Infant Morbidity Research Articles

Early Prediction of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants using Non-invasive Electrical Cardiometry

Abstract Background Prematurity is a term for the broad category of neonates born at less than 37 weeks' gestation following onset of the last menstrual period. Different degrees of prematurity are defined by gestational age (GA) or birth weight (BW). Prematurity is associated with approximately one- third of all infant deaths. Complications of prematurity are the underlying cause of the higher rate of infant mortality and morbidity in preterm infants compared to full term infants. Objective To identify hemodynamic changes during the first 48hrs in life using non-invasive cardiometry and how these changes can predict which infants would develop clinical and echocardiographic criteria for PDA treatment. Patients and Methods This Prospective cohort study was conducted at tertiary care hospital at the neonatal intensive care units of Ain Shams University, Children’s Hospital from October 2021 till April 2022 and performed on preterm neonates who are less than 35 weeks gestational age and admitted to the NICU of pediatric hospital. Results Hemodynamically-significant PDA group had significantly lower systolic, diastolic blood pressure and mean arterial blood pressure than hemodynamically not significant PDA group at each time of follow up and significantly higher heart rate at (12, 15, 18, 21, 24, 27, 30, 33, 36, 39, 45, 48) hours in patients with hemodynamically-significant PDA. There was statistically significant difference between the two studied groups as regards vital data of Oxygen saturation (SpO2) and UOP which were significantly lower in hemodynamically-significant PDA. Conclusion in our prospective cohort study increased heart rate, decreased mean arterial blood pressure predict a clinically significant PDA requiring treatment. Furthermore, vital data seem to be a good non invasive tools to monitor hemodynamic changes in preterms with hemodynamically significant PDA. However, further studies with a higher number of patients are necessary to ground the outcomes of these preliminary considerations.

Planning, Implementation, and Evaluation of a Postpartum Nurse Home Visit Service to Improve Health Equity

ObjectiveTo describe how a college of nursing and urban academic medical center partnered with the local health department to plan, implement, and evaluate a universal nurse home visit service to improve health equity in the postpartum period. DesignEvidence-based practice. Setting/Local ProblemWide health disparity in rates of maternal and infant morbidity and mortality in Chicago, Illinois. PatientsAll patients who gave birth at the medical center and lived in Chicago. Intervention/MeasurementsA nurse home visit was offered after birth to all eligible patients beginning in March 2020. We used data from a Web-based platform to determine key performance indicators for the program and examined patient demographics to determine equitable delivery of the service for all visits provided in 2022. ResultsThere were 1,488 patients eligible for a home visit and 714 who received a home visit. The average contact rate was 76%, the scheduling rate was 63%, the completion rate for scheduled visits was 76%, and the population reach was 48%. Sixty-eight percent of families visited were from high-economic-hardship zip code areas of the city. Eighty-one percent of visits resulted in at least one referral to meet a family’s need, and 98% of patients surveyed rated their visit as “very helpful.” ConclusionThe successful implementation of this public–private partnership was due in part to an organizational culture that supports health equity initiatives, the inclusion of system-wide stakeholders, having a process in place to monitor outcomes, and hiring a diverse team of nurses who prioritize respectful patient-centered care.

Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants

Retinopathy of prematurity (ROP) is a major morbidity of preterm infants causing visual impairment, including blindness, for which timely treatment is vital and prevention is key. Increasing evidence suggests that exposure to neonatal sepsis contributes to ROP development. To investigate the association between neonatal sepsis and ROP in 2 large-scale cohorts of preterm infants born at less than 29 weeks' gestation. This retrospective cohort study was conducted using data from the German Neonatal Network (GNN) and Norwegian Neonatal Network (NNN). The GNN involves 68 and the NNN includes 21 level III neonatal intensive care units. Participants were infants born at a gestation of 22 weeks and 0 days to 28 weeks and 6 days and enrolled in the GNN between January 1, 2009, and December 31, 2022, and NNN between January 1, 2009, and December 31, 2018. Data were analyzed from February through September 2023. Single or multiple episodes of culture-proven sepsis. Any ROP and treatment-warranted ROP. Among 12 794 infants in the GNN (6043 female [47.2%] and 6751 male [52.8%]; mean [SD] gestational age, 26.4 [1.5] weeks) and 1844 infants in the NNN (866 female [47.0%] and 978 male [53.0%]; mean [SD] gestational age, 25.6 [1.5] weeks), the mean (SD) birth weight was 848 (229) g and 807 (215) g, respectively. Any ROP was present in 6370 infants (49.8%) in GNN and 620 infants (33.6%) in NNN, and treatment-warranted ROP was present in 840 infants (6.6%) in GNN and 140 infants (7.6%) in NNN. In both cohorts, there were increasing rates of treatment-warranted ROP with each sepsis episode (no sepsis: 572 of 10 658 infants [5.4%] in GNN and 85 of 1492 infants (5.7%) in NNN; 1 episode: 190 of 1738 infants in GNN [10.9%] and 29 of 293 infants [9.9%] in NNN; 2 episodes: 53 of 314 infants in GNN [16.9%] and 13 of 49 infants [26.5%] in NNN; 3 episodes: 25 of 84 infants [29.8%] in GNN and 3 of 10 infants [30.0%] in NNN). After adjusting for multiple confounders in the GNN dataset, the number of sepsis episodes was associated with ROP and treatment-warranted ROP compared with 0 episodes (1 episode: adjusted odds ratio [aOR], 1.44 [95% CI, 1.27-1.63]; P < .001 and OR, 1.60 [95% CI, 1.31-1.96]; P < .001, respectively; 2 episodes: OR, 1.81 [95% CI, 1.35-2.42]; P < .001 and OR, 2.38 [95% CI, 1.68-3.37]; P < .001, respectively; 3 episodes: OR, 4.39 [95% CI, 2.19-8.78]; P < .001 and OR, 3.88 [95% CI, 2.29-6.55]; P < .001, respectively). These associations were confirmed for any ROP by propensity score matching (for example, the aOR with propensity score matching was 1.76 [95% CI, 1.54-2.02]; P < .001 for 1 episode vs 0 episodes and 1.58 [95% CI, 1.12-2.22]; P = .007 for 3 episodes vs 0 or 1 episode). In the NNN dataset, surgical NEC was associated with treatment-warranted ROP (multivariable analysis: aOR, 3.37 [95% CI, 1.78-6.37]; P < .001). This study found that in the large-scale GNN cohort, recurrent culture-proven sepsis was associated with ROP and treatment-warranted ROP in infants born at less than 29 weeks.

The Effect of Plastic Wrap Use to Prevent Hypothermia on Neonatal Mortality and Morbidity in Extreme Preterm Infants

Background: Hypothermia immediately afterbirth is common, especially in preterm (PT) infants because of their skin immaturity. If it is prolonged, it can lead to mortality and morbidity. Although plastic wrap (PW) can improve neonatal hypothermia by decreasing evaporative heat loss, its effect on mortality and morbidity is uncertain. Aim: The aim of the study was to detect if PW can decrease mortality and morbidity in PT infants from 240 to 296 weeks’ gestation. Design: The study design was a retrospective study. Setting: The study was conducted at two neonatal intensive care units (NICUs). Materials and Methods: NICUs medical records from 2021 to 2023. Statistical Analysis: The data were analyzed using logistic regression analysis. Results: A total of 187 PT infants from 240 to 296-week gestation were admitted to both NICUs during that period, 148 PT infants were included in the study. Mean gestational age (GA) was 27.2 ± 2.7 weeks and mean birth weight was 865 ± 375 g; 75 PT infants (51%) were male, and 30 PT infants (20.2%) were hypothermic on admission. After adjusting for risk factors that potentially increased the mortality, admission temperature did not affect the mortality significantly (odds ratio [OR]: 0.8, confidence interval [CI]: 0.6–1.1). The only factor that increased the mortality significantly was GA (OR: 1.1, CI: 1.05–1.4). The other model that tested the effect of admission temperature on the morbidity showed that none of the morbidities were significantly decreased after adjusting for risk factors, necrotizing enterocolitis (OR: 1.05, CI: 0.8–1.3), intraventricular hemorrhage (OR: 0.8, CI: 0.6–1.09), bronchopulmonary dysplasia (OR: 1.1, CI: 0.8–1.3), retinopathy of prematurity (OR: 1.2, CI: 0.9–1.4), and late-onset sepsis (OR: 1.1, CI: 0.9–1.4). Conclusion: PW applied immediately after birth seemed to improve admission temperature in PT infants from 240 to 296-week gestation, but it did not improve neonatal mortality or morbidity.

Evaluation of Procalcitonin and Presepsin in prediction for early onset neonatal sepsis.

Objective: To determine the presepsin and procalcitonin significance in cord blood and compare with lactate and C-Reactive protein for early prediction of neonatal sepsis. Study Design: Case Control Study. Setting: Military Hospital Rawalpindi. Period: Sep 2018 to July 2019. Methods: Mothers, having deliveries with early or prolonged rupture of membrane, preterm, dai handled, meconium and failure of induction have been included. Out of 60 neonates, nineteen were cases with a clearly documented suspicion of sepsis and confirmed by neonatologists, remaining were control. Mean and Standard Deviation were calculated. The difference in all biochemical markers levels among case and control groups were assessed by independent t-test. Sensitivity, specificity, accuracy, and predictive value of both markers were calculated by medcalc diagnostic calculator. Regression analysis to access the strength. Receiver Operating Characteristics curve for most accurate cut off values and Area Under the Curve was calculated. Results: Independent sample t test revealed the strong association of procalcitonin and presepsin with neonatal sepsis. Presepsin has higher positive predictive value 83.33% and negative predictive value 90.48% with 88.33% accuracy while procalcitonin has positive predictive value 62.50%, negative predictive value 88.89% and accuracy 78.33%. Stepwise regression analysis showed better in combination than single in predication of neonatal sepsis. The cutoff value for procalcitonin was 0.4ng/ml (AUC of 84.5%.) and for presepsin was 305pg/ml (AUC of 86.5%). Conclusion: In comparison to lactate and CRP, a prediction model that incorporates two biochemical indicators, procalcitonin and presepsin, can reduce infant mortality and morbidity by spotting neonatal sepsis early.

Congenital Anomalies and their Outcomes in the Neonate Intensive Care Unit in Misurata Center

Background and objective. Congenital anomalies are a significant cause of infant morbidity and mortality. This study examined the prevalence, types, and associated risk factors of congenital anomalies and their outcomes in infants admitted to the Neonatal Intensive Care Unit (NICU) of Misurata Hospital, Libya, from January to December 2022. Methods. A retrospective review of medical records of infants with congenital anomalies admitted to the NICU of Misurata Hospital from January to December 2022 was conducted. Data on demographics, clinical presentation, maternal factors, and outcomes were collected. Descriptive and statistical analyses were performed. Results. A total of 53 infants with congenital anomalies were included. The mortality rate was 34%. The most prevalent anomalies were congenital heart defects, hypospadias, cleft lip and palate, hydrocephalus, and syndromic baby. Cesarean section, sepsis, maternal age over 35 years, high parity, polyhydramnios, diabetes mellitus, and oligohydramnios were associated with increased risk of mortality or congenital anomalies. Conclusions. Congenital anomalies pose a substantial burden on neonatal health in this setting. Cesarean section, sepsis, and specific maternal factors were identified as risk factors. These findings underscore the importance of tailored care for mothers and infants with congenital anomalies to improve outcomes.

Neuroinflammatory reactive astrocyte formation correlates with adverse outcomes in perinatal white matter injury.

Perinatal white matter injury (WMI) is the leading cause of long-term neurological morbidity in infants born preterm. Neuroinflammation during a critical window of early brain development plays a key role in WMI disease pathogenesis. The mechanisms linking inflammation with the long-term myelination failure that characterizes WMI, however, remain unknown. Here, we investigate the role of astrocyte reactivity in WMI. In an experimental mouse model of WMI, we demonstrate that WMI disease outcomes are improved in mutant mice lacking secretion of inflammatory molecules TNF-α, IL-1α, and C1q known, in addition to other roles, to induce the formation of a neuroinflammatory reactive astrocyte substate. We show that astrocytes express molecular signatures of the neuroinflammatory reactive astrocyte substate in both our WMI mouse model and human tissue affected by WMI, and that this gene expression pattern is dampened in injured mutant mice. Our data provide evidence that a neuroinflammatory reactive astrocyte substate correlates with adverse WMI disease outcomes, thus highlighting the need for further investigation of these cells as potential causal players in WMI pathology.

The Risk Factors of Low Birth Weight in Primary Health Care Centres: A Comparative Study in Selected Rural and Urban Settings in a Southwestern State of Nigeria

The World Health Organization (WHO) defines low birth weight (LBW) as less than 2500g at birth, a critical predictor of infant morbidity and mortality. LBW prevalence is notably higher in developing countries (15%) compared to developed ones (7%), affecting 5–6 million children annually in Nigeria. This study aimed to identify and compare LBW risk factors in rural and urban areas of Ondo State, Nigeria, and to describe the socio-demographic and pregnancy characteristics of affected mothers. Conducted from January 2021 to August 2022, the case-control study analyzed live birth records from selected primary health centers. Factors such as socio-demographics, anthropometrics, nutrition, maternal morbidity, and antenatal care were considered. Logistic regression models, both bivariate and multivariate, were used to analyze the data. The study found a LBW incidence of 10.2%, with 9.7% in rural and 11% in urban areas. BMI, maternal age, occupation, and marital status were not correlated with LBW. In urban areas, lower parity and frequent medication use during pregnancy were linked to lower LBW risk, while ANC visits significantly impacted LBW incidence (p &amp;lt; 0.05). Overall, ANC visits, iron supplement use, and parity were significant LBW risk factors, particularly in urban settings, whereas socio-demographic factors showed no substantial association.

Effect of maternal aflatoxin exposure on growth and morbidity of infants 0 to 3 months

Aflatoxin exposure has been implicated in adverse human health outcomes in areas where the toxin is prevalent in foods [1]. Consequently, many people may be chronically exposed to large amounts of the toxin worldwide. The effect of aflatoxin exposure is felt more in developing countries and this may be attributed to high levels of malnutrition coupled with chronic exposure to high levels of the toxin in their diets [2]. Consumption of high levels of aflatoxins has been associated with aflatoxicosis resulting in death, while chronic dietary exposure to aflatoxins is associated with liver and other cancers and poor growth outcomes in young children [3]. Exposure of infants to aflatoxins may be detrimental to their normal growth and other aspects of health later in life. Early linear growth retardation is associated with poor cognitive development, reduced physical productivity, a greater risk of poor pregnancy outcomes later in life, including low birth weight babies and a greater risk of obesity, coronary heart disease, diabetes and hypertension later in life [3]. Therefore, protection of fetuses, infants and young children from the effects of aflatoxins through maternal exposure would not only reduce the risk of them not realizing their cognitive potential, but also contribute to reducing the risk of non-communicable diseases whose prevalence is on the rise, not just in developed countries, but also in developing countries.

Asuhan Kebidanan Komprehensif Pada Ny. S Umur 42 Tahun Dengan Kehamilan Resiko Tinggi Umur, Anemia Dan Kekurangan Energi Kronis (KEK) Di Puskesmas Kaliwadas Kabupaten Brebes

. According to WHO (2019) TB mortality rate (AKI) in the world namely 303,000 people. Maternal Mortality Rate (MMR) in ASEAN (2020), namely amounting to 235/100,000 live births. Based on data from the Ministry of Health Figures Maternal mortality (MMR) in Indonesia in 2020 was 4,627 deaths. Data Health Department (2021) MMR 62 cases. Data from Kaliwadas Community Health Center (2022) MMR 0 case. The aim of this research was to reduce maternal and infant morbidity and mortality rates in Brebes district, especially the Kaliwadas Community Health Center area. This research method is qualitative research, namely a research method carried out by exploring, describing and explaining and predicting a phenomenon that occurs on the basis of it in the field. The results of this research are after carrying out comprehensive midwifery care in Mrs. S is 42 years old with risk factors: age, anemia and CED at the Community Health Center Kaliwadas from the third trimester of pregnancy, childbirth, newborns, postpartum and family planning using Varney and midwifery approaches SOAP found gaps between theory and practice.

Association of Maternal Lifestyle Factors and Hemoglobin with Low Birth Weight

Background: Low birth weight (LBW) is a major global public health problem and a leading cause of neonatal mortality, as well as a significant risk factor for infant and under-five morbidity and mortality. Objective: The study aimed to determine the association between maternal lifestyle factors and low birth weight, and to investigate the relationship between maternal hemoglobin levels and LBW infants. Methods: A total of 518 samples were included in the study, comprising 259 cases and 259 controls. Data were collected using a standard questionnaire administered through interviews and medical record reviews. The questionnaire covered maternal lifestyle factors and hemoglobin levels. Logistic regression was employed to analyze the associations between maternal lifestyle risk factors, hemoglobin levels, and low birth weight. Descriptive statistics were calculated for each variable, and statistical relationships were assessed using IBM SPSS version 25, with a significance level set at 0.05. Results: The study found that maternal hemoglobin levels (OR=0.742, 95% CI: 0.644-0.855, p&lt;0.001) and gestational age (OR=0.776, 95% CI: 0.696-0.866, p&lt;0.001) were inversely associated with low birth weight. Conversely, previous pregnancies (OR=5.043, 95% CI: 2.004-12.689, p=0.001 for one previous pregnancy), low maternal income (OR=7.156, 95% CI: 2.369-21.617, p&lt;0.001), specific occupations (OR=2.354, 95% CI: 1.416-3.914, p=0.001), and being underweight (OR=26.829, p&lt;0.001) were positively associated with low birth weight. Conclusion: These findings emphasize the importance of considering various socio-economic and health factors in the prevention and management of low birth weight, with a particular focus on maternal occupational status, income, previous pregnancies, gestational age, pregnancy complications, and maternal hemoglobin levels.

Randomised crossover study on pulse oximeter readings from different sensors in very preterm infants

ObjectiveIn extremely preterm infants, different target ranges for pulse oximeter saturation (SpO2) may affect mortality and morbidity. Thus, the impact of technical changes potentially affecting measurements should be assessed. We...

THE INFLUENCE OF MARMET TECHNIQUE ON ASI PRODUCTION IN POST PARTUM MOTHERS

Breast milk is the best and most ideal food for babies, because breast milk contains all the nutrients needed in the right amount and balance. In addition, breast milk contains immune substances or antibodies that function to protect infants from various germs so that they can prevent various diseases that are at risk of increASIng morbidity and mortality in infants. However, until now there are still many babies who do not get breast milk on the first day of birth, this causes many nutritional problems for babies in Indonesia to occur, one of which is insufficient nutrition in infants. This research is a quantitative method using a quASI-experimental method. This study aims to determine whether there is an effect of the Marmet Technique on Breast Milk Production in Postpartum Mothers at the Village Health Post of Simpang Bayat Bayung Lencir in 2023. This research was conducted in March-June 2023. The population in this study were all post partum mothers 1-7 days at the Simpang Bayat Poskesdes totaling 24 post partum mothers. The sample of this research is 20 people. The technique used is Accidental Sampling. This research uses univariate and bivariate analysis. Based on the results of the study, it was shown that there was an increase in milk production using the guinea pig technique and data analysis obtained p value = 0.000 (α &lt; 0.05) so that there was an influence between the guinea pig technique and breast milk production. It is hoped that the results of this study can provide additional knowledge for health workers in providing care for breastfeeding mothers in increASIng breast milk production, as well as for midwifery education can add to midwifery literature so that they can provide broader insights on maternity, especially regarding how to expel breast milk

Rol del hospital de día de diabetes “Ana Goitia” en la reducción de la morbimortalidad materno-infantil

Background: Gestational diabetes is any degree of carbohydrate metabolism disorder that begins or is first diagnosed during pregnancy. It is the most common metabolic disease of pregnancy and a public health problem due to the high prevalence and maternal-fetal complications it can cause. For this reason, it is of vital importance the medical management in the detection of risk factors for the prevention of gestational diabetes, early diagnosis and adequate treatment and follow-up to reduce morbidity and mortality. Material and methods: A systematic literature review and a descriptive study of medical records of patients attended during the period 2022 in the diabetes day hospital of a mother and child hospital in the province of Buenos Aires were carried out. Results: It was observed that, out of 112 births to diabetic mothers, 100% of the women had a normal puerperium, 81% of the babies were born weighing less than 4000g and 9% had fetal macrosomia. Conclusion: In conclusion, the role of the day hospital has proven to be of great importance in reducing complications and promoting a healthy pregnancy. Interdisciplinary collaboration and personalized care are key to address maternal and infant morbidity and mortality

Epidemiology of neural tube defects in Finland: a nationwide register study 1987-2018.

Our aim was to evaluate the prevalence, mortality, regional and sex distribution of neural tube defects (NTDs) in Finland. Data for this population-based study were collected from 1987 to 2018 from the national health and social welfare registers. There were in total 1634 cases of NTDs, of which 511 were live births, 72 pregnancies ended in stillbirth and 1051 were terminations of pregnancy due to fetal anomaly (TOPFA). The total prevalence of NTDs was 8.6 per 10 000 births and it increased slightly annually (OR 1.008; 95% CI: 1.002, 1.013) during the 32-year study period. The birth prevalence of NTDs decreased (OR 0.979; 95% CI: 0.970, 0.987), but the prevalence of TOPFA increased annually (OR 1.024; 95% CI 1.017, 1.031). The perinatal mortality of NTD children was 260.7 per 1000 births and the infant mortality was 184.0 per 1000 live births, whereas these measures in the general population were 4.6 per 1000 births and 3.3 per 1000 live births, respectively. There was no difference in the NTD prevalence between males and females (P-value 0.77). The total prevalence of NTDs varied from 7.1 to 9.4 per 10 000 births in Finland by region. Although the majority of NTDs are preventable with an adequate folic acid supplementation, the total prevalence increased in Finland during the study period when folic acid supplementation was mainly recommended to high-risk families and to women with folic acid deficiency. NTDs remain an important cause of infant morbidity and mortality in Finland.

Human milk antibodies to global pathogens reveal geographic and interindividual variations in IgA and IgG.

BACKGROUNDThe use of high-throughput technologies has enabled rapid advancement in the knowledge of host immune responses to pathogens. Our objective was to compare the repertoire, protection, and maternal factors associated with human milk antibodies to infectious pathogens in different economic and geographic locations.METHODSUsing multipathogen protein microarrays, 878 milk and 94 paired serum samples collected from 695 women in 5 high and low-to-middle income countries (Bangladesh, Finland, Peru, Pakistan, and the United States) were assessed for specific IgA and IgG antibodies to 1,607 proteins from 30 enteric, respiratory, and bloodborne pathogens.RESULTSThe antibody coverage across enteric and respiratory pathogens was highest in Bangladeshi and Pakistani cohorts and lowest in the U.S. and Finland. While some pathogens induced a dominant IgA response (Campylobacter, Klebsiella, Acinetobacter, Cryptosporidium, and pertussis), others elicited both IgA and IgG antibodies in milk and serum, possibly related to the invasiveness of the infection (Shigella, enteropathogenic E. coli "EPEC", Streptococcus pneumoniae, Staphylococcus aureus, and Group B Streptococcus). Besides the differences between economic regions and decreases in concentrations over time, human milk IgA and IgG antibody concentrations were lower in mothers with high BMI and higher parity, respectively. In Bangladeshi infants, a higher specific IgA concentration in human milk was associated with delayed time to rotavirus infection, implying protective properties of antirotavirus antibodies, whereas a higher IgA antibody concentration was associated with greater incidence of Campylobacter infection.CONCLUSIONThis comprehensive assessment of human milk antibody profiles may be used to guide the development of passive protection strategies against infant morbidity and mortality.FUNDINGBill and Melinda Gates Foundation grant OPP1172222 (to KMJ); Bill and Melinda Gates Foundation grant OPP1066764 funded the MDIG trial (to DER); University of Rochester CTSI and Environmental Health Sciences Center funded the Rochester Lifestyle study (to RJL); and R01 AI043596 funded PROVIDE (to WAP).

Navigating Diagnostic and Treatment Challenges of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia.

Advances in perinatal intensive care have significantly enhanced the survival rates of extremely low gestation-al-age neonates but with continued high rates of bronchopulmonary dysplasia (BPD). Nevertheless, as the survival of these infants improves, there is a growing awareness of associated abnormalities in pulmonary vascular development and hemodynamics within the pulmonary circulation. Premature infants, now born as early as 22 weeks, face heightened risks of adverse development in both pulmonary arterial and venous systems. This risk is compounded by parenchymal and airway abnormalities, as well as factors such as inflammation, fibrosis, and adverse growth trajectory. The presence of pulmonary hypertension in bronchopulmonary dysplasia (BPD-PH) has been linked to an increased mortality and substantial morbidities, including a greater susceptibility to later neurodevelopmental challenges. BPD-PH is now recognized to be a spectrum of disease, with a multifactorial pathophysiology. This review discusses the challenges associated with the identification and management of BPD-PH, both of which are important in minimizing further disease progression and improving cardiopulmonary morbidity in the BPD infant.

Use of Real-World Data and Machine Learning to Screen for Maternal and Paternal Characteristics Associated with Cardiac Malformations.

Effective prevention of cardiac malformations, a leading cause of infant morbidity, is constrained by limited understanding of etiology. The study objective was to screen for associations between maternal and paternal characteristics and cardiac malformations. We selected 720,381 pregnancies linked to live-born infants (n=9,076 cardiac malformations) in 2011-2021 MarketScan US insurance claims data. Odds ratios were estimated with clinical diagnostic and medication codes using logistic regression. Screening of 2,000 associations selected 81 associated codes at the 5% false discovery rate. Grouping of selected codes, using latent semantic analysis and the Apriori-SD algorithm, identified elevated risk with known risk factors, including maternal diabetes and chronic hypertension. Less recognized potential signals included maternal fingolimod or azathioprine use. Signals identified might be explained by confounding, measurement error, and selection bias and warrant further investigation. The screening methods employed identified known risk factors, suggesting potential utility for identifying novel risk factors for other pregnancy outcomes.

Outcomes and Morbidities in Low-Birth-Weight Neonates: A Retrospective Study From Western India.

Low birth weight (LBW) increases infant morbidity and mortality and is a major public health concern, especially in resource-constrained settings. The purpose of this retrospective study was to assess the outcomes and morbidities related to LBW neonates referred to a neonatal intensive care unit (NICU) in Western India. The present study examined the medical records of newborns weighing less than 2 kg at birth who were admitted to the NICU between September 15, 2016, and September 15, 2017. Data on long-term outcomes, clinical manifestations, morbidities, mortality, and demographic variables were gathered and analyzed. Descriptive statistics were used to present continuous variables as mean and standard deviation (SD), while categorical variables were presented as frequencies and percentages. Bivariate and multivariate logistic regression analyses were carried out to find the association between gestational age and major morbidities among LBW babies. Of 4710 births, 327 (6.9%) were LBW. The leading morbidities of LBW babies were respiratory distress syndrome (RDS) 153 (46.8%), neonatal jaundice 92 (28%), and septicemia 81 (25%), contributing to 58 (17.7%) deaths. Lower gestational age was associated with significantly higher adjusted odds of RDS (<28 weeks: reference; 28-32 weeks: adjusted odds ratio (AOR) 0.07, 95% confidence interval (CI) 0.01-0.33; ≥37 weeks: AOR 0.001, 95% CI 0.00005-0.02) and RDS-related mortality (28-32 weeks: AOR 0.26, 95% CI 0.06-1.13; ≥37 weeks: AOR 0.07, 95% CI 0.01-0.43). Among 250 successfully discharged cases, at 12 months, 18 (13.7%) had a weight below the 3rd percentile, and 9 (6.8%) failed the neurodevelopmental screening. LBW infants in this setting experience significant morbidities, mortality, and long-term growth and developmental effects. To alleviate the burden associated with LBW, improved neonatal care facilities, infection control protocols, and focused interventions are essential.

Evolutionary bridges: how factors present in amniotic fluid and human milk help mature the gut.

Necrotizing enterocolitis (NEC) continues to be a leading cause of morbidity and mortality in preterm infants. As modern medicine significantly improves the survival of extremely premature infants, the persistence of NEC underscores our limited understanding of its pathogenesis. Due to early delivery, a preterm infant's exposure to amniotic fluid (AF) is abruptly truncated. Replete with bioactive molecules, AF plays an important role in fetal intestinal maturation and preparation for contact with the environment, thus its absence during development of the intestine may contribute to increased susceptibility to NEC. Human milk (HM), particularly during the initial phases of lactation, is a cornerstone of neonatal intestinal defense. The concentrations and activities of several bioactive factors in HM parallel those of AF, suggesting continuity of protection. In this review, we discuss the predominant overlapping bioactive components of HM and AF, with an emphasis on those associated with intestinal growth or reduction of NEC.