Late Preterm Infants Research Articles

Exploratory analysis of the economically justifiable price of nirsevimab for healthy late-preterm and term infants in Colombia.

Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent respiratory syncytial virus (RSV) infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia's children under 1 year of age. A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$ 4828, U$ 5128, and U$ 19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. the economically justifiable cost for nirsevimab in Colombia is between U$ 21 to U$ 44 per dose, depending on the willingness to pay used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Early brain cognitive development in late preterm infants: an event-related potential and resting EEG study

BackgroundLate preterm infants (LPIs) are at risk of neurodevelopmental delay. Research on their cognitive development is helpful for early intervention and follow-up.MethodsEvent-related potential (ERP) and resting electroencephalography (RS-EEG) were used to study the brain cognitive function of LPIs in the early stage of life. The Gesell Developmental Scale (GDS) was used to track the neurodevelopmental status at the age of 1 year after correction, and to explore the neurophysiological indicators that could predict the outcome of cognitive development in the early stage.ResultsThe results showed that mismatch response (MMR) amplitude, RS-EEG power spectrum and functional connectivity all suggested that LPIs were lagging behind. At the age of 1 year after correction, high-risk LPIs showed no significant delay in gross motor function, but lagged behind in fine motor function, language, personal social interaction and adaptability. The ROC curve was used to evaluate the predictive role of MMR amplitude in the brain cognitive development prognosis at 1 year, showing a sensitivity of 80.00% and a specificity of 90.57%. The area under the curve (AUC) was 0.788, with a P-value of 0.007.ConclusionsBased on our findings we supposed that the cognitive function of LPI lags behind that of full-term infants in early life. Preterm birth and perinatal diseases or high risk factors affected brain cognitive function in LPIs. MMR amplitude can be used as an early predictor of brain cognitive development in LPIs.Trial registrationThis clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR). Trial registration number: ChiCTR2100041929. Date of registration: 2021-01-10. URL of the trial registry record: https://www.chictr.org.cn/.

Analysis of triadic interaction between parents, their preterm infants, and a sonorous object

In the period between birth and approximately 9 months, adults introduce infants to triadic (adult–infant–object) communication. The objective of this study is to explore how early triadic interactions arise and develop in moderate–late preterm infants. We observed and analyzed seven preterm infants at 2, 3, and 4 months of age in triadic interactions with a caregiver and a sonorous object. In the first 2 months of the infant’s life, the responsibility for the interaction rests with the adult. As time went by, parents used a wider range of semiotic systems to communicate with the child, about and through the object. The results demonstrated the presence of triadic interactions in a preterm population beginning in the third month of life. Interaction is structured with the object, its sound, rhythm, and pauses. The parents’ use of pauses was adjusted to the child’s availability. These pauses became longer and more communicative over time, which allowed more participation on the part of the infants. Communication is facilitated by the rhythmic components of the triadic interaction (time/pauses/structure of the interaction sequence).

Evaluation of cerebral autoregulation of oxygen by NIRS method during postnatal transition period in term and late preterm newborns without resuscitation requirement.

Pulse oximetry is commonly used to monitor arterial oxygen saturation and heart rate during the transition period and reference intervals have been determined. However, the effect of the change in arterial oxygen saturation on tissue oxygenation does not seem to be the same. So, a non-invasive method for monitoring cerebral or regional tissue oxygenation will be potentially useful for vulnerable infants. This study aims to evaluate the effectiveness of cerebral autoregulation in the first 10 min after delivery in term and late preterm newborns without resuscitation requirement. Cerebral tissue oxygen saturation was measured in the first 10 min after birth with near-infrared spectroscopy (NIRS) from the left forehead. Peripheral oxygen saturation was measured with pulse oximetry from the right hand and cerebral fractional tissue oxygen extraction was calculated. Nineteen late preterms and 20 term infants were included in the study. There was no statistically significant difference between median cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction values of late preterm and term infants (p < 0.001). There was a strong inverse relationship between cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction (p < 0.001). In late preterm infants similar to term infants, arterial oxygen saturation and cerebral tissue oxygen saturation increased with time, but inverse reduction of cerebral fractional tissue oxygen extraction showed the presence of an active autoregulation in the brain. This can be interpreted as the ability of the brain to protect itself from hypoxia by regulating oxygen uptake during normal fetal-neonatal transition process. A larger scale multi-center randomized control trial is now needed to further inform practice.

Vitamin D Levels Assessment among the Neonates with and without Seizures: A Single Center Cross-Sectional Study.

The impact that vitamin D (vit D) has on a variety of medical conditions like diabetes, cardiovascular, oncological, and central nervous system disorders has been a topic of interest for many years now. It is well-known that vit D deficiency is substantially more common in epileptics than in healthy subjects. The current research was piloted to analyse the vit D levels of the blood in newborns with seizures, as well as mothers' vit D status included subjects. A cross-sectional examination was piloted at a tertiary care center, which had a neonatal intensive care unit (NICU). The subjects were neonates and their mothers. The levels of vit D were measured in term and late preterm newborns who had been brought to the NICU with convulsions. Term or late preterm infants who were healthy and hospitalized in the same hospital's postnatal unit as their mothers served as the controls for the study. Demographics, as well as the vit D levels of both the neonate and the mother, were estimated and compared and evaluated for any significance, keeping significance at less than 0.05. Of the 72 neonates included, they were similarly distributed between the epileptic (37) and healthy subjects. (40) The mothersy subjects.cluded, they were sim D levels averaged 15.11 ded, they were similarly distributed b D levels of their newborns were 13.26 ± 5.12 ng/mL (P = 0.77). There was no significant variance between the healthy and epileptic neonates (P = 0.212). The current studyficant variance between the healthy and epileptic neonates (eptic with convulsions. Termserum vit D levels and epileptic activity in neonates. Nevertheless, the levels of the vitamin were < 20 ng/mL among all the neonates. Interventions to improve the vit D levels have to be implemented.

Inhaled nitric oxide therapy for preterm infants after 7 days of age: a scoping review protocol

IntroductionInhaled nitric oxide (iNO) use is recommended for persistent pulmonary hypertension of the newborn in term and late preterm infants. Recently, iNO therapy to prevent bronchopulmonary dysplasia (BPD) or rescue...

2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

Analysis of the Fecal Metabolomic Profile in Breast vs. Different Formula Milk Feeding in Late Preterm Infants.

Human milk is the gold standard for infant nutrition, but when it is not available or insufficient to satisfy the needs of the infant, formula milk is proposed as an effective substitute. A prospective observational cohort study was conducted on late preterm infants fed with breast and two different formula milks. On this basis, they were divided into three groups: group FMPB (fed with formula + postbiotic), group FM (fed with standard formula), and group BM (breastfed). Stool samples for a metabolomic study were collected at T0 (5-7 days after birth), T1 (30 days of life), and T2 (90 days of life), giving rise to 74 samples analyzed via liquid chromatography coupled with high-resolution mass spectrometry. The T0, T1, and T2 LC-MS raw data were processed for Partial Least Square Discriminant Analysis (PLS-DA), followed by a statistical analysis. This preliminary study highlighted a good overlapping between the fecal metabolome of breast and substitute feeding systems, confirming the efficacy of the formula preparations as breast milk substitutes. Moreover, several similarities were also detected between the FMPB and BM metabolome, highlighting that the addition of a postbiotic to standard formula milk could be more effective and considered a better alternative to breast milk.

Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants: A Quality Improvement Project.

Late preterm births account for a large portion of preterm births, yet the optimal method of nutrition and enteral feeding in this population remains unclear and often involves intravenous (IV) fluids. To develop and implement a late preterm feeding protocol in order to decrease the necessity of IV access, decrease the use of starter parenteral nutrition (PN), and reduce the pain endured by an infant in the neonatal intensive care unit. The Plan-Do-Study-Act quality improvement model was utilized as a framework for the implementation of this quality improvement project. A literature review was conducted and subsequently, a feeding protocol was developed and included the more judicious use of starter PN. This protocol was implemented, evaluated, and adopted. A second Plan-Do-Study-Act cycle was completed with the addition of an auto-text reminder incorporated into admission notes in the electronic medical record. The implementation of the protocol significantly reduced placement of IV access and the use of starter (PN) in late preterm infants without considerable differences in balancing measures. The percentage of infants who received peripheral IV access declined considerably from 70% to 42% ( P = .0017) subsequently, less pain endured by the infants. There was a decrease in the initiation of starter PN from 55% to 7% ( P < .00001). Administering enteral feedings on admission to stable, late preterm infants reduced the need for peripheral IV access and thus decreased pain from this procedure.

EBNEO commentary: Caffeine to prevent intermittent hypoxaemia in late preterm infants: Randomised controlled dosage trial.

EBNEO commentary: Caffeine to prevent intermittent hypoxaemia in late preterm infants: Randomised controlled dosage trial.

Effects of a valved infant-bottle with ergonomic teat on the coordination of sucking, swallowing, and respiration in late-preterm infants. The Safe Oral Feeding randomized Trial.

Breastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle. This unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant'Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio. Forty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0-36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03-1.23) in the B-EXP arm and 1.75 (1.21-2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013). The valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.

Growth and micronutrient status parameters of Nigerian preterm infants consuming preterm formula or breastmilk.

Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal morbidities compared to term infants, however dedicated nutritional guidelines are lacking. Moderate-to-late preterm infants received a preterm formula (n = 17) or breastmilk (n = 24) from age 2-10 weeks in a non-randomized, open-label observational study. Anthropometric measurements were assessed bi-weekly. Blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D (25OHD) were analyzed at age 2 and 10 weeks. Average growth per day was 14.7 g/kg BW/day in formula-fed and 12.8 g/kg BW/day in breastmilk-fed infants but not different from each other. Length and head circumference in both groups were in line with the median reference values of the Fenton growth chart. At 10 weeks of age, hemoglobin tended to be higher in the formula-fed group (10.2 g/dL vs. 9.6 g/dL, p = 0.053). 25OHD increased in formula- and breastmilk-fed infants from 73.8 to 180.9 nmol/L and from 70.7 to 97.6 nmol/L, respectively. Serum retinol only increased in the formula-fed group (0.63 to 1.02 µmol/L, p < 0.001). Breastfeeding resulted in adequate growth in moderate-late preterm infants but was limiting in some micronutrients. The preterm formula provided adequate micronutrients, but weight gain velocity was higher than the Fenton reference value. Unfortified breastmilk resulted in adequate growth in weight, length and head circumference in Nigerian moderate to late preterm infants during an study period of 8 weeks, but status of vitamin D, vitamin A and iron needs to be monitored. The high-energy formula, developed for very preterm infants, resulted in higher growth in body weight in moderate to late preterm infants than the median of the Fenton preterm growth chart. This study supports the necessity of dedicated nutritional guidelines, and regular monitoring of growth and nutritional status of moderate to late preterm infants.

Cord Blood Albumin; A Predictor of Neonatal Jaundice

Objective: To determine significance of cord blood albumin as predictor of neonatal hyperbilirubinemia. Methodology: This cross-sectional was conducted in 6 months from 24-4-2021 to 23-9-2021 at Department of neonatology, Recep Tayyip Erdogan Hospital, Muzaffargarh. Early preterm, late preterm and term neonates, age less than 1 week were included in the study. Patients were divided in three groups on basis of gestational age. Group 1 was included early preterm; group 2 was included late preterm and group 3 was including term neonates. Cord blood samples were taken in sterile vials for serum albumin at birth. Patients were followed from 2nd to 7th day of life for development of jaundice. Patients who had transcutaneous bilirubin more than 5mg/dl were selected for serum bilirubin level estimation. Results: A total of 73 newborn babies were studied; with an average age of approximately 4.94+1.68 days. There were 52.1% male and 47.9% female babies. There were no significant differences in average blood cord albumin and direct bilirubin levels among these groups. However, significant variations were observed in terms of total bilirubin and indirect bilirubin levels, with early and late preterm babies displaying higher levels compared to term babies. Moreover, the study established significant inverse correlations between cord blood albumin levels and both total bilirubin (r ? -0.389, p = 0.001) and indirect bilirubin levels (r ? -0.313, p = 0.007). Conclusion: Study provides compelling evidence to support the role of cord blood albumin as a predictor of neonatal jaundice through its observed inverse correlations with bilirubin levels. The findings underscore the potential clinical utility of cord blood albumin as an early diagnostic marker for identifying newborns at risk of developing jaundice.

Respiratory morbidity and short-term outcome in moderate preterm, late preterm, and early-term infants at a tertiary care hospital in Southern India

ABSTRACT Introduction: Moderate and late preterm and early-term infants constitute a significant proportion of hospitalizations in neonatal intensive care units (NICU), yet have been perceived as low-risk groups. Their gestational age-specific data have been poorly studied, including respiratory morbidity and outcome. Objectives: The objectives of this study were to determine the respiratory morbidity among moderate and late preterm and early-term infants and to study their short-term outcomes. Materials and Methods: A longitudinal descriptive hospital-based study was conducted at a tertiary care hospital in Southern India, from January 2018 to June 2019. Newborns between 32 and &lt;39 completed weeks, after gestational age assessment, were observed until discharge and later followed up to 40 weeks of gestation. The outcome was recorded in terms of respiratory issues, length of hospital stay, and readmissions within a month. Results: Two hundred and fifty babies were included in the study. NICU care was required in 78%, 72%, and 9.2% of moderate preterm, late preterm, and early-term infants, respectively. Respiratory distress was noted in 78%, 66%, and 6% of moderate preterm, late preterm, and early-term infants, respectively. The association of respiratory distress with gestational age was highly significant (P &lt; 0.0001). Surfactant requirement was 12%, 6%, and 1.7% among the three groups. The average length of NICU stay was 7.8 days, 6.5 days, and 0.3 days among moderate and late preterms and early-term infants, respectively. Conclusion: Moderate and late preterms and early-term infants have significant morbidities. Gestational age has a substantial correlation with respiratory distress and neonatal outcomes. Knowledge about these issues can ensure improved outcome in these infants.

Racial Differences in Respiratory Morbidity in Late Preterm Infants: A Retrospective Cohort Study.

Objectives. The role of race in late preterm respiratory morbidity has not been adequately described. We aimed to determine whether neonatal respiratory morbidity differs between Black and White late preterm infants. Methods. Single-centre retrospective cohort study at King's College Hospital NHS Foundation Trust, London, UK of infants born at 34 to <37 weeks of gestational age. The incidence of invasive ventilation was used as the main outcome. Results. In the study period 354 Black and 673 White late preterm infants were admitted. Black, compared to white infants, had a lower incidence of invasive ventilation (19% vs 27%, P < .001) and a lower incidence of non-invasive ventilation (22% vs 34%, P < .001). Black infants had a shorter duration and cost of stay compared to White infants (P = .011 and <0.001 respectively). Conclusion. Black late preterm infants needed less frequently invasive and non-invasive ventilation and had a shorter duration and cost of stay compared to White late preterm infants.

Ab. No. 71 Evaluate the Neurobehavioral Status of Preterm Infants at Term Equivalent Age

Introduction: Neurobehavioral development of preterm infants differs from term born infants at term equivalent age and has been shown to be related to environmental and biological factors. Importantly, differences has been shown in neurobehavioral developmental at term in preterm children compared with term born children are associated with later motor, cognitive and behavioural difficulties and contribute to neurodevelopmental impairments in school-age children born preterm. The purpose of the study is to assess the neurobehavior development in infants born as preterm, for early intervention. The study focuses on age-appropriate movement patterns, motor milestones and any delayed development in infants born as preterm. Methods: Total 25 patients, Very Preterm Infants - 13, Late Preterm Infants- 12, From Dhiraj general hospital. Group 1 (VPI), Group 2 (LPI) were assessed at the time of discharge using HNNE at term corrected age. Each of the 34 items on the HNNE was assigned an optimality score of 0, 0.5, 1 totaling up to 34. Descriptive demographics and clinical data statistics were analysed by SPPS 26 software and quantitative comparison of neurobehavior was made using two sample t-tests. Result: Total 25 infants (13 VPI and 12 LPI),the mean of VPI was (20.077 ± 1.2221/ 34), LPI was (25.250 ± 1.3899/34) with a mean difference of 5.173 (0.0001). Conclusion: VPI are more immature than their term counterparts even on reaching TCA. The pattern of abnormality varied to various perinatal exposures neurobehavior examination at term equivalent age is useful in evaluating the impact of neonatal intensive care. Implication: Assessment of neurobehavior from birth helps determining, the term newborn is developing normally or not, impact of various exposures to perinatal variables whether the infant may have any long term developmental problems so, that appropriate interventions can be commenced immediately.

Особенности адаптационного периода и характеристика состояния поздних недоношенных новорожденных в раннем детстве

The purpose was to study the features of adaptation in the neonatal period and the health status in early childhood of late premature newborns. Material and methods. An analysis was carried out of 267 cases of premature babies born at 34–36 weeks of gestation and 211 outpatient records during their follow-up observation from 2021 to 2023 at Children’s Hospital No. 1 in Kazan. Results. The most common causes of adaptation disorders in late premature infants were respiratory disorders, hyperbilirubinemia, infections, and hypoxic-ischemic lesions of the central nervous system. In the first year of life, the incidence of acute lower respiratory tract infections was observed in 22% of patients, neurological abnormalities in 36%, and decreased physical development in 31% of late premature infants. Conclusion. Morpho-functional immaturity and disturbances in the adaptation period lead to a decrease in the protective and adaptive reactions of premature infants with a gestation period of 34–36 weeks in the early age.

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

Динамика показателей психомоторного развития на фоне медицинской абилитации у детей первого года жизни с нарушением моторного развития, родившихся с разным гестационным возрастом

Aim. To assess the dynamics of psychomotor development indicators during medical habilitation in infants of the first year of life with impaired motor development, born with different gestational ages. Design. Comparative study. Materials and methods. Eighty children of the first year of life were examined. The main group consisted of 64 infants with impaired motor development, the control group — 16 healthy full-term infants. Depending on the gestational age at birth, the infants of the main group were divided into 4 subgroups: very premature (n = 16), moderately premature (n = 16), late premature (n = 16), and full-term (n = 16) infants. Before and after the completion of the medical habilitation course, all patients were assessed for psychomotor development using the L.T. Zhurba and E.M. Mastyukova scale. Results. Before the medical habilitation course, patients in all studied subgroups showed a delay in psychomotor development, which was more pronounced in very premature infaants. Against the background of medical habilitation measures, the most pronounced positive dynamics were noted in premature babies, especially in very premature patients. Conclusion. The results obtained can be used to develop a differentiated approach to managing patients of different gestational ages with impaired motor development, which will help to increase the effectiveness of medical habilitation and minimize the severity of motor disorders. Keywords: perinatal central nervous system damage, impaired motor development, infants, premature infants, psychomotor development.

Insights into Risk: Exploring Retinopathy of Prematurity and Short-term Comorbidities in Moderate-to-Late Preterm Infants.

Retinopathy of prematurity (ROP) and short-term comorbidity data moderate-to-late preterm (MLP) infants in Saudi Arabia are limited. The present study mainly aimed to identify ROP incidence and severity in MLP infants. The secondary objective was to explore whether moderate preterm infants are more prone to systemic short-term comorbidities compared to late preterm infants. This retrospective study was conducted at King Abdulaziz University Hospital, a tertiary center in Jeddah, Saudi Arabia. Two-hundred and sixty-eight MLP infants born with gestational ages (GAs) of 32 to 36 + 6 weeks were included. Births were classified as moderate preterm (GA 32 to 33 + 6 weeks) and late preterm (GA 34 to 36 + 6 weeks) and the two groups were compared with an independent t-test. ROP incidence was 1.5%; all cases were stage 1 and involved zone II or III. No patient had type 1 ROP requiring treatment. The short-term comorbidity incidence was high (76.1%) and included hyperbilirubinemia (n = 206, 76.7%), respiratory distress syndrome (n = 178, 66.4%), hypoglycemia (n = 32, 11.9%,), and transient tachypnea of newborn (n = 25, 9.3%). Moderate preterm infants were more likely to have lower birth weight (P < 0.001), any-stage ROP (P = 0.032), respiratory distress syndrome (P = 0.031), intraventricular hemorrhage (P = 0.038), and hyperbilirubinemia (P < 0.001) compared to the late preterm infants. Any-stage ROP incidence among MLP infants was low, with no type 1 ROP cases requiring treatment. Short-term comorbidity incidence was relatively high among the moderate preterm infants. Despite the low non-type 1 ROP incidence at our center, MLP infants require proper surveillance of systemic short-term comorbidities.