Preterm Infants Research Articles

Significance of T-receptor and kappa-deletion recombina- tion excision rings as molecular markers in the assessment of newborns of different gestational ages

Currently, there is a large number of studies indicating that preterm infants have reduced levels of T-receptor and kappa-deletion recombination excision rings (TREC and KREC) as indicators of impaired T- and/or B-cell immunity. Studies aimed at in-depth study of the causative factors that led to the decrease in the estimated indicators remain relevant. Purpose. Determination of the influence of somatometric parameters and prenatal factors on the level of TREC and KREC in newborns, as well as evaluation of the dynamics of these indicators from gestational age. Material and methods. The study included 203 neonates with gestational ages ranging from 22 to 41 weeks. TREC and KREC were isolated by PCR from dried blood spots on Guthrie cards. Blood sampling was performed as part of neonatal screening. The estimated parameters were analyzed according to gestational age, somatometric data and prenatal factors (mode of delivery, number of fetuses in pregnancy). Statistical analysis was performed using the StatTech v. 4.1.4 software. Results. It was found that the increase in gestational age by 1 week increases the KREC level by 44.610·105 (rxy = 0.271, p < 0.001), TREC level by 27.274·105 (rxy = 0.264, p = 0.002). Linear regression analysis showed weak direct relationships between TREC and KREC levels and anthropometric data. Children from multiple pregnancies had significantly higher TREC values than infants from singleton pregnancies (p < 0.001). Conclusion. The immune system of premature newborns is capable of producing adequate amounts of TREC and KREC. Between 22 and 28 weeks of age, the most intense increase in the assessed indicators occurs, after which their levels relatively stabilize. Since TREC and KREC levels tend to decrease in preterm newborns, a comprehensive evaluation of the dynamics of these indicators depending on significant prenatal and somatometric data is extremely important.

Clinicopathologic Characterization of Invasive Fungal Intestinal Infections in Pediatric Patients.

Invasive fungal intestinal infections are rare in pediatric patients with limited studies reported to date. Retrospective study of invasive intestinal fungal infections in pediatric patients. For fungal specification, 18S rRNA gene PCR was performed using formalin-fixed paraffin-embedded tissues. A total of 19 cases from 18 patients were included (13 males, 72%) with a median age of 20 days (8 days-14 years). About 13 patients (72%) presented within 67 days of birth and 11 patients (61%) were premature and 14 patients (78%) had a significant medical history. The most common location was the jejunum/ileum (56%) followed by the right colon and terminal ileum (22%). In 10 patients, the fungal elements were seen in the mucosa with 3 extending into the submucosa, and only 3 patients showed full-thickness involvement. Tissue necrosis and angioinvasion were seen in 13 (72%) and 8 (44%) patients, respectively. Morphologically, organisms consistent with Candida spp. were seen in 17 patients and with a mucoraceous mold in 1 patient. A 18S rRNA gene sequencing performed in 18 cases identified Candida dubliniensis in 16 cases and Candida spp. in 2 cases. During the study follow-up period, 56% of the patients died. In our experience, most cases were due to Candida spp. and predominantly in premature infants and associated with poor outcomes.

EPIDEMIOLOGY OF RESPIRATORY DISTRESS IN PRETERM NEWBORNS ADMITTED WITH RESPIRATORY DISTRESS IN NICU: A CROSS SECTIONAL STUDY

Background:Respiratory distress is one of the most common cause of newborns admitting to NICUs. The objective of this cross-sectional study was to examine the epidemiological profile of preterm neonates with respiratory distress in the NICU. It was carried out from August 2023 to July 2024 at Akash institute of medical sciences and research centre, Devanahalli, Bengaluru Rural. Materials and Methods: This cross-sectional study included 42 neonates under the age of 28 days. Respiratory distress was diagnosed using specific criteria, and detailed clinical assessments were performed to confirm the aetiology. Data on demographics, risk factors, and therapeutic modalities were collected and analysed using SPSS version 25. Results: A total number of 81 neonates are admitted in NICU for respiratory distress, 42 cases were preterm. In those preterm ,late preterm babies 33(79%) had respiratory distress, followed by moderate preterm 5(12%). Males, 23(54.76%) were more prone for respiratory distress compared to females, 19 (45.24%). LSCS ,34 (80.95%)was the major cause for respiratory distress. All cases required oxygen supportbut oxygen prongs was given to 23(54.76%) cases, CPAP was given to 16 (38.05%) cases, 3(7.14%) were mechanically ventilated. Low birth weight infants,24(57%) weremore prone for respiratory distress compared to very low birth weight 11(26%) and extreme low birth weight infants 1 (3%). 15 (35.71%) cases were not having any risk factors but 9 (21.42%) had PIH. TTNB, in 19(45.23%) cases was the most common aetiology for causing respiratory distress. Conclusion: This study underscores the necessity for heightened awareness and specialized care protocols for preterm neonates, particularly those born via LSCS and those with low birth weight, to mitigate the risks and improve outcomes associated with respiratory distress.

The role of early aggressive nutrition on growth of very preterm or very low birth weight infants

Background Very preterm infants (<32 weeks gestational age) are at high risk of poor neurodevelopmental outcomes. Early aggressive parenteral nutrition (protein ³ 2g/kg/day) can reduce the incidence of malnutrition in very preterm infants. At present, Fatmawati General Hospital does not have a standard nutritional protocol for preterm infant. Objective To determine the difference in growth (days to regain birth weight and growth velocity) of very preterm (<32 weeks gestational age) or very low birth weight (VLBW) (<1500g) infants who were born and hospitalized in the Neonatal Unit of Fatmawati General Hospital, Jakarta, before and after applying early aggressive parenteral nutrition using a nutrition protocol from Cipto Mangunkusumo Hospital, Jakarta. Methods A quasi-experimental study was conducted on 23 very preterm or VLBW infants in the Neonatal Unit of Fatmawati General Hospital, from July to November 2019. Control group data were taken from medical records of very preterm or VLBW babies discharged from our unit from January 2018 – to June 2019 and compared to those of the intervention group. Results The intervention group regained their birth weight significantly faster than the control group [mean 7.43 (SD 3.5) vs. 16.73 (SD 5.1) days, respectively; (P=0.00)]. Mean growth velocity was also significantly higher in the intervention group than in the control group [14.6 (SD 6.0) vs. 8.9 (SD 6.9) gram/kg/day, respectively; (P=0.002)]. Conclusion Provision of early aggressive parenteral nutrition reduces the time to regain birth weight and leads to higher growth velocity in very preterm/VLBW infants.

A Simple MRI Score Predicts Pathological General Movements in Very Preterm Infants with Brain Injury-Retrospective Cohort Study.

Very preterm infants are at increased risk of brain injury and impaired brain development. The Total Abnormality Score and biometric parameters, such as biparietal width, interhemispheric distance and transcerebellar diameter, are simple measures to evaluate brain injury, development and growth using cerebral magnetic resonance imaging data at term-equivalent age. The aim of this study was to evaluate the association between the Total Abnormality Score and biometric parameters with general movements in very preterm infants with brain injury. This single-center retrospective cohort study included 70 very preterm infants (≤32 weeks' gestation and/or <1500 g birth weight) born between January 2017 and June 2021 in a level-three neonatal intensive care unit with brain injury-identified using cerebral magnetic resonance imaging data at term-equivalent age. General movements analysis was carried out at corrected age of 8-16 weeks. Binary logistic regression and Spearman correlation were used to examine the associations between the Total Abnormality Score and biometric parameters with general movements. There was a significant association between the Total Abnormality Score and the absence of fidgety movements [OR: 1.19, 95% CI = 1.38-1.03] as well as a significant association between the transcerebellar diameter and fidgety movements (Spearman ρ = -0.269, p < 0.05). Among very preterm infants with brain injury, the Total Abnormality Score can be used to predict the absence of fidgety movements and may be an easily accessible tool for identifying high-risk very preterm infants and planning early interventions accordingly.

Can deep learning classify cerebral ultrasound images for the detection of brain injury in very preterm infants?

Cerebral ultrasound (CUS) is the main imaging screening tool in preterm infants. The aim of this work is to develop deep learning (DL) models that classify normal vs abnormal CUS to serve as a computer-aided detection tool providing timely interpretation of the scans. A population-based cohort of very preterm infants (220-306 weeks) born between 2004 and 2016 in Nova Scotia, Canada. A set of nine sequential CUS images per infant was retrieved at three specific coronal landmarks at three pre-identified times (first, sixth weeks, and term age). A radiologist manually labeled each image as normal or abnormal. The dataset was split into training/development/test subsets (80:10:10). Different convolutional neural networks were tested, with filtering of the most uncertain prediction. The model's performance was assessed using precision/recall and the receiver operating area under the curve. Sequential CUS retrieved for 538/665 babies (81% of the cohort). Four thousand one hundred eighty images were used to develop and test the model. The model performance was only discrete at the beginning but, through different machine learning strategies was boosted to good levels averaging 0.86 ROC AUC (95% CI: 0.82, 0.90) and 0.87 PR AUC (95% CI: 0.84, 0.90) (model uncertainty estimation filters using normalized entropy threshold = 0.5). This study offers proof of the feasibility of applying DL to CUS. This basic diagnostic model showed good discriminative ability to classify normal versus abnormal CUS. This serves as a CAD and a framework for constructing a prognostic model. This DL model can serve as a computer-aided detection tool to classify CUS of very preterm babies as either normal or abnormal. This model will also be used as a framework to develop a prognostic model. Binary computer-aided detection models of CUS are applicable for classifying ultrasound images in very preterm babies. This model acts as a step towards developing a model for predicting neurodevelopmental outcomes in very preterm babies. This model serves as a tool for interpretation of CUS in this patient population with a heightened risk of brain injury.

Human milk microbiota, oligosaccharide profiles, and infant gut microbiome in preterm infants diagnosed with necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a severe intestinal disease of very preterm infants with mother's own milk (MOM) providing protection, but the contribution of the MOM microbiota to NEC risk has not been explored. Here, we analyze MOM of 110 preterm infants (48 NEC, 62 control) in a cross-sectional study. Breast milk contains viable bacteria, but there is no significant difference in MOM microbiota between NEC and controls. Integrative analysis between MOM microbiota, human milk oligosaccharides (HMOs), and the infant gut microbiota shows positive correlations only between Acinetobacter in the infant gut and Acinetobacter and Staphylococcus in MOM. This study suggests that NEC protection from MOM is not modulated through the MOM microbiota. Thus, "'restoring" the MOM microbiota in donor human milk is unlikely to reduce NEC, and emphasis should instead focus on increasing fresh maternal human milk intake and researching different therapies for NEC prevention.

Adjusted versus Targeted Fortification in Extremely Low Birth Weight Preterm Infants: Fortin Study-A Randomized Clinical Trial.

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of <1000 g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomized to AF group and 23 to TF group. AF was based on blood urea nitrogen (BUN) concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day). No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge, nor during the intervention. Protein intake was significantly higher in the AF group (5.02 g/kg/day vs. 4.48 g/kg/day, p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants.

Evidence-based nutrition for the very preterm infant in 2024

Evidence-based nutrition for the very preterm infant in 2024

Social determinants of health and somatic growth in preterm infants and children with chronic lung disease.

Bronchopulmonary dysplasia (BPD), a common complication of prematurity, is associated with impaired lung function and increased morbidity in childhood. These children display heterogeneous somatic growth patterns which may ultimately impact their risk for later respiratory disease. We aim to understand the relationship between socioenvironmental exposures and growth in this population. A retrospective longitudinal cohort study was conducted using participants (n = 616) enrolled in the Johns Hopkins Outpatient BPD Registry. Growth measurements between 0 and 36 months of age were obtained. Somatic growth measurements, both corrected and uncorrected for gestational age, were converted to z-scores using Center for Disease Control and Prevention normative data. Using a participant's residential zip code, we utilized the 2019 Area Deprivation Index (ADI), the Childhood Opportunity Index (COI) 2.0, and neighborhood food insecurity data from the Maryland Food Bank. Linear regression analysis was performed employing individual socioenvironmental measures as independent variables and growth z-scores as dependent variables in univariate analysis. Univariate analysis was repeated adjusting for gestational age, BPD severity, and the presence of a gastrostomy tube (GT). Of the three measures analyzed, national COI (nCOI) showed a significant association with mean weight z-scores, mean ADI showed some association with mean weight z-scores, and the percentage of a community experiencing food insecurity showed no association with mean weight z-scores. After adjusting for gestational age, BPD severity, and presence of a GT, children living in areas of greater opportunity (higher nCOI values), had significantly lower weight z-scores at 12 months corrected and at 24 and 36 months uncorrected CONCLUSIONS: Our findings suggest that the COI 2.0, a multidimensional measure, captures more facets of an individual's social environment, as compared to the singular nature of a measure of food insecurity. There are several potential explanations for the phenomenon seen, and further understanding of this dynamic is crucial for designing effective interventions and policies to better address inequities in outcomes.

Machine Learning for the Identification of Key Predictors to Bayley Outcomes: A Preterm Cohort Study.

The aim of this study was to understand how neurological development of preterm infants can be predicted at earlier stages and explore the possibility of applying personalized approaches. Our study included a cohort of 64 preterm infants, between 24 and 34 weeks of gestation. Linear and nonlinear models were used to evaluate feature predictability to Bayley outcomes at the corrected age of 2 years. The outcomes were classified into motor, language, cognitive, and socio-emotional categories. Pediatricians' opinions about the predictability of the same features were compared with machine learning. According to our linear analysis sepsis, brain MRI findings and Apgar score at 5th minute were predictive for cognitive, Amiel-Tison neurological assessment at 12 months of corrected age for motor, while sepsis was predictive for socio-emotional outcome. None of the features were predictive for language outcome. Based on the machine learning analysis, sepsis was the key predictor for cognitive and motor outcome. For language outcome, gestational age, duration of hospitalization, and Apgar score at 5th minute were predictive, while for socio-emotional, gestational age, sepsis, and duration of hospitalization were predictive. Pediatricians' opinions were that cardiopulmonary resuscitation is the key predictor for cognitive, motor, and socio-emotional, but gestational age for language outcome. The application of machine learning in predicting neurodevelopmental outcomes of preterm infants represents a significant advancement in neonatal care. The integration of machine learning models with clinical workflows requires ongoing education and collaboration between data scientists and healthcare professionals to ensure the models' practical applicability and interpretability.

Correlation Between Skeletal Muscle Mass and Fat-Free Mass in Infants Born Very Preterm

Assessing growth quality in preterm infants present challenges, particularly with the use of the standard fat-free mass (FFM) measurement. We report here a moderate correlation between indirect skeletal muscle mass (SMM) measurements using the D3-creatine dilution method and FFM measured with air-displacement plethysmography. SMM could serve as an indicator of growth quality.

Silencing miR-155–5p expression improves intestinal damage through inhibiting inflammation and ferroptosis in necrotizing enterocolitis

BackgroundNecrotizing enterocolitis (NEC) is a condition characterized by acquired damage to the mucosal lining, predominantly affecting premature infants. Bioinformatics assessments uncovered a notable rise in miR-155–5p expression in the intestinal tissues of infants suffering from NEC. Nevertheless, the development of NEC's underlying mechanisms and the role of miR-155–5p are still not well understood. This research aimed to explore the role of miR-155–5p in NEC and to elucidate its underlying mechanisms. MethodsTo replicate NEC in vitro, lipopolysaccharide (LPS) was employed, whereas an in vivo rat model of NEC was established using formula feeding and exposure to hypoxia. Subsequently, levels of inflammatory cytokines, cell survival, and apoptosis rates were assessed. Various biochemical indicators such as glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) were measured utilizing a purchased diagnostic kit. For the assessment of reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) within FHC cells, analysis by flow cytometry was conducted. Additionally, the technique of Western blotting was utilized to analyze the levels of ferroptosis-associated proteins. Moreover, hematoxylin and eosin (H&E) staining was carried out to observe the histopathological alterations in the intestinal tissue samples from rats with necrotizing enterocolitis (NEC). ResultsReducing miR-155–5p improved the survival of FHC cells exposed to LPS, decreased cell apoptosis, inflammation, and ferroptosis, and mitigated intestinal damage in NEC rats. Furthermore, SLC7A11 was found to be a direct target of miR-155–5p. The inhibition of miR-155–5p decreased LPS-induced inflammation and ferroptosis in both FHC cells and NEC rats by promoting SLC7A11 expression. This effect was evidenced by increased levels of ferroptosis-related proteins FTH1 and GPX4, decreased COX-2 and ACSL4 levels, lower lipid peroxidation marker MDA, reduced antioxidant markers GSH, SOD, and CAT, fewer IL-6 and TNF-α, and suppression of the IκBα/NF-κB p65 signaling pathway. ConclusionsIn conclusion, reducing miR-155–5p could improve intestinal damage in NEC by inhibiting inflammation and ferroptosis. These findings may provide theoretical insights for the development of new therapies for NEC.

Development and application of a population pharmacokinetic model repository for caffeine dose tailoring in preterm infants

ABSTRACT Background Considerable interindividual variability for the pharmacokinetics of caffeine in preterm infants has been demonstrated, emphasizing the importance of personalized dosing. This study aimed to develop and apply a repository of currently published population pharmacokinetic (PopPK) models of caffeine in preterm infants to facilitate model-informed precision dosing (MIPD). Research design and methods Literature search was conducted using PubMed, Embase, Scopus, and Web of Science databases. Relevant publications were screened, and their quality was assessed. PopPK models were reestablished to develop the model repository. Covariate effects were evaluated and the concentration–time profiles were simulated. An online simulation and calculation tool was developed as an instance. Results Twelve PopPK models were finally included in the repository. Preterm infants’ age and body size, especially the postnatal age and current weight, were identified as the most clinically critical covariates. Simulated blood concentration–time profiles across these models were comparable. Caffeine citrate-dose regimen should be adjusted according to the age and body size of preterm infants. The developed online tool can be used to facilitate clinical decision-making. Conclusions The first developed repository of PopPK models for caffeine in preterm infants has a wide range of potential applications in the MIPD of caffeine.

Regulation of host metabolism and defense strategies to survive neonatal infection

Two distinct defense strategies, disease resistance (DR) and disease tolerance (DT), enable a host to survive infectious diseases. Newborns, constrained by limited energy reserves, predominantly rely on DT to cope with infection. However, this approach may fail when pathogen levels surpass a critical threshold, prompting a shift to DR that can lead to dysregulated immune responses and sepsis. The mechanisms governing the interplay between DR and DT in newborns remain poorly understood. Here, we compare metabolic traits and defense strategies between survivors and non-survivors in Staphylococcus epidermidis (S. epidermidis)-infected preterm piglets, mimicking infection in preterm infants. Compared to non-survivors, survivors displayed elevated DR during the initial phase of infection, followed by stronger DT in later stages. In contrast, non-survivors showed clear signs of respiratory and metabolic acidosis and hyperglycemia, together with exaggerated inflammation and organ dysfunctions. Hepatic transcriptomics revealed a strong association between the DT phenotype and heightened oxidative phosphorylation in survivors, coupled with suppressed glycolysis and immune signaling. Plasma metabolomics confirmed the findings of metabolic regulations associated with DT phenotype in survivors. Our study suggests a significant association between the initial DR and subsequent DT, which collectively contributes to improved infection survival. The regulation of metabolic processes that optimize the timing and balance between DR and DT holds significant potential for developing novel therapeutic strategies for neonatal infection.

Mapping prenatal predictors and neurobehavioral outcomes of an epigenetic marker of neonatal inflammation – A longitudinal population-based study

BackgroundDNA methylation levels at specific sites can be used to proxy C-reactive protein (CRP) levels, providing a potentially more stable and accurate indicator of sustained inflammation and associated health risk. However, its use has been primarily limited to adults or preterm infants, and little is known about determinants for − or offspring outcomes of − elevated levels of this epigenetic proxy in cord blood. The aim of this study was to comprehensively map prenatal predictors and long-term neurobehavioral outcomes of neonatal inflammation, as assessed with an epigenetic proxy of inflammation in cord blood, in the general pediatric population. MethodsOur study was embedded in the prospective population-based Generation R Study (n = 2,394). We created a methylation profile score of CRP (MPS-CRP) in cord blood as a marker of neonatal inflammation and validated it against serum CRP levels in mothers during pregnancy, as well as offspring at birth and in childhood. We then examined (i) which factors (previously associated with sustained inflammation) explain variability in MPS-CRP at birth, including a wide range of prenatal lifestyle and clinical conditions, pro-inflammatory exposures, as well as child genetic liability to elevated CRP levels; and (ii) whether MPS-CRP at birth associates with child neurobehavioral outcomes, including global structural MRI and DTI measures (child mean age 10 and 14 years) as well as psychiatric symptoms over time (Child Behavioral Checklist, at mean age 1.5, 3, 6, 10 and 14 years). ResultsMPS-CRP at birth was validated with serum CRP in cord blood (cut-off > 1 mg/L) (AUC = 0.72). Prenatal lifestyle pro-inflammatory factors explained a small part (i.e., < 5%) of the variance in the MPS-CRP at birth. No other prenatal predictor or the polygenic score of CRP in the child explained significant variance in the MPS-CRP at birth. The MPS-CRP at birth prospectively associated with a reduction in global fractional anisotropy over time on mainly a nominal threshold (β = -0.014, SE = 0.007, p = 0.032), as well as showing nominal associations with structural differences (amygdala [(β = 0.016, SE = 0.006, p = 0.010], cerebellum [(β = -0.007, SE = 0.003, p = 0.036]). However, no associations with child psychiatric symptoms were observed. ConclusionPrenatal exposure to lifestyle-related pro-inflammatory factors was the only prenatal predictor that accounted for some of the individual variability in MPS-CRP levels at birth. Further, while the MPS-CRP prospectively associated with white matter alterations over time, no associations were observed at the behavioral level. Thus, the relevance and potential utility of using epigenetic data as a marker of neonatal inflammation in the general population remain unclear. In the future, the use of epigenetic proxies for a wider range of immune markers may lend further insights into the relationship between neonatal inflammation and adverse neurodevelopment within the general pediatric population.

Evaluation of Etiological Causes and Demographic Characteristics of Neonatal Seizure in Adiyaman University Training And Research Hospital, Türkiye: A Retrospective Study

Aim: Neonatal seizures are different from seizures seen at other ages in terms of etiology, clinical follow-up, treatment and prognosis. The purpose of this study was to determine the etiological causes and demographic characteristics of neonates admitted due to seizures in the neonatal intensive care unit. Methods: This is an original study involving newborns hospitalized for seizures in the neonatal intensive care unit at Adıyaman University Training and Research Hospital. The files of 40 patients followed up due to seizures between September 2016 and July 2021, were examined retrospectively. 40 out of 45 patients satisfied the inclusion criteria. The files of 40 patients were retrospectively analyzed in terms of age, sex, gestational age, birth weight, mode of delivery, APGAR score, seizure etiology, intervention and treatment, electroencephalography (EEG), trans fontanel ultrasonography (USG) and brain magnetic resonance imaging (MRI) findings, length of hospital stay, and mortality rates. Results: The study group consisted of 40 patients, 21 girls (52.5%) and 19 boys (47.5%). Twenty-seven (67%) of the patient group were born at term and 13 (33%) preterm. The mean birth week was 38, and the mean birth weight was 2900 g. The underlying seizure etiology was unknown in 37.5% (n = 15) of cases, while the most common known etiological cause was hypoxic ischemic encephalopathy, seen in 20% (n = 8). The mortality rate in our patient group was 22.5% (n = 9). Conclusion: Among the known causes of neonatal convulsions, hypoxic-ischemic encephalopathy in term babies and germinal matrix bleeding in preterm babies were found to be the most common causes. However, despite all kinds of examinations and evaluations, the cause of a significant portion of them has not been determined. Long-term follow-up of newborns with convulsions is required to detect early neurodevelopmental problems that may develop during follow-up.

Therapeutic Plasma Exchange for a Critically Ill Late Preterm Infant with Multisystem Inflammatory Syndrome of Children: A Case Report and Review of the Literature

AbstractMultisystem inflammatory syndrome of children (MIS-C) is a clinical picture that entered the medical nomenclature after the coronavirus disease 2019 pandemic. Although it primarily affects older children, there have been a limited number of cases reported during the neonatal period. Herein we present a patient, a late preterm infant, with severe MIS-C-related cerebral sinus venous thrombosis who was successfully treated with therapeutic plasma exchange. Practitioners can consider therapeutic plasma exchange as a safe and effective option for the treatment of critically ill MIS-C cases.

Prevalence of iron deficiency in extreme preterm infants at 4 or 6 months corrected age despite receiving prophylactic iron supplements.

Prevalence of iron deficiency in extreme preterm infants at 4 or 6 months corrected age despite receiving prophylactic iron supplements.

Effect of probiotic administration to breastfeeding mothers with very low birthweight neonates on some neonatal and maternal outcomes: study protocol for a randomised, double-blind, placebo-controlled trial

IntroductionPremature birth and very low birth weight (VLBW) are leading causes of neonatal mortality. Almost all premature infants experience hyperbilirubinaemia. Administering probiotics to breastfeeding mothers may positively affect infant outcomes....