Outcomes In Preterm Infants Research Articles

Comparative Study Of Neurodevelopmental Outcomes In Premature Infants With And Without Early Intervention Programs

Comparative Study Of Neurodevelopmental Outcomes In Premature Infants With And Without Early Intervention Programs

Trajectories of attention problems in preschoolers born very preterm

BackgroundChildren born preterm are at heightened risk for neurodevelopmental impairment, including specific deficits in attention. Few studies have investigated change over time in attention problems prior to school entry. The current study aims to describe trajectories of attention problems from age 2 through 5 years in a cohort of children born <30 weeks of gestational age (GA), identify sociodemographic, medical, and neurobehavioral characteristics associated with attention trajectories, and test whether attention problem trajectories predict the risk of a reported attention‐deficit/hyperactivity disorder (ADHD) diagnosis.MethodsWe studied 608 infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study, a prospective, multisite study of infants born <30 weeks of GA. Parents reported on child attention problems at ages 2, 3, 4, and 5 years using the Child Behavior Checklist and the Behavior Assessment System for Children. Sociodemographic and medical characteristics were assessed via maternal interview and medical record review. Neurobehavioral characteristics were determined using neonatal and 2‐year assessments. Parent report of child ADHD diagnosis was obtained. We used latent growth curve (LGC) modeling to test our study aims.ResultsA linear LGC model provided the best fit to the data. The average trajectory of attention problems evidenced low initial levels of symptoms and little change over time, yet there was significant heterogeneity in both initial levels and change over time. Individual differences in trajectory parameters were associated with sociodemographic, medical, environmental, and neurobehavioral characteristics. Children with higher initial levels of attention problems as well as steeper increases in attention problems over time were more likely to have a reported ADHD diagnosis.ConclusionsThere is significant heterogeneity in trajectories of attention problems from age 2 to 5 in children born <30 weeks of GA and these differences have clinical relevance. These data could inform follow‐up guidelines for preterm infants.

Neonatal Sequential Organ Failure Assessment Score Predicts Respiratory Outcomes in Preterm Newborns with Late-Onset Sepsis: A Retrospective Study

Introduction: Neonatal sequential organ failure assessment (nSOFA) score predicts mortality in preterm newborns. The aim of the study was to assess whether nSOFA score could predict respiratory outcomes in preterm infants with late-onset sepsis (LOS). Methods: This retrospective, observational, single-center study enrolled infants with gestational age <32 weeks born between January 2016 and June 2023 who experienced an episode of LOS during NICU stay. The primary outcome was death or bronchopulmonary dysplasia (BPD); secondary outcomes were BPD, death or mechanical ventilation (MV) on day 5 after the onset of LOS, and MV on day 5 after the onset of LOS. The nSOFA score was assessed at the onset of LOS and after 6 ± 1, 12 ± 3, and 24 ± 3 h. Results: Neonatal SOFA score was significantly higher in patients who developed each outcome versus those who did not at all timings. Maximal nSOFA score during the first 24 h after onset of LOS was an independent predictive factor for death or BPD (p = 0.007), BPD (p = 0.009), and death or MV on day 5 (p = 0.009), areas under the curve (AUC) were 0.740 (95% CI: 0.656–0.828), 0.700 (95% CI: 0.602–0.800), and 0.800 (95% CI: 0.710–0.889), respectively. Maximal nSOFA score also predicted moderate to severe BPD (p = 0.019) and death or moderate to severe BPD (p < 0.001). Maximal nSOFA ≥4 was associated with odds ratio (OR) of 7.37 (95% CI: 2.42–22.44) for death or BPD, 4.86 (95% CI: 1.54–15.28) for BPD, and 7.99 (95% CI: 3.47–18.36) for death or MV on day 5. AUC of the predicting model was 0.895 (95% CI: 0.801–0.928) for BPD, 0.897 (95% CI: 0.830–0.939) for death or BPD, 0.904 (95% CI: 0.851–0.956) for MV on day 5, 0.923 (95% CI: 0.892–0.973) for death or MV on day 5. Conclusion: Maximal nSOFA score during the first 24 h after the onset of LOS predicts respiratory outcomes and allows identification of patients who may crucially benefit from lung-protective measures.

Enhancement of Family-Centred Care Is Associated with a Reduction in Postmenstrual Age at Discharge in Preterm Infants

Background/Objectives: Long hospitalisation has been recognized as an independent risk factor for poor neurodevelopmental outcomes of preterm infants. Systematic training and early inclusion of parents in their preterm infant’s care is a strategy to shorten the length of hospital stay. We implemented an enhanced stepwise family-centred care program and assessed its effects on postmenstrual age (PMA) at discharge and parental satisfaction. Methods: This prospective single-centre longitudinal cohort study was carried out in a German level III neonatal unit from October 2020 to May 2023. Five consecutive 6-month cohorts (1 baseline and 4 intervention cohorts, 169 infants and their caregivers) were analysed. Results: Mean PMA at discharge did not change in the total cohort but declined significantly in patients without neonatal morbidities from baseline to cohort 4 (37.2 ± 1.4 to 36.1 ± 1.6 weeks; p = 0.036). Concomitantly, discharge with tube feeding raised from 2.4% to 74.1% (p &lt; 0.001) and discharge with home monitoring raised from 9.8% to 74.1% (p &lt; 0.001), while unplanned readmissions remained unchanged (p = 0.44). Parental satisfaction with time point of discharge increased non-significantly from baseline to cohort 4 (75.8% vs. 95.7%; Chi2 0.22). Conclusions: Discharge of preterm infants at a significantly lower PMA is feasible through enhancement of family-centred care and is very well accepted by parents.

Role of early postnatal aEEG and brain MRI in predicting neurodevelopmental outcome in preterm infants at the age of 1 year

BackgroundPreterm birth is a principal reason for perinatal morbidity and mortality increasing the incidence of severe neurodevelopmental deficits. There is growing proof that early postnatal amplitude-integrated electroencephalography (aEEG) has a prognostic value for neurodevelopmental consequence in preterm born neonates. Furthermore, MRI has been widely utilized to enhance comprehension of the brain substrate responsible for neurodevelopmental abnormalities. Thus, this study aims at evaluating the role of early postnatal aEEG and brain MRI in forecasting neurodevelopmental consequence in preterm infants at the age of 1 year.MethodsA cohort study performed in the neonatal intensive care unit of a tertiary hospital during the duration from October 2021 to June 2023 including 60 preterm neonates < 32 weeks of gestation. All cases were monitored by aEEG within the 1st 72 h of life for at least 4 h, and then brain MRI and aEEG were done at term equivalent age (TEA) of 40 weeks. Regarding the neurodevelopmental outcome, our cases were assessed by Bayley scale III screening test at the age of 1 year.ResultsOf the study participants, 41.7% were males, and 58.3% were females with a mean gestational age of 30.40 ± 0.94 weeks and mean weight of 1.36 ± 0.17 kg. aEEG showed that 83.3% of the cases had continuous normal background activity at TEA, and MRI showed that 75% of the cases were normal. Comparing between non-affected and affected groups as categorized by Bayley scale regarding aEEG and MRI findings, there was greatly statistically significant difference between the two groups (P < 0.001). Brain MRI showed higher sensitivity and accuracy than aEEG.ConclusionBrain MRI at TEA is more sensitive and accurate than aEEG to predict the neurodevelopmental outcome. aEEG at TEA is more predictor for neurodevelopmental outcome than at birth. The combination of both aEEG and brain MRI at TEA gives more prediction about the degree of affection in neurodevelopmental outcome in preterm infants.

Enteral micronutrient supplementation and neurodevelopmental outcomes in preterm or low birth weight infants: A systematic review and meta-analysis.

The association of enteral micronutrient supplementation and the neurodevelopmental outcomes of preterm or low birth weight (LBW) infants is controversial. This research was prospectively registered (CRD42023454034). We searched MEDLINE, Embase, PsycInfo, ClinicalTrials. gov, and the Cochrane Library for randomised clinical trials (RCTs) or quasi-RCTs comparing any enteral micronutrients supplementation with placebo or no supplementation in preterm or LBW infants. The primary outcome was neurodevelopmental impairment (NDI), with secondary outcomes involving various neurodevelopmental tests and disabilities. There was no evidence of an association between enteral micronutrients supplementation and the risk of NDI (RR, 1.03; 95% CI, 0.93-1.14; moderate certainty evidence). There was no evidence that the supplemented groups enhanced cognitive (MD, 0.65; 95% CI, -0.37 to 1.67; low certainty evidence), language (SMD, -0.01; 95% CI, -0.11 to 0.09; moderate certainty evidence), or motor scores (SMD, 0.04; 95% CI, -0.06 to 0.15; very low certainty evidence) or IQ (SMD, -0.20; 95% CI, -0.53 to 0.13; very low certainty evidence). Subgroup analysis showed that multiple micronutrients supplementation improved expressive language score (MD, 1.42; 95% CI, 0.39-2.45), and zinc supplementation enhanced fine motor score (SMD, 1.70; 95% CI, 0.98-2.43). The overall heterogeneity was low. This study demonstrates that enteral micronutrient supplementation is associated with little or no benefits in neurodevelopmental outcomes for preterm or LBW infants. Well-designed RCTs are needed to further ascertain these associations.

Gut Microbiota-Derived Metabolites and Their Role in the Pathogenesis of Necrotizing Enterocolitis in Preterm Infants: A Narrative Review

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease that occurs predominantly in premature infants and is characterized by the inflammation and necrosis of the intestine, showing high morbidity and mortality rates. Despite decades of research efforts, a specific treatment is currently lacking, and preventive strategies are the mainstays of care. This review aims to help understand the complex interplay between gut microbiota and their metabolites in NEC pathogenesis. In particular, we focused on how these factors can influence gut health, immune responses, and intestinal barrier integrity. Discussion: Current research has increasingly focused on the role of the gut microbiota and their metabolites in NEC pathogenesis, thanks to their involvement in modulating gut health, immune responses, and intestinal barrier integrity. Conclusions: A deeper understanding of the interplay between gut microbiota and their metabolites is essential for developing personalized strategies to prevent NEC. By targeting these microbial interactions, new therapeutic approaches may emerge that offer improved outcomes for preterm infants at a high risk of NEC.

Effect of an early music intervention on emotional and neurodevelopmental outcomes of preterm infants at 12 and 24 months.

Few studies have found long-term effects of early musical environmental enrichment in the NICU on preterm infant's development. This study examines how early music enrichment affects emotional development and effortful control abilities in 12- and 24-month-old very preterm (VPT) infants. One hundred nineteen newborns were recruited, including 83 VPTs and 36 full-term (FT) infants. The VPT infants were randomly assigned to the music intervention (44 VPT-Music) or control (39 VPT-control) groups. VPT-Music infants listened specifically designed music intervention from the 33rd week of gestation until hospital discharge. At 12 and 24 months, children were clinically evaluated using the Bayley-III Scales of Infant and Toddler Development and the Laboratory Temperament Assessment Battery, and at 24 months, with 3 additional episodes of the Effortful Control Battery. Our analysis showed that during a fear eliciting task, the VPT-Music group expressed lower level of fear reactivity and higher positive motor actions than VPT-controls and FT infants. At 24 months, the VPT-music group had lower scores for negative motor actions in the joy task, compared to both VPT-control and FT groups. In addition, both FT and VPT-music had higher scores of sustained attention compared to VPT-controls, but the contrasts were not significant. No significant effects on mental, language and motor outcomes were identified and for all three dimensions of the ECBQ. The present study suggests that an early music intervention in the NICU might influence preterm children's emotional processing at 12 and 24 months. Limitations and suggestions for future research are highlighted.

Short-Term Outcomes and Complications of Premature Infants with a Birth Weight ≤ 1500g

prognosis of a premature infant is correlated with the conditions of medical care, both during and after birth, as well as the quality of the environment they are welcomed into. Objective: The aim of our study is to highlight the complications and outcomes of premature infants with a birth weight ≤ 1500g, by identifying the factors of morbidity and mortality, and then comparing our results with other studies. Materials and Methods: This is a retrospective descriptive, epidemiological, clinical, therapeutic, and developmental study conducted over a two-year period, from June 1, 2019, to June 30, 2021, in the neonatology and neonatal resuscitation unit at CHU HASSAN II of Fès. Results: We reported a mortality rate of 54% among the newborns, with the main causes of death being alveolar hemorrhage (43.41%), septic shock (29.45%), and severe respiratory distress (20.93%). The main complications and conditions observed during the hospital stay were: hyaline membrane disease (35.26%), alveolar hemorrhage (26.14%), patent ductus arteriosus (14.93%), hemodynamic instability (56.01%), electrolyte imbalances (44.81%), neonatal jaundice (54.77%), anemia (46.05%), thrombocytopenia (54.77%), apnea of prematurity (51.81%), intraventricular hemorrhage (12.86%), and neonatal infection (85.89%). Conclusion: The results of our study serve as a wake-up call for the necessity of implementing a management and prevention plan to improve the prognosis of premature infants with a birth weight ≤ 1500g.

Innovative Use of Nanomaterials in Treating Retinopathy of Prematurity

Background/Objectives: Retinopathy of prematurity (ROP) is a severe condition primarily affecting premature infants with a gestational age (GA) of 30 weeks or less and a birth weight (BW) of 1500 g or less. The objective of this review is to examine the risk factors, pathogenesis, and current treatments for ROP, such as cryotherapy, laser photocoagulation, and anti-VEGF therapy, while exploring the limitations of these approaches. Additionally, this review evaluates emerging nanotherapeutic strategies to address these challenges, aiming to improve ROP management. Methods: A comprehensive literature review was conducted to gather data on the pathogenesis, traditional treatment methods, and novel nanotherapeutic approaches for ROP. This included assessing the efficacy and safety profiles of cryotherapy, laser treatment, anti-VEGF therapy, and nanotherapies currently under investigation. Results: Traditional treatments, while effective in reducing disease progression, exhibit limitations, including long-term complications, tissue damage, and systemic side effects. Nanotherapeutic approaches, on the other hand, have shown potential in offering targeted drug delivery with reduced systemic toxicity, improved ocular drug penetration, and sustained release, which could decrease the frequency of treatments and enhance therapeutic outcomes. Conclusions: Nanotherapies represent a promising advancement in ROP treatment, offering safer and more effective management strategies. These innovations could address the limitations of traditional therapies, reducing complications and improving outcomes for premature infants affected by ROP. Further research is needed to confirm their efficacy and safety in clinical practice.

Moving on from clinical animal-derived surfactants to peptide-based synthetic pulmonary surfactant.

Research on lung surfactant has exerted a great impact on newborn respiratory care and significantly improved survival and outcome of preterm infants with respiratory distress syndrome (RDS) due to surfactant deficiency because of lung immaturity. Current clinical, animal-derived, surfactants are among the most widely tested compounds in neonatology However, limited availability, high production costs, and ethical concerns about using animal-derived products constitute important limitations in their universal application. Synthetic lung surfactant offers a promising alternative to animal-derived surfactant by providing improved consistency, quality and purity, availability and scalability, ease of production and lower costs, acceptance, and safety for the treatment of neonatal RDS and other lung conditions. Third-generation synthetic surfactants built around surfactant protein B (SP-B) and C (SP-C) peptide mimics stand at the forefront of innovation in neonatal pulmonary medicine, while nasal continuous positive airway pressure (nCPAP) has become the standard non-invasive respiratory support for preterm infants. nCPAP can prevent the risk of chronic lung disease (bronchopulmonary dysplasia) and reduce lung injury by avoiding intubation and mechanical ventilation, is a relatively simple technique and can be initiated safely and effectively in the delivery room. Combining nCPAP with noninvasive, preferably aerosol, delivery of synthetic lung surfactant promises to improve respiratory outcomes for preterm infants, especially in low-and-middle income countries.

Using heart rate variability to predict neurological outcomes in preterm infants: a scoping review.

Infants born preterm are at higher risk of neurological complications, including intraventricular haemorrhage and white matter injury. After discharge, these infants may experience adverse neurodevelopmental outcomes and exhibit lower educational attainment. Early detection of brain injury and accurate prediction of neurodevelopmental impairment would allow early intervention and support. Heart rate variability (HRV) describes the variation of time intervals between each subsequent heartbeat. HRV is controlled by the autonomic nervous system, which may be affected by hypoxia and compromised blood flow. While HRV has primarily been investigated in neonatal sepsis, the association between HRV, brain injury and neurodevelopmental outcomes in preterm infants is less established. The present scoping review examines the utility of HRV monitoring for predicting short-term and long-term neurological outcomes in preterm infants. Following systematic search of Medline, Embase, Web of Science and the Cochrane Library, 15 studies were included. Nine studies examined the relationship between HRV and brain injury, with all but two showed an association. Eight studies examined the relationship between HRV and long-term outcomes and all eight found an association. This scoping review suggests that decreased HRV in the neonatal period is associated with short- and long-term neurodevelopmental outcomes in preterm infants. IMPACT: Changes in heart rate variability correlate with the occurrence of intraventricular haemorrhage in preterm infants. A decrease in heart rate variability may precede the development of intraventricular haemorrhage. Alterations in heart rate variability correlate with long-term neurodevelopmental outcomes. Significant variability exists in metrics used in assessing heart rate variability.

First postnatal lactate blood levels on day 1 and outcome of preterm infants with gestational age

Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks. We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models. First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; p = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; p = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; p = 0.001). In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.

Preterm Infant Enteral Feeding Practices in Saudi Arabia: A Scoping Review

Abstract Background: Preterm infants are at risk of developing nutritional deficiencies, which is further compounded by the fact that providing them with adequate nutrition is often challenging. Enteral feeding (EF) practices vary across neonatal units and can be impacted by the setting and geographical region. There is also a lack of evidence on best practices. Objective: To investigate EF practices and related nutrition factors, patterns, and outcomes in preterm infants in Saudi Arabia by examining studies published in this area. Methods: A search was conducted for articles on EF practices among preterm infants in Saudi Arabia that were published between January 2010 and May 2024. Searches were carried out across five electronic databases and through searching inward and backward citation and reference lists of relevant papers. Studies that described or assessed EF practices used in preterm infants from any region of Saudi Arabia and were published in English or Arabic were included. Results: The database and manual search resulted in 1905 articles. After removing duplicates and applying the inclusion/exclusion criteria, 14 publications were included: 12 were observational studies, 1 was a conference abstract (with retrospective analysis), and 1 was a commentary. Of these, 7 studies were conducted in the Central Province, 6 in the Western Province, and 1 in the Eastern Province. More than half of the publications (8 of 14) were published between 2021 and 2023. The studies included were categorized to three themes based on their aim: studies describing practices on mother–infant bond to encourage breastfeeding, assessing nutritional status and EF, and assessing EF as a risk factor for developing prematurity complications. Conclusion: While research activity on EF practices in Saudi Arabia has increased very recently, yet there is a paucity of studies, particularly experimental studies that focus on both short- and long-term health outcomes.

The Effect of Lactic Acidosis on Neonatal Outcomes in Premature Infants

The aim of the study was to evaluate neonatal outcomes in preterm infants.Materials and methods. The study included 58 premature neonates divided into 2 groups: «A» (N=34) with an adverse neonatal period ending in death and «B» (N=24) who survived. Clinical assessment of the infant, measurement of blood gases, acid-base balance (ABB) and lactate, recording of lung ventilation parameters, calculation of mean airway pressure, oxygenation index (OI) and ventilation efficiency index (VEI), neurosonography and, in case of death, pathological and histological examination of the brain were performed.Results. Elevated lactate was found in 24 patients (70.5%) in group A and in 12 patients (50%) in group B. The mean lactate levels in groups A and B were 8.1±3.3 and 6.3±2.8 mmol/L, respectively. In group A, 19 (55.9%) infants had severe acidosis, corresponding to a pH of 7.19 to 6.80. In group B, only 8 (33.3%) infants had a pH between 7.0 and 7.19. At birth, neonates in both groups were found to have a base deficit (BD), which was significantly lower in group A than in group B (P=0.004). There were no trends toward reduction of acidosis or normalization of ABB in infants in group A. Plasma BE levels in group B had returned to normal by 96 hours postpartum. The frequency of grade II, III peri/intraventricular hemorrhage (PIVH) and hemorrhage of other localization in group A were 8 (23.5%), 9 (26.5%), and 3 (8.8%), respectively. In group B, grade I PIVH and hemorrhage of other localization occurred in 5 (20.8%) and 1 (4.2%) cases, respectively. In neonates with grade II PIVH, severe lactic acidosis was diagnosed at birth: venous blood pH was 6.97 [6.8; 7.22], BE was (–21.6) [–30; –7.2] mmol/L, lactate level was 8.5 [6.3; 12.9] mmol/L, and pO₂ was 50.5 [20.5; 64] mm Hg. In infants with grade III PIVH, pH was –7.26 [7.12; 7.28], BE was (–8.1) [–8.9; –7] mmol/L, lactate was 7.6 [4.8; 8.9] mmol/L, and pO₂ was 33 [30; 50] mm Hg. Cell damage of varying severity affected all brain structures, as evidenced by absence or deformation of nuclei and nucleoli, and peripheral chromatin condensation. Morphological immaturity of brain structures was another negative factor.Conclusion. Lactic acidosis diagnosed at birth in premature infants is one of the indicators of perinatal hypoxia severity. Critical pH, BE, and lactate levels, as well as lack of response to treatment, contribute to structural brain damage and worsen prognosis. Severe changes in oxygen and lactate levels that persist for two days after birth lead to severe PIVH and irreversible brain changes.

Deep Learning Model for Predicting Neurodevelopmental Outcome in Very Preterm Infants Using Cerebral Ultrasound

ObjectiveTo develop deep learning (DL) models applied to neonatal cranial ultrasound (CUS) and clinical variables to predict neurodevelopmental impairment (NDI) in very preterm babies (VPI) at 3 years of corrected age. Patients and MethodsA retrospective study of a cohort of VPI (220-306 weeks' gestation) born between 2004 and 2016 in Nova Scotia, Canada. Clinical data at hospital discharge, and CUS images at three time points were used to develop DL models using elastic net (EN) and convolutional neural network (CNN). The models' performance was compared using Precision Recall Area Under the Curve (PR-AUC) and area under Receiver Operation Characteristic curve (ROC-AUC) with their 95% Confidence intervals. ResultsOf 665 eligible VPI, 619 (93%) infants with 4184 CUS images were included. The CNN model combining CUS, and clinical variables showed better performance (PR-AUC 0.75, C.I. 072 – 0.79 and ROC-AUC 0.71, CI 0.67 - 0.74) in the prediction of positive NDI outcome compared to the traditional models based solely on clinical predictors (PR AUC 0.60 (0.52-0.68), and ROC-AUC of 0.72 (0.68-0.75). When analyzed by the CUS plane and acquisition timepoint, the model utilizing the anterior coronal plane at 6 weeks of age provided the highest predictive accuracy: PR-AUC 0.81 (0.77-0.91) and ROC-AUC 0.78 (0.66-87). ConclusionWe developed and internally validated a DL prognostic model to predict NDI in VPI at 3 years utilizing CUS and clinical predictors. Early and accurate identification of infants at risk for NDI enables referral to targeted interventions which improves functional outcomes.

The impact of volume and neonatal level of care on outcomes of moderate and late preterm infants.

Evaluate the relationship of neonatal unit level of care (LOC) and volume with mortality or morbidity in moderate-late preterm (MLP) (32-36 weeks' gestation) infants. Retrospective cohort study of 650,865 inborn MLP infants in 4976 hospitals-years using 2003-2015 linked administrative data from 4 states. Exposure was combined neonatal LOC and MLP annual volume. The primary outcome was death or morbidity (respiratory distress syndrome, severe intraventricular hemorrhage, necrotizing enterocolitis, sepsis, infection, pneumothorax, extreme length of stay) with components as secondary outcomes. Poisson regression models adjusted for patient characteristics with a random effect for unit were used. In adjusted models, high-volume level 2 units had a lower risk of the primary outcome compared to low-volume level 3 units (aIRR 0.90 [95% CI 0.83-0.98] vs. aIRR 1.13 [95% CI 1.03-1.24], p < 0.001) CONCLUSION: MLP infants had improved outcomes in high-volume level 2 units compared to low-volume level 3 units in adjusted analysis.

Neurodevelopmental outcome in preterm infants

Background and objectives. Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. It is one of the world's critical health problems because it may be a significant cause of long-term neurodevelopmental disability. The purpose of this work was to evaluate the impact of premature birth and brain injuries on neurological development and to identify problems as soon as possible in order to prevent or minimize sequelae as much as possible. Materials and methods. Between June 2022 and July 2024, 374 infants were examined at “Prof. Dr. Panait Sarbu” Clinical Hospital of Obstetrics and Gynecology. Each baby's gross and fine motor development was assessed, cognitive acquisitions were evaluated using an adapted Denver Developmental Screening Test, and where needed, physical therapy, head ultrasound/MRI, EEG, or genetic tests were recommended. Results. From the 374 infants evaluated (M/F: 142/232), 72 were excluded considering the normal term of birth. Of the other 302, 23 did not present for follow-up checks after one or two appointments, and 54 completed all evaluations up to 21-24 months (the study is ongoing). 5/54 had poor neurodevelopmental outcomes, almost all due to very preterm birth. From the remaining 225 babies, with a few exceptions with variable neurological damage (13/225), no motor or cognitive development abnormalities have been observed in the evaluations carried out so far. Conclusions. In our cohort, almost all babies who completed or did not the follow-up program had normal development (261/279), but in some cases, prematurity, brain lesions, or genetic causes remain associated with a poor long-term outcome. Establishing a follow-up system for premature infants is necessary because early management during the period of higher brain plasticity may prevent neurological complications and improve the quality of life.

Effects of dexamethasone on short-term and long-term outcomes in late preterm infants with twin pregnancy: an observational study

Objective: To investigate the effect of prenatal dexamethasone on short-term outcomes and long-term neurological development in late preterm infants with twin pregnancy. Methods: A total of 315 pregnant women with twin pregnancy and their preterm infants who delivered in Peking University Third Hospital from January 2019 to December 2022 were retrospectively analyzed. The clinical data of pregnant women and preterm infants were collected. They were divided into non-medication group (93 pregnant women and 186 preterm infants), medication after 34 weeks group (123 pregnant women and 246 preterm infants), and medication before 34 weeks group (99 pregnant women and 198 preterm infants). Short-term outcomes of preterm infants were analyzed, including the incidence of neonatal respiratory distress syndrome (NRDS), wet lung, hypoglycemia, neonatal septicemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and neonatal necrotizing enterocolitis (NEC). "Ages and Stages Questionnaire-Third Edition (ASQ-3) scale" was used to follow up the late neurological development of preterm infants at the corrected age of 6-54 months, and the level of neurological development was compared. Results: (1) General conditions: the gestational age at delivery in the non-medication group [36.1 weeks (35.6, 36.6 weeks)] was later than that in the medication after 34 weeks group [36.1 weeks (35.2, 36.4 weeks)] and medication before 34 weeks group [35.2 weeks (34.2, 36.2 weeks)] groups, and the differences were statistically significant (all P<0.05). After correcting for gestational age, there was no significant difference in birth weight among the three groups (H=3.808, P=0.149). There were no significant differences in gender and the proportion of small for gestational age among the three groups (all P>0.05). (2) Short-term outcome: the incidence of wet lung was 7.0% (13/186), 11.0% (27/246) and 16.2% (32/198) in the non-medication group, medication after 34 weeks group and medication before 34 weeks group, respectively, and the difference was statistically significant (P=0.018). There were no significant differences in the incidence rates of NRDS, hypoglycemia, sepsis, IVH, BPD, and NEC among the three groups (all P>0.05). Logistic regression analysis with gestational age and newborn birth weight as confounding factors showed that early gestational age (OR=0.884, 95%CI: 0.837-0.933, P<0.001) and increased incidence of selective intrauterine growth restriction type I (OR=2.967, 95%CI: 1.153-7.639, P=0.024) could both lead to an increased incidence of wet lung. (3) Long-term outcomes: a total of 109 pregnant women completed the follow-up, and 218 preterm infants with a corrected age of 6-54 months at the end of follow-up were enrolled, including 86 cases in the non-medication group, 66 cases in the medication after 34 weeks group, and 66 cases in the medication before 34 weeks group. There were no significant differences in the scores of communication, gross motor, fine motor, problem solving and personal-social among the three groups (all P>0.05). Conclusion: Prenatal administration of a single course of dexamethasone does not affect the neonatal birth weight and short-term outcomes of twin late preterm infants, and has no adverse effect on the neurological development of twin late preterm infants with a corrected age of 6-54 months.

Long-Term Neurodevelopmental Outcomes in Very Preterm Infants with Severe Birth Asphyxia: A Multi-Center Cohort Study

Long-Term Neurodevelopmental Outcomes in Very Preterm Infants with Severe Birth Asphyxia: A Multi-Center Cohort Study