Low Birth Weight Infants Research Articles

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 and burden of low birthweight related to maternal PM2.5 exposure in Iran: A national causal inference study

BackgroundMaternal ambient fine particulate matter (PM2.5) has been linked with fetal low birthweight (LBW), while national causal evidence is limited, particularly in low- and middle-income countries. MethodsWe used nationwide registry-based birth records of 3839531 singleton livebirths, with maternal age (MA) between 15 and 49 years, across 31 provinces in Iran from 2013 through 2018. Monthly gridded concentrations of ambient PM2.5 during entire pregnancy were estimated through validated spatiotemporal models. We adopted traditional logistic/linear regression and double robust model (DRM) based on generalized propensity scores (GPS) to evaluate associations of maternal PM2.5 exposure with LBW risk and birthweight change. MA-specific exposure-response functions were investigated using restricted cubic splines in both traditional and casual inference models. PM2.5-attributable LBW burden were parallelly estimated, under the scenarios of achieving counterfactual exposure levels of multiple WHO interim targets. ResultsA total of 228655 LBW births were identified, and mean birthweight of was 3187 g. Both traditional and causal modelling approaches yielded consistently positive associations of maternal PM2.5 exposure with increased LBW risk and reduced birthweight, but marginally larger effect estimates were seen under GPS-based DRM analyses. Specifically, a 10-μg/m3 increase in ambient PM2.5 during the entire pregnancy was associated with the odds of 1.071 (95% confidence interval: 1.066, 1.076) for LBW and reduced birthweight of 8.9 (8.4, 9.4) g in GPS-based DRM analysis. MA-stratified analyses suggested non-linear exposure-response relationships of PM2.5 exposure with both LBW (Pnonlinear <0.001) risk and birthweight change (Pnonlinear <0.001) over the exposure range of 17–104 μg/m3, with notably steeper slopes at low concentrations (<37.3 μg/m3). According to GPS-based DRM analysis, achieving the interim target level 1–3 of annual PM2.5 (i.e., 35, 25, and 15 μg/m3) could avoid 5.5%–32.6% of overall LBW infants and birthweight loss of 7.0–57.6 g per livebirth during 2013–2018 in Iran. ConclusionsOur findings provided nationwide evidence of causality for elevated LBW risk and birthweight loss associated with maternal PM2.5 exposure in Iran. Improving air quality through multisectoral efforts may avoid dramatic LBW burden to promote neonatal health later in life.

Urinary output of very low birth weight infants during the first weeks of life

Introduction: Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age, are missing. Methods: This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants. Results: VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 ml/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGAN), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants. Conclusion: UOP is dynamic in the postnatal period and differs significantly between gestational age cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.

Use of transpyloric feeds in extremely low birth weight infants at risk of severe bronchopulmonary dysplasia—a single center experience

Use of transpyloric feeds in extremely low birth weight infants at risk of severe bronchopulmonary dysplasia—a single center experience

Greater and Earlier Exposure of Mother's Own Milk Compared to Donor Human Milk Moderates Risk and Severity of Bronchopulmonary Dysplasia.

Background: Bronchopulmonary dysplasia (BPD) is a common complication of preterm very low birth weight (VLBW) infants. Mother's own milk (MOM) may mitigate the severity of BPD. Pasteurized donor human milk (PDHM) is often used as an alternative when MOM is unavailable with limited information on the influence of PDHM on BPD risk and severity. Objective: To compare the influence of MOM to PDHM on risk and severity of BPD in preterm VLBW infants. Design/Methods: A retrospective chart review of preterm (<34 weeks) and VLBW (<1,500 g) infants born at the Children's Hospital of Richmond from 2019 to 2021 was performed. The analysis included demographics, type and timing of nutrition received (MOM, PDHM, Formula), and incidence/severity of BPD based on National Institute of Child Health & Human Development (NICHD) definition. Data analysis used chi-square, linear regression, and a multinomial logistic regression test. Results: A total of 200 infants met inclusion criteria, of which 116 (58%) had no BPD, 34 (17%) had mild BPD, 32 (16%) had moderate BPD, and 18 (9%) had severe BPD. Infants exposed to MOM within the first 3 days and within the first 7 days of life had lower incidence of moderate to severe BPD when compared to those with no MOM exposure (p = 0.02, p = 0.04). The percent of MOM received throughout hospitalization moderated the incidence of BPD (p = 0.01, 95% Confidence Interval (CI) [-0.14, -0.02]), such that as the percent of MOM received increased, the effect of gestational age on severity of BPD decreased. In contrast, the percent of PDHM received throughout hospitalization did not moderate BPD incidence (p = 0.61, 95% CI [2.28, 3.43]). Conclusion: These results identify that earlier and greater total exposure to MOM, but not PDHM, was associated with decreased moderate to severe BPD in <34-week preterm VLBW infants.

Donor Human Milk Fat Content Is Associated with Maternal Body Mass Index.

Introduction: Donor human milk is increasingly being utilized for both preterm and term infants when mother's milk is unavailable. With the rising prevalence of maternal overweight and obesity, it is crucial to evaluate the relationship between maternal body mass index and the fat and energy content of donor human milk. Objectives: To assess the impact of maternal body mass index on human milk fat content. Methods: A cross-sectional study was carried out using retrospective data from women who made their first human milk donation at ≥15 days postpartum at a human milk bank in São Paulo, Brazil, from January 2018 to December 2020. Data of sociodemographic, obstetric, health, and anthropometric measures were collected by the human milk bank staff. Milk fat and energy content were determined using the crematocrit test. Analysis of variance and multiple linear regression were used to compare means of crematocrit and fat. We determined the p-values using a test of heterogeneity and linear trend and presented the one with the lower p-value. Results: Most donors were between 25 and 35 years old, had higher education, were employed, and lived with a partner. At the time of milk donation, 40.9% of women were overweight or obese. The fat (1.09 g/dL) and energy (9.83 kcal/dL) content of human milk were higher in obese donor compared with eutrophic donors. Conclusions: The fat and energy content of human milk were associated with maternal body mass index, suggesting the potential value for selective use of high fat and high calorie donor milk for very low birthweight or premature infants.

Fc-Afucosylation of VAR2CSA-Specific Immunoglobulin G and Clinical Immunity to Placental Plasmodium falciparum Malaria.

Acquired immunity to Plasmodium falciparum malaria is mainly mediated by immunoglobulin G (IgG) targeting erythrocyte membrane protein 1 (PfEMP1). These adhesins mediate infected erythrocyte (IE) sequestration, protecting IEs from splenic destruction. PfEMP1-specific IgG is therefore thought to protect mainly by inhibiting IE sequestration. VAR2CSA-type PfEMP1 mediates placental IE sequestration, putting pregnant women exposed to P falciparum parasites at risk of placental malaria (PM). Levels and Fc-afucosylation of VAR2CSA-specific plasma IgG were measured by a modified enzyme-linked immunosorbent assay (FEASI). We also measured the ability of the IgG to inhibit IE adhesion and to induce natural killer (NK) cell degranulation. The results were related to parity and clinical pregnancy outcomes. Parity was positively correlated with levels and Fc-afucosylation of VAR2CSA-specific IgG, and with birth weight and plasma IgG inhibition of IE adhesion in vitro. Fc-afucosylation of VAR2CSA-specific IgG increased NK-cell degranulation. Women with Fc-afucosylated VAR2CSA-specific IgG had a reduced risk of delivering a low birth weight (LBW) baby, but not of PM or anemia. Fc-afucosylated VAR2CSA-specific IgG effectively induced NK-cell degranulation and was associated with protection against LBW, independent of IgG levels. Our study has implications for the development of VAR2CSA-based subunit vaccines, which exclusively induce Fc-fucosylated IgG.

Impact of Kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge

Background: To assess the impact of kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge. Methods: This randomized controlled trial was conducted in Department of Neonatology in Bangabandhu Sheikh Mujib Medical University over a period of 15 months from March 2022 to June 2023. Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to &lt;2000g and gestational age 28 weeks to &lt;34 weeks were enrolled in the study after getting informed written consent from parents or caregiver. Infants with major congenital anomalies were excluded from this study. All data were analyzed by statistical package for social sciences (SPSS) version 25 (IBM, USA). Results: Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to &lt;2000 g. Among them, 80 infants fulfilled inclusion criteria. Growth was significantly better in KMC plus massage therapy group. Mean weight gain per kg per day in KMC plus massage therapy group was 13.34±10.20 g and it was nearly half in KMC group 6.18±11.84 g only (p-value-0.01). Increase in length was 0.95±0.62 cm in KMC plus massage therapy group vs KMC group 0.66±0.49 cm (p-value-0.04). Increase in OFC was 0.59±0.29 cm in KMC plus massage therapy group vs KMC group 0.42±0.33 cm at discharge (p-value-0.03). Hospital stay in KMC group was 6.36±3.52 days, alternatively it was more 8.33±2.39 days in KMC plus massage therapy group. The dissimilarity was statistically significant (p-value-0.01) Study implication: Massage therapy potentiates benefits of kangaroo mother care in respect to better growth, so massage can be added along with KMC for better outcome. Conclusions: Massage therapy added to KMC is more effective than KMC alone in improving growth, although it did not affect the hospital stay.

HucMSCs-derived Exosomes Promote Lung Development in Premature Birth via Wnt5a/ROCK1 Axis.

Bronchopulmonary dysplasia (BPD) frequently affects extremely preterm and low birth weight infants, with current treatments lacking specificity. Enhancing extra-uterine preterm alveoli development and repairing damage are crucial for BPD management. Here we show that exosomes derived from human umbilical cord mesenchymal stem cells (hucMSCs-Exos) can enhance fetal lung development in mice by delivering specific contents. Briefly, hucMSCs-Exos were extracted using ultracentrifugation and identified by transmission electron microscopy (TEM), flow cytometry, Western blot (WB), and nanoparticle tracking analysis (NTA). These exosomes were then administered to pregnant mice via tail vein injection. Embryonic lung tissues were collected at E13.5 and E18.5 via cesarean section and analyzed using hematoxylin-eosin (HE) staining, immunofluorescence, and TEM. Proteomic analysis was conducted to identify protein components in the exosomes, and WB was used to assess protein expression changes. hucMSCs-Exos from full-term infants were more effective in promoting cell proliferation than those from preterm infants. In vivo, full-term hucMSCs-Exos significantly enhanced alveolarization in fetal lung tissues. Proteomic analysis revealed higher Wnt5a expression in full-term hucMSCs-Exos, and further experiments confirmed a direct interaction between Wnt5a and ROCK1. WB also showed increased expression of the autophagy marker LC3B in the lung tissues of mice treated with full-term exosomes. In conclusion, term hucMSCs-Exos may directly regulate the phosphorylation of ROCK1 in mouse lung tissue through naturally enriched Wnt5a, thus promoting autophagy of AT2 cells and lamellar body development, and ultimately enhance the alveolarization and reducing the incidence of BPD in premature infants.

Risk Factors for Necrotizing Enterocolitis in Very Low Birth Weight Infants in a Tertiary Care Hospital

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition correlated with increased morbidity and mortality in very low birth weight (VLBW) infants. The pathophysiology of NEC remains elusive due to its multifactorial nature. However, the identification and prevention of significant factors that cause NEC can improve the outcome of these neonates. Objective: To identify factors associated with the development of definite NEC, based on the modified Bell staging criteria stage II and III, in VLBW infants in a setting of tertiary care hospital. Materials and Methods: A single-center, case-control study was conducted in VLBW infants who were admitted to the neonatal intensive care unit (NICU) of Bhumibol Adulyadej Hospital, Bangkok, Thailand, between January 2008 and December 2022. Clinical data were collected from the electronic medical records. For each case of NEC, two controls without NEC, as non-NEC, were matched based on gestational age and period of hospitalization in the department. Data of mothers, infants, feeding patterns, and comorbidities prior to the diagnosis of NEC were analyzed. Results: There were 65 and 130 infants in the NEC and the non-NEC group, respectively. Infants in both groups had similar baseline characteristics. Multiple logistic regression showed the amount of human milk at the age of 14 days (adjusted OR 0.08, p&lt;0.001) was a protective factor against NEC. Conversely, prolonged parenteral nutrition (PN) use (adjusted OR 4.81, p&lt;0.001) and septic shock (adjusted OR 4.36, p=0.02) were risk factors for NEC. Conclusion: Early initiation of human milk may reduce the incidence of NEC. On the other hand, infants requiring extended PN and suffering septic shock were at an increased risk of developing NEC.

Breastfeeding supports growth in small for gestational age infants: A systematic review and meta-analysis.

Small for gestational age is defined as birthweight <10th percentile on standardised age and sex-specific growth charts. Rapid catch-up growth seen post-natal is associated with adiposity and cardiometabolic syndromes later in life. Breastfeeding has positive effects on growth in premature and low-birthweight infants. Therefore, examining the impact of exclusive breastfeeding on growth parameters in small for gestational age infants is important. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist guided review and meta-analysis. Four databases were searched. Five articles (4702 infants) met inclusion criteria. The effect of 4-6 months of breastfeeding on growth was measured using weight, length, head circumference, z-scores and change between timepoints. Study quality was considered very low using Grading of Recommendations, Assessment, Development and Evaluation tool. Random effects models assessed the effect of breastfeeding on weight and length catch-up growth. Differences in weight and length were seen (-8.36, 95%CI: -11.26 to -5.46 and -7.50, 95%CI: -1.92 to -4.18, p < 0.001), with substantial heterogeneity (I2 > 90%). Breastmilk supports growth in small for gestational age infants, though limited evidence exists for catch-up growth in the first 6 months. The magnitude and direction of the effect could not be determined.

Vitamin B12 concentrations vary greatly in milk donated to a large provincial milk bank, and are influenced by supplementation and parity

Feeding parent's milk with supplemental donor milk (DM) is the optimal way to feed very low birth weight (VLBW) infants instead of formula; however, suboptimal neurodevelopment persists. This is believed due, in part, to suboptimal nutrition. Given vitamin B12's role in neurodevelopment and increased adoption of plant-based diets among females of child-bearing age, we aimed to determine the adequacy of vitamin B12 in DM (n=380 donors) and associated donor characteristics. Vitamin B12 was measured in consecutive raw DM donations received at the milk bank from March 2020-2021 using a validated competitive chemiluminescent enzyme immunoassay (IMMULITE 2000, Siemens). Donor characteristics were obtained from screening records and associations with milk vitamin B12 concentrations explored using a generalized additive model. Donors were 32±4 years old (mean±SD), and DM was expressed 98±85 days postpartum. Vitamin B12 concentrations in DM had a median (25th, 75th percentile) of 232 (149, 373) pmol/L; 64% had concentrations <310pmol/L (common cut-off for inadequacy in healthy term-born infants). In a multivariable analysis, donors consuming a vitamin B12-containing supplement had higher DM vitamin B12 (β±SE: 80.3±25.4pmol/L; p=0.020) compared to those not taking a supplement. Primiparous donors had higher DM vitamin B12 than multiparous donors (36.7±18.2pmol/L greater; p=0.044). No associations were observed for other donor characteristics. Milk donated to a large human milk bank showed evidence of suboptimal vitamin B12; levels were associated with both donor vitamin B12-containing supplement use and parity. Further research as to whether and when milk bank donors are recommended to consume a supplement and the benefits and risks of routine vitamin B12 supplementation of DM-fed infants is warranted.

Increased adverse pregnancy outcomes among decreased assisted reproductions during the COVID-19 pandemic: insights from a birth cohort study in Southwest China

ObjectivesWe elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes.MethodsA total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled.ResultsART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32–3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78–3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05–2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of − 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from − 0.21% (P = 0.646) in 2018–2019 to an increase of + 0.89% (P = 0.030) in 2019–2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of − 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57–4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78–3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42–4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65–2.97).ConclusionART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes.

Association between the occupation of pregnant women’s partners and risks of infant low birth weight and preterm birth in a prospective birth cohort: the Japan Environment and Children’s Study

Association between the occupation of pregnant women’s partners and risks of infant low birth weight and preterm birth in a prospective birth cohort: the Japan Environment and Children’s Study

Gambaran Faktor Risiko Kejadian Stunting pada Ibu dengan Anak Balita Stunting di Wilayah Kerja Puskesmas Baregbeg

Stunting is one of the main nutritional issues that Indonesian toddlers face. The prevalence of stunting in toddlers (children under five years old) was 30.8% in 2018, according to the Basic Health Research (Riskesdas) results. This dropped to 27.67% in 2019 (Indonesian Nutrition Status Survey (SSGI), 2019), and then increased to 24.4% in 2021 (SSGI, 2021). The purpose of this study is to identify the risk factors for stunting in women in the Ciamis Regency working area of the Baregbeg Community Health Center who have stunted children under five in 2024. Descriptive research using a cross-sectional design was the methodology employed. Using a questionnaire, the study's population composed of all the mothers of 36 kids with stunting in the Baregbeg Health Center's working area. The majority of stunted toddlers had a history of exclusive breastfeeding (80.56%), middle class mothers in a middle educational level (55.56%), low parental income (86.11%), low birth weight babies (86.11%), infectious diarrheal diseases (86.11%), poor diet (77.78%), and an unvarried diet (88.88%), based to the research's results. To help to prevent potential problems with the child's growth and development, it is advised that moms of stunted children give their children greater care.

Reimagining Kangaroo Care for Preterm Infants: A Novel Garment for Safe and Comfortable Bonding.

Kangaroo Care (KC) has been proven to enhance physiological stability, growth, and bonding in preterm, low-birthweight infants. Despite its benefits, KC is underutilized in Level IV Neonatal Intensive Care Units (NICUs) due to challenges in managing medical equipment. This study introduces the Kangarobe™, a novel garment designed to facilitate safe, comfortable, and efficient KC for medically fragile infants in high-acuity NICUs. From 2021 to 2023, a feasibility study was conducted involving 25 infant-parent dyads in a Level IV NICU. The Kangarobe™ was designed using human-centered design principles and tested on infants dependent on respiratory support. Surveys employing a 5-point Likert scale were administered to parents and nursing staff to assess safety, comfort, ease of use, and procedural access. Survey results showed positive feedback from both parents and nursing staff, particularly in the areas of safety and comfort. For example, 72-80% of parents and nurses responded positively regarding ease and comfort. High level of agreement (76%) on the security of medical line management, with minimal negative feedback. In addition, parents using the Kangarobe™ held their infants for an average of 171 min per session, with a notable increase compared to the typical 75 min, indicating enhanced comfort and feasibility for extended KC sessions. The Kangarobe™ successfully enabled the secure management of medical lines and tubes, with the vertical access window improving procedural efficiency without interrupting KC. The Kangarobe™ demonstrates promise in addressing barriers to KC in high-acuity NICUs. By enhancing safety, comfort, and ease of use, it supports wider adoption of KC practices, potentially improving patient safety, staff efficiency, and family-centered care.

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 ≤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.

Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status.

Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Under-standing the impact of workload and regional differences on these rates is crucial for improving outcomes. This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities. Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters: capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates. This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with 2 rather than 1 neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates. Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

"I Was Broken and Still Had to Stay Strong. I Cannot Be Weak": Understanding Parental Role Conflicts Following a Premature Birth.

The challenging transition to parenthood affects both mothers and fathers; yet, the strain intensifies with a premature birth in the neonatal intensive care unit (NICU), underscoring the importance of acknowledging and addressing potential differences in parental roles. This paper aimed to investigate how parental role conflicts among mothers and fathers of preterm-born infants hospitalized in German NICUs manifest and investigated potential parental resources. Twenty-four participants, 17 mothers, and seven fathers of very low birth-weight infants were interviewed. A thematic content analysis was performed at a semantic level. Fathers feel pressured to fulfill the role expectations, often leading to the suppression of paternal feelings and needs. For mothers, deviating from societal expectations regarding their expressive roles can be distressing, as they worry that such deviation might hinder their infants from having a successful start in life. Consulting with healthcare professionals shows to ease challenges for both parental roles. Maternal and paternal challenges are often rooted in expectations placed on their societal roles. Highlighting these challenges can be essential for increasing awareness and effectively addressing them. Tailored nursing practices may have the potential to facilitate individuals' navigation of uncertainties and fulfillment of caregiving roles.

Dosing, Toxicity and Drug Concentrations for Ganciclovir/Valganciclovir in Preterm and Low Birthweight Infants Treated for Cytomegalovirus

Background: There is a lack of data regarding suitable dosage when administering intravenous ganciclovir (GCV) or oral valganciclovir (valGCV) to preterm and low birthweight infants with cytomegalovirus (CMV) disease. Methods: Data were collected for infants born before 32 weeks gestation and/or weighing less than 1.8 kg treated for CMV disease with GCV or valGCV between 2016 and 2023. Results: Twenty-four infants (58% males and 48% Asian ethnicity) with a median gestation of 31 weeks [interquartile range (IQR): 26.6–36.1], median weight of 950 g (IQR: 470–1692) and median age of 45 days (IQR: 6–84) at initiation of treatment were included. Seventeen infants were treated for symptomatic postnatal CMV and 7 for symptomatic congenital CMV. Most infants receiving GCV had 6 mg/kg twice daily dosing and most receiving valGCV had 16 mg/kg twice daily dosing. Fourteen infants had drug concentrations measured with combined geometric mean minimum blood plasma concentration (Cmin) of 2.44 mg/L and maximum blood plasma concentration of 7.98 mg/L for doses of 6 mg/kg GCV and 16 mg/kg valGCV, which is higher compared with term infants. The estimated area under the curve at 12 hours (AUC0–12h) was 54.34 mg × h/L, which doubled the value for term infants in a previous study. Notably, AUC0–12h had an inverse relationship with gestational age and weight. Infants with lower gestation and higher Cmin showed a higher tendency for more than 1 adverse effect. Conclusions: GCV and valGCV use among preterm and very low birthweight infants with CMV disease resulted in a higher incidence of adverse events, increased AUC0–12h and elevated Cmin compared with term infants. Further pharmacokinetic studies are necessary to determine the ideal dosage in this population.