Low Birth Weight Infants Research Articles

Impact of Omega-3 Enriched Lipid Emulsions on Retinopathy of Prematurity in Very Low Birth Weight Infants: A Retrospective Cohort Analysis.

To assess the effects of ω-3 long-chain polyunsaturated fatty acid (LCPUFA)-enriched lipid emulsions (SMOFlipid) vs. traditional soybean oil-based lipid emulsions (Intralipid) on the occurrence and severity of retinopathy of prematurity (ROP) in infants with very low birth weight (VLBW). In this retrospective cohort study, 301 VLBW infants who received either SMOFlipid or Intralipid for a minimum of 14 d were included. The main outcome measured was the frequency and severity of ROP, with secondary outcomes covering other complications associated with preterm birth. Of the infants studied, 180 were administered SMOFlipid, while 121 received Intralipid. The incidence of ROP was notably lower in the SMOFlipid group (32.8% vs. 45.5%; RR 0.59; 95% CI 0.36-0.94; P = 0.026). Additionally, the occurrence of severe ROP was reduced by 66.06% in infants given SMOFlipid (5.6% vs. 16.5%; RR 0.30; 95% CI 0.13-0.66; P = 0.002). Multivariate logistic regression suggested that using SMOFlipid was linked to a reduced risk of both ROP (OR 0.44; 95% CI 0.24-0.82; P = 0.010) and severe ROP (OR 0.09; 95% CI 0.03-0.30; P < 0.001). There were no considerable differences noted in other complications associated with preterm birth between the two groups. Compared to Intralipid, SMOFlipid treatment reduced both the risk and severity of ROP. Parenteral supplementation with fish oil-containing emulsions might offer a novel approach to lowering the incidence and severity of ROP in VLBW infants.

Diet diversity score might be associated with reproductive health in women and infant outcomes: a systematic review.

Lifestyle and diet may affect the reproductive cycle. A dietary index called Diet Diversity Score (DDS) may be related to various reproductive outcomes. The present review aims to look over and conclude the prior studies on the relationship between the diversity of food ingredients and issues related to reproductive health and pregnancy. In the case of this relationship, our findings can increase clinical knowledge and help recommend a well-balanced diet for the target group. A comprehensive search was performed in major databases such as PubMed, Google Scholar, Web of Science, Scopus, and Scientific Information Database until March 2024. This research was combined with a search of Elsevier and SpringerLink databases, which led to the inclusion of relevant articles in this review. Our study was conducted based on 27 articles from 2012 to 2023, all containing a possible link between dietary diversity and reproductive complications. The Newcastle-Ottawa Scale quality assessment was used to evaluate the quality of included studies. Due to our results, a higher score in DDS, which led to an increased intake of major nutrients and a greater variety of foods, was correlated with a lower risk of reproductive health disorders such as polycystic ovary syndrome, maternal anaemia, and maternal bone status, as well as a reduced likelihood of certain birth outcomes, including low-birth weight infants, Apgar score and congenital heart defect. These findings highlight the importance of improving the DDS for maternal and infant health.

Description of Nutritional Knowledge of Mothers Who Give Birth to Low Birth Weight Babies and Non-Low Birth Weight Babies at Tidar Hospital, Magelang

Background: The impact of babies with the Low Birth Weight (LBW) category in the long term can have a risk of experiencing respiratory disorders, infections, and even death. The incidence of LBW can be influenced by gestational age of less than 37 weeks, maternal age of less than 20 years or more than 35 years, pregnancy spacing, maternal occupation, and maternal nutritional knowledge. Purpose: Describe the nutritional knowledge of mothers who give birth to LBW and non-LBW babies at Tidar Hospital Magelang Methods: This type of research is descriptive with a Cross Sectional research design. The study population was mothers who gave birth in April 2022 at Tidar Hospital, Magelang. The sampling method was carried out using the total sampling technique with a total of 20 respondents. Primary data collection techniques include filling out questionnaires and interviewing respondents directly. Results: The number of mothers who are included in the category of having LBW babies is 3 people (15%) and mothers with the category of Non-LBW Babies are 17 people (85%). The nutritional knowledge of mothers with the category of LBW babies has a good, sufficient, and less score which is evenly distributed, namely 1 respondent each. While those who are Non-LBW have a good score of 13 respondents, a sufficient score of 1 respondent, and a less score of 3 respondents. Conclusion: Mothers who give birth to babies in the non-LBW category have better nutritional knowledge than mothers who give birth to babies in the LBW category.

Histopathological evaluation of placenta in low-birth-weight babies at a tertiary care center of Nepal

Background &amp; Objectives: Pregnancy-related death and morbidity rates are significantly impacted by the prenatal care provided to expectant mothers. Low birth weight (LBW) is the single most important factor among the several causes of perinatal mortality; consequently, placentas from all LBW babies (LBWB) should be routinely investigated to determine the likely reason. The purpose of this study was to evaluate the pathological alterations in the placenta associated with LBWB. Materials and Methods: This is a cross-sectional observational study performed at Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavre, Nepal. In this study, 100 placentae were included. 44 placentae from full-term delivered babies and 56 from pre-term delivered babies, all of them weighing less than 2500 gms. A gross and microscopic examination of the placentae was done. Results: 100 placentas from low-birth-weight babies were studied. Most of the mothers were in the age group of 26-30 years with primi contributing to 59%. Gross findings like infarction and calcification were noted in 8% and 29 % of the cases. Microscopic findings like Intervillous hemorrhage (44%), Syncytial knots (69%), Stromal fibrosis (24%), Basement membrane thickening (26%), Cytotrophoblastic hyperplasia (28%), Increased villous vascularity (12%), Fibrinoid necrosis (17%), Calcification (38%), Villitis (12%) and Chorangiosis (15%) were noted. Conclusion: Histopathological study together with clinical examination of placenta is simple and cost-effective technique in identifying the features present in LBWB placentae.

The invisible enemy: A systematic review and meta-analysis of maternal smokeless tobacco use as a risk factor for low birth weight.

Smokeless tobacco use is a growing public health concern, with potential adverse implications for foetal outcomes if consumed during pregnancy. Birth weight is an important predictive measure for health outcomes of a child throughout their lifespan. Despite extensive literature, it is unclear whether smokeless tobacco consumption during pregnancy has an adverse effect on birth weight. Hence, this review was conducted to determine whether an association exists between maternal smokeless tobacco consumption during pregnancy and birth weight of infants. Systematic literature search was performed in Medline (via PubMed), Embase, Scopus, and CINAHL with no restrictions on language or time until May 2024. All observational studies that examined the relationship between maternal smokeless tobacco use and low birth weight of infants were eligible for inclusion. Methodological quality of included studies was assessed using the Newcastle Ottawa Scale. Thirty-three studies were eligible for the review, including twenty-eight cohort, three case-control and two cross-sectional studies. A statistically significant association between use of smokeless tobacco and low birth weight was reported in thirteen studies. Eleven studies reported a statistically significant reduction in mean birth weight in maternal smokeless tobacco users. Pooled estimates of eighteen studies with 733,061 participants showed that there was a statistically significant association (OR = 2.25 [1.63, 3.11] P<0.001); between maternal smokeless tobacco use during pregnancy and low birth weight. Subgroup analysis found a significant association between mishri consumption during pregnancy and low birth weight (n = 646 participants, OR = 10.98 [2.03, 59.34], P = 0.005), but not betel nut (n = 8007 participants, OR = 1.02 [0.84, 1.25]), betel quid (n = 483 participants, OR = 1.51 [0.47, 4.89]) or khat (n = 475 participants, OR = 1.41 [0.64-3.09]). This review presents an association between maternal smokeless tobacco use and low birth weight, and reduction in mean birth weight. It is suggested that cessation and reduction of maternal smokeless tobacco use should receive specific attention within routine prenatal care. The results of this study highlight the need for further preventive public health campaigns to create awareness about detrimental effects of smokeless tobacco on foetal outcomes. Patient education in the primary care setting will aid in promoting smokeless tobacco cessation prior to pregnancy.

Transitional nutrition for very low birth weight infants in neonatal intensive care units: Where do we stand now?

The role of nutrition in managing preterm infants, particularly those classified as very low birth weight (VLBW), is pivotal. Optimal nutrition is vital, as early growth deficits and inadequate neonatal nourishment have been linked to significant long-term developmental issues. In the neonatal intensive care units (NICU), tailored nutritional interventions are necessary to meet the unique dietary needs of these infants. Despite advances in neonatal nutrition, gaps remain in understanding the ideal composition and duration of parenteral nutrition, the process of transitioning to enteral feeding, and the need for breast milk augmentation. This review explores current insights and methodologies in the nutritional management of VLBW infants during the critical transition phase. It addresses existing challenges, recent progress, and future directions in enhancing nutritional care for these at-risk infants, aiming to improve outcomes.

The Relationship of Anemia In Pregnant Women With Low Birth Weight

Background: Pregnancy anemia is one indicator of measuring the success of a nation's health development. Anemia in pregnant women can increase the risk of LBW. As adults, LBW babies have a greater risk of stunting. This study aimed to determine the relationship between the incidence of anemia in pregnant women and low birth weight in the Ngancar Community Health Center area, Kediri Regency. Methods: This research design uses a retrospective cohort. The population in this study was 346 respondents, and the sample was 186. A simple random sampling technique and measuring instruments were used in the form of a Pregnancy Mother's Register Book and a Childbirth Register Book. The research was conducted on 20-25 August 2023 in the Ngancar Community Health Center Working Area, Kediri Regency. The independent variable is the incidence of anemia in pregnant women (X), and the dependent variable is low birth weight (LBW) (Y). Bivariate data analysis with Spearman Rank with a significant value (p ˂ 0.05). Results: The results of data analysis using Spearman Rank regarding the relationship between the incidence of anemia in pregnant women and Low Birth Weight obtained a significant value (p) of 0.0001 (p &lt; 0.05). Thus, it is stated that there is a relationship between the incidence of anemia in pregnant women and low birth weight. Conclusion: Anemia can increase the occurrence of LBW, but from this research, it is known that not all pregnant women with anemia in their pregnancies will give birth to LBW babies because anemia is not the only factor causing LBW. Pregnancy checks are done monthly, and good nutrition and Fe tablets are needed to prevent anemia and LBW

A Cross Sectional Study On Prevalence And Risk Factors For Low Birth Weight Babies In South India

Background : Low birth weight continues to be a significant public health problem globally and is associated with a range of both short and long term consequences. Objectives : 1.To estimate the prevalence of low birth weight babies delivered in GGH, Kurnool. 2. To find out the association of risk factors in low birth weight babies. Methods : An observational cross-sectional study was conducted in GGH, Kurnool, Andhra pradesh. Prevalence of low birth weight, exposure to different risk factors was recorded using a preformed questionnaire. Results : Low birth weight is present in 17.8% of the babies of the study group. Half of the mothers birth conception interval was less than 3 years. 99% of the mothers had morethan 4 antenatal visits and they are taking IFA Tablets. Occupation of the mother, height of the mother, weight gain during pregnancy, history of infections malaria, dengue were significantly associated and important determinants of low birth weight. Conclusion : Imparting health and nutrition education by health functionaries to antenatal mothers and early detection of high risk pregnancy and timely referral to higher institution will reduce the LBW problem

Feasibility of the use of Kangaroo mother care in the transfer of preterm and low-birth-weight infants: a two-arm nonrandomized controlled cluster feasibility study of neonatal transport in Cape Coast, Ghana

BackgroundDespite progress made towards SDG 3, sub-Saharan Africa lags behind the rest of the world, accounting for over 50% of global neonatal deaths.The increased number of hospital births in the region has not reciprocated the reduction in neonatal mortality rates. Sick newborns face uncertain journeys from peripheral facilities to specialized centres arriving in suboptimal conditions, which impacts their outcomes, due partly to the scarcity of dedicated neonatal transport services.MethodsThis was a 2-arm nonrandomized controlled cluster study of preterm and low-birth-weight neonates transferred from eight peripheral sites to a tertiary neonatal unit via conventional methods or the KMC (August 2022–April 2023).ResultsA total of 77 (mother-baby pairs) were recruited, 34 in the KMC group and 43 in the conventional arm. Most (60%) were transported by taxis/private cars. Overall mortality was 20.8%. No untoward event was recorded for neonates transported by KMC, with marginally better temperatures on arrival. Although the observed differences were not statistically significant given that this was not the primary aim, the findings add to evidence that KMC transport may not be more life-threatening than the current practice of transporting newborns in the caregiver’s arms. KMC transport has the added advantage of ensuring non-separation of the small and sick child from its mother from birth and improved temperatures upon arrival.ConclusionKMC transport for preterm and Low birth weight infants using available transport in Sub-Saharan Africa is feasible. Local large-scale randomized trials are needed to gather more evidence for policy direction needed to inform a scale-up of this low-cost intervention.Trial registrationISRCTN98748162. Retrospectively registered 02.09.2024.

Factors Associated with the Prolonged Use of Donor Human Milk at the Da Nang Hospital for Women and Children in Vietnam.

Donor human milk (DHM) from a human milk bank (HMB) is used to feed low-birthweight (LBW) and preterm infants when mothers cannot provide their own breastmilk. The misuse of DHM could interfere with mothers' breastmilk and weaken breastfeeding efforts. This study aimed to identify factors behind prolonged DHM usage during the first six years of Vietnam's first HMB. Data were extracted from the Da Nang HMB's digital monitoring system. We defined prolonged DHM use as four or more days in the neonatal unit and two or more days in postnatal wards. Over six years, 25,420 infants received DHM, with 45.3% of the infants being female, 54.7% being male, 70.0% being born via cesarean section, and 77.2% being full-term. In the neonatal unit (n = 7001), 38.0% of infants used DHM for ≥4 days. Adjusted odds ratios (aORs) for prolonged use were 0.14 for infants weighing <1000 g, 0.78 for infants weighing 1000-<1500 g, and 0.67 for infants weighing ≥2000 g (p < 0.01), compared to those weighing 1500-<2000 g. Compared to gestational ages of 32-<34 weeks, the aORs were 0.26 for <28 weeks, 0.71 for 34-<37 weeks, and 0.35 for ≥37 weeks (p < 0.01). In postnatal wards (n = 18,419), 53.1% of infants used DHM for ≥2 days. Compared to term, normal-weight infants, the aORs were 1.25 for LBW-preterm, 1.17 for LBW-term, and 1.21 for normal-weight-preterm infants (p < 0.05). Prolonged DHM use was associated with cesarean births in neonatal units (aOR 2.24, p < 0.01) and postnatal wards (aOR 1.44, p < 0.01). DHM is used briefly to bridge nutritional gaps and transition to mothers' breastmilk, but LBW, preterm births, and cesarean births are linked to prolonged use. Healthcare providers should support those at risk of prolonged DHM use and prioritize reducing unnecessary cesarean births.

Long-term parenteral nutrition and delayed establishment of enteral nutrition in extremely low birth weight infants with high enterostomy site is associated with prolonged cholestasis.

Cholestatic liver damage is frequently observed in extremely low-birth-weight infants (ELBWIs) followed by enterostomy. We retrospectively investigated the factors related to liver damage. ELBWIs who underwent enterostomy at our institution between January 2013 and December 2022 for gastrointestinal disease during the neonatal period were reviewed. Cases presenting with direct bilirubin > 2.0mg/dl for > 1month after enterostomy were designated as the prolonged cholestatic liver (p-CL) group and compared with cases without cholestatic liver damage, the (non-CL) group. Thirty-nine patients (21 in the p-CL group and 18 in the non-CL group) were included. Survival was significantly lower in the p-CL group (52.4% [11/21] vs. 88.9% [16/18]; p = 0.020). Significant differences were found in the birth weight (587.8g vs. 698.0g, p = 0.040) and small intestinal length to the enterostomy (47.6cm vs. 72.8cm, p = 0.004). Patients in the non-CL group started enteral feeding and reached > 100ml/kg/day earlier than those in the p-CL group. The length of time with parenteral nutrition was an independent risk factor for prolonged cholestasis (p = 0.02). The birth weight and stoma site level may affect time with PN and enteral feeding management, subsequently resulting in prolonged cholestatic liver damage in ELBWIs with high prematurity.

Intratracheal administration of budesonide with surfactant for prevention of death or bronchopulmonary dysplasia in extremely low birth weight infants - a before-after study.

Previous studies have suggested a potential role for inhaled corticosteroids, such as budesonide, in reducing bronchopulmonary dysplasia (BPD) among preterm infants. The objective of our study was to investigate the effectiveness of intratracheal administration of corticosteroid with surfactant on the composite outcome of death or BPD at 36 weeks in extremely low birth weight (ELBW) infants. This before-after cohort study compared outcomes in ELBW infants with respiratory distress syndrome (RDS) who received intratracheal surfactant with budesonide to a historical cohort who received surfactant alone. Data was collected retrospectively for neonates in the surfactant group and prospectively for those receiving surfactant plus budesonide. A total of 385 ELBW infants were included. Death or BPD occurred in 123/203 (60.5%) in the surfactant with budesonide group versus 105/182 (57.6%) in the surfactant group; adjusted odds ratio 1.10 (95% CI 0.69 to 1.75; p=0.69). Statistical analysis revealed no significant difference in the incidence of the composite primary outcome (death or BPD at 36 weeks of post menstrual gestational age), and its components, between the two study groups. In our study, co-administration of budesonide and surfactant was deemed safe and feasible among ELBW infants with RDS. However, we did not observe a significant reduction in the rates of composite or individual outcomes of death or BPD. Larger, randomized controlled trials are necessary to explore the potential advantages of this intervention.

Congenital heart disease and arrhythmia disorders in newborns with congenital diaphragmatic hernia: a 23-year experience at a UK university pediatric surgical centre

PurposeCongenital diaphragmatic hernia (CDH) is associated with congenital heart disease (CHD) and index newborns reportedly may experience cardiac arrhythmia disorders [Tella et al.—Pediatric Critical Care Medicine 2022]. This study analyses, details and reports contemporary outcome metrics of CHD and cardiac rhythm disease (CRD) in CDH babies attending a university surgical centre.MethodsRetrospective analysis of medical records of all newborns undergoing Bochdalek CDH repair between 1999 and 2021 at a university paediatric surgical centre. CDH newborns with CHD and neonatal arrythmias were identified from echocardiogram and electrocardiogram (ECG) investigative studies. Operative native diaphragm and / or use of patch repair(s) was documented. Outcome(s) measured—(i) mortality and (ii) cardiopulmonary interventions including ventilatory strategies—ECMO (%), inotropes and anti-arrhythmic therapy(s).ResultsOf 173 CDH neonates, 95 (55%) had CHD of which 9 babies (10%) had cardiac arrhythmias. CDH and co-existing CHD was linked with (a) lower infant birth weights (3130 g vs 3357 g, p = 0.05), (b) increased use of inotrope agents (48.4% vs 39.3%, p = 0.03) and (c) greater use of high-frequency oscillatory ventilation (38.9% vs 23%, p = 0.004). CDH babies experiencing arrythmias were at higher risk (%) of developing pulmonary hypertension (66.7% vs 28.7%, p = 0.01). No significant differences were observed in ECMO utilisation (12% vs 6%, p = 0.46) or patch repair(s) (53% vs 46%, p = 0.06) in CDH patients with and without CHD. CHD was not associated with increased risk(s) of mortality (OR 2.58, 95% CI 0.81–8.24, p = 0.11). Of 9 index CDH patients with arrhythmias—4 babies (44%) required interventional treatments.ConclusionCHD was prevalent in a high percentage (%) of CDH newborns treated at this university centre and associated with increased use (%) of cardiovascular respiratory support including patch repair. A minority of patients (2.3%) had cardiac rhythm disorders requiring treatment(s). In those developing arrhythmias pulmonary hypertension may be a risk-linked event. Optimising outcomes to offset pulmonary hypertension requires further appraisal. Future large-scale population studies may help underscore the ‘real apparent incidence’ of cardiac rhythm disorders in CDH.

Response of the ductus arteriosus to acetaminophen or indomethacin in extremely low birth weight infants.

Acetaminophen and indomethacin are used for medical management of a patent ductus arteriosus. This study compared the efficacy of these agents in ELBW infants. This was a retrospective study of all courses of indomethacin and acetaminophen. Baseline characteristics, details of pharmacologic therapy, toxicity, and acetaminophen serum concentrations were collected. The primary analysis compared rates of ductus closure with indomethacin versus acetaminophen using Pearson's Chi-squared test. Ductus closure after a single course of therapy was similar between acetaminophen and indomethacin 16% vs. 18%, (p = 0.79). No differences were found in gestational age, birth weight, patient acuity, toxicity, or acetaminophen concentrations between those courses that resulted in closure compared to those that did not. When comparing single-agent exposure, indomethacin was initiated earlier (9.0 vs. 13.5 days, p = 0.022) but PDA closure rates were similar between groups. Acetaminophen and indomethacin produced similar rates of ductus closure in this population.

Assessing the impact of antenatal care utilization on low birth weight: A hospital-based case-control study

Low birth weight (LBW) being important determinant of child survival and development, is a preventable public health problem. The antenatal care (ANC) as an instrument that can reduce LBW, especially, in developing world with unexpectedly high level. Present study evaluated the effect of utilization of ANC services on LBW. A hospital-based case-control study carried after the ethical approval at university hospital, Varanasi, India during October, 2019 to September, 2021 on mothers delivering singleton baby. The case and control mothers decided 86 and 129 in the ratio of 2:3 at a =5% and (1-b) = 90%. Data was collected on a pre-designed and pre-tested questionnaire. Bivariate and multivariable forward logistic regression was performed. The statistical significance was judged at a = 0.05.Utilization of ANC services, milk intake, tea and snacks intake and gestational age at birth emerged as the significant contributor to LBW.Likelihood of LBW babies was 2.83 times higher to mothers who hadn’t avail ANC services compared to those who had availed complete ANC services. Likelihood of LBW was also 3.73 and 3.16 times higher in mothers who hadn’t taken milk and had taken but occasionally compared to regular users. Mothers with tea and snacks frequency once or twice were 3.18 times more likely to birthing LBW babies than the mothers with frequency more than twice. The likelihood of LBW birth was as high as 7.61 times in pre-term birth as compared to full-term. Complete ANC services be ensured through the gross root health workers. Milk and tea &amp; snacks intake if not possible in mothers of poverty pockets, these be advised to add one extra meal in their routine meal.

The Association between Perinatal Complications and Adverse Childhood Experiences: Findings from a Nationwide Online Survey.

This study aimed to evaluate the association between maternal adverse childhood experiences (ACEs) levels and the risk of perinatal complications. This is a retrospective cohort study of 5,693 mother-child pairs born between 2019 and 2021, who completed questionnaires on maternal ACE scores and perinatal complications such as preterm birth, low birth weight infants, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), and premature rupture of membrane (PROM). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression according to the three ACE score groups after adjusting for confounding factors such as maternal age, child's sex, household income, and maternal education. Maternal ACEs have a significant positive correlation with preterm birth (OR: 1.42, 95% CI: 1.09-1.86, p for trend = 0.009), PIH (OR: 1.55, 95% CI: 1.17-2.07, p for trend = 0.002), and PROM (OR: 1.42, 95% CI: 1.09-1.84, p for trend = 0.01). These associations remained unchanged when stratified according to smoking, alcohol consumption, and obesity. Maternal ACEs were associated with the risk of perinatal complications such as preterm birth, PIH, and PROM. · Maternal ACEs are linked to higher risks of preterm birth, PIH, and PROM.. · Parental divorce, emotional abuse, and neglect were the most common ACEs among Japanese mothers.. · Mothers with ACEs score ≥ 2 had a higher risk of perinatal complications..

Early Transpyloric Tube Feeding in Preventing Adverse Respiratory Events in Extremely Low Birth Weight Infants.

It has been demonstrated that aspiration during endotracheal intubation in preterm infants with gastroesophageal reflux is a contributing factor in the worsening of lung diseases and the development of bronchopulmonary dysplasia (BPD). This study aims to compare the safety and efficacy of early transpyloric (TP) tube feeding with that of nasogastric (NG) tube feeding in relation to BPD. The study population consisted of 39 extremely low birth weight infants (ELBWIs) with mechanical ventilation and an enteral feeding volume of 50 mL/kg/day, which were randomly assigned to different groups based on the method of tube feeding. The primary outcome was the incidence of adverse events. The hazard ratio for primary adverse events was significantly lower in the TP group. The TP group had a median time of 34 days (range 24-85) and the NG group 24 days (range 13-70). In general, neither group exhibited severe intestinal complications or poor growth. Early TP tube feeding may be a safer alternative method of NG tube feeding for intubated ELBWIs and has been shown to reduce the frequency of adverse respiratory events.

Successful Treatment of Aortic Coarctation in an Extremely Low Birth Weight Infant with Balloon Angioplasty.

In our case report, we present a case of successful antegrade balloon angioplasty performed via the femoral vein on a 980-gram neonate with severe coarctation of the aorta. Upon reviewing the literature, we found no cases of balloon angioplasty for coarctation performed via the femoral vein in infants with a lower birth weight than in our case. Our aim is to underline that each patient may require individual evaluation and management options.

Risk factors and adverse outcomes of initial non-invasive ventilation failure in very low birth weight infants: a multicenter retrospective cohort study

Objective: To investigate the risk factors of initial non-invasive ventilation(NIV) failure and its association with adverse outcomes in very low birth weight infants (VLBWI). Methods: A retrospective cohort study was conducted, collecting clinical data of 2 102 VLBWI who received NIV within 30 minutes after birth, admitted to 18 NICU of Suxinyun Neonatal Perinatal Collaboration Network (SNPN) from January 1st, 2019 to December 31st, 2022. According to the outcome of NIV within the first 72 hours, the study cohort was divided into success group and failure group. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for NIV failure and its association with adverse outcome. Results: A total of 2 102 VLBWI were included, consisting of 1 078 males (51.3%). The gestational age was 29 (28, 31) weeks, and the birth weight was 1 250 (1 090, 1 380) g. The initial NIV failure rate was 15.3%(321/2 102). Multivariate Logistic regression analysis showed that smaller gestational age (OR=0.67, 95%CI 0.61-0.74, P<0.001), maternal hypertensive disorders during pregnancy (OR=10.31, 95%CI 7.48-14.21, P<0.001), Apgar score at the first minute ≤7 (OR=1.40, 95%CI 1.01-1.93, P=0.042), grade 3-4 respiratory distress syndrome (RDS)(OR=2.85, 95%CI 1.69-4.81, P<0.001), ≥2 times pulmonary surfactant (PS) treatment (OR=3.78, 95%CI 2.09-6.83, P<0.001), fraction of inspired oxygen (FiO2)>0.30 (OR=2.21, 95%CI 1.64-2.98, P<0.001) were all independent risk factors for initial NIV failure. The failure group had higher risks of mortality (OR=10.19, 95%CI 6.50-15.97, P<0.001), pneumothorax (OR=4.33, 95%CI 1.59-11.79, P=0.004), neonatal pulmonary hemorrhage (OR=8.48, 95%CI 4.08-17.64, P<0.001), moderate to severe bronchopulmonary dysplasia (BPD)(OR=1.75, 95%CI 1.19-2.56, P=0.004), and intraventricular hemorrhage (IVH) ≥grade Ⅲ (OR=2.18, 95%CI 1.27-3.73, P=0.004) compared to the success group. Conclusions: Small gestational age, maternal hyertensive disorders during pregnancy, Apgar score at the first minute ≤7, grade 3-4 RDS, PS treatment ≥2 times and FiO2 >0.30 are risk factors for initial NIV failure in VLBWI. Initial NIV failure is associated with increased risk of mortality, pneumothorax, pulmonary hemorrhage, moderate to severe BPD, and IVH ≥grade Ⅲ.

Building vancomycin population pharmacokinetic model for Japanese low birth weight infants in comparing it with previously reported pediatric population pharmacokinetic models.

Vancomycin (VAN) is one of therapeutic agents for severe infections, and its efficacy and safety are subject to therapeutic drug monitoring. However, there is a lack of data regarding the administration of VAN to low birth weight (LBW) infants. This presents a challenge to ensure optimal dosing and maximize the benefits of VAN therapy in this specialized patients. VAN serum samples were collected through opportunistic sampling for clinical use. Population Pharmacokinetics (PopPK) analysis was conducted with a one-compartment model in a nonlinear mixed-effects model using Phoenix NLME (Certara ver.8.4). We compared the final model with the 12 previously reported PopPK models. A total of 106 samples from 25 patients were obtained to establish the PopPK model for LBW infants. We successfully developed one-compartment PopPK model using Phoenix NLME based on Japanese LBW infants receiving VAN with body weights of less than 2,500 g. The covariates in our PopPK model are postmenstrual age, body weight, and serum creatinine for clearance and postnatal age for volume of distribution. A comparison of the goodness-of-fit metrics indicated that our PopPK model achieved better prediction accuracy for VAN blood concentrations, as indicated by the lower values of these metrics. We successfully established a PopPK model incorporating PNA and PMA as new covariates. By addressing the issue of data scarcity in LBW infants, our study provides insights and strategies to manage VAN therapy in LBW infants, thus optimizing its effectiveness and safety.