Preterm Infants Research Articles

Clinical profile of neonatal jaundice patients admitted in a tertiary care hospital in Khulna, Bangladesh

Background: A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in an otherwise healthy term infant is the most common reason for readmission to the hospital. Therefore, it is necessary to evaluate different aspects of neonatal jaundice in our clinical setup. Objective: The objective of this research was to find out different associated causes, clinical features, and treatment options for neonatal jaundice. Methods: A cross-sectional study was conducted in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh with a total number of 140 neonates with jaundice from January 2018 to January 2021. All data were collected and analyzed prospectively. Convenient purposive sampling was the sampling method. Results: In this study, 79.2% of neonates were full-term and 20.8% were preterm neonates. Physiological jaundice (33.5%) was found as the commonest type. Jaundice with infection was associated with 32.8% of cases. Jaundice with umbilical redness, discharge, and/or foul-smelling (17.9%), and reluctance to feed were commonly associated symptoms. Hepatomegaly and splenomegaly were detected in 7.1% and 3.6% neonates respectively. Phototherapy was given in 61% of cases and 17.8% (25) cases exchange therapy was required. In neonates with physiological jaundice, phototherapy was recommended for most of the cases. In the case of ABO and Rh incompatibility, exchange therapy was required most often along with phototherapy. Conclusion: Physiological jaundice is the most common pattern of neonatal jaundice. Most often, neonatal jaundice may co-exist with neonatal infections. In most cases, phototherapy is required along with or without exchange therapy, depending upon the associated causes and conditions. Mediscope 2024;11(2): 58-61

Thermal equilibrium as a predictor of growth efficiency in preterm infants

IntroductionProviding adequate nutrition to preterm infants to achieve postnatal growth similar to intrauterine growth remains challenging due to the unpredictability of individual determinants.Material and methodsWe used a calculation program for infant incubators to compare the estimated heat balance with the caloric intake and growth rate in Very Low Birth Weight Infants (VLBWI).Results and discussionA group of 32 VLBWI was studied over a period of 14–28 days. An interrelationship between thermal equilibrium and growth rate was observed, with standardized incubator settings being unable to avoid periods of negative thermal balance and concomitantly poor growth rate.ConclusionDetermining personalized incubator settings by means of a calculation program could help improve nutrition and growth in preterm infants.

Association of furosemide versus chlorothiazide exposures with serum sodium, potassium, and chloride among infants with bronchopulmonary dysplasia.

To examine the association of novel furosemide versus thiazide diuretic exposure with changes in serum sodium, potassium, and chloride levels among infants with grade 2/3 bronchopulmonary dysplasia (BPD). Retrospective cohort study of infants admitted to a level IV neonatal intensive care unit (NICU) with grade 2/3 BPD. We measured within-subject change in serum sodium, potassium, and chloride before and after diuretic initiation using multivariable regression to adjust for differences in dosing and clinical covariates. We identified 94 infants contributing 137 novel diuretic exposures. No significant difference was noted in the association between chlorothiazide versus furosemide and serum sodium, potassium, or chloride change in multivariable modeling. Changes in serum electrolytes were similar for chlorothiazide and furosemide, questioning the perception that chlorothiazide leads to less electrolyte derangement among preterm infants with grade 2/3 BPD.

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

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

Formula protein versus human milk protein and the effects on growth in preterm born infants

Purpose of review This review aims to evaluate the latest available evidence on the differences between human milk proteins versus infant formula proteins and its effects on growth and development in preterm infants. Recent findings High protein intake supports initial growth in preterm infants, although the long-term benefits remain unclear. Human milk requires adequate fortification to meet nutritional needs of preterm born infants. Formula feeding, with its higher protein content, may accelerate early weight gain but also increases the risk of necrotizing enterocolitis. Current evidence showed no significant advantages of human milk-derived fortifiers over bovine milk-derived fortifiers. Furthermore, studies published during the review period do not provide new evidence that alters the existing understanding of differences in neurodevelopmental outcomes between infants fed human milk and those fed formula. Summary Both fortified human milk and preterm formula support growth in preterm infants, but human milk offers additional protective benefits, such as reducing the risk of necrotizing enterocolitis, making it the preferred option. Balancing immediate growth needs with potential long-term developmental outcomes remains crucial, highlighting the need for further research to determine the optimal protein intake for preterm infants.

Metabolomic profiling of human feces and plasma from extrauterine growth restriction infants.

Extrauterine growth restriction (EUGR) affects a substantial proportion of preterm infants and may influence both short-term complications and long-term sequelae. While many preterm infants with EUGR are secondary to small for gestational age (SGA) or very low birth weight (VLBW), a subset of EUGR infants do not exhibit these conditions. The purpose of this study is to investigate the metabolic profiles and biomarkers of EUGR infants in the absence of SGA and VLBW. A total of 100 feces (n = 50) and plasma samples (n = 50) were collected from participants categorized as either EUGR (EUGR group) or non-EUGR (NonEUGR group) in the absence of SGA and VLBW. Metabolites were characterized via UPLC-MS/MS using the Discovery HD4® platform. Data normalization, partial least squares discriminant analysis (PLSDA), and KEGG enrichment analysis of metabolite profiles were performed using the MetaboAnalyst 6.0. The clinical characteristics of preterm infants differed significantly between the EUGR and NonEUGR groups at discharge, including length of stay, weight Z-score, weight, height Z-score, height, head circumference, and fat-free mass. The PLSDA model exhibited clustering within groups and separation between groups. A total of 58 and 71 differential metabolites were identified in feces and plasma samples, respectively. They were involved in pathways such as caffeine, galactose, glutathione, cysteine, and methionine metabolisms. In the feces sample, 1-palmitoyl-galactosylglycerol exhibited a significant negative correlation with the growth characteristics of preterm infants, while 1-palmitoyl-2-palmitoleoyl-GPC displayed the opposite pattern. In plasma samples, androsterone glucuronide displayed a significant positive correlation with the growth characteristics of preterm infants, whereas 2-methoxyhydroquinone sulfate generated an opposite pattern. Moreover, 2-oleoylglycerol and sphinganine-1-phosphate exhibited the highest area under the curve in feces and plasma samples, respectively, according to diagnostic ROC curves. Preterm infants with EUGR, in the absence of SGA and VLBW, exhibit specific clinical characteristics and metabolomic profiles. Sphinganine-1-phosphate and 2-oleoylglycerol may hold promise as diagnostic markers for EUGR in the absence of SGA and VLBW. The objective of this study is to identify the differential metabolites in preterm infants with extrauterine growth restriction (EUGR) in the absence of small for gestational age (SGA) or very low birth weight (VLBW). Preterm infants with EUGR without SGA and VLBW exhibit specific clinical characteristics and metabolomic profiles. Sphinganine-1-phosphate and 2-oleoylglycerol emerged as potential diagnostic biomarkers for EUGR. This study enhances our understanding of the metabolomic profile in preterm infants with EUGR without SGA or VLBW. Our findings will offer valuable evidence for improving nutritional management and shedding light on the associated pathophysiological mechanisms of EUGR.

Point-of-care lung ultrasound for continuous positive airway pressure discontinuation in preterm infants.

To determine if the lung ultrasound score (LUS) is predictive of successful continuous positive airway pressure (CPAP) discontinuation in preterm neonates born <32 weeks' gestation with history of respiratory distress syndrome. Retrospective study of preterm infants requiring CPAP. Univariate and multivariate logistic regression performed to formulate a predictive score using clinical variables with and without LUS. Area under the curve (AUC) was compared to determine the added predictive ability of LUS. Forty-one patients with discontinuation attempts associated with a LUS were included. Lower LUS obtained within 0-7 days prior to CPAP discontinuation was associated with successful CPAP discontinuation (OR 0.46 [0.23, 0.91]; p = 0.025). Cross-validated AUC for clinical variables alone (Model 1) was 0.85 (95% CI: 0.74-0.93) versus 0.90 (95% CI: 0.81-0.97) when LUS was incorporated (Model 2, p < 0.001). AUC of LUS alone was 0.83 (95% CI: 0.68-0.93, p < 0.0001). In preterm infants requiring CPAP, LUS aids in the prediction of successful CPAP discontinuation and may significantly improve a predictive tool.

Vitamin D for very preterm infants-determining the how, when, and why.

A recent survey study found that 400 IU/day vitamin D is the most common dose in United States neonatal intensive care units. Results of clinical trials are inconsistent, and, therefore, have not determined the optimal vitamin D dose for efficacy and safety in the neonatal intensive care unit. Future studies must consider the unique attributes of perinatal vitamin D metabolism and the potential role of vitamin D in immune function and organ development. IMPACT: Preterm infant vitamin D metabolism is a complex yet important area of research.

Editorial: Postnatal brain development in moderate and late preterm infants: challenges and context-relevant interventions

Editorial: Postnatal brain development in moderate and late preterm infants: challenges and context-relevant interventions

Oscillatory blood pressure values in newborn infants: observational data over gestational ages.

Normative blood pressure (BP) values on preterm infants exist but are based on small cohorts of infants. Utilizing electronic medical records (EMR), we can explore earlier gestational ages (GA) and follow their progression to 40 weeks corrected gestational age (CGA). A retrospective cohort study of infants within the SSM Health System from 7/01/2013 through 6/30/2023. Infants born at >22 0/7 weeks but < 41 weeks GA were included if any BP measurements existed (n=29,323 infants, 1.4 million BPs). Data was extracted electronically from EMR using Microsoft SQL. Systolic BP (SBP), mean arterial pressures (MAP), and Diastolic BP (DBP) were determined for each week of life from birth and percentile ranges (1st to 99th) for infants alive at CGA, and BP patterns for GA determined. Percentiles for SBP, DBP and MAP are provided. There is a rapid increase in BP at all gestations during the first two weeks, thus BP values are higher at any CGA in infants born at an earlier GA than infants born at that GA. For MAP values between the 5th and 10th percentile, the GA is appropriate for first week then use CGA + 5 mmHg. After the first week, 2.8 X CGA is between 90 and 95 percentile for SBP. . . The BP is dependent on the gestational age at birth and the corrected gestational age when it is measured. SBP, MAP, and DBP all increase rapidly in the two weeks of life prior to a gradual increase over time.

Family Nurture Intervention and mother-preterm infant autonomic emotional connection in the neonatal intensive care unit: A review.

We review methods and outcomes of a novel parenting intervention, Family Nurture Intervention (FNI), that promotes early mother-infant autonomic co-regulation and emotional connection in the neonatal intensive care unit (NICU). FNI involves individualised mother-infant calming sessions combined with maternal emotional expression. Two parallel group randomised controlled trials have evaluated FNI. The first,recruited 150 preterm newborns (26-34 weeks GA) and their mothers, randomised into two groups: FNI (n = 78) and Standard Care (SC) only (n = 72). Dyadic, infant and maternal outcomes were assessed at discharge, 18-months and 4-5 years corrected age. The second,recruited 135 infants from two level 4 NICUs (FNI n = 66, SC n = 69) with similar outcomes assessed at discharge/term equivalent. Relative to SC, FNI infants showed improved development and relational health through 5 years. At term age, FNI infants had better autonomic regulation and more mature brain activity and cortical connectivity on EEG. FNI mothers also reported fewer anxiety and depression symptoms post-discharge. At 18-month, FNI infants obtained higher cognitive and language scores, and lower attention and social behaviour scores than SC infants. FNI improves the early life development and relational health of high-risk preterm infants. Further research is important to assess its efficacy in other high-risk populations and contexts.

Effect of hospital nutrition program on growth of very low birth weight preterm babies.

Objective: To determine the effect of hospital nutrition program on growth of very low birth weight (VLBW) and extremely low birth weight (ELBW) babies. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of Recep Tayyep Erdogan Hospital, Muzaffargarh, Pakistan. Period: February 2024 to July 2024. Methods: Inclusion criteria were preterm newborns weighing below 1500 grams, admitted in NICU and who received total parenteral nutrition (TPN). VLBW was labeled as birth weight between 1000-1499 grams, while ELBW as birth weight &lt;1000 grams. Hospital nutrition program included TPN plus orogastric feed or nasogastric feeding plus micronutrients. Effect of hospital nutrition program was described as effective if the baby at the time of discharge added 17-20 g/kg/day according to ESPHGAN recommendation. Results: In a total of 131 newborns, 69 (52.7%) were boys. The mean gestational age, and birth weight were 29.68±1.87 weeks, and 1024.50±144.23 grams, respectively. The mean net daily weight gain at the time of discharge was 12.77±3.63 grams. The effective hospital nutrition program was noted in 23 (17.6%) babies. Effectiveness of hospital nutrition program was significantly associated with higher birth weight (1094.78±114.41 vs. 1009.54±145.93 grams, p=0.010), very low birth weight versus extremely low birth weight (87.0% vs. 13.0%, p&lt;0.001), head circumference ≥30 cm (87.0% vs. 53.7%, p=0.003), and gestational age &gt; 28 weeks (87.0% vs. 57.4%, p=0.008). Conclusion: The hospital nutrition program had limited effectiveness, with only 17.6% of VLBW and ELBW infants achieving the recommended weight gain by discharge.

Predictors of Nasal Continuous Positive Airway Pressure Failure in Preterm Infants With Respiratory Distress Syndrome

Respiratory support in infants with respiratory distress syndrome (RDS) plays an important role in the reduction of mortality and complications, but the treatment fails in some infants. This study aimed to identify the predictors of continuous positive airway pressure (CPAP) failure in preterm infants with RDS. This cross-sectional retrospective study was conducted on RDS-diagnosed preterm infants admitted to the neonatal intensive care unit of Fatemieh Hospital (Hamadan city) in 2021-2022. The infants were examined in terms of risk factors for CPAP failure. Data extracted from the medical records were recorded in a checklist and analyzed with SPSS version 21 software at a confidence level of 95%. CPAP failure was recorded in 37.6% of the studied 202 infants. The need for resuscitation at birth, low gestational age, low birth weight, multiple births, low 1-min and 5-min Apgar scores, the need for higher FIO2 and PEEP, acidosis, and the need for surfactant administration were significantly associated with CPAP failure. In logistic regression, low gestational age (OR 1.30, 95% CI: 1.082-1.576) and the need for resuscitation at birth (OR 0.426, 95% CI: 0.202-0.898) were the major predictors of CPAP failure. Lower gestational age and the need for PPV in the delivery room are good predictors of CPAP failure in preterm infants with RDS, who receive nasal CPAP as primary respiratory support.

Investigation of Prognosis and Related Factors of Premature Neonates

The birth of premature infants remains a challenge in many societies. This cross-sectional study investigates prenatal care and influential factors in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of Fatemieh Educational-Medical Center in Hamadan, Iran, from March 2018 to March 2019. We examined premature infants with a gestational age of less than 37 weeks who were admitted to the NICU. Data on demographic and maternal characteristics, length of hospital stay, maternal underlying diseases, probable causes of preterm birth, neonatal complications, treatment types, treatment-related complications, resuscitation needs, ventilation, and mortality rates were extracted from patient records. Among 388 preterm infants studied, 204 (52.6%) were female. The mean gestational age was 31.8±2.8 weeks, birth weight was 1647.4±625.6 grams, and average hospital stay was 10.2±9.3 days. The most common maternal underlying disease was pregnancy-induced hypertension or preeclampsia (22.2%), respiratory distress syndrome, jaundice, and low birth weight were the leading reasons for hospitalization (84%). Neonatal outcomes included 92 (23.7%) deaths, 25 (6.4%) intraventricular hemorrhages, 39 (10.1%) patent ductus arteriosus cases, 20 (5.2%) bronchopulmonary dysplasia cases, and 41 (10.6%) retinopathy of prematurity cases. Regression analysis revealed significant predictors of neonatal mortality, including male gender, maternal underlying diseases, need for cardiopulmonary resuscitation, low Apgar score at one-minute, lower birth weight, shorter gestational age, and NICU stay duration. This study underscores the high neonatal mortality rate among preterm infants. Implementing preventive measures, particularly addressing maternal underlying diseases and low birth weight, can significantly reduce neonatal mortality.

Markers of intracellular energy supply under conditions of hypoxia in premature babies

Markers of intracellular energy supply under conditions of hypoxia in premature babies

Assessment and Early Intervention in the Neonatal Intensive Care Unit for a Preterm Infant With Williams Syndrome

Assessment and Early Intervention in the Neonatal Intensive Care Unit for a Preterm Infant With Williams Syndrome

Screen Time dan Kualitas Tidur dengan Kadar Hemoglobin pada Remaja Putri

Iron anemia is the biggest macro nutritional problem in Indonesia, which occurs in toddlers, pregnant women and adolescent girls. Adolescent girls with anemia are at risk of giving birth to LBW babies (&lt;2500 grams), giving birth to premature babies, neonatal infections and death in the baby's mother during delivery. The aim of this study was to analyze the relationship between screen time and sleep quality with hemoglobin levels in adolescent girls. This research method uses quantitative observational research with a cross-sectional design and a sample size of 76 respondents using a purposive sampling technique. The results of this study show that 55 respondents (72.4%) had normal hemoglobin levels and 21 respondents (27.6%) had poor hemoglobin levels. The bad screen time category was 40 respondents (52.6%) and the good one was 36 respondents (47.4%). And the category of poor sleep quality was 57 respondents (75.0%) and good sleep quality was 19 respondents (25%). The results of this study showed that there was no relationship between screen time and sleep quality and hemoglobin levels in young women at SMA Karya Bakti and SMKN 6 Palu.

Screen Time dan Kualitas Tidur dengan Kadar Hemoglobin pada Remaja Putri

Iron anemia is the biggest macro nutritional problem in Indonesia, which occurs in toddlers, pregnant women and adolescent girls. Adolescent girls with anemia are at risk of giving birth to LBW babies (&lt;2500 grams), giving birth to premature babies, neonatal infections and death in the baby's mother during delivery. The aim of this study was to analyze the relationship between screen time and sleep quality with hemoglobin levels in adolescent girls. This research method uses quantitative observational research with a cross-sectional design and a sample size of 76 respondents using a purposive sampling technique. The results of this study show that 55 respondents (72.4%) had normal hemoglobin levels and 21 respondents (27.6%) had poor hemoglobin levels. The bad screen time category was 40 respondents (52.6%) and the good one was 36 respondents (47.4%). And the category of poor sleep quality was 57 respondents (75.0%) and good sleep quality was 19 respondents (25%). The results of this study showed that there was no relationship between screen time and sleep quality and hemoglobin levels in young women at SMA Karya Bakti and SMKN 6 Palu.

Risk factors for and short-term prognosis of intrauterine infection in preterm infants.

To identify the risk factors for and short-term prognosis of intrauterine infection (IUI) in preterm infants. We retrospectively collected clinical data regarding preterm infants (28+0-36+6 weeks of gestational age) with IUI from the neonatal intensive care unit of our hospital between June 2017 and June 2022. The pathologic characteristics of the infants were classified using the Redline criteria, and the resulting groups were compared with respect to their clinical characteristics, indicators of infection, complications, and mortality rates. Three hundred thirty (78.1%) of the 422 enrolled neonates showed signs of histologic IUI; 51.8% showed histologic chorioamnionitis alone, and 48.2% showed both histologic chorioamnionitis and funisitis. The independent risk factors identified for IUI were maternal prenatal invasive manipulation, premature rupture of membranes (>18 hours before labor), and prenatal C-reactive protein concentration. The infants with IUI showed higher incidences of respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, and prolonged mechanical ventilation. Low gestational age and low birth weight of preterm infants were significantly associated with a higher incidence of histologic IUI, more severe inflammation, and a higher incidence of complications. Histologic IUI is associated with high complication and mortality rates in preterm infants, as is an increasing severity of inflammation.

Impact of non-invasive ventilation on microbial colonisation patterns in preterm infants: a single-centre study.

The objective of this study is to assess the relationship between non-invasive ventilation (NIV) and the colonisation of oral and nasal microbiota in preterm infants within the neonatal intensive care unit (NICU). A prospective cohort study. The NICU of Zhejiang University Children's Hospital. Patients include preterm infants with a gestational age of 28-35 weeks, enrolled within the first 24 hours of life. Infants were categorised based on respiratory support: NIV, which included nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation or high-flow nasal cannula; and no respiratory support, defined as room air or low-flow nasal cannula at ≤2 L/min. The primary outcome was the colonisation of oral and nasal microbiota at 5 days post birth, measured by colony-forming units per millilitre (CFU/mL), with colonisation defined as bacterial growth >103 CFU/mL. The study included 100 preterm infants, with 50 in each group. Nasal microbial colonisation was observed in 56% (28/50) of the NIV group, significantly higher than the 28% in the no respiratory support group. No significant differences were found in oral colonisation. Adjusted binary logistic regression showed an association between NIV and increased risk of nasal colonisation (adjusted OR=2.91, 95% CI 1.12 to 7.58, p=0.028). NIV in preterm infants was linked to a higher risk of nasal microbial colonisation. This finding suggests the need for further research and consideration of infection control strategies in the NICU.