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Objective Administering surfactant timely and appropriately is important to minimize lung injury but remains challenging in preterm neonates with respiratory distress syndrome. The published literature supports that lung ultrasound (LUS) score can predict surfactant need. Neonatal LUS scanning specification and parameter setting guidelines have been recently published for standardization. However, variations in scanning protocols and machine settings hinder its clinical implementation widely. This observational study aims to internally validate the suggested LUS protocol in a neonatal intensive care unit to establish a correlation between LUS scores and surfactant need as the first step of integrating LUS in the clinical practice. Study Design LUS was performed on 40 eligible preterm neonates within 3 hours after birth or before surfactant administration between May 2020 and March 2021. The neonates were between 27 and 32 weeks' gestational age, and all had respiratory distress. Neonates with known congenital anomalies were excluded. A high-frequency linear probe was used to obtain LUS images from six lung zones which were scored using a 0 to 3 system, yielding a maximum of 18 points. Treating physicians were blinded to the LUS score. Receiver operating characteristic analysis determined the optimal LUS score cut-off for predicting surfactant need. Results Fifteen of the 40 neonates (38%) required higher oxygen fraction and received surfactant. In our cohort, an LUS score ≥10 was identified as the optimal cut-off for predicting surfactant need, with a sensitivity of 80% and specificity of 84%. The area under the curve was 0.8 (p = 0.0003). LUS predicted surfactant need at a median of 3.5 hours earlier than traditional clinical decision (p < 0.0037). Conclusion LUS is a helpful adjunct for predicting surfactant need in preterm neonates. This study describes an approach to implement the LUS protocol and score for clinical decision-making in the clinical practice. Key Points LUS is a helpful adjunct for predicting surfactant need in preterm neonates. Machine setting variation and probe selection may affect LUS image and score. LUS score should be validated at the local unit before clinical implementation. [ABSTRACT FROM AUTHOR]

Objective Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with end-organ injury including intraventricular hemorrhage. Early treatment may reduce morbidities but may result in overtreatment. This study aimed to examine the association between commonly obtained echocardiographic markers within the first 12 hours of life and eventual treatment of an hsPDA. Study Design Patients with <32 weeks' gestational age had blinded echocardiograms done within the first 12 hours of life as part of research protocols. Subsequent treatment of the patent ductus arteriosus (PDA) was determined by the clinical team independent of echocardiogram results. t -tests and chi-square tests were done for continuous data and categorical outcomes. A receiver operating curve was created to optimize cutoff values. Results Among 199 neonates studied (mean time of echocardiogram 6.7 h after birth), those needing PDA treatment had higher left ventricular output (LVO), right ventricular output (RVO), and superior vena cava (SVC) flow (p -values 0.007, 0.044, and 0.012, respectively). Cutoffs for predicting PDA treatment were LVO > 204 mL/kg/min (63% sensitivity, 66% specificity), RVO > 221 mL/kg/min or SVC flow > 99 mL/kg/min (sensitivities 70 and 43%, specificities 48 and 73%, respectively). Conclusion Preterm neonates with higher markers of cardiac output in the first 12 hours of birth later required PDA treatment. These data are the first to use standard cardiac output measures in the first 12 hours of life to predict the need for future PDA treatment. Further prospective studies will need to be performed to corroborate these associations between echocardiographic markers and clinical outcomes/morbidities. Key Points Early diagnosis of hsPDA may prevent severe morbidity and death. There are echocardiographic markers beyond duct size and flow direction that may aid early diagnosis. Cardiac output markers within the first 12 hours of life may predict need for treatment of hsPDA. [ABSTRACT FROM AUTHOR]

Purpose: Bronchopulmonary dysplasia (BPD) is a respiratory morbidity related to prematurity. Early prediction of BPD allows the selection of patients who would benefit from new therapies. Lung ultrasound (LUS) is a non-invasive diagnostic tool that has proven to be reliable for many neonatal diseases recently. The study aimed to detect the role of LUS in predicting BPD at days 7 and 14 of life in preterm babies. Methods: This was a prospective cohort study that included 95 preterm babies ≤ 34 weeks. Lung ultrasounds were performed on days 7 and 14 of life. Results: The mean gestational age of the studied neonates was 30.25 ± 2.21 weeks. The mean birth weight was 1347.66 ± 432.14 gm. Patients who developed BPD had statistically significantly higher LUS scores on both days 7 and 14 of life. At first examination, a LUS score > 8 showed a sensitivity of 83.33% and a specificity of 60.87%, whereas at follow-up, a LUS score > 8 showed a sensitivity of 76.39% and a specificity of 82.61%. The multivariate logistic regression analysis shows that the most important factors associated with BPD were gestational age ≤ 30 weeks, LUS score at first examination > 8, platelets ≤ 245 × 109/L, segment neutrophils ≤ 42%, and CRP > 5 mg/l. Conclusions: The LUS score predicts BPD at 7 and 14 days of life. LUS scores increased with increasing BPD severity. LUS score > 8 was an independent factor in the prediction of BPD. [ABSTRACT FROM AUTHOR]

Background: As hyperbilirubinemia is one of the key contributors to brain damage and is crucial to identify those instances that are at risk as it is more prevalent and severe among the preterms. Many studies are available in the literature for terms babies but there is paucity of data for pre terms. Aims and Objectives: The aim of this study was to assess serum bilirubin at 24 h of live birth as a indicator of significant hyperbilirubinemia in preterm neonates. Materials and Methods: It was a prospective observational study conducted in the department of pediatrics of tertiary care center, Jodhpur on 150 preterms born within 33-36 weeks 6 days after considering the exclusion criteria in the study. Area under the receiver operating characteristic (ROC) curve was used to identify significant hyperbilirubinemia within 1 week of life, along with it the cutoff value of total serum bilirubin (TSB) at 24 h of life was calculated. Results: A total of 150 enrolled preterm newborns were followed up. TSB at 24 h of life was proved to be significant using the ROC curve, where area under the curve is 0.96 which was statistically significant. Among 150 preterms, 70 newborns with TSB >4.2 mg/dL developed jaundice, and 65 babies (98.48%) required phototherapy. Hence, preterms with TSB >4.2 mg/dL have a significant risk of developing hyperbilirubinemia. (Sensitivity: 98.48%, specificity: 94.05%, negative predictive value: 98.75%, and positive predictive value: 92.86%). Conclusion: TSB for preterms at 24 h of life can support to predict the significant hyperbilirubinemia successfully. Preterms with cutoff value of serum bilirubin level >4.2 mg/dL are observed to be more prone to develop significant hyperbilirubinemia requiring appropriate intervention at the earliest. [ABSTRACT FROM AUTHOR]

Background: As hyperbilirubinemia is one of the key contributors to brain damage and is crucial to identify those instances that are at risk as it is more prevalent and severe among the preterms. Many studies are available in the literature for terms babies but there is paucity of data for pre terms. Aims and Objectives: The aim of this study was to assess serum bilirubin at 24 h of live birth as a indicator of significant hyperbilirubinemia in preterm neonates. Materials and Methods: It was a prospective observational study conducted in the department of pediatrics of tertiary care center, Jodhpur on 150 preterms born within 33–36 weeks 6 days after considering the exclusion criteria in the study. Area under the receiver operating characteristic (ROC) curve was used to identify significant hyperbilirubinemia within 1 week of life, along with it the cutoff value of total serum bilirubin (TSB) at 24 h of life was calculated. Results: A total of 150 enrolled preterm newborns were followed up. TSB at 24 h of life was proved to be significant using the ROC curve, where area under the curve is 0.96 which was statistically significant. Among 150 preterms, 70 newborns with TSB >4.2 mg/dL developed jaundice, and 65 babies (98.48%) required phototherapy. Hence, preterms with TSB >4.2 mg/dL have a significant risk of developing hyperbilirubinemia. (Sensitivity: 98.48%, specificity: 94.05%, negative predictive value: 98.75%, and positive predictive value: 92.86%). Conclusion: TSB for preterms at 24 h of life can support to predict the significant hyperbilirubinemia successfully. Preterms with cutoff value of serum bilirubin level >4.2 mg/dL are observed to be more prone to develop significant hyperbilirubinemia requiring appropriate intervention at the earliest.

Abstract Weight gain in low birth-weight babies remains a challenge to the management of the neonatal period in low and middle-income countries like Ethiopia. Therefore, this study aimed to determine the time to adequate weight gain and its predictors among low-birth-weight preterm neonates admitted to neonatal intensive care unit of public hospitals in Bahir Dar City. An institution-based retrospective follow-up study was conducted from March 4 to April 3, 2023, using three years of data. About 344 low-birth-weight preterm babies were recruited and followed up until 28 days of age. Model goodness-of-fit was checked by Cox Snell residuals test. The Cox-Proportional Hazards Model was used to assess predictors of weight gain with a statistically significant level of P-value

Background: Neonatal sepsis is a serious systemic infection that might be fatal. Early diagnosis is challenging. The c-reactive protein (CRP)/albumin ratio is a promising biomarker that may help with early diagnosis and timely management of sepsis. Aim of the work: to study the sensitivity and specificity of the CRP/albumin ratio as a diagnostic marker of neonatal sepsis in preterm newborns. Patients and Methods: in this case-control study CRP/albumin ratio was estimated in 154 preterm newborns admitted to Neonatal Intensive Care Units (NICUs) of Cairo University Children's Hospitals. They were divided into 2 groups. Group (I), the sepsis group “based on positive blood culture” (n=54), and group (II), a control group, with no clinical signs or laboratory evidence of sepsis (n=100). Results: The mean age of newborns in the sepsis group was 3 ± 2.5 days vs 4.5 ± 2.5 days for the control group. The sepsis group had a mean ± SD CRP/albumin ratio higher than that of the control group (18.5 ± 20 vs 0.6± 0.7, p= 0.00). 30 (55%) of those in the sepsis group died; they had a mean ± SD CRP/albumin ratio of 20± 21, vs 15 ± 17 for those who survived (p value=0.3). Neonatal Sepsis was best diagnosed by the CRP/albumin ratio above the cutoff value of 1.5 with 100 % sensitivity, 95% specificity, 91.5 % positive predictive value (PPV), 100 % negative predictive value (NPV), (area under the curve (AUC)= 0.99, and 95 % confidence interval (CI) 0.983 - 1), which was not different than that of CRP alone (p=0.800). CRP above the cutoff point of 4.3 showed 96.3 % sensitivity, 96% specificity, 92.9 % PPV, 98 % NPV, (AUC= 0.99 , 95 % CI 0.983 - 1). The I/T ratio (shift to the left) above the cutoff point of 0.2 showed 64.8% sensitivity, 100 % specificity, 100% PPV and 84% NPV (AUC= 0.94 , 95% CI 0.891 - 0.973). Conclusion: CRP/albumin ratio is a highly sensitive and specific early diagnostic biomarker for neonatal sepsis in premature newborns that has marginal superiority to the CRP in the diagnosis of neonatal bacterial sepsis. More studies are needed to validate the sensitivity and specificity of a score that combines both the CRP/ albumin ratio above 1.2 and the I/T ratio above 0.2 in predication of true positive cases and exclusion of the true negative cases.

Introduction: Initial surge of thyroid-stimulating hormone (TSH) in neonates increases free and total triiodothyronine (T3) and tetraiodothyronine (T4) in 24–36 hours following birth, and the effect then gradually wanes off. As somatic and intellectual development is dependent on normal thyroid function especially in infancy, normative data in these children may be of immense value to diagnose hypothyroidism in this subset of infants. Comprehensive normative values of thyroid function parameters in preterm neonates are scarcely available. The objective of this study was to determine the normative value of thyroid function parameters in preterm neonates. Methods: Preterm neonates (n = 102) born at 34 and 35 weeks of gestation of euthyroid mothers from an iodine-sufficient population were evaluated for T3, T4, free thyroxine (FT4) and TSH during 3–7 days after birth and again after 1 month. The expected date of delivery (EDD) and Ballard score were used to identify the duration of gestation. Results: The mean gestational age was 34.7 ± 0.41 weeks. The mean (± SD) for T3 (ng/dl), T4 (μg/dl), FT4 (ng/ml) and TSH (μIU/ml) on days 3–7 following birth was as follows: 156 ± 44.6, 12.8 ± 3.7, 1.50 ± 0.54 and 7.13 ± 6.04, respectively. Around 4 weeks of age, values changed to 104 ± 38.4, 12.1 ± 4.02, 1.46 ± 0.42 and 3.25 ± 2.85, respectively. All parameters changed significantly around 4 weeks, except FT4. None of the parameters were correlated with gestational age or body weight at birth. Normative values for each parameter in percentiles were generated. Conclusion: This study generated the normative values of the thyroid function test during the first week and after around 4 weeks of life for premature neonates (born at 34–35 weeks).

Objectives: Dramatic brain morphological changes occur throughout the third trimester of gestation. In this study, we investigated whether the predicted brain age (PBA) derived from graph convolutional network (GCN) that accounts for cortical morphometrics in third trimester is associated with postnatal abnormalities and neurodevelopmental outcome. Methods: In total, 577 T1 MRI scans of preterm neonates from two different datasets were analyzed; the NEOCIVET pipeline generated cortical surfaces and morphological features, which were then fed to the GCN to predict brain age. The brain age index (BAI; PBA minus chronological age) was used to determine the relationships among preterm birth (i.e., birthweight and birth age), perinatal brain injuries, postnatal events/clinical conditions, BAI at postnatal scan, and neurodevelopmental scores at 30 months. Results: Brain morphology and GCN-based age prediction of preterm neonates without brain lesions (mean absolute error [MAE]: 0.96 weeks) outperformed conventional machine learning methods using no topological information. Structural equation models (SEM) showed that BAI mediated the influence of preterm birth and postnatal clinical factors, but not perinatal brain injuries, on neurodevelopmental outcome at 30 months of age. Conclusions: Brain morphology may be clinically meaningful in measuring brain age, as it relates to postnatal factors, and predicting neurodevelopmental outcome. Clinical relevance statement: Understanding the neurodevelopmental trajectory of preterm neonates through the prediction of brain age using a graph convolutional neural network may allow for earlier detection of potential developmental abnormalities and improved interventions, consequently enhancing the prognosis and quality of life in this vulnerable population. Key Points: •Brain age in preterm neonates predicted using a graph convolutional network with brain morphological changes mediates the pre-scan risk factors and post-scan neurodevelopmental outcomes. •Predicted brain age oriented from conventional deep learning approaches, which indicates the neurodevelopmental status in neonates, shows a lack of sensitivity to perinatal risk factors and predicting neurodevelopmental outcomes. •The new brain age index based on brain morphology and graph convolutional network enhances the accuracy and clinical interpretation of predicted brain age for neonates. [ABSTRACT FROM AUTHOR]

Background: Intraventricular haemorrhage (IVH) often arises as a cerebral complication directly related to preterm birth. The impaired autoregulation of cerebral blood flow is closely associated with IVH in preterm neonates. Three-dimensional pseudo-continuous arterial spin labelling (3D-pCASL) is a noninvasive magnetic resonance imaging (MRI) technique used for evaluating cerebral perfusion. Objective: This study aimed to compare cerebral blood flow values among three distinct groups using 3D-pCASL: preterm neonates with and without IVH and preterm neonates at term-equivalent age. Materials and methods: A total of 101 preterm neonates who underwent conventional MRI and 3D-pCASL were included in this study. These neonates were categorised into three groups: 12 preterm neonates with IVH, 52 preterm neonates without IVH, and 37 healthy neonates at term-equivalent age. Cerebral blood flow measurements were obtained from six brain regions of interest (ROIs)—the frontal lobe, temporal lobe, parietal lobe, occipital lobe, basal ganglia, and thalamus—in the right and left hemispheres. Results: The cerebral blood flow values measured in all ROIs of preterm neonates with IVH were significantly lower than those of neonates at term-equivalent age (all P<0.05). Additionally, the cerebral blood flow in the temporal lobe was lower in preterm neonates without IVH than in neonates at term-equivalent age (16.87±5.01 vs. 19.76±5.47 ml/100 g/min, P=0.012). Furthermore, a noteworthy positive correlation was observed between post-menstrual age and cerebral blood flow in the temporal lobe (P=0.037), basal ganglia (P=0.010), and thalamus (P=0.010). Conclusion: The quantitative cerebral blood flow values, as measured by 3D-pCASL, highlighted that preterm neonates with IVH had decreased cerebral perfusion. This finding underscores the potential of 3D-pCASL as a technique for evaluating the developmental aspects of the brain in preterm neonates. [ABSTRACT FROM AUTHOR]

Raised serum bilirubin levels can cause kernicterus, and premature infants are at increased risk owing to metabolic immaturity. The standard treatment for neonatal jaundice is phototherapy, but probiotics alone can reduce the duration of phototherapy and hospitalisation. To determine the effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates. The open-labelled randomised controlled trial was conducted from January 2022 to January 2023 in the neonatal unit of the University of Lahore Teaching Hospital, Pakistan. A total of 76 preterm neonates who fulfilled the selection criteria were included and divided into two groups. Both groups received standard phototherapy. In Group B, a probiotic (Saccharomyces boulardii) 125 mg, twice daily, orally (in 5 cc of whichever milk the infant was receiving) was given until discharge from hospital. The primary outcome measurements were the duration of phototherapy and the length of hospitalisation. The mean (SD) duration of phototherapy was 36.55 (14.25) hours in Group A and 24.61 (9.25) hours in Group B (p <0.05). The mean (SD) duration of hospital stay was 47.36 (16.51) hours in Group A and 33.13 (8.93) hours in Group B (p <0.05). Oral probiotics (Saccharomyces boulardii) have a significant effect on the duration of phototherapy for neonatal hyperbilirubinaemia, and they decrease the chances of nosocomial infection. Exploration of clinical outcomes by investigating faecal flora and undertaking large randomised controlled trials of various probiotics are needed. ABE: acute bilirubin encephalopathy; CNS: central nervous system; GA: gestational age; IVIG: intravenous immunoglobulin; KSD: kernicterus; NNU: neonatal unit; RCT: randomised controlled trial; S. boulardii: Saccharomyces boulardii. [ABSTRACT FROM AUTHOR]

Objectives: Extremely preterm (EPT; gestational week < 28 + 0, < 1000 g) neonates are vulnerable to infections and necrotising enterocolitis, important contributors to mortality and morbidity. However, knowledge regarding their immune maturation remains limited. We here investigated the longitudinal development of functional T‐cell capacity in EPT infants. Methods: Peripheral blood mononuclear cells were isolated at 14th and 28th day (D) and at gestational week 36 + 0 (Gw36) from EPT infants, participated in a randomised, double‐blind, placebo‐controlled study of Lactobacillus reuteri DSM 17938 probiotic supplementation. Blood collected from 25 full‐term (FT) infants at D14 was used as control. The secretion of immune mediators was determined through comprehensive Luminex panels after stimulation with human T‐cell activator CD3/CD28 beads. Results: The levels of many mediators were low in EPT infants at D14, whereas the secretion of several chemokines was higher in EPT than in FT infants. Furthermore, Th2:Th1 cytokine ratios were higher in EPT than in FT infants. Progressively elevated secretion of, for example, IFN‐γ, TNF and IL‐17A in EPT infants was observed from D14 to D28 and then at Gw36. Elevated levels were observed for many proinflammatory mediators at D28. Probiotic supplementation or perinatal factors (e.g. clinical chorioamnionitis, preeclampsia and delivery mode) did not influence the cytokine and chemokine responses. Conclusions: Immune mediators induced by T‐cell activation in EPT infants were mainly reduced at D14 and Th2 skewed compared to those in FT infants, but mostly recovered at Gw36, indicating immune maturation. Increased proinflammatory responses at D28 may be related to the heightened risk of severe immune‐associated complications seen in EPT infants. [ABSTRACT FROM AUTHOR]

Aim: We investigated the influence of physiological‐based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life. Methods: This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups. Results: We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups. Conclusion: PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation. [ABSTRACT FROM AUTHOR]

Background: Surfactant therapy now a days become the primary modality of treatment in Preterm neonates with respiratory distress mainly Respiratory Distress Syndrome(RDS). In Extremely low birth weight babies such as birth weight < 1000g, incidence of RDS as a significant cause of mortality and morbidity remains high. Present study was aimed to assess the immediate outcome of surfactant therapy in preterm neonates with RDS. Material and Methods: Present study was a single-center, prospective, observational study, conducted in preterm neonates less than 34 weeks gestation (estimated from mother's 1st trimester ultrasound report or based on Ballard's score if ultrasound report not available) diagnosed with RDS, required mechanical ventilation were treated with surfactant therapy. Results: In our study we included a total of 122 preterm neonates, 94 were males and 28 were females. Common clinical features were tachypnea (99.2%), chest indrawing (99.2%), grunting (97.5 %), apnea (37.7 %) & cyanosis (35.2 %). Mean respiratory rate before surfactant therapy was 82.9 ± 5.5, but it was drastically improved after surfactant administration which was 50.6 ± 10.3. Same pattern observed with SPO2 which showed 83.5 ± 2.6 before and after was 94.4 ± 2.1 and heart rate was 146.8 ± 8.7 before and after was 126.7 ± 8.3. Mean Silverman Anderson Score (SAS) in case of preterm neonate was 6.7 ± 0.7 before and 2 ± 1.2 after surfactant therapy. In our study of 122 neonates in which surfactant has been administered 78 were discharged (63.9 %) while 34.4 % (42) were expired. 2 patients were LAMA. Conclusion: Surfactant therapy significantly improved survival in Respiratory Distress Syndrome (RDS) as indicated by significant improvement in vital parameters as well as Silverman Anderson Score. [ABSTRACT FROM AUTHOR]

Background The incidence of neonatal septic shock in low-income countries is 26.8% with a mortality rate of 35.4%. The evidence of the hemodynamic effects of noradrenaline in neonates remains sparse. This study was carried out to evaluate the effects of noradrenaline in neonates with septic shock. Methods This was a single-center prospective cohort study in a tertiary care hospital's level III neonatal intensive care unit. Neonates with septic shock and those who received noradrenaline as a first-line vasoactive agent were included. Clinical and hemodynamic parameters were recorded before and after one hour of noradrenaline infusion. The primary outcomes were: response at the end of one hour after starting noradrenaline infusion and mortality rate. Results A total of 21 babies were analyzed. The cohort comprised 17 preterm neonates. The mean age of presentation with septic shock was 74.3 h. Resolution of shock at one hour after starting noradrenaline was achieved in 76.2% of cases. The median duration of hospital stay was 14 days. The mean blood pressure improved after the initiation of noradrenaline from 30.6 mm of Hg [standard deviation (SD) 6.1] to 37.8 mm of Hg (SD 8.22, p  < 0.001). Fractional shortening improved after noradrenaline initiation from 29% (SD 13.5) to 45.1% (SD 21.1, p  < 0.001). The mortality rate was 28.6% in our study. Conclusion Noradrenaline is a potential drug for use in neonatal septic shock, with improvement in mean blood pressure and fractional shortening; however, further studies with larger sample sizes are needed to confirm our findings before it can be recommended as first-line therapy in neonatal septic shock. [ABSTRACT FROM AUTHOR]

Background: The optimal timing for clamping the umbilical cord remains controversial. This study aimed to assess the optimal timing of umbilical cord clamping and its effect on preterm neonates. Methods: The study was a randomized controlled trial with the registration number: NCT06000800. It was conducted at Kasr Al Ainy Maternity Hospital, Cairo University Hospital, where a total of 80 pregnant women were randomly pooled and randomly divided into four groups with each group comprising 20 pregnant women. Umbilical cord clamping was performed in the first group immediately (5 sec after birth), after 30 sec in the second group, after 60 sec in the third group, and after 90 sec in the fourth group. After birth, clinical and laboratory parameters were assessed and recorded at the 1st, 6th, 12th, 24th, and 48th hours for all preterm neonates. Results: Delayed cord clamping at 90 sec was linked to improved preterm neonatal outcomes including heart rate at the 1st and the 6th hours; respiratory rate at the 12th hour; oxygen saturation at the 1st hour; hemoglobin, hematocrit, and blood glucose levels at the 6th, 12th, 24th, and 48th hours; but also linked to increase in bilirubin levels at the 12th, 24th, and 48th hours (P < 0.001). There was no statistically significant difference concerning APGAR score; respiratory rate at the 12th hour, temperature at the 1st, 6th, 12th, 24th, and 48th hours; hemoglobin, hematocrit, and blood glucose at the 1st hour; and bilirubin at the 1st, 6th, and 12th hours in all groups (5, 30, 60, and 90 sec) (P > 0.05). Conclusion: Better levels of blood glucose and hemoglobin were seen in preterm neonates whose cord clamping was delayed. Further studies should be carried out to determine the optimal timing of umbilical cord clamping with larger samples, for extended delay of clamping for more than 90 sec, and with recording of parameters for an extended period of follow-up even past the neonatal period. [ABSTRACT FROM AUTHOR]

Aims: Whether and when glomerular filtration rate (GFR) in preterms catches up with term peers is unknown. This study aims to develop a GFR maturation model for (pre)term-born individuals from birth to 18 years of age. Secondarily, the function is applied to data of different renally excreted drugs. Methods: We combined published inulin clearance values and serum creatinine (Scr) concentrations in (pre)term born individuals throughout childhood. Inulin clearance was assumed to be equal to GFR, and Scr to reflect creatinine synthesis rate/GFR. We developed a GFR function consisting of GFRbirth (GFR at birth), and an Emax model dependent on PNA (with GFRmax, PNA50 (PNA at which half of GFR max is reached) and Hill coefficient). The final GFR model was applied to predict gentamicin, tobramycin and vancomycin concentrations. Result: In the GFR model, GFRbirth varied with birthweight linearly while in the PNA-based Emax equation, GA was the best covariate for PNA50, and current weight for GFRmax. The final model showed that for a child born at 26 weeks GA, absolute GFR is 18%, 63%, 80%, 92% and 96% of the GFR of a child born at 40 weeks GA at 1 month, 6 months, 1 year, 3 years and 12 years, respectively. PopPK models with the GFR maturation equations predicted concentrations of renally cleared antibiotics across (pre)term-born neonates until 18 years well. Conclusions: GFR of preterm individuals catches up with term peers at around three years of age, implying reduced dosages of renally cleared drugs should be considered below this age. [ABSTRACT FROM AUTHOR]

Aim: To investigate cerebral blood volume (CBV) in preterm neonates using time‐resolved near‐infrared spectroscopy. Methods: In this prospective observational study, time‐resolved near‐infrared spectroscopy measurements of CBV using tNIRS‐1 were performed in 70 preterm neonates. For measurements, a sensor was placed for a duration of 1 min, followed by four further reapplications of the sensor, overall five measurements. Results: In this study, 70 preterm neonates with a mean ± SD gestational age of 33.4 ± 1.7 weeks and a birthweight of 1931 ± 398 g were included with a postnatal age of 4.7 ± 2.0 days. Altogether, 2383 CBV values were obtained with an overall mean of 1.85 ± 0.30 mL/100 g brain. A total of 95% of the measured CBV values varied in a range from −0.31 to 0.33 from the overall individual mean. Taking the deviation of the mean of each single application for each patient, this range reduced from −0.07 to 0.07. The precision of the measurement defined as within‐variation in CBV was 0.24 mL/100 g brain. Conclusion: The overall mean CBV in stable preterm neonates was 1.85 ± 0.30 mL/100 g brain. The within‐variation in CBV was 0.24 mL/100 g brain. Based on the precision obtained by our data, CBV of 1.85 ± 0.30 mL/100 g brain may be assumed as normal value for this cohort. [ABSTRACT FROM AUTHOR]

Acting as a central hub in regulating brain functions, the thalamus plays a pivotal role in controlling high-order brain functions. Considering the impact of preterm birth on infant brain development, traditional studies focused on the overall development of thalamus other than its subregions. In this study, we compared the volumetric growth and shape development of the thalamic hemispheres between the infants born preterm and full-term (Left volume: P = 0.027, Left normalized volume: P < 0.0001; Right volume: P = 0.070, Right normalized volume: P < 0.0001). The ventral nucleus region, dorsomedial nucleus region, and posterior nucleus region of the thalamus exhibit higher vulnerability to alterations induced by preterm birth. The structural covariance (SC) between the thickness of thalamus and insula in preterm infants (Left: corrected P = 0.0091, Right: corrected P = 0.0119) showed significant increase as compared to full-term controls. Current findings suggest that preterm birth affects the development of the thalamus and has differential effects on its subregions. The ventral nucleus region, dorsomedial nucleus region, and posterior nucleus region of the thalamus are more susceptible to the impacts of preterm birth.

Abstract Background Mortality in premature neonates is a global public health problem. In developing countries, nearly 50% of preterm births ends with death. Sepsis is one of the major causes of death in preterm neonates. Risk prediction model for mortality in preterm septic neonates helps for directing the decision making process made by clinicians. Objective We aimed to develop and validate nomogram for the prediction of neonatal mortality. Nomograms are tools which assist the clinical decision making process through early estimation of risks prompting early interventions. Methods A three year retrospective follow up study was conducted at University of Gondar Comprehensive Specialized Hospital and a total of 603 preterm neonates with sepsis were included. Data was collected using KoboCollect and analyzed using STATA version 16 and R version 4.2.1. Lasso regression was used to select the most potent predictors and to minimize the problem of overfitting. Nomogram was developed using multivariable binary logistic regression analysis. Model performance was evaluated using discrimination and calibration. Internal model validation was done using bootstrapping. Net benefit of the nomogram was assessed through decision curve analysis (DCA) to assess the clinical relevance of the model. Result The nomogram was developed using nine predictors: gestational age, maternal history of premature rupture of membrane, hypoglycemia, respiratory distress syndrome, perinatal asphyxia, necrotizing enterocolitis, total bilirubin, platelet count and kangaroo-mother care. The model had discriminatory power of 96.7% (95% CI: 95.6, 97.9) and P-value of 0.165 in the calibration test before and after internal validation with brier score of 0.07. Based on the net benefit analysis the nomogram was found better than treat all and treat none conditions. Conclusion The developed nomogram can be used for individualized mortality risk prediction with excellent performance, better net benefit and have been found to be useful in clinical practice with contribution in preterm neonatal mortality reduction by giving better emphasis for those at high risk.

Abstract Background The length of hospital stay of very-low-birth-weight neonates (birth weight

Bone calcium turnover is aggravated in pregnant women recommended to bed rest. In the present cross-sectional study, we aimed to clarify whether preterm neonates would benefit from calcium supplementation during pregnancy. Forty-two mothers (37.5 ± 6.7 years), recommended bed rest at home, and 42 preterm neonates (24–37 weeks gestational age) were enrolled. Neonates' serum calcium was quantified at birth. Mothers' calcium intake from foods and supplements during pregnancy was assessed. Serum 25-OH-D was measured in both mothers and neonates at birth. Results showed that mothers' calcium intake from foods was significantly lower than the recommended daily reference value (p < 0.001), while total calcium intake including supplements was close to the calcium reference value of 1000 mg/day (p = 0.648). Neonates' serum calcium concentration was significantly higher in mothers receiving calcium supplementation during pregnancy compared to mothers who did not (p < 0.001). A significant association between neonates' serum calcium levels and mothers' calcium supplementation was evident, even when adjusted to mothers' age, pre-pregnancy BMI, gestational age, and neonates' birth weight (beta = +0.460, p = 0.025). A statistically significant correlation between neonates' and mothers' serum 25-OH-D levels was found (r = 0.891, p < 0.001). In conclusion, calcium status in preterm neonates, born by bedridden women, could be enhanced after calcium supplementation during gestation. [ABSTRACT FROM AUTHOR]

Summary: Background: Melatonin plays an important role in organism functioning, child growth, and development. Of particular importance is melatonin for preterm infants. The aim of our research was to study the peculiarities of melatonin levels depending on various factors in preterm infants with gestational age (GA) of less than 34 weeks. Methods: The study involved 104 preterm infants with GA less than 34 weeks who were treated in the neonatal intensive care unit (NICU). The level of melatonin in urine samples was determined by an enzyme-linked immunosorbent assay. Results: Melatonin concentration was significantly lower in extremely and very preterm infants compared to moderate preterm (3.57 [2.10; 5.06] ng/ml vs. 4.96 [3.20; 8.42] ng/ml, p = 0.007) and was positively correlated with GA (Spearman r = 0.32; p < 0.001). Positive correlations were revealed between melatonin levels and Apgar scores at the 1st (Spearman r = 0.31; p = 0.001) and 5th minutes after birth (Spearman r = 0.35; p < 0.001). Melatonin levels were lower in newborns with respiratory distress syndrome (p = 0.011). No significant correlations were found between melatonin concentration and birth weight (Spearman r = 0.15; p = 0.130). There were no associations of melatonin concentrations and mode of delivery (p = 0.914), the incidence of early-onset sepsis (p = 0.370) and intraventricular hemorrhages (p = 0.501), and mechanical ventilation (p = 0.090). The results of multiple regression showed that gestational age at birth was the most significant predictor of melatonin level in preterm infants (B = 0.507; p = 0.001). Conclusion: Gestational age and the Apgar score were associated with decreased melatonin levels in preterm infants. The level of melatonin in extremely and very preterm infants was lower compared to moderate preterm infants. [ABSTRACT FROM AUTHOR]

Background: Mortality in premature neonates is a global public health problem. In developing countries, nearly 50% of preterm births ends with death. Sepsis is one of the major causes of death in preterm neonates. Risk prediction model for mortality in preterm septic neonates helps for directing the decision making process made by clinicians. Objective: We aimed to develop and validate nomogram for the prediction of neonatal mortality. Nomograms are tools which assist the clinical decision making process through early estimation of risks prompting early interventions. Methods: A three year retrospective follow up study was conducted at University of Gondar Comprehensive Specialized Hospital and a total of 603 preterm neonates with sepsis were included. Data was collected using KoboCollect and analyzed using STATA version 16 and R version 4.2.1. Lasso regression was used to select the most potent predictors and to minimize the problem of overfitting. Nomogram was developed using multivariable binary logistic regression analysis. Model performance was evaluated using discrimination and calibration. Internal model validation was done using bootstrapping. Net benefit of the nomogram was assessed through decision curve analysis (DCA) to assess the clinical relevance of the model. Result: The nomogram was developed using nine predictors: gestational age, maternal history of premature rupture of membrane, hypoglycemia, respiratory distress syndrome, perinatal asphyxia, necrotizing enterocolitis, total bilirubin, platelet count and kangaroo-mother care. The model had discriminatory power of 96.7% (95% CI: 95.6, 97.9) and P-value of 0.165 in the calibration test before and after internal validation with brier score of 0.07. Based on the net benefit analysis the nomogram was found better than treat all and treat none conditions. Conclusion: The developed nomogram can be used for individualized mortality risk prediction with excellent performance, better net benefit and have been found to be useful in clinical practice with contribution in preterm neonatal mortality reduction by giving better emphasis for those at high risk. [ABSTRACT FROM AUTHOR]

Background: The length of hospital stay of very-low-birth-weight neonates (birth weight < 1500 g) depends on multiple factors. Numerous factors have been reported to influence the length of hospital stay (LOS). The objective of this study was to identify the length of hospital stay and associated factors among very-low-birth-weight preterm neonates. Method: A hospital-based, cross-sectional study was conducted. Data was collected using a pretested, structured questionnaire from April 1 to November 30, 2022. The data was entered using Epidata and Stata version 15.1. The frequencies, mean, median, and interquartile range were used to describe the study population about relevant variables. A linear regression model was used to see the effect of independent variables on dependent variables. Result: About 110 very low-birth-weight preterm neonates who survived to discharge were included in the study. The median birth weight was 1370 g, with an IQR of 1250–1430. The mean gestational age was 32.30 ± 1.79 weeks. The median length of hospital stay was 24 days, with an IQR of 13.5–40. The gestational age, type of initial management given, and presence of complications had a significant association with the length of hospital stay for VLBW preterm neonates. Conclusion: The median hospital stay was 24 days. The gestational age, presence of complications, and type of initial management given were associated with LOS for VLBW preterm neonates. The length of the hospital stay of the VLBW preterm neonates can be reduced by applying the standards of care of very-low-birth-weight preterm neonates. [ABSTRACT FROM AUTHOR]

BackgroundAdequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia.MethodsA cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation.ResultsThe study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits.ConclusionAddressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates’ overall well-being and long-term outcomes.

Abstract Background Many years ago, it was proposed that prone positioning and infant massage would benefit preterm and babies with low birth weight. Aim of the work Evaluating the effectiveness of massage therapy and the neonatal prone position on the heart rate (HR) and blood oxygen saturation level (SPO2) of premature neonates in neonatal intensive care units. Subject and methods Our study was conducted as a single-center, randomized controlled clinical trial at the NICUs of Menoufia University Hospital. After enrollment, the (240) cases were divided into group A: (80) infants with prone position, group B: (80) infants with massage therapy (as intervention groups), group C: (80) infants as a control group (without intervention). Results Regarding group A, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group B, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group C, there was no significant difference between the First and last days of intervention regarding HR at 15, 30, 45, and 60 min. Conclusion Prone position and infant’s massage equally reduce Heart Rate and increase preterm babies' blood oxygen saturation level neonates admitted in NICU.

Abstract Background Non-nutritive sucking (NNS) is a reflex in neonates where they suck on objects without receiving food. It aids in oral development and self-regulation. Preterm birth can affect NNS and feeding. Based on current guidelines, early evaluation is crucial for identifying any delay in normal development in this population. Hence, the current study aims to profile non-nutritive sucking skills in full-term (37 to < 42 weeks) and preterm (32 to < 37 weeks) neonates and to compare non-nutritive sucking skills between the groups. Method A total of 180 neonates completed this study. “The test for oropharyngeal dysphagia in Indian neonates” (TOD-IN) was used to profile non-nutritive sucking. The number of sucks, swallows, bursts, duration of sucking, suck/le per swallow, and pause duration was also assessed. Results There was a statistically significant difference between the groups for non-nutritive sucking at p = < .001 and Cohen’s d had a large effect size (d = 1.42). Preterm neonates had a lesser number of sucks, bursts, swallows, and duration of sucking but had a higher pause duration compared to full-term neonates. Conclusion Non-nutritive sucking skills develop with advancing postmenstrual age and a detailed profile is imperative for a proper assessment to identify progress and delays.

ABSTRACTBackground & objective Sugammadex is a drug used to reverse the muscle relaxation effect of rocuronium. Its use is still limited in preterm neonates. The aim of this study was to compare the efficacy of Sugammadex with that of neostigmine in reversing rocuronium-induced muscle relaxation in preterm neonates and to evaluate the safety of its use in this age group.Patients and methods This randomized clinical trial was carried out on Sixty preterm neonates, planned for elective inguinal hernia repair under general anaesthesia. The patients were divided into two equal groups. Group N used neostigmine and group S used Sugammadex as the reversal agent for rocuronium.Results In Sugammadex group the mean reversal time (1.15 ± 0.42) min and the mean recovery time (17 ± 6.64) min were significantly shorter than in the neostigmine group (8.9 ± 1.6) min and (27.16 ± 9.26) min respectively, with p value

Abstract Background Gut dysbiosis contributes to the high risk of bloodstream infection (BSI) among premature infants. Most prior studies of the premature infant gut microbiota were conducted in Western countries and prior to development of current tools for strain-resolved analysis. Methods We performed metagenomic sequencing of weekly fecal samples from 75 premature infants at a single hospital in Singapore. We evaluated associations between clinical factors and gut microbiota composition using PERMANOVA and mixed effects linear regression. We used inStrain to perform strain-level analyses evaluating for gut colonization by BSI-causing strains. Results Median (interquartile range) gestation was 27 (25, 29) weeks, and 63% of infants were born via Cesarean section. Antibiotic exposures (PERMANOVA; R2 = 0.017, p = 0.001) and postnatal age (R2 = 0.015, p = 0.001) accounted for the largest amount of variability in gut microbiota composition. Increasing postnatal age was associated with higher relative abundances of several common pathogens (Enterococcus faecalis: p

Background: Magnesium (Mg) is a vital element which plays a significant role in the human body. Respiratory distress syndrome (RDS) is one of the most common problems in preterm neonates. The current study aimed to investigate the role of serum Mg level as a prognostic factor in neonates diagnosed with RDS. Methods: This case-control study was performed in Vali-e-Asr Hospital, Tehran, Iran, for two years. A total of 100 preterm infants (50 cases, 50 controls) admitted to NICU were enrolled in this study. Demographic data, serum magnesium level, therapeutic interventions, and neonatal outcomes were investigated and the obtained data were analyzed using SPSS software. P-value less than 0.05 was considered significant. Results: Of 100 neonates, 52% were male. The mean gestational age and birth weights were 33.4 ± 2.4 weeks and 2062 ± 72 gr, respectively. The findings revealed that the mean serum magnesium level in neonates with RDS was 2.02 ± 0.57 mg/dl, while it was 2.35 ± 0.67 mg/dl for neonates in the control group (P-value=0.001). Additionally, the calculated odds ratio of 2.38 indicated a correlation between reduced serum Mg levels and the occurrence of RDS. Conclusion: The serum level of Mg among neonates with RDS was significantly lower, but the lower level of Mg was not associated with adverse outcomes in neonates.

Background: Many years ago, it was proposed that prone positioning and infant massage would benefit preterm and babies with low birth weight. Aim of the work: Evaluating the effectiveness of massage therapy and the neonatal prone position on the heart rate (HR) and blood oxygen saturation level (SPO2) of premature neonates in neonatal intensive care units. Subject and methods: Our study was conducted as a single-center, randomized controlled clinical trial at the NICUs of Menoufia University Hospital. After enrollment, the (240) cases were divided into group A: (80) infants with prone position, group B: (80) infants with massage therapy (as intervention groups), group C: (80) infants as a control group (without intervention). Results: Regarding group A, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group B, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group C, there was no significant difference between the First and last days of intervention regarding HR at 15, 30, 45, and 60 min. Conclusion: Prone position and infant's massage equally reduce Heart Rate and increase preterm babies' blood oxygen saturation level neonates admitted in NICU. [ABSTRACT FROM AUTHOR]

Background: Non-nutritive sucking (NNS) is a reflex in neonates where they suck on objects without receiving food. It aids in oral development and self-regulation. Preterm birth can affect NNS and feeding. Based on current guidelines, early evaluation is crucial for identifying any delay in normal development in this population. Hence, the current study aims to profile non-nutritive sucking skills in full-term (37 to < 42 weeks) and preterm (32 to < 37 weeks) neonates and to compare non-nutritive sucking skills between the groups. Method: A total of 180 neonates completed this study. "The test for oropharyngeal dysphagia in Indian neonates" (TOD-IN) was used to profile non-nutritive sucking. The number of sucks, swallows, bursts, duration of sucking, suck/le per swallow, and pause duration was also assessed. Results: There was a statistically significant difference between the groups for non-nutritive sucking at p = <.001 and Cohen's d had a large effect size (d = 1.42). Preterm neonates had a lesser number of sucks, bursts, swallows, and duration of sucking but had a higher pause duration compared to full-term neonates. Conclusion: Non-nutritive sucking skills develop with advancing postmenstrual age and a detailed profile is imperative for a proper assessment to identify progress and delays. [ABSTRACT FROM AUTHOR]

Background Uncertainty exists regarding the ideal interval between the administration of antenatal corticosteroids (ACS) and delivery. The study's objective was to assess the risks of perinatal mortality and respiratory distress syndrome (RDS) among preterm neonates whose mothers gave birth within 48 h of the administration of ACS and those whose mothers gave birth between 48 h and 7 days. Methods The study design was a secondary analysis of data from an observational prospective chart review study that was carried out in Tanzania in 2020. Preterm infants born to mothers who got at least one dose of ACS between 28 and 34 weeks of pregnancy were included. Results A total of 346 preterm neonates (294 singletons and 52 twins) were exposed to ACS. Compared to infants born 48 h following the first dose of ACS, those exposed to the drug between 48 h and 7 days had significantly decreased rates of perinatal mortality and RDS. Multivariable analysis revealed that infants exposed ACS between 48 h and 7 days prior to delivery had lower risk of perinatal mortality (aRR 0.30, 95% CI 0.14–0.66) and RDS (aRR 0.27, 95% CI 0.14–0.52). Conclusion The first dose of ACS given between 48 h and 7 days before delivery was associated with a lower risk of perinatal mortality and RDS than when the first dose was given <48 h before delivery. To improve neonatal outcomes, healthcare providers should consider administering ACS to mothers at the appropriate time. [ABSTRACT FROM AUTHOR]

Background & objective: Sugammadex is a drug used to reverse the muscle relaxation effect of rocuronium. Its use is still limited in preterm neonates. The aim of this study was to compare the efficacy of Sugammadex with that of neostigmine in reversing rocuronium-induced muscle relaxation in preterm neonates and to evaluate the safety of its use in this age group. Patients and methods: This randomized clinical trial was carried out on Sixty preterm neonates, planned for elective inguinal hernia repair under general anaesthesia. The patients were divided into two equal groups. Group N used neostigmine and group S used Sugammadex as the reversal agent for rocuronium. Results: In Sugammadex group the mean reversal time (1.15 ± 0.42) min and the mean recovery time (17 ± 6.64) min were significantly shorter than in the neostigmine group (8.9 ± 1.6) min and (27.16 ± 9.26) min respectively, with p value <0.001. The patients in the Sugammadex group showed significantly lower heart rate than those in neostigmine group but showed no significant difference as regard mean blood pressure at 3, 6, 9,12,15 and 18 min after drug injection. There were no significant complications noted in both group. Conclusion: Sugammadex is well tolerated in the Preterm neonates with shorter recovery and reversal time when compared to neostigmine. [ABSTRACT FROM AUTHOR]

Background: Gut dysbiosis contributes to the high risk of bloodstream infection (BSI) among premature infants. Most prior studies of the premature infant gut microbiota were conducted in Western countries and prior to development of current tools for strain-resolved analysis. Methods: We performed metagenomic sequencing of weekly fecal samples from 75 premature infants at a single hospital in Singapore. We evaluated associations between clinical factors and gut microbiota composition using PERMANOVA and mixed effects linear regression. We used inStrain to perform strain-level analyses evaluating for gut colonization by BSI-causing strains. Results: Median (interquartile range) gestation was 27 (25, 29) weeks, and 63% of infants were born via Cesarean section. Antibiotic exposures (PERMANOVA; R2 = 0.017, p = 0.001) and postnatal age (R2 = 0.015, p = 0.001) accounted for the largest amount of variability in gut microbiota composition. Increasing postnatal age was associated with higher relative abundances of several common pathogens (Enterococcus faecalis: p < 0.0001; Escherichia coli: p < 0.0001; Klebsiella aerogenes: p < 0.0001; Klebsiella pneumoniae: p < 0.0001). Antibiotic exposures were generally associated with lower relative abundances of both frequently beneficial bacteria (e.g., Bifidobacterium species) and common enteric pathogens (e.g., Enterobacter, Klebsiella species). We identified strains identical to the blood culture isolate in fecal samples from 12 of 16 (75%) infants who developed BSI, including all infections caused by typical enteric bacteria. Conclusions: Antibiotic exposures were the dominant modifiable factor affecting gut microbiota composition in a large cohort of premature infants from South-East Asia. Strain-resolved analyses indicate that the gut is an important reservoir for organisms causing BSI among premature infants. [ABSTRACT FROM AUTHOR]

(1) Background: dexamethasone is used for the prevention and treatment of chronic lung disease (CLD) in premature neonates, and its impact on cardiac performance and pulmonary vascular resistance has not been well studied. (2) Methods: eligible neonates of <30 weeks gestational age (GA) had echocardiograms performed on them at three time points—before the initiation of dexamethasone (Echo-1), 24–48 h post the completion of dexamethasone therapy (Echo-2), and 7–14 days after course completion (Echo-3). (3) Results: 28 neonates with a 25.2 week mean GA and 652.9 g birthweight were included. The mean cumulative dose of dexamethasone was 0.98 mg/kg, given over 8–10 days. Echo-1 and Echo-2 showed a significant improvement in the right ventricular fractional area change (RV FAC 44.88 vs. 49.71, p = 0.025), tricuspid annular plane systolic excursion (TAPSE 0.65 cm vs. 0.70 cm, p = 0.013), and RV S' (7.18 vs. 8.56, p = 0.05). The left ventricular (LV) ejection fraction was similar but with a significant increase in the LV S' (4.77 vs. 6.01, p = 0.006). A longitudinal analysis at three time points showed a significant increase in RV FAC (0.02 units 95% CI (0.00–0.04), p = 0.037), TAPSE (0.09 units 95% CI (0.06–0.13), p < 0.001), RV S' (0.97 units (95% CI = 0.11–1.84), p = 0.028), a reduction in the eccentricity index (0.07 units 95% CI (−0.14–−0.01), p = 0.030), and an increase in the LV S' (0.56 units (95% CI = 0.18–0.94)). (4) Conclusion: The use of postnatal dexamethasone for the prevention/treatment of CLD in premature neonates resulted in an expected improvement in respiratory status along with a significant improvement in the echocardiographic measures of biventricular heart performance. [ABSTRACT FROM AUTHOR]

Objective This study aimed to test whether mildly elevated bilirubin levels in preterm infants are associated with increased signal intensity (SI) on magnetic resonance imaging (MRI) of the basal ganglia (BG). Study Design MRI was performed at term equivalent age in 55 postpreterm infants using a neonatal MRI 1-T scanner. SI of the BG was correlated with mild hyperbilirubinemia. Results BG MRI SI was significantly increased in infants with mild hyperbilirubinemia on T1-weighted image (T1; p = 0.0393) and T2-weighted image (T2; p = 0.0309). We found no effect of gestational age or sepsis on BG MRI intensity; however, there was a significant effect of acidosis on T1 (p = 0.0223) but not on T2 (p = 0.2316). Infants with combined hyperbilirubinemia and acidosis had the most significant increase in SI on both T1 and T2 respectively (p = 0.0072 and 0.0195, respectively). Conclusion We found a positive association between increased BG MRI SI and mildly elevated bilirubin levels. The effect was greatly strengthened when hyperbilirubinemia was associated with acidosis. Key Points Excessive bilirubin is neurotoxic to the neonatal brain. It is deposited in the BG. BG MRI SI is increased with bilirubin deposition. The premature brain is more vulnerable to bilirubin associated MRI changes. [ABSTRACT FROM AUTHOR]

Background: Magnesium (Mg) is a vital element which plays a significant role in the human body. Respiratory distress syndrome (RDS) is one of the most common problems in preterm neonates. The current study aimed to investigate the role of serum Mg level as a prognostic factor in neonates diagnosed with RDS. Methods: This case-control study was performed in Vali-e-Asr Hospital, Tehran, Iran, for two years. A total of 100 preterm infants (50 cases, 50 controls) admitted to NICU were enrolled in this study. Demographic data, serum magnesium level, therapeutic interventions, and neonatal outcomes were investigated and the obtained data were analyzed using SPSS software. P-value less than 0.05 was considered significant. Results: Of 100 neonates, 52% were male. The mean gestational age and birth weights were 33.4 ± 2.4 weeks and 2062 ± 72 gr, respectively. The findings revealed that the mean serum magnesium level in neonates with RDS was 2.02 ± 0.57 mg/dl, while it was 2.35 ± 0.67 mg/dl for neonates in the control group (P-value=0.001). Additionally, the calculated odds ratio of 2.38 indicated a correlation between reduced serum Mg levels and the occurrence of RDS. Conclusion: The serum level of Mg among neonates with RDS was significantly lower, but the lower level of Mg was not associated with adverse outcomes in neonates. [ABSTRACT FROM AUTHOR]

Our hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30–60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage. A prospective, open-label, randomized, controlled trial was conducted at Vall d'Hebron Hospital from July 2014 to December 2018. All pregnant women at risk of impending preterm birth (≥26.0-<33.0 weeks of gestation) who were admitted to the obstetrics emergency department were evaluated for eligibility. If they met the eligibility criteria, they were invited to participate in the study and, if they agreed, they signed an informed consent. Patients were randomly assigned to one of two groups: ECC group and DCC group. Our study included a total of 57 patients: 30 in the ECC group and 27 in the DCC group. Due to a lack of funding and low recruitment rates, the study was discontinued in 2018. Maternal characteristics and obstetric outcomes were similar between both groups. The intention-to-treat analysis did not reveal any differences between groups for neonatal red blood cell transfusions, neonatal IVH or maternal postpartum haemorrhage. There were no differences for secondary outcomes. Similarly, no differences were observed in the as-treated analysis. The primary and secondary outcomes of our study were not achieved. Therefore, more meta -analysis and trials are needed to evaluate the appropriate timing of cord clamping in preterm birth. [ABSTRACT FROM AUTHOR]

Objective: To report the frequency of IVH in preterm neonates and IVH grading on cranial ultrasound. Methodology: This prospective cross-sectional study was carried out at NICH. All preterm infants of either gender were consecutively enrolled. Detailed history of the infant regarding the clinical examination and socio-demographic characteristics of the infants were noted. IVH was observed in all preterm neonates, and all infants were categorized according to the Papile grading. Results: Of 144 neonates, the mean age was 2.34 ±0.97 days. There were 93 (64.6%) males and 51 (35.4%) females. IVH was observed in 144 (37.6%) neonates. A significant mean difference of age (p: <0.001), gestational age (p: <0.001), birth weight (p: <0.001), APGAR score at 1 min (p; <0.001), APGAR score at 5 min (p: <0.001) was observed in between IVH and non IVH neonates. Furthermore, a significant association of place of admission (p: <0.001), mode of delivery (p: 0.038), need of invasive/non-invasive ventilator (p: 0.002), and preterm status (p: <0.001) was observed with IVH. IVH grade I was observed in 75 (52.1%), grade II in 45 (31.3%), grade III in 18 (12.5%), and grade IV in 6 (4.2%) neonates. Conclusion: A notably higher number of preterm neonates had IVH. While grade I was most common, a majority exhibited severe grades (III and IV). Extremely early preterm births carried increased risk of spontaneous delivery and greater reliance on invasive/non-invasive ventilator support. [ABSTRACT FROM AUTHOR]

Abstract Objectives Extremely preterm (EPT; gestational week

Necrotising enterocolitis (NEC) is a devastating condition that poses a significant risk of morbidity and mortality, particularly among preterm babies. Extensive research efforts have been directed at identifying optimal treatment and diagnostic strategies but results from such studies remain unclear and controversial. Among the most promising candidates are prebiotics, probiotics and their metabolites, including short chain fatty acids (SCFAs). Such metabolites have been widely explored as possible biomarkers of gut health for different clinical conditions, with overall positive effects on the host observed. This review aims to describe the role of gut microbiome derived SCFAs in necrotising enterocolitis. Until now, information has been conflicting, with the primary focus on the main three SCFAs (acetic acid, propionic acid, and butyric acid). While numerous studies have indicated the relationship between SCFAs and NEC, the current evidence is insufficient to draw definitive conclusions about the use of these metabolites as NEC biomarkers or their potential in treatment strategies. Ongoing research in this area will help enhance both our understanding of SCFAs as valuable indicators of NEC and their practical application in clinical settings.

Background: Preterm neonates routinely undergo many painful procedures in the neonatal intensive care unit. Due to their nonverbal state, these neonates are unable to express their pain, resulting in underestimation and insufficient pain relief. Neglecting pain may lead to complications affecting neurodevelopment and causing permanent injuries to the brain. Music therapy provides sensory stimulation to preterm neonates, resulting in improved physiological and behavioral responses and reduced pain perception. To assess the impact of music therapy on alleviating pain in preterm neonates during painful medical procedures. The study utilized a quasi-experimental research design with a two-group post-test-only approach. Methods: In the present study, a total of 60 preterm neonates were divided equally into a control group and an experimental group (30 participants per group). The intervention and control groups were matched before the intervention. The experimental group received music therapy during painful procedures, while the control group received routine care during the same procedures. The Neonatal Pain Agitation and Sedation Scale (NPASS Tool) was used to measure pain levels during painful procedures. Results: The intensity of pain in both groups was the same before the intervention. In this study, the mean±SD values of intra-test pain level were 8.63±0.56 and 2.96±0.89 in the control and experimental groups, respectively. Moreover, the mean±SD values of the post-test pain level in the control and experimental groups were 7.53±0.89 and 1.1±0.88, respectively. The obtained t-test value in the intra-test was obtained at 29.57 (P

Abstract Background The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) include early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ventilation. Preterm neonates with RDS who fail CPAP are at higher risk for chronic lung disease as well as death. Unfortunately, in low resource settings CPAP may be the only treatment available for these neonates. Objective To determine the prevalence of CPAP failure among premature newborns with RDS and associated factors. Methods We conducted a prospective observational study over the first 72 h of life on 174 preterm newborns with RDS receiving CPAP at Muhimbili National Hospital (MNH). At MNH newborns with Silverman Andersen Score (SAS) of ≥ 3 are commenced on CPAP; surfactant and mechanical ventilation are very scarce. Study newborns not maintaining oxygen saturation > 90% or with SAS score ≥ 6 despite being on 50% oxygen and PEEP of 6 cmH2O and those with > 2 episodes of apnoea needing stimulation or positive pressure ventilation in 24 h were considered as CPAP failure. The prevalence of CPAP failure was determined as a percentage and factors associated were determined by logistic regression. A p-value of