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This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors. [ABSTRACT FROM AUTHOR]

Objective Late-onset sepsis (LOS) is a major public health burden globally. Newborns with very low birth weight (VLBW) are at high risk of mortality related to LOS. The protective effect of breast milk feeding against many infections has been studied but data on the effect of breast milk feeding on LOS mortality are limited. In this study, we aimed to evaluate the risk factors for LOS-related mortality. Methods This single-center, case–control study was conducted retrospectively from August 2013 to July 2018. VLBW newborns with ≤32 weeks of gestational age who had culture-proven LOS were included in the study. Demographics, clinical and laboratory data, and parenteral and enteral feeding details within 72 hours before LOS episodes were extracted from electronic and paper medical records. Results A total of 190 LOS episodes were identified in 168 VLBW newborns with a median birth weight of 888 (695–1,143) g. Lower birth weight (adjusted odds ratio [aOR] 0.81, 95% confidence interval [CI] [0.69–0.96], p = 0.01), C-section delivery (aOR 0.38, 95% CI [0.17–0.84], p = 0.02), gram-negative (aOR 4.97, 95% CI [2.01–12.28], p = 0.001) and polymicrobial sepsis (aOR 6.29, 95% CI [1.34–29.47], p = 0.03), and lower breast milk feeding 72 hours before LOS episodes (aOR 0.89, 95% CI [0.80–0.99], p = 0.03) were independently associated with higher odds of LOS related death. Conclusion Gram-negative sepsis was associated with higher odds of LOS mortality and C-section delivery was associated with lower odds of LOS mortality. Additionally, every 10 mL/kg/day increase in breast milk feeding was associated with 11% lower odds of LOS mortality although this finding should be interpreted cautiously as there may be unadjusted confounders due to the study design. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. METHODS: Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. RESULTS: 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2--at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. CONCLUSIONS: Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis found that approximately one fifth of survivors of hypoxic-ischemic encephalopathy (HIE) in low- and middle-income countries (LMICs) develop cerebral palsy (CP), even in cases of mild HIE. HIV-exposed infants have inferior neurobehavioral functioning, which may affect their quality of life and ability to develop relationships. Daycare attendance has a positive impact on language development in preterm children, particularly among firstborn and children with low maternal education. Early shared reading, improved attendance rates at NICU follow-up programs, and screenings for autism spectrum disorder (ASD) are effective interventions for preterm children. Neighborhood characteristics can influence cognitive outcomes in infants with HIE, highlighting the need for targeted interventions. Implementing parental reading practices in the NICU promotes bonding and neurodevelopment in preterm infants. A pilot study in 2021 found that parental reading in NICUs is safe and beneficial for premature infants' neurodevelopment. [Extracted from the article]

This document is a collection of abstracts from the 15th International Newborn Brain Conference. The abstracts cover a range of topics related to newborn brain health and development. One study focuses on perinatal hypoxic-ischemic brain damage and the activation of the caspase pathway. Another examines the yield of genetic testing in cases of posterior fossa anomalies. A third investigates the association between nighttime births and neonatal asphyxia or hypoxic ischemic encephalopathy. The fourth explores the incidence of multi-organ dysfunction in neonates with hypoxic ischemic encephalopathy. The fifth focuses on prenatal MRI brain findings associated with epilepsy. The final abstract examines the associations between cerebral metabolism/hemodynamic parameters and neurodevelopmental outcomes. The document also includes two medical cases, one involving infants with hypoxic-ischemic encephalopathy and genetic or congenital anomalies, and the other involving a patient with a rare metabolic disorder. These cases highlight the importance of genetic testing in diagnosing and managing congenital diseases. [Extracted from the article]

To evaluate differences in reproductive and neonatal outcomes on the basis of the time interval from cesarean delivery to subsequent frozen embryo transfer (FET). Retrospective cohort. Multicenter fertility practice. Women undergoing autologous elective single embryo transfer FET after prior cesarean delivery. Time from prior cesarean delivery to subsequent FET. live birth (LB). A total of 6,556 autologous elective single embryo transfer FET cycles were included. Frozen embryo transfer cycles were divided into eight groups on the basis of the time interval from prior cesarean delivery to subsequent FET in months. A secondary analysis was then performed with time as a continuous variable. The proportion of LBs did not differ significantly across all time interval groups and over continuous time (range: 40.0%–45.6%). The mean gestational age at the time of delivery did not significantly differ as the time between prior cesarean delivery and subsequent FET increased (range: 37.3–38.4). When time was evaluated continuously, the proportion of preterm births was higher with a shorter time between cesarean delivery and subsequent FET. The mean birth weight ranged from 3,181–3,470g, with a statistically significant increase over time. However, the proportions of extremely low birth weight, very low birth weight, and low birth weight did not significantly differ. There were no significant differences in reproductive outcomes on the basis of the time interval from cesarean delivery to FET, including LB. The proportion of preterm deliveries decreased with a longer time between cesarean delivery and FET. Differences in mean neonatal birth weight were not clinically significant because the proportion of low birth weight neonates was not significantly different over time. Although large, this sample cannot address all outcomes associated with short interpregnancy intervals, particularly rarer outcomes such as uterine rupture. When counseling patients, the timing of FET after cesarean delivery must be balanced against the risks of increasing maternal age on reproductive and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Researchers have concluded, unsurprisingly, that preterm infants randomized to enhanced developmental support had better developmental outcomes than infants whose caregivers did not receive the training. The researchers started with the very safe hypothesis that enhanced developmental support provided by caregivers — mothers, mainly — would improve the outcomes of infants born preterm to families with low income. The used an intervention which included training was provided by a multidisciplinary team with specialized knowledge of early intervention and infant development. The training began in the Neonatal Intensive Care Unit (NICU) and continued after the infant was discharged. [ABSTRACT FROM AUTHOR]

Aim: To explore whether and how expressing breast milk is perceived as helpful in coping with negative emotions due to premature birth by mothers of very low birth weight (VLBW) infants. Methods: Qualitative interviews and a retrospective cross‐sectional questionnaire with mothers of VLBW infants were conducted and analysed using an exploratory sequential mixed‐method design. Hypotheses were built using qualitative content analysis and quantitatively tested using multivariate regression analysis. Results: Interviews with 12 mothers and questionnaires of 518 mothers were analysed. Coping with prematurity by expressing milk was seen as a way to maintain the caregiving role for the mothers, where three relevant factors arouse: making up for what happened, providing the best for their infant and fear of low milk supply. Quantitative analysis showed that mothers with a high milk supply (Coef. = 1.1, p < 0.000) and more feelings of guilt due to premature birth (Coef. = −0.1; p = 0.015) perceived expressing breast milk significantly more as a resource for coping. Conclusion: This study adds knowledge on how expressing breast milk for their VLBW infant may support mothers in coping with premature birth, by revealing the association with milk supply and feelings of guilt due to premature birth. [ABSTRACT FROM AUTHOR]

The article discusses the life course approach to early life exposures and development of chronic obstructive pulmonary disease (COPD). Topics include life-course approaches to health disparities, how COPD can be considered as a manifestation of structural violence, and research areas to address COPD across the life course.

Aim Methods Results Conclusion In extremely low birth weight infants, fluid overload has been associated with bronchopulmonary dysplasia and death. Excessive weight loss may increase the risk of meconium obstruction and intestinal perforation. As these infants display oliguria followed by polyuria, we embarked on a diuresis‐led volume replacement strategy as of January 2020.This single‐centre analysis presents data of infants <1000 g birth weight surviving for more than 3 days admitted 2017–2019 (n = 217, daily volume increase) versus 2020–2022 (n = 2022, diuresis‐led volume replacement).The second cohort had lower gestational age (median [interquartile range]: 253/7 [243/7–264/7] vs. 263/7 [251/7–282/7] weeks), less antenatal steroids (58% vs. 69%), more indomethacin (66% vs. 47%) and higher initial diuresis (5.6 [4.9–6.8] vs. 4.8 [4.2–5.5] mL/kg/h) but did not differ by relative weight loss at Day 7 of life. Employing binary logistic regression with gestational age, antenatal steroids and indomethacin as covariates, the cohorts did not differ by rates of patent ductus arteriosus, abdominal surgery or severe retinopathy of prematurity, while there were significant declines in sepsis (from 32% to 19%), bronchopulmonary dysplasia (from 26% to 23%) and mortality (from 13% to 7%).Diuresis‐led volume replacement appears to be safe and maybe beneficial. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: The optimal patent ductus arteriosus (PDA) closure method in very low birth weight (VLBW) infants is uncertain. In 2019, the first transcatheter occlusion device was approved in the United States for infants ≥700 g. We described survival and short-term outcomes among VLBW infants who underwent transcatheter or surgical PDA closure (2018-2022). METHODS: Vermont Oxford Network members submitted data on infants born from 401 to 1500 g or 22 to 29 weeks' gestational age. Adjusted risk ratios (aRR) for survival, length of stay (LOS), prematurity complications, and discharge support were used to compare transcatheter versus surgical closure. Subgroup analyses were conducted for infants with birth weight ≥700 g and born in 2020-2022. RESULTS: Overall, 6410 of 216 267 infants at 726 hospitals received invasive PDA treatment. Transcatheter closure increased from 29.8% in 2018 to 71.7% in 2022. VLBW infants undergoing transcatheter closure had higher survival (adjusted rate ratio [aRR] 1.03; 1.02-1.04) with similar LOS (aRR 1.00; 0.97-1.03), neonatal complications (aRR 1.00; 0.98-1.01), and receipt of discharge support (aRR 0.94; 0.89-1.01). In subgroup analyses, survival (aRR 1.02; 1.00-1.04) and discharge support (aRR 0.90; 0.81-1.01) were similar between groups, whereas selected neonatal complications (aRR 0.95; 0.93-0.98) and LOS (aRR 0.95; 0.90-0.99) were lower after transcatheter closure. CONCLUSIONS: Transcatheter PDA closure in VLBW infants was increasingly used after 2018. Selected short-term outcomes for infants receiving transcatheter closure may be more favorable, compared with surgical, and warrants further clinical investigation. [ABSTRACT FROM AUTHOR]

Congenital pulmonary airway malformations (CPAMs) represent a well-known cluster of rare lung malformations affecting 1 in 2500 live births. The natural history of many CPAMs is to increase their size in the second trimester, reach a plateau, and, in about 50% of cases, regress and to become barely detectable during the third trimester. Little is known about cases of affected neonates born prematurely: only six cases are described in the literature, recording different conduct and outcomes. Herein, we report the case of a very low birth weight infant born at GW 28 without antenatal findings and presenting at birth with severe respiratory distress, requiring ventilation. Chest X-rays and a CT scan showed the presence of a solid mass in the left lung. An initial conservative approach was adopted as the baby gained respiratory stability within the first days of life. Routine ultrasound (US) showed a progressive reduction of the lesion, mimicking the process of involution that CPAM can exhibit during late gestation. The rarity of the condition does not allow the formulation of any suggestions regarding one type of management over the other. An initial conservative approach seems to be appropriate with regards to the outcome and possible intra- and post-operative complications. [ABSTRACT FROM AUTHOR]

Background: Extremely low birth weight (ELBW) neonates (birth weight ≤ 1000 g) are at high risk to develop drug-induced acute kidney injury (AKI). However, we lack a pragmatic detection tool to capture their time-dependent (patho)physiologic serum creatinine (Scr) patterns. Pottel et al. suggested rescaling Scr by dividing Scr with the mean Scr value of the age- and sex-specific reference population. We explored if this Pottel method can detect drug-related nephrotoxicity in ELBW neonates. Methods: A previously reported dataset on Scr changes in ELBW neonates exposed to ibuprofen, amikacin, or vancomycin was updated to calculate Pottel scores for every available Scr value in the first 28 postnatal days. We hereby used previously published postnatal age-specific 50th centile values in an ELBW population. Linear mixed models were applied, analyzing Pottel scores as response variable and continuous time (day), drug exposure, and interaction thereof in the explanatory model. Results: Serum creatinine (n = 3231) observations in 201 ELBW neonates were collected. A statistically significant rise of Pottel scores was observed with ibuprofen starting from postnatal day 4. In addition, a cumulative effect of treatment with mean Pottel scores on day 0 of 1.020 and on day 3 during treatment of 1.106 (95% CI 1.068–1.145, p < 0.001) was observed, corrected for effect of antibiotics. Antibiotic administrations showed a small but statistically significant difference up to postnatal day 5. Conclusions: As rescaled Scr biomarker, the Pottel method showed a clear association with ibuprofen-exposed ELBW neonates, suggesting its applicability as a pragmatic bedside alternative tool to assess nephrotoxicity. [ABSTRACT FROM AUTHOR]

This study aims to analyze the main risk factors for acute kidney injury in the subgroup of very-low birth weight newborns, using the diagnosing criteria of the Kidney Disease Improving Global Outcomes (KDIGO) or the Acute Kidney Injury Network (AKIN). A systematic review of the literature was performed on the EMBASE® and PubMed® platforms. Studies that evaluated the risk factors for developing AKI in VLBW newborns were included. For the meta-analysis, we only included the risk factors that were associated with AKI in the univariate analysis of at least two studies. After an initial screening, abstract readings, and full-text readings, 10 articles were included in the systematic review and 9 in the meta-analysis. The incidence of AKI varied from 11.6 to 55.8%. All the studies have performed multivariate analysis, and the risk factors that appeared most were PDA and hemodynamic instability (use of inotropes or hypotension), sepsis, and invasive mechanical ventilation. After the meta-analysis, only cesarian delivery did not show an increased risk of AKI, all the other variables remained as important risk factors. Moreover, in our meta-analysis, we found a pooled increased risk of death in newborns with AKI almost 7 times. Conclusion: AKI in VLBW has several risk factors and must be seen as a multifactorial disease. The most common risk factors were PDA, hemodynamic instability, sepsis, and invasive mechanical ventilation. What is known: • Acute kidney injury is associated with worst outcomes in all ages. It´s prevention can help diminish mortality. What is new: • A synthesis of the main risk factors associated with AKI in very low birth weight newborns. [ABSTRACT FROM AUTHOR]

This document summarizes several articles in the field of medicine, providing valuable insights into the latest advancements in medical research and treatment options. The articles cover a range of topics, including a new cell therapy for sickle cell disease, the use of recombinant ADAMTS13 in treating immune thrombotic thrombocytopenic purpura, the timing of red blood cell transfusions in premature infants, the use of early cold stored platelet transfusion in severely injured patients, and the role of FOXO1 in memory programming in CAR T cells. The information is concise and focused on the scientific aspect of the topics, making it useful for library patrons conducting research on these specific areas of medicine. [Extracted from the article]

This article provides guidelines for blood product transfusions in neonates and infants based on current evidence. The guidelines recommend specific transfusion volumes for different blood products and address concerns about transfusion-associated necrotizing enterocolitis (NEC) and the use of plasma for volume expansion. The authors conducted a survey and found that the majority of providers in their neonatal network were familiar with and following the guidelines. Future trials are expected to further refine transfusion recommendations for specific patient populations. [Extracted from the article]

Objective This study aimed to assess the iron status prior to discharge in very low birth weight (VLBW) infants utilizing reticulocyte hemoglobin content (CHr) and evaluate the impact of delayed cord clamping (DCC) on iron status. Study Design This is a retrospective analysis of VLBW infants from two tertiary level of care Neonatal Intensive Care Units. The primary outcome was the proportion of VLBW infants with low CHr (<29 pg) prior to discharge. Hematologic parameters were also compared between infants who received or did not receive DCC. Infants with a positive newborn screen for hemoglobin Bart's were excluded. Results Among the 315 infants included, 99 infants (31.4%) had low CHr prior to discharge. The median (interquartile range) CHr prior to discharge was 30.8 pg (28.4–39 pg). DCC was performed in 46.7% of infants. Hemoglobin at birth, discharge, and CHr prior to discharge were higher and the need for blood transfusion and the number of infants with low CHr prior to discharge were lower in the DCC group. Conclusion Approximately 31.4% of VLBW infants had low CHr near the time of discharge suggesting they were iron deficient. DCC improved hematological parameters prior to discharge in VLBW infants. CHr content can be used to guide iron supplementation in VLBW infants to potentially improve their iron status and long-term neurocognitive outcomes. Key Points DCC was associated with an improved hemoglobin and iron status at discharge in VLBW infants. CHr is an early and reliable marker for iron deficiency. Approximately one in three VLBW infants can be iron deficient at the time of discharge. [ABSTRACT FROM AUTHOR]

Aim: There is limited literature available about necrotising enterocolitis (NEC) in low‐ and middle‐income countries. This study sought to determine the proportion, pattern and risk factors for mortality among very low birth weight (VLBW) neonates with NEC in a middle‐income setting. Methods: A retrospective observational cohort study was conducted on all infants with birth weights less than 1501 g admitted from 2018 to 2020 at Groote Schuur Hospital, Cape Town, South Africa. Data were obtained from the Vermont Oxford Network and hospital folders. Results: A total of 104/1582 (6.6%) neonates were diagnosed with NEC with a median onset of 8 days of life. The mortality rate was 39.0%, compared to the all‐cause mortality rate of 18.7% for VLBW neonates. Thirty‐two (32.0%) neonates with NEC were transferred for surgery of whom 10 (31.3%) died. Small for gestational age (p = 0.13), NEC stage 2B or above (p = 0,002), a positive blood culture (p = 0.018), a raised C‐reactive protein (p = 0.013), hyponatraemia (p = 0.004), anaemia requiring blood transfusion (p = 0.003) and thrombocytopenia requiring platelet transfusion (p = 0.033) were associated with mortality. A positive blood culture was found in 37.0% with a predominance of Klebsiella pneumoniae isolates. Conclusion: NEC has an early onset and a high mortality rate in our setting. [ABSTRACT FROM AUTHOR]

Background: Within the neonatal intensive care unit (NICU), infants frequently receive packed red blood cell (PRBC) transfusions. Although medically necessary, potential negative long- and short-term outcomes exist following PRBC transfusions in very low birth-weight (VLBW) infants (<1500 g). Synthesis of the literature demonstrates that the use of a restrictive PRBC transfusion policy can lead to a decreased number of transfusions administered with no increase in long-term neurodevelopmental outcomes. Blood transfusions have also been linked to the diagnosis of necrotizing enterocolitis (NEC) or intraventricular hemorrhage (IVH) in VLBW infants. Purpose: For this quality improvement project, a restrictive PRBC transfusion policy was implemented in a level IV NICU to promote consistent care and evaluate changes in PRBC administration. Methods: The data were collected both pre- and post-policy implementation including: the number of blood transfusions, diagnosis of NEC, and diagnosis of IVH among infants <1500 g. Results: The data showed no significant change in the number of PRBC transfusions administered. Likewise, few infants were diagnosed with NEC or IVH during this same time period with minimal change between pre- and post-policy implementation data. Implications for Practice and Research: Following policy implementation, there was a significant improvement in communication among providers regarding transfusion ordering and the inclusion of hematocrit thresholds in daily progress notes. This unintended outcome has helped to promote sustainability and enhance patient care within the NICU where this policy was implemented. Continued data collection may be beneficial in indicating whether a standardized PRBC transfusion policy will impact the administration of transfusions and diagnosis of NEC or IVH. [ABSTRACT FROM AUTHOR]

Background: Trillions of microbial cells in the human body are thought to be vital to human survival. Microbial cell populations are at maximum density within the intestinal compartment, referred to as the gut microbiota. Aim: To describe the neonatal microbiota in hospitalized preterm patients and to detect the relation between necrotizing enterocolitis (NEC), sepsis and preterm gut microbiota. Patients and methods: This was a prospective study on preterm very low birth weight neonates. Rectal swabs were collected at postnatal weeks one, two and three. The Illumina MiSeq system was employed to sequence the 16S rRNA gene. Results were compared to that of routine blood culture and were correlated with the use of antimicrobials. Results: Rectal swabs of the first week had predominantly no organisms (89.7%). Klebsiella genus was the most predominant bacteria in all rectal swabs (5.8%, 22.0%, 22.0% of the 1st, 2nd and in 3rd swabs results respectively). In spite of the non-significant results on the level of number of operational taxonomic unit (OTU) and chao indices, the association of microbiota change with NEC and sepsis could not be excluded. The significant organisms at phylum level in NEC and sepsis groups was Proteobacteria. There was no significant correlation between change of antibiotic therapy and results of rectal swabs at the 1st, 2nd and 3rd weeks. Conclusion: The gut of preterm neonates born by CS who received antibiotics was mostly sterile at first week. Subsequent colonization by pathogenic organisms such as Klebsiella and Enterobacter occurred after the first week. [ABSTRACT FROM AUTHOR]

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This study investigated the predictive factors for perinatal bacterial transmission in very-low-birth-weight infants (VLBWIs) born to mothers with a history of intrapartum colonization. We retrospectively reviewed the medical records of 173 VLBWIs, wherein pathogens were confirmed in maternal cultures obtained from the blood, urine, and vagina during the intrapartum period from 2013 to 2020. Newborns were categorized based on microbiological tests, including gastric aspirates, endotracheal aspirates, blood, and skin/nasal swab cultures collected immediately after birth. Infants whose cultures matched their maternal pathogens were categorized into the "transmission group" (n = 45), while those who tested negative were assigned to the "control group" (n = 128). The predominant maternal-colonizing pathogen observed was Escherichia coli (30.6%), which also emerged as the primary colonizing pathogen in neonates (35.6%). Transmission group had higher incidences of maternal leukocytosis, chorioamnionitis, and cervical cerclage. Regarding neonatal characteristics, the transmission group demonstrated lower initial base excesses (− 6.3 ± 3.9 vs. − 9.2 ± 4.9, P < 0.05) and higher C-reactive protein levels (0.1 ± 0.3 vs. 0.4 ± 0.8, P < 0.05). Notably, regarding major neonatal outcomes, transmission group had higher mortality rates and incidences of severe intraventricular hemorrhage. These findings may be useful for making decisions when considering antibiotic treatment for infants with a history of maternal colonization. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Adverse intrauterine environment was believed to have deleterious effects on the gonadal function. However, the association between impaired intrauterine growth and fertility in adult males has not been established.To compare the reproductive rates of males born small for gestational age (SGA), with low birth weight (LBW) or very low birth weight (VLBW) with control groups.The Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) statement was followed to search PubMed, Web of Science, Cochrane Library, and Embase databases from inception to June 16, 2023. Cohort studies investigating the reproductive rates of males born SGA, with LBW or VLBW were included. A random or fixed effects model was used for different exposures.A total of 10 studies out of 3,801 records were included. Males born SGA showed a higher risk of infertility than the control group (odds ratio, OR = 0.91, 95% confidence interval, 95% CI 0.89–0.93, p = 0.000). The reproductive rates of individuals born with LBW or VLBW were lower than the control group (OR = 0.86, 95% CI 0.78–0.94, p = 0.001; OR = 0.57, 95% CI 0.40–0.81, p = 0.002, respectively). Participants were further divided into two age groups of 18–35 and 35–45 years. In both subgroups, the reproductive rates were lower in males born SGA, with LBW or VLBW compared with controls. Sensitivity analysis showed the robustness of the pooled estimates among LBW and VLBW.In summary, SGA, LBW, and VLBW were associated with a higher risk of male infertility in both early and middle adulthood. Achieving optimal intrauterine growth would be helpful to prevent male infertility. [ABSTRACT FROM AUTHOR]

Objectives: To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g). Study design: A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present. Results: 218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA. Conclusions: The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To investigate the clinical characteristics and course of parenteral nutrition‐associated cholestasis (PNAC) in very low birth weight (VLBW) infants.The charts of VLBW infants were retrospectively reviewed. The clinical characteristics of infants with and without PNAC were compared, trends in liver enzymes were investigated, and the characteristics of infants with PNAC were analysed based on age of onset.PNAC was observed in 53 (13.2%) of 403 infants who survived and completed follow‐up and was associated with significantly lower gestational age, birth weight, and adverse neonatal outcomes. PNAC started at a median 32 (interquartile range 23–47) days, PN was applied for 53 (34.5–64.5) days, the maximum direct bilirubin (DB) was observed at 63 (50–76) postnatal days, and PNAC resolved at 94 (79–122) postnatal days postnatal age. PNAC lasted 61 (38–89.5) days. AST and ALT normalised at 111 (100.3–142.0) and 109.5 (97–161.3) postnatal days. Infants with early‐onset PNAC had significantly longer PN duration, higher maximum DB, and higher maximum AST than those with late‐onset PNAC.Elevated DB, AST, and ALT persist for a long period after discontinuing PN. We suggest a cautious approach that involves waiting and reducing the frequency of additional repetitive examinations. [ABSTRACT FROM AUTHOR]

We aimed to comprehensively pool the prevalence of autism spectrum disorder (ASD) diagnosis by birth weight, gestational age, and size for gestational age. PubMed, EMBASE, Web of Science, Ovid PsycINFO, and Cochrane Library were searched up to December 22, 2021. We pooled data using the random-effects model and quantified heterogeneity using the I2 statistic. Of 66 643 records initially identified, 75 studies were included in the meta-analysis. The pooled prevalence estimates of ASD diagnosis are as follows: very-low-birth weight, 3.1% (912 ASD/66,445 individuals); low-birth weight, 2.3% (5672 ASD/593,927 individuals); normal-birth weight, 0.5% (17,361 ASD/2,378,933 individuals); high-birth weight, 0.6% (4505 ASD/430,699 individuals); very preterm, 2.8% (2113 ASD/128,513 individuals); preterm, 2.1% (19 672 ASD/1 725 244 individuals); term, 0.6% (113,261 ASD/15,297,259 individuals); postterm, 0.6% (9419 ASD/1,138,215 individuals); small-for-gestational-age, 1.9% (6314 ASD/796,550 individuals); appropriate-for-gestational-age, 0.7% (21,026 ASD/5,936,704 individuals); and large-for-gestational-age, 0.6% (2607 ASD/635,666 individuals). Compared with the reference prevalence (those in normal-birth weight, term, and appropriate-for-gestational-age individuals), the prevalence estimates of ASD diagnosis in very-low-birth weight, low-birth weight, very preterm, preterm, and small-for-gestational-age individuals increased significantly, while those in high-birth weight, postterm, and large-for-gestational-age individuals did not change significantly. There were geographical differences in the prevalence estimates. This meta-analysis provided reliable estimates of the prevalence of ASD diagnosis by birth weight, gestational age, and size for gestational age, and suggested that low-birth weight (especially very-low-birth weight), preterm (especially very preterm), and small-for-gestational-age births, rather than high-birth weight, postterm, and large-for-gestational-age births, were associated with increased risk of ASD diagnosis. However, in view of marked between-study heterogeneity in most conditions, unknown effects of certain important confounders associated with ASD due to limited information in original articles, and included studies from a relatively small number of countries, the findings of this study should be interpreted with caution. [ABSTRACT FROM AUTHOR]

As the limits of fetal viability have increased over the past 30 years, there has been a growing body of evidence supporting the idea that chronic disease should be taken into greater consideration in addition to survival after preterm birth. Accumulating evidence also suggests there is early onset of biologic aging after preterm birth. Similarly, chronic kidney disease (CKD) is also associated with a phenotype of advanced biologic age which exceeds chronologic age. Yet, significant knowledge gaps remain regarding the link between premature biologic age after preterm birth and kidney disease. This review summarizes the four broad pillars of aging, the evidence of premature aging following preterm birth, and in the setting of CKD. The aim is to provide additional plausible biologic mechanisms to explore the link between preterm birth and CKD. There is a need for more research to further elucidate the biologic mechanisms of the premature aging paradigm and kidney disease after preterm birth. Given the emerging research on therapies for premature aging, this paradigm could create pathways for prevention of advanced CKD. [ABSTRACT FROM AUTHOR]

This study aimed to determine the mortality in a Jamaican birth cohort over a 3-month period. Data on the outcome of 87.5% of all births in Jamaica between July and September 2011 were used to determine trends in and determinants of neonatal mortality. There were 9650 live births and 144 neonatal deaths yielding a Neonatal Mortality Rate of 14.9/1000 (95% CI: 12.6–17.52/1000) livebirths. One hundred and twenty-one (84%) deaths occurred within the first seven days of life giving an Early Neonatal Mortality Rate of 12.5/1000 (95%CI: 10.4–15.0/1000) livebirths and a Late Neonatal Mortality Rate of 2.38/1000 (95%CI: 1.51–3.57/1000) live births. Sixty-nine (48%) deaths occurred within the first 24 hours. Thirty-eight neonates (26%) died prior to being admitted to a neonatal unit, approximately within 2 hours of life. Maternal age <15 years, decreasing birthweight, prematurity, male gender, multiple gestation and birth by caesarean section were associated with an increased risk of mortality p < 0.05. In order for Jamaica to experience further decline in its Neonatal Mortality Rate to meet the Sustainable Developmental Goal of at least as low as 12 per 1,000 live births by 2030 the focus must be on decreasing mortality in the very low birth weight infants who disproportionally contribute to mortality as well as continuing to implement measures to further decrease mortality in the larger infants. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is the most common serious complication of very preterm infants (VPI) or very low birth weight (VLBW) infants. Studies implicate viral infections in etiopathogenesis. The aim of this study was to summarize the relationship between viral infections and BPD through a systematic review and meta-analysis. We searched PubMed, Embase, the Web of Science Core Collection, and the Cochrane Database on December 19, 2023. We included observational studies that examined the association between viral infections and BPD in preterm infants. We extracted data on study methods, participant characteristics, exposure assessment, and outcome measures. We assessed study risk of bias using the Newcastle-Ottawa Scale (NOS). We included 17 and 15 studies in the qualitative review and meta-analysis, respectively. The meta-analysis showed a significant association between viral infection and BPD diagnosed at 36 weeks postmenstrual age (odds ratio (OR): 2.42, 95% confidence interval: 1.89–3.09, 13 studies, very low certainty of evidence). In a subgroup analysis of specific viruses, cytomegalovirus (CMV) proved to be significantly associated with BPD diagnosed at 36 weeks postmenstrual age (OR: 2.34, 95% confidence interval: 1.80–3.05, 11 studies). We did not find an association between viral infection and BPD diagnosed on the 28th day of life, probably due to the small sample size of the included prospective studies. Conclusion: Viral infections, especially CMV, are associated with an increased risk of BPD in preterm infants. Methodologically reliable prospective studies with large samples are needed to validate our conclusions, and high-quality randomized controlled studies are needed to explore the effect of prevention or treatment of viral infections on the incidence of BPD. What is Known: • Studies have attempted to identify viral infections and bronchopulmonary dysplasia in preterm infants; however, results have been inconsistent. What is New: • Systematic demonstration that viral infections, particularly cytomegalovirus, are positively associated with bronchopulmonary dysplasia diagnosed in preterm infants at the 36th week of postmenstrual age. • The importance of screening for viral infections in preterm infants, especially cytomegalovirus. More high-quality studies should be produced in the future to investigate the causal relationship between viral infections and bronchopulmonary dysplasia. [ABSTRACT FROM AUTHOR]

Background: Respiratory distress syndrome (RDS) is a leading cause of premature infant death. One of the most successful therapies for Bronchopulmonary dysplasia (BPD) is anti-inflammatory medication using corticosteroids. However, systemic corticosteroid administration is not suggested due to long-term side effects. We aim to study the effect of early intratracheal instillation of surfactant/budesonide with surfactant in preterm infants with severe Respiratory distress syndrome (RDS). Methods: This cross sectional study was carried out in the Pediatric Department, on 60 preterm infants weighing less than 1,500g who were admitted to the neonatal intensive care unit (NICU) of Zagazig University Hospital, during the period from November 2021 to November 2022. The treatment group (surfactant and budesonide) was given a mixture of 0.25 mg/kg (1 mL/kg) of budesonide and 100 mg/kg (4 mL/kg) of surfactant, and the control group (surfactant only) was given 100 mg/kg (4 mL/kg) of surfactant only. Results: There was no statistical significant difference between studied groups as regard Surfactant redoes, BPD, BPD moderate to severe, duration of non-invasive ventilation, duration of invasive ventilation, death, intraventricular hemorrhage (IVH), ROP and NEC. Among Surfactant-budesonide group; 16.7% Surfactant redoes, 26.7% BPD, 16.7% death, 6.7% IVH, 16.7% ROP, 0 % NEC and median duration of non-invasive ventilation is 3 days for surfactant-budesonide and control groups. Conclusions: Early intratracheal administration of budesonide and surfactant in preterm infants with sever RDS might decrease BPD and mortality without disturbing surfactant function. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We encountered an extremely low birth weight infant with breast milk‐transmitted cytomegalovirus (CMV) infection. To determine the transmission route, we conducted direct sequence analysis of two variable CMV genes, UL139, and UL146. When utilizing breast milk, the possibility of acquired CMV infection should be considered and tested for prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective The risk of intraventricular hemorrhage (IVH) and periventricular leukomalacia is associated with low birth weight and gestational age. Caesarean section (CS) may reduce the risk of IVH, although it has been a matter of debate. The aim of this study was to evaluate the influence of the mode of delivery (MOD) on the development of IVH and cystic periventricular leukomalacia (cPVL). Study Design We analyzed an initial cohort of 11,023 very low birth weight (VLBW) infants born between January 2010 and December 2019. Infants with major malformations and gestational age <23 weeks and ≥32 weeks were excluded. A final cohort of 8,251 newborns was analyzed. Data was collected from Portuguese National very low birth weight registry. Cases were classified as vaginal delivery (VD) or CS. Outcome was assessed in univariate and logistic regression analyses. Results The median gestational age was 29 weeks (IQR 3.3) and the median weight was 1,100 g (IQR 555). The prevalence of IVH was significantly higher in the VD group versus the CS group, across all grading levels:1,144 newborns had grade I IVH (16% VD vs. 14% CS, p <0.01), 706 had grade II IVH (12% VD vs. 7.6% CS, p <0.01), and 777 had grade III IVH (14% VD vs. 7.9% CS, p <0.01). Post-hemorrhagic ventricular dilatation occurred in 457 newborns (8.3% VD vs. 4.6% CS, p <0.01) and 456 newborns had periventricular hemorrhagic infarction (8.4% VD vs. 4.5% CS, p <0.01). There was no association between MOD and cPVL. After applying a logistic regression analysis, including known risk factors for IVH and cPVL, VD was independently associated with an increased risk of IVH (odds ratio [OR] 1.600[1.423–1.799], p <0.001) and its complications (OR 1.440[1.195–1.735], p <0.001). MOD was not associated with an increased risk of cPVL. Conclusion Our study suggests that CS is associated with a reduced risk of IVH and its complications in preterm VLBW infants < 32 weeks of gestational age. A CS should be considered in this group of infants to prevent the development of IVH and its complications. Key Points IVH and cPVL are risk factors for neurological disabilities. CS may decrease the risk of IVH in preterms <32 weeks GA. There is no association between the MOD and cPVL. [ABSTRACT FROM AUTHOR]

Neonatal hyperglycaemia poses risks, and the efficacy of insulin therapy is uncertain, warranting comprehensive research and guidelines. The present study reports the case of an extremely preterm neonate with an extremely low birth weight (ELBW; <1,000 g) admitted to the neonatal intensive care unit (NICU) due to recurrent hyperglycaemic episodes (peak level, 465 mg/dl) with transient hypoglycaemia on the first day of life. The mother, a 31-year-old primiparous woman, had gestational hypertension and preeclampsia, resulting in neonatal distress at birth and the need for positive pressure ventilation for stabilisation. The condition of the baby remained stable in the NICU following resuscitation. The case described herein details the management of a neonate facing multiple stresses and metabolic challenges, including grade IV hyaline membrane disease, grade II necrotising enterocolitis and a patent foramen ovale with good heart contractility. The initial laboratory findings revealed pancytopenia. At 1 h of life, the neonate experienced hypoglycaemia (33 mg/dl), treated with a 10% bolus dextrose infusion and continuous parenteral nutrition. Glucose infusion rate (GIR) adjustments followed local guidelines. Cardiovascular support with dobutamine and dopamine addressed the low blood pressure. Subsequently, the neonate developed hyperglycaemia, requiring insulin therapy and GIR adjustments. By close monitoring and promptly intervening, the authors were able to achieve stable blood glucose levels using insulin boluses (0.1 U) and adjusting the GIR to 10.9 mg/kg body weight (BW)/min. Stable glycaemia was attained by the 4th day prior to referral, with a GIR of 12.4 mg/kg BW/min. The case in the present study highlights the challenges of managing extremely preterm infants with ELBW and emphasises effective resuscitation and NICU interventions. It was hypothesised that her refractory hyperglycaemia was caused by her underlying extremely premature neonatal condition, including inadequate insulin response, gluconeogenesis, reduced glucose transporter levels, insufficient protein intake affecting insulin-like growth factor-1 release, immature pancreas development and stress-related hormonal responses. [ABSTRACT FROM AUTHOR]

Purpose: Administering early parenteral amino acids to very low birth weight (VLBW) premature infants (birth body weight [BBW]<1,500 g) is challenging due to factors such as holidays, cost, and access to sterile compounding facilities. Using advance-prepared parenteral nutrition (PN) may address this issue and should be evaluated for its safety and potential benefits. Methods: We extracted data from medical records collected between July 2015 and August 2019. VLBW infants received PN for at least seven days and were split into two groups: the traditional group (n=30), which initially received a glucose solution and then PN on workdays, and the pre-preparation group (n=16), which received advance-prepared PN immediately upon admission to the neonatal intensive care unit. Results: The median BBWs of the traditional and pre-preparation groups were 1,180.0 vs. 1,210.0 g. In the initial two days, the pre-preparation group had a significantly higher amino acid intake (2.23 and 2.24 g/kg/d) than the traditional group (0 and 1.78 g/kg/d). The pre-preparation group exhibited greater head circumference growth ratio relative to birth (7th day: 1.21% vs. -3.57%, p=0.014; 21st day: 7.71% vs. 3.31%, p=0.017). No significant differences in metabolic tolerance were observed. Conclusion: Advanced preparation of PN can be safely implemented in VLBW preterm infants, offering advantages such as early, higher amino acid intake and improved head circumference growth within the first 21 days post-birth. This strategy may serve as a viable alternative in settings where immediate provision of sterile compounding facilities is challenging. [ABSTRACT FROM AUTHOR]

This article provides information on fetal growth restriction (FGR), a condition where a fetus does not reach its full growth potential due to a pathological factor. It discusses the classification of FGR based on gestational age at diagnosis and explores the causes and outcomes of pre- and periviable FGR. The article emphasizes the importance of genetic counseling and testing in cases of FGR and provides information on the prevalence of genetic anomalies, structural defects, and congenital infections in these cases. It also discusses the incidence and outcome of placental insufficiency as a cause of FGR. The article highlights the varying frequency of hypertensive disorders of pregnancy (HDP) in pre- and periviable FGR and their impact on maternal and fetal/neonatal health. It concludes by discussing the management of pre- and periviable FGR, including the consideration of termination of pregnancy in certain cases and the determination of the mode of delivery for fetuses alive at birth. [Extracted from the article]

This article explores the relationship between birth size and neonatal health outcomes, specifically focusing on low birth weight (LBW) and prematurity. It emphasizes the need for a comprehensive approach to address the determinants of neonatal health, including maternal health, access to antenatal care, and healthcare infrastructure. The article also discusses the historical context of understanding intrauterine growth and the development of growth charts. In low-income countries, there is a higher prevalence of intrauterine growth restriction (IUGR), which is the second most common cause of perinatal health issues and deaths. Babies with IUGR are at risk for various complications and long-term health issues. The causes and management of IUGR are still being researched. [Extracted from the article]

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Objectives: Although recent discoveries regarding the biomarkers of newborn screening (NBS) programs by tandem mass spectrometry (MS/MS) highlight the critical need to establish reference intervals (RIs) specifically for preterm infants, no such RIs has been formally published yet. This study addressed the gap by offering a comprehensive set of reference intervals (RIs) for preterm neonates, and illustrating the dynamic changes of each biomarker with age. Design and methods: The NBS data of 199,693 preterm newborns (< 37 weeks of gestation) who met the inclusion and exclusion criteria from the NNSCP database were included in study analysis. The birth weight stratified dynamic trend of each biomarker were captured by their concentrations over age. Reference partitions were determined by the method of Harris and Boyd. RIs, corresponding to the 2.5th and 97.5th percentiles, as well as the 0.5th, 25th, 50th, 75th and 99.5th percentiles were calculated using a non-parametric rank approach. Results: Increasing birth weight is associated with an elevation in the levels of arginine, citrulline, glycine, leucine and isobarics, methionine, ornithine, phenylalanine, and valine, whereas the levels of alanine, proline and tyrosine decrease. Additionally, two short-chain acylcarnitines (butyrylcarnitine + isobutyrylcarnitine and isovalerylcarnitine + methylbutyrylcarnitine) and a median-chain acylcarnitine (octenoylcarnitine) decrease, while four long-chain acylcarnitines (tetradecanoylcarnitine, palmitoylcarnitine, palmitoleylcarnitine and oleoylcarnitine) increase with increasing birth weight. Age impacts the levels of all MS/MS NBS biomarkers, while sex only affects the level of malonylcarnitine + 3-hydroxybutyrylcarnitine (C3-DC + C4-OH) in very low birth weight preterm neonates. Conclusion: The current study developed reference intervals (RIs) specific to birth weight, age, and/or sex for 35 MS/MS biomarkers, which can help in the timely evaluation of the health and disease of preterm neonates. [ABSTRACT FROM AUTHOR]

Background: while most gut microbiota research has focused on term infants, the health outcomes of preterm infants are equally important. Very-low-birth-weight (VLBW) or extremely-low-birth-weight (ELBW) preterm infants have a unique gut microbiota structure, and probiotics have been reported to somewhat accelerate the maturation of the gut microbiota and reduce intestinal inflammation in very-low preterm infants, thereby improving their long-term outcomes. The aim of this study was to investigate the structure of gut microbiota in ELBW neonates to facilitate the early identification of different types of low-birth-weight (LBW) preterm infants. Methods: a total of 98 fecal samples from 39 low-birth-weight preterm infants were included in this study. Three groups were categorized according to different birth weights: ELBW (n = 39), VLBW (n = 39), and LBW (n = 20). The gut microbiota structure of neonates was obtained by 16S rRNA gene sequencing, and microbiome analysis was conducted. The community state type (CST) of the microbiota was predicted, and correlation analysis was conducted with clinical indicators. Differences in the gut microbiota composition among ELBW, VLBW, and LBW were compared. The value of gut microbiota composition in the diagnosis of extremely low birth weight was assessed via a random forest-machine learning approach. Results: we briefly analyzed the structure of the gut microbiota of preterm infants with low birth weight and found that the ELBW, VLBW, and LBW groups exhibited gut microbiota with heterogeneous compositions. Low-birth-weight preterm infants showed five CSTs dominated by Enterococcus, Staphylococcus, Klebsiella, Streptococcus, Pseudescherichia, and Acinetobacter. The birth weight and clinical indicators related to prematurity were associated with the CST. We found the composition of the gut microbiota was specific to the different types of low-birth-weight premature infants, namely, ELBW, VLBW, and LBW. The ELBW group exhibited significantly more of the potentially harmful intestinal bacteria Acinetobacter relative to the VLBW and LBW groups, as well as a significantly lower abundance of the intestinal probiotic Bifidobacterium. Based on the gut microbiota's composition and its correlation with low weight, we constructed random forest model classifiers to distinguish ELBW and VLBW/LBW infants. The area under the curve of the classifiers constructed with Enterococcus, Klebsiella, and Acinetobacter was found to reach 0.836 by machine learning evaluation, suggesting that gut microbiota composition may be a potential biomarker for ELBW preterm infants. Conclusions: the gut bacteria of preterm infants showed a CST with Enterococcus, Klebsiella, and Acinetobacter as the dominant genera. ELBW preterm infants exhibit an increase in the abundance of potentially harmful bacteria in the gut and a decrease in beneficial bacteria. These potentially harmful bacteria may be potential biomarkers for ELBW preterm infants. [ABSTRACT FROM AUTHOR]

Objectives: To understand the prevalence and survival rates of preterm birth )PTB( is of utmost importance in informing healthcare planning, improving neonatal care, enhancing maternal and infant health, monitoring long-term outcomes, and guiding policy and advocacy efforts. Methods: The medical records of preterm infants admitted to the Neonatal Intensive Care Unit )NICU( with a diagnosis of prematurity at the Maternity and Children's Hospital )MCH(, Al Kharj, Saudi Arabia, were reviewed between January 2018 and December 2022. Data were collected on birth weight )BW(, gender, number of live births, gestational age, mortality, nationality, APGAR score, length of stay in the NICU, and maternal details. Original Article Results: A total of 9809 live births were identified between 2018 and 2022, of which 139 )3.9%( were born preterm. The overall mortality rate of the included sample was 7.19%, whereas the mortality rate according to BW was 38.4% of those born with extremely low birth weight )ELBW(. The most common intrapartum complications were malpresentation )15.1%(, placental complications )4.3%(, and cord complications )3.6%(. Conclusion: This study provides valuable insights into the prevalence of PTB in the country, particularly focusing on the vulnerability of extremely preterm babies. [ABSTRACT FROM AUTHOR]

Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014–2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at <28 weeks of age and extremely low birth weight infants (ELBWI) were more likely to receive physical rehabilitation interventions. The length of stay at the NICU and hospital, as well as the rate of discharge, were higher in patients who received physical rehabilitation than those in infants who did not. Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU. [ABSTRACT FROM AUTHOR]

ackground: Respiratory distress syndrome causes significant morbidity and death especially among very low birth weight babies. Though the use of CPAP and surfactant have been shown to improve survival, these interventions were scarcely available in the past. This study aimed at comparing the clinical outcomes of preterm babies with RDS delivered at the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex at two different periods. Objective: To compare the birth weight specific mortality rates and overall mortality rates of preterm babies with RDS between two periods in the neonatal ward of the Ife Hospital Unit of OAUTHC. Methods: A retrospective study comparing outcomes of 92 babies with RDS at GA 26 to 33+6 weeks between January 2015 and May 2016 and managed with intranasal oxygen alone to 104 babies of same gestational age characteristics between January 2019 and May 2020 who were managed with CPAP/surfactant. Results: The mean weight and gestational age of the babies respectively were 1.36 (±0.37) kg and 31.14 (±2.3) weeks in 2015/2016 and 1.35 (±0.322) kg and 30.95 (±2.24) weeks in 2019/2020. The overall case fatality rate and birth-weight specific mortality rates for ELBW, VLBWand LBW were 33.7%, 62.5%, 35.2% and 9.1% in 2015/2016 and 18.3%, 58.3%, 15.5% and 9.7% respectively in 2019/2020. Conclusion: While the use of CPAP and the administration of surfactant clearly show improved survival among very low birth weight babies who are at increased risk of death from RDS, this was not the case for extreme low birth weight babies.