Lower Gestational Age Research Articles

Increased risk of persistent pulmonary hypertension of the newborn in twin anaemia polycythaemia sequence donors.

Introduction This study aimed to describe the prevalence and risk factors for respiratory complications in monochorionic twins with twin anaemia polycythaemia sequence (TAPS). Methods All neonates diagnosed with postnatal TAPS at our centre between 2002 and 2023 were included in this retrospective study. The primary outcome was the prevalence of respiratory complications, including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and persistent pulmonary hypertension of the newborn (PPHN). Secondary outcomes included need of respiratory support during admission and a risk-factor analysis for adverse respiratory outcome. Results In our study of 100 postnatally diagnosed TAPS pregnancies, 32% (62/199) experienced RDS and 13% (25/199) had BPD, with no difference between donors and recipients. PPHN occurred in 7% of cases, more frequently in donors (11%, 11/100) than in recipients (3%, 3/100) (OR = 1.3, 95%CI 0.2-2.6). Lower gestational age at birth and severe fetal anaemia were found to be significant independent risk factors associated with PPHN in TAPS twins (OR = 0.3, 95%CI 0.1-0.5), respectively (OR = 1.9, 95%CI 0.8-3.1). Conclusion TAPS donor twins have a four-fold increased risk of PPHN due to anaemia compared to recipient twins. Given the life-threatening nature of PPHN, TAPS twins should be born in hospitals equipped to treat it.

Risk Factors of the Severity of COVID-19 Infection in Infants

Background: The global COVID-19 crisis has profoundly affected populations worldwide. While it is widely accepted that older individuals are at greater risk of severe illness, data indicate that in newborns and infants, the disease is generally not fatal. Objectives: This cross-sectional study aimed to examine the roles of laboratory tests and clinical symptoms in determining the severity of COVID-19 infection in infants younger than three months. Methods: This study included all infants less than three months old with positive PCR tests for COVID-19 admitted to the Children's Medical Center between October 2020 and March 2022. We analyzed the association between disease severity and clinical symptoms, as well as laboratory findings. Results: Sixty-four neonates and infants under three months of age with COVID-19 participated in the study. Our findings suggest that lower birth weight and gestational age are associated with increased disease severity. Infants with underlying medical conditions were found to have a higher risk of reaching stage IIb or greater severity. Among laboratory and clinical findings, only white blood cell (WBC) count and cough symptoms showed a significant correlation with disease severity. Conclusions: Clinical evaluations, along with factors such as birth weight, gestational age, and underlying conditions, appear more effective in guiding decision-making for COVID-19 severity in infants. Further studies are necessary to explore the influence of these factors on COVID-19 severity in this age group.

Post-Discharge Growth Among Extremely Preterm Infants With or Without Bronchopulmonary Dysplasia.

This study aimed to evaluate whether bronchopulmonary dysplasia (BPD) and home respiratory care (HRC) after discharge, including home oxygen therapy (HOT) or home mechanical ventilation (HMV), were associated with the growth of extremely preterm infants. This secondary study uses data from a study on the infant and early childhood development survey of low-birth-weight infants in the Health, Labor, and Welfare Science Research. We enrolled 788 singleton extremely preterm infants appropriate for gestational age (GA). BPD was defined as the requirement of supplemental oxygen or respiratory support at 36 weeks corrected GA. We compared trends of anthropometric measurements from age 0 to 5 years among infants with non-BPD, BPD without HRC, and BPD with HRC. We obtained 4113 weight and length measurements. At age 0-5 years, the BPD with the HRC group weighed less and was shorter than the other two groups. Lower GA and BPD status were significantly associated with growth failure of weight at 3 and 5 years after adjustment for potential risk factors. Lower GA was significantly associated with growth failure of length at 3 and 5 years. Conversely, although BPD status was significantly associated with growth failure of length at 3 years, it was not at 5 years. Among extremely preterm infants, BPD with HRC was associated with a significant growth delay at 0-5 years compared with non-BPD and BPD without HRC. However, the effect of different severities of BPD on growth failure of length was attenuated with age.

The impact of skin-to-skin contact upon stress in preterm infants in a neonatal intensive care unit

IntroductionNeonatal stress significantly affects the early adaptation, maturation and long-term development of preterm infants.The objective of the studyTo investigate the effect of skin-to-skin contact (SSC) on stress level in preterm infants.Materials and methodsThe research was a prospective study. Stress indicators (cortisol, melatonin) were measured before the SSC began (pre-intervention level) and after this intervention (post-intervention).ResultsThe study included 150 preterm infants in the NICU with gestational age (GA) ≤36 weeks. Pre-intervention salivary cortisol level was higher in extremely and very preterm neonates compared to moderate and late preterm newborns (p = 0.028), in children with low Apgar scores (p = 0.041), in those who were on mechanical ventilation (p = 0.005), and suffered neonatal sepsis (p = 0.005). Pre-intervention melatonin level was lower in children with low Apgar scores (p = 0.032). Salivary cortisol levels were significantly decreased after SSC in preterm infants [pre-intervention: 0.294 (0.111; 0.854) μg/dL vs. post-intervention: 0.127 (0.070; 0.229) μg/dL, p < 0.001], and urinary melatonin levels were significantly increased after SSC [pre-intervention: 4.01 (2.48; 6.34) ng/mL vs. post-intervention: 5.48 (3.39; 9.17) ng/mL, p < 0.001]. A greater reduction in cortisol levels after skin-to-skin contact was revealed in infants with a lower gestational age (p = 0.022), in boys compared to girls (p = 0.012), in infants with respiratory distress syndrome (p = 0.048), in those who had mechanical ventilation compared to non-ventilated neonates (p = 0.008), and in infants with seizures (p = 0.036). The melatonin levels increased more intensively in infants with low Apgar scores (p = 0.002), and in those with late-onset sepsis (p = 0.006).ConclusionThe reduction in cortisol levels and the increase in melatonin levels provided strong evidence that SSC ameliorated the NICU-related stress in preterm infants. We found higher indicators of stress and more dramatic responses to SSC in reducing indicators of stress in infants with lower GA than in infants with higher GA, indicating that SSC may be even more important for lower GA infants. The infants who need SSC the most should not be denied the care they need to reduce the stress they experience from being born too soon and continuing their gestational development in the stressful environment of the NICU.

Predictors of Nasal Continuous Positive Airway Pressure Failure in Preterm Infants With Respiratory Distress Syndrome

Respiratory support in infants with respiratory distress syndrome (RDS) plays an important role in the reduction of mortality and complications, but the treatment fails in some infants. This study aimed to identify the predictors of continuous positive airway pressure (CPAP) failure in preterm infants with RDS. This cross-sectional retrospective study was conducted on RDS-diagnosed preterm infants admitted to the neonatal intensive care unit of Fatemieh Hospital (Hamadan city) in 2021-2022. The infants were examined in terms of risk factors for CPAP failure. Data extracted from the medical records were recorded in a checklist and analyzed with SPSS version 21 software at a confidence level of 95%. CPAP failure was recorded in 37.6% of the studied 202 infants. The need for resuscitation at birth, low gestational age, low birth weight, multiple births, low 1-min and 5-min Apgar scores, the need for higher FIO2 and PEEP, acidosis, and the need for surfactant administration were significantly associated with CPAP failure. In logistic regression, low gestational age (OR 1.30, 95% CI: 1.082-1.576) and the need for resuscitation at birth (OR 0.426, 95% CI: 0.202-0.898) were the major predictors of CPAP failure. Lower gestational age and the need for PPV in the delivery room are good predictors of CPAP failure in preterm infants with RDS, who receive nasal CPAP as primary respiratory support.

Time to positivity of Coagulase Negative Staphylococcus In Neonatal Blood Cultures as an adjunct tool to help discriminate between sepsis and contamination.

To assess the usefulness of time to positivity (TTP) to distinguish between sepsis and contamination in coagulase-negative staphylococci (CoNS) isolates. Unicentric retrospective observational. Medical records of 168 patients with suspected sepsis and positive blood culture for CoNS were reviewed. Patients were subdivided into sepsis (29%) and probable contamination (71%). Logistic regression analyses were performed to evaluate different risk factors and clinical signs and symptoms associated with sepsis. TTP cut-off value that best discriminated sepsis from contamination was found to be 18 h. Regression analysis revealed that TTP ≤ 18 h, gestational age ≤32 weeks, taquycardia/bradycardia and hypoactivity/lethargy were independent predictors of sepsis. TTP is useful in distinguishing sepsis from contamination, especially in neonates with lower gestational age (<32 weeks). The clinical signs that most increase the discriminatory power of TTP are the presence of tachycardia/bradycardia or hypoactivity.

Risk factors for and short-term prognosis of intrauterine infection in preterm infants.

To identify the risk factors for and short-term prognosis of intrauterine infection (IUI) in preterm infants. We retrospectively collected clinical data regarding preterm infants (28+0-36+6 weeks of gestational age) with IUI from the neonatal intensive care unit of our hospital between June 2017 and June 2022. The pathologic characteristics of the infants were classified using the Redline criteria, and the resulting groups were compared with respect to their clinical characteristics, indicators of infection, complications, and mortality rates. Three hundred thirty (78.1%) of the 422 enrolled neonates showed signs of histologic IUI; 51.8% showed histologic chorioamnionitis alone, and 48.2% showed both histologic chorioamnionitis and funisitis. The independent risk factors identified for IUI were maternal prenatal invasive manipulation, premature rupture of membranes (>18 hours before labor), and prenatal C-reactive protein concentration. The infants with IUI showed higher incidences of respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, and prolonged mechanical ventilation. Low gestational age and low birth weight of preterm infants were significantly associated with a higher incidence of histologic IUI, more severe inflammation, and a higher incidence of complications. Histologic IUI is associated with high complication and mortality rates in preterm infants, as is an increasing severity of inflammation.

Diuresis-led volume replacement strategy in extremely low birth weight infants.

In extremely low birth weight infants, fluid overload has been associated with bronchopulmonary dysplasia and death. Excessive weight loss may increase the risk of meconium obstruction and intestinal perforation. As these infants display oliguria followed by polyuria, we embarked on a diuresis-led volume replacement strategy as of January 2020. This single-centre analysis presents data of infants <1000 g birth weight surviving for more than 3 days admitted 2017-2019 (n = 217, daily volume increase) versus 2020-2022 (n = 2022, diuresis-led volume replacement). The second cohort had lower gestational age (median [interquartile range]: 253/7 [243/7-264/7] vs. 263/7 [251/7-282/7] weeks), less antenatal steroids (58% vs. 69%), more indomethacin (66% vs. 47%) and higher initial diuresis (5.6 [4.9-6.8] vs. 4.8 [4.2-5.5] mL/kg/h) but did not differ by relative weight loss at Day 7 of life. Employing binary logistic regression with gestational age, antenatal steroids and indomethacin as covariates, the cohorts did not differ by rates of patent ductus arteriosus, abdominal surgery or severe retinopathy of prematurity, while there were significant declines in sepsis (from 32% to 19%), bronchopulmonary dysplasia (from 26% to 23%) and mortality (from 13% to 7%). Diuresis-led volume replacement appears to be safe and maybe beneficial.

The association of gene polymorphisms of adenosine and dopamine receptors with the response to caffeine citrate treatment in infants with apnea of prematurity: a prospective nested case-control study

BackgroundTo investigate the potential influence of adenosine and dopamine receptor genes polymorphisms in combination with clinical factors on the response of preterm infants to caffeine citrate treatment in apnea of prematurity (AOP).MethodsA prospective nested case-control study enrolled 221 preterm infants with gestational age < 34 weeks. These infants were divided into the response (n = 160) and the non-response groups (n = 61). 22 single-nucleotide polymorphisms in adenosine and dopamine receptor genes were genotyped. The basic characteristics and clinical outcomes of the two groups were compared. Univariate logistic regression analysis was performed to evaluate the differences in genotype distribution between the groups. Multivariable logistic regression analysis was performed to identify independent risk and protective factors and develop a nomogram to predict caffeine citrate response in preterm infants.ResultsPreterm infants in the non-response group had lower gestational age, lower birth weight, longer periods of oxygen supplementation and caffeine citrate use, and higher incidence of patent ductus arteriosus (PDA), bronchopulmonary dysplasia (BPD), neonatal respiratory distress syndrome (NRDS), retinopathy of prematurity (ROP), and brain injury (P < 0.05 for all). The ADORA1 rs10920573, ADORA2B rs2015353, ADORA3 rs10776728, DRD3 rs7625282, and DRD3 rs6280 gene polymorphisms were associated with caffeine citrate response in preterm infants (PFDR < 0.05 for all). The ADORA1 rs10920573 CC (aOR, 3.51; 95% CI, 1.34–9.25) and DRD3 rs6280 CT genotypes (aOR, 3.19; 95% CI, 1.53–6.65) were independent risk factors for non-response, whereas greater gestational age (aOR, 0.631; 95% CI, 0.53–0.75) was an independent protective factor for response. The concordance index of the nomogram was 0.764 (95% CI, 0.687–0.842), and the calibration and decision curve analysis indicated the nomogram had excellent predict performance.ConclusionsAdenosine receptor gene and dopamine receptor gene polymorphisms influence caffeine citrate treatment response in AOP. By combining genetic and clinical variables, it is possible to predict the response to caffeine citrate treatment in preterm infants.

A review of the risk factors for Autism

Abstract Background Autism Spectrum Disorder (or Autism) is a neurodevelopmental and neurological condition, with prevalence of 1 in 100 children globally. This review examines the most common factors associated with Autism. Methods We conducted a scoping review of factors associated with an increased risk of developing Autism. These included genetic predisposition, parental age, gender, birth complications and morbidities due to other medical conditions. Results Evidence from twin studies shows a 90% genetic predisposition towards Autism - with 102 genes strongly associated with Autism, including SCN1A and SLC6A1. There are also genetic syndromes and chromosomal disorders associated with Autism, including Fragile X syndrome and Tuberous Sclerosis complex (TSC). Several studies have demonstrated an increased risk with advanced parental age (&amp;gt;35 years) (e.g., fathers &amp;gt;50 years are 2.2 times more likely to have a child with Autism than those &amp;lt;30 years). Other factors include infections during pregnancy (e.g. immune dysfunction) and gestational diabetes. Prematurity, such as low birth weight (&amp;lt;1500g) and low gestational age (&amp;lt;32 weeks) are also associated with an increased risk of Autism. With regard to gender, boys are more likely to be diagnosed with Autism - gender ratio of 3:1 and 4:1 has been reported in different populations. Abnormalities in brain development during early prenatal or postnatal periods may increase the risk of Autism. These abnormalities can lead to social, communication, and behavioural challenges characteristic of Autism. Conclusions Autism is a complex and heterogeneous condition that likely arises from a combination of factors such as genetic susceptibility and pre- and postnatal factors. An understanding of these factors is important for early detection, intervention, and support for children to improve their quality of life and reduce morbidity. Key messages • Risk factors associated with an increased risk of developing Autism include genetic predisposition, parental age, gender, birth complications and other comorbidities. • There is need to increase awareness of the risk factors of Autism to improve quality of life.

Incidence of Retinopathy of Prematurity in Early Onset Neonatal Sepsis

Background: Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. Early-onset neonatal sepsis, has been identified as a potential contributing factor to the incidence of ROP. Aim of the study: The aim of this study was to assess the incidence of retinopathy of prematurity in early onset neonatal sepsis. Methods: This cross-sectional study was conducted in Department of Ophthamology and Neonatal Intensive Care Unit (NICU), Dr. Sirajul Islam Medical College &amp; Hospital Ltd., Dhaka, Bangladesh from June 2022 to July 2024. Total 300 preterm neonates with ROP were included in this study. Then, they were divided into two groups- group A: 150 patients with early onset neonatal sepsis and group B: 150 patients with late onset neonatal sepsis. Result: The mean gestational age in Group A was significantly lower (28.9 ± 2.3 weeks) than Group B (30.1 ± 2.2 weeks) (p &lt; 0.01). Maternal infections were higher in Group A (50%). Oxygen therapy duration was longer in Group A (14 ± 3 days) than in Group B (10 ± 2 days) (p &lt; 0.01). Group A had more cases of ROP (70% vs. 57%, p = 0.02). Risk factors for ROP included gestational age &lt;28 weeks (OR = 2.10), oxygen therapy (OR = 1.60), and mechanical ventilation (OR = 1.45). Conclusion: This study concludes that neonates with early-onset neonatal sepsis had higher incidence and severity of ROP, with key risk factors being low gestational age, prolonged oxygen therapy, mechanical ventilation, and maternal infections.

The effect of histological and subclinical chorioamnionitis and funisitis on breathing effort in premature infants at birth: a retrospective cohort study

Antenatal inflammation in the form of chorioamnionitis (fetal membranes; HCA) and funisitis (umbilical vessels; FUN) is a major risk factor for preterm birth. Exposure to HCA + FUN affects infants by releasing mediators that may suppress respiratory drive. While the association between clinical chorioamnionitis (CCA) and (depressed) spontaneous breathing has been described, we have investigated the association between breathing and HCA + FUN. Infants born < 30 weeks’ gestation with available placental pathology assessments were included. Infants were compared at multiple levels: infants with vs without HCA + FUN (comparison 1) and infants with subclinical HCA + FUN vs infants without any chorioamnionitis (comparison 2). The primary outcome was breathing effort, defined as minute volume (MV) of spontaneous breathing in the first 5 min after birth. We also assessed tidal volume (Vt), respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2) and oxygen requirement (FiO2). Regression analyses were performed to control for confounding factors. One hundred eighty-six infants were included (n = 75 infants with HCA + FUN vs. n = 111 infants without HCA + FUN). Comparison 1: Infants with HCA + FUN had lower gestational ages 26+5 (25+0–28+1; median (IQR) and lower birthweights (mean ± SD; 943 ± 264) compared to infants without HCA + FUN (28+4 (27+0–29+1) weeks, p < 0.001 and 1023 ± 270 g, p = 0.049). Comparison 2: Subclinical HCA + FUN was diagnosed in 46/75 HCA + FUN infants. Infants with subclinical HCA + FUN had lower gestational ages (26+6 (25+1–28+3) vs. 28+4 (27+2–29+1) weeks, p < 0.001) without significant differences for birthweights (987 ± 248 vs. 1027 ± 267 g, p = 0.389) compared to infants without any chorioamnionitis (n = 102 infants). After adjustment, HCA + FUN was associated with lower MV (p = 0.025), but subclinical HCA + FUN was not (p = 0.226). HCA + FUN and subclinical HCA + FUN were associated with lower Vt (p = 0.003; p = 0.014), SpO2 at 5 min (p = 0.021; 0.036) and SpO2/FiO2 ratio (p = 0.028; p = 0.040).Conclusion: HCA + FUN and subclinical HCA + FUN are associated with reduced oxygenation and parameters that reflect breathing effort in premature infants at birth.What is Known:• Acute antenatal inflammation, in the form of chorioamnionitis (fetal membranes) and funisitis (umbilical vessels), affects a large proportion of premature infants.• Clinical chorioamnionitis is associated with reduced breathing effort and oxygenation in premature infants at birth.What is New:• Histological and subclinical chorioamnionitis and funisitis are associated with reduced breathing effort parameters and oxygenation in premature infants at birth.

Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants

BackgroundThe objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).MethodThe data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.ConclusionMaternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.

Bronchopulmonary dysplasia to predict neurodevelopmental impairment in infants born extremely preterm.

Bronchopulmonary dysplasia (BPD) in extremely low gestational age neonates (ELGANs) was associated with neurodevelopmental impairment (NDI). However, the best endpoint of BPD assessment to predict subsequent NDI remains unclear. We re-analyzed the PREMILOC trial, previously designed to test the effect of prophylactic hydrocortisone on survival without BPD at 36 weeks of postmenstrual age (BPDW36) in ELGANs, to compare predictive models of NDI considering baseline characteristics, respiratory course up to and BPD status at 36 or 40 weeks of postmenstrual age (BPDW36/BPDW40). Among 404/519 (77.8%) infants enrolled in the trial alive at 2 years of age, all neurocognitive scores were available for 302 (74.8%) patients. Gestational diabetes and sex were identified as the only statistically significant baseline predictors of NDI. Adding BPDW40 to this baseline model was found to be superior to predict NDI compared to BPDW36, leading to a mean difference of the developmental quotient of -6.7 points (95% confidence interval: -10.0 to -3.50, P < 0.001). The prophylactic hydrocortisone treatment effect on survival without BPDW40 was found to be highly significant (OR = 2.08 [95% confidence interval: 1.36 to 3.17], P < 0.001). These data suggest a better accuracy of BPDW40 to predict NDI in ELGANs, an important finding for future clinical trials and research in drug development. EudraCT number 2007-002041-20, ClinicalTrial.gov number, NCT00623740. The best endpoint to assess BPD as a surrogate to predict neurocognitive impairment in infants born extremely preterm remains unclear. This study strongly suggests a better discriminative value of BPD as assessed at 40 weeks of postmenstrual age (instead of 36 weeks) to predict neurocognitive impairments at 2 years of age in children born extremely preterm. This study supports the switch up to 40 weeks of the primary outcome chosen in future clinical trials designed to prevent BPD. Our data also provide evidence of the beneficial effect of HC on preventing BPD at full-term equivalent age.

66 Survival and school-age outcomes of extremely premature neonates with intraventricular hemorrhage

Abstract Background Extremely low gestational age (ELGA) neonates are at risk for intraventricular hemorrhage (IVH) and periventricular hemorrhagic infarction (PVHI). There is no clear consensus on the prognosis of these conditions. Objectives The aim of this study was to compare the survival, and the neurodevelopmental outcomes (NDO) at school-age for neonates with IVH and/or PVHI, to those without. Design/Methods This retrospective single-center study (2012-2017) included neonates less than 26 weeks gestational age (GA) who received resuscitation and early intensive care. Imaging data were collected from cranial US for the presence of IVH described by Papile grading. Survival was defined as survival to discharge. NDO were classified as no neurodevelopmental impairment (NDI), no NDI with multidisciplinary referrals, and the adverse outcome was defined as NDI at school-age. NDI included any diagnosis of cerebral palsy, global developmental delay, intellectual disability, visual or hearing impairment. Autism spectrum disorder (ASD) was included as an outcome of interest. Results 164 infants met inclusion criteria, of whom 156 survived resuscitation. Mean GA was 24 weeks and 6 days (SD 6 days) and mean birth weight 701g (SD 125g), grade I-II IVH was present in 43 (28%) infants, and grade III-IV IVH was present in 48 (31%) infants. Survival was 45% for those with bilateral grade III-IV IVH, 53% for unilateral grade III-IV IVH, 78% for bilateral grade I-II IVH, 80% for unilateral grade I-II IVH, and 81% for no IVH groups. 108 infants survived to discharge and 90 had complete follow up at school age. 30% of children had NDI and ASD was diagnosed in 12%. Logistic regression for adverse outcome demonstrated an adjusted odds-ratio (OR) 0.30 (95% CI 0.14, 0.56) for gestational age (p &amp;lt;0.001). The logistic regression resulted in adjusted OR 0.72 (95% CI 0.21, 2.37) for grade I-II IVH and OR 1.43 (95% CI 0.4, 5.03) for Grade III-IV IVH (p=0.63). Conclusion In neonates born ELGA, survival decreased with increasing severity of IVH. Decreasing GA, but not severity of IVH, was predictive of neurodevelopmental impairment. Extremely preterm infants born &amp;lt; 26 weeks are at high risk of NDI and of ASD.

Psoriasis: Sind Geschlechtsunterschiede bedeutsam?

Background: Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden for women. Objective: Sex-dependent differences in disease manifestation, severity, treatment choices, subjective disease perception, and the impact on quality of life and risk factors are described and comprehensively discussed. Methods: A literature search was conducted using MEDLINE (PubMed) and the Cochrane Library for systematic reviews to investigate the challenges in treating women with psoriasis. Results and conclusions: : The incidence, prevalence, and manifestation of psoriasis of the skin are similar between different sexes. Genetic and environmental factors such as obesity and metabolic syndrome are risk factors and are not equally relevant or pronounced in women and men. Overall, women have a lower disease severity measured by the Psoriasis Area Severity Index, which is associated with a higher impairment of their life quality measured by the Dermatology Life Quality Index compared with men. In addition, women with psoriasis are more likely to have depression than men. Hormonal factors affect psoriasis, with a correlation of high estrogen levels and improvement of psoriasis. Data regarding differences in prescribing patterns of systemic treatments and the severity of psoriasis are not entirely consistent. Registry studies show that men tend to have more severe psoriasis and, in some cases, are prescribed systemic therapies more frequently. Women tend to respond better to systemic treatments and to experience more adverse events. Treatment options are the same for both sexes, except during pregnancy and lactation. Various treatment options are contraindicated due to fear of fetal or neonate harm and lack of data. Topical steroids can be prescribed with a high degree of safety during pregnancy. For other topical therapies (calcineurin inhibitors and vitamin D analogs), no studies of adverse effects in pregnancy are available, and safety data mainly stem from studies examining effects after systemic administration. Antitumor necrosis factor monoclonal antibodies (except for certolizumab pegol) have been associated with a possible increased risk of preterm birth, low gestational age, and cesarean deliveries. Prospective data on the safety of biologics other than antitumor necrosis factor-alpha antibodies to accurately assess whether novel biologics (eg, anti-interleukin 17, 12/23, 23) can be used for systemic therapy in pregnancy are lacking or currently being conducted. © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.

Esophagitis, treatment outcomes, and long-term follow-up in children with esophageal atresia.

Survival rates in children born with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) have improved; however, morbidity associated with the disease remains high. This study aimed to assess the prevalence of gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), fungal esophagitis, esophageal strictures, and long-term outcomes in children with EA/TEF. We conducted a retrospective chart review on patients with EA/TEF who were seen at Children's Wisconsin from January 2003 to January 2023. Patients born with EA/TEF were included if they underwent at least one endoscopy after 1 year of age. GERD was diagnosed based on abnormal findings on endoscopy, pH-metry, and/or history of fundoplication. EoE and fungal esophagitis were diagnosed based on abnormal endoscopy. Esophageal stricture diagnosis was based on findings on endoscopy and/or esophagram, and clinical symptoms necessitating esophageal dilation. Eighty-five patients (64.7% males, mean age 7.5 years) were included, the majority had type C EA/TEF (90.6%). GERD was diagnosed in 61.1% (n = 52), 49.4% (n = 42) by macro and/or microscopic endoscopic findings, 22.3% (n = 19) by abnormal pH-metry, and 21.1% (n = 18) by the need for fundoplication for refractory reflux and/or esophageal stricture. Risk of GERD increased with lower gestational age (p = 0.0030), lower birth weight (p = 0.023), and long-gap EA (p = 0.034). In children diagnosed with GERD, only 13.4% of patients (n = 7/52) were able to be weaned off proton pump inhibitor (PPI) without disease recurrence. However, overall, at the completion of the study, 44.7% (n = 38) of patients were successfully weaned off PPI without evidence of GERD. EoE was diagnosed in 20% of the patients (n = 17). All patients diagnosed with EoE required escalation of therapy from PPI alone to swallowed corticosteroids in 52.9% (n = 9), dupilumab in 23.5% (n = 4), elemental formula in 17.6% (n = 3), and elemental formula and swallowed steroids in 5.8% (n = 1). Fungal esophagitis was diagnosed in 15.3% of patients (n = 13). An esophageal stricture requiring dilation was diagnosed in 77.6% (n = 66) of patients at a mean age of 28.5 months, with over 60% diagnosed by 24 months of age. Children born with EA/TEF continue to be at high risk of developing GERD, EoE, fungal esophagitis, and esophageal stenosis. Diagnostic and therapeutic endoscopy remains a high-yield test to identify and treat these comorbidities.

Pharmacoepidemiology of combination pulmonary vasodilator therapy in critically ill infants.

New drugs to target different pathways in pulmonary hypertension has resulted in increased combination therapy, but details of this use in infants are not well described. In this large multicenter database study, we describe the pharmacoepidemiology of combination pulmonary vasodilator therapy in critically ill infants. We identified inborn infants discharged home from a Pediatrix neonatal ICU from 1997 to 2020 exposed to inhaled nitric oxide, sildenafil, epoprostenol, or bosentan for greater than two consecutive days. We compared clinical variables and drug utilisation between infants receiving simultaneous combination and monotherapy. We reported each combination's frequency, timing, and duration and graphically represented drug use over time. Of the 7681 infants that met inclusion criteria, 664 (9%) received combination therapy. These infants had a lower median gestational age and birth weight, were more likely to have cardiac and pulmonary anomalies, receive cardiorespiratory support, and had higher in-hospital mortality than those receiving monotherapy. Inhaled nitric oxide and sildenafil were most frequently used, and utilisation of combination and monotherapy for all drugs increased over time. Inhaled nitric oxide and epoprostenol were used in infants with a higher gestational age, earlier postnatal age, and shorter duration than sildenafil and bosentan. Dual therapy with inhaled nitric oxide and sildenafil was the most common combination therapy. Our study revealed an increased use of combination pulmonary vasodilator therapy, favouring inhaled nitric oxide and sildenafil, yet with considerable practice variation. Further research is needed to determine the optimal combination, sequence, dosing, and disease-specific indications for combination therapy.

Assessing the efficacy of electrocardiogram for heart rate evaluation during newborn resuscitation at birth: a prospective observational study.

This study aimed to assess the efficacy of electrocardiogram (ECG) compared to pulse oximetry (PO) in detecting heart rate (HR) during high-risk newborn resuscitation. A prospective observational study was performed with high-risk delivery cases to measure the time required for HR detection. A conventional PO and a standard ECG monitor were used for HR assessment. Forty-one infants were analyzed in the study, and 11 among them needed resuscitation. Nine were <32 gestational weeks (GA), 28 were 33-35 GA, and 4 were >36 GA at birth. ECG time for placement to HR detection was significantly faster than PO detection [30 (20-43.5) vs. 125 (100-175) seconds, P<0.001]. ECG time for placement to HR detection was the fastest in the infants below 32 GA at birth [19 (11.5-30) vs. 34.5 (25-44.25) vs. 39.5 (30-64.75) seconds, P=0.039). ECG effectively evaluated HR during neonatal resuscitation compared to PO. Low gestational age infants who need resuscitation often may benefit in HR evaluation with nearby standard ECG.

Maternal Anemia during Pregnancy and Infant Birth Outcomes: A Prospective Cohort Study in Eastern Maharashtra, India

BackgroundAnemia during pregnancy may be associated with poor infant outcomes, although its consequences may vary based on etiology and timing. ObjectivesWe examined the associations between anemia and anemia-related biomarkers during pregnancy and infant outcomes [birthweight, gestational age at birth, birthweight-for-gestational age percentile, and infant hemoglobin (Hb) at 6 wk of age] in Nagpur, Eastern Maharashtra, India. MethodsWe conducted a prospective cohort study of 200 pregnant women. In the first trimester, venous blood was collected to assess Hb via cyanmethemoglobin analysis, micronutrient status (ferritin, vitamin B12, and folate), and inflammation (C-reactive protein). Hb was also assessed in capillary samples using a hemoglobinometer in the first and third trimesters for mothers and at 6 wk for infants. Associations were assessed using generalized linear models controlling for background characteristics. ResultsIn the first trimester, high (compared with normal) venous Hb was significantly associated with lower gestational age at birth [β: −1.0 wk, 95% confidence interval (CI): −1.9, −0.2] and higher birthweight-for-gestational age percentile (β: 20.1, 95% CI: 9.0, 31.2). Mild anemia, moderate anemia, and high (compared with normal) capillary Hb were significantly associated with lower birthweight (β: −147.7 g, 95% CI: −243.4, −51.7; β: −77.7 g, 95% CI: −123.9, −31.4; and β: −236.0 g, 95% CI: −478.0, −48.1) and birthweight-for-gestational age percentile (β: −7.3, 95% CI: −13.7, −0.9; β: −8.4, 95% CI: −14.1, −2.8; and β: −8.9, 95% CI: −15.9, −1.9). Higher serum ferritin was significantly associated with higher birthweight (β: 2.0 g, 95% CI: 0.1, 3.9) and gestational age at birth (β: 0.01 wk, 95% CI: 0.00, 0.01). In the third trimester, mild anemia was significantly associated with lower gestational age at birth (β: −0.5 wk, 95% CI: −0.7, −0.3). ConclusionsAssociations between maternal anemia during pregnancy and infant outcomes were mixed indicating further studies are needed to better understand these relationships.