Gestational Birth Research Articles

Effect of gestational age on growth of low birth weight infant: retrospective cohort study

Introduction: Growth is essential in children, especially in the first two years of life. History of low birth weight (LBW) and gestational age are known to be several factors that influence growth and relate to growth retardation. This study aims to analyze the effect of gestational age on the growth of LBW infants. Methods: An observational analytical study design with a retrospective cohort approach and quantitative study methods was conducted in September 2023. Subjects were gathered by simple random sampling. Twenty-four preterm infants and 24 full-term infants born from September 2021 to September 2022 who met the inclusion criteria were followed up. Subjects were weighed on a scale, and the results were plotted on the World Health Organization (WHO) weight-for-age growth chart. The plotted results are presented as a Z-score, which can be further categorized into two groups: severely underweight and underweight (growth not achieved), along with normal and risk of overweight (growth achieved). Result: Of the 48 subjects, the majority were male (66.67%), aged between 12-15 months (39,6%), born by cesarean section (83.3%), and had a history of exclusive breastfeeding (64.6%). Most subjects with a history of full-term and preterm LBW were in the normal category (70.8% and 75%, respectively). The result showed full-term LBW infants have 1.75 times greater risk of not achieving growth than preterm LBW with RR 1.750 (95%CI 0.588 to 5.207). Conclusion: Gestational age affects growth, with full-term infants at more risk of not achieving growth.

Maternal EGCG intervention mitigates chronic hypertension during pregnancy in spontaneously hypertensive rats without adverse effects on pregnancy outcomes

Background: Chronic hypertension during pregnancy is a significant concern, associated with increased risks of maternal-fetal morbidity and mortality. Epigallocatechin gallate (EGCG), a compound known for its cardioprotective properties, has gained attention as a potential health supplement due to its favorable safety profile. Objective: This study aims to investigate the effects of maternal EGCG supplementation on elevated blood pressure and pregnancy outcomes in a rodent model of chronic hypertension, specifically using spontaneously hypertensive rats (SHR). Furthermore, the study explores the influence of maternal EGCG supplementation on the blood pressure of SHR offspring during early postnatal development. Methods: SHR dams received oral EGCG at 30 mg/kg body weight. Systolic blood pressure (SBP) monitored weekly throughout gestation period and until postpartum day 21. Pregnancy outcomes - litter size, pup viability, and birth weights - were recorded. SBP in weaned SHR offspring was monitored from 5 to 13 weeks of age to assess long-term effects of maternal EGCG treatment. Daily cage-side observations evaluated general health, behavior, and signs of toxicity. Plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, and creatinine were analyzed to evaluate liver and kidney function. Results: EGCG treatment in SHR dams progressively reduced maternal SBP throughout gestation and the postpartum period. However, EGCG administration did not affect pregnancy outcomes (gestation duration, litter size, and birth weights). Markers of liver and kidney function (ALT, AST, urea, and creatinine) showed no signs of organ injury in EGCG-treated groups. Contrary to expectations, SBP in SHR offspring exposed to perinatal EGCG did not decrease compared to control groups, indicating maternal EGCG did not alter the offspring's hypertension predisposition. Conclusion: Maternal EGCG supplementation effectively lowered blood pressure in hypertensive dams without compromising pregnancy outcomes or causing liver and kidney damage. These findings suggest that EGCG may be a safe cardioprotective supplement during pregnancy. However, perinatal EGCG exposure did not alter the inherent genetic predisposition to hypertension in SHR offspring. Keywords: Theaceae; Camellia sinensis; green tea; catechins, EGCG; hypertension, pregnancy outcomes, perinatal, spontaneously hypertensive rats, chronic hypertension during pregnancy

Risk factors for and short-term prognosis of intrauterine infection in preterm infants.

To identify the risk factors for and short-term prognosis of intrauterine infection (IUI) in preterm infants. We retrospectively collected clinical data regarding preterm infants (28+0-36+6 weeks of gestational age) with IUI from the neonatal intensive care unit of our hospital between June 2017 and June 2022. The pathologic characteristics of the infants were classified using the Redline criteria, and the resulting groups were compared with respect to their clinical characteristics, indicators of infection, complications, and mortality rates. Three hundred thirty (78.1%) of the 422 enrolled neonates showed signs of histologic IUI; 51.8% showed histologic chorioamnionitis alone, and 48.2% showed both histologic chorioamnionitis and funisitis. The independent risk factors identified for IUI were maternal prenatal invasive manipulation, premature rupture of membranes (>18 hours before labor), and prenatal C-reactive protein concentration. The infants with IUI showed higher incidences of respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, and prolonged mechanical ventilation. Low gestational age and low birth weight of preterm infants were significantly associated with a higher incidence of histologic IUI, more severe inflammation, and a higher incidence of complications. Histologic IUI is associated with high complication and mortality rates in preterm infants, as is an increasing severity of inflammation.

Association between Ureaplasma colonization and bronchopulmonary dysplasia defined by different criteria in very low birth weight infants: A retrospective cohort study.

To study the association between Ureaplasma colonization and bronchopulmonary dysplasia (BPD) with different definitions in very low birth weight (VLBW) infants. A retrospective cohort study was performed with VLBW infants admitted from January 2019 to October 2021. Neonates with a positive respiratory tract Ureaplasma culture were included in the study group. Control group infants, matched for gestational age (±1 week), birth weight (±100 g), and birth year, had a negative respiratory tract Ureaplasma culture during the same period. The primary outcomes included the incidence and severity of BPD, defined by various criteria. The study included 302 neonates (151 in the study group and 151 in the control group). After adjusting for confounders, Ureaplasma colonization was not associated with BPD as defined by the National Institutes of Health (NIH) in 2001 (adjusted odds ratio [aOR]: 0.820, 95% confidence interval [CI]: 0.362-1.860, p = .635). However, it was associated with BPD as defined by the NIH in 2018 (aOR: 2.490, 95% CI: 1.128-5.497, p = .024) and the Neonatal Research Network (NRN) in 2019 (aOR: 2.352, 95% CI: 1.077-5.134, p = .032). Additionally, VLBW infants with Ureaplasma colonization had a higher risk of moderate-severe BPD according to the NIH 2001 (aOR: 2.352, 95% CI: 1.077-5.134, p = .032), NIH 2018 (aOR: 6.339, 95% CI: 1.686-23.836, p = .006), and NRN 2019 definitions (aOR: 3.542, 95% CI: 1.267-9.904, p = .016). Ureaplasma colonization is not associated with BPD by the NIH 2001 definition, but is associated with an increased incidence by the NIH 2018 or NRN 2019 definitions.

DIAGNOSTIC VALUE OF HEMATOLOGICAL PARAMETERS IN NEONATAL SEPSIS

Background: Neonatal infections, mainly sepsis, constitute an extremely important cause of morbidity and mortality in newborns, particularly in developing countries. Early diagnosis is important for receiving proper treatment and better prognosis. Objective: To assess the diagnostic ability of different hematological parameters in neonatal sepsis taking blood culture as a gold standard. Methods: A total of 102 neonates admitted to NICU, at PAEC General Hospital, Islamabad, between Feb, 2023 to April, 2024, with clinical suspicion for sepsis were included in the study. Each patient was subjected to lab investigations which included WBC, ANC, Platelets, CRP and blood culture. Neonates were categorized as Group A (culture-positive sepsis, n=48) and Group B (culture-negative sepsis, n=54). The diagnostic performance of these hematological indices was evaluated on the basis of comparison with culture report. Results: The percentage of neonates was 54.2% for the Group A and 57.4% for the Group B, no statistically significant difference (p = 0.756). Likewise, there was no statistically significant difference in the average gestational age and birth weight between Group A (36.8 ± 2.4 weeks; 2.65 ± 0.58 kg) and Group B (37.1 ± 2.2 weeks; 2.72 ± 0.62 kg) (p = 0.530 and p = 0.620, respectively). Leukocytosis was recorded in 25.0% of the neonates in group A compared to 9.3% of the babies in group B (p=0.032). Thrombocytopenia was observed in 58.3% of culture- positive neonates compared to that in 31.5% culture negatives cases (p = 0.011). Significantly higher proportions of neonates from Group A had elevated CRP levels (> 10 mg/L) compared to those from Group B (79.2% vs. 22.2%, p < 0.001). Conclusion: Hematological parameters, especially CRP levels, ANC and thrombocytopenia are useful markers for diagnosis of neonatal sepsis. CRP, in particular, showed the best sensitivity and specificity as a sepsis biomarker for neonates.

Low Antenatal Care Number of Consultations Is Associated with Gestational Weight Gain and Birth Weight of Offspring of Teenage Mothers: A Study Based on Colombian and Mexican Cohorts.

More than 70% of pregnant adolescents in developing countries experience inappropriate gestational weight gain (GWG). To determine the association of the number of antenatal care visits (ANC) with GWG, birth weight, and their differences between two countries. A prospective study was conducted in two cohorts of adolescents, one from Mexico and one from Colombia. The study calculated pregestational body mass index (BMI), obtained GWG and birth weight, and collected socioeconomic characteristics. Birth weight was categorized according to gestational age. A total of 690 mother-child pairs were included, of which 42.6% were Colombian and 57.4% Mexican. The study found no association between socioeconomic characteristics and GWG or birth weight. Colombian adolescents were more likely to experience insufficient GWG (68%), compared with 36% of Mexican adolescents. Colombian adolescents who attended fewer than eight ANC visits were at increased risk of insufficient GWG, whereas Mexican adolescents were at increased risk of excessive GWG. Mexican adolescents who began their pregnancies overweight or obese were at increased risk of excessive GWG. Fewer than eight ANC visits were associated with small for gestational age (SGA) in the Mexican cohort. Inadequate numbers of ANC visits were associated with excessive and insufficient GWG, and SGA. Promoting ANC in adolescent pregnancy is essential to prevent suboptimal GWG and SGA. This study highlights the need for interventions targeting pregnant adolescents from low socioeconomic backgrounds, prioritizing early initiation of prenatal care (first trimester) and a drastic reduction in the high rates of cesarean sections in this group.

The Effect of Different Antenatal Betamethasone Regimens on Neonatal Outcomes

Objective: Preterm births sometimes occur before the completion of antenatal steroid therapy. Some specialists recommend administering betamethasone at 12-h intervals when birth is expected to occur quickly. The purpose of this study was to compare neonatal outcomes in pregnancies in which betamethasone was administered at 12-or 24-h intervals. Material and Methods: Neonates born at <34 gestational weeks were included in this retrospective study. They were assigned to groups based on antenatal betamethasone therapy: those receiving no steroid, a single dose, and two doses at 12 or 24-h intervals. Results: Six hundred forty-four babies were enrolled including 536 Turkish and 108 refugee pregnant women. The antenatal steroid treatment rate was lower in the refugee group (p<0.05), while 12-h interval treatment was similar between Turkish and refugee groups. Intubation at birth among no steroid, a single dose and two-dose treatment groups (12- or 24-h) were 53/136 (38.9%), 62/222 (28%), and 65/286 (22.7%), and mortality rates were 34/136 (27.9%), 48/222 (21.6%), and 50/286 (17.5%), respectively (p<0.05). Thirty-six (n: 286) of the patients received two doses of betamethasone as 12-h intervals (n:36) and 24-h intervals (n:250). Times elapsing from first betamethasone administration to birth in the 12 and 24-h groups were 22 h and 92 h, respectively (p<0,001). Median gestational week and birth weight were lower in the 24-h interval group than 12-h interval group (29 and 30 weeks, p=0.007; 1190 and 1362 g, p=0.015, respectively). Conclusion: Antenatal betamethasone administered at 12-h intervals may be a suitable option when preterm birth is expected within 24 hours. This regimen is associated with better neonatal outcomes, including lower intubation and mortality rates, as well as higher gestational age and birth weight, compared to the 24-h interval group.

Cardiogenic Necrotizing Enterocolitis in Infants with Congenital Heart Disease: A Systematic Review and Meta-analysis.

Necrotizing enterocolitis (NEC) is a known cause of morbidity and mortality in infants with congenital heart disease (CHD), but reports about the burden of cardiogenic NEC frequently conflict. To synthesize the extant literature on the incidence, risk factors, and prognosis of NEC in patients with CHD. Medline, Cochrane, and EMBASE were searched from 1946 through 2023 for studies of NEC in infants 0-12months of age with CHD. Risk of bias was assessed with validated tools for incidence and risk factors. Pooled estimates were meta-analyzed by risk of bias or synthesized without meta-analysis. Eighty-six studies with a total of 67,924 participants were included. The incidence of cardiogenic NEC was 7.1% (95% CI 4.7-10.5%) in term infants and 13.0% (10.2-16.5%) in low birthweight preterm infants. NEC required surgery in 0.8% (0.5-1.1%) of term and 2.7% (2.0-3.7%) of premature infants, respectively. Only gestational age and birth weight were consistently associated with risk of NEC. Restricting pooled estimates to studies of moderate or low risk of bias significantly reduced the number of studies included. Necrotizing enterocolitis is a common cause of morbidity in infants with CHD, but additional research is needed to determine which infants are at highest risk of developing NEC and would benefit most from a change in management. This systematic review and meta-analysis was conducted according to a prespecified protocol registered at the Prospective Register of Systematic Reviews (CRD42021282114).

Work resumption and economic independence among women with paid employment one year after childbirth

Abstract Background In Europe, women are more likely to be unemployed compared to men. Also, they more often hold part-time employment. After pregnancy and childbirth, women often reduce their working hours further or even exit the workforce altogether. This not only impacts their individual career, financial stability, and economic independence, but also their own health and well-being and that of their offspring. Objectives We aim to study the patterns of women’s work resumption in the first year after childbirth, and if sick leave during pregnancy and birth outcomes small for gestational age (SGA) and preterm birth play a role in this. Data from Statistics Netherlands and the Dutch Perinatal Registry from 114,722 Dutch pregnant women in paid employment (2016) were used for the analyses. Next to descriptive analyses, multivariate regression was used to assess which factors contribute to economic independence one year after childbirth. Results After pregnancy, over 50% of women reduced their working hours, and 12% became unemployed. The largest reduction was found in the group working fulltime (from 31 to 11%), in contrast, the group working 20-25 hours per week increased from 19 to 28% one year after childbirth. Among the women with sick leave during pregnancy (11%), the decrease in working hours was more pronounced and almost 40% of them became unemployed. The percentage of women being economically independent changed from 88% at the onset of pregnancy to 78% one year after childbirth. Next to employment factors (working hours and contract type), migration background and lower education were associated with lower odds of economic independence. Moreover, sick leave during pregnancy and having a SGA baby also reduced the odds of economic independence. Conclusions After pregnancy, women tend to work less than before, or even exit the workforce, with considerable impact on their economic independence. This is even more pronounced in the group with sick leave during pregnancy. Key messages • Despite paid maternity leave, pregnancy and childbirth negatively impact work force participation in women. • The need for sick leave during pregnancy is predictive of reduced work resumption and economic independence one year after pregnancy.

Многоликая офтальмопатия недоношенных

Relevance. Retinopathy (ophthalmopathy) of prematurity (ROP) is a severe vasoproliferative eye disease that primarily affects profoundly premature infants. It is one of the most acute problems in pediatric ophthalmology, as this disease occupies a leading position in the structure of blindness and visual impairment in early childhood. Purpose. To present in detail the main achievements of the scientific research of the pediatric ophthalmologist in the N.I. Pirogov Russian National Research Medical University about the dominant problem of neonatal ophthalmology – ROP. Material and methods. The literature review of scientific publications and dissertations was conducted by the staff of the Department of Ophthalmology at the Pediatric Faculty of N.I. Pirogov Russian National Research Medical University under the guidance of the department head, corresponding member of the Russian Academy of Sciences, Professor E.I. Sidorenko. These works studied the morphological, physiological, and biochemical characteristics of the visual system in premature newborns and the pathogenesis of ROP. Results. Analysis of the conducted research convincingly demonstrated that in children with ROP, all eye tissues are affected, not just the retina; therefore, it is more accurate to refer to this disease as «ophthalmopathy of prematurity». Researchers have proposed to identify the first preclinical angiospastic phase in the development of ophthalmopathy of prematurity. The course of the disease, treatment effectiveness, and recurrence (reactivation) rates depend on various factors that need to be considered in the treatment of ROP. It is recognized that the most significant factors are the degree of prematurity, primarily gestational age and birth weight of the premature infant. Researches that do not consider these risk factors will significantly affect research results and assessments of the effectiveness of ROP. Conclusion. The accumulated experience requires distinguishing forms of ROP not only based on birth weight and gestational age but also based on the degree of prematurity. Key words: premature infants, retinopathy of prematurity, risk factor analysis, gestational age, degree of prematurity, birth weight

Child COVID-19 rates and migrant status: A quantitative study in the Lisbon area (Mar 2020-Jun 2022)

Abstract Introduction According to OECD data, immigrant children were over-represented among COVID-19 cases compared to non-immigrant children. However, evidence is missing on whether their migrant status is associated with testing positive for COVID-19. Therefore, we aimed to estimate COVID-19 positivity rates among children residing in five municipalities of the Lisbon metropolitan area, Portugal, and to analyze migrant status as a determinant of health. Methods We conducted a prospective cross-sequential cohort study with 989 children born in 2015, 2018, and 2020 (48.5% non-immigrants; 51.5% immigrants). Sociodemographic data were collected through interview-based questionnaires, and the child’s birth weight and gestational age were obtained from the primary health center’s information system (SClinico). COVID-19 test results (conducted between March 2020 and June 2022) were obtained from the national surveillance system (SINAVE Lab) and categorized into two primary outcomes: ever positive for COVID-19 (yes/no) and positivity frequency for COVID-19 (count). Robust and standard Poisson regressions were used to estimate the association between primary outcomes and demographic, socioeconomic, and clinical variables. We estimate relative risks (RR) and prevalence ratios (PR) with 95% confidence intervals. Results The positivity rate is lower for immigrant children (12% vs 17%). Compared with non-immigrant, and adjusting for other factors, immigrant children are 52% less likely to be ever positive for COVID-19 (PR = 0.482; IC 95%: 0.392-0.594), and the estimated number of positive tests is 54% lower (RR = 0.456; IC 95%: 0.362-0.574). Conclusions Being an immigrant is a protective factor against testing positive for COVID-19, aligning with the well-known immigrant paradox. These results underscore the need for further research into the immunological profiles of this population and are crucial for guiding strategies to manage emerging public health crises. Key messages • Immigrant children living in the Lisbon metropolitan area may have a protective factor against testing positive for COVID-19, consistent with the well-known immigrant paradox. • Understanding COVID-19 positivity rates and associated factors in children is crucial for guiding effective strategies to manage and mitigate emerging public health crises.

Preterm Birth and Caregiver Employment Decisions

This survey study compares employment decisions among caregivers of preterm infants during the first 3 years of an infant’s life by gestational age and birth weight.

Accelerating adverse pregnancy outcomes research amidst rising medication use: parallel retrospective cohort analyses for signal prioritization

BackgroundPregnant women are significantly underrepresented in clinical trials, yet most of them take medication during pregnancy despite the limited safety data. The objective of this study was to characterize medication use during pregnancy and apply propensity score matching method at scale on patient records to accelerate and prioritize the drug effect signal detection associated with the risk of preterm birth and other adverse pregnancy outcomes.MethodsThis was a retrospective study on continuously enrolled women who delivered live births between 2013/01/01 and 2022/12/31 (n = 365,075) at Providence St. Joseph Health. Our exposures of interest were all outpatient medications prescribed during pregnancy. We limited our analyses to medication that met the minimal sample size (n = 600). The primary outcome of interest was preterm birth. Secondary outcomes of interest were small for gestational age and low birth weight. We used propensity score matching at scale to evaluate the risk of these adverse pregnancy outcomes associated with drug exposure after adjusting for demographics, pregnancy characteristics, and comorbidities.ResultsThe total medication prescription rate increased from 58.5 to 75.3% (P < 0.0001) from 2013 to 2022. The prevalence rate of preterm birth was 7.7%. One hundred seventy-five out of 1329 prenatally prescribed outpatient medications met the minimum sample size. We identified 58 medications statistically significantly associated with the risk of preterm birth (P ≤ 0.1; decreased: 12, increased: 46).ConclusionsMost pregnant women are prescribed medication during pregnancy. This highlights the need to utilize existing real-world data to enhance our knowledge of the safety of medications in pregnancy. We narrowed down from 1329 to 58 medications that showed statistically significant association with the risk of preterm birth even after addressing numerous covariates through propensity score matching. This data-driven approach demonstrated that multiple testable hypotheses in pregnancy pharmacology can be prioritized at scale and lays the foundation for application in other pregnancy outcomes.

Clinical profile of meconium aspiration syndrome with special reference to birth weight, gestational age and immediate outcome at tertiary care centre

Clinical profile of meconium aspiration syndrome with special reference to birth weight, gestational age and immediate outcome at tertiary care centre

Associations between gestational exposure to perfluoroalkyl substances, fetal growth, and the mediation effect of thyroid hormones

Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) may cause adverse birth outcomes. Thyroid hormones may play a key role in mediating the effects of PFAS. We enrolled 374 mother-infant pairs from the Ezhou birth cohort study between 2019 and 2020. Eight PFASs and six thyroid hormones were measured in maternal serum during the first trimester of pregnancy. Neonatal growth metrics, including birth weight, length, head circumference, and gestational age, were acquired. Multivariate linear regression was performed to determine the associations between maternal serum PFAS and thyroid hormone levels and birth outcomes and a mediation analysis was also conducted. Except for perfluoroheptanoic acid (41.2%), the other seven PFAS detection rates were more than 85%, and the highest median concentration was observed for PFOSA with levels of 5.21 ng/mL. After controlling for typical confounders, we observed a decrease in birth length (cm) with increasing serum concentrations of perfluorononanoic acid (PFNA) (β = -0.54; 95% CI = -1.0, -0.08) and perfluorohexane sulfonate (PFHxS) (β = -0.64; 95% CI = -0.86, -0.42). Additionally, a decrease in birth head circumference was observed with increasing concentrations of perfluorooctanote (PFOA) (β = -0.73, 95% CI = -1.19, -0.27) and PFHxS (β = -0.30; 95% CI = -0.53, -0.07). Maternal free triiodothyronine (FT3) mediated 36.7% of the negative association between PFNA and birth length, and free thyroxine (FT4) mediated 30.8% of the effect of PFOA on head circumference. When performing stratified analysis by infant sex, the associations might differ between boys and girls. Our study suggested prenatal exposure to some PFASs was negatively associated with birth length and circumference, and FT3 and FT4 may partly mediate the association.

Changes in the prevalence of intellectual disability among 10-year-old children in Sweden during 2011 through 2021: a total population study

BackgroundRecent studies have suggested an increasing prevalence of intellectual disability diagnoses in some countries. Our aim was to describe the trend in the prevalence of intellectual disability diagnoses in Sweden and explore whether associated sociodemographic and perinatal factors can explain changes in the prevalence.MethodsWe used a register-based nationwide cohort of residents in Sweden born between 2001 and 2011. We calculated the prevalence of intellectual disability diagnoses by age 10 for each birth cohort and the prevalence ratios in relation to the baseline year 2011, overall and by severity of intellectual disability, and comorbidity of autism and attention-deficit/hyperactivity disorder. The prevalence ratios were stratified and adjusted for associated sociodemographic and perinatal factors.ResultsAmong 1,096,800 individuals, 8,577 were diagnosed with intellectual disability by age 10. Among these, 3,949 (46%) and 2,768 (32%) were also diagnosed with autism and attention-deficit/hyperactivity disorder, respectively, and 4% were diagnosed with profound, 8% severe, 20% moderate, 52% mild, and 16% other/unspecific intellectual disability. The recorded age-10 prevalence of intellectual disability diagnoses increased from 0.64% (95% confidence interval 0.59–0.69%) in 2011 to 1.00% (0.94–1.06%) in 2021, corresponding to an annual prevalence ratio of 1.04 (1.04–1.05). The increase was, however, restricted to mild, moderate, and other/unspecific intellectual disability diagnoses, while the trends for profound and severe intellectual disability diagnoses were stable. The increasing trend was perhaps less pronounced among females and children with diagnosed attention-deficit/hyperactivity disorder, but independent of the co-occurrence of autism. The prevalence ratios did not change with stratification or adjustment for other associated demographic and perinatal factors.ConclusionThe recorded prevalence of diagnosed mild and moderate intellectual disability among 10-year-olds in Sweden has increased over the recent decade. This increase could not be explained by changes in associated sociodemographic or perinatal factors, including birth weight, gestational age, and parental age, migration status, and education at the child’s birth. The increase instead may be due to changes in diagnostic practices in Sweden over time.

76 White matter microstructure and motor function at 8 years of age in children born preterm

Abstract Background White matter injury (WMI) in preterm neonates is characterized by focal areas of white matter necrosis (punctate WMI) and more diffuse impairments in white matter (dysmaturation). White matter dysmaturation is reflected as lower fractional anisotropy (FA) measured by diffusion tensor imaging (DTI). Reduced white matter FA in neonatal DTI has been associated with adverse motor function at early ages in children born preterm. Yet, how white matter FA at school-age relates to motor function at this later age is largely unknown. Objectives To assess the relationship between white matter FA and motor function at 8 years of age in children born very preterm. Design/Methods 110 children born very preterm (mean birth gestational age [GA] 28.19 weeks, range 24-32 weeks) completed MRI scans in the neonatal period and again at 8 years of age (mean age 8.35 years, SD = 0.38). Neonatal WMI was quantified on the neonatal T1-weighted images with significant WMI defined as WMI volume &amp;gt; 40 mm3. FA at 8 years was assessed using tract-based spatial statistics (TBSS). Movement Assessment Battery for Children, 2nd Ed (M-ABC-2) was used to assess fine and gross motor function at 8 years of age. Motor outcomes from the M-ABC total score were grouped as: Significant Movement Difficulty &amp;lt; 56 (below 5th percentile, n = 31), At-risk of Movement Difficulty 57-67 (5th-15th percentile, n = 23), and Unlikely to Have Movement Difficulty &amp;gt; 68 (above 15th percentile, n = 56). FA in the white matter skeleton was compared between motor outcome groups using threshold-free cluster enhancement (TFCE), adjusting for birth GA and significant WMI, and correcting for multiple comparisons across skeleton voxels using permutation testing with 5000 permutations. Results Table 1 outlines descriptive differences in the three motor outcome groups. Children born preterm who are Unlikely to Have Movement Difficulty at 8 years had significantly higher FA (p &amp;lt; .05) compared to those At-risk of or with Significant Movement Difficulty, especially in the corpus collosum (Figure 1), controlling for birth GA and significant neonatal WMI. Those with Significant Movement Difficulty had the lowest FA. Conclusion In children born preterm at age 8 years, white matter FA is associated with motor performance, independent of significant neonatal WMI. Our findings indicate that white matter dysmaturation persists and has functional significance through school-age.

Severe anemia in preterm infants associated with increased bacterial virulence potential and metabolic disequilibrium.

Anemia in preterm infants is associated with gut dysbiosis and necrotizing enterocolitis. Our study aimed to identify the bacterial functions and metabolites that can explain the underlying mechanisms of anemia associated disease conditions. We conducted a case control study in preterm infants with cases having a hematocrit 25%. The control infants were matched by birth gestational age and weight. Fecal samples were collected before, at the onset, and after the onset of anemia in cases and with matched postnatal age in controls for metagenomics and metabolomics analyzes. 18 anemic and 20 control infants with fecal samples collected at 17 days, 5 weeks, and 7 weeks postnatal age were included. Virulence factor potential, decrease in beta diversity evolution, and larger changes in metabolome were associated with severe anemia. Metabolite abundances of N-acetylneuraminate and butyrobetaine were associated with virulence factor potential. Anemic group had decreased prostaglandin and lactic acid levels. Fecal omics data showed that severe anemia is associated with a pro-inflammatory gut microbiota with more virulent and less commensal anaerobic bacterial activities. Future studies can examine the link between anemia-associated dysbiosis and clinical outcomes and predict an infant-specific hematocrit threshold that negatively affects clinical outcomes. Severe anemia in preterm infants contributes to a pro-inflammatory gut with greater bacterial virulence and less commensal bacterial activities. The multiomics approach using non-invasive fecal biospecimens identified functional and metabolic changes in the gut microbiota and these mechanistic changes are plausible explanations for anemia-associated disease conditions in preterm infants. Our findings identified biological changes of the gut environment in severely anemic preterm infants that can offer guidance for clinical management.

Fifteen Years of Neonatal Therapeutic Hypothermia: Clinical Trends Show Unchanged Post-Rewarming Outcomes despite Reduction in Hypoxic-Ischemic Encephalopathy Severity

Introduction: Hypoxic-ischemic encephalopathy (HIE) affects 1–2 per 1,000 births and is associated with mortality and long-term neurodevelopmental challenges. At present, therapeutic hypothermia (TH) is the only neuroprotective intervention for these infants. This study examines whether HIE severity, clinical management during TH, and post-rewarming outcomes have changed since its introduction 15 years ago. Methods: Neonatal characteristics, HIE severity, management during TH, and post-rewarming MRI of all infants with HIE undergoing TH between 2008 and 2023 were compared across three five-year epochs. Linear regression was used to estimate annual changes over time. Results: In total, 252 infants underwent TH. Median gestational age (39.5 weeks), birth weight (3,376 g), and time to start TH (4.25 h) remained stable over time. Apgar score at 5 min (p = 0.031) and lowest pH <1 h postpartum (p = 0.020) increased over time. Thompson score at 1–3 h decreased across epochs (p = 0.046). There was an increase in percentage with normal-mild aEEG background patterns on admission (p = 0.041) and a decrease in aEEG-confirmed seizures (p < 0.001) and antiseizure medication (p < 0.001). Inotropic support decreased (p = 0.007), and use of invasive mechanical ventilation decreased over the last 5 years. Mortality (28.6%) and post-rewarming composite adverse outcome (i.e., neonatal mortality and/or adverse MRI score) (37.9%) remained unchanged. Number of infants seen at 2-year follow-up increased (p < 0.001). Conclusion: Over the last 15 years, we treated more infants with milder HIE, as indicated by lower Thompson and milder aEEG scores, and the need for invasive cardiorespiratory support declined. However, there were no improvements in composite adverse outcome (mortality and/or adverse MRI score).

The effects of nutrition on mesenteric oxygenation among neonates with neonatal encephalopathy: a randomized clinical trial.

We aimed to evaluate the effects of minimal enteral nutrition (MEN) on mesenteric blood flow and oxygenation with Doppler USG and Near Infrared Spectroscopy (NIRS) during therapeutic hypothermia (TH) in babies with HIE. This prospective, randomized-controlled study was composed of infants receiving MEN (study group, n = 30) and infants who were not fed (control group, n = 30) during hypothermia. Infants were monitored continuously with NIRS and mesenteric blood flow velocities were measured with Doppler USG before and after feeding. The mean gestational age and birth weight for the study and control group were 38.73 ± 1.5-39.09 ± 1.02 weeks and 3076 ± 280.4-3295 ± 391 grams, respectively. Time to reach full enteral nutrition and hospital stay were significantly shorter in the study group (p = 0.049, p = 0.016). Infants in the study group experienced less feeding intolerance (p = 0.006). No infant developed necrotizing enterocolitis (NEC) in both groups. No difference was determined in pre- and post-feeding cerebral rSO2 measurements during TH and normothermia. Mesenteric rSO2, CSOR, and mesenteric blood flow measurements in the study group during normothermia were significantly increased, respectively (p = 0.03, p < 0.01, p < 0.01). In our study, we observed that MEN during TH does not lead to a significant change in cerebral and mesenteric oxygenation. Although we did not observe an increase in blood flow and oxygenation, the absence of NEC and a lower incidence of feeding intolerance in the study group may suggest that feeding during TH is safe and feasible. MEN during TH treatment does not lead to a significant change in cerebral and mesenteric oxygenation. This is the first study evaluating the effects of MEN on mesenteric oxygenation and blood flow velocities in infants with hypoxic-ischemic encephalopathy during TH with Doppler USG and NIRS, concomitantly. MEN during TH may be safe and feasible.