Immature Infants Research Articles

Two-year-olds selectively seek help, but not based on helper maturity.

Help-seeking is a strategy by which children signal their need for social learning. In three experiments, we examined when and from whom 2-year-old (N = 146 children; mean age = 31.4 months) US children from diverse ethnoracial and economic backgrounds (62% White; 9% Latine; 24% low-income) seek help in problem-solving contexts. In Experiment 1, children sought more help when unfamiliar (and thus unable to solve) than when familiar with a problem. In Experiment 2, children selectively sought help from knowledgeable as opposed to ignorant helpers. Against our prediction, children in neither experiment preferred mature (adult) over immature (infant or peer) helpers. In Experiment 3, children again did not prefer mature over immature helpers when helpers were depicted with realistic photos instead of line drawings (as in Experiments 1 and 2). We discuss the findings in relation to children's knowledge of their status as social learners.

Neurofilament light chain associates with IVH and ROP in extremely preterm infants.

Neurofilament light chain (NfL) is known for indicating adult brain injury, but the role of NfL in extremely preterm infants is less studied. This study examines the relationship between NfL and neurovascular morbidities in these infants. A secondary analysis of the Mega Donna Mega trial was conducted on preterm infants <28 weeks gestational age (GA). The study measured NfL levels and proteomic profiles related to the blood-brain barrier in serum from birth to term-equivalent age, investigating the association of NfL with GA, retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), and blood-brain barrier proteins. Higher NfL levels were seen in the first month in infants with severe IVH and for those born <25 weeks GA (independent of ROP or IVH). Additionally, infants born at 25-27 weeks GA with high NfL were at increased risk of developing severe ROP (independent of IVH). NfL was significantly associated with the proteins CDH5, ITGB1, and JAM-A during the first month. NfL surges after birthin extremely preterm infants, particularly in those with severe IVH and ROP, and in the most immature infants regardless of IVH or ROP severity. These findings suggest NfL as a potential predictor of neonatal morbidities, warranting further validation studies. This study shows that higher NfL levels are related to neurovascular morbidities in extremely preterm infants. The degree of immaturity seems important as infants born <25 weeks gestational age exhibited highpostnatal serum NfL levels irrespective of neurovascular morbidities. Our findings suggest a potential link between NfL and neurovascular morbidities possibly affected by a more permeable blood-brain barrier.

Less Invasive Surfactant Administration in Preterm Infants in Tertiary Neonatal Intensive Care Units in Germany: A Survey

Introduction: The European guideline for treatment of respiratory distress syndrome recommends less invasive surfactant administration (LISA) as the preferred method of surfactant administration in spontaneously breathing preterm infants. However, there is limited evidence on practical aspects such as sedation and catheter types, leading to considerable variability between centers. Methods: An anonymous online survey (www.soscisurvey.de) was sent to 164 tertiary neonatal intensive care units (NICUs) in Germany including 43 questions on practical aspects of LISA. Results: Of 122 (74%) participating NICUs, 117 (96%) reported experience with LISA with 82% of those reporting LISA as their preferred method of surfactant administration. Indications for surfactant administration differed widely between NICUs. Most (89%) used FiO2-thresholds only or in combination with other criteria, such as Silverman score/signs of dyspnea (41%) or lung ultrasound findings (3%). Prophylactic surfactant was administered by 42%. Differences in use of LISA in extremely immature infants were reported (e.g., 36% did not perform LISA in infants below 24–26 weeks). Preferred drugs for sedation were (Es-)Ketamine, followed by Propofol and Midazolam. Minimum time interval between subsequent LISA procedures was 4 (2–6) h. Catheters specifically designed for LISA were used by most NICUs (69%). Conclusion: This survey shows that LISA is common practice in German NICUs, but with considerable variability in practical aspects. These data may serve as a guidance for NICUs that have not yet implemented LISA and might be helpful design clinical trials with the aim to standardize and/or optimize LISA.

Reflections about being born extremely preterm in children and adolescents: A qualitative descriptive study

BackgroundThe survival of the smallest and most immature preterm infants, born at 23–24 weeks of gestation, has improved significantly. While there is a substantial amount of research on the neurocognitive and social outcomes of extremely premature birth, little is known about the survivors' subjective experience of being born preterm and its effect on later life. AimsThe purpose was to study the subjective experiences of school-aged children born at 23–24 weeks of gestation, in order to understand their perspectives on how being born extremely early had affected their life. Study designQualitative descriptive study. Methods18 school-aged children (12 girls and 6 boys, 7–15 years of age), born at 23 or 24 weeks of gestation, were interviewed. The semi-structured interview guide covered six topics about quality of life: somatic health, functioning, learning and memory, emotional health, social relations, experience of prematurity and its effect. ResultsMost children reported memories, which were told to them by parents, about their premature birth and early life. Using qualitative thematic analysis, the narratives of the children were classified into three groups: 1) the go-with-the-flow children, who identified little or no effect of prematurity, 2) the ponderers, who reflected on some effects such as minor physical challenges, and 3) the hesitants, who either did not connect their challenges with prematurity, or did not produce much reflection overall. ConclusionsChildren had been told about their early life by the parents and repeated these memories indicating that prematurity had become a significant part of the family story. Differences were found how the children reflected on the impact of prematurity in their personal life. It is essential to include preterm survivors' own perspectives already during childhood and adolescence into the research of extreme prematurity.

Mineral supplementation for very preterm infants fed fortified human milk.

The safety and feasibility of human milk fortification with bovine colostrum (BC) were investigated in very preterm infants (FortiColos trial, NCT03537365). The BC product contained lower calcium, phosphate, and iron levels compared to the conventional fortifier (CF). We tested whether fortification with BC plus extra phosphate was sufficient to support the infants' mineral status assessed by blood biochemistry. In a randomised controlled trial (FortiColos, NCT03537365), mineral status was compared after fortification with BC versus CF. Blood calcium, phosphate, and haemoglobin were determined before and up to 3 weeks after the start of fortification (at the mean age of 8-9 days). The maximum supplemental doses of calcium, phosphate, and iron given were retrieved from patient medical records. Results were adjusted for gestational age,birth weight, and enteral nutrition with the mother's own milk and/or donor human milk. Blood values of calcium, phosphate, and haemoglobin were similar between groups. Infants in both groups required supplementation with calcium and phosphate, but infants fed BC required higher maximum doses of phosphate and calcium (p < 0.05) to maintain acceptable blood values. Regardless of fortification groups, the most immature (<29 weeks of gestation) and small for gestational ageinfants showed a higher risk for requiring additional phosphate (odds ratio [OR]: 3.9, p < 0.001; OR: 2.14, p = 0.07, respectively). The use of BC as a fortifier for human milk requires additional phosphate and calcium relative to a CF. Regardless of the fortification product, the most immature and small infants require additional mineral supplementation.

Echocardiography Assessment of Left Ventricular Function in Extremely Preterm Infants, Born at Less Than 28 Weeks’ Gestation, With Bronchopulmonary Dysplasia and Systemic Hypertension

The survival of smaller and more immature premature infants has been associated with lifelong cardiorespiratory comorbidities. Infants with bronchopulmonary dysplasia (BPD) undergo routine screening echocardiography to evaluate for development of chronic pulmonary hypertension, a late manifestation of pulmonary vascular disease. Our aim was to evaluate left ventricular (LV) performance in infants with BPD and pulmonary vascular disease who developed systemic hypertension. We hypothesized that infants with hypertension were more likely to have impaired LV performance. We present a single-center cross-sectional study of premature infants born at less than 28 0/7weeks'gestational age with a clinical diagnosis of BPD. Infants were categorized by the systolic arterial pressure (SAP) at time of echocardiography as hypertensive (SAP ≥90mm Hg) or normotensive (SAP <90mm Hg). Sixty-four patients were included. Infants with hypertension showed altered LV diastolic function with prolonged tissue Doppler imaging-derived isovolumic relaxation time (54.2±5.1 vs 42.9±8.2, P<.001), lower E:A, and higher E:e'. Indices of left heart volume/pressure loading (left atrium:aorta and LV end-diastolic volume [6.1±2 vs 4.2±1.2, P<.001]) were also higher in the hypertensive group. Finally, infants in the hypertensive group had higher pulmonary vascular resistance index (4.42±1.1 vs 3.69±0.8, P=.004). We conclude that extremely preterm infants with BPD who develop systemic hypertension are at risk of abnormal LV diastolic dysfunction. Increased pulmonary vascular resistance index in the hypertensive group may relate to pulmonary venous hypertension secondary to LV dysfunction. This is an important consideration in this cohort when selecting the physiologically most appropriate treatment.

Dried Baby Formula as a Source of Opportunistic Members of Enterobacteriaceae for Infants

For evaluating the prevalence of Enterobacteriaceae in baby formulas, we examined 60 different samples of powdered infant milk formula and milk-cereal based infant formula that is recommended for first-day birth and from 6-month age, respectively, and collected from various supermarkets, shops, and pharmacies. Six (20.0%) and thirteen (43.3%) powdered infant milk formulas and milk-cereal based infant formulas, respectively, were contaminated by different Enterobacteriaceae involved Enterobacter cloacae ssp. cloacae, Pantoea spp., Enterobacter hormaechei, and Raoultella ornithinolytica, which were identified using traditional biochemical tests and the vitek2 compact system. Only five samples of investigating milk-cereal based infant formula type have coliforms count of 4 MPN/g. All species were susceptible to gentamycin, while all were resistant to cephalothin antibiotics. Eventually, 20.0 % of powdered infant milk formula samples were unacceptable referred to Egyptian standards (2072/2006) and most of the comparable international standards. In the study, we proved the contamination of powdered milk baby formula by Enterobacteriaceae, which mainly causes health problems in immature and immunocompromised infants. The dried infant formula factories are more needful for good hygiene and safety systems applications. This study is one of the fewest studies conducted in Egypt to isolate Enterobacteriaceae members from dried foods; especially milk-cereal based infant formula.

Multidimensional assessment of infant, parent and staff outcomes during a family centered care enhancement project in a tertiary neonatal intensive care unit: study protocol of a longitudinal cohort study

BackgroundThe therapeutic advances and progress in the care for preterm infants have enabled the regular survival of very immature infants. However, the high burden of lifelong sequelae following premature delivery constitutes an ongoing challenge. Regardless of premature delivery, parental mental health and a healthy parent–child relationship were identified as essential prerogatives for normal infant development. Family centered care (FCC) supports preterm infants and their families by respecting the particular developmental, social and emotional needs in the Neonatal Intensive Care Unit. Due to the large variations in concepts and goals of different FCC initiatives, scientific data on the benefits of FCC for the infant and family outcome are sparse and its effects on the clinical team need to be elaborated.MethodsThis prospective single centre longitudinal cohort study enrols preterm infants ≤ 32 + 0 weeks of gestation and/or birthweight ≤ 1500 g and their parents at the neonatal department of the Giessen University Hospital, Giessen, Germany. Following a baseline period, the rollout of additional FCC elements is executed following a stepwise 6-months approach that covers the NICU environment, staff training, parental education and psychosocial support for parents. Recruitment is scheduled over a 5.5. year period from October 2020 to March 2026. The primary outcome is corrected gestational age at discharge. Secondary infant outcomes include neonatal morbidities, growth, and psychomotor development up to 24 months. Parental outcome measures are directed towards parental skills and satisfaction, parent-infant-interaction and mental health. Staff issues are elaborated with particular focus on the item workplace satisfaction. Quality improvement steps are monitored using the Plan- Do- Study- Act cycle method and outcome measures cover the infant, the parents and the medical team. The parallel data collection enables to study the interrelation between these three important areas of research. Sample size calculation was based on the primary outcome.DiscussionIt is scientifically impossible to allocate improvements in outcome measures to individual enhancement steps of FCC that constitutes a continuous change in NICU culture and attitudes covering diverse areas of change. Therefore, our trial is designed to allocate childhood, parental and staff outcome measures during the stepwise changes introduced by a FCC intervention program.Trial registrationClinicaltrials.gov, trial registration number NCT05286983, date of registration 03/18/2022, retrospectively registered, http://clinicaltrials.gov.

Changes in neonatal care : Implications for ophthalmological care

Preterm infants are at risk of characteristic, sometimes life-threatening diseases and development of deficits related to immaturity. In the field of ophthalmology, retinopathy of prematurity (ROP) and vision impairment reflect structural and functional disturbances in this large group of patients. In high income countries, more and more very immature preterm infants survive into adolescence and adulthood. To characterize the impact of an increasing number of surviving individuals born preterm on the provision of ophthalmological care in Germany. A literature search and analysis of key figures and quality indicators published in national health registers were carried out. Currently, about 60,000 preterm infants are born in Germany every year. Of these, approximately 3600 extremely immature preterm infants with agestational age < 28weeks are treated with a curative approach on neonatal units. The survival rate is around 80%. Arise in the proportion of infants suffering from severe ROP has not been observed in recent years in Germany. The incidences of other structural and functional visual impairments vary between 3% and 25% in high income countries. The incidence of ROP apparently has not increased in Germany. However, specific peculiarities of the structure and function of the visual system of individuals born preterm have to be taken into account. Approximately 70,000 outpatient check-ups of infants and toddlers, who require both, ophthalmological and developmental neurological expertise, are estimated for Germany each year.

Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks-A Qualitative Descriptive Study.

(1) Background. The birth of an infant at 23 to 24 weeks poses a significant challenge to healthy parent-infant bonding because of the high risk of infant loss and the prolonged separation. The aim of this study was to retrospectively explore the narratives of parents with children born at 23-24 weeks about their bonding formation and relational experiences. (2) Methods. This was a qualitative descriptive study conducted with Finnish parents of children born at 23 or 24 weeks of gestation. Twenty-nine mothers and eight fathers were retrospectively interviewed using a semi-structured interview about the bonding process with their infant during the period in the neonatal intensive care unit (NICU) and their later parent-child relationship. Parents' narratives were deductively analysed according to a framework previously developed for studying parental bonding. (3) Results. Our results showed that several parents described the bonding process as natural or even easy despite the traumatic start to parenthood. Support from NICU staff and providing opportunities for participation in infant care and parent-infant physical closeness were reported to enhance the bonding process. Our study identified earlier parenting experience as a new element supporting bonding. (4) Conclusions. According to our results, essential elements enhancing parent-infant bonding in NICU settings seem to be supporting parents psychologically, promoting parent-infant closeness, and encouraging parental participation in the infants' care, even with the most immature infants.

Association of Gestational Age at Birth With Left Cardiac Dimensions at Near-Term Corrected Age Among Extremely Preterm Infants

Remodeling and altered ventricular geometry have been described in adults born preterm. Although they seem to have an adverse cardiac phenotype, the impact of various degrees of prematurity on cardiac development has been scarcely reported. In this study, we evaluated the impact of gestational age (GA) at birth on cardiac dimensions and function at near-term age among extremely preterm infants. This is a retrospective single-center cohort study of infants born at <29weeks ofGA between 2015 and 2019. Infants with available clinically acquired echocardiography between 34 and 43weeks were included. Two groups were investigated: those born <26weeks and those born ≥26weeks. All measurements were done by an expert masked to clinical data using the raw images. The primary outcome was measurements of cardiac dimensions and function based on GA group. Secondary outcomes were the association between cardiac dimensions and postnatal steroid exposure and with increments of GA at birth. A total of 205 infants were included (<26weeks, n=102; ≥26weeks, n=103). At time of echocardiography, weight (2.4±0.5 vs 2.5±0.5kg, P=.86) and age (37.2±1.6 vs 37.1±1.9weeks, P=.74) were similar between groups. There was no difference in metrics of right-sided dimensions and function. However, left-sided dimensions were decreased in infants born <26weeks, including systolic left ventricle (LV) diameter (1.06±0.20cm vs 1.12±0.18cm, P=.02), diastolic LV length (2.85±0.37 vs 3.02±0.57cm, P=.02), and estimated LV end-diastolic volume (5.36±1.69 vs 6.01±1.79mL, P=.02). In our cohort of very immature infants, birth at the extreme of prematurity was associated with smaller left cardiac dimensions around 36weeks of corrected age. Future longitudinal prospective studies should evaluate further the impact of prematurity on LV development and performance and their long-term clinical impact.

Monocyte signature as a predictor of chronic lung disease in the preterm infant.

Inflammation is a key driver of morbidity in the vulnerable preterm infant exposed to pre- and postnatal hazards and significantly contributes to chronic lung disease, i.e. bronchopulmonary dysplasia (BPD). However, the early changes in innate immunity associated with BPD development are incompletely understood. In very immature preterm infants below 32 weeks gestational age (GA; n=30 infants), monocyte subtypes were identified by Flow Cytometry at birth and throughout the postnatal course including intracellular TNF expression upon LPS stimulation. Complementing these measurements, cytokine end growth factor expression profiles (Luminex® xMAP®; n=110 infants) as well as gene expression profiles (CodeLinkTM Human I Bioarray; n=22) were characterized at birth. The abundance of monocyte subtypes differed between preterm and term neonates at birth. Specifically, CD14++CD16+ (intermediate) monocytes demonstrated a dependency on PMA and elevated levels of nonclassical (CD14+CD16++) monocytes characterized preterm infants with developing BPD. Postnatally, lung injury was associated with an increase in intermediate monocytes, while high levels of nonclassical monocytes persisted. Both subtypes were revealed as the main source of intracellular TNF-α expression in the preterm infant. We identified a cytokine and growth factor expression profile in cord blood specimen of preterm infants with developing BPD that corresponded to the disease-dependent regulation of monocyte abundances. Multivariate modeling of protein profiles revealed FGF2, sIL-2 Rα, MCP-1, MIP1a, and TNF-α as predictors of BPD when considering GA. Transcriptome analysis demonstrated genes predicting BPD to be overrepresented in inflammatory pathways with increased disease severity characterized by the regulation of immune and defense response pathways and upstream regulator analysis confirmed TNF-α, interleukin (IL) -6, and interferon α as the highest activated cytokines in more severe disease. Whereas all BPD cases showed downstream activation of chemotaxis and activation of inflammatory response pathways, more severe cases were characterized by an additional activation of reactive oxygen species (ROS) synthesis. In the present study, we identified the early postnatal presence of nonclassical (CD14+CD16++) and intermediate (CD14++CD16+) monocytes as a critical characteristic of BPD development including a specific response pattern of monocyte subtypes to lung injury. Pathophysiological insight was provided by the protein and transcriptome signature identified at birth, centered around monocyte and corresponding granulocyte activation and highlighting TNFα as a critical regulator in infants with developing BPD. The disease severity-dependent expression patterns could inform future diagnostic and treatment strategies targeting the monocytic cell and its progeny.

Association of response time and intermittent hypoxemia in extremely preterm infants.

To determine the relationship between medical staff's response time (RT) to oxygen saturation (SpO2 ) below 80% and the associated time from tactile intervention until SpO2 normalisation (CT). Time-lapse video and continuous SpO2 were recorded for six consecutive 24 h periods. Regression analyses of RT and SpO2 in association with postmenstrual age (PMA), weight, infant sex and frequency of intermittent hypoxemia (IH). Five hundred and twelve hypoxemia episodes received tactile intervention in 20 extremely preterm infants (gestational age ≤28 weeks, birthweight <1500 g). Median RT was 20.5 s (IQR 16.63-25.50). RT increased with increased IH frequency (p = 0.023) independently of PMA and weight. SpO2 decreased by 3.7% with every 10 s RT (p = 0.039). Time until SpO2 normalisation was strongly associated with RT (β = 0.58, p = 0.042). The association was amplified by lower PMA (p = 0.043). Female preterm infants experienced longer RT than males (p = 0.027). Because the total length of an IH is the sum of RT and CT, preterm infants with low PMA can reach a critical hypoxemia duration of >60 s, even with short RT. The RT is a critical factor that affects the overall time of IH treatments and the depth of desaturation. The consequences of a prolonged RT are worse for more immature preterm infants.

How do the skin barrier and microbiome adapt to the extra-uterine environment after birth? Implications for the clinical practice.

The multiple protective functions of the skin derive from the interactions between epithelial skin and immune cells as well as the commensal microbiota. Developed in the last trimester of intra-uterine life, the skin barrier adapts dynamically after birth. Specific differences in the structure and physiology have been disclosed between infant and adult skin. The stratum corneum of infants is thinner and structured by thicker corneocytes with a more anisotropic surface in comparison to adult skin. Lower levels of the natural moisturizing factor and its constituents, together with the increased protease activity in the epidermis result in dry baby skin and ongoing adaptation of the desquamation to the extra-uterine environment. Infant epidermis is characterized by an accelerated proliferation rate and clinically competent permeability barrier in term neonates, despite the higher baseline values of transepidermal water loss in infants. The skin surface of newborns is less acidic, which could increase susceptibility to diaper and atopic dermatitis. Immediately after birth, skin is colonized by commensal bacteria-a process dependent on the mode of delivery and of major importance for the maturation of the immune system. Skin bacterial diversity and dysbiosis have been related to different pathology such as atopic and seborrheic dermatitis. This paper focuses on the ongoing structural, functional and biochemical adaptation of the human skin barrier after birth. We discuss the interactions on the 'skin barrier/ microbiota/ immune system' axis and their role in the development of competent functional integrity of the epidermal barrier.

Platelets and ductus arteriosus closure in neonates

Platelet plug formation is critically involved in murine ductus arteriosus closure and thrombocytopenia in preterm infants seems to negatively affect spontaneous and pharmacologically induced ductal closure. Furthermore, platelet dysfunction may contribute to ductal patency, especially in extremely immature infants. Neonatal platelets likely have multifaceted roles during ductal closure, such as secretion of several signaling molecules and facilitation of specific cell-cell interactions. The only available randomized-controlled trial on platelet transfusions in preterm infants with patent ductus arteriosus demonstrated that a liberal transfusion regimen did not promote ductal closure, but was associated with an increased rate of intraventricular hemorrhage.Herein, we discuss the available mechanistic evidence on the role of platelets in ductus arteriosus closure and their potential clinical implications in preterm infants. We further briefly outline future research directions aimed at a better understanding of platelet-endothelial interactions in neonatal health and disease.

Exposure to polyethylene microplastics alters immature gut microbiome in an infant in vitro gut model.

Infants are characterized by an immaturity of the gut ecosystem and a high exposure to microplastics (MPs) through diet, dust and suckling. However, the bidirectional interactions between MPs and the immature infant intestinal microbiota remain unknown. Our study aims to investigate the impact of chronic exposure to polyethylene (PE) MPs on the gut microbiota and intestinal barrier of infants, using the new Toddler mucosal Artificial Colon coupled with a co-culture of epithelial and mucus-secreting cells. Gut microbiota composition was determined by 16S metabarcoding and microbial activities were evaluated by gas, short chain fatty acid and volatolomics analyses. Gut barrier integrity was assessed via evaluation of intestinal permeability, inflammation and mucus synthesis. Exposure to PE MPs induced gut microbial shifts increasing α-diversity and abundance of potentially harmful pathobionts, such as Dethiosulfovibrionaceae and Enterobacteriaceae. Those changes were associated to butyrate production decrease and major changes in volatile organic compounds profiles. In contrast, no significant impact of PE MPs on the gut barrier, as mediated by microbial metabolites, was reported. For the first time, this study indicates that ingestion of PE MPs can induce perturbations in the gut microbiome of infants. Next step would be to further investigate the potential vector effect of MPs.

Biomarkers of gut injury in neonates - where are we in predicting necrotising enterocolitis?

Despite advances in neonatal care Necrotising Enterocolitis (NEC) continues to have a significant mortality and morbidity rate, and with increasing survival of those more immature infants the population at risk of NEC is increasing. Ischaemia, reperfusion, and inflammation underpin diseases affecting intestinal blood flow causing gut injury including Necrotising Enterocolitis. There is increasing interest in tissue biomarkers of gut injury in neonates, particularly those representing changes in intestinal wall barrier and permeability, to determine whether these could be useful biomarkers of gut injury. This article reviews current and newly proposed markers of gut injury, the available literature evidence, recent advances and considers how effective they are in clinical practice. We discuss each biomarker in terms of its effectiveness in predicting NEC onset and diagnosis or predicting NEC severity and then those that will aid in surveillance and identifying those infants are greatest risk of developing NEC.

Gentle as a mother's touch: C-tactile touch promotes autonomic regulation in preterm infants

Preterm infants are challenged to adapt to an extrauterine milieu, while their interoceptive system and autonomic regulation capacity is still immature. Caressing parental touch is known to foster parasympathetic regulation in infants by stimulating C-tactile (CT) afferents and in preterm infants, slow stroking stimulation also leads to a heart rate decrease. The particular impact of maternal stroking has not yet been investigated and factors influencing the maturation of the CT system in preterm infants remain unclear. We therefore analysed 53 standardized events in which preterm infants (24 to 36 weeks gestational age at birth) were stroked by their mothers. Video analysis revealed that mothers use CT optimal velocities to stroke their preterm child. Analysis of pulse oximetric data showed no effect of stroking on infantile blood oxygenation, but a significant decrease of the heart rate. Compared to term-born children, this decrease was delayed by about two minutes. Furthermore, our data suggested that more immature preterm infants benefited less from stroking than more mature ones. We conclude that maternal stroking touch targets CT afferents in preterm infants and that the preterm CT system is not yet mature.

Improved Macro- and Micronutrient Supply for Favorable Growth and Metabolomic Profile with Standardized Parenteral Nutrition Solutions for Very Preterm Infants.

Very preterm infants are at high risk for suboptimal nutrition in the first weeks of life leading to insufficient weight gain and complications arising from metabolic imbalances such as insufficient bone mineral accretion. We investigated the use of a novel set of standardized parenteral nutrition (PN; MUC PREPARE) solutions regarding improving nutritional intake, accelerating termination of parenteral feeding, and positively affecting growth in comparison to individually prescribed and compounded PN solutions. We studied the effect of MUC PREPARE on macro- and micronutrient intake, metabolism, and growth in 58 very preterm infants and compared results to a historic reference group of 58 very preterm infants matched for clinical characteristics. Infants receiving MUC PREPARE demonstrated improved macro- and micronutrient intake resulting in balanced electrolyte levels and stable metabolomic profiles. Subsequently, improved energy supply was associated with up to 1.5 weeks earlier termination of parenteral feeding, while simultaneously reaching up to 1.9 times higher weight gain at day 28 in extremely immature infants (<27 GA weeks) as well as overall improved growth at 2 years of age for all infants. The use of the new standardized PN solution MUC PREPARE improved nutritional supply and short- and long-term growth and reduced PN duration in very preterm infants and is considered a superior therapeutic strategy.

Oxygenation of Newborns

The last 20–30 years, the oxygen exposure of newborn infants has been substantially reduced. This is mainly due to a dramatic reduction in the use of oxygen in the delivery room in newborn infants in need of positive pressure ventilation (PPV) and the better control of oxygen saturation with clearly defined targets in immature infants in need of supplemental oxygen during treatment in neonatal intensive care units. Term and near-term infants in need of IPPV in the delivery room should start with a FiO2 of 0.21. Between 28 and 31 weeks of gestation, an initial FiO2 of 0.21–0.30 is generally recommended. For immature infants, a higher FiO2 than 0.3 may be needed, although the optimal initial level is not defined. For all groups, it is recommended to adjust the FiO2 according to oxygen saturation (SpO2) and heart rate response. For immature infants, the combination of prolonged bradycardia and an SpO2 not reaching 80% within 5 min of life is associated with a substantially increased risk of death. For immature infants beyond the delivery room, an SpO2 target between 91 and 95% is recommended.