Research progress in artificial intelligence for the diagnosis and management of diseases in preterm infants

Objectives: To analyze the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and lung diseases (wet lung, RDS, BPD, pneumothorax) in preterm infants. Methods: Preterm infants (corrected gestational age <37 weeks) hospitalized in the neonatology department of Yan'an University Hospital from January 2023 to December 2023 were selected as the study subjects, and their clinical data and 25-hydroxyvitamin D [25(OH)D] levels in the first 24 h of life were collected (by the random number table method to avoid selection bias) in a retrospective cohort study with the basis of the Serum 25(OH)D level was used to categorize preterm infants into high vitamin D and low vitamin D groups, and to compare the incidence of lung diseases in preterm infants in the 2 groups. Results: A total of 414 preterm infants were selected, and 237 preterm infants were finally included for analysis. The mean serum 25(OH)D level in preterm infants within 24 hours of birth was 16.97 ng/mL. 140 cases in the low-vitamin D group had a serum 25(OH)D level of (11.88± 2.74) ng/mL. 97 cases in the high-vitamin D group had a serum 25(OH)D level of (24.31± 7.52) ng/mL; the rate of births in the fall in the low-vitamin D group was was significantly higher than that of the high-vitamin D group (P<0.05), the utilization rate of lung surface active substance was higher than that of the high-vitamin D group (P<0.05), and the incidence of RDS and BPD was significantly higher than that of the high-vitamin D group (P<0.05). Univariate logistic regression analysis suggested that season of birth, serum 25(OH)D level, 5 min Apgar score and prenatal hormone use were associated with pulmonary complications in preterm infants (P<0.05). Multifactorial logistic regression analysis showed that higher serum 25(OH)D levels reduced the risk of pulmonary complications in preterm infants, which was statistically significant (B=-0.056, RR= 0.946, 95% CI: 0.910-0.984, P=0.006); higher 5-min Apgar scores had a lower incidence of pulmonary complications in preterm infants, which was statistical significance (B=-0.722, RR= 0.486, 95% CI: 0.281~0.840, P=0.010); prenatal use of hormones will reduce the risk of pulmonary complications in preterm infants (B=-0.763, RR= 0.466, 95% CI: 0.261~0.833, P=0.010). Conclusion: Low vitamin D levels at birth in preterm infants may increase the incidence of RDS and BPD.

After completing this article, readers should be able to: 1. Describe the epidemiology and pathophysiology of gastroesophageal reflux (GER) in preterm neonates. 2. Delineate the associations of GER with apnea, chronic lung disease, behavior, and growth of preterm infants. 3. Review the investigations used to evaluate GER in preterm infants. 4. Describe nonpharmacologic and pharmacologic therapies for GER. Gastroesophageal reflux (GER) is a normal physiologic event occurring across the age spectrum. It may contribute to a variety of disorders, including esophagitis, feeding problems, and airway disease in all age groups. (1) A large number of symptoms and signs have been purported to be caused by GER despite a lack of data showing a clear association between a specific symptom and GER. In preterm infants, empiric therapy often is administered using agents of unproven efficacy and safety to treat symptoms that likely are unrelated to GER. In a survey on management practices for GER in preterm infants, common treatment strategies included positioning (98%) and slopes (96%), histamine 2 (H 2) receptor antagonists (100%), feed thickeners (98%), antacids (96%), prokinetics (79%), proton pump inhibitors (PPIs) (65%), and dopamine receptor antagonists (53%). (2)(3) The safety, efficacy, and appropriate dosing recommendations for most medical therapies remain uncertain in neonates. In this review, we attempt to summarize the current literature regarding physiology, pathophysiology, and diagnostic and management strategies for GER pertinent to the neonate, with an emphasis on the preterm infant. GER describes the retrograde movement of stomach contents (air or feeding, liquid or semisolid, acid or alkaline, enzymes or bile salts) into the esophagus. GER disease (GERD) occurs when GER causes symptoms or signs such as pain, poor weight gain, esophagitis, hematemesis, and airway symptoms, including apnea, aspiration, recurrent pneumonia, chronic lung disease (CLD), or large airway inflammation. However, any of these symptoms or signs …

Respiratory diseases have become one of the leading causes of death in premature infants in China. Due to the application of prenatal glucocorticoid for the treatment of fetal lung maturation, pulmonary surfactant (PS), various types of respiratory support technologies, clinical diagnosis and treatment strategies for respiratory diseases are more effective, and the diagnosis and treatment of most of the common respiratory diseases of premature infants have their own guidelines and clinical pathways. At present, most of the clinical research hotspots of respiratory diseases focus on genes research, early intervention methods and precise diagnosis and treatment of immature lung and pulmonary diseases in premature infants. This article intends to elaborate on the pathological basis, imaging findings and outcomes of common pulmonary diseases in premature infants and immature lung, to explore the clinical value of imaging examination in pulmonary diseases of premature infants and immature lung, and to assist in the clinical implementation of accurate diagnosis and treatment of pulmonary diseases in premature infants. Key words: Respiratory distress syndrome, newborn; Bronchopulmonary dysplasia; Infant, premature, diseases; Immature lung; Lung diseases; Diagnosis, computer-assisted; Infant, premature

Preventing Postnatal Cytomegalovirus Infection in the Preterm Infant: Should It Be Done, Can It Be Done, and at What Cost?

The role of oxidative stress remains unclear in the multifactorial pathophysiologic mechanism of lung disease in preterm infants. The aim of this study was to examine the associations among chronic lung disease (CLD), oxidative stress, and oxygen requirements in preterm infants. Prospective, longitudinal, and correlational design. Preterm infants born at <32 weeks' gestation (N = 31), median gestation of 29.0 weeks (range 24.9-31.7). The diagnosis of CLD was obtained from the medical record. Oxidative stress was measured using 8-hydroxydeoxyguanosine (8-OHdG) in the cord blood at birth and urine on Days 1 and 7. Oxygen requirements were measured using fraction of inspired oxygen (FIO2) recorded in the first hour after birth/admission and the average FIO2 during the first 12 hr and 7 days after birth. Descriptive statistics are presented. Comparison analyses were performed using Kruskal-Wallis and Fisher's exact tests. Infants with CLD (n = 12) had lower gestational age (p = .04) and weight (p = .04) at birth, more days on the ventilator (p = .004), and longer neonatal intensive care unit stay (p = .04) compared to infants without CLD (n = 19). CLD was associated with lower oxidative stress levels (p = .03) and higher oxygen requirements during the first 12 hr (p = .025) and on Day 7 (p = .001). Lower oxidative stress levels on Day 7 were associated with higher oxygen requirements in the first 12 hr (p = .01) and on Day 7 (p = .03). Our results linking CLD and higher oxygen requirements with low oxidative stress contradict previous reports. Findings identify a gap in knowledge for postresuscitation oxygen therapy in preterm infants and expose the role of oxidative stress from inflammation and intermittent hypoxia in the etiology of CLD.

Characterization of Early Pulmonary Hypertension in Infants Born Preterm: A Key Step Toward Improving Outcomes

A Follow-up Study of Preterm Infants Given Budesonide Using Surfactant as a Vehicle to Prevent Chronic Lung Disease in Preterm Infants

Objective To analyze the risk factors associated with allergic disease in preterm infants during the first year of life.To investigate whether there was any association between peripheral blood eosinophils and allergic di-sease during the first year of life benefit of hydrolyzed formula feeding in preterm infants. Methods A nested case-control study was conducted in a cohort of artificial feeding preterm infants admitted to Neonatal Intensive Care Unit, Shanghai Children's Medical Center from January 2012 to April 2013.The preterm infants were monitored from birth up to 1 year of age and the findings were related to development of allergic disease.Individuals with allergic disease during the first year of life(cases) were matched with gender, as previously described with two individuals(controls) who remained event-free during the study.The risk factors associated with allergic disease in preterm infants during the first year of life were analyzed.And whether there was any association between peripheral blood eosinophils and allergic di-sease during the first year of life benefit of a hydrolyzed formula feeding in preterm infants was investigated.Different variables in control and case individuals were compared with t test for normal distribution measurement date, χ2 tests for categorical variables and Mann-Whitney U test for non-normal distribution measurement date, and multiple conditio-nal Logistic regression were used to investigate the risk factors associated with allergic disease in preterm infants. Results Thirty-four individuals were in cases and 68 individuals were in controls.In a conditional multivariable Logistic model, peripheral blood eosinophils of preterm infants at full enteral feeding(EOS-2)(OR=5.941, 95%CI: 1.165-41.375, P 0.05). Conclusions Peripheral blood eosinophils of preterm infants at full enteral feeding EOS-2 and family history of allergy were the 2 independent risk factors for allergic disease in preterm infants during the first year of life.Contrast to individuals fed with standard preterm formula after birth, individuals fed with hydrolyzed formula had lower association between factors of peripheral blood eosinophils and family history of allergy, and allergic disease during the first year of life. Key words: Infant, preterm; Protein hydrolyzed formula; Eosinophils; Allergic disease

Background: Surfactant replacement therapy (SRT) is an integral part of management of preterm surfactant deficiency respiratory distress syndrome (RDS). Its role in the management of RDS has been extensively studied. However, its efficacy in the management of lung disease in preterm infants born with intrauterine growth restriction (IUGR) has not been systematically studied.Objective: To evaluate the efficacy of exogenous SRT in the management of preterm IUGR lung disease.Methods: A systematic search of all available randomized clinical trials (RCT) of SRT in preterm IUGR infants was done according to the standard Cochrane collaboration search strategy. Neonatal respiratory outcomes were compared between the preterm IUGR and appropriately grown for gestational age (AGA) preterm infant populations in eligible studies.Results: No study was identified which evaluated the efficacy or responsiveness of exogenous SRT in preterm IUGR infants as compared to preterm AGA-infants. The only study identified through the search strategy used small for gestational age (SGA; defined as less than tenth centile for birth weight) as a proxy for IUGR. The RCT evaluated the efficacy or responsiveness of SRT in preterm SGA group as compared to AGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary air leaks, and days on the ventilator did not differ between both groups. However, the requirement for prolonged nasal continuous positive airway pressure (p < 0.001), supplemental oxygen therapy (p < 0.01), and the incidence of bronchopulmonary dysplasia at 28 days and 36 weeks (both p < 0.01) was greater in SGA-infants.Discussion: There is currently insufficient data available to evaluate the efficacy of SRT in preterm IUGR lung disease. A variety of research strategies will be needed to enhance our understanding of the role and rationale for use of SRT in preterm IUGR lung disease.

The purpose of this study was to develop and validate an empirical scoring system to predict the evolution of neonatal respiratory distress syndrome (RDS) into chronic lung disease (CLD) in preterm infants, by comparing it with a more complicated logistic regression model. Clinical study. Neonatal intensive care unit. The retrospective analysis of a 3-year experience showed that a gestational age (GA) of less than 30 weeks, a birth weight (BW) of less than 1000 g, the diagnosis of hyaline membrane disease (HMD) and pulmonary interstitial emphysema (PIE) during the first 72 h of life, the peak inspiratory pressure (PIP) and the fraction of inspired oxygen (FIO2) were the highest relative risk factors correlated with the evolution of CLD. On this basis an empirical and a statistical scoring system were defined and prospectively applied at 3 and 5 days of life to 228 neonates with BW less than 1,250 g. The results obtained with both scoring systems were then compared. Of the 149 infants surviving at 28 days of life, 67 (GA: 29.9 +/- 2.3 weeks; BW: 1,058 +/- 143 g) were normal and 82 (GA: 27.5 +/- 3.9 weeks: BW: 838 +/- 200 g) had CLD. Using a cut-off value of 4.0, the empirical scoring system showed a specificity of 97.0% and a sensitivity of 92.7% on the 3rd day of life; on the 5th day of life the specificity was still 95.5%, while sensitivity remained 92.7%. The areas under the ROC curves plotted with both scoring systems tested were similar. The proposed empirical scoring system is easy to use and is highly reliable. The application of this scoring system provides the opportunity to direct aggressive treatment for CLD toward only very high risk patients between the 3rd and 5th days of life.

To investigate risk factors for metabolic bone disease (MBD) in preterm infants and establish a nomogram model for predicting MBD risk. A total of 1104 preterm infants were enrolled, among whom 809 were included in the modelling set and 295 were included in the validation set. The modelling set was divided into MBD (n = 185) and non-MBD (n = 624) groups. A multivariate logistic regression analysis was used to investigate the independent risk factors for MBD. R software was used to plot the nomogram model, which was then validated by the data of the validation set. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the nomogram model's performance, and the clinical decision curve was used to assess the clinical practicability of the model. Gestational age, time of trophic feeding initiation, parenteral nutrition duration, necrotizing enterocolitis, bronchopulmonary dysplasia, cholestasis and sepsis were independent risk factors for MBD in preterm infants (P < 0.05). The ROC curve of the modelling set had an area under the curve (AUC) of 0.801; the risk prediction value of 0.196 corresponding to the maximum Youden index was the best value, and the prediction critical value was 125 points. The ROC curve of the validation set had an AUC of 0.854. The calibration curve analysis showed good accuracy and consistency between the model's predicted and actual values. The nomogram model provides an efficient tool for the early assessment of MBD risk. Preterm infants with scores ≥ 125 should receive close attention and interventions in the early stage. • The incidence and severity of MBD are inversely proportional to gestational age and birth weight. Bone loss can lead to prolonged hospital stay, ventilator dependence, pathological fractures and short stature. • Gestational age, time of trophic feeding initiation, parenteral nutrition duration, necrotizing enterocolitis, bronchopulmonary dysplasia, cholestasis and sepsis were independent risk factors for MBD in preterm infants. The nomogram model provides an efficient tool for the early assessment of MBD risk.

. Halliday HL, Ehrenkranz RA. Moderately early (7–14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2001;(2):CD001144 (latest version 2 November 2000). ....

We aimed to investigate the role of hypoxia-ischemia in the pathophysiology of early NEC/NEC like disease (ENEC) and classic NEC/NEC like disease (CNEC) in preterm infants. In this pilot study, preterm infants who developed the clinical symptoms and signs of NEC/NEC like disease were divided into two groups as early (≤ 7 days, ENEC) or late (> 7 days, CNEC) groups. Beside clinical variables, serum L-lactate, endothelin-1 (ET-1), platelet activating factor (PAF), and intestinal fatty acid binding protein (I-FABP) levels were measured from umbilical/peripheric venous blood in the first hour of life and during the clinical presentation in all groups. A total of 86 preterm infants were enrolled in the study. In the ENEC group, the incidences of fetal umbilical artery Doppler velocimetry abnormalities, IUGR, and delayed passage of first meconium were higher. In addition, mean levels of L-lactate, ET-1, PAF, and I-FABP were higher in the first hour of life.Conclusion: Our study firstly showed that the dominant pathophysiological factor of ENEC is prenatal hypoxic-ischemic event where intestinal injury and inflammation begin in-utero and become clinically apparent in the first week of life. Therefore, we propose a new term "Hypoxic-Ischemic Enterocolitis (HIEnt)" for the definition of ENEC in preterm infants with prenatal hemodynamic disturbances and IUGR. This new sight can provide individualized preventive and therapeutic strategies for preterm infants.What is Known:• The pathophysiology of early necrotizing enterocolitis (NEC) or NEC-like disease which is seen in the first week of life seems different than classic necrotizing enterocolitis (CNEC) which is always seen after the first week of life.What is New:• This study suggests that perinatal hypoxic-ischemic process with inflammation is the point of origin of fetal intestinal injury leading to ENEC.• We propose a new term "Hypoxic-Ischemic Enterocolitis (HIEnt)" for the definition and differentiation of this unique clinical entity.

Controversy exists regarding which of the 2 major strategies currently used to prevent chronic lung disease (CLD) in preterm infants is optimal: noninvasive continuous positive airway pressure (NCPAP) or intubate-surfactant-extubate (INSURE). Preterm infants often require surfactant administration because of respiratory distress syndrome. To evaluate whether early INSURE or NCPAP alone is more effective in preventing CLD, death, or both. We searched the MEDLINE, EMBASE, Cochrane Controlled Trials Register, and Cumulative Index to Nursing and Allied Health Literature databases from their inception to January 2, 2015, along with conference proceedings and trial registrations. Randomized clinical trials that compared early INSURE with NCPAP alone in preterm infants who had never been intubated before the study entry were selected. Among 1761 initially identified articles, 9 trials (1551 infants) were included. Duplicate study selection and data extraction were performed. Meta-analysis was conducted using random-effects models with quality-of-evidence assessment according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Seven main outcomes were selected a priori to be assessed according to GRADE, including a composite outcome of CLD and/or death, CLD alone, death alone, air leakage, severe intraventricular hemorrhage, neurodevelopmental impairment, and a composite outcome of death and/or neurodevelopmental impairment. There were no statistically significant differences between early INSURE and NCPAP alone for all outcomes assessed. However, the relative risk (RR) estimates appeared to favor early INSURE over NCPAP alone, with a 12% RR reduction in CLD and/or death (RR, 0.88; 95% CI, 0.76-1.02; risk difference [RD], -0.04; 95% CI, -0.08 to 0.01; moderate quality of evidence), a 14% decrease in CLD (RR, 0.86; 95% CI, 0.71-1.03; RD, -0.03; 95% CI, -0.06 to 0.01; moderate quality of evidence), and a 50% decrease in air leakage (RR, 0.50; 95% CI, 0.24-1.07; RD, -0.03; 95% CI, -0.06 to 0.00; very low quality of evidence). The sample size was less than the optimal information size. Currently, no evidence suggests that either early INSURE or NCPAP alone is superior to the other. INSURE does not appear to increase CLD and/or death, CLD alone, and air leakage and may reduce these adverse outcomes compared with NCPAP alone. Further adequately powered trials are required.

Reliability of Echocardiographic Indicators of Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia