Preterm Newborns Research Articles

Umbilical cord blood as a substitute for neonatal blood in measuring serum albumin and immunoglobulin G levels.

In this study, we investigated the clinical feasibility of using umbilical cord blood as an alternative to neonatal blood for measuring serum albumin and immunoglobulin G (IgG) levels in newborns, including preterm newborns. Serum levels of albumin and IgG were measured in cord and neonatal blood from singleton newborns. We analyzed correlations and systematic errors between cord and neonatal blood measurements, stratifying the results for very preterm newborns (VPNs) born at a gestational age of less than 32 weeks and non-VPNs born at a gestational age of 32 weeks or later. Among all 494 newborns (78 VPNs and 416 non-VPNs), serum albumin and IgG levels were determined for 95.7% and 88.7% of them, respectively. Strong correlations between cord and neonatal blood were observed for the serum albumin and IgG levels (rs = 0.864 and 0.966, respectively). Moreover, the measurement errors between cord and neonatal blood were small for all newborns (0.2g/dL and 65mg/dL, respectively). These findings were consistent with both VPNs and non-VPNs. Umbilical cord blood is a suitable substitute for neonatal blood in measuring serum albumin and IgG levels in newborns, even in premature newborns.

Peculiarities of development and lesions of the central nervous system in late preterm newborns

Peculiarities of development and lesions of the central nervous system in late preterm newborns

Targeting survival without morbidity: Heart rate characteristics for oxygen supplementation optimization in neonatal care

The preterm newborn is susceptible to many diseases related to oxidative stress, and supplemental oxygen therapy and its interaction with inflammatory processes may be a contributing factor to their underlying pathophysiology. Supplemental oxygen therapy can lead to over-oxygenation, and can complicate ischemia–reperfusion processes, which in turn can promote oxidative stress pathways. We hypothesize that the optimal dose of supplemental oxygen therapy likely varies for each preterm infant based on their unique and developing physiology, and may be adjusted through the assessment autonomic nervous function and pulmonary resilience by measuring heart rate variability. We present preliminary findings demonstrating that among extremely preterm infants with low-to-moderate heart rate characteristics index (HRCi) scores (indicating healthy ANS function) during the first six postnatal days, exposure to a low target oxygen saturation range was associated with decreased risk of the composite outcome of death by 36 weeks postmenstrual age (PMA), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and/or retinopathy of prematurity (ROP). This suggests a novel therapeutic approach to supplemental oxygen delivery in the neonatal intensive care unit (NICU) wherein the HRCi can be leveraged to guide the prescription of individualized target oxygen saturation ranges that are responsive to each infant’s unique and dynamic physiology, minimizing the risks of morbidity and mortality.

Neurodevelopment Outcome among Preterm Infants Admitted in Neonatal Intensive Care Unit

Introduction: With increasing the survival rates of premature babies, the management of long term complications, especially neurodevelopmental disorder is becoming an important issue for a better life. Aims: To assess the factors associated with adverse neurodevelopment outcome among preterm infants admitted in Neonatal Intensive Care Unit (NICU). Methods and Material: This prospective cohort study was conducted in Department of Neonatology, BSMMU, Dhaka, Bangladesh. Premature infants (<34 weeks) discharged from the NICU were enrolled and followed up for neurodevelopmental assessment at 6 months of age. Prenatal, perinatal, and postnatal features of the babies were recorded. The Bayley-III scale was used to assess the composite scores. Continuous variables were analyzed using an independent t-test and categorical variables with chi-square test. Logistic regression analysis was performed to find out the relationship of risk factors with neurodevelopmental scores. Results: A total 47 patients were analysed at 6 months of age using Bayley scale III. Mean birth weight and gestational age was 1595.11 ± 377.17g and 32.43 ± 1.48 weeks respectively. Mean cognitive, motor and language score were 80.79±14.51, 82.87±14.53 and 82.98±13.72 respectively. Despite the fact that all mean scores were normal, 27.7% of infants in cognition, 23.4% in motor, and 31.9% in language had a BSID-III value < 70. Variables like gestational age < 30 weeks, birth weight <1500 grams, and convulsion have been linked to poor neurodevelopmental outcomes. However, regression analysis revealed none of them were significant. Conclusions: In our study, at six months of age, the cognitive, language, and motor scores of preterm newborns (less than 34 weeks of gestation) were within normal limits. Of the newborns, we observed that 27.7% had cognitive delay and 31.9% experienced language delay. J Dhaka Med Coll. 2022; 31(2) : 251-257

Vitamin D Deficiency is Associated with Hypocalcemia in Preterm Infants

Background: Vitamin D deficiency results in various problems, like rickets, osteomalacia, heart problems, cancer, diabetes, and autoimmune diseases. Hypocalcemia is a common disorder among preterm infants, indicating vitamin D deficiency. This study was conducted to analyze the association of vitamin D deficiency with hypocalcemia in preterm infants.Materials and methods: A cross-sectional study was performed in preterm infants born in our hospital from December 2022 to May 2023. Venous blood was collected within the first 24 hours to assess vitamin D and calcium levels. Chi-square test and logistic regression analysis were used to assess the association of gestational age, sex, birth weight, and vitamin D with the incidence of hypocalcemia. The significance was determined with p<0.05.Results: There were 40 preterm newborns, comprising 37.5% moderately preterm, 20% very preterm, and 42.5% extremely preterm. Most subjects were female (52.5%). Low birth weight, very low birth weight, and extremely low birth weight occurred in 55%, 27.5%, and 17.5%, respectively. Vitamin D insufficiency and deficiency were observed in 20% and 80% subjects, respectively. Most subjects had hypocalcemia (62.5%). Chi-square test obtained a significant association of vitamin D deficiency with hypocalcemia (p=0.029).Conclusion: Vitamin D deficiency is significantly associated with the incidence of hypocalcemia in preterm infants.Keywords: Vitamin D, hypocalcemia, preterm neonates

The Diagnostic and Prognostic Values of Soluble CD14 Subtype (Presepsin) in Early Detection of Early Onset Neonatal Sepsis in Preterm Newborns

Abstract Background The diagnosis of “suspected sepsis” in neonates in the NICU is one of the most common and challenging diagnoses due to the nonspecific signs of sepsis. therefore, laboratory investigation is necessary in cases of doubt or if there are risk factors. A promising biomarker: Presepsin (P-SEP), or Soluble Cluster of Differentiation 14 Subtype (sCD14-ST) is generated as a part of the body’s response to bacterial infection. It is effective in the early phase of inflammation, and it is detected as an early marker of sepsis in neonates. Aim and Objectives to evaluate the diagnostic value of presepsin in early neonatal sepsis and prognostic value for severity, mortality and hospital stay length. Subjects and Methods This prospective observational study include two groups, one group included 36 neonates with risk factors for early-onset sepsis, along with 20 uninfected neonates as the control group. Both groups were subjected to the calculation of Rodwell score, SNAP II score, serum presepsin levels, CRP measurement, and blood culture and assessed for clinical severity, mortality, and hospital stay length. Result Serum baseline presepsin was significantly elevated in sepsis group (P < 0.001), Presepsin showed the best diagnostic performance over Rodwell score (AUC 0.989; sensitivity of 93.8% and specificity of 95%). Presepsin levels on day 3 were significantly elevated in non-survived patients (P < 0.001), with better predictive performance for 28-day mortality and rapid progression to death than SNAP II score (AUC 0.880; sensitivity of 83.3% and specificity of 87.5%). Conclusion presepsin day 1 was useful diagnostic tools in culture proven early onset neonatal sepsis, presepsin at day 3 could be a good predictor for gram negative infections, 28-day mortality, and sepsis severity.

Retrospective analysis of reference intervals for dried blood spot based ms/ms newborn screening programs in Chinese preterm neonates: a nationwide study

ObjectivesAlthough recent discoveries regarding the biomarkers of newborn screening (NBS) programs by tandem mass spectrometry (MS/MS) highlight the critical need to establish reference intervals (RIs) specifically for preterm infants, no such RIs has been formally published yet. This study addressed the gap by offering a comprehensive set of reference intervals (RIs) for preterm neonates, and illustrating the dynamic changes of each biomarker with age.Design and methodsThe NBS data of 199,693 preterm newborns (< 37 weeks of gestation) who met the inclusion and exclusion criteria from the NNSCP database were included in study analysis. The birth weight stratified dynamic trend of each biomarker were captured by their concentrations over age. Reference partitions were determined by the method of Harris and Boyd. RIs, corresponding to the 2.5th and 97.5th percentiles, as well as the 0.5th, 25th, 50th, 75th and 99.5th percentiles were calculated using a non-parametric rank approach.ResultsIncreasing birth weight is associated with an elevation in the levels of arginine, citrulline, glycine, leucine and isobarics, methionine, ornithine, phenylalanine, and valine, whereas the levels of alanine, proline and tyrosine decrease. Additionally, two short-chain acylcarnitines (butyrylcarnitine + isobutyrylcarnitine and isovalerylcarnitine + methylbutyrylcarnitine) and a median-chain acylcarnitine (octenoylcarnitine) decrease, while four long-chain acylcarnitines (tetradecanoylcarnitine, palmitoylcarnitine, palmitoleylcarnitine and oleoylcarnitine) increase with increasing birth weight. Age impacts the levels of all MS/MS NBS biomarkers, while sex only affects the level of malonylcarnitine + 3-hydroxybutyrylcarnitine (C3-DC + C4-OH) in very low birth weight preterm neonates.ConclusionThe current study developed reference intervals (RIs) specific to birth weight, age, and/or sex for 35 MS/MS biomarkers, which can help in the timely evaluation of the health and disease of preterm neonates.

Neonatal Enteroviral Meningoencephalitis: Clinical and Paraclinical Characteristics of a Nosocomial Outbreak in Colombia

Enteroviruses (EVs) are a common cause of infection in neonates, they spread from person to person by a variety of routes and can cause severe symptoms and complications, including meningoencephalitis, myocarditis, and hepatic failure. We report the clinical and paraclinical characteristics of six patients diagnosed in a hospital cluster with late-onset sepsis, mostly preterm newborns. The most common symptoms were the same as a sepsis-like syndrome, the predominant sign of presentation was fever. The most frequent laboratory finding was elevated C-reactive protein, and later positive cerebrospinal fluid multiplex for EVs. Support treatment was given. A benign course was observed. Seizures were the only complication, with a normal electroencephalography at 6-month follow-up. In-hospital cases would benefit from a high clinician suspicion and early detection for achieving immediate isolation and containment measures to limit the spread to sick and vulnerable newborns, avoiding clusters.

Serum Vitamin D Concentrations and Associated Factors in Term and Preterm Newborns in Guadalajara, Mexico

Serum Vitamin D Concentrations and Associated Factors in Term and Preterm Newborns in Guadalajara, Mexico

Artificial Intelligence Applications in Neonatal Critical Care: A Scoping Review

Background: The development of artificial intelligence (AI) approaches impacted drug discovery, medical imaging, customized diagnostics, and therapeutics. Medicine will be transformed by AI. One such area of medicine where AI is significantly improving care is neonatology. Objective: The objective of this scoping review is to explore the applications of AI in neonatal critical care and its outcome. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted utilizing the Web of Science, MEDLINE (PubMed), and Scopus databases. The search was limited to full-text publications on AI applications in neonatal critical care that were published between January 1, 2019, and December 31, 2023. Articles specifically addressing the application of AI in neonatal care have been considered within the scope of this review. At least three reviewers had independently executed the screening, data abstraction, and exploration. Results: Database searches yielded 631 articles, of which 11 met the inclusion criteria. The research encompassed extensive AI applications in neonatal critical care, employed for prognosis, diagnosis, and therapy strategizing. Artificial neural networks, machine learning, deep learning, and shallow hybrid neural networks were the commonly utilized AI techniques (neonatal critical care). These methods were applied to screen for inborn metabolic abnormalities, predict various outcomes, including death and sepsis, identify diseases such as sepsis, and assess neurodevelopmental outcomes in preterm newborns, helping plan several medical treatments. The included research demonstrated encouraging outcomes when using AI in neonatal critical care. Conclusions: AI-driven electronic arrangements upgrade neonatal basic care by improving risk forecast, promising critical commitments to future health care. Be that as it may, careful appraisal, evidence-based considers, and determination of safety, ethics, and information straightforwardness issues are essential before implementation. Acceptance by administrative bodies and the therapeutic community pivots on tending to these concerns.

Intergrowth 21 Versus Fenton 2013 Growth Charts: Congruence in Assessing the Birth Size and the Proportion of Extra-uterine Growth Restriction in Preterm Babies

Background: Intergrowth-21st and Fenton 2013 growth charts are used for postnatal growth monitoring in preterms. There is no international consensus on which graph to refer to and why. This study is a local validation, of which graph would be plausible for the Indian population to detect small-for-gestational-age (SGA) and extra-uterine growth restriction (EUGR) babies, abetting in the settlement of this ambiguity. Objectives: The primary objective was to compare the Intergrowth-21st with Fenton 2013 growth charts for birth size classification and to detect the proportion of EUGR in preterms. The secondary objective was to assess the proportion of comorbidities in SGA babies by both these graphs. Methods: The design of the study was a prospective comparative observational study. All preterm newborns (24–&lt;37 weeks of gestation) admitted to the neonatal intensive care unit of Noble Hospital and Research Center, Maharashtra, were the participants. Weight, length, and head circumference were plotted on Intergrowth 21 and Fenton growth charts at birth and at 4 weeks of age or at 36 weeks of postmenstrual age whichever is later. Corresponding Z-scores and percentiles were calculated electronically from their respective online software. Outcome: the reliability of Intergrowth-21st when compared to Fenton 2013 growth charts in assessing the birth size was better, and detection of the proportion of EUGR in preterm babies was better with Fenton charts. Results: A total of 429 preterm babies with a mean gestational age of 33.3 ± 2.4 weeks were included in the study. Fenton (67.1%) overestimated the proportion of EUGR when compared to Intergrowth-21st (18.6%) which was statistically significant (P &lt; 0.001). On the contrary, although the proportion of SGA babies detected was higher with Intergrowth-21st (29.8%) when compared to Fenton (19.6%), there was moderate-to-high statistically significant agreement observed between the two growth charts in detecting SGA babies (Kappa = 0.716, P &lt; 0.001). The proportion of comorbidities did not vary significantly among the SGA babies between the growth charts (P &gt; 0.05). Conclusion: Fenton overestimates EUGR when compared to Intergrowth-21st, whereas both the growth charts are equally good in identifying SGA babies with no differences in the comorbidities detected. Intergrowth-21st standards look more pertinent for growth monitoring in the current study setting for Indian preterm babies.

Maternal social support and resilience in caring for preterm newborns at the neonatal intensive care unit (NICU): A qualitative study

IntroductionMothers with preterm babies at the NICU are at a high risk of acquiring psychological distress as a result of unexpected and upsetting experiences. While there is a strong emphasis on the infant's health, the mother's well-being, particularly her mental health, is sometimes disregarded. A qualitative exploratory descriptive design was used to explore maternal social support and resilience in caring for preterm newborns at the NICU in Municipal hospital in Ghana from May to July 2022. MethodsA qualitative exploratory method was used, and a purposive sampling technique was used to select 15 postnatal women who had their preterm babies on admission to the NICU until data saturation. Data was analysed using thematic content analysis. ResultsThe findings of the study showed that social support for their mothers as they care for their preterm infants contributed to their resilience. Three themes emerged from the analysis of the data: informational support, instrumental support and psychosocial support. ConclusionThere is a need for training in communication skills and counselling for healthcare professionals working in the NICU to be able to communicate effectively with mothers and also adopt a family-centered approach in the care of preterm infants. This will support mothers to strengthen their resilience when caring for their premature babies in the NICU. The role of instrumental support for mothers specifically financial and physical care support in building maternal resilience cannot be overemphasised.

Coping strategies, psychological reactions, and supportive needs of fathers with premature newborns in the neonatal intensive care unit

PurposeThe research aimed to determine the psychological reactions, coping strategies, and support needs of fathers of newborns in the NICU. Methods210 fathers of preterm newborns in the NICU in Iran completed the hospital anxiety and depression questionnaire, Abbreviated form of Coping Orientation to Problems Experienced inventory (Brief-Cope), and fathers' support needs questionnaire. ResultsThe mean (SD) of depression and anxiety scores were 9.51 (2.3) and 9.05 (2.2), respectively. 63% of the fathers used emotion-oriented coping methods. Most of their support needs were expressed in self and family care dimensions. The results showed a significant correlation between avoidance coping strategies and fathers' depression (r = 0.15, P = 0.02). ConclusionConsidering the experience of anxiety and depression in the fathers of preterm newborns hospitalized in NICU departments, nurses must support them. They can manage fathers' psychological reactions by identifying and meeting their support needs. Nurses should plan interventions that reduce fathers' use of avoidant coping strategies.

Role of fibroblast growth factor-23 as an early marker of metabolic bone disease of prematurity

PurposeMetabolic bone disease of prematurity (MBDP) remains a significant cause of morbidity in extremely premature newborns. In high-risk patients, suspected diagnosis and subsequent treatment modifications, with limitations in terms of sensitivity and specificity, rely on low phosphorus levels and/or high levels of alkaline phosphatase (ALP). We investigated the potential of fibroblast growth factor-23 (FGF23) as an early marker for MBDP when measured at 3–4 weeks of life in at-risk patients.MethodsA single-center prospective observational non-interventional study including preterm newborns of both sexes, with a gestational age of less than 32 weeks and/or a birth weight of less than 1500 g. In the standard biochemical screening for MBDP performed between 3 and 4 weeks of life within a nutritional profile, the determination of FGF23 was included along with other clinical and metabolic studies. The study was conducted at Marqués de Valdecilla University Hospital in Santander, Spain, from April 2020 to March 2021. Participants provided informed consent. Biochemical analyses were conducted using various platforms, and follow-up evaluations were performed at the discretion of neonatologists. Patients at high risk for MBDP received modifications in treatment accordingly. The sample was descriptively analyzed, presenting measures of central tendency and dispersion for continuous variables, and absolute numbers/percentages for categorical ones. Tests used included t-tests, Mann‒Whitney U tests, chi-square tests, logistic regressions, Pearson correlation, and ROC curve analysis (IBM SPSS Statistics version 19). Significance level: P < 0.05.ResultsIn the study involving 25 at-risk premature newborns, it was found that 20% (n = 5) were diagnosed with MBDP. Three of these patients (60%) were identified as high-risk based on standard biochemical evaluation at 3–4 weeks of age, while the other two patients (40%) were diagnosed in subsequent weeks. However, in all 5 patients, measurement of FGF23 levels would allow for early identification and optimization of treatment before other markers become altered. Low levels of FGF23 at 3–4 weeks, even with normal phosphorus and ALP levels, indicate the need for modifications in nutritional supplementation.ConclusionsMBDP remains a significant concern in extremely premature newborns. Current diagnostic methods rely on limited biochemical markers. Early detection of low FGF23 levels enables timely interventions, potentially averting demineralization.

Thymosin β4 and β10 Expression in Human Organs during Development: A Review.

This review summarizes the results of a series of studies performed by our group with the aim to define the expression levels of thymosin β4 and thymosin β10 over time, starting from fetal development to different ages after birth, in different human organs and tissues. The first section describes the proteomics investigations performed on whole saliva from preterm newborns and gingival crevicular fluid, which revealed to us the importance of these acidic peptides and their multiple functions. These findings inspired us to start an in-depth investigation mainly based on immunochemistry to establish the distribution of thymosin β4 and thymosin β10 in different organs from adults and fetuses at different ages (after autopsy), and therefore to obtain suggestions on the functions of β-thymosins in health and disease. The functions of β-thymosins emerging from these studies, for instance, those performed during carcinogenesis, add significant details that could help to resolve the nowadays so-called "β-thymosin enigma", i.e., the potential molecular role played by these two pleiotropic peptides during human development.

Exploring factors influencing delayed first antibiotic treatment for suspected early-onset sepsis in preterm newborns: a study before quality improvement initiative

BackgroundEarly-onset sepsis (EOS) is a serious illness that affects preterm newborns, and delayed antibiotic initiation may increase the risk of adverse outcomes.PurposeThe objective of this study was to examine the present time of antibiotic administration in preterm infants with suspected EOS and the factors that contribute to delayed antibiotic initiation.MethodsIn this retrospective study in China, a total of 82 early preterm infants with suspected EOS between December 2021 and March 2023 were included. The study utilized a linear regression analytical approach to identify independent factors that contribute to delayed antibiotic administration.ResultsThe mean gestational age and birth weight of the study population were 29.1 ± 1.4 weeks and 1265.7 ± 176.8 g, respectively. The median time of initial antibiotic administration was 3.8 (3.1-5.0) hours. Linear regression revealed that severe respiratory distress syndrome (RDS) (β = 0.07, P = 0.013), penicillin skin test (PST) timing (β = 0.06, P < 0.001) and medical order timing (β = 0.04, P = 0.017) were significantly associated with the initial timing of antibiotic administration.ConclusionsThere is an evident delay in antibiotic administration in preterm infants with suspected EOS in our unit. Severe RDS, PST postponement and delayed medical orders were found to be associated with the delayed use of antibiotics, which will be helpful for quality improvement efforts in the neonatal intensive care unit (NICU).

Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes.

Cardiopulmonary and infectious complications are more common in preterm newborns after preterm premature rupture of membranes (pPROM). Fetal echocardiography may be helpful in predicting neonatal condition. Our aim was to assess the cardiovascular changes in fetuses from pregnancies complicated by pPROM and possible utility in predicting the intrauterine or neonatal infection, and neonatal heart failure (HF). It was a prospective study enrolling 46 women with singleton pregnancies complicated by pPROM between 18+0 and 33+6 weeks of gestation and followed until delivery. 46 women with uncomplicated pregnancies served as a control group. Fetal echocardiographic examinations with the assessment of cardiac structure and function (including pulmonary circulation) were performed in all patients. Mean gestational age of pPROM patients was 26 weeks. Parameters suggesting impaired cardiac function in fetuses from pPROM were: higher right ventricle Tei index (0.48 vs. 0.42 p<0.001), lower blood flow velocity in Ao z-score (0.14 vs. 0.84 p=0.005), lower cardiovascular profile score (CVPS), higher rate of tricuspid regurgitation (18.2 % vs. 4.4 % p=0.04) and pericardial effusion (32.6 vs. 0 %). Intrauterine infection was diagnosed in 18 patients (39 %). 4 (8.7 %) newborns met the criteria of early onset sepsis (EOS). HF was diagnosed in 9 newborns. In fetal echocardiographic examination HF group had shorter mitral valve inflow time and higher left ventricle Tei index (0.58 vs. 0.49 p=0.007). Worse cardiac function was observed in fetuses from pPROM compared to fetuses from uncomplicated pregnancies.

Neonatal inflammation and its association with asthma and obesity in late childhood among individuals born extremely preterm.

Asthma and obesity are frequent outcomes among individuals born extremely preterm and are associated with decreased lifespan. Neonatal inflammation is associated with chronic neurodevelopmental disorders; however, it is less studied in association with other later childhood chronic disorders in this population. Fourteen hospitals in 5 U.S. states enrolled 1506 infants born before 28 weeks of gestation in the Extremely Low Gestational Age Newborn cohort in 2004-2014. Neonatal blood spots were collected on postnatal days 1, 7, 14, 21, and 28, and used to measure 14 inflammation-related proteins. Associations were evaluated between high (top quartile) levels of proteins and two chronic health disorders at ages 10 and 15 years: physician-diagnosed asthma and obesity (body mass index ≥95th percentile). Few associations were found between high levels of 14 inflammation-related proteins, either on a single day or on multiple days, and either asthma or obesity. Similarly, few associations were found in analyses stratified by sex or presence/absence of prenatal inflammation. In extremely preterm newborns, systemic elevations of inflammation-related proteins during the neonatal period were not associated with childhood asthma and obesity outcomes at 10 or 15 years of age. In the large multi-center Extremely Low Gestational Age Newborn (ELGAN) cohort, sustained elevation of neonatal levels of inflammation-related proteins was not consistently associated with asthma or obesity outcomes at 10 or 15 years of age. This finding contrasts with reported associations of perinatal inflammation with obesity at 2 years and neurodevelopmental disorders at 2-15 years in the ELGANs, suggesting that unlike neurodevelopment, peripubertal obesity and asthma may be driven by later childhood exposures. Future research on perinatal mechanisms of childhood asthma and obesity should account for both fetal and later exposures and pathways in addition to inflammation at birth.

Single-cell transcriptomic analysis reveals heterogeneous features of myeloid-derived suppressor cells in newborns.

The transitory emergence of myeloid-derived suppressor cells (MDSCs) in infants is important for the homeostasis of the immune system in early life. The composition and functional heterogeneity of MDSCs in newborns remain elusive, hampering the understanding of the importance of MDSCs in neonates. In this study, we unraveled the maturation trajectory of polymorphonuclear (PMN)-MDSCs from the peripheral blood of human newborns by performing single-cell RNA sequencing. Results indicated that neonatal PMN-MDSCs differentiated from self-renewal progenitors, antimicrobial PMN-MDSCs, and immunosuppressive PMN-MDSCs to late PMN-MDSCs with reduced antimicrobial capacity. We also established a simple framework to distinguish these distinct stages by CD177 and CXCR2. Importantly, preterm newborns displayed a reduced abundance of classical PMN-MDSCs but increased late PMN-MDSCs, consistent with their higher susceptibility to infections and inflammation. Furthermore, newborn PMN-MDSCs were distinct from those from cancer patients, which displayed minimum expression of genes about antimicrobial capacity. This study indicates that the heterogeneity of PMN-MDSCs is associated with the maturity of human newborns.

Support breastfeeding in premature infants in the neonatal intensive care unit

The multiple benefits of human milk in newborns are known, especially in preterm newborns by reducing the rates of neonatal sepsis, necrotizing enterocolitis, retinopathy of prematurity and better results in neurodevelopment. However, rates of exclusive breast milk use remain low. To achieve higher percentages of successful breastfeeding, strategies must be applied from the NICU, such as expressed within the first 6 hours of life, skin-to-skin contact and administration of colostrum in the cheeks, all well, in order to have sufficient volume of breast milk since this is the main barrier they face, not having enough milk. There are very few studies that evaluate when to initiate suctions directly to the maternal breast, using the empty breast as non-nutritive suction could improve the performance of VLBW to the maternal breast.