Low Birth Weight Preterm Infants Research Articles

Evaluating the moderating role of accredited social health activists on adverse birth outcomes in rural India

BackgroundThe Indian government established the Accredited Social Health Activists (ASHA) program in 2006 to improve access and healthcare coverage in rural regions. The objective of this study was to examine the moderating role of ASHA home visits and ASHA-accompanied antenatal care visits (ANC) on the relationship between sociodemographic latent classes of pregnant women and preterm birth and low birth weight infants in rural Mysore District, India. MethodsUtilizing a prospective cohort study conducted between 2011 and 2014, secondary data analysis was performed among 1540 pregnant women in rural Mysore, India. Latent class analysis was performed to identify sociodemographic distinct patterns. Multivariable logistic regression was performed to examine the moderating effects of ASHA-accompanied ANC visits and ASHA home visits on preterm birth and low birth weight. ResultsAmong women who never/rarely had ASHA-accompanied ANC visits, women in Class 1 “low socioeconomic status (SES)/early marriage/multigravida/1 child or more” had higher odds of preterm birth (adjusted odds ratio [aOR]: 2.62, 95% confidence interval [CI]: 1.12–6.12 compared to Class 4 “high SES/later marriage/primigravida/no children.”. Women in Class 3 “high SES/later marriage/multigravida/1 child or more” had higher odds of preterm birth compared to class 4. Women in Class 2 “low SES/later marriage/primigravida/no children” had higher odds of low birth weight infant. ConclusionThe findings demonstrate that ASHA accompanying women to ANC moderates the risk of preterm births among women in high-risk SES groups. Targeted policies and interventions in improving and strengthening the ASHA program are needed to reduce inequalities in adverse birth outcomes in rural India.

Correlation between diminished vagal tone and somatic dysfunction severity in very and extremely low birth weight preterm infants assessed with frequency spectrum heart rate variability and salivary cortisol.

Osteopathic manipulative treatment (OMT) is evolving in the neonatal intensive care unit (NICU) setting. Studies showed its efficacy in length of stay and hospitalization costs reduction. Moreover, it was suggested that OMT has a modulatory effect on the preterm infants’ autonomic nervous system (ANS), influencing saturation and heart rate. Even if OMT is based on the palpatory examination of the somatic dysfunctions (SD), there are controversies about its identification and clinical relevance. The objective of this study was to evaluate the inter-rater reliability, clinical characteristics, and functional correlation of the SD Grade score with the heart rate variability (HRV) and the salivary cortisol (sCor) using a multivariate linear model approach. To evaluate those features, we implemented an ad hoc SD examination for preterm infants that was performed by 2 trained osteopaths. It was based on the new variability model of SD that includes an SD Grade assessment procedure. The ANS features were assessed by frequency parameters of HRV studying high frequency (HF), low frequency (LF), and HF/LF, whereas sCor was tested with a radioimmunoassay. The ANS assessment was standardized and performed before SD testing. Sixty-nine premature infants were eligible. SD Grade showed excellent concordance between the blinded raters. Using SD Grade as a grouping variable, the infants presented differences in GA, Apgar, pathological findings, length of stay, and ventilatory assistance. In our multivariate model, HF, LF, and LF/HF resulted linearly correlated with SD Grade. Instead, sCor presented a linear correlation with 5’ Apgar and respiratory distress syndrome but not with SD Grade. SD Grade was in line with the natural history of the underdevelopment due to prematurity. Our models indicate that the cardiac vagal tone is linearly related with SD Grade. This finding may improve the multidisciplinary decision making inside NICU and the management of modifiable factors, like SD, for cardiac vagal tone regulation.

Standard Fortification Using Bovine Liquid Human Milk Fortifier and Target Pooled Donor Milk May Not Meet Enteral Protein Requirements of The Very Low Birth Weight Preterm Infant

Upon completion, participant will be able to describe protein intakes in VLBW infants receiving fortified donor human milk.

Successful ‘Kangaroo Mother Care’: A Necessity for Preterm Low Birth Weight Babies in Rural Hospital Settings in Bangladesh

Kangaroo Mother Care (KMC) is a cost-effective solution in taking care of pre-term low birth weight neonates not only in developing countries with scarce resources, but also in developed countries with easy accessibility to technological advances like incubators. It provides an easy solution where the mother herself acts as an incubator and keeps the baby close to her in skinto- skin contact, and provides the baby the warmth, food, shelter and love that the baby needs to ensure its survival.In this paper we described the successful management of a preterm baby born at 29th gestational weeks weighing only 980 gm in a rural setting without any incubator and other technological equipment. The baby was in a critical condition since birth and despite adequate medical therapy she remained hypothermic. The KMC was initiated to keep her warm and marked improvements were noticed in the baby. The baby was discharged at day-14 with a body weight of 1100gm. Baby was in regular follow up and subsequently at 2-months 24days,she reached a desired body weight of 2100gm with improvement in feeding, movement and vital signs.It is concluded that, in a limited resource setting, KMC can act as a very effective measure in preventing neonatal morbidity by adequate heat regulation, exclusive breastfeeding and promoting early discharge from hospital. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 875-882

Necrotizing Enterocolitis in a Term Newborn: A Case Report

This case report describes a 5-day-old term infant with necrotizing enterocolitis (NEC). The clinical presentation, diagnostic reasoning, current literature, hospital course, and follow-up are discussed. Necrotizing enterocolitis is a gastrointestinal emergency characterized by severe inflammation and ischemic necrosis of the intestinal mucosa. Usually a condition of prematurity, NEC primarily occurs in very low birth weight premature infants. Necrotizing enterocolitis can be managed medically or surgically, depending on the severity. Although the etiology of NEC is unknown, the clinical presentation includes abdominal distention and tenderness, feeding intolerance, grossly bloody stools, and severe hypotension and acidosis.

The Predictive Effect of Individual and Environmental Factors on Motor Performance of Low Birth Weight Infants

Objectives: Premature infants in the neonatal intensive care unit (NICU) are exposed to environmental risks that may cause developmental problems i. The present study aimed to investigate the predictive effect of individual and environmental factors on the motor performance of low birth weight preterm infants. Methods: This cross-sectional study was performed in the neonatal clinic of Shahid Akbarabadi Hospital in Tehran City, Iran. A group of 90 low birth weight infants were enrolled in the study by non-probabilistic method and according to the inclusion criteria. Test of infant motor performance (TIMP), sensory profile2 (infant section), affordance in the home environment for motor development (AHEMD), and a demographic questionnaire were used to evaluate motor performance, sensory status, home environment, and other factors (birth weight, corrected age, parent’s education, etc.), respectively. Results: TIMP elicited score was positively correlated with the infant’s age (r=0.390, P<0.001) and infant’s weight (r=0.260, P=0.011), and negatively correlated with duration of hospitalization in NICU (r=-0.210, P=0.047). A significant negative correlation was observed between TIMP elicited score and total infant sensory profile2 score (r=0.391, P<0.001) and a positive correlation was observed between TIMP elicited score and total affordance in the home environment for motor development score (r=0.207 P=0.049). Discussion: The present study’s results showed that elicited movement has a significant relationship with infant sensory status and home environment and demographic variables (infant’s age, gender, infant’s weight, type of delivery, NICU duration, father and mother’s age, number of family children) and the sensory status has a more predictive effect on infant motor performance than the environmental questionnaire.

Early gut microbiota in very low and extremely low birth weight preterm infants with feeding intolerance: a prospective case-control study.

The potential role of the gut microbiota in the pathogenesis of feeding intolerance (FI) remains unclear. Understanding the role of the gut microbiota could provide a new avenue for microbiota-targeted therapeutics. This study aimed to explore the associations between aberrant gut microbiota and FI in very low or extremely low birth weight (VLBW/ELBW) preterm infants. In this observational case-control study, VLBW/ELBW infants were divided into two groups: FI group and feeding tolerance (FT) group. 16S rRNA gene sequencing was performed to analyze the gut microbial diversity and composition of the infants. The differences in the gut microbiota of the two groups were compared. In total, 165 stool samples were obtained from 44 infants, among which, 31 developed FI and 13 served as controls. Alpha diversity was the highest in the meconium samples of the two groups. LEfSe analysis revealed that the abundances of Peptostreptococcaceae, Clostridiales and Clostridia in the FT group were significantly higher than in the FI group. At the phylum level, the FI group was dominated by Proteobacteria, and the FT group was dominated by Firmicutes. The meconium samples of the FI group had higher proportions of γ-proteobacteria and Escherichia-Shigella and a lower proportion of Bacteroides compared with the FT group. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis demonstrated that aberrant gut bacteria in the FI group were strongly associated with dysregulation of C5-Branched-dibasic-acid-metabolism, protein kinases, and sporulation. These findings reveal candidate microbial markers to prevent FI. Increased relative abundances of γ-proteobacteria and Escherichia-Shigella and decreased abundance of Bacteroides in meconium were associated with an increased risk of FI, while Peptostreptococcaceae, Clostridiales and Clostridia reduced the risk of FI in VLBW/ELBW infants.Supplemental material for this article may be found at 10.1007/s12275-022-2180-2.

Effect of Small Volume Blood Sampling on the Outcomes of Very Low Birth Weight Preterm Infants.

Very low birth weight (VLBW) preterm infants universally experience anemia of prematurity (AOP) while growing up. The effects of reduced blood sample volume on AOP, packed red blood cell (PRBC) transfusion, and outcome in VLBW preterm infants were examined in this study. To reduce blood loss due to phlebotomy, we set up a small volume blood sampling procedure in VLBW infants. In this retrospective study, we compared the VLBW infants who had undergone standard blood sampling (control group, n = 20) with those who underwent small volume blood sampling (study group, n = 84), with both groups receiving PRBC transfusion under restrictive criteria. Blood loss from phlebotomy and PRBC transfusion volume over 30 days was significantly lower in the study group than in the control group. Compared to the control group, hematocrit, reticulocyte, and iron levels were significantly higher in the study group. There were no significant differences in the proportion of patent ductus arteriosus, severe intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia between the two groups. The small volume blood sampling resulted in lower PRBC transfusion volume, less severe anemia, and greater bone marrow function at 30 days of age. This strategy can reduce potential adverse effects of PRBC transfusion in VLBW preterm infants.

Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight.

Background and objectiveThere remains controversy regarding vitamin D deficiency and bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. This study aimed to determine the prevalence of vitamin D deficiency assessed by umbilical cord blood 25-hydroxyvitamin D [25(OH)D] in preterm infants in northeast China and to evaluate the ability and optimal threshold of 25(OH)D for predicting BPD.MethodsThe clinical data of VLBW and ELBW preterm infants with known cord-blood 25(OH)D levels were analyzed retrospectively. Infants were divided into groups based on their cord-blood 25(OH)D levels and BPD diagnosis. Logistic regression was performed to assess the risk factors for BPD and a nomogram was established. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal threshold of cord-blood 25(OH)D concentration for predicting BPD.ResultsA total of 267 preterm infants were included, of which 225 (84.3%) exhibited vitamin D deficiency and 134 (50.2%) were diagnosed with BPD. The incidence of BPD was lower in the group with a 25(OH)D level of >20 ng/ml than in the other groups (P = 0.024). Infants with BPD had lower cord-blood 25(OH)D levels than those without BPD (11.6 vs. 13.6 ng/ml, P = 0.016). The multivariate logistic regression model revealed that 25(OH)D levels (odds ratio [OR] = 0.933, 95% confidence interval [95% CI]: 0.891–0.977), gestational age (OR = 0.561, 95% CI: 0.425–0.740), respiratory distress syndrome (OR = 2.989, 95% CI: 1.455–6.142), and pneumonia (OR = 2.546, 95% CI: 1.398–4.639) were independent risk factors for BPD. A predictive nomogram containing these four risk factors was established, which had a C-index of 0.814. ROC curve analysis revealed that the optimal cutoff value of 25(OH)D for predicting BPD was 15.7 ng/ml (area under the curve = 0.585, 95% CI: 0.523–0.645, P = 0.016), with a sensitivity of 75.4% and a specificity of 42.9%.ConclusionsA cord-blood 25(OH)D level of <15.7 ng/ml was predictively valuable for the development of BPD. The nomogram established in this study can help pediatricians predict the risk of BPD more effectively and easily.

The Effect of High Humidity Environments on Very Low Birth Weight Preterm Infants: A Systematic Review

The scholarly evidence on the timing and practice of interventional care administered to preterm infants in high-humidity environments is unclear. This makes evaluating the prognosis of preterm infants with comorbidities difficult and means that clinical medical staff lack clear guidelines for care. This systematic review was designed to explore the prognostic effects of interventions for comorbidities performed on very low birthweight preterm infants in high humidity environments to provide an empirical basis for developing related clinical-care guidelines. An electronic database was searched for all relevant documents published between 1930 and September 2021. The keywords used were "premature infants" OR "very low weight premature infants" OR "very low weight premature infants" AND "humidity", and the target groups were premature infants weighing ≤ 1,500 grams or delivered at ≤ 34 weeks of gestation. The timing and practice of interventions in high humidity environments and the occurrence and prognosis of related comorbidities were explored. The main findings cover the issues of body weight, total water intake, electrolytes, urine output, insensitivity water loss, infection, common complications, and mortality in preterm infants. After reviewing the methods, quality, and efficacy of the research in the identified studies, 9 articles were selected for integrated synthesis. Recommendations for the use of high humidity with infants delivered at ≤ 30 weeks of gestation or at birth weights ≤ 1,000 grams were integrated. An environment with a relative humidity of 70%-80% should be used during the first postpartum week and 50%-60% during the second postpartum week. The recommended total duration of use of a high-humidity environment is two weeks to avoid delaying the development of the stratum corneum. Physiological indicators shown to exhibit significant improvement under this regimen include reduced total water intake, increased urine output, and a lower incidence of hypernatremia. The appropriate timing and practice of high humidity intervention were integrated in this study. It is hoped that this review provides an evidence-based clinical practice guideline for preterm infant care.

The trajectory of general movements from birth until 12 - 14 weeks corrected age in very low birthweight and extremely low-birthweight infants born preterm

&#x0D; Background. General movement assessment (GMA) is an assessment tool with high predictive validity for neurodevelopmental outcomes in preterm infants. Information available describing the trajectory of general movements (GMs) in high-risk preterm-born infants and the use thereof in low- and middle-income countries is limited.&#x0D; Objective. To describe the trajectories of GMs from birth until 12 - 14 weeks’ corrected age, and determine the association of known perinatal risk factors on GM trajectories in very low-birthweight and extremely low-birthweight preterm infants.&#x0D; Methods. This was a longitudinal, prospective cohort study with 119 preterm infants born at &lt;33 weeks’ gestation and with a birthweight &lt;1 500 g. GMs were recorded at four key age periods: 1 - 2 weeks after birth to 33 weeks post menstrual age (PMA); 34 - 37 weeks PMA; term equivalent age (TEA); and 12 - 14 weeks corrected age. Detailed perinatal data were collected.&#x0D; Results. A total of 300 GMAs were conducted, 157 during the preterm age, 55 during TEA and 88 at 12 - 14 weeks corrected age. At &lt;33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34 - 37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs recorded at term equivalent age were abnormal. At 12 - 14 weeks corrected age, 7% of GMs were abnormal and 93% normal.&#x0D; Conclusion. GMs were predominantly abnormal prior to term with a significant decrease in abnormality at 12 - 14 weeks corrected age. Lower birthweight and lower PMA were associated with increased odds for abnormal GMs. In a resource-constrained environment, observing GMs at 12 - 14 weeks corrected age (during the fidgety period) is a time- and cost-effective method to determine the risk for adverse neurodevelopment.&#x0D;

Obstetric and perinatal outcomes of teenage pregnant women: a retrospective study

Background: teenage pregnancy is a worldwide social problem. The aim of this study is to provide more data for a better understanding of the possible maternal and foetal risks associated with teenage pregnancies.&#x0D; Methods: the hospital records of all pregnant women, aged between 14 and 19, from the obstetric registers of the Policlinico Umberto I Hospital in Rome, between 2000 and 2010, have been completely reviewed (n=184). For each pregnant woman socio-demographic characteristics, obstetric history, pregnancy and birth outcomes were also determined. Our results were compared with a control group composed of 150 primigravida adult women aged 20-29 years who delivered at the Policlinico Umberto I Hospital in Rome in the same period.&#x0D; Results: the mean age ± SD of the study group was 17.9 ± 1.2, while that of the control group was 25.4 ± 2.4. The control group had a significantly lower risk of preterm delivery (p=0.000). The rate of low birth weight babies born to the young mothers was significantly higher than that of babies born to the adult mothers (p=0.036). The study group had a lower risk of instrumental delivery and a higher proportion of spontaneous delivery (p=0.000). Finally, we observed a statistically significant difference of the APGAR score at the fifth minute between the two groups (p=0.004).&#x0D; Conclusions: our results seemed to confirm the outcomes of previous studies for adolescent pregnant women, mainly regarding the increased risks of preterm deliveries and low birth weight babies, the higher incidence of spontaneous vaginal delivery and the lower incidence of instrumental delivery.

A predictive clinical model for moderate to severe intraventricular hemorrhage in very low birth weight infants.

Intraventricular hemorrhage (IVH) occurs in 15-45% of all very low birth weight (VLBW) preterm infants. Despite improvements in the perinatal care, the incidence of IVH remains high. As more preterm infants survive, there will be a larger burden of neurodevelopmental abnormalities borne by former preterm infants. The objective of this study was to develop a predictive clinical model of IVH risk within the first few hours of life in an effort to augment perinatal counseling and guide the timing of future targeted therapies aimed at preventing or slowing the progression of disease. This is a prospective observational cohort study of VLBW infants born in the NICU at John's Hopkins Children's Center from 2011 to 2019. The presence and severity of IVH was defined on standard head ultrasound screening (HUS) using the modified Papile classification. Clinical variables were identified as significant using absolute risk regression from a general linear model. The model predictors included clinically meaningful variables that were not collinear. This study took place at the Johns Hopkins Children's Center Level IV NICU. The study sample included VLBW infants treated in the neonatal intensive care unit (NICU) at John's Hopkins Children's Center from 2011 to 2019. A total of 683 infants included in the study had no or grade I IVH, and 115 infants had grades II through IV IVH. Exclusion criteria included admission to the JHH NICU after 24 h of age, BW &gt; 1500 g, and failure to consent. The main outcome of this study was the presence of grades II-IV IVH on standard head ultrasound screening using the modified Papile classification [1]. A total of 798 VLBW infants were studied in this cohort and 14.4% had moderate to severe IVH. Fifty four percent of the cohort was black, 33% white, and half of the cohort was male. A higher gestational age, 5-min Apgar score, hematocrit, and platelet count were significantly associated with decreased incidence of IVH in a multi-predictor model (ROC 0.826). In the face of continued lack of treatments for IVH, prevention is still a primary goal to avoid long-term developmental sequela. This model can be used for perinatal counseling and may provide important information during the narrow therapeutic window for targeted prevention therapies.

Irisin concentration in infant formulas and breast milk.

Irisin is a newly discovered myokine with antiobesity properties. The delivery of irisin with the breast milk or formula is an emerging concept that myokine present at human milk influences postnatal energy balance and developmental parameters. The aim of the study was to evaluate irisin concentration in breast milk of mothers with term and preterm babies and in infant formulas. A total of 49 lactating mothers were enrolled in the study: 31 mothers of very low birth weight preterm infants and 18 mothers of term infants. Milk samples were collected twice: during the first week after delivery and after 4 weeks of delivery. Irisin concentration was determined using ELISA kits both in human milk and in samples of 14 different infant formulas. There were no differences in milk irisin levels between preterm and full-term milk samples during both the 1st and the 4th week after delivery. There were also no differences in irisin concentration between transitional milk and mature milk in both tested groups. Irisin concentrations in preterm and full-term milk were significantly higher than in formulas for 30 days period after delivery. A significant increase of irisin concentration in natural milk 4 weeks postdelivery in comparison to 1st week after delivery was observed (mean difference 0.362 µg/mL; P=0.0063). This study provides evidence that irisin is present in infant formulas, although in less amount than in human milk. Further research is needed to assess, if children fed with infant formulas may disadvantage from lower irisin supply.

Evaluation of Inpatient Starter Parenteral Nutrition Use in the Neonatal Intensive Care Unit.

Parenteral nutrition (PN) promotes growth and development in neonatal patients while avoiding malnutrition and metabolic derangements. Very low birth weight premature infants should be started on PN within 24 to 48 hours after birth. The objective of this study was to compare starter PN solution use at a freestanding children's hospital health care system before and after the development of a standard starter PN protocol. The secondary objective was to evaluate the estimated annual cost savings due to a standard protocol. A single-center, retrospective chart review of neonates who received starter PN in the NICU setting from October through December 2020 after the implementation of the protocol was conducted. The protocol was developed based on usage trends from October through December 2019. Starter PN use was compared within neonatology groups before and after the development of a standardized protocol. In 2019, 108 neonates weighing <1.8 kg were admitted to the NICUs, while 101 were admitted in 2020. However, 170 neonates received starter PN in 2019, while only 94 neonates received starter PN in 2020. Overall, protocol adherence was 88%. The mean gestational age for patients who were initiated on starter PN decreased from 31 weeks in the pre-protocol group to 28 weeks in the post-protocol group (p < 0.001). The mean birth weight pre-protocol was 1.61 kg, which decreased to a mean of 1.23 kg in the post-protocol group (p < 0.001). The estimated annual cost savings for the inpatient pharmacy department was approximately $13,000 with the initiation of a standard protocol. The implementation of a standard starter PN protocol decreased usage and variability in NICU practice and aligned more with the American Society for Parenteral and Enteral Nutrition recommendations.

Temporal trends in intraventricular hemorrhage in preterm infants: A Brazilian multicenter cohort

Intraventricular hemorrhage (IVH) is a serious problem in preterm infants. Brazilian national data are unknown. To evaluate the incidence and temporal trend of IVH in very low birth weight (VLBW) preterm infants of 18 centers of the Brazilian Network on Neonatal Research. National prospective multicenter cohort study including inborn VLBW preterm infants aged 230/7- 336/7 weeks' gestation, admitted between 2013 and 2018. The center with the mean incidence rate was used as reference. We applied two adjustments models using perinatal variables, and perinatal+neonatal diseases. Of 6,420 infants, 1951/30.4% (range 27.1-33.8%) had IVH and the disease showed a significant trend towards an overall increase in incidence over time (p=0.003), especially in three centers. Severe IVH (grade III or IV) occurred in 32.2% (range 29.2-34.5%) of those affected by IVH, with a stable incidence. After adjustments for perinatal variables, the differences persisted among centers: for global IVH, 7 centers had significantly lower rates (OR ranging from 0.31 to 0.62), and 2 presented rates higher than the reference center (OR ranging from 2.00 to 12.46) for severe HIV. Considering perinatal and neonatal variables, 6 centers had significantly lower rates (OR ranging from 0.36 to 0.60) for global IVH than the reference center and 3 had statistically higher rates (OR 1.72, 1.86 and 11.78) for severe forms. The incidence rate of IVH in this Brazilian cohort was high and it revealed an increasing trend towards over time. The severe IVH rate was also worrisome.

Body Weight Gain Status during the Incubator Weaning Process in Very Low Birth Weight Premature Infants.

Incubator care is essential for premature infants during early hospitalization. As the infants’ conditions improve, incubator weaning becomes necessary. This retrospective study aimed to evaluate the effect of body weight gain and status of intake-calorie gain on the incubator weaning process for very low birth weight (VLBW) premature infants. The study included 127 VLBW premature neonates. We analyzed data on clinical characteristics potentially associated with the weaning period and the end-weaning body weight (EWBW), including body weight gain status, intake-calorie gain status, and disease conditions. The neonates were weaned from the incubators at a mean postmenstrual age (PMA) of 35.1 ± 1.3 weeks; postnatal days, 37.7 ± 18.2 days; and body weight, 1882.8 ± 157.1 g. The total weaning period was 3.5 ± 3.1 days. Regarding the weaning period, there was a strong positive relationship only in the end-weaning PMA and the daily body weight within 3 days before incubator weaning. Further, regarding the factors associated with EWBW, only the end-weaning PMA and necrotizing enterocolitis had a significant positive impact. Body weight gain and the status of intake-calorie gain showed no association with either the weaning period or the EWBW and, thus, were not related to the incubator weaning process.

The Effect of Initial Mode of Respiratory Support on Bronchopulmonary Dysplasia in Extremely Low Birth Weight Preterm Infants

The Effect of Initial Mode of Respiratory Support on Bronchopulmonary Dysplasia in Extremely Low Birth Weight Preterm Infants

Intravitreal Bevacizumab Is Associated With Prolonged Ventilatory Support in Preterm Infants With Bronchopulmonary Dysplasia

Intravitreal bevacizumab (IVB), an anti-vascular endothelial growth factor (VEGF) antibody, is a widely adopted treatment for retinopathy of prematurity (ROP). Although animal studies have demonstrated that IVB inhibits alveologenesis in neonatal rat lung, the clinical influence of IVB on respiratory outcomes has not been studied. Does IVB affect the respiratory outcome in preterm infants with bronchopulmonary dysplasia? We retrospectively assessed very low birth weight (VLBW) preterm infants admitted to our neonatal ICU between January 2016 and June 2021. Furthermore, we evaluated the short-term respiratory outcomes after IVB therapy in VLBW preterm infants requiring ventilatory support at 36weeks' postmenstrual age (PMA). One hundred seventy-four VLBW preterm infants with bronchopulmonary dysplasia were recruited. Eighty-eight infants showed ROP onset before being ventilator free, and 78 infants received a diagnosis of the most severe ROP before being ventilator free. Among them, 32 received a diagnosis with type 1 ROP and received IVB treatment. After adjusting for gestational age, birth body weight, and baseline respiratory status, we discovered that IVB is associated significantly with prolonged ventilatory support and a lower likelihood of becoming ventilator free (hazard ratio, 0.53; P= .03). IVB may have a short-term respiratory adverse effect in patients requiring ventilatory support at 36weeks' PMA. Therefore, long-term follow-up for respiratory outcomes may be considered in VLBW infants who receive IVB treatment.

Postnatal Cytomegalovirus Infection: Is it Important? A 10-Year Retrospective Case-control Study of Characteristics and Outcomes in Very Preterm and Very Low Birth Weight Infants.

To determine the characteristics and outcomes of postnatal cytomegalovirus (pCMV) infection in preterm infants in a neonatal intensive care unit (NICU). A retrospective, matched case-control study in a tertiary NICU. Infants born between January 2009 and December 2019, <32 weeks' gestational age (GA) and/or birth weight (BW) <1500 g with pCMV infection were matched 1:1 with cytomegalovirus-(CMV)-negative infants by year of admission, gender, GA and BW. Primary outcome was death ≤36 weeks' postmenstrual age or bronchopulmonary dysplasia (BPD). Secondary outcomes were length of ventilation (LOV), length of stay (LOS) and neurodevelopmental impairment (NDI) at corrected age 1 and 2 years. Forty-eight pCMV-positive infants (median GA 25.3 weeks, BW 695 g, age 58 days) were identified from 1659 infants (incidence 2.9%). The most common symptoms of pCMV infection were abdominal distension (43.8%), sepsis-like syndrome (29.2%), thrombocytopenia (60.5%) and conjugated hyperbilirubinemia (60.9%). Compared with controls, there were no significant differences in the composite outcome of death or BPD (56.3% vs. 37.5%; P = 0.1) or NDI at 1 and 2 years (51.9% vs. 44%; P = 0.8; 71.4% vs. 50%; P = 0.4). pCMV-positive infants had a significantly longer median LOV (23.5 vs. 12 days)* and LOS (140 vs. 110.5 days)*. Eleven (22.9%) infants received antivirals. Ten improved and 1 died. Two untreated infants died (1 from pCMV infection). Clinically identifiable pCMV infections are significant and associated with increased respiratory support and prolonged hospital stay in vulnerable infants. pCMV screening and preventive measures against transmission merit consideration.*P < 0.05.