed for the occurrence of Pulmonary Hemorrhage, the need for a second dose of surfactant, oxygen index, mean blood pressure and mean arterial pressure (MAP) in infants under 34 weeks of age compared to more than 34 weeks (p < 0.05). Conclusion: These findings suggest that the combination therapy of surfactant and budesonide may be beneficial, particularly in preterm infants with less than 34 weeks gestational age and 1500 birth weight. However, further studies with larger sample sizes and longer follow-up periods are needed to confirm these results and assess long-term outcomes. Trial registration: The study was registered at the Iranian Registry of Clinical Trials website under the code IRCT20201222049802N1. https://en.irct.ir/user/trial/48117/view. Registration date: 28/02/2021. Public repository: Data set This research data set link is displayed on the Zanjan-Iran Medical Sciences website: https://repository.zums.ac.ir/cgi/users/login? target=https%3 A%2 F/repository.zums.ac.ir/id/eprint. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is a complex, multifactorial lung disease affecting preterm neonates that can result in long-term pulmonary and non-pulmonary complications. Current therapies mainly focus on symptom management after the development of BPD, indicating a need for innovative approaches to predict and identify neonates who would benefit most from targeted or earlier interventions. Clinical informatics, a subfield of biomedical informatics, is transforming healthcare by integrating computational methods with patient data to improve patient outcomes. The application of clinical informatics to develop and enhance clinical therapies for BPD presents opportunities by leveraging electronic health record data, applying machine learning algorithms, and implementing clinical decision support systems. This review highlights the current barriers and the future potential of clinical informatics in identifying clinically relevant BPD phenotypes and developing clinical decision support tools to improve the management of extremely preterm neonates developing or with established BPD. However, the full potential of clinical informatics in advancing our understanding of BPD with the goal of improving patient outcomes cannot be achieved unless we address current challenges such as data collection, storage, privacy, and inherent data bias.

Background: Emerging evidence suggests the clinical utility of N terminal pro B type natriuretic peptide (NT-proBNP) in multiple cardiac and pulmonary abnormalities both in adult and pediatric populations. To date, however, there is no consensus regarding its efficacy for the prediction and severity of bronchopulmonary dysplasia in premature neonates. The objective of the present meta-analysis was to determine differences in NT-proBNP among neonates that develop BPD or die from BPD and to evaluate if there is relative information on the diagnostic accuracy of the method. Methods: We conducted a systematic search according to the PRISMA guidelines and looked into Medline (1966–2023), Scopus (2004–2023), Clinicaltrials.gov (2008–2023), EMBASE (1980–2023), Cochrane Central Register of Controlled Trials CENTRAL (1999–2022) and Google Scholar (2004–2023) together with the reference lists from included studies. The potential risk of bias encountered in our study was evaluated using the QUADAS -2 tool. Finally, a total of 9 studies met the eligibility criteria, comprising 1319 newborns, from which 397 developed BPD and 922 were unaffected controls. Results: The results retrieved from our meta-analysis showed that newborns suffering from BPD had notably elevated NT-proBNP levels after birth when compared with healthy neonates (SMD 2.57, 95% CI 0.41, 4.72). The summary effect of the AUC meta-analysis showed that NT-proBNP was very accurate in detecting neonates at risk of developing severe BPD or dying from the disease (AUC −0.16, 95% CI −0.23, −0.08). No studies reported data relevant to the sensitivity and/or specificity of the method in diagnosing BPD. Conclusion: Serum NT-proBNP levels represent a potential future biomarker with great diagnostic validity for the prediction of BPD complicating preterm deliveries. The limited amount of studies included and the significant variations in cutoff values and timing of measurement still restrict the application of NT-proBNP as an established clinical biomarker for BPD. The design of larger prospective studies will provide a more representative number of participants and will address the discrepancies in existing literature. [ABSTRACT FROM AUTHOR]

Background: Pain causes mental-psychological injuries in babies by affecting neuronal development. This study was conducted to evaluate effect of music therapy and Swaddling on physiological indicators and pain intensity caused by blood sampling in preterm neonates. Method and Materials: This randomized controlled clinical trial was performed on 51 preterm neonates admitted to NICU of Persian Gulf Hospital in Bushehr. The newborns were divided into music, swaddling and control groups by random block allocation method. For neonates in music therapy group, music was played from 5 minutes before to two minutes after blood sampling, while neonates in swaddling group were swaddled with a thin sheet from 10 minutes before blood sampling to two minutes after. In all groups, HR and o2sat were measured 30 seconds before, during, 30, 60, 90, 120 seconds after blood sampling. Also, from 30 second before blood sampling to 2 minutes after, neonates' faces were filmed and pain assessment checklist was completed each 30 seconds. Data analyzed using Kruskall Wallis H and ordinal regression tests. Results: There was a significant difference between pain score in intervention groups, so that pain score in Swaddling group was lower than music group at 90 and 120 seconds. In intervention groups, HR changes were lower than control group. No significant difference was observed between three groups regarding o2 saturation. Conclusion: Results showed that swaddling and music therapy can reduce pain caused by blood sampling and keep vital signs more stable, but swaddling has a greater effect on reducing pain in newborns.

Background and Objective: Due to the prevalence of myocardial dysfunction and Patent Ductus Arteriosus (PDA) in a large number of preterm neonates, the prognosis of these infants is highly related to their early diagnosis and treatment. In this regard, the present study aimed to determine the relationship between troponin T level and the prognosis of premature neonates admitted to the Neonatal Intensive Care Unit (NICU) of Fatemieh Hospital in Hamadan. Materials and Methods: In this cross-sectional study, a certain number of infants who underwent serum levels of troponin T from 72 hours to one week after birth were assessed for demographic information, length of hospital stay, complications during hospitalization, acidosis, inotropic agents, recovery, and mortality, as well as their relationship with troponin level. Results: Out of 61 neonates, 22 patients had large PDA with a troponin level of 436±50.2 pg/ml, 14 patients had a small PDA with a troponin level of 260.5±89.8 pg/ml, and 25 patients were without PDA with a troponin level of 277.1±229.7 pg /ml (P = 0.203). There was no statistically significant difference between the three groups. The mean levels of troponin were 423±521 and 274±154 pg/ml in deceased and surviving neonates, respectively (P=0.194). Inotropic was significantly higher in deceased patients (P=0.003), and troponin T level was statistically significant (P=0.008). The relationship between troponin level and severe acidosis (P=0.051) was not significant, with a small difference that could be clinically valuable. Conclusion: Serum troponin T level was higher in preterm neonates with large PDA and deceased ones who received inotropic agents due to hemodynamic disorders and severe acidosis.

Background: According to the latest evidence, infants with gestational age < weeks (33 weeks and six days or less) or birth weight = 2,000 grams are at risk of prematurity retinopathy (ROP) and should be screened. It is preventable in most cases and treatable if diagnosed on time; otherwise, the disease is progressive and quickly leads to blindness. In the final stages of the disease, treatment is complicated and, in some cases, impossible and expensive. Therefore, this study was conducted to evaluate the early diagnosis and treatment of this disease and the prophylactic effect of melatonin. Methods: This study was a clinical trial conducted on all preterm infants admitted to the neonate intensive care unit (NICU) ward of Akbarabadi and Ali Asghar hospitals of Iran University of Medical Sciences. Study information was given to the parents, and they were included in the study after obtaining written consent. These infants were randomly divided into two groups; for the first group, melatonin (3 mg/kg/day) was administered from day 7 of birth to the end of week 37, and the second group (control group) did not receive this drug. After completing the course, the two groups were evaluated and compared regarding the incidence of retinopathy prematurity. Results: Sixteen neonates in two groups were included in this study. Between the two groups, there was not any significant difference in neonatal gender (P=0.6), mean gestational age (P=0.6), birth weight (P=0.7), average APGAR score in minutes 1 (P=0.3) and five (P=0.1), umbilical cord PH (P=0.8), mechanical ventilation and CPAP (P=0.4), other respiratory support (P=0.7), duration of hospitalization (P=0.7), final weight (P=0.7). 13.3% of neonates in the melatonin group and 36.7% of the control group had ROP. There was a significant difference in the incidence of ROP according to the study group (P=0.03). However, there was no significant relationship between the study group and the severity of neonatal ROP (P=0.9). Conclusion: Our data suggested that treating preterm infants with melatonin could effectively reduce the incidence of ROP. [ABSTRACT FROM AUTHOR]

Abstract Background Systemic infections caused by the black yeast-like fungus Exophiala dermatitidis are rare, but are associated with high mortality especially in immunocompromised patients. We report the first case of E. dermatitidis fungemia in a premature extremely low birth weight (ELBW) neonate who succumbed despite antifungal therapy with liposomal amphotericin (AMB) and fluconazole. A systematic review of all fungemia cases due to E. dermatitidis was also conducted aiming for a better understanding of the risk factors, treatment strategies and outcomes. Case presentation A male, ELBW premature neonate, soon after his birth, developed bradycardia, apnoea and ultimately necrotizing enterocolitis with intestinal perforation requiring surgical intervention. Meanwhile, he had also multiple risk factors for developing bloodstream infection, such as intubation, mechanical ventilation, central venous catheter (CVC), parenteral nutrition, empirical and prolonged antibiotic use. His blood cultures were positive, firstly for Acinetobacter junii and then for Klebsiella pneumoniae together with E. dermatitidis while on fluconazole prophylaxis and antibiotic empiric therapy. Despite the treatment with broad spectrum antibiotics, liposomal AMB and fluconazole, the newborn succumbed. A literature review identified another 12 E. dermatitidis bloodstream infections, mainly in patients with hematologic malignancies and solid organ transplant recipients (61%), with overall mortality 38% despite CVC removal and antifungal therapy. Conclusions Due to the rarity of E. dermatitidis infections, little is known about the characteristics of this yeast, the identification methods and the optimal therapy. Identification by common biochemical tests was problematic requiring molecular identification. Resolution of neonatal fungemia is difficult despite proper antifungal therapy especially in cases with multiple and severe risk factors like the present one. Therapeutic intervention may include CVC removal and treatment for at least 3 weeks with an azole (itraconazole or fluconazole after susceptibility testing) or AMB monotherapy but not echinocandins or AMB plus azole combination therapy.

Background and purpose: Gavage feeding tubes increase the length of stay and reduce the growth process in neonates. The aim of this study was to determine the effect of non-nutritive sucking on weight gain and length of stay in neonates that required gavage feeding. Materials and methods: In a clinical trial, neonates were selected via convenience sampling and randomly assigned into an intervention group (n=37) or a control group (n=38). Data including demographic information, admission and discharge dates, and neonates’ weights were recorded. In the intervention group, non- nutritive sucking was performed by the mother's finger at the same time as the gavage feeding. Data analysis was performed in SPSS V20 applying independent t-test, Mann-Whitney, and Chi-square. Results: The mean weight at discharge was 90.73 g higher in the intervention group than the control group (P=0.121). The mean weight loss was found to be higher in control group than the intervention group (P= 0.818). The mean length of stay was 14.22± 8.32 days in intervention group and 14.61±7.34 in control group, indicating no significant differences between the two groups (P=0.830, statistical power=60%). Conclusion: Non-nutritive sucking had no significant positive effect on length of stay and weight gain in preterm infants. Further studies with larger sample size are suggested. (Clinical Trials Registry Number: IRCT20200617047806N1)

Background: Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development. Non-pharmacological interventions that involve manual techniques are described, considering protocols that can be reproduced by physical therapists, with positive and negative outcomes reports. Data sources: Systematic review follows PRISMA 2020 statements guidelines. Primary and specific health sciences databases (Science Direct, Pubmed, Scielo, Embase and Scopus) were consulted between October 2021 and May 2022. Articles considered were clinical trials, randomized or not, that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes: "pain" and "stress". Results: Fifteen articles were selected for analysis, reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources. The non-pharmacological therapies most applied in isolation were massage, swaddling or wrapping, gentle touch and kinesthetic stimulation, and the combined therapies were non-nutritive sucking and swaddling, oral sucrose and swaddling, sensory stimulation and familiar odors, and sensory saturation. The outcomes found were relaxation, pain, and stress reduction after the application of painful procedures. The behavioral changes included crying, grimacing, yawning, sneezing, jerky arm or leg movements, startles, and finger flaring. The vital signs included heart rate, blood oxygen saturation level, and pulse respiration. Conclusions: Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques. They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way. [ABSTRACT FROM AUTHOR]

Background: There is a relative lack of information about the consequences of antibiotic therapy during pregnancy or the first postnatal days on brain development, function, and subsequent issues. Objectives: This study investigated the correlation between antibiotic therapy and the timing of complete oral feeding in premature neonates admitted to the Neonatal Intensive Care Unit. Methods: In this descriptive-retrospective study conducted in Mahdieh Hospital in Tehran, the duration of antibiotic therapy and the date of complete oral feeding tolerance were obtained through electrical patient records. Antibiotic exposure was divided into three categories: Less than 24 hours, between 3 and five days, and more than five days. Results: A total of 340 neonates aged 30 to 37 weeks were reviewed. In 2.9% of neonates, no antibiotics were prescribed, and 62.1% received antibiotics for less than five days and 35% for more than five days. There was a significant inverse correlation between the duration of antibiotic therapy and neonatal weight when complete oral feeding tolerance occurs. When taking complete oral feeding, neonates who took antibiotics for more than five days weigh less than neonates in the other two groups. However, there was no significant correlation between the duration of antibiotic therapy and the duration of oral feeding. There was a significant correlation between the type of antibiotics and the duration of his/her oral feeding. Thus, the duration of oral feeding was longer in neonates who had taken cefotaxime, amikacin, and vancomycin than other antibiotics. Yet, there was no significant correlation between the type of antibiotic and the process of neonatal weight gain. Conclusions: The findings of the present study showed that the type of antibiotics and the duration of antibiotic therapy are correlated to neonatal feeding, neonatal weight, and neonate's one-minute Apgar score. [ABSTRACT FROM AUTHOR]

Introduction: The association of maternal vitamin D status with preterm labor has been considered in the recent decade, although reported findings have been inconsistent. This study was performed aimed to compare serum 25-hydroxy vitamin D levels between women with idiopathic preterm labor and women with term labor. Methods: This case-control study was performed in 2020 on 60 women aged 18-35 years who had referred to Bentolhoda Hospital in Bojnourd for delivery. Serum levels of 25-hydroxyvitamin D were determined in 30 women with idiopathic preterm delivery with gestational age of 28 to 37 weeks (case group) and 30 women with term delivery (control group) by sandwich ELISA. Patients' information including demographic information, clinical status and pregnancy history were collected through a questionnaire. Data were analyzed by SPSS 16 software (version 16) and Chi-square and Pearson correlation coefficient test. P

Background: Pain causes mental-psychological injuries in babies by affecting neuronal development. This study was conducted to evaluate effect of music therapy and Swaddling on physiological indicators and pain intensity caused by blood sampling in preterm neonates. Method and Materials: This randomized controlled clinical trial was performed on 51 preterm neonates admitted to NICU of Persian Gulf Hospital in Bushehr. The newborns were divided into music, swaddling and control groups by random block allocation method. For neonates in music therapy group, music was played from 5 minutes before to two minutes after blood sampling, while neonates in swaddling group were swaddled with a thin sheet from 10 minutes before blood sampling to two minutes after. In all groups, HR and o2sat were measured 30 seconds before, during, 30, 60, 90, 120 seconds after blood sampling. Also, from 30 second before blood sampling to 2 minutes after, neonates' faces were filmed and pain assessment checklist was completed each 30 seconds. Data analyzed using Kruskall Wallis H and ordinal regression tests . Results: There was a significant difference between pain score in intervention groups, so that pain score in Swaddling group was lower than music group at 90 and 120 seconds. In intervention groups, HR changes were lower than control group. No significant difference was observed between three groups regarding o2 saturation. Conclusion: Results showed that swaddling and music therapy can reduce pain caused by blood sampling and keep vital signs more stable, but swaddling has a greater effect on reducing pain in newb [ABSTRACT FROM AUTHOR]

Background: Systemic infections caused by the black yeast-like fungus Exophiala dermatitidis are rare, but are associated with high mortality especially in immunocompromised patients. We report the first case of E. dermatitidis fungemia in a premature extremely low birth weight (ELBW) neonate who succumbed despite antifungal therapy with liposomal amphotericin (AMB) and fluconazole. A systematic review of all fungemia cases due to E. dermatitidis was also conducted aiming for a better understanding of the risk factors, treatment strategies and outcomes.Case Presentation: A male, ELBW premature neonate, soon after his birth, developed bradycardia, apnoea and ultimately necrotizing enterocolitis with intestinal perforation requiring surgical intervention. Meanwhile, he had also multiple risk factors for developing bloodstream infection, such as intubation, mechanical ventilation, central venous catheter (CVC), parenteral nutrition, empirical and prolonged antibiotic use. His blood cultures were positive, firstly for Acinetobacter junii and then for Klebsiella pneumoniae together with E. dermatitidis while on fluconazole prophylaxis and antibiotic empiric therapy. Despite the treatment with broad spectrum antibiotics, liposomal AMB and fluconazole, the newborn succumbed. A literature review identified another 12 E. dermatitidis bloodstream infections, mainly in patients with hematologic malignancies and solid organ transplant recipients (61%), with overall mortality 38% despite CVC removal and antifungal therapy.Conclusions: Due to the rarity of E. dermatitidis infections, little is known about the characteristics of this yeast, the identification methods and the optimal therapy. Identification by common biochemical tests was problematic requiring molecular identification. Resolution of neonatal fungemia is difficult despite proper antifungal therapy especially in cases with multiple and severe risk factors like the present one. Therapeutic intervention may include CVC removal and treatment for at least 3 weeks with an azole (itraconazole or fluconazole after susceptibility testing) or AMB monotherapy but not echinocandins or AMB plus azole combination therapy. [ABSTRACT FROM AUTHOR]

Background and purpose: Gavage feeding tubes increase the length of stay and reduce the growth process in neonates. The aim of this study was to determine the effect of non-nutritive sucking on weight gain and length of stay in neonates that required gavage feeding. Materials and methods: In a clinical trial, neonates were selected via convenience sampling and randomly assigned into an intervention group (n=37) or a control group (n=38). Data including demographic information, admission and discharge dates, and neonates’ weights were recorded. In the intervention group, non- nutritive sucking was performed by the mother's finger at the same time as the gavage feeding. Data analysis was performed in SPSS V20 applying independent t-test, Mann-Whitney, and Chi-square. Results: The mean weight at discharge was 90.73 g higher in the intervention group than the control group (P=0.121). The mean weight loss was found to be higher in control group than the intervention group (P= 0.818). The mean length of stay was 14.22± 8.32 days in intervention group and 14.61±7.34 in control group, indicating no significant differences between the two groups (P=0.830, statistical power=60%). Conclusion: Non-nutritive sucking had no significant positive effect on length of stay and weight gain in preterm infants. Further studies with larger sample size are suggested. [ABSTRACT FROM AUTHOR]

ObjectivesThe evidence that risks of morbidity and mortality are higher when very premature newborns are born during the on-call period is inconsistent. This study aimed to assess the impact of this situation among other determinants of outcomes, particularly newborn characteristics and care organization.MethodsObservational study including all infants born < 30 weeks’ gestation in a French tertiary perinatal center between 2007 and 2020. On-call period corresponded to weekdays between 6:30 p.m. and 8:30 a.m., weekends, and public holidays. The primary endpoint was survival without severe morbidity, including grade 3–4 intraventricular hemorrhage (IVH), cystic periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity. The relationship between admission and outcome was assessed by an adjusted odds ratio (aOR) on the propensity of being born during on-call period and expressed vs. weekday. Secondary analyses were carried out in extremely preterm newborns (

Background: There is a dearth of studies in Iran on the efficacy of probiotics in reducing necrotizing enterocolitis (NEC), yielding contradictory results. Therefore, the present study aimed to assess the effect of probiotics on milk tolerance and the prevention of NEC in preterm neonates. Methods: This randomized triple-blind clinical trial study was conducted on all preterm neonates between 30 and 36 weeks gestation and birth weight >1250 g hospitalized in the neonatal intensive care unit (NICU) at Bentolhoda Hospital in Bojnurd, Iran. Thereafter, 76 eligible neonates were randomly assigned to two groups of oral placebo (n=38) and BB care probiotic (n=38). Subsequently, the following information was extracted based on the hospital checklist: early or late NEC (after 7 days of birth), types of NEC (grade I, II, and III), length of hospitalization, time to reach complete oral nutrition, weight at discharge, and milk tolerance. Results: In the current study, 52.6% and 47.4% of newborns in control and intervention groups were male, and no significant difference was observed between the two groups (P= 0.646). The incidence of NEC was significantly reduced among the intervention group. The feeding onset in the placebo group was significantly later, as compared to that in the intervention group. A significant difference was detected between the two groups in the length of hospital stay and weight gain during hospitalization. Conclusion: As evidenced by the obtained results, the administration of probiotics in preterm neonates might prevent NEC. Moreover, it can shorten the onset time of feeding and hospitalization duration.

Background: Examination for retinopathy of prematurity (ROP) is one of the procedures that can be stressful for neonates admitted to a neonatal intensive care unit. This study compared breast milk and sucrose in pain relief and coping with the stress of ROP examination using the Astrid Lindgren and Lund Children’s Hospital Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo). Methods: The present study was carried out on a total of 63 preterm infants (including breast milk group [n=21], sucrose group [n=21], and distilled water group [n=21]). The neonates were given 0.5 ml/kg of breast milk, sucrose, or distilled water 2 min before the examination. The ROP eye examinations were video recorded from 5 min before to 15 min after the examination, and infants’ pain and stress levels were assessed using the ALPS-Neo by two blinded evaluators 5 min before, during, and 5, 10, and 15 min after the examination. Results: No statistically significant differences were observed during the examinations in the mean scores of the ALPS-Neo among the three groups (P>0.05). However, there were statistically significant differences among the three groups after the examinations (P

Exposure to repetitive pain during the neonatal period has been shown to have important short and long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. A uniform taxonomy of neonatal prolonged pain is still lacking to this day which contributes to suboptimal prolonged pain management in neonatal intensive care units. Accordingly, a scoping review exploring the state of knowledge about prolonged pain in preterm neonates hospitalised in the neonatal intensive care unit will contribute to the developing field of neonatal prolonged pain and provide recommendations for clinical prolonged pain management. To determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalised in neonatal intensive care units. Scoping review. An electronic search was conducted from inception to November 2023 in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. Included studies discussed concepts related to neonatal prolonged pain such as definitions of prolonged pain, indicators of prolonged pain, contexts that result in prolonged pain, prolonged pain evaluation tools, consequences of prolonged pain and interventions for prolonged pain management. Key concepts of neonatal prolonged pain were identified in the 86 included articles of this scoping review such as definitions (n = 26), indicators (n = 39), contexts (n = 49), scales (n = 56), consequences of prolonged pain (n = 30) and possible interventions for prolonged pain management (n = 22). Whilst a consensus on a definition has yet to be achieved, no proximate event was shown to cause prolonged pain and a time criterion was identified by authors as being relevant in defining prolonged pain. Interestingly, the context of hospitalisation was identified as being the most indicative of prolonged pain in premature neonates and should guide its evaluation and management, whilst only limited pain management interventions and consequences were discussed. The findings of this scoping review contribute to the foundation of growing knowledge in neonatal prolonged pain and shed light on the ambiguity that currently exists on this topic in the scientific literature. This review summarises knowledge of key concepts necessary for a better understanding of prolonged pain and stresses the importance of considering contexts of hospitalisation for prolonged pain evaluation and management in neonatal intensive care units, with the objective of improving developmental outcomes of premature neonates. A scoping review reveals that the contexts of prolonged pain in premature neonates hospitalised in the neonatal intensive care unit are essential in guiding its evaluation and management. [ABSTRACT FROM AUTHOR]

Despite ongoing research and recent discoveries, there remains a paucity of data regarding COVID-19 and its implications for pregnant women, particularly its effects on the developing fetus. To date, there are a limited number of articles available regarding the utility of Extra Corporeal Membrane Oxygenation (ECMO) for cardio-respiratory support of pregnant women during the perinatal period. Additionally, there are only a few case reports detailing the delivery management of a baby born to a mother on ECMO support. Here, we report a case of a premature, low birth weight neonate delivered by a 32-year-old woman while on ECMO due to severe acute respiratory distress syndrome resulting from COVID-19 infection. [ABSTRACT FROM AUTHOR]

Neonatal mortality is one of the important health indicators and mortality prediction is applied for auditing and benchmarking, comparing the outcomes in neonatal intensive care units (NICUs), controlling individual differences in populations in clinical trials and evaluating efficacy. In this research work, we aimed to establish and compare two models (neural network and logistic regression models) for prediction of mortality in premature neonates upon admission to the NICU. This modeling research was conducted based on the information of 1618 neonates for prediction of mortality risk until the 28th day of life. In total, 80% and 20% of the data were considered for training and testing of the designed models, respectively. Finally, we achieved to predict the probability of infant mortality based on the 5th minute after birth data. Modeling was performed with two methods; neural network [multi layer perceptron (MLP) with education of back-propagation (BP)] and logistic regression (binominal form in MATLAB R2016a). The results showed that the MLP (with 60 neurons in the hidden layer) had more acceptable indices compared to logistic regression. While both neural network and logistic regression were able to predict the neonatal mortality risk, the neural network is more effective than logistic regression model in performance comparison. [ABSTRACT FROM AUTHOR]

Background: Critically ill neonates receiving blood products are at risk of transfusion-related complications. The quality of nursing care in this regard can be enhanced through continuous evaluations. Aim: This study aimed to assess the performance of nurses in a neonatal intensive care unit (NICU) regarding the transfusion of blood and blood products. Method: This descriptive cross-sectional study was carried out on the nurses working in an NICU in Tehran, Iran, during 2017. The performance of nurses was investigated for 550 blood transfusion procedures by structured observation through a researcher-made checklist with 40 items in three steps. The data were analyzed using SPSS software (version 22) using descriptive statistics and a generalized estimating equation. Results: The highest frequency (66.2%; n=365) of transfusions was observed for fresh frozen plasma. In the pre-transfusion phase, no case out of 550 transfusion procedures, ensuring the openness of the vein with normal saline injections run (100%), the carriage of blood products from the blood bank to the ward by the box Specific (76.2%), assess blood and blood products sensitivity (34.1%) and control of blood tests for blood count and coagulation factors (20.5%). In the transfusion phase, slow shaking the blood bag during injection (68.6%) and venous line washing with saline solution (45%) were not according to guidelines. After the transfusion phase, the volume of infused products, blood types, post-transfusion reactions and vital signs, and status of product labeling were recorded in 100% of the nursing reports. Implications for Practice: The performance of nurses was poor in many cases during the transfusion stage which can affect the health of the neonates. Therefore, it is recommended to provide continuous and persistent training for the staff.

Background: Respiratory distress syndrome (RDS) is a common lung problem in neonates born before 28 weeks of pregnancy. The current study aimed to assess the clinical outcomes of Nasal Continuous Positive Airway Pressure (NCPAP), as compared to humidified high flow nasal cannula (HHFNC) in the treatment of premature neonates with RDS.Methods: This randomized control trial was conducted on 60 preterm neonates (gestation Results: There were no significant differences in primary and secondary outcomes, including pneumothorax, patent ductus arteriosus (PDA), chronic lung disease, surfactant injection, tracheal intubation, death, necrotizing enterocolitis (NEC), days of delay in establishing full enteral feeds, duration of hospitalization, and the number of the days for oxygen requirement between NCPAP and HHFNC groups.Conclusion: HHFNC and NCPAP techniques have the same efficacy in the treatment of RDS in neonates, and there was no difference between the two techniques in terms of treatment failure and clinical outcomes. Since HHFNC is less invasive with the same efficacy compared to CPAP, we recommend that it can be used as a primary modality in preterm neonates with RDS.

This case report investigates the management of a 24-week-old neonate with congenital cytomegalovirus (CMV) infection and its sequelae, including severe intrauterine growth restriction, thrombocytopenia, and brain anomalies, ultimately progressing to lissencephaly. The diagnostic challenges included delayed clinical suspicion of congenital CMV, which was not identified until after delivery through CMV DNA polymerase chain reaction, and differentiating its symptoms from other potential causes of the neonate's condition. Aggressive interventions included antibiotics, antiviral therapy with ganciclovir, and supportive measures such as intubation, CPR, respiratory support, blood transfusions, and management of coagulopathy. Despite these efforts, the patient deteriorated due to progressive hypoperfusion, hypoxemic cardiorespiratory failure, and disseminated intravascular coagulopathy. Due to the poor prognosis and extent of multiorgan damage, support was withdrawn per parental consent. This case highlights the complications encountered when managing an advanced-stage neonatal CMV infection and emphasizes the importance of a multidisciplinary and holistic approach to guide diagnosis and treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Manalac et al.)

Purpose: To evaluate the relationship between retinopathy of prematurity (ROP) severity and neurodevelopmental outcomes in premature neonates at 0–36 months corrected age.Methods: A retrospective chart review was performed on 228 neonates screened for ROP at the UCLA Mattel Children's Hospital between 2011 and 2018. Demographic information, clinical outcomes, ROP severity (no ROP, type 1 ROP, type 2 ROP), and Bayley-III neurodevelopmental scores were collected. Infants were grouped into corrected age cohorts (0–12, 12–24, and 24–36 months) to assess neurodevelopmental outcomes with increasing age. Within each age cohort, ANOVA and Chi-Square testing were used to detect differences in birth characteristics and neurodevelopmental scores between infants with type 1 ROP, type 2 ROP, or no ROP. Univariable analyses assessed the relationship between ROP severity and neurodevelopmental outcomes within each age cohort. A multivariable analysis was then performed to determine if ROP severity remained significantly associated with worse neurodevelopmental scores after controlling for birth weight (BW), intraventricular hemorrhage grade (IVH), health insurance type, male sex, and age at Bayley testing.Results: Without controlling for factors associated with prematurity, neonates with type 1 ROP had poorer cognition (p = 0.001) and motor (p = 0.006) scores at ages 0–12 months and poorer cognition (p = 0.01), language (p = 0.04) and motor (p = 0.04) scores at ages 12–24 months than infants without ROP, but no significant differences were detected at ages 24–36 months. After adjusting for BW, IVH, insurance type, male sex, and age at Bayley testing, ROP severity was no longer associated with worse neurodevelopmental scores in any domain.Conclusion: This study emphasizes that poorer neurodevelopmental outcomes in preterm neonates are most likely related to lower birthweight, associated co-morbidities of prematurity, and socioeconomic factors such as health insurance, not severity of ROP itself.

Objective  In premature neonates, bloody stools and/or abdominal distension with feeding intolerance may be inaugural signs of necrotizing enterocolitis (NEC). We assessed the ability of near-infrared spectroscopy (NIRS) to distinguish those neonates with NEC soon after the occurrence of these symptoms. Study Design  We prospectively collected NIRS measurements of abdominal and cerebral regional tissue oxygen saturation (r-SO 2), with values masked by an opaque cover. Two physicians, blinded to the NIRS data, determined whether the gastrointestinal symptoms were related to NEC 10 days after symptom onset. Results  Forty-five neonates with mean (standard deviation [SD]) gestational, birth weight and postnatal ages of 31 (3.9) weeks, 1,486 (794) g, and 18 (14) days were enrolled over 30 months. Gastrointestinal symptoms were related to NEC in 23 patients and associated with other causes in 22. Analysis of the 48 hours of monitoring revealed comparable abdominal r-SO 2 and splanchnic-cerebral oxygenation ratio (SCOR) in patients with and without NEC (r-SO2: 47.3 [20.4] vs. 50.4 [17.8], p  = 0.59, SCOR: 0.64 [0.26] vs. 0.69 [0.24], p  = 0.51). Results were unchanged after NIRS analysis in 6-hour periods, and restriction of the analysis to severe NEC (i.e., grade 2 and 3, 57% of the NEC cases). Conclusion  In this study, NIRS monitoring was unable to individualize NEC in premature infants with acute gastrointestinal symptoms. [ABSTRACT FROM AUTHOR]

OBJECTIVE Historically, prophylactic indomethacin (pINDO) has been used in some institutions for patent ductus arteriosus (PDA) in extremely low birthweight neonates while other institutions have used it as prophylaxis for intraventricular hemorrhage (IVH). The objective of this study was to evaluate the incidence of IVH and PDA with or without pINDO in premature neonates. METHODS This was a retrospective, single-center study comparing neonatal outcomes in neonates weighing 1250 grams or less who received pINDO (pINDO group) to those who did not (No pINDO group) after our institution discontinued its routine use. RESULTS A total of 399 infants were included for analysis (pINDO, n = 141; No pINDO, n = 258). No difference was found between pINDO and No pINDO groups in incidence of any IVH (18% vs 14%, respectively) or severe IVH (7% vs 3%, respectively) when adjusting for gestational age and antenatal corticosteroids. Although the incidence of moderate-to-large PDA was lower in the pINDO group (13% vs 23%, respectively, adjusted p = 0.002), there was no significant difference for PDA requiring surgery (4% vs 3%, respectively). Results demonstrated a higher incidence of bronchopulmonary dysplasia (BPD) in the pINDO group (55% vs 41%, respectively, adjusted p = 0.014). CONCLUSION No difference in the incidence of IVH, severe IVH, or PDA requiring surgery was observed between groups, whereas an increase in BPD was seen with use of pINDO. These data support our institutional practice change to discontinue routine use of pINDO in premature neonates. Further research is needed to guide clinical practice. [ABSTRACT FROM AUTHOR]

Objective Intra-ventricular hemorrhage (IVH) is the leading cause of mortality and disability in premature neonates. The present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU)at Fatemieh Hospital in Hamadan, Iran, in 2016. Methods & Materials This retrospective cross-sectional study was conducted on 178 neonates with a gestational age of ≤ 32 weeks admitted to Fatemieh Hospital affiliated to the Hamadan University of Medical Sciences, Hamadan, Iran, in 2016. The study population was selected using the census method. The newborns were subjected to cranial ultrasound on the seventh day of life, and they were assigned into two case and control groups (namely neonates with IVH and those without IVH, respectively). Intra- ventricular hemorrhage was classified into four grades regarding Papile classification. The patients' demographic specifications, including 1- and 5-minute Apgar scores, type of delivery, birth weight, use of mechanical ventilation, prenatal corticosteroid, gestational age, and some complications (e.g., Pneumothorax), were collected using a checklist. The data were analyzed using SPSS software version 16. Results According to the results, the prevalence of IVH in premature infants admitted to NICU was approximately 20%, and 61.2% of the neonates were male. The participants' mean gestational age was 30.39 weeks. The comparison of delivery type between the case and control groups revealed no significant difference (P=0.197). Furthermore, there was a significant difference between the two groups in terms of their need for mechanical ventilation (P=0.03), Pneumothorax(P=0.001), and 5-minute Apgar scores (P=0.04). Moreover, the incidence of IVH had a significant relationship with the mean gestational age (P=0.001) and birth weight (P=0.04). Conclusion According to the findings, the premature newborns admitted to the NICU revealed a relatively high prevalence of IVH. The condition is aggravated in preterm neonates by some factors such as low birth weight, 5-minute Apgar score, gestational age, and the need for mechanical ventilation. [ABSTRACT FROM AUTHOR]

Congenital junctional ectopic tachycardia is a rare and special type of supraventricular arrhythmia. Junctional ectopic tachycardia is characterized by persistently elevated heart rates that may cause an impairment in cardiac function. Junctional ectopic tachycardia is considered one of the most difficult-totreat conditions even with a combination of antiarrhythmic medications. Ivabradine is a novel antiarrhythmic medication used to decrease the heart rate in adults with angina pectoris. We report a first case of a premature neonate with a normal heart structure who developed junctional ectopic tachycardia and was subsequently treated successfully with ivabradine. [ABSTRACT FROM AUTHOR]

Objectives: Disruption of smooth intrauterine brain development is a significant consequence of premature birth that may lead to adverse neurological outcomes. Although noteworthy progress has been made in the management of prematurity, the rates of neonatal morbidity and neurodevelopmental disorders remain high, underlining the need to find clinical practices that particularly protect the central nervous system. Aim: To identify recent articles regarding pharmacological and non-pharmacological brain-focused clinical practices (BFCP) for premature neonates at high risk of neuronal injury. Materials and methods: We did an extensive search of PubMed and Google Scholar for relevant research published between 2000 and 2020. Results: Nineteen full-length original research papers fulfilled the inclusion criteria and were selected for the purpose of the present review. Non-pharmacological BFCP intend to improve the neonate's experience in the NICU environment and can be applied by a multidisciplinary team, while pharmacological ones are related to novel molecules that aim to quell apoptosis and inflammation or promote neurogenesis. Conclusions: In the future, a combination of pharmacological and non-pharmacological BFCP might be considered as the most promising protection and/or treatment provided in clinical practice to premature neonates at high risk of neuronal injury. [ABSTRACT FROM AUTHOR]

Background: Examination for retinopathy of prematurity (ROP) is one of the procedures that can be stressful for neonates admitted to a neonatal intensive care unit. This study compared breast milk and sucrose in pain relief and coping with the stress of ROP examination using the Astrid Lindgren and Lund Children’s Hospital Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo). Methods: The present study was carried out on a total of 63 preterm infants (including breast milk group [n=21], sucrose group [n=21], and distilled water group [n=21]). The neonates were given 0.5 ml/kg of breast milk, sucrose, or distilled water 2 min before the examination. The ROP eye examinations were video recorded from 5 min before to 15 min after the examination, and infants’ pain and stress levels were assessed using the ALPS-Neo by two blinded evaluators 5 min before, during, and 5, 10, and 15 min after the examination. Results: No statistically significant differences were observed during the examinations in the mean scores of the ALPSNeo among the three groups (P>0.05). However, there were statistically significant differences among the three groups after the examinations (P<0.05) and in the mean duration of stress adaptation (P<0.05). The duration of stress adaptation in the breast milk group was 11.4 min on average which was lower than that reported for the other groups. Conclusion: Breast milk was more effective in the reduction of pain and stress after ROP examinations, compared to sucrose or distilled water. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of studies in Iran on the efficacy of probiotics in reducing necrotizing enterocolitis (NEC), yielding contradictory results. Therefore, the present study aimed to assess the effect of probiotics on milk tolerance and the prevention of NEC in preterm neonates. Methods: This randomized triple-blind clinical trial study was conducted on all preterm neonates between 30 and 36 weeks gestation and birth weight >1250 g hospitalized in the neonatal intensive care unit (NICU) at Bentolhoda Hospital in Bojnurd, Iran. Thereafter, 76 eligible neonates were randomly assigned to two groups of oral placebo (n=38) and BB care probiotic (n=38). Subsequently, the following information was extracted based on the hospital checklist: early or late NEC (after 7 days of birth), types of NEC (grade I, II, and III), length of hospitalization, time to reach complete oral nutrition, weight at discharge, and milk tolerance. Results: In the current study, 52.6% and 47.4% of newborns in control and intervention groups were male, and no significant difference was observed between the two groups (P= 0.646). The incidence of NEC was significantly reduced among the intervention group. The feeding onset in the placebo group was significantly later, as compared to that in the intervention group. A significant difference was detected between the two groups in the length of hospital stay and weight gain during hospitalization. Conclusion: As evidenced by the obtained results, the administration of probiotics in preterm neonates might prevent NEC. Moreover, it can shorten the onset time of feeding and hospitalization duration. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to estimate the incidence of retinopathy of prematurity (ROP) and investigate its perinatal and neonatal risk factors in a tertiary hospital in Saudi Arabia. Methodology: This was a retrospective cohort study of premature infants admitted to a neonatal intensive care unit at a tertiary hospital in Jeddah, Saudi Arabia, from January 2016 to December 2017. Participants who met the screening criteria for ROP were included and followed up until spontaneous recovery or laser treatment. Results: A total of 119 infants screened, the incidence of ROP was 21.8% (26/119). A plus disease was diagnosed in 15.4% (4/26) of the ROP infants. For most, 80.7% (21/26) of the ROP regressed spontaneously, and 19.2% (5/26) required a laser intervention. The mean gestational age (GA) of infants diagnosed with ROP was 25.62 ± 1.58 weeks and the median birth weight (BW) 750 (interquartile range: 280) g. Lower GA, lower BW, prolonged oxygen therapy, and mechanical ventilation (MV) were significantly related to ROP disease and severity. Requiring resuscitation at birth, a lower Apgar score at 1-min, poor weight gain proportion at 6 weeks, and requiring a blood transfusion were significantly associated with ROP disease. Conclusion: Compared to other local studies, the incidence of ROP was lower in our population. Lower GA, low BW, prolonged oxygen therapy and MV, and poor weight gain at 6 weeks are well-documented risk factors. We recommend close monitoring of weight gain and oxygen therapy and modifying risk factors in preterm infants to lower the incidence and the severity of ROP. [ABSTRACT FROM AUTHOR]

Severe neonatal gastrointestinal diseases such as necrotizing enterocolitis or spontaneous intestinal perforation are potentially lethal conditions which predominantly occur in preterm infants. Cytomegalovirus (CMV), which is known to cause congenital and acquired infections in the newborns, has also been implicated in such severe gastrointestinal diseases in premature infants. However, the pathogenic role of CMV and effect of antiviral therapy in severe gastrointestinal disease in premature neonates is currently unclear. We present an infant, born at 26-weeks' gestation, presented with progressive dyspepsia and abdominal distention after the closure of the symptomatic patent ductus arteriosus at the day of life (DOL) 4, requiring the emergent surgery for ileal perforation at the DOL8. After the surgery, abdominal symptoms persisted and the second emergent surgery was performed for the recurrent ileal perforation at DOL17. Even then the abdominal symptoms prolonged and pathological examination in the affected intestine at the second surgery showed CMV inclusion body. Immunoreactivity for CMV antigen was detected in the specimen at the first surgery on DOL8. Blood and urinary CMV-DNA were detected at DOL28. CMV-DNA was also detected in the dried umbilical cord which was obtained within a week from birth. A 6-week course of intravenous ganciclovir (12 mg/kg/day) was started at DOL34 and then symptoms resolved along with decreasing blood CMV-DNA. Pathological findings characteristic of CMV were not detected in the resection specimen at the ileostomy closure at DOL94. These observations indicate that anti-CMV therapy may be beneficial for some premature infants with severe CMV-associated gastrointestinal diseases and warrants further studies focusing on pathogenic role, diagnosis, treatment and prevention of this underrecognized etiology of severe gastrointestinal diseases particularly in premature neonates.

Objectives: Abdominal distention is a common indicator of feeding intolerance in premature newborns. In the absence of a precise definition, abdominal distention and its degree are highly subjective. The aim of this study was to construct references and smoothed percentiles for abdominal circumference (AC) and AC to head circumference (HC) ratio (AC/HC) in infants born between 24 weeks and 34 weeks of gestational age.Methods: ACs and HCs were collected weekly in eutrophic premature infants without congenital abdominal or cerebral malformation. AC and HC charts were modeled using the LMS method, excluding measures associated with abdominal distention at clinical examination or intracranial abnormality at cerebral ultrasounds. Changes in AC and AC/HC over time were studied by repeated-measures analysis using mixed-effects linear models.Results: A total of 1,605 measurements were made in 373 newborns with a mean gestational age of 31 [29–33] weeks and mean birth weight of 1,540 [1,160–1,968] g. Of these measurements, 1,220 were performed in normal conditions. Gestational age, postnatal age, singleton status, and respiratory support were significantly associated with AC and AC/HC. LMS curves were generated according to gestational age groups and postnatal age, with coherent profiles. AC/HC was 0.91 [0.86–0.95] in absence of abdominal distention. It was higher in cases of abdominal distention (0.95 [0.89–1.00], p < 0.001) and necrotizing enterocolitis (0.98 [0.93–1.07], p < 0.001).Conclusions: References constructed for AC and AC/HC might be used to assess feeding tolerance in premature infants. AC/HC was more relevant than AC to rationalize the diagnosis of abdominal distention.

Disruption of smooth intrauterine brain development is a significant consequence of premature birth that can lead to adverse neurological outcomes. Although noteworthy progress has been made in the management of preterm neonates, rates of neonatal morbidity and neurodevelopmental disorders remain high in this population, underlining the need to find and institute care practices that protect, in particular, the central nervous system (CNS). A promising model of care for premature neonates is "neuroprotective care", which reduces the sensory and environmental stimuli of the neonatal intensive care unit (NICU), supporting, in this way, the neuroplasticity of the developing neonatal brain. The clinical practices of this model aim to prevent or minimize the presentation of neurodevelopmental disorders. They can be applied by a specialized interdisciplinary team in the NICU, and close cooperation with the family of the neonate in the care plan is crucial. [ABSTRACT FROM AUTHOR]

BACKGROUND: The mother-newborn relationship is more important in neonates hospitalized in the NICU than in healthy neonates. This study was conducted to explore the experiences of the mothers of infants hospitalized in the NICU. MATERIALS AND METHODS: This qualitative study was done in 2016 by adopting a conventional content analysis approach. Thirty-five mothers in the NICUs, Imam Hossein Hospital and Fatemieh Hospital were selected. Their experiences were assessed using in-depth individual semi-structured interviews. Sampling was purposive and was continued until reaching data saturation. RESULTS: Two hundred and nine primary codes were extracted. After removing duplicates and overlaps, 95 primary codes were categorized in 8 subcategories, 2 accessory categories and 1 main category based on their appropriateness, agreement, and similarity. The accessory categories of "mothers' worries" and "mothers' hopes" were merged into a more general, abstract category named "dual feelings about the baby". CONCLUSIONS: The nurses' awareness of the mothers' experiences can help design interventions to promote the quality of care for mothers and infants in the critical period of the NICU admission. [ABSTRACT FROM AUTHOR]

Background: Respiratory distress syndrome (RDS) is acommonlungproblem in neonates born before 28 weeks of pregnancy. The current study aimed to assess the clinical outcomes of Nasal Continuous Positive Airway Pressure (NCPAP), as compared to humidified high flow nasal cannula (HHFNC) in the treatment of premature neonates with RDS. Methods: This randomized control trial was conducted on 60 preterm neonates (gestation <34 weeks and birth weight <2,000 g) with mild to moderate RDS (respiratory severityscore of 4 to 7) andoxygen requirement 60% or less. They were randomly assigned to either NCPAP or HHFNC groups. Treatment failure in the first 72h after birth was the primary outcome. Secondary outcomes included Pneumothorax, patent ductus arteriosus (PDA), chronic lung disease, surfactant injection, tracheal intubation, necrotizing enterocolitis (NEC), several days of delay in establishing full enteral feeds, extended length of hospital stay and oxygen therapy days, and death. Data were analyzed in SPSS software (version16) usingindependent t-test, chi-square, and logistic regression statistical testsat 95% significant level. Results: There were no significant differences in primary and secondary outcomes, including pneumothorax, patent ductus arteriosus (PDA), chronic lung disease, surfactant injection, tracheal intubation, death, necrotizing enterocolitis (NEC), days of delay in establishing full enteral feeds, duration of hospitalization, and the number of the days for oxygen requirement between NCPAP and HHFNC groups. Conclusion: HHFNC and NCPAP techniques have the same efficacy in the treatment of RDS in neonates, and there was no difference between the two techniques in terms of treatment failure and clinical outcomes. Since HHFNC is less invasive with the same efficacy compared to CPAP, we recommend that it can be used as a primary modality in preterm neonates with RDS. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased.Study Design: Retrospective cross-sectional analysis.Methods: We analyzed the 2006 to 2012 Kids' Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD.Results: The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002).Conclusions: Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis.Level Of Evidence: 4 Laryngoscope, 130: 2056-2062, 2020. [ABSTRACT FROM AUTHOR]

Paediatric patients are at risk of developing pressure injuries; however, there is a paucity of literature addressing the specific considerations related to pressure injury prevention for this patient cohort. Pressure injuries are generally linked to the adult patient population, hence most of the literature available to date is related to prevention and management of pressure injuries in older people or adult patients considered to be at high risk. The aim of this paper is to outline recommended pressure injury risk assessments for the neonatal/paediatric patient and to highlight some specific pressure injury prevention considerations when caring for this often-overlooked patient population. [ABSTRACT FROM AUTHOR]

The INtubation-SURfactant-Extubation (INSURE) procedure is a widely-used surfactant administration method to treat preterm infants with respiratory distress syndrome (RDS) but is not always successful. We conducted a systematic review to identify early predictive factors for failure of this procedure. A systematic literature search was performed until July 2018 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Original studies comparing INSURE success with INSURE failure in preterm infants with RDS were included. A predefined data extraction form was used to retrieve data from articles, and methodological quality was assessed using the SIGN checklists. Fifteen studies out of 690 identified records met inclusion criteria. Methodological quality varied, only 8 studies performed multivariate analysis. We identified 20 different risk factors in total. Evidence for birth weight (BW) as a predictor for INSURE failure was inconsistent, but there was a significant association between decreasing gestational age (GA) and failure risk. RDS severity was assessed in multiple ways, using arterial blood gas values, imaging, and scoring systems. In conclusion, extremely low BW, low GA, and severe RDS appear to be risk factors for INSURE failure. However, evidence is inconsistent due to important methodological heterogeneity. Therefore, clinical applicability of these results is limited and implies the need for future large cohort studies on this subject. [ABSTRACT FROM AUTHOR]

Background. Diagnosing acute kidney injury (AKI) in preterm newborns, who are particularly susceptible to renal damage, is a serious challenge as there is no definite consensus about the diagnostic criteria. Objectives. The objective of this study was to measure the values for selected urinary biomarkers and estimated glomerular filtration rate (eGFR) among a population of preterm infants with uncomplicated clinical course as well as to determine whether these markers depend on birth weight (BW), gestational age (GA), postnatal age (PNA), or gender. Material and methods. The prospective study was carried out in neonatal intensive care unit (NICU). The evaluation included 57 children that were divided into 3 categories according to BW: low birth weight (LBW) - 1501-2500 g (22 infants); very low birth weight (VLBW) - 1000-1500 g (25 infants); and extremely low birth weight (ELBW) - 750-999 g (10 infants). Urine samples were collected daily between the 4th and 28th day of life for measurements of creatinine (Cr), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and human kidney injury molecule 1 (hKIM1). Results. The values of the 3 urine tubular biomarkers, serum creatinine and eGFR were taken in substantially healthy preterm infants with normal kidney function at 4 time intervals during the neonatal period. Their correlations were determined and a multivariable regression analysis was carried out with respect to BW, GA, PNA, and gender. Trends of the studied markers in terms of PNA and BW were also assessed with the Jonckheere-Terpstra test. Conclusions. Glomerular and tubular function in preterm neonates during the 1st month of life is significantly influenced by BW, GA, PNA, and gender. [ABSTRACT FROM AUTHOR]