Outcome In Preterm Neonates Research Articles

Elimination of Candida Sepsis and Reducing Several Morbidities in a Tertiary NICU in Greece After Changing Antibiotic, Ventilation, and Nutrition Protocols

Background/Objectives: In recent years, strategies for improving outcomes in preterm neonates have been implemented in various aspects of neonatal care. This study aims to determine the prevalence, microbiology, and outcomes of late-onset sepsis (LOS) and the incidence of other morbidities in very preterm neonates following the implementation of specific infection control, enteral feeding, and ventilation strategies. Methods: This study retrospectively compared the morbidity and mortality of preterm neonates with a 23−32 weeks gestational age over two periods, period A (2010–2014),and period B (2018–2022). A series of changes were introduced between these periods, including restrictive use of antibiotics, aggressive enteral feeding, and wider use of non-invasive ventilation modalities. Results: A total of 310 neonates were included: 163 in period A and 147 in period B. The mean duration of antibiotic treatment was reduced from 4 ± 2 to 2 ± 1 days and from 5 ± 2 to 3 ± 1 days for suspected early-onset sepsis and LOS, respectively, and from 11.2 ± 4 to 16 ± 4 days for confirmed LOS between the two study periods. The incidence of LOS was 24% and 18%, while, for multiple LOS episodes, it was 26% and 11% in periods A and B, respectively. Total parenteral nutrition (TPN) duration and gestational age were independent predictors of LOS in both periods. The rate of Candida infections declined from 9.2% to 0.7%. The full enteral nutrition in period B was achieved after a median of 7.5 days compared with 10 days (p = 0.001), resulting in fewer days of TPN (p = 0.008). Episodes of feeding intolerance and necrotizing enterocolitis I (NEC I) were significantly reduced (p < 0.001). Incidence of intraventricular hemorrhage were significantly decreased. Conclusions: After changing antibiotic, ventilation, and nutrition protocols, Candida infections were almost completely eliminated. The incidence of LOS and multiple LOS episodes decreased. Early full enteral nutrition was achieved without adverse effects, and fewer episodes of food intolerance were observed. Candida elimination appears feasible when antibiotic stewardship is implemented in conjunction with other interventions in an NICU.

Which aEEG patterns could predict neurodevelopmental outcome in preterm neonates? - A systematic review.

Amplitude-integrated electroencephalogram (aEEG) enables continuous and simplified bedside monitoring of brain function. This review aims to investigate aEEG's value as a predictor of neurodevelopment outcome in preterm infants. PubMed, Embase and Web of Science were systematically searched according to the PRISMA in April 2023 and updated in October 2023. The protocol was registered on PROSPERO platform and the methodological quality of studies was analyzed using the Newcastle-Ottawa Scale (NOS). Nineteen articles (18 cohort and 1 case-control study) were included, reporting the recording of aEEG in 2074 preterm neonates and its association to neurodevelopment outcome. In most studies, aEEG recording started within 72h of life. The mean NOS score for prospective and retrospective cohort studies were 6 (4-7, median 6) and 6.6 (6-7, median 7), respectively. The case-control study received 7 stars. Burst suppression and low voltage background were associated with poor neurodevelopmental outcome, while normal background and established cyclicity was correlated with a favorable outcome, especially when they occurred in the first week of life. The background patterns and cyclicity of aEEG seems to be reliable patterns to help predict neurodevelopmental outcome in premature infants, especially when monitorization started early.

Neurodevelopmental outcomes of permanent and temporary CSF diversion in posthemorrhagic hydrocephalus: a Hydrocephalus Clinical Research Network study.

This study investigated neurodevelopmental outcomes in preterm neonates with posthemorrhagic hydrocephalus (PHH), focusing on the comparative effectiveness of temporary and permanent CSF diversion strategies. This multicenter prospective observational cohort study (2012-2021) involved preterm infants diagnosed with PHH who underwent either initial permanent or temporary CSF diversion. Patients were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), at 15-30 months and, when possible, at 36-42 months of corrected age. Statistical analyses included univariable and multivariable regression models to examine the associations between BSID-III scores and various treatment and patient factors. Among 106 patients, 15 (14%) underwent initial permanent CSF diversion, while 91 (86%) received temporary diversion. Patients who underwent permanent diversion had lower cognitive scores (58.2 ± 5.7) compared to those temporized (69.0 ± 15.9) (p = 0.01). Temporized patients who later required conversion to permanent diversion demonstrated poorer composite (66.6 ± 18.0 vs 79.9 ± 18.8, p = 0.02), expressive (4.6 ± 3.2 vs 7.0 ± 3.7, p = 0.03), and receptive (4.2 ± 3.3 vs 6.1 ± 3.0, p = 0.04) language scores compared to those weaned from temporary CSF diversion. No significant difference in outcomes was observed between patients temporized with a ventriculosubgaleal shunt versus a ventricular reservoir. Ventricle size at the time of initial CSF diversion was not associated with BSID-III scores. However, univariable analysis showed that a larger ventricle size at the time of conversion to permanent diversion was associated with lower neurodevelopmental scores across all domains. Multivariate analysis, adjusting for intraventricular hemorrhage (IVH) grade, complex chronic conditions, and postmenstrual age, revealed that larger ventricle size at the time of conversion correlated negatively with composite motor (effect size -0.47, CI -0.82 to -0.11, p = 0.01) and fine motor (-0.08, CI -0.15 to -0.01, p = 0.03) scores. This study suggested that the choice between permanent and temporary CSF diversion as initial treatments may affect neurodevelopmental outcomes in preterm neonates with PHH, which are influenced by IVH severity and timing of intervention. The findings support early temporization and avoiding delays to optimize permanent shunting. Monitoring ventricular size closely during this phase is critical, as larger ventricular size at the time of conversion is associated with poorer outcomes. These results highlight the necessity for adapting treatment strategies on the basis of individual patient characteristics, responses, and progress in managing PHH.

Efficacy of Pasteurised Donor Human Milk on the Growth of Preterm Neonates: A Research Protocol of a Randomised Control Trial

Introduction: Growth restriction is a common complication affecting a significant proportion of Very Low Birth Weight (VLBW) infants, with estimates suggesting that up to 97% of these vulnerable newborns are impacted. While Maternal Own Milk (MOM) is the gold standard for nutrition, pasteurised Donor Human Milk (DHM) offers a safe and nutritious alternative when MOM is not available. This research investigation aims to examine and compare the effects of MOM and DHM on growth parameters and outcomes in preterm infants. Need of the Study: Preterm infants are disproportionately vulnerable to neurodevelopmental delays and other complications, underscoring the importance of identifying effective interventions to support their growth and development. While MOM is widely recognised as the optimal source of nutrition, the potential benefits of DHM warrant further investigation. Given the limited research directly comparing MOM and DHM, this study aims to address this knowledge gap and explore the impact of these nutritional sources on the developmental outcomes of preterm neonates. Aim: To compare the efficacy of pasteurised DHM on anthropometric indices (Weight/Head circumference/Length) of preterm neonates until the age of discharge. Materials and Methods: This randomised controlled trial will be conducted in the Neonatal Intensive Care Unit (NICU) and Ward of Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Wardha, Maharashtra, India, from January 2024 to January 2026. All preterm infants born before 37 weeks of gestation and receiving enteral nutrition during the study duration will be enrolled. Participants will be randomly assigned to one of three groups based on the type of milk consumed: MOM, DHM, or a combination of both. Anthropometric measurements {Weight (once every day in the morning from 6 AM to 8 AM), head circumference and length (both once weekly on every Sunday in the morning from 6 AM to 8 AM)} will be recorded regularly until discharge. Recording anthropometric measurements regularly (daily/weekly) at consistent times (6 AM-8 AM) enables timely detection of growth issues, prompt intervention and informed discharge planning. This approach ensures accuracy, consistency and comprehensive tracking of patient growth and development until discharge. Data analysis will be performed using Statistical Package for the Social Sciences (SPSS) version 21.0 software. Analysis of Covariance (ANCOVA) will be employed to compare anthropometric indices among groups. Weight Gain Velocity (WGV) will be calculated by dividing the weight on the 10th day by the weight on the 1st day, multiplying by 1,000 and expressing the result in grams per kilogram per day (g/kg/day). Logistic regression analysis will be used to compare the incidence of Feeding Intolerance (FI) among groups.

Caregiver Experiences, Healthcare Provider Perspectives and Child Outcomes with Virtual Care in a Neonatal Neurodevelopmental Follow-Up Clinic: A Mixed-Methods Study.

Caregiver and healthcare provider perspectives of virtual care have not been explored in depth in the literature for neonatal follow-up clinics. Our objective was to evaluate caregivers' and healthcare providers' perspectives and compare neurodevelopmental outcomes of preterm neonates before and after implementing virtual care during the SARS-CoV-2 pandemic. Semi-structured interviews were conducted with families and healthcare providers, designed and analyzed using phenomenological qualitative methods. A retrospective cohort study was conducted to evaluate and compare neurodevelopmental characteristics of two preterm cohorts, one before ("in-person") and after ("virtual") virtual care. Three themes were identified: increased confidence in in-person assessments, adequate delivery of information using virtual platforms and a preference for specialized care through the neonatal follow-up clinic. A total of 252 infants born preterm, 104 infants in the in-person group and 148 infants in the virtual group, were included in the study. The adjusted odds ratio (aOR) of cerebral palsy was lower when virtual care was used compared to in-person assessments (aOR = 0.11, 95% CI 0.01-0.98) while the adjusted odds of cognitive delay measured by in-person standardized testing were higher (aOR = 2.78, 95% CI 1.25-6.19). Caregivers and healthcare providers prefer in-person assessments for comprehensive developmental support. It may be more challenging to detect subtle cognitive differences using caregiver-reported measures. Cerebral palsy may be missed when assessments are completed virtually.

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation—a before-and-after, non-controlled quality improvement study

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists’ Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants’ individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event “evaluation of plans” (0.5 [IQR 0.0–1.0] versus 1.0 [1.0–2.0], p = 0.049). Following the educational intervention, training participants’ knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome. What is Known:• In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers’ actual work.• In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.What is New:• This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit.• There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.

Impact of antenatal corticosteroids-to-delivery interval on very preterm neonatal outcomes: a retrospective study in two tertiary centers in Japan

BackgroundAntenatal corticosteroids (ACS) are administered to prevent neonatal complications and death in women at risk of imminent preterm birth. Internationally, the optimal interval from ACS to delivery (ACS-to-delivery interval) is within seven days; however, evidence in Asian populations specifically is limited. This study aimed to investigate the association between ACS-to-delivery interval and the incidence of neonatal complications in Japan.MethodsThis retrospective observational study enrolled singleton neonates born preterm at < 32 weeks of gestational age between 2012 and 2020 at two tertiary centers. A total of 625 neonates were divided into the following four groups according to the timing of ACS (measured in days): no ACS (n = 145), partial ACS (n = 85), ACS 1–7 (n = 307), and ACS ≥ 8 (n = 88). The following outcomes were compared between the groups: treated respiratory distress syndrome (RDS), severe intraventricular hemorrhage (IVH), treated patent ductus arteriosus (PDA), necrotizing enterocolitis, sepsis, bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity (ROP), periventricular leukomalacia, and death discharge.ResultsThe ACS 1–7 group had significantly decreased adjusted odds ratios (ORs) for treated RDS (0.37 [95% confidence interval: 0.23, 0.57]), severe IVH (0.21 [0.07, 0.63]), treated PDA (0.47 [0.29, 0.75]), and treated ROP (0.50 [0.25, 0.99]) compared with the no ACS group. The ACS ≥ 8 group also showed significantly reduced adjusted ORs for RDS (0.37 [0.20, 0.66]) and treated PDA (0.48 [0.25, 0.91]) compared with the no ACS group. However, the adjusted ORs for BPD significantly increased in both the ACS 1–7 (1.86 [1.06, 3.28]) and ACS ≥ 8 groups (2.94 [1.43, 6.05]) compared to the no ACS group.ConclusionsAn ACS-to-delivery interval of 1–7 days achieved the lowest incidence of several complications in preterm neonates born at < 32 weeks of gestational age. Some of the favorable effects of ACS seem to continue even beyond ≥ 8 days from administration. In contrast, ACS might be associated with an increased incidence of BPD, which was most likely to be prominent in neonates delivered ≥ 8 days after receiving ACS. Based on these findings, the duration of the effect of ACS on neonatal complications should be studied further.

EP65 - Case Series of 45 Preterm Neonates with Surgical Necrotizing Enterocolitis

Abstract Aim The objective of this study was to determine if the timing of surgery from the onset of necrotising enterocolitis (NEC) diagnosis affects clinical outcomes in preterm neonates. Methods We enrolled 45 preterm neonates who were transferred to the Evelina Children’s Hospital for surgical management of NEC between 2015 and 2018. Neonates had an established diagnosis of NEC as per Bell’s staging criteria. Surgical indications were: pneumoperitoneum, failure to improve despite medical management, shock, peritonitis, abdominal mass or loops, and unresolving intestinal obstruction. Results Average time from NEC onset to surgery was 4.2 days (±9.04) for all neonates, with an average of 5.72 days (±11.42) for neonates with pneumoperitoneum and 2.05 days (±3.22) for neonates without pneumoperitoneum (p=0.09). 26 neonates (57.7%) presented with pneumoperitoneum. Time of NEC onset to surgery was inversely correlated to mortality and directly correlated to postoperative parenteral nutrition at 28 days, although neither were significant (p=0.392 and p=0.744, respectively). 6 neonates (13%) developed short gut postoperatively. Conclusions Although pneumoperitoneum is the most reliable indication for surgery, timing to operation took longer for those neonates than those without pneumoperitoneum. Longer timing to surgery was associated with lower mortality and slightly higher odds of requiring parenteral nutrition postoperatively, although not statistically significant. Though preliminary evidence suggests worse clinical outcomes for neonates with sooner surgery, more trials with larger sample sizes are needed to see if this is statistically significant.

The influence of antenatal betamethasone timing on neonatal outcome in late preterm infants: a single-center cohort study.

Many pregnancies continue after antenatal corticosteroid exposure. Since long-term effects on late preterm neonatal outcome remain controversial, it remains unknown whether pregnant women who are at risk for preterm birth during the late preterm period and had prior antenatal corticosteroid exposure would benefit from an additional course of antenatal corticosteroids. We evaluated the need for future trials on this topic by comparing short term effects from antenatal betamethasone to long-term effects. We also examined the value of a risk-adapted approach. We observed neonatal outcomes in late preterm infants (34/0-36/0 weeks of gestation) who were exposed to antenatal betamethasone either up to 10 days prior birth (n = 8) or earlier in pregnancy (n = 89). We examined a real world population from the University Hospital Magdeburg (Germany) between 01 January 2012 and 31 December 2018, and a simulated high-risk population that was derived from the original data. The indicators for relevant adverse outcomes did not differ in the unselected population. In the simulated high-risk population, recent antenatal corticosteroid administration significantly reduced the incidence of relevant cardiorespiratory morbidities (OR = 0.00, p = 0.008), and reduced the number needed to treat from 3.7 to 1.5. The superiority of recent antenatal corticosteroid administration in the late preterm period over earlier exposure strongly depended on the prevalence of respiratory disease. Before considering clinical trials on additional antenatal corticosteroid courses in the late preterm period, antenatal assessment tools to predict respiratory morbidity need to be developed.

Fetal inflammatory response syndrome predicts early-onset sepsis and cystic periventricular leukomalacia in preterm neonates: A retrospective study.

Fetal inflammatory response syndrome (FIRS), the fetal equivalent of chorioamnionitis, is associated with poorer neonatal outcomes. FIRS is diagnosed through placental histology, namely by the identification of funisitis (inflammation of the umbilical cord) and chorionic vasculitis (inflammation of fetal vessels within the chorionic plate). The aim of this study was to identify and evaluate associations between FIRS and neonatal outcomes in preterm neonates. We performed a retrospective cohort study at a level III neonatal intensive care unit (NICU), from January 1st 2008 to December 31st 2022, involving all inborn neonates with a gestational age below 30 weeks. We compared preterm neonates based on whether their placental histology described funisitis with chorionic vasculitis (FCV) or not. The study included 113 preterms, 27 (23.9%) of those had FCV and 86 (76.1%) did not. After adjusting to gestational age, prolonged rupture of membranes and preeclampsia, FCV was independently associated with the development of early-onset sepsis (OR = 7.3, p = 0.021) and cystic periventricular leukomalacia (OR = 4.6, p = 0.004). The authors identified an association between FIRS and the development of early-onset sepsis and cystic periventricular leukomalacia, highlighting the importance of early detection and management of this condition in order to improve long-term neonatal outcomes.

Preterm Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Prematurity is a significant cause of neonatal morbidity and mortality, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to determine the prevalence and outcomes of preterm neonates admitted to the neonatal intensive care unit of a tertiary care hospital. This descriptive cross-sectional study was conducted among preterm neonates at a tertiary care hospital between July 15, 2022 to July 14, 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: F-NMC/557/078-079). Neonates with gestational age less than 37 weeks were included in the study. Total sampling method was used. Among 980 neonates admitted to intensive care unit, preterm neonates were 112 (11.43%). A total of 69 (61.61%) preterm neonates were outborn, and 65 (58.04%) were male. The median gestational age and birth weight were 32 weeks (interquartile range: 30- 34 weeks) and 1500 gm (interquartile range: 1300-1800 gm), respectively. There were 60 (53.57%) neonates with sepsis, 51 (45.54%) with neonatal jaundice and 38 (33.93%) with respiratory distress. Death occurred in 12 (10.71%) preterm neonates in the hospital. The prevalence of preterm neonates was similar to other studies done in similar settings.

Comparative study to evaluate the role of antenatal magnesium sulphate for neurological outcome in preterm neonates

Comparative study to evaluate the role of antenatal magnesium sulphate for neurological outcome in preterm neonates

Timing of Umbilical Cord Clamping in Preterm Neonates: A Randomized Controlled Trial

Background: The optimal timing for clamping the umbilical cord remains controversial. This study aimed to assess the optimal timing of umbilical cord clamping and its effect on preterm neonates. Methods: The study was a randomized controlled trial with the registration number: NCT06000800. It was conducted at Kasr Al Ainy Maternity Hospital, Cairo University Hospital, where a total of 80 pregnant women were randomly pooled and randomly divided into four groups with each group comprising 20 pregnant women. Umbilical cord clamping was performed in the first group immediately (5 sec after birth), after 30 sec in the second group, after 60 sec in the third group, and after 90 sec in the fourth group. After birth, clinical and laboratory parameters were assessed and recorded at the 1st, 6th, 12th, 24th, and 48th hours for all preterm neonates. Results: Delayed cord clamping at 90 sec was linked to improved preterm neonatal outcomes including heart rate at the 1st and the 6th hours; respiratory rate at the 12th hour; oxygen saturation at the 1st hour; hemoglobin, hematocrit, and blood glucose levels at the 6th, 12th, 24th, and 48th hours; but also linked to increase in bilirubin levels at the 12th, 24th, and 48th hours (P &lt; 0.001). There was no statistically significant difference concerning APGAR score; respiratory rate at the 12th hour, temperature at the 1st, 6th, 12th, 24th, and 48th hours; hemoglobin, hematocrit, and blood glucose at the 1st hour; and bilirubin at the 1st, 6th, and 12th hours in all groups (5, 30, 60, and 90 sec) (P &gt; 0.05). Conclusion: Better levels of blood glucose and hemoglobin were seen in preterm neonates whose cord clamping was delayed. Further studies should be carried out to determine the optimal timing of umbilical cord clamping with larger samples, for extended delay of clamping for more than 90 sec, and with recording of parameters for an extended period of follow-up even past the neonatal period.

Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022.

Adequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia. A cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation. The study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits. Addressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates' overall well-being and long-term outcomes.

Micronutrients supplementation and the outcome in preterm neonates in a tertiary health centre

Approximately 15 mil[1]lion babies are born preterm each year.1 Preterm infants commonly experience postnatal growth failure due to insufficient intake of micro[1]nutrients. We aim to determine the outcome of preterm neonates that received micronutrients. Methods: The study subjects com[1]prised of 210 preterm neonates admitted to (SCBU) of Federal Medical Centre, Brinin kebbi, Kebbi State from 1st June 2020 to 30st May, 2022. The subjects were randomized into two groups; 100 preterm neonates (Study group) received micronutrients (Reload; Reload Brands, LLC, Salt Lake City, Utah, USA) while, 110 preterm neonates (Control group) did not receive micronutrients. Biodata and other important information were obtained. All the babies (210) received the usual treatment protocol of preterm admitted to our SCBU. Ethical ap[1]proval was obtained from the Research and Ethics Committee. Results: Birth weights of the 210 neonates ranged from 800grams to the highest 2500grams with mean CC –BY 4.0 birth weight of 1.54kg ±0.95. Av[1]erage daily weight gains in 71% of the study subjects ranged from 25grams to a maximum of 29 grams per day while, in the non- micronutrients group, 54% had daily weight gain range of 10- 14grams per day (p = 0.001). Twelve (12%) of the Micronutrient group (MG) and 30% 0f the Non-Micronutrient group (NMG) had need for blood transfusion respectively (p = 0.002). The average ho sp ital stay wa s 22.95±9.68; hospital stay for the MG was 8 to 21 days while that of the NMG was 22 to 42 days (p = 0.001). C o n c l u s i o n s : M i c r o n u t r i - ents intake were in consistent with optimal weight gain, shorter hospital stay and lower need for blood transfusion in preterm newborns. Recommendations: We recommend early commencement of mi c r o n u t r i e n t s u p p leme n t (Reloads) in preterm babies.

Equivalence of single and standard doses of antenatal corticosteroids for late preterm neonatal outcomes: insights from a secondary analysis

BackgroundThe recent paradigm shift of treating individuals at risk of late preterm birth with antenatal corticosteroids warrants an assessment of the effect of single dosage. ObjectiveTo compare outcomes of neonates born in the late preterm period (34.0-36.6 weeks) following a single dose of antenatal corticosteroids versus placebo. Study designWe performed a secondary analysis of the Antenatal Late Preterm Steroids (ALPS) trial (Gyamfi-Bannerman C. et al.). All individuals enrolled in the parent trial who received only a single dose of either antenatal corticosteroids or placebo and delivered within 24 hours were included. Primary outcome was a composite of respiratory support at 72 hr., including continuous positive airway pressure or high flow nasal cannula ≥ 2 h, oxygen with an inspired fraction of ≥ 30% for ≥ 4 h, or mechanical ventilation. ResultsOf the 2,831 individuals in the parent trial, 1,083 (38.3%) met inclusion criteria; of them, 539 (49.8%) received a single dose of antenatal corticosteroids and 544 (50.2%) a single placebo dose. The placebo and antenatal corticosteroids groups had similar demographic and clinical characteristics. There was no difference in the rate of the primary respiratory outcome (aRR 1.12, 95% CI 0.85-1.47) or in the rate of respiratory distress syndrome (aRR 1.47, 95% CI 0.95-2.26) between those who received a single antenatal corticosteroids dose or placebo. An exploratory stratification by randomization-to-delivery intervals of 12-hour increments also showed no association with lower primary respiratory outcome rates. ConclusionIn individuals with late preterm birth pregnancies who received antenatal corticosteroids and delivered before a second dose, there were no differences in neonatal respiratory morbidities compared to placebo.

Association of low hemoglobin at birth and neurodevelopmental outcomes in preterm neonates ≤28 weeks' gestation: a retrospective cohort study.

To compare neurodevelopmental outcomes at 18-24 months corrected age (CA) for preterm infants who had hemoglobin levels <120 g/l versus those with hemoglobin level ≥120 g/l at birth. We included infants of ≤28 weeks gestational age (GA) born between January 2009 and June 2018. The primary outcome was neurodevelopmental impairment (NDI) at 18-24 months. Multivariable logistic regression was applied to determine the association. Of the 2351 eligible neonates, 351 (14.9%) had hemoglobin levels <120 g/L at birth. Of the 2113 surviving infants, 1534 (72.5%) underwent developmental follow-up at 18-24 months CA. There was no statistically significant difference in ND outcomes between the two groups. The composite outcome of death or NDI was significantly higher in the low hemoglobin group. In preterm infants ≤28 weeks GA, initial hemoglobin <120 g/L at birth was not associated with neurodevelopmental impairment at 18-24 months CA among survivors.

Elevated Urine Hyaluronan Concentrations Are Associated with an Unfavorable Respiratory Outcome in Preterm Neonates at 40 Weeks Postmenstrual Age

Introduction: Hyaluronan (HA) is a major component of the extracellular matrix. Increased pulmonary HA concentrations are associated with several respiratory disorders and is a pathophysiological feature of lung disease. We investigated whether elevated urine HA is a biomarker of an unfavorable 40-week respiratory outcome in preterm infants. Methods: Infants comprised a cohort of preterm neonates <31 weeks gestational age (GA) from the Prematurity-Related Ventilatory Control (Pre-Vent) multicenter study. HA was quantified in urine obtained at 1 week and 1 month of age. Respiratory status at 40 weeks post-menstrual age (PMA) was classified as unfavorable [either (1) deceased at or before 40 weeks PMA, (2) an inpatient on respiratory medication, O2 or other respiratory support at 40 weeks, or (3) discharged prior to 40 weeks on medications/O2/other respiratory support], or favorable (alive and previously discharged, or inpatient and off respiratory medications, off O2, and off other respiratory support at 40 weeks PMA). The association between urine HA and the unfavorable 40 week PMA outcome was examined using a multivariate logistic generalized estimation equation model. Results: Infants with higher HA at 1 week (but not 1 month) showed increased odds of unfavorable respiratory outcome at 40 weeks PMA (OR [95% CI] = 1.87 per 0.01 mg [1.27, 2.73]). Discussion and Conclusion: Neonatal urine screening for HA could identify infants at risk for death or need for respiratory support at term-corrected age (40 weeks PMA). The relationship between elevated HA at 1 week and an unfavorable 40 week outcome was stronger in infants with lower GA.

Intraventricular hemorrhage on mortality and neurological outcomes in premature infants

Background: Intraventricular hemorrhage (IVH) is the commonly encountered clinical event in preterm neonates which imposes significant morbidity and mortality. Although there is a rapid advancement in the neonatal care, IVH is the common cause of neonatal intensive care units admissions. The present study was carried out to evaluate the risk factors, mortality and neurological outcomes in preterm neonates with IVH. Methods: This was a prospective study conducted on 75 preterm neonates who were delivered before 37 weeks of gestation. The neonates were subjected to cranial ultrasound for the diagnosis of IVH and graded as per the severity. The neonatal and prenatal variables were recorded and analysed to find its association with IVH progression and mortality. Immediate neurological outcome was also assessed among the IVH preterm neonates. Results: In this study out of 75 preterm neonates, the prevalence of IVH was 18 (24%). The main neonatal factors for IVH are less gestational age at delivery, 28-31 weeks (p=0.001), birth weight &lt;1500 gm (p=0.001), APGAR scores &lt;5 at 1 and 5 minutes (p&gt;0.05) and maternal factors associated with IVH is premature rupture of membranes (p=0.01). The mortality rate among the IVH preterm neonates was 7 (38.9%). The significant predictors of mortality were male gender (p=0.004), grade III and IV IVH (p=0.001) and birth weight (p=0.001). The main neurological outcomes observed were seizures and post-hemorrhagic ventricular dilatation. Conclusions: Increased severity of IVH, early gestational age and low birth weight were associated with mortality in preterm neonates with IVH.

Neurodevelopmental Outcome after Culture-Proven or So-Called Culture-Negative Sepsis in Preterm Infants.

(1) Background: Prematurity is a serious condition associated with long-term neurological disability. This study aimed to compare the neurodevelopmental outcomes of preterm neonates with or without sepsis. (2) Methods: This single-center retrospective case-control study included infants with birth weight < 1500 g and/or gestational age ≤ 30 weeks. Short-term outcomes, brain MRI findings, and severe functional disability (SFD) at age 24 months were compared between infants with culture-proven or culture-negative sepsis or without sepsis. A chi-squared test or Mann-Whitney U test was used to compare the clinical and instrumental characteristics and the outcomes between cases and controls. (3) Results: Infants with sepsis (all sepsis n = 76; of which culture-proven n = 33 and culture-negative n = 43) were matched with infants without sepsis (n = 76). Compared with infants without sepsis, both all sepsis and culture-proven sepsis were associated with SFD. In multivariate logistic regression analysis, SFD was associated with intraventricular hemorrhage (OR 4.7, CI 1.7-13.1, p = 0.002) and all sepsis (OR 3.68, CI 1.2-11.2, p = 0.021). (4) Conclusions: All sepsis and culture-proven sepsis were associated with SFD. Compared with infants without sepsis, culture-negative sepsis was not associated with an increased risk of SFD. Given the association between poor outcomes and culture-proven sepsis, its prevention in the neonatal intensive care unit is a priority.