Complications Of Prematurity Research Articles

The association between preterm delivery and autism spectrum disorder in childhood: A retrospective cohort study.

Prematurity complications are a leading cause of mortality and morbidity in offspring, including adverse neurodevelopmental outcomes. The association between preterm birth (PTB) and autism spectrum disorder (ASD) remains debated. To investigate the association between PTB and ASD diagnosis during childhood. This cohort study analyzed data from community clinics and a tertiary hospital, encompassing deliveries from 2005 to 2017. ASD incidence was compared across gestational age categories: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term (≥37 weeks). Additional comparisons were made between all preterm (<37 weeks) and term deliveries (≥37 weeks). Cumulative ASD incidence was assessed using Kaplan-Meier survival curves and a Cox proportional hazards model adjusted for potential confounders. Among 114 975 pregnancies, 0.3% delivered at <28 weeks, 0.6% at 28-32 weeks, and 6% at 32-37 weeks, with 6.9% preterm deliveries overall. Univariable analysis revealed a significant association between PTB and ASD (1.6% for <28 weeks vs 0.3% for 28-32 weeks vs 0.8% for 32-37 weeks vs 0.7% for term, P = 0.036). Crude ASD incidence was 0.8% (odds ratio [OR] 1.21, 95% confidence interval [CI] 0.93-1.56, P = 0.15). However, adjusted results showed no significant association: adjusted hazard ratio = 0.74 (95% CI 0.24-2.34, P = 0.61) for <28 weeks, 0.99 (95% CI 0.24-3.99, P = 0.98) for 28-32 weeks, and 1.07 (95% CI 0.81-1.43, P = 0.63) for 32-37 weeks. Kaplan-Meier analysis showed similar cumulative ASD incidence across groups (P = 0.855). This retrospective cohort study found no significant association between PTB and childhood ASD diagnosis.

Intraventricular Hemorrhage and Survival, Multimorbidity, and Neurodevelopment

Intraventricular hemorrhage (IVH) has proven to be a challenging and enduring complication of prematurity. However, its association with neurodevelopment across the spectrum of IVH severity, independent of prematurity, and in the context of contemporary care remains uncertain. To evaluate national trends in IVH diagnosis and the association with survival and neurodevelopmental outcomes at 2 years of age. This whole-population cohort study was conducted using data from the UK National Neonatal Research Database. Infants born at less than 29 weeks' gestation with any grade of IVH between January 2013 and December 2019 in England were included and matched with controls. Data analysis occurred from November 2023 to June 2024. IVH grades 1 to 4 (Papile classification). The primary outcome was survival without severe neurodevelopmental impairment (NDI) at 2 years' corrected age including severe delays (inability to understand or use >5 words or signs; being unable to walk, sit, or use hands; blindness; or uncorrectable hearing impairment). Secondary outcomes included gross and fine motor function, receptive and expressive communication, vision, hearing, and overall developmental progress. Outcomes were derived from clinician-entered data and analyzed using multiple logistic regression. Between 2013 and 2019, of 26 756 infants born at less 29 weeks' gestation in England, 8461 received a diagnosis of IVH (5570 low-grade and 2891 high-grade, and 8328 were included in the study. Overall, 5519 included infants had low-grade IVH with a median [IQR] gestational age of 26 (25-27) weeks, of which 2477 (48.88%) were male. Of the 2809 included infants with high-grade IVH, the median (IQR) gestational age was 25 (24-26) weeks and 1710 (60.88%) were male. The mean (SD) incidence of high-grade IVH (108 [6.7] per 1000 live extremely preterm births) and low-grade IVH (208 [10.4] per 1000 live extremely preterm births) increased between 2013 and 2019, although this did not reach statistical significance for high-grade IVH. Survival without severe NDI decreased significantly after high-grade IVH (a 74% reduction; aOR, 0.26; 95% CI, 0.22-0.31), and to a lesser extent after low-grade IVH (a 12% reduction; aOR, 0.88; 95% CI, 0.79-0.98). Although low-grade IVH was associated with functional impairments, most survivors, 2283 of 4379 infants (52.15%), had no NDI, and the association with NDI was accounted for by grade 2 IVH. Decreased survival without severe NDI was observed with increasing grade of IVH, decreasing gestation, bilateral compared to unilateral injuries, and increasing morbidity count (severe retinopathy of prematurity, bronchopulmonary dysplasia, and surgical necrotizing enterocolitis). Impairments in gross motor function and communication were common, especially among those with high-grade IVH (with prevalences of 44.55% [715 of 1605 infants] and 48.91% [784 of 1603 infants], respectively). In this cohort study, IVH was highlighted as a persistent issue with substantial neurodevelopmental implications despite advances in care. This study offers useful data for counseling families; however, follow-up to school age is necessary to grasp the full impact of these injuries on children's lives.

Individual-, Hospital-, and Community-Level Factors Associated with Sudden Unexpected Infant Death Among Infants Born Preterm in 5 US States.

To investigate individual-, hospital-, and community-level factors associated with sudden unexpected infant death (SUID) among infants born preterm. The following linked dataset from 5 states (California, Michigan, Oregon, Pennsylvania, and South Carolina) from 2005 through 2020 was used: (1) infant birth and death certificates; (2) maternal and infant birth hospitalization discharge records; (3) birthing hospital data from the American Hospital Association; and (4) community-level data from the Social Vulnerability Index (SVI).) Multivariable models were used to assess the independent association between these multilevel factors and SUID, adjusting for several maternal and infant characteristics. Overall, we found that maternal demographic factors (race and ethnicity, education, insurance) and infant gestational age were significant predictors of SUID. There was no difference in SUID odds by state, urban influence code, and maternal complications of pregnancy. Compared with mothers who lived in areas with the lowest SVI, those who resided in the highest SVI were more likely to experience SUID. There was no difference in SUID odds between infants who did or did not experience one or more complications of prematurity. For hospital-level factors, there was no difference in SUID odds among infants cared for in teaching vs nonteaching hospitals or in low vs high volume preterm birth hospitals. Individual- and community-level factors were associated with SUID among infants born preterm. The neonatal intensive care unit hospitalization may provide a critical window of opportunity to engage families about SUID-risk reducing practices.

Lung recruitment with HFOV versus VTV/AC in preterm infants with RDS.

To compare the effect of lung recruitment using high frequency ventilation versus volume targeted ventilation on duration of intubation as well as its effect on lung inflammation in preterm infants with respiratory distress syndrome. The study was conducted on a total of 40 preterm infants, 34 weeks gestational age or less, having RDS that needed intubation and mechanical ventilation within the first 72h after their birth at the NICU of Mansoura University Children's Hospital during the period from July 2020 to July 2022. Infants included were randomly assigned into two groups, Group A who were subjected to LRM using HFOV (20 cases) and Group B who were subjected to LRM using VTV/AC (20 cases). TGF-β1 level was measured in BAL samples of all studied infants at two time points; before lung recruitment maneuver and at day 5 after lung recruitment or just before extubation if extubation occurs earlier than 5 days. Lung recruitment maneuver had no significant effect on time to extubation. Both groups showed no significant difference in rate of prematurity complications nor delta change of TFG-β1 level in tracheal aspirate of those preterm infants measured before lung recruitment and five days after recruitment or at extubation when extubation occurred earlier. Lung recruitment maneuver was not associated with significant difference between both groups of preterm infants. The results obtained from our study, being the first of its kind to compare the effect of lung recruitment, provide a promising research area for further investigations.

The Use of Novel Therapies in the Management of Haemolytic Disease of the Fetus and Newborn (HDFN): Scientific Impact Paper No. 75.

Haemolytic disease of the fetus and newborn (HDFN) is a rare condition that causes a baby to develop anaemia while growing inside the woman; or after birth. Left untreated, this may lead to stillbirth or neonatal death. HDFN is caused when the pregnant woman's antibodies cross the placenta, enter the baby's circulation, and attach to proteins called antigens (inherited from the father) on the baby's haemoglobin containing red blood cells, and cause them to break apart, causing fetal anaemia. Women routinely have their blood tested at the start of pregnancy to assess their ABO blood group and Rh antigens. There are five main Rhesus antigens: D, C, c, E, e; with anti-D being responsible for most cases of HDFN. If a woman is found to be Rh D negative; a 'non-invasive' blood test is performed to assess if the fetal blood group is the same as the woman's. If a woman is found to be Rh D negative, and the baby is found to be D positive, the baby is at risk. This is because the baby has inherited the D antigen from the father; so-called Rhesus incompatibility. Other red blood cell antibodies such as anti-Kell or anti-Duffy can also cause fetal anaemia. Women at highest risk of developing HDFN are those who have had at least one previous birth or a sensitising event (such as abdominal trauma) in a current or previous pregnancy, causing the woman and baby's blood to mix. Current treatment for haemolytic disease of the fetus involves giving fetal blood transfusions, with a small risk of early labour or pregnancy loss. If anaemia develops later in pregnancy, early delivery of the baby may be recommended; which could lead to complications of prematurity. In cases of mild HDFN, the baby may only require light therapy for neonatal jaundice. However, if the anaemia occurs earlier in pregnancy and is severe, the baby may need blood transfusions while still in the womb - and after birth may require an exchange transfusion, to remove the woman's antibodies from their circulation and to treat the anaemia. Intravenous immunoglobulin (IVIG) is a potential non-invasive method to prevent or delay the onset of severe anaemia. It is a blood product given intravenously every week to women who have been deemed at very high risk of early onset HDFN. It can be started at the end of the first trimester until birth, or until anaemia develops. This paper will discuss the evidence behind IVIG and other novel therapies during pregnancy, including the risks and the benefits. The developers of the paper include obstetricians, neonatologists and haematologists to provide different opinions on this topic.

The role of stem cells in the management of neonatal posthemorrhagic hydrocephalus.

Neonatal intraventricular hemorrhage (IVH) is a common complication of prematurity as it affects 12.4% of preterm infants weighing under 1500g. Posthemorrhagic hydrocephalus (PHH) is an important complication of neonatal IVH and can have serious long-term consequences such as cognitive impairment and cerebral palsy. The purpose of this review is to determine whether stem cell transplantation can play a role in the treatment of neonatal IVH mainly focusing on the prevention of the catastrophic sequelae of neonatal IVH, as well as to the improve outcome of these patients. A literature search was performed using the PubMed/MEDLINE and Scopus databases, and after meticulous screening, eight articles were finally selected. The authors included both animal and human studies in this narrative review. Our review included eight articles, five animal studies and three human studies, including one phase 1 clinical trial, one pilot study, and one case report. Intraventricular transplantation of mesenchymal stem cells (MSCs) early after IVH diagnosis seems to prevent the development of PHH, improve myelination, and reduce periventricular cell death, inflammation, and reactive gliosis. It also seems to be a safe and well-tolerated procedure in preterm infants. Animal and human study findings regarding stem cell transplantation in the treatment of IVH show promising results in reducing the risk of PHH. Further research with larger series is needed to better determine its safety and efficacy. Larger studies such as randomized controlled trials could establish the efficacy and tolerability of the treatment.

Prospective Cohort Study Investigating Polyunsaturated Fatty Acids and Chronic Lung Disease in Preterm Infants.

Chronic lung disease (CLD) is a complication of prematurity. Studies examining the effects of long-chain polyunsaturated fatty acids (LC-PUFAs) on CLD are conflicting. This study investigated LC-PUFAs in the red blood cell membrane (RBCM) in preterm infants. This prospective observational study included infants with gestational age <32 weeks or birth weight <2 kg and at least one LC-PUFA measurement in the first month of life. Subjects without CLD (CON group) were compared to those with CLD (CLD group) and then by CLD severity. Seventy infants were included (CON n=29; CLD n=41). Twenty six infants had Grade 1 CLD; 12 had Grade 2 CLD; 3 had Grade 3 CLD. When the CLD group was compared to the CON group, the overall mean (95% confidence interval) RBCM% for linoleic acid (LA) was similar (CLD vs. CON 12.5% [11.7% - 13.4%] vs. 11.2% [10.2 - 12.3%] p=0.06) but the overall mean arachidonic acid (ARA) was lower (17.6% [17.1% - 18.0%] vs. 18.6% [18.1% - 19.2%], p<0.01). During weeks 1-4, LA% was similar, while ARA% was lower in weeks 2 and 3 (18.8% ± 2.2% vs. 20.0% ± 1.5%, p=0.05, 16.8% ± 2.0% vs. 18.3% ± 1.6%, p=0.01). A similar trend was noted when groups were compared by CLD severity. The CLD group had a higher overall mean ∝-linolenic acid (ALA) compared to the CON group (0.4% [0.3% - 0.4%] vs. 0.2% [0.2 % - 0.3%], p<0.01) but no difference in docosahexaenoic acid (DHA) (3.8% [3.4% - 4.1%] vs. 3.8% [3.4% - 4.3%], p=0.80). During weeks 1-4, ALA% was higher during week 1 only (0.4% ± 0.3% vs. 0.2% ± 0.1%, p<0.01), and DHA% was similar for weeks 1-4. Results were similar when groups were compared by CLD severity. In this study, low ARA status was associated with CLD.

Late postnatal steroid treatment using oral betamethasone can help to close ductus arteriosus in extremely preterm infants who cannot be weaned from ventilation

Late postnatal steroids are given to premature infants who cannot be weaned from ventilation because of the possible development of bronchopulmonary dysplasia (BPD). At that time, some infants still have a patent ductus arteriosus (PDA). In our experience, the use of betamethasone (BTM) seems to reduce the need for surgical/endovascular treatment of PDA. We evaluated herein the impact of oral BTM on PDA in extremely preterm infants with BPD. Extremely preterm infants (GA < 29 weeks) with PDA and treated with BTM to facilitate extubation/avoid reintubation were included in this retrospective, single-centre study. BTM was administered orally at 0.3 mg/kg/day for 3 days, 0.15 mg/kg/day the following 2 days, and 0.05 mg/kg/day on the last day. An echocardiography was performed before and after BTM treatment. The 51 infants included were born at a median [IQR] GA of 25.7 [25.0–26.7] weeks. At the time of BTM treatment (28 [26–30] days), 94.1% (48/51) were on invasive ventilation, and most (44/48, 91.7%) were extubated after BTM treatment. At that time, nearly all infants had a closed or non-haemodynamically significant PDA (50/51, 98.0%). None required surgical or endovascular treatment after BTM. Adverse effects included transient moderate hypertension (68.6%), transient hyperglycaemia (15.7%), and transient slowing of postnatal weight gain during BTM treatment.Conclusion: In extremely preterm infants with a severe respiratory condition at 3 weeks of life, oral BTM treatment can help wean invasive ventilation and is associated with PDA closure. It could reduce the need for surgical or endovascular treatment that are associated with serious adverse effects. Trial registration: Clinicaltrials.gov NCT05987202.What is Known:• Patent ductus arteriosus and bronchopulmonary dysplasia are two most frequent complications of extreme prematurity.• Betamethasone is one of the corticosteroids used to help wean invasive ventilation in infants at risk for bronchopulmonary dysplasia.What is New:• In extremely preterm infants still ventilated after 3 weeks of life and suffering from patent ductus arteriosus, treatment with oral betamethasone facilitated ventilatory weaning• Oral betamethasone treatment was associated with patent ductus arteriosus closure in almost all infants.

Single-Cell RNA Sequencing to Guide Autologous Preterm Cord Mesenchymal Stromal Cell-Therapy.

The chronic lung disease bronchopulmonary dysplasia (BPD) remains the most common complication of extreme prematurity (<28 weeks of gestation). Umbilical cord-derived mesenchymal stromal cells (UC-MSCs) represent an opportunity for autologous cell-therapy, as UC-MSCs have been shown to improve lung function and structure in experimental BPD. However, characterization and repair capacity of UC-MSCs derived from donors with pregnancy-related complications associated with prematurity remain unexplored. To characterize UC-MSCs' transcriptome and determine if pregnancy-related complications (preeclampsia and chorioamnionitis) alter their therapeutic potential. Single-cell RNA sequencing (scRNA-seq) was used to compare the transcriptome of UC-MSCs derived from five term donors, 16 preterm donors, and human neonatal dermal fibroblasts (HNDFs, control cells of mesenchymal origin), and correlated with their therapeutic potential in experimental BPD. Using publicly available neonatal lung single-nuclei RNA sequencing data, we also determined putative communication networks between UC-MSCs and resident lung cell populations. Most UC-MSCs displayed a similar transcriptome despite of their pregnancy-related conditions and mitigated hyperoxia-induced lung injury in newborn rats. Conversely, HNDFs, one term and two preeclampsia preterm UC-MSC donors exhibited a distinct transcriptome enriched in genes related to fibroblast function and senescence and were devoid of therapeutic benefit in hyperoxia-induced BPD. Conversely, therapeutic UC-MSCs displayed a unique transcriptome active in cell proliferation and distinct cell-cell interactions with neonatal lung cell populations, including NEGR and NRNX pathways. Term and preterm UC-MSCs are lung protective in experimental BPD. scRNA-seq allows to identify donors with a distinct UC-MSC transcriptome characteristic of reduced therapeutic potential.

Endoplasmic Reticulum Stress in Bronchopulmonary Dysplasia: Contributor or Consequence?

Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity. Oxidative stress (OS) and inflammation are the major contributors to BPD. Despite aggressive treatments, BPD prevalence remains unchanged, which underscores the urgent need to explore more potential therapies. The endoplasmic reticulum (ER) plays crucial roles in surfactant and protein synthesis, assisting mitochondrial function, and maintaining metabolic homeostasis. Under OS, disturbed metabolism and protein folding transform the ER structure to refold proteins and help degrade non-essential proteins to resume cell homeostasis. When OS becomes excessive, the endogenous chaperone will leave the three ER stress sensors to allow subsequent changes, including cell death and senescence, impairing the growth potential of organs. The contributing role of ER stress in BPD is confirmed by reproducing the BPD phenotype in rat pups by ER stress inducers. Although chemical chaperones attenuate BPD, ER stress is still associated with cellular senescence. N-acetyl-lysyltyrosylcysteine amide (KYC) is a myeloperoxidase inhibitor that attenuates ER stress and senescence as a systems pharmacology agent. In this review, we describe the role of ER stress in BPD and discuss the therapeutic potentials of chemical chaperones and KYC, highlighting their promising role in future therapeutic interventions.

Necrotizing enterocolitis following spontaneous intestinal perforation in very low birth weight neonates.

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are severe gastrointestinal complications of prematurity. The clinical presentation and treatment of NEC and SIP (peritoneal drain vs laparotomy) can overlap; however, the pathogenesis is distinct. Therefore, a patient initially treated for SIP can subsequently develop NEC. This phenomenon has only been described in case reports, and no risk factor evaluation exists. We evaluate clinical characteristics, risk factors, and outcomes of patients treated for a distinct episode of NEC after SIP. We performed a retrospective review of very low birth weight (<1500 g) neonates who presented with pneumoperitoneum between 07/2004 and 09/2022. Data was obtained from two separate neonatal intensive care units that were part of the same institution. Patients with an initial preoperative, intraoperative, or pathological diagnosis of NEC were excluded. Patients with an intraoperative diagnosis of SIP or preoperative diagnosis of SIP successfully treated with a peritoneal drain (PD) were evaluated. Patients subsequently treated (medically or surgically) for NEC after SIP were then compared to SIP-alone patients. Clinical characteristics included demographics, gestational age (GA), birth weight (BW), perinatal risk factors (chorioamnionitis, steroids, indomethacin), postoperative feeding regimen, and length of stay (LOS) were compared. Of the 278 patients included, 31 (11.2%) patients had NEC after SIP. There was no difference in GA (25 weeks vs 25 weeks, p = 0.933) or BW (760 g vs 735 g, p = 0.370) between NEC after SIP vs SIP alone cohorts, respectively. Twenty (64%) of NEC after-SIP patients were previously treated with LP. NEC after SIP occurred with a median onset of 56 days. Pneumatosis was the most frequent (81%) presenting symptom and 12 (39%) patients had hematochezia. Four (12.9%) patients required LP for NEC and all had NEC intraoperatively and on pathology. A majority (77.4%) of patients were on breast milk (BM) at time of NEC diagnosis. NEC after SIP patients had lower maternal age at delivery (29.0 vs 25.0, p = 0.055) and the incidence of NEC after LP (primary or failed drain) was higher than PD alone (16.7% vs 6.2%, p = 0.007). NEC after SIP patients had longer LOS (135 vs 81, p < 0.001). We report an 11.2% incidence of NEC at a median of 56 days following successful treatment of SIP, resulting in increased LOS. SIP patients are a high-risk cohort and protocols to prevent this phenomenon should be investigated.

Preterm birth is associated with dystonic features and reduced cortical parvalbumin immunoreactivity in mice.

Preterm birth is a common cause of dystonia. Though dystonia is often associated with striatal dysfunction after neonatal brain injury, cortical dysfunction may best predict dystonia following preterm birth. Furthermore, abnormal sensorimotor cortex inhibition is associated with genetic and idiopathic dystonias. To investigate cortical dysfunction and dystonia following preterm birth, we developed a new model of preterm birth in mice. We induced preterm birth in C57BL/6J mice at embryonic day 18.3, ~24 h early. Leg adduction variability and amplitude, metrics we have shown distinguish between dystonia from spasticity during gait in people with CP, were quantified from gait videos of mice. Parvalbumin-positive interneurons, the largest population of cortical inhibitory interneurons, were quantified in the sensorimotor cortex and striatum. Mice born preterm demonstrate increased leg adduction amplitude and variability during gait, suggestive of clinically observed dystonic gait features. Mice born preterm also demonstrate fewer parvalbumin-positive interneurons and reduced parvalbumin immunoreactivity in the sensorimotor cortex, but not the striatum, suggesting dysfunction of cortical inhibition. These data may suggest an association between cortical dysfunction and dystonic gait features following preterm birth. We propose that our novel mouse model of preterm birth can be used to study this association. Mouse models of true preterm birth are valuable for studying clinical complications of prematurity. Mice born preterm demonstrate increased leg adduction amplitude and variability during gait, suggestive of clinically observed dystonic gait features. Mice born preterm demonstrate fewer parvalbumin-positive interneurons and reduced parvalbumin immunoreactivity in the sensorimotor cortex, suggesting dysfunction of cortical inhibition. Mice born preterm do not demonstrate changes in parvalbumin immunoreactivity in the striatum. Cortical dysfunction may be associated with dystonic gait features following preterm birth.

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

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. To investigate EF practices and related nutrition factors, patterns, and outcomes in preterm infants in Saudi Arabia by examining studies published in this area. 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. 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. 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.

Assessment Of Fetal Maturity At Various Gestational Ages Using Modified Dubowitz Scoring System

Objective: Using a modified Dubowitz scoring system, evaluate and compare the maturity of neonates born at different gestational ages into three groups: 28+0 to 35+6 weeks, 36+0 to 36+6 weeks, and 37+0 to 37+6 weeks. Methods: This prospective observational research was carried out at Holy Family Hospital, Rawalpindi, in units 1 and 2 of the Department of Obstetrics and Gynaecology. The research covered all neonates born between 28+0 and 37+6 weeks of gestation. Following clearance from the ERB and authorization from the hospital administration, data collecting began. After the informed consent of the parent /guardian of the neonate, a detailed maternal and neonatal history was taken including demographic data and obstetric history. All neonates enrolled in the study were divided into three groups. Group A include neonates delivered between 28+0 - 35+6 weeks. Group B includes neonates delivered between 36+0 - 36+6 weeks and group C includes neonates delivered between 37+0 - 37+6 weeks. Fetal maturity of all three groups was estimated by using Modified Dubowitz scoring and secondary fetal outcomes (Birth weight, APGAR score &amp; complications of prematurity) were also measured. Data was entered on pre-designed proforma. Results: SPSS version 25 was used to enter and evaluate the data. Determining neonatal maturity using a modified Dubowitz scoring system was the main result. The assessment of birth weight, APGAR score, and preterm problems are secondary fetal outcomes. Conclusion: According to the study's findings, newborns of varying gestational ages can benefit from using the Modified Dubowitz score as a valuable tool to predict fetal development. Additionally, the study finds that the idea of the early maturation of Asian populations in our community is valid. This will help us make decisions on whether to do iatrogenic preterm births in complex circumstances.

Temporal Dynamics of Oxidative Stress and Inflammation in Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common lung complication of prematurity. Despite extensive research, our understanding of its pathophysiology remains limited, as reflected by the stable prevalence of BPD. Prematurity is the primary risk factor for BPD, with oxidative stress (OS) and inflammation playing significant roles and being closely linked to premature birth. Understanding the interplay and temporal relationship between OS and inflammation is crucial for developing new treatments for BPD. Animal studies suggest that OS and inflammation can exacerbate each other. Clinical trials focusing solely on antioxidants or anti-inflammatory therapies have been unsuccessful. In contrast, vitamin A and caffeine, with antioxidant and anti-inflammatory properties, have shown some efficacy, reducing BPD by about 10%. However, more than one-third of very preterm infants still suffer from BPD. New therapeutic agents are needed. A novel tripeptide, N-acetyl-lysyltyrosylcysteine amide (KYC), is a reversible myeloperoxidase inhibitor and a systems pharmacology agent. It reduces BPD severity by inhibiting MPO, enhancing antioxidative proteins, and alleviating endoplasmic reticulum stress and cellular senescence in a hyperoxia rat model. KYC represents a promising new approach to BPD treatment.

Sacrococcygeal Teratoma: Tales of the “Tailbone” Tumour in a Newborn

Sacrococcygeal teratoma (SCT) is a rare tumour with a low incidence, but it is the most common extragonadal tumour in the newborn. It occurs at the base of the coccyx (tailbone) and is derived from embryonic germ cell layers. Although the majority are benign in nature, they are associated with significant morbidity and mortality for the mother and the foetus. A multidisciplinary approach is needed where an accurate early diagnosis should be made antenatally, leading to anticipation of complications during intrapartum for the mother and foetus, and ultimately early, complete surgical excision of the tumour. The prognosis for survival is good after resection. We report a case of a newborn delivered at 29 weeks who was diagnosed with SCT at post-partum but unfortunately passed away due to the complications of prematurity before surgery could be performed. This case report highlights the literature review of this pathology, especially the management of SCT, which begins in the antenatal period soon after the diagnosis is made.

THE NEONATAL PERIOD OF EXTREMELY PREMATURE NEWBORNS ON THE BACKGROUND OF PREMATURE RUPTURE OF THE MEMBRANE - POSSIBILITY OF OBSTETRICAL INFLUENCE

Premature rupture of the amniotic membranes is the cause of one third of premature births, it is especially critical in extremely premature pregnancies, when prologation of expectant tactics increases the risk of intrauterine infection. The purpose of the study is to study the clinical effectiveness of the management algorithm for pregnant women with preterm membrane rupture in extremely premature pregnancy. Research material and methods. The study included pregnant women with preeclampsia in the gestational period of 25-27 weeks. 34 patients of group I received help according to the clinical protocol of the Ministry of Health, in 35 pregnant women of group II, the concentration of glucose in amniotic fluid less than 0.5 μmol/l, regardless of the presence of other criteria for chorioamnionitis, was an indication for delivery. In both groups, the mortality of newborns up to 7 days and up to 28 days of life, the main neonatal complications, as well as the features of ventilation support were analyzed. Results and their discussion. Choosing the time of delivery based on the determination of the reduced content of glucose in the amniotic fluid allows you to prevent the development of pneumonia, complications of prematurity - necrotic enterocolitis and periventricular hemorrhages, reduce the time required for ventilation support and additional oxygen supply. Conclusions: 1.Improved tactics of management of patients with PRPO in extremely premature terms allows to reduce the frequency of not only complications of prematurity associated with infection - congenital pneumonia (from 52.9% to 27.9%), skin manifestations of the infectious process (from 44.1 % to 20.0%), pronounced leukocytosis (from 58.9% to 37.1%), but also other diseases of the neonatal period - NEC (from 29.4% to 2.8%), BPD (from 52.9 % to 34.3%) and PVC (from 58.9% to 28.6%).2. Choosing the time of delivery based on the determination of the reduced amniotic concentration made it possible to reduce the duration of invasive (from 6.1 to 3.4 days) and non-invasive ventilation (from 21.8 to 18.0 days), as well as additional oxygen supply during non-invasive ventilation ( from 7.9 to 3.4 days).

The Impact of Oral Maternal Colostrum Administration on the Immune System of Premature Babies

In children under five years of age, premature complications are now the second leading cause of death. Colostrum has important benefits in promoting the maturity of premature infants' organ functions and preventing infections. Preterm infants are recommended to be given colostrum orally and pharyngeally as early as possible after birth to provide immune protective effects for their bodies. However, the sucking and swallowing functions of preterm infants are often not optimal, partly due to comorbidities, which poses a significant challenge. As a result, the immune system of preterm infants is often low. This literature review aimed to evaluate the effect of oropharyngeal colostrum feeding through subgroup analysis based on complications. Descriptive research was conducted in April-June 2024 using the literature review method with PRISMA guidelines for RCTs. Literature sources were obtained from Pubmed (MEDLINE), Science Direct, Google Scholar, and Cochrane with a publication limit of the last ten years (2014-2023). Of the 1,657 results, 13 articles met the criteria. A total of 1,451 preterm infants were included in the 13 RCT studies. Results showed a lower incidence of late-onset sepsis and Necrotizing Enterocolitis (NEC) in the group that received oropharyngeal colostrum. The administration of oropharyngeal colostrum was shown to have a positive impact on the development and defense of the immune system of preterm infants, reduce health problems such as sepsis and NEC, accelerate the recovery of birth weight, and reduce the incidence of mortality.

Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis.

Evidence supporting the benefits of delayed cord clamping is increasing; however, there is no clear recommendation on cord management during newborn resuscitation. This study aimed to investigate the effects of resuscitation initiated with an intact umbilical cord, hypothesizing it is a safe stabilization procedure that improves neonatal outcomes. Systematic search was conducted in MEDLINE, Embase, CENTRAL, and Web of Science from inception to March 1, 2024. Eligible articles compared neonatal outcomes in newborns receiving initial stabilization steps before and after cord clamping. Twelve studies met our inclusion criteria, with six RCTs included in the quantitative analysis. No statistically significant differences were found in delivery room parameters, in-hospital mortality, or neonatal outcomes between the examined groups. However, intact cord resuscitation group showed higher SpO2 at 5 min after birth compared to cord clamping prior to resuscitation group (MD 6.67%, 95% CI [-1.16%, 14.50%]). There were no significant differences in early complications of prematurity (NEC ≥ stage 2: RR 2.05, 95% CI [0.34, 12.30], IVH: RR 1.25,95% CI [0.77, 2.00]). Intact cord management during resuscitation appears to be a safe intervention; its effect on early complications of prematurity remains unclear. Further high-quality RCTs with larger patient numbers are urgently needed. Initiating resuscitation with an intact umbilical cord appears to be a safe intervention for newborns. No statistically significant differences were found in delivery room parameters, in-hospital mortality, and neonatal outcomes between the examined groups. The utilization of specialized resuscitation trolleys appears to be promising to reduce the risk of intraventricular hemorrhage in preterm infants. Further high-quality RCTs with larger sample sizes are urgently needed to refine recommendations.

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.