Lower Gestational Age Research Articles

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.

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.

Effects of the COVID-19 pandemic on maternal-fetal outcomes in a nonepidemic designated hospital: a retrospective study and clinical experience summary

ObjectiveTo assess the changes in maternal-fetal outcomes in a nonepidemic designated hospital during the COVID-19 pandemic.MethodsThis retrospective cohort study was conducted between January 1, 2019, and December 31, 2021 on pregnant patients. The fixed-effects regression model was used to determine changes in birth outcomes and pregnancy-related complications between three periods with the pre-epidemic cohort as the control group. Logistic regression was applied to determine the odds ratio (OR) for binary outcomes.ResultsThere were 15,261 births during the pre-epidemic period, and this number decreased by 15% and 23% to 12,980 and 11,736 in the first and second epidemic cohorts, respectively. The mean birth weight during the pre-epidemic period was 3319 which decreased to 3309 and 3272 g in the following periods. Excluding stillbirth and preterm, all other outcomes differed significantly between the three periods. Gestational diabetes mellitus (GDM) (17–19%) and maternal hypertension (9.2–11%) appeared to increase. Compared to the pre-epidemic period, the odds of macrosomia and LGA significantly decreased in the second epidemic cohort (adjusted ORs: 0.76 and 0.8), while the odds of low birth weight (LBW) and small gestation age (SGA) increased (ORs: 1.25 and 1.16). The odds of neonatal asphyxia (OR: 1.4), and hypertension (OR: 1.29) appeared to increase in the second epidemic cohort, while GDM decreased in the first cohort (OR: 0.88) and increased in the second cohort (OR: 1.15). Vaginal delivery underwent a marginal decrease in both the first and second epidemic cohorts (ORs: 0.89 and 0.92).ConclusionThe COVID-19 pandemic may have had a substantial and long-term impact on non-infected pregnant women and newborns. Our research results provided precious research information and clinical experience summary for population health research in the future.

High-Frequency Percussive Ventilation: A Promising Rescue Strategy in Severe Lung Disease of Extremely Low Gestational Age Neonates.

Objective: The aim of this study was to evaluate high-frequency percussive ventilation (HFPV) as a rescue strategy for extremely low gestational age neonates (ELGANs) with severe lung disease. Methods: This is a retrospective review of 16 ELGANs with severe lung disease who were placed on HFPV following a lack of improvement on other modes of conventional and high-frequency ventilation. Results: The gestational age of these 16 infants was 25 (24, 26) weeks and their birth weight was 640 (535, 773) grams [median (IQR)], with the survivors being more immature compared to those who died [24 (23, 26) and 26 (25, 28) weeks, respectively; (p = 0.04)]; and with an overall mortality of 31% (N = 5). Of those who died, 60% were SGA (p = 0.02). Following placement on HFPV, the survivors had a statistically significant decrease in their respiratory severity scores (RSSs) [11 (9, 14) to 6 (5, 13), p = 0.03] compared to those who did not survive [15 (11, 16) to 11 (6.8, 14.5), p = 0.32] due to an improvement in their oxygenation [FiO2: 0.95 (0.85, 1) to 0.6 (0.4, 0.9), p = 0.01; compared to 1 (1, 1) to 1 (0.7, 1); survivors and non-survivors, respectively; p = 0.32]. Chest X-rays also showed significantly improved aeration due to decreased areas of atelectasis in those who survived. Conclusions: HFPV may be an appropriate rescue mode of high-frequency ventilation in the ELGAN population with severe lung disease, particularly for patients with impaired oxygenation and ventilation difficulties due to shifting atelectasis and mucous plugging.

Vitamin D Receptor-Interplay in COVID-19-Negative, -Infected, and -Vaccinated Women during Pregnancy.

Background: The trophoblast is a significant source of vitamin D synthesis during pregnancy, with the literature suggesting its role in fetal growth. We aim to underline a possible mechanism that would explain negative fetal outcomes in COVID-19-positive mothers by examining the relationship between altered placental structure and function and throphoblast cells' vitamin D receptor levels. Methods: The study included 170 placental samples collected from women who gave birth at term without complications, divided into three groups: COVID-19-positive and unvaccinated, COVID-19-negative and vaccinated, and COVID-19-negative and unvaccinated, with exclusion criteria for any other medical complications. Immunohistochemistry (IHC) was performed to detect vitamin D receptor (VDR) expression, and immediate fetal outcomes (weight and Apgar score) were assessed. Results: We found lower gestational age at birth, lower birth weight, and reduced placental VDR (vitamin D receptor) levels in COVID-19-positive women compared to COVID-19-vaccinated and COVID-19-negative women. Conclusions: The presence of the vitamin D receptor in the placenta is related to fetal and placental growth. Its deficiency may contribute to negative fetal outcomes in COVID-19-positive cases.

Epidemiology and treatment of herpes simplex virus in the neonatal intensive care unit.

Describe the epidemiology and clinical characteristics of infants in the neonatal intensive care unit (NICU) with acyclovir exposure and herpes simplex virus (HSV) infection. Our primary analysis was to evaluate the prevalence of HSV infection among infants in the NICU who received acyclovir. We compared characteristics of infants with and without HSV and used multivariable regression analyses to assess associations between infection and clinical outcomes. Of 1,057,061 infants, 17,910 (2%) received acyclovir. Of those who received acyclovir, 1090 (5%) had HSV. Infection was associated with lower gestational age and lower birth weight. Multivariable models demonstrated that infected infants had higher mortality, greater postmenstrual age at discharge, and longer length of stay. Infants in the NICU who received acyclovir and have HSV are more likely to be born at lower gestational age, have lower birth weight, and have higher morbidities and mortality.

Association between early pulmonary arterial pressure measurements and bronchopulmonary dysplasia or mortality in very preterm infants: a prospective cohort study

BackgroundPrematurity is a significant risk for bronchopulmonary dysplasia related pulmonary artery pressure.ObjectiveTo determine the association between pulmonary artery pressure in the early days of life and the development of bronchopulmonary...

Antiviral Treatment and Risk of Hearing Loss in Asymptomatic and Mild Symptomatic Infants With Congenital Cytomegalovirus.

To assess hearing outcomes at 24 months of age in infants with mild congenital cytomegalovirus (cCMV) infection, depending on whether they have received antiviral treatment or not. A retrospective study within the European Registry of Children with cCMV was performed. Included children had cCMV diagnosed in utero/in the first 21 days of life, with normal physical examination, alanine aminotransferase <80 U/L and platelets >100,000 cs/mm3 and absence of hearing loss (HL) at birth. Cranial ultrasound (cUS) and/or cranial magnetic resonance imaging was normal or with minor findings (isolated lenticulostriate vasculopathy and/or germinolysis/caudothalamic or subependymal cysts, and/or focal/multifocal white matter involvement). The main outcome was the presence of HL at 24 months of age. One hundred ninety-six patients met inclusion criteria. A total of 34.7% received antiviral treatment with valganciclovir/ganciclovir. Children treated had lower gestational age, birth weight and head circumference, and maternal primary infection was less frequent. Among treated children, 21.3% presented minor findings in cUS versus 6.3% in nontreatment group (P = 0.003). Nine patients (4.6%) developed HL at 24 months. Among children with HL, 20% presented minor findings in cUS versus 11.3% in non-HL group (P = NS). HL rate was similar in treated and nontreated groups (4.6% vs. 6.3%; P = 0.6). One-third of the children were treated with antivirals and infants with minor neuroimaging findings at birth were more likely to receive antiviral. There were no differences in the prevalence of HL at 2 years of age between treated and not-treated children. Minor neuroimaging findings were not clearly associated with an increased risk of delayed onset HL.