Mortality In Preterm Infants Research Articles

Evaluation of Health-Related Values and Preferences of Adults Who Were Preterm Infants and Parents of Preterm Infants Concerning Use of Prophylactic Cyclooxygenase Inhibitor Drugs

There is wide variability in the use of prophylactic cyclooxygenase inhibitor (COX-I) drugs to prevent morbidity and mortality in preterm infants. Parents of preterm infants are rarely involved in this decision-making process. To explore the health-related values and preferences of adults who were preterm infants and families of preterm infants concerning the prophylactic use of indomethacin, ibuprofen, and acetaminophen initiated within the first 24 hours after birth. This cross-sectional study used direct choice experiments conducted in 2 phases of virtual video-conferenced interviews between March 3, 2021, and February 10, 2022: (1) a pilot feasibility study and (2) a formal study of values and preferences, using a predefined convenience sample. Participants included adults born very preterm (gestational age <32 weeks) or parents of very preterm infants currently in the neonatal intensive care unit (NICU) or having graduated from the NICU in the last 5 years. Relative importance of clinical outcomes, willingness to use each of the COX-Is when presented as the only option, preference for using prophylactic hydrocortisone vs indomethacin, willingness to use any of the COX-Is when all 3 options are available, and relative importance of having family values and preferences included in decision-making. Of 44 participants enrolled, 40 were included in the formal study (31 parents and 9 adults born preterm). The median gestational age of the participant or the participant's child at birth was 26.0 (IQR, 25.0-28.8) weeks. Death (median score, 100 [IQR, 100-100]) and severe intraventricular hemorrhage (IVH) (median score, 90.0 [IQR, 80.0-100]) were rated as the 2 most critical outcomes. Based on direct choice experiments, most participants were willing to consider prophylactic indomethacin (36 [90.0%]) or ibuprofen (34 [85.0%]), but not acetaminophen (4 [10.0%]) when offered as the only option. Among participants who initially chose indomethacin (n = 36), if prophylactic hydrocortisone was offered as a potential therapy with the caveat that both cannot be used simultaneously, only 12 of 36 (33.3%) preferred to remain with indomethacin. Variability in preference was noted when all 3 COX-I options were available, indomethacin (19 [47.5%]) being the most preferred option followed by ibuprofen (16 [40.0%]), while the remainder opted for no prophylaxis (5 [12.5%]). The findings of this cross-sectional study of former preterm infants and parents of preterm infants suggest that there was minimal variability in how participants valued the main outcomes, with death and severe IVH being rated as the 2 most important undesirable outcomes. While indomethacin was the most preferred form of prophylaxis, variability was noted in the choice of COX-I interventions when participants were presented with the benefits and harms of each drug.

The efficacy of Kangaroo-Mother care to the clinical outcomes of LBW and premature infants in the first 28 days: A meta-analysis of randomized clinical trials.

The objective of this study was to systematically determine the benefits of Kangaroo-Mother Care (KMC) on the clinical outcomes of low birthweight (LBW) and preterm infants. For this study, the following databases were retrieved for articles published until November 2021: PubMed, Web of Science, EBSCO, and the Cochrane library. The primary clinical outcome was mortality between enrollment and 28 days. The secondary clinical outcomes were the mean duration of hospital stay, hypothermia, sepsis, exclusive breastfeeding at the end of the neonatal period, and exclusive breastfeeding at discharge. We conducted a meta-analysis, which included 17 RCTs, involving overall 17,668 participants. The results of this meta-analysis showed that KMC could reduce the primary clinical outcome of mortality between enrollment and 28 days (RR: 0.80, 95% Cl: 0.71-0.91, p < 0.01). For the secondary clinical outcomes, KMC had a varying degree of benefits on the mean duration of hospital stay (SMD: -0.96, 95% Cl: -1.02-0.90, p < 0.001), hypothermia (RR: 0.45, 95% Cl: 0.27-0.75, p < 0.01), and sepsis (RR: 0.79, 95% Cl: 0.70-0.89, p < 0.001). The exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge of KMC had benefits, which was not statistically different though (OR: 2.16, 95% Cl: 0.55-8.41, p = 0.27; OR: 1.16, 95% Cl: 0.82-1.64, p = 0.39, respectively). KMC was decreased mortality in LBW and premature infants between enrollment and 28 days. In addition, KMC also had a favorable effectiveness on the secondary clinical outcomes, such as mean duration of hospital stay, hypothermia, sepsis. Moreover, KMC also had a slight effectiveness on exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge.

Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand.

Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings. We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aORs) and a 95% confidence interval (CI). Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birth weights of the neonates were 29 (27-31) weeks and 1,180 (860-1,475) grams, respectively. By multivariable analysis, GA (aOR: 0.65; 95% CI: 0.55-0.77), small for GA (aOR: 4.93; 95% CI: 1.79-13.58), multifetal gestation (aOR: 2.23; 95% CI: 1.12-4.46), intubation within 24 hours (aOR: 5.39; 95% CI: 1.35-21.64), and severe respiratory distress syndrome (aOR: 5.00; 95% CI: 1.05-23.89) were significantly associated with composite outcomes. Very preterm infants who had a lower GA were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities. · In very preterm neonates, the composite outcomes and mortality rate were 29.4 and 12.3%.. · Composite outcomes were associated with lower GA, SGA, multifetal gestation, intubation, and severe RDS.. · Mortality was associated with lower GA or Apgar score at 5 minutes, SGA, and PPHN..

Intracranial ultrasound abnormalities and mortality in preterm infants with and without fetal growth restriction stratified by fetal Doppler study results.

To evaluate whether fetal growth restriction (FGR) with or without abnormal Dopplers is associated with intracranial abnormalities and death in premature infants. Premature infants with and without FGR born between 2016 and 2019 were included. Primary outcome was death, severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). Groups were compared using standard bivariate testing and multivariable regression. Among 168 FGR and 560 non-FGR infants, FGR infants with abnormal Dopplers had an increased incidence of death, severe IVH or PVL compared to non-FGR infants (13% (16/123) vs. 7% (41/560); p = 0.03) while FGR infants with normal Dopplers had a nonsignificant decrease. In a logistic regression model, FGR with abnormal Dopplers was associated with more than three times higher odds of death, severe IVH or PVL (OR 3.2, 95% CI 1.54,6.49; p < 0.001). Growth-restricted infants with abnormal Dopplers had an increased risk of death, intracranial abnormalities, and prematurity-related morbidities.

Impact of an Online Program of Bubble Continuous Positive Airway Pressure Education in a Resource-Constrained Setting.

Respiratory distress is a leading cause of preterm infant mortality in sub-Saharan Africa. Bubble continuous positive airway pressure (CPAP) is emerging as a potentially safe, cost-effective way of delivering noninvasive respiratory support in low-income and middle-income countries. However, without healthcare providers who are knowledgeable and skilled in the use of this technology, suboptimal neonatal care and related health disparities are likely to persist. We hypothesized that an Internet-based, blended curriculum on bubble CPAP for bedside providers in low-resource mother-baby units (MBUs) could be developed and implemented and lead to improvements in clinical knowledge, reasoning, and learner confidence in bubble CPAP. Clinical educators from Israel, Ghana, and the United States used the analysis, design, development, implementation, and evaluation (ADDIE) design framework to create an online curriculum for two MBUs in Kumasi, in the Ashanti Region of Ghana. Participants completed pre and post curriculum knowledge tests and completed surveys on their perspectives. Fifty-four interdisciplinary health professionals from the MBUs participated in the curriculum. Median knowledge test scores improved from 64% (interquartile range [IQR] = 50-72%) to 81% (IQR = 71-89%) after participation in the curriculum (P < 0.001). Learners reported high levels of confidence with bubble CPAP after participating in the curriculum and evaluated the curricular components highly. An online curriculum was successfully implemented and led to changes in healthcare worker knowledge in bubble CPAP. This may be an effective way to deliver education to healthcare professionals in resource-constrained countries and warrants further study.

Risk factors for mortality of preterm infants in the neonatal medicine department of the ‘Mère-Enfant’ University Hospital Centre of Libreville

Background: Reducing neonatal mortality of preterm infants is a public health priority in developing countries. The objective of this study was to study the risk factors for mortality of preterm infants in the neonatology department of UHCME-JEF. Methods: A retrospective, analytical study was done over 36 months (January 2019-December 2021) in the neonatology department of UHCME-JEF. Maternal and newborn parameters were studied. All hospitalized preterm newborns were included. Results: The prevalence of prematurity was 44.6%. The mortality rate was 18.7%. The mean age of mothers was 28.05±6.5 years. They were unemployed (69.4%) and single (73.6%). The three main causes of death were sepsis (41.7%), respiratory failure (26.0%), and anoxic-ischemic encephalopathy (15.3%). The risk factors associated with death were multiparity [p=0.001, OR=2.0, IC 95% (1.32-3.00)], pre-existing maternal diabetes [p=0.007, OR=2.4, IC 95% (1.31-4.52)], prenatal check-up not done [p=0, 024, OR=1.5 IC 95% (1.04-2.05)], GA&lt;28SA [p&lt;0.001, OR=1.8 IC 95% (1.24 -2.71)], Apgar &lt;3 at the first [p=0.036, OR=1.8, IC 95% (1.21-2.76)] and fifth minute [p=0.010, OR=3.2, IC 95% (1.35-7.74)] resuscitation at birth [p=0.017, OR=1.5, IC 95% (1.04-2.05)], birth weight &lt;1000 g (p=0.001, OR=2.8, IC 95% (1.92-4.23)], hypotonia [p=0.001, OR=1.6, IC 95% (1.23-2.32)], asphyxia [p=0.020, OR=1.7 CI 95% (1.09-2.55)], hypothermia [p&lt;0.001, OR=2.1, CI 95% (1.56-2.86)], the presence of thrombocytopenia [p=0.001, OR=1.9, CI 95% (1.62-2.93)] and glycemic dysregulation [p=0.001, OR=2.8, CI 95% (2.09-3.73)]. Conclusions: The mortality of preterm newborns remains a major problem in our department. It is necessary to promote good surveillance of pregnancy, and correct care of premature infants in the delivery room and hospitalization.

Analysis of Postoperative Outcomes and Extrauterine Growth Retardation in Preterm Infants with Necrotizing Enterocolitis: A Retrospective Study.

High mortality and extrauterine growth retardation (EUGR) remain serious problems in preterm infants after necrotizing enterocolitis (NEC) surgery. This study investigated the risk factors for mortality and EUGR in preterm infants after NEC surgery. The risk factors were analyzed retrospectively by univariate analysis and multivariate logistic regression analysis in 52 preterm infants, who underwent NEC surgery and were hospitalized in neonatology department of Shanghai Children's Hospital between May 2014 and December 2021. Patients were divided into survival and death groups. Survivors were divided into two groups according to whether EUGR occurred when they achieved full enteral feeding after surgery. The mortality of preterm infants after NEC surgery was 26.9% (14/52). About 55.3% (21/38) of survivors developed postoperative EUGR. (1) Age at surgery, proportion of shock, and intestinal perforation differed significantly between the survival and death groups (p = 0.001, 0.005, and 0.02, respectively). Shock (p = 0.02, odds ratio [OR] = 8.86, 95% confidence interval [CI]: 1.43-55.10) and intestinal perforation (p = 0.03, OR = 6.12, 95% CI: 1.16-32.41) were significant risk factors for death. (2) Compared with the non-EUGR group, proportion of preoperative EUGR, postoperative 1-week calories, and parenteral nutrition time differed significantly in EUGR group (p = 0.001, 0.01, and 0.04, respectively). Preoperative EUGR (p = 0.02, OR = 18.63, 95%CI: 1.77-196.42) was a significant risk factor for postoperative EUGR. Shock and intestinal perforation are significant risk factors for death in preterm infants after NEC surgery. Survivors are prone to EUGR, and preoperative EUGR is a significant risk factor. In addition, adequate caloric intake and achievement of full enteral feeding as soon as possible may be beneficial to improve EUGR of preterm infants after NEC surgery. · Shock and intestinal perforation are risk factors for death in preterm infants after NEC surgery.. · Preoperative EUGR is a risk factor for postoperative EUGR in preterm infants after NEC surgery.. · Active correction of shock and avoiding intestinal perforation may help improve the outcomes..

Platelet parameters and the association with morbidity and mortality in Preterm Infants.

There is growing recognition of the role of platelets in inflammation and immune responses, and platelets have been associated with various cardiovascular diseases. It is also known that neonatal morbidities are related to overall platelet activity, and platelet parameters may have the potential to predict morbidities and mortality in preterm infants. This study aimed to assess the initial platelet parameters and the association with major morbidities and mortality in preterm neonates. We retrospectively reviewed data from very preterm neonates with a gestational age (GA) <32 weeks who were admitted between June 2020 and May 2021 for platelet parameters (counts, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (platelet counts x MPV/10000(%)) at birth. Major morbidities included early- onset sepsis (EOS) ≤3 days after birth, severe intraventricular hemorrhage (IVH) grade ≥3, and early or overall mortality. A total of 197 very preterm neonates were studied. Their mean (±SD) GA was 28.0 ± 2.4 weeks, birth weight was 990 ± 293 g, platelet counts were 245 ± 81 x1000/μL, MPV was 10.0 ± 0.7 fl, PDW was 11.0 ± 1.6 fl, and plateletcrit was 0.24 ± 0.08%. MPV had a weak negative correlation with both GA (r = -0.234, p = 0.001) and BW (r = -0.343, p <0.001). A lower plateletcrit was associated with EOS (0.14 (0.04-0.22) % vs. 0.23 (0.19-0.30) %, p = 0.027), severe IVH ≤7 days after birth (0.18 (0.14-0.27) % vs. 0.23 (0.20-0.30) %, p = 0.022), and early and overall mortality (0.15 (0.20-0.30) % vs. 0.23 (0.20-0.30) %, p = 0.049; 0.20 ± 0.09 % vs. 0.25 ± 0.07 %, p = 0.008). A lower plateletcrit within 24 hours of birth was associated with EOS, severe IVH ≤7 days after birth, and first-week and overall mortality in very preterm neonates.

Prevalence and Outcome of Management of Respiratory Distress Syndrome: A Systematic Review

The main goal of this review is about Respiratory distress syndrome, which starts within hours of delivery, is really a major cause of neonatal respiratory distress; it remains a leading cause of morbidity and mortality in preterm infants. The following search databases were used PubMed, the Web of Science, Science Direct, EBSCO, and the Cochrane Library. Utilizing Rayyan QCRI, studies papers were screened by title and abstract before being subjected to a full-text evaluation. This review invest

Involvement of miR-495 overexpression in the pathogenesis of bronchopulmonary dysplasia in preterm infants via the targeting of NEDD4L-ENaC pathway.

Bronchopulmonary dysplasia (BPD) is a severe pulmonary complication causing morbidity and mortality in preterm infants. A key histopathological feature of BPD is late lung growth retardation, in which the process of alveolarization is hindered and the mechanism of which is unclear. Emerging evidence indicates that microRNAs (miRNAs) promote the development of BPD via the inhibition of their target genes. MiR-495 has been reported to be involved in various lung diseases. However, the physiological function of miR-495 in BPD has not yet been fully understood. Differentially expressed miRNAs in peripheral blood of patients with BPD were compared with those of normal controls. A dual-luciferase reporter assay was performed to identify the target genes of miR-495. A BPD neonatal rat model was established by injecting lipopolysaccharide (LPS) in the amniotic sac of pregnant rats. The morphology of the lungs was observed using hematoxylin and eosin (HE) staining. The expression of miR-495, neural precursor cell expressed developmentally down-regulated 4-like (NEDD4L), and epithelial Na+ channel (ENaC) was tested using quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blot analysis, and immunofluorescent (IF) staining. The expression of miR-495 was significantly increased in the peripheral blood samples of premature infants with BPD and verified using qRT-PCR. NEDD4L was proven to be the target gene of miR-495. Additionally, miR-495 expression was also increased in the lungs of rat pups with BPD at postnatal day (P) 3 compared with the control group. qRT-PCR and Western blot results showed that NEDD4L expression was decreased while ENaC expression was increased at the transcriptional and translational levels. IF staining results showed that NEDD4L level was decreased while ENaC level was increased in the LPS-induced BPD rat model, which was consistent with abnormal changes in alveolar structure. The aberrant overexpression of miR-495 may contribute to the development of BPD by targeting NEDD4L-ENaC pathway, implying an imbalance in lung fluid clearance.

Suppressive role of vascular endothelial growth factor on intestinal apoptosis in induced necrotizing enterocolitis in rats.

Necrotizing enterocolitis (NEC) is a devastating disease that can cause mortality in preterm babies. NEC may develop through an apoptotic pathway that is known to be inhibited by vascular endothelial growth factor (VEGF). This study determined whether VEGF exerted a protective effect against the development of NEC and apoptosis in rats. To determine the effect of VEGF in NEC rats, neonatal rats were randomized into 4 groups: the control group, the NEC group, the NEC + intraperitoneal VEGF (50 ng/kg) group (NEC + VEGF IP group), and the NEC + oral VEGF (50 ng/kg) group (NEC + VEGF OR group). NEC was induced by lipopolysaccharide/hypoxia and cold stress. The animals were sacrificed 72 hours later. After laparotomy, we obtained a region of the proximal small bowel from the ileocecal valve about 18 cm in length. The NEC histological grade, apoptosis histological score, and caspase-3 activity were lower in the NEC + VEGF IP and OR groups than in the NEC group. In the NEC + VEGF IP and OR groups, the messenger RNA expression of apoptotic and inflammatory genes, such as Bax, NF-κB, p53, Fas, FasL, and PAF-R, but not that of Bcl-2, was decreased, as was the Bax/Bcl-2 protein ratio. Histological analysis revealed that the apoptosis-blocking effect of VEGF was more effective in the NEC + VEGF IP group than in the NEC + VEGF OR group. We identified apoptotic and inflammatory genes to confirm the preventive effect of VEGF pretreatment on NEC in rats. This study presents a novel approach to prevent apoptosis via VEGF pretreatment in rats with lipopolysaccharide/hypoxia-induced NEC.

Oral Application of Mother's Own Milk for Reducing Necrotizing Enterocolitis in Preterm Infants: An Updated Meta-Analysis of RCTs.

Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) are the major contributors to mortality and morbidity in preterm infants. This updated meta-analysis was aimed to assess the effects of mother's milk on the incidence of NEC, LOS, and other clinical outcomes in preterm infants. PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. A total of 13 RCTs with 1330 infants were included in the final analysis. Significant difference in NEC (stage 2 or 3) was found between the intervention group and the control group (RR = 0.508, 95% CI: 0.314-0.822, and P=0.008). The incidence of proven LOS (RR = 0.809, 95% CI: 0.610-1.071, and P=0.139) and death (RR = 0.800, 95% CI: 0.571-1.122, and P=0.196) was comparable between the two groups. Statistical differences in the incidence of proven or probable LOS (RR = 0.705, 95% CI: 0.577-0.862, and P=0.001) and length of hospitalization (WMD = -4.868, 95% CI: -6.608 to -3.128, and P < 0.001) between the intervention group and the control group were observed. The results of this updated meta-analysis showed that compared to the placebo, mother's milk provides better effects in reducing the incidences of NEC, proven or probable LOS, and the length of stay, whereas no significant benefit of mother's milk was observed in reducing the incidence of proven LOS and death.

Essential Fatty Acid Supplementation and Early Inflammation in Preterm Infants: Secondary Analysis of a Randomized Clinical Trial

Introduction: Postnatal inflammation is associated with increased mortality and adverse outcomes in preterm infants. The essential fatty acids arachidonic acid (ARA) and docosahexaenoic acid (DHA) are precursors of lipid mediators with a key role in resolving inflammation. Our aim was to investigate the effect of ARA and DHA supplementation on systemic inflammation in very preterm infants and to identify clinical factors associated with early inflammation. Methods: Secondary analysis of data from a randomized clinical trial (ImNuT study). Infants with gestational age (GA) less than 29 weeks were randomized to receive a daily enteral supplement with ARA 100 mg/kg and DHA 50 mg/kg (ARA:DHA group) or MCT oil (control group) from the second day of life to 36 weeks postmenstrual age. ARA, DHA, and four proinflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α) were analyzed in repeated dried blood samples from birth to day 28 and the area under the curve (AUC) for each variable was calculated. Results: The intention to treat population included 120 infants with mean (SD) GA 26.4 (1.7). The ARA:DHA group had significantly lower IL-6 levels from day 3 to day 28 compared to the control group, mean difference AUC log₁₀ (95% CI): 0.16 (0.03–0.30) pg/mL, p = 0.018. There was no correlation between ARA or DHA blood concentrations and cytokine levels. Having a low gestational age was independently associated with increased levels of all cytokines during the first 4 weeks of life. Conclusions: Enhanced supplementation with ARA and DHA may modulate inflammation in very preterm infants.

Predictors of Bronchopulmonary Dysplasia in Infants With Birth Weight Less Than 1500 g.

Bronchopulmonary dysplasia (BPD) is a complication of preterm and low birth weight infants. The incidence of BPD has not decreased over the past 20 years. Complications of BPD include rehospitalization, chronic lung disease, cardiovascular disease, and impaired growth and development which will affect the patient's quality of life. There are unfortunately limited data available regarding BPD in Indonesia. This study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm and low birth infants. This study aims to determine predictors of BPD in infants with birth weight less than 1500 g. We conducted a retrospective cohort study that included 116 infants with birth weight <1500 g. Twenty-two (19%) infants had BPD with the highest proportion (63.6%) in the 28 to 31 weeks of gestational age. Multivariate analysis showed mechanical ventilation in more than first 2 days of life (P = .008; HR = 7.7), hematocrit <39% (P = .001; HR = 12), and hemodynamically significant patent ductus arteriosus (hsPDA; P = .041; HR = 3.5) were significant predictors of BPD in infants with birth weight <1500 g.

Influence of daytime versus nighttime births on late preterm infant outcomes

To determine whether delivery time of day is associated with differences in neonatal management or outcome in late preterm infants. Previous investigations of neonatal morbidity based on delivery time of day have focused on infants at term and early preterm gestational ages. This is a secondary analysis of ALPS, a multicenter trial of patients with anticipated late preterm delivery (34w0d-36w6d) randomized to betamethasone or placebo. Patients were assigned to a daytime (0700-1859) or nighttime cohort (1900-0659) using the documented time of birth. Study group characteristics were compared using chi-squared test for categorical data and Wilcoxon test for continuous data. Logistic regression models were used to adjust for birth weight, mode of delivery, and ALPS group assignment. The primary outcome was the administration of respiratory resuscitation in the first 30 minutes of life. Characteristics of the two cohorts are summarized in Table 1. There were 1539 daytime deliveries and 1288 nighttime deliveries. The daytime birth cohort had a significantly higher rate of Cesarean delivery and a higher mean birth weight. There was no significant difference in the primary outcome of administration of respiratory resuscitation in the first 30 minutes of life (aRR 1.03, 95% CI 0.86-1.24, p=0.73). Secondary outcomes, including administration of surfactant and NICU admission, were also comparable between the groups (Table 2). Of infants who received surfactant, the average duration of time to surfactant administration was not significantly different between daytime versus nighttime births. Previous studies have inconsistently demonstrated an association of delivery time of day with neonatal morbidity and mortality in early preterm and term infants. Here, we show that in late preterm infants, daytime compared to nighttime birth is not associated with increased neonatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality

To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care.

Presepsin: a biomarker of early-onset neonatal sepsis

Neonatal early-onset sepsis represents one of the most common diseases leading to morbidity and mortality in preterm infants. A prompt diagnosis is still a challenge in the clinical practice due to several biases affecting the current standard of care performance. In this regard, the soluble cluster of differentiation CD14 subtype, namely Presepsin, has been shown to be a promising diagnostic biomarker of sepsis in newborns. Although Presepsin provides high accuracy and short results output, its reliability in daily clinical practice is still an issue that needs further investigation. Therefore, in the present review we offer an overview of Presepsin role as diagnostic tool of early-neonatal onset sepsis.

Utility of transforming growth factor beta-1 in diagnosis of neonatal necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) yet remains a leading cause of morbidity and mortality in premature infants. The developmental deficiency of transforming growth factor-Beta (TGF-β) in the intestine is a risk factor for NEC in premature infants.We aimed to investigate the potential utility of serum TGF-β1 in the early diagnosis and severity assessment of NEC. This prospective case-control study was conducted on 102 VLBW neonates aging less than 32 weeks and weighing less than 1500 gm. They were divided into NEC group of 52 preterm neonates with symptoms and signs of NEC and 50 age and sex-matched neonates without NEC as a control group. All neonates underwent full medical history taking, clinical examination, radiological and laboratory investigations including CBC, CRP, fecal occult blood, and serum TGF-β1. Serum TGF-β1 was tested in NEC patients at the onset of symptoms and signs and 7 days later. Serum TGF-β1 was significantly lower in NEC patients at the onset of symptoms than the control group (P = 0.004) while after 7 days of onset serum TGF-β1 was significantly higher than at the onset of symptoms (P < 0.001). In NEC patients with stage I, TGF-β1 was significantly higher than in NEC patients with stage ≥II (P = 0.027).In conclusion serum TGF-β1 is downregulated in neonatal necrotizing enterocolitis and can be used as a useful biomarker for early diagnosis of NEC and to assess disease severity.

Biomarkers of necrotizing enterocolitis in the era of machine learning and omics

Necrotizing enterocolitis (NEC) continues to be a major cause of morbidity and mortality in preterm infants. Despite decades of research in NEC, no reliable biomarkers can accurately diagnose NEC or predict patient prognosis. The recent emergence of multi-omics could potentially shift NEC biomarker discovery, particularly when evaluated using systems biology techniques. Furthermore, the use of machine learning and artificial intelligence in analyzing this ‘big data’ could enable novel interpretations of NEC subtypes, disease progression, and potential therapeutic targets, allowing for integration with personalized medicine approaches. In this review, we evaluate studies using omics technologies and machine learning in the diagnosis of NEC. Future implications and challenges inherent to the field are also discussed.

966: LATE (≥ 7 DAYS) SYSTEMIC POSTNATAL CORTICOSTEROIDS FOR BRONCHOPULMONARY DYSPLASIA: A META-ANALYSIS

Introduction: One of the several complications associated with preterm birth is bronchopulmonary dysplasia (BPD), a disorder characterized by abnormal development of the lungs and subsequent breathing problems. We aim to determine the safety and efficacy of late (≥ 7 days) systemic corticosteroids for the prevention of BPD in preterm infants. Methods: We searched electronic databases, international trial registers, grey literature sources, and reference lists of articles to identify relevant randomized controlled trials (RCTs) on the use of systemic corticosteroids for the prevention of BPD. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0), calculated risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CI for continuous outcomes. Results: Our meta-analysis included 24 RCTs (2617 infants); 21 RCTs involved dexamethasone while 3 RCTs involved hydrocortisone. Our analysis showed that compared to the control group, late corticosteroids significantly decreased neonatal mortality at various ages: 28 days (RR 0.62, 95% CI 0.40-0.95, I2=0%), 36 weeks postmenstrual age (RR 0.73, 95% CI 0.56-0.95, I2=0%), latest reported age (RR 0.82, 95% CI 0.68-0.99, I2=0%), and before hospital discharge (RR 0.80, 95% CI 0.66-0.98, I2=0%). Late systemic corticosteroids did not significantly affect the incidence of BPD at 28 days after birth (RR 0.91, 95% CI 0.83-1.00, I2=40%) and 36 weeks postmenstrual age (RR 0.90, 95% CI 0.82-1.00, I2=27%). However, late corticosteroids decreased the frequency of late rescue with corticosteroids (RR 0.56, 95% CI 0.43-0.73, I2=61%). Late corticosteroids increased the risk of hyperglycemia, glycosuria, and hypertension. Infants who were administered corticosteroids were also found to have significantly less failure to extubate on the 3rd, 7th, and 14th day after treatment. Conclusions: The use of late systemic corticosteroids is shown to have significantly reduced the mortality in preterm infants, but had no significant effect on the incidence of BPD. More RCTs with longer follow-ups addressing the appropriate dose and timing of steroid therapy are needed.