Care Of Preterm Newborns Research Articles

Monitoring lung and cerebral oxygenation using near-infrared spectroscopy in preterm infants during kangaroo mother care

Lung function has never been assessed during kangaroo mother care (KMC) in preterm infants. We measured lung (rSO2L) and cerebral (rSO2C) oxygenation by near-infrared spectroscopy (NIRS) in infants born at less than 32 weeks of gestation or weighing ≤ 1500 g during KMC. rSO2L, rSO2C, and pulmonary (FOEL) and cerebral (FOEC) tissue oxygen extraction fraction were measured in 20 preterm infants before, during, and after a 2-h period of KMC at a mean postnatal age of 36 ± 21 days of life. We found that rSO2L, rSO2C, FOEL, and FOEC did not change in our patients. After 120 min of KMC, rSO2L was lower (71.3 ± 1.4 vs. 76.7 ± 4.6%; P = 0.012) in infants with BPD (n = 6; 30%) than in infants without BPD (n = 14 = 60%), while FOEL was higher (0.26 ± 0.02 vs. 0.20 ± 0.05; P = 0.012).Conclusion: Cerebral and lung oxygenation did not change in preterm infants during KMC. A transient decrease in lung oxygenation was offset by the increase in oxygen extraction, but these changes were clinically insignificant. These results confirm the safety of KMC in preterm infants who are in stable clinical conditions.What is Known• Kangaroo mother care (KMC) is widely used to improve the care of preterm newborns since it improves their outcome.• KMC is safe as patients’ vital parameters, are not negatively affected, but lung function has never been directly assessed.What is New• Cerebral and lung oxygenation measured by near-infrared spectroscopy did not change during KMC.• A transient decrease in lung oxygenation compensated for by the increase in oxygen extraction occurred only in infants with BPD, but these changes were clinically insignificant.

#848 Influence of nutrition and other factors on preterm newborns’ kidney development

Abstract Background and Aims According to WHO, in 2020, preterm newborns represented around 10% of all newborns in the world. Premature birth is deeply connected with the risk of developing a chronic kidney disease later in life. This is caused by defects in kidney development (primarily the lower number of nephrons) that are often difficult to identify in the complicated clinical picture of premature babies. Our study aims at providing knowledge on the relationship between preterm infant kidney development and morbidities, nutrition, and blood biomarkers. Method Creatinine was measured in 130 extremely preterm newborns (less than 28 weeks of gestation) enrolled in a randomized controlled trial (Mega Donna Mega) in two Swedish neonatal intensive care units. Creatinine was measured in whole blood or serum with the enzymatic method. Individuals with 4 or more serum creatinine measurements (n = 92) were shortlisted for eGFR calculation. eGFR was calculated with the Wilhelm-Bals weight-based equation due to the lack of length measurements. The patients were divided in 3 groups based upon their kidney development status. This was indirectly assessed using the exponential regression curve describing the eGFR trends as model and the doubling time as discriminating parameter. Data about morbidity, treatment, nutrition, blood lipidomics and proteomics were also collected during the MegaDonnaMega trial and has been used to investigate the differences between the three groups. A linear model adjusted for sex and gestational age was used to analyse lipidomics and proteomics data in relation to eGFR. The omics analysis used average data from the first month of age. Data analysis was performed in R, SPSS, SAS and GraphPad statistical programs. Results Subjects were divided in 3 groups from best to worst kidney function development. The parameter used, doubling time, is inversely correlated to eGFR and kidney development. Subjects in group 1 reached the normal at-term birth eGFR (40 ml/min/1.73 m2) at around 50 days of age, whereas the other two groups were delayed (66 days for group 2, 78 for group 3). Subjects in group 2 and 3 were characterized by longer stay at the NICU, lower weight and length in respect to infants in group 1. Subjects in groups 2 and 3 also showed more co-morbidities in respect to group 1. Regarding nutrition, subjects administered with maternal milk had shorter doubling times when compared to those administered with donor or mixed milk. Six serum fatty acids correlated with the eGFR trends: heptadecanoic (FA 17:0) showed a negative correlation, while palmitoleic (16:1n-7), gamma-linolenic (18:3n-6), erucic (22:1n-9) docosapentaenoic (22:5n-6) and tricosanoic (23:0) acid showed positive correlations. 45 serum proteins correlated with the eGFR trends, in particular, inflammatory and proliferative pathways showed an inverse correlation with eGFR. Conclusion We have detected differences in the eGFR trends of preterm newborns that could be traced back to nutrition and other factors. Moreover, we identified several serum fatty acids and proteins that correlated with eGFR and therefore kidney development. The data indicates that postnatal kidney development may be important to consider in the clinical care of preterm newborns.

Mother Support Groups for Raising Awareness in the Community About Kangaroo Mother Care and Breastfeeding in the Era of COVID-19: Experiential Learning

Introduction This article explores the establishment and subsequent challenges faced by a Mother Support Group (MSG) initiated in Gujarat, India, focusing on promoting Kangaroo Mother Care (KMC) and exclusive breastfeeding, particularly amid the COVID-19 era. Methods The methodology involved adapting to COVID-19 restrictions, utilizing online platforms for training and webinars, and collaborating with ASHA workers for community outreach. The MSG members received training on breastfeeding and KMC, followed by practical demonstrations and community visits. Although initial efforts were promising, the group’s sustainability faltered when key stakeholders withdrew, revealing challenges in maintaining community-driven interventions. Results and discussion The article underscores the importance of sustained efforts in establishing and retaining parent support groups. The lack of comprehensive data collection limits the ability to evaluate specific outcomes, but we highlight the potential benefits of MSG, including improved breastfeeding practices and KMC adherence. We acknowledge the need for robust frameworks and standard operating procedures to enhance the sustainability of such initiatives, emphasizing the importance of community involvement and leadership in supporting disadvantaged newborns. Conclusion We draw attention to the complexities of sustaining grassroots initiatives and call for further research to develop effective models that address the unique needs of marginalized communities, particularly regarding the care of preterm newborns.

Characterization and neuroprotective care for preterm newborns in an Intensive Care Unit

Objective: To characterize the clinical-epidemiological profile of premature infants admitted to the intensive unit of a public hospital in Paraná. Methods: This is a retrospective observational study based on 170 medical records of newborns <32 weeks, born and staying at the study institution and without associated pathologies, hospitalized between 2017 and 2021. Data were collected between June and August 2022, after approval of the Ethics Committee, and, subsequently, a descriptive analysis was carried out, with simple and relative frequencies, mean, median, standard deviation and interquartile range, and inferential, using the chi-square test and the Mann-Whitney test. Results: The majority were male, delivered by cesarean section, very premature, with very low birth weight, Apgar ≥7 at the fifth minute, needing immediate assistance at birth. There were 31 (18.2%) deaths and there was a higher frequency of peri-intraventricular hemorrhage in males preterm newborns, with lower gestational ages, birth weight and Apgar. Minimum care measures were recorded in 43 (25.3%) medical records, which guided neuroprotective care and reduced the risk of brain injury and subsequent problems. Conclusion: Identifying the profile and factors that can be intervened can prevent premature dbirths and reduce the number of newborns affected by peri-intraventricular hemorrhage. The importance of developing public policies and effective programs aimed at maternal and child health is highlighted, in order to improve quality of care and reduce negative outcomes.

Factors influencing fathers’ involvement in the care of hospitalized preterm newborns in Balaka, Malawi

BackgroundMalawi has one of the highest incidences of premature birth, with twice the mortality compared to full-term. Excluding fathers from preterm newborn care has negative consequences, including father feeling powerless, missed bonding opportunities with the newborn, additional strain on the mother, and negative family dynamics such as breakdown in communication, reduced trust, and strained relationships. In Malawi, there is no deliberate policy to have fathers involved in preterm care despite having high incidence of preterm birth and neonatal mortality. There is also limited literature on the factors that influence fathers’ involvement in the care. The aim of the study was to explore factors influencing fathers’ involvement in the care of hospitalized preterm newborns.MethodsA descriptive qualitative study design was used, guided by Theory of planned behaviour and the model proposed by Lamb on male involvement. Sixteen in-depth interviews were conducted with fathers of preterm infants purposively and conveniently sampled in June 2021. Interviews were digitally recorded and transcribed verbatim. Data were organized and analyzed using Nvivo software and thematic analysis approach was used because the approach allows deeper understanding of the data, identification of patterns and themes, and provides rich insights into participants’ experiences and perspectives.ResultsThe barriers and facilitators that influence a father’s involvement in the care of preterm newborn babies include: perceived difficulty with care activities and benefits of involvement, gender roles and socio-cultural beliefs, work and other family responsibilities, social support, baby’s physical appearance/nature and health status, feedback from the baby, multiple births, and hospital’s physical environment and provision of basic needs.ConclusionThe study found that fathers value their involvement in caring for hospitalized preterm newborns but face barriers. Evidence-based interventions like education programs, training sessions, and support groups can help fathers overcome barriers and promote better outcomes for infants and families.

Development of the Individualised Developmental Care Knowledge and Attitude Scale

BackgroundThere is a need for a valid and reliable scale to determine the individualised developmental care levels of nurses who provide care for preterm newborns. AimsTo develop the Individualised Developmental Care Knowledge and Attitude Scale for nurses who provide care to preterm newborns and to evaluate its validity and reliability. MethodsThis methodological study was performed with 260 nurses who provide care for preterm newborns in neonatal intensive care units. The content validity of the research was evaluated under the guidance of professionals working in the pediatric field. Collected data were analysed using values, percentage, mean, standard deviation, correlation analysis, Cronbach's alpha reliability coefficient and factor analysis methods. ResultsThe total Content Validity Index for all items was found to be 0.930. The result of Bartlett's test of sphericity (x2 = 4691.061, p = 0.000) was significant, and the KMO (Kaiser-Meyer-Olkin) measure of sampling adequacy was 0.906. The fit indices for confirmatory factor analysis were x2/SD = 4.35, GFI = 0.97, AGFI = 0.97, CFI = 0.97, RMSEA = 0.057 and SRMR = 0.062. All of the related fit indices were in the accepted range. The Individualised Developmental Care Knowledge and Attitude Scale was developed at the end of the study, and 34 items and four dimensions were identified. The Cronbach's alpha of the full scale was 0.937. ConclusionsFrom the results, it can be concluded that the Individualised Developmental Care Knowledge and Attitude Scale is both a reliable and valid measurement tool for determining individualised developmental levels.

Effectiveness Of Simulation- Based Learning In Term Of Competency Regarding Pre-Term Newborn Care Among Nursing Students: An Quasi Experimental Study

Background: Premature birth is a sudden event of birth below the 37th week of pregnancy. In the third trimester, that is, 27-40 weeks of gestation when the baby’s major stages of development take place, the baby receives a wonderful blood supply to its respiratory system that enables it to breathe for the first time.
 Material And Method: A Quasi- experimental Non- equivalent control group pre-test post-test design was adopted to assess the effectiveness of simulation based learning in terms of competency of nursing students. Data was collected from 114 students studying BSc. 3rd Year in M.M. College of Nursing, and M.M. Institute of Nursing, Mullana, Ambala, Haryana. Study participants were randomly allotted in experimental group (n=55) and comparison group (n=59) by using purposive sampling technique. The data was collected by using selected variables, Structured Knowledge Questionnaires, Objective Structured Clinical Examination (OSCE) and Clinical Decision Making Ability Questionnaires.
 Results: The study findings showed that majority of the nursing students (80%) were female in experimental group and (79.66%) in comparison group. The mean post-test knowledge score (26.22±5.24) of nursing students in experimental group was higher than the mean post -test knowledge score (22.46±6.54) of comparison group. The mean post-test skills score (45.40±7.45) of nursing students in experimental group was lower than the mean post -test skills score (45.51±8.36) of comparison group. The mean post-test clinical decision making ability score (17.84±2.84) of nursing students in experimental group was higher than the mean post-test clinical decision making ability score (14.39±5.47) of comparison group. The calculated ‘t’ value of post-test knowledge scores in experimental and comparison group (p=0.00*) and the calculated ‘t’ value of post-test skills scores in experimental and comparison group (p=0.94*) The calculated t value of post-test clinical decision making ability scores in experimental and comparison group(p=0.00*) was found to be statistically significant at 0.05 level of significance.
 Conclusion: The study concluded that Simulation based learning was effective in enhancing the competency in terms of knowledge, skills and clinical decision making ability regarding Preterm Newborn Care among Nursing Students.

The care of the magic of life before and after its beginning.

The Journal of Perinatal Medicine helps me a lot to understand how impacted in my work as Neonatologist the crucial importance of permanently think on prenatal development and postnatal experiences of the newborn we are caring, and how the parents live the moment. We should produce High Technology but at the same time seriously consider High Prenatal life Advances. Possibly noother field of medicine has undergone such dramatic progress in reducing mortality and morbidity as the care of preterm newborns. In recent years, remarkable advances in the care of pregnant women and their babies have led toan increase in infant survival. However, advances in neonatal care need to be accompanied by mechanisms that help us deliver care safely to this most vulnerable population. Great progress has been made in perinatal care, but the health-care system must do much more. The health-care system faces a great challenge, the era of reflection between real progress and innovations. It means: Seriously consider what we are really doing and what we should really do.

How delayed full enteral feeding could affect extrauterine growth restriction in a neonatal intensive care unit: a retrospective, short-term, observational single-center study.

Achieving adequate growth in preterm newborns through enteral feeding is one of the most important aspects of providing medical assistance in neonatal intensive care units due to not only improved outcomes (the prevention of complications such as necrotizing enterocolitis) but also the evaluation of the well-known consequences of adequate weight gain beyond metabolism and cognitive abilities later in life. In our study, we evaluated how the impact of delayed full enteral feeding could influence the entity of extrauterine growth restriction. We retrospectively analyzed the data of preterm subjects from a neonatal intensive care unit anonymous database. We detected significant correlations between delayed full enteral feeding as well as prolonged parenteral nutrition and extrauterine growth restriction. The achievement of full enteral feeding in the shortest possible time may be reasonably considered an important aspect in preterm newborn care.

Experience of family members in the care of preterm newborns discharged from a neonatal intensive care unit

Objective: to understand the experience of family members in the care of preterm newborns discharged from the Neonatal Intensive Care Unit. Methods: qualitative study, developed with 16 family members of preterm newborns discharged from a neonatal unit through semi-structured interviews. Data were submitted to thematic content analysis. Results: three categories were listed: Family members' rearrangements in the care of the preterm newborn at home; recognizing the specific care needs of the preterm child; and care in the face of complications and sequelae resulting from prematurity. Conclusion: family members recognize that the preterm newborn requires differentiated care and, therefore, experience a reorganization of their daily lives to promote the care of the child after discharge from the neonatal unit. Contributions to practice: this study points out the relevance of the nurse's work with families in neonatal units by strengthening family skills so that they can undertake care, so that it can be offered safely and meet the health demands that arise on a daily basis at home, in addition to guiding them about the need for monitoring the child after discharge.

Direct costs of prematurity and factors associated with birth and maternal conditions.

ABSTRACTOBJECTIVE To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay.METHODS This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component.RESULTS A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40–8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00).CONCLUSIONS We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.

Osteopathic Manipulative Treatment Regulates Autonomic Markers in Preterm Infants: A Randomized Clinical Trial.

Osteopathic manipulative treatment (OMT) has been found to be effective in the context of premature infants. Nonetheless, no studies have investigated the immediate effects of OMT on heart rate variability (HRV). As altered HRV reflects poor or worsening newborn’s clinical conditions and neurodevelopment, should OMT improve HRV fluctuations, it could become a relevant intervention for improving the care of preterm newborns. Therefore, this study aimed to evaluate whether OMT could affect HRV. The study was carried out at the Buzzi Hospital in Milan. From the neonatal intensive care unit, ninety-six preterm infants (41 males) were enrolled and were randomly assigned to one of two treatment groups: OMT or Static Touch. The infants were born at 33.5 weeks (±4.3) and had a mean birth weight of 2067 g (±929). The study had as primary outcome the change in the beat-to-beat variance in heart rate measured through root mean square of consecutive RR interval differences (RMSSD); other metrics were used as secondary and exploratory analyses. Despite the lack of statistically significant results regarding the primary outcomeand some study limitations, compared to static touch, OMT seemed to favor a parasympathetic modulation and improved HRV, which could reflect improvement in newborn’s clinical conditions and development.

CONTINUIDADE DO CUIDADO AO RECÉM-NASCIDO PRÉ-TERMO EGRESSO DA UNIDADE NEONATAL: VIVÊNCIAS DE FAMILIARES

ABSTRACT Objective: to investigate the continuity of care of preterm newborns discharged from the neonatal unit from the perspective of family members. Method: qualitative exploratory study, based on the conceptual perspective of continuity of care, developed with 16 relatives of preterm newborns discharged from a neonatal unit of a university hospital in the state capital of Mato Grosso, Brazil. Data collection occurred from August to November 2019, through semi-structured interviews conducted in the participants' homes and subsequently submitted to the content analysis technique. Results: the 16 family members reported their perspectives on the continuity of care for preterm newborns who graduated from the neonatal unit, revealing informational fragility in the scope of primary care and other health services; a satisfactory relationship through the link with the service in which the child was born, which is materialized by the access to the follow-up outpatient clinic; and difficulty access to care, lack of articulation and communication between the different levels of care, compromising the implementation of the reference and counter-reference between the services. Conclusion: the continuity of care after discharge is brokered by the family itself, due to its protagonism and autonomy when caring for the child in the neonatal unit. Regardless of whether health services act in an articulated way, families seek health spaces, information and sources of support to support care.

Early discharge and hospital-assisted home care is associated with better neurodevelopmental outcome in preterm infants

AimsTo compare hospital-assisted neonatal home care and standard hospital care for preterm newborns on neurodevelopment at 2 years corrected age, as well as duration of hospitalization, breastmilk rates, and readmissions before 1 year. MethodsThis observational study enrolled 415 inborn neonates <34+ 6 weeks that received home care (2008 to 2015) in the French University Hospital of Toulouse and 3186 neonates from the national cohort of infants discharged in 2011 that received standard hospital neonatal care (EPIPAGE 2). Neurodevelopment at 2 years was assessed with the Ages and Stages Questionnaire-3 (ASQ-3). ResultsAt two years corrected age, infants in home care had 61% less risk of overall low ASQ ≤220 (OR = 0.4 [0.3–0.5], p < 0.001) and 31–80% less risk of low scores in four out of five domains compared to standard care. Home care was associated with shorter hospital stays (− 9 days; p < 0.001), higher breastmilk rates at final discharge (OR = 3.6 [2.8–4.6], p < 0.001 for singletons and OR = 2.3 [1.6–3.1], p < 0.001 for multiples), and more breastmilk feeding for at least six months (OR = 1.8 [1.3–2.3], p < 0.001 for singletons, OR = 3.6 [2.1–6.3], p < 0.001 for multiples). Readmissions also occurred less frequently with home care than with standard care, except for twins (OR = 0.7 [0.6–0.8], p < 0.001). ConclusionHospital-assisted neonatal home care for preterm infants was associated with better neurodevelopment at 2 years corrected age, shorter duration of hospitalization, and higher rates of breastmilk feeding at 6 months.

The effect of routine probiotics supplementation on preterm newborn health: a regression discontinuity analysis

Despite ongoing debate about the health impact of probiotics, rigorous evidence assessing the use of probiotics in routine preterm newborn care is lacking. We aimed to estimate the causal effect of routine probiotics supplementation on moderately preterm newborns' anthropometric development (weight-for-age and height-for-age z scores) and risk of late-onset sepsis. This study used a regression discontinuity analysis based on hospital guidelines that recommended routine probiotics supplementation for neonates born before 34 completed weeks of gestation. Data for this study came from electronic medical records of a level III neonatal care center in Germany and were collected between 2013 and 2019. Newborns born between 30 to 38 completed weeks of gestation without severe congenital defects were eligible for inclusion. Outcomes were weight-for-age and height-for-age z scores at discharge as well as late-onset sepsis. Study participants included 1734 preterm neonates. The results showed no significant intention-to-treat effect on weight-for-age (effect: -0.033 SD; 95% CI: -0.220, 0.155), length-for-age (-0.133 SD; 95% CI: -0.380, 0.114), or late-onset sepsis probability (-1.175 percentage points; 95% CI: -6.556, 4.205). There was no evidence for significant effects of probiotics for any of the study's endpoints on those complying with the hospital guidelines (local average treatment effect). Routine treatment of moderately preterm newborns with probiotics is unlikely to improve anthropometric outcomes. Complier-level analysis suggested that this finding was not simply driven by a lack of physician compliance with hospital guidelines but by an overall absence of large health effects from the treatment itself. Moreover, overall sepsis risk was low and did not change significantly as a result of probiotics supplementation. The findings of this study therefore do not support the routine use of probiotics for improving growth or preventing late-onset sepsis in moderately preterm neonates.

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

Erratum: Reduced Hippocampal Dendrite Branching, Spine Density and Neurocognitive Function in Premature Rabbits, and Reversal with Estrogen or TrkB Agonist Treatment.

Preterm-born children suffer from neurological and behavioral disorders. Herein, we hypothesized that premature birth and non-maternal care of preterm newborns might disrupt neurobehavioral function, hippocampal dendritic arborization, and dendritic spine density. Additionally, we assessed whether 17β-estradiol (E2) replacement or the TrkB receptor agonist, 7,8-dihydroxyflavone (DHF), would reverse compromised dendritic development and cognitive function in preterm newborns. These hypotheses were tested by comparing preterm (E28.5) rabbit kits cared and gavage-fed by laboratory personnel and term-kits reared and breast-fed by their mother doe at an equivalent postconceptional age. Neurobehavioral tests showed that both premature-birth and formula-feeding with non-maternal care led to increased anxiety behavior, poor social interaction, and lack of novelty preference compared with term-kits. Dendritic branching and number of total or mushroom dendritic spines were reduced in the CA1 field of preterm-kits compared with term controls. While CDC42 and Rac1/2/3 expression levels were lower, RhoA-activity was higher in preterm-kits compared with term controls. Both E2 and DHF treatment reversed prematurity-induced reduction in spine density, reduced total RhoA-GTPase levels, and enhanced cognitive function. Hence, prematurity and non-maternal care result in cognitive deficits, and reduced dendritic arbors and spines in CA1. E2 replacement or DHF treatment might reverse changes in dendritic spines and improve neurodevelopment in premature infants.

TREATMENT OF RESPIRATORY DISTRESS-SYNDROME IN PRETERM NEWBORNS WITH THE USE OF EXOGENOUS SURFACTANT (PORACTANT ALFA): CLINLCAL GUIDLINES

Respiratory distress-syndrome (RDS) is an acute lung disease that occurs mainly in pretermnewborns due to deficiency of pulmonary surfactant and immaturity of the respiratory system. Its symptoms appear shortly after birth, and the clinical course in the absence of treatment is characterized by a worsening condition during the first 2 days of life.Despite the improvement and effectiveness of the prevention and treatment of RDS, this disease remains an important cause of death in newborns. According to European data, mortality associated with RDS can reach 10%, and according to the latest official statistical data from the United States, this disease ranks 8thamong the most important causes of death in infants.According to official statistical data from obstetrical hospitals, the incidence of RDS in Ukraine in 2016 was 194 cases per 1000 premature babies. The majority of patients in modern Ukrainianneonatal intensive care units die from the complications associated with this disease, especially intraventricular hemorrhages.The clinical recommendations contain sections on the etiology, pathogenesis, clinical presentation, antenatal prevention of RDS with recommendations for stabilizationafter birth and further,at the neonatal intensive care unit. Separately, the metabolism of surfactant, the importance of drug selection and the correct dose of surfactant use, practical recommendations on its use, indications, preparation for use and administration techniques are presented taking into account the international evidence-based data.Clinical guideline was elaborated for neonatologists, pediatric anesthesiologists and residents to improve the quality of medical care for preterm newborns at risk for developing or having RDS; the optimization of methods of medical care for preterm newborns to decrease the incidence of the disease, development of complications and mortality of premature babies at risk for or developing RDS.

Reduced Hippocampal Dendrite Branching, Spine Density and Neurocognitive Function in Premature Rabbits, and Reversal with Estrogen or TrkB Agonist Treatment.

Preterm-born children suffer from neurological and behavioral disorders. Herein, we hypothesized that premature birth and non-maternal care of preterm newborns might disrupt neurobehavioral function, hippocampal dendritic arborization, and dendritic spine density. Additionally, we assessed whether 17β-estradiol (E2) replacement or the TrkB receptor agonist, 7,8-dihydroxyflavone (DHF), would reverse compromised dendritic development and cognitive function in preterm newborns. These hypotheses were tested by comparing preterm (E28.5) rabbit kits cared and gavage-fed by laboratory personnel and term-kits reared and breast-fed by their mother doe at an equivalent postconceptional age. Neurobehavioral tests showed that both premature-birth and formula-feeding with non-maternal care led to increased anxiety behavior, poor social interaction, and lack of novelty preference compared with term-kits. Dendritic branching and number of total or mushroom dendritic spines were reduced in the CA1 field of preterm-kits compared with term controls. While CDC42 and Rac1/2/3 expression levels were lower, RhoA-activity was higher in preterm-kits compared with term controls. Both E2 and DHF treatment reversed prematurity-induced reduction in spine density, reduced total RhoA-GTPase levels, and enhanced cognitive function. Hence, prematurity and non-maternal care result in cognitive deficits, and reduced dendritic arbors and spines in CA1. E2 replacement or DHF treatment might reverse changes in dendritic spines and improve neurodevelopment in premature infants.

Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation Study.

BackgroundAlthough rates of preterm birth continue to increase globally, identification of preterm from low birth weight infants remains a challenge. The burden of low birth weight vs preterm is greatest in resource-limited settings, where gestational age (GA) prior to delivery is frequently not known because ultrasound in early pregnancy is not available and estimates of the date of the mother’s last menstrual period (LMP) may not be reliable. An alternative option is to assess GA at birth to optimize referral and care of preterm newborns. We previously developed and pilot-tested a system to measure the simplified gestational age score (SGAS) based on 4 easily observable neonatal characteristics.ObjectiveThe objective of this study is to adapt the scoring system as a tablet app (potentially scalable approach) to assess feasibility of use and to validate whether the scoring system accurately predicts prematurity by itself, over and above birth weight in a large sample of newborns.MethodsThe study is based in Nagpur, India, at the Research Unit of the National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research. The Android tablet app for the SGAS (T-SGAS) displays de-identified photographs of skin, breasts, and genitalia across a range of GAs and line drawings of infant posture. Each item is associated with a score. The user is trained to choose the photograph or line drawing that most closely matches the newborn being evaluated, and the app determines the neonate’s GA category (preterm or term) from the cumulative score. The validation study will be conducted in 3 second level care facilities (most deliveries in India occur in hospitals, and women known to be at risk of preterm birth are referred to second level care facilities). Within 24 hours of delivery, women and their babies who are stable will be enrolled in the study. Two auxiliary nurse midwives (ANMs) blinded to prior GA assessments will use the T-SGAS to estimate the GA status of the newborn. An independent data collector will abstract the GA from the ultrasound recorded in the hospital chart and record the date of the mother’s LMP. Eligibility for analysis is determined by the ultrasound and LMP data being collected within 1 week of each other to have a rigorous assessment of true GA.ResultsPublication of the results of the study is anticipated in 2019.ConclusionsUntil GA dating by ultrasound is universally available and easy to use in resource-limited settings, and where there are restrictions on ultrasound use due to their use for sex determination and abortion of female fetuses, this study will determine whether the T-SGAS app can accurately assess GA in risk categories at birth.Trial RegistrationClinicalTrials.gov NCT02408783; https://clinicaltrials.gov/ct2/show/NCT02408783 (Archived by Webcite at http://www.webcitation.org/75S2kmr3T)International Registered Report Identifier (IRRID)DERR1-10.2196/11913