Risk Preterm Infants Research Articles

Perinatal Hypoxia-Inducible Factor Stabilization Preserves Lung Alveolar and Vascular Growth in Experimental Bronchopulmonary Dysplasia.

Rationale: Antenatal inflammation with placental dysfunction is strongly associated with high bronchopulmonary dysplasia (BPD) risk in preterm infants. Whether antenatal or postnatal HIF (hypoxia-inducible factor) augmentation can preserve lung structure and function and prevent pulmonary hypertension after intrauterine inflammation is controversial.Objectives: To determine whether antenatal or postnatal prolyl-hydroxylase inhibitor (PHi) therapy increases lung HIF expression, preserves lung growth and function, and prevents pulmonary hypertension in a rat model of chorioamnionitis-induced BPD caused by antenatal inflammation.Methods: Endotoxin (ETX) was administered to pregnant rats by intraamniotic injection at Embryonic Day 20, and pups were delivered by cesarean section at Embryonic Day 22. Selective PHi drugs, dimethyloxalylglycine or GSK360A, were administered into the amniotic space at Embryonic Day 20 or after birth by intraperitoneal injection for 2 weeks. Placentas and lung tissue were collected at birth for morphometric and Western blot measurements of HIF-1a, HIF-2a, VEGF (vascular endothelial growth factor), and eNOS (endothelial nitric oxide synthase) protein contents. At Day 14, lung function was assessed, and tissues were harvested to determine alveolarization by radial alveolar counts, pulmonary vessel density, and right ventricle hypertrophy (RVH).Measurements and Main Results: Antenatal PHi therapy preserves lung alveolar and vascular growth and lung function and prevents RVH after intrauterine ETX exposure. Antenatal administration of PHi markedly upregulates lung HIF-1a, HIF-2a, VEGF, and eNOS expression after ETX exposure.Conclusions: HIF augmentation improves lung structure and function, prevents RVH, and improves placental structure following antenatal ETX exposure. We speculate that antenatal or postnatal PHi therapy may provide novel strategies to prevent BPD due to antenatal inflammation.

Oral Care Prevents Late-Onset Sepsis in Risk Preterm Infants

The incidence of infections in preterm infants is still quite high. In this study, oral care with human breast milk was implemented in risk preterm infants as a precaution. The study was conducted using a quasi-experimental method with a non- equivalent control group and posttest only design in 40 risk preterm infants. The participants were divided into two groups of 20. The data were analyzed using independent t-test and a Wilcoxon test. The results show that this intervention has an effect on the incidence of late-onset sepsis in preterm infants. The effect is based on symptoms: body temperature instability ( p = 0.021), C-reactive protein ( p = 0.006), and leukocytes ( p = 0.020) all indicated differences between the two groups. It is recommended that this practice be adopted as a routine therapy program in perinatology. Keywords: exclusive breastfeeding, late-onset sepsis, oral care, risk preterm infants, sepsis Abstrak Perawata n Mulut Mencegah Sepsis Neonatorum Awitan Lambat pada Bayi Prematur Risiko Tinggi. Angka kejadian infeksi setelah lahir pada bayi prematur masih cukup tinggi. Pelaksanaan intervensi pemberian oral care menggunakan air susu ibu pada bayi prematur risiko tinggi telah dilakukan sebagai pencegahan. Penelitian dilakukan menggunakan metode kuasi eksperimen dengan desain post-test only, kelompok kontrol non ekuivalen, pada 40 bayi prematur risiko tinggi sebagai sampel. Responden dibagi menjadi dua kelompok, masing-masing kelompok 20 responden. Data dianalisis menggunakan uji t independen dan wilcoxon. Hasil Intervensi ini terbukti memiliki manfaat terhadap dalam menurunkan kejadian sepsis neonatorum awitan lambat pada bayi prematur berdasarkan tanda klinis seperti ketidakstabilan suhu tubuh (p value 0,021), hasil pemeriksaan C-Reaktif Protein (p value 0,006) dan leukosit (p value 0,020) yang menunjukkan adanya perbedaan yang bermakna antara kelompok kontrol dan kelompok intervensi. Intervensi ini diharapkan dapat dilanjutkan menjadi program terapi rutin yang akan dilakukan di ruang rawat perinatologi. Kata Kunci: ASI eksklusif, bayi prematur, oral care, sepsis, sepsis neonatorum awitan lambat

Oral Care Prevents Late-Onset Sepsis in Risk Preterm Infants

Oral Care Prevents Late-Onset Sepsis in Risk Preterm Infants

Indole-3-lactic acid, a metabolite of tryptophan, secreted by Bifidobacterium longum subspecies infantis is anti-inflammatory in the immature intestine.

Background:Necrotizing enterocolitis (NEC), a necrotic inflammation of the intestine, represents a major health problem in the very premature infant. Although prevention is difficult, the combination of ingestion of maternal-expressed breastmilk in conjunction with a probiotic provides the best protection. In this study, we establish a mechanism for breastmilk/probiotic protection.Methods:Ultra-high-performance liquid chromatography-tandem mass spectrometry of B. infantis secretions was used to identify an anti-inflammatory molecule. Indole-3-lactic acid (ILA) was then tested in an established human immature small intestinal cell line, necrotizing colitis enterocytes and other immature human enteroids for anti-inflammatory effects and to establish developmental function. ILA was also examined in immature and mature enterocytes.Results:We have identified indole-3-lactic acid, a metabolite of breastmilk tryptophan, as the anti-inflammatory molecule. This molecule is developmentally functional in immature but not mature intestinal enterocytes, ILA reduces the IL-8 response after IL-1β stimulus. It interacts with the transcription factor aryl hydrocarbon receptor (AHR) and prevents transcription of the inflammatory cytokine IL-8.Conclusions:This molecule produced by B. infantis (ATCC No. 15697) interaction with ingested breastmilk functions in a complementary manner and could become useful in the treatment of all at risk premature infants for necrotizing enterocolitis if safety and clinical studies are performed.

The Prediction of Mortality Risk in Preterm Infants Hospitalized in the Neonatal Intensive Care Unit Using SNAPPE-II Score System

Background: The physiologic status of an infant at birth and at the time of admission to hospital is influential in determining the infant outcome, which can be evaluated through scoring systems. Objectives: The current study aimed at predicting the mortality risk of preterm infants with a birth weight less than 1500 g hospitalized in the neonatal intensive care unit (NICU) of Vali-e-Asr Hospital, Tehran, according to SNAPPE-II (score for neonatal acute physiology with perinatal extension-II) score. Methods: The study was conducted on 343 neonates with a birth weight less than 1500 g and a gestational age less than 32 weeks hospitalized within the first 12 hours after birth. The infants’ background data was collected through a demographic characteristics questionnaire. SNAPPE-II scoring system was also completed including items such as the lowest blood pressure, the lowest arterial oxygen pressure, the lowest body temperature, the lowest serum pH, the incidence of seizure and its frequency, and urine output. Then, the final score was calculated for each infant. The cutoff point, the area under the curve, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the system were also calculated. The correlation between neonatal variables and the outcome neonatal mortality were evaluated. Results: Totally, 252 infants survived 24 hours after birth, and 91 passed away within this time (26.4%). The total SNAPPE-II score was 16.94 ± 16.46 in the survivor infants and 51.6 ± 22.98 in the non-survivors. The area under the receiver operating characteristic (ROC) curve with the cutoff point of 27.5 was 0.89; the sensitivity and specificity of the system were 79% and 85%, respectively. PPV and NPV of the SNAPPE-II system were 58.9% and 93.4%, respectively. A significant correlation was observed between the outcome of neonatal death and the variables of birth weight, temperature, and mean blood pressure (P = 0.00). Conclusions: Since the sensitivity and specificity of the SNAPPE-II system as well as its cutoff point were appropriate in the current study, and considering the simplicity of the system and the short time it takes to be completed within the first 12 hours after the birth, this system was considered a proper predictor of death in infants with neonatal mortality risk and can be routinely implemented, while providing health and medical care for Iranian infants.

Improving preoperative identification of infants at risk for severe retinopathy of prematurity.

To increase preoperative identification of at-risk infants for severe Retinopathy of prematurity (ROP) to >95% by August 2016, with a secondary aim of reducing the number of infants with 100% intraoperative peripheral oxygen saturation (SpO2) during the same time. Prospective quality improvement project centered on preterm surgical infants admitted to Primary Children's Hospital (n = 41). Preoperative ROP risk identification rates were analyzed using an annotated run chart, intraoperative SpO2 and laser intervention were compared using un-paired t test. Preoperative identification of ROP risk increased from 60 to 100% and no infant was exposed to 100% SpO2 intraoperatively during the study period. The incidence of laser intervention in this population decreased by 45% from 22 to 12% (p = 0.21). Simplifying our preoperative handoff increased our rates of correct identification and communication ROP risk in preterm infants while decreasing exposure to 100% SpO2.

Respiratory morbidity, atopy and asthma at school age in preterm infants aged 32-35weeks.

Little is known about respiratory morbidity and asthma risk in preterm infants (PTIs) with a gestational age (GA) over 32weeks. This was a prospective study carried out from birth to 7-8years, comparing two groups: (a) PTIs (GAs 32weeks + 1day to 35weeks + 0days, without comorbidities) and (b) full-term infants (FTIs; GA ≥ 37weeks). Risk and protective factors for bronchiolitis and asthma were identified. A total of 232 children (116/group) were included. Sixty-six (56.9%) PTIs and 43 (37.1%) FTIs presented bronchiolitis (p = 0.002). Recurrent wheezing was 52 (44.8%) on PTIs versus 36 (31.0%) on FTIs (p = 0.03). Asthma at school aged was 27 (23.3%) on PTIs and 8 (6.9%) on FTIs (p = 0.020). Asthma risk factors were only detected in group A.Conclusion: PTIs had a higher prevalence of bronchiolitis, recurrent wheezing and asthma; risk factors for asthma are the following: older siblings, allergic father, atopic dermatitis and antibiotic treatment in the first 3years of life and prematurity itself, which also acted as protective factor for atopic dermatitis. What is known: • In recent decades, there has been a significant increase in the birth of premature babies and consequently, also in the pathologies secondary to the prematurity: a greater number of complications and disorders related to the development and maturation of many organs and systems, especially the respiratory system. Several studies, especially in full-term infants and very preterm infants, have tried to elucidate the risk factors that may influence the development of persistent or chronic respiratory problems such asasthma, but little is known about the aetiology of these disorders in the late or moderate preterm infants. Inthis group of children, the role played by certain factors (early use of antibiotics, chorioamnionitis, smokeexposure, paternal asthma, etc.) on late respiratory morbidity, or asthma, is inconclusive. • Moderate-to-late preterm infants are more predisposed to developing recurrent wheezing/asthma and should adopt control measures. What is new: • Our work provides data related to little-understood aspects of respiratory diseases in this group of late or moderate preterm infants (gestational age between 32 weeks plus 1 day and 35 weeks plus 0 days), by monitoring their evolution from birth to 7-8 years of age, compared with another group of full-term newborns. We aimed to establish the prevalence of bronchiolitis and recurrent wheezing in these children during their first years of life. • The prevalence of school-aged asthma and the risk factors for contracting it were also investigated.

Turkish Neonatal Society guideline on parenteral nutrition in preterm infants.

Postnatal growth failure due to inappropriate and insufficient nutrition is a risk for preterm infants, especially for very-low-birth-weight or extremely-low-birth-weight infants. This extrauterine growth failure causes negative effects on long-term neurodevelopment. Early initiation of intensive parenteral nutrition with appropriate protein and energy supply is a nutritional emergency when enteral feeding cannot be achieved. This approach prevents protein catabolism and helps achievement of positive protein balance and postnatal growth. Protein, lipid, and glucose initiation with appropriate doses that reach timely goals constitute the major elements of parenteral nutrition. The transition to enteral nutrition with the mother’s milk at the earliest convenience must be targeted in parenteral nutrition.

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants.

Özkan H, Köksal N, Doğan P, Güney-Varal İ, Bağcı O, Özgür T. The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its` effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants ( < 34 weeks` gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

Role of Genetic Susceptibility in the Development of Bronchopulmonary Dysplasia

To assess heritable contributions to bronchopulmonary dysplasia (BPD) risk in a twin cohort restricted to gestational age at birth <29 weeks. A total of 250 twin pairs (192 dichorionic, 58 monochorionic) born <29 weeks gestational age with known BPD status were identified. Three statistical methods applicable to twin cohorts (χ2 test, intraclass correlations [ICCs], and ACE modeling [additive genetic or A, common environmental or C, and unique environmental or E components]) were applied. Heritability was estimated as percent variability from A. Identical methods were applied to a subcohort defined by zygosity and to an independent validation cohort. χ2 analyses comparing whether neither, 1, or both of monochorionic (23, 19, 16) and dichorionic (88, 56, 48) twin pairs developed BPD revealed no difference. Although there was similarity in BPD outcome within both monochorionic and dichorionic twin pairs by ICC (monochorionic ICC = 0.34, 95% CI [0.08, 0.55]; dichorionic ICC = 0.39, 95% CI [0.25, 0.51]), monochorionic twins were not more likely than dichorionic twins to have the same outcome (P = .70). ACE modeling revealed no contribution of heritability to BPD risk (% A = 0.0%, 95% CI [0.0%, 43.1%]). Validation and zygosity based cohort results were similar. Our analysis suggests that heritability is not a major contributor to BPD risk in preterm infants <29 weeks gestational age.

Triagem neurológica de recém-nascidos pré-termo com hemorragias peri e intraventriculares: estudo transversal observacional

Introdução: Recém-nascidos pré-termo (RNPT) com menos de 27 semanas de idade gestacional apresentam vulnerabilidade para o desenvolvimento de hemorragias peri e intraventriculares (HPIV), o que pode afetar a mielinização e organização do córtex cerebral, acarretando possíveis prejuízos ao desenvolvimento. Objetivo: Avaliar o comportamento neurológico de RNPT acometido por HPIV com e sem sepse segundo a versão resumida do Método Dubowitz, delimitar a presença de itens desviantes da avaliação e comparar com as respostas obtidas pelo grupo controle (sem HPIV). Métodos: Estudo transversal realizado no Hospital Municipal Universitário de São Bernardo do Campo (SP). Os RNPT foram divididos em três grupos, sendo dois estudos (HPIV e HPIV + sepse) e um controle. Os participantes foram avaliados com idade correspondente ao termo. A versão resumida do método, utilizada como triagem para recém-nascidos de risco neurológico é constituída por 12 itens. As análises foram realizadas segundo pontuações desviantes nestes itens e comparadas com as pontuações esperadas para a normalidade. Os dados obtidos foram comparados na pontuação resumida e na pontuação da versão íntegra. Resultados: A frequência de RNPT com pontuações atípicas foram: 40% no grupo HPIV + sepse, 10% no grupo HPIV e 15% no controle. Conclusão: A HPIV de forma isolada não parece ser um fator significante para presença de itens desviantes no Método Dubowitz resumido. A presença de HPIV em graus mais severos esteve associada à presença de sepse. Os RNPT com HPIV associada à sepse obtiveram pior desempenho neurológico.

Clinical study of early inhalation of Budesonide in the prevention of bronchopulmonary dysplasia in very low birth weight infants

Objective To investigate the preventive and adverse effects of postnatal inhalation of Budesonide in early stage on bronchopulmonary dysplasia (BPD) in very low birth weight infants. Methods A total of 105 cases of high risk premature infants with BPD, who were born in the Neonatal Intensive Care Unit (NICU) from Shenzhen Maternity and Child Healthcare Hospital from July 15, 2015 to December 25, 2016, and their gestational age ≥27 weeks and < 32 weeks or birth weight ≥1 000 g and <1 500 g were collected for a prospective randomized controlled trial, and were randomly divided into 3 groups: early inhalation group(34 cases), late inhalation group(34 cases) and non-inhalation group(37 cases). The oxygen time, and the incidence of BPD, periventricular-intraventricular hemorrhage(IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis of the newborns (NEC), patent ductus arteriosus in preterm infants (PDA), sepsis and hyperglycemia of infants in 3 groups were compared. Results The average oxygen time in early inhalation group was 9 days, while in late inhalation group and the non-inhalation group was 15 days and 18 days, respectively.The average oxygen time in early inhalation group was significantly lower than that in the late inhalation group and the non-inhalation group, with the difference being statistically significant (H=6.09, P 0.05). Conclusions Postnatal inhalation of Budesonide in early stage in high risk very low birth weight infants can reduce the incidence of BPD and the oxygen time, and the adverse reactions are not obvious. Key words: Infant, premature; Very low birth weight infant; Bronchopulmonary dysplasia; Glucocorticoid; Budesonide; Inhalation

Low Microbial Diversity and Abnormal Microbial Succession Is Associated with Necrotizing Enterocolitis in Preterm Infants.

Despite increased efforts, the diverse etiologies of Necrotizing Enterocolitis (NEC) have remained largely elusive. Clinical predictors of NEC remain ill-defined and currently lack sufficient specificity. The development of a thorough understanding of initial gut microbiota colonization pattern in preterm infants might help to improve early detection or prediction of NEC and its associated morbidities. Here we compared the fecal microbiota successions, microbial diversity, abundance and structure of newborns that developed NEC with preterm controls. A 16S rRNA based microbiota analysis was conducted in a total of 132 fecal samples that included the first stool (meconium) up until the 5th week of life or NEC diagnosis from 40 preterm babies (29 controls and 11 NEC cases). A single phylotype matching closest to the Enterobacteriaceae family correlated strongly with NEC. In DNA from the sample with the greatest abundance of this phylotype additional shotgun metagenomic sequencing revealed Citrobacter koseri and Klebsiella pneumoniae as the dominating taxa. These two taxa might represent suitable microbial biomarker targets for early diagnosis of NEC. In NEC cases, we further detected lower microbial diversity and an abnormal succession of the microbial community before NEC diagnosis. Finally, we also detected a disruption in anaerobic microorganisms in the co-occurrence network of meconium samples from NEC cases. Our data suggest that a strong dominance of Citrobacter koseri and/or Klebsiella pneumoniae, low diversity, low abundance of Lactobacillus, as well as an altered microbial-network structure during the first days of life, correlate with NEC risk in preterm infants. Confirmation of these findings in other hospitals might facilitate the development of a microbiota based screening approach for early detection of NEC.

Family nurture intervention in preterm infants increases early development of cortical activity and independence of regional power trajectories

Premature delivery and maternal separation during hospitalisation increase infant neurodevelopmental risk. Previously, a randomised controlled trial of Family Nurture Intervention (FNI) in the neonatal intensive care unit demonstrated improvement across multiple mother and infant domains including increased electroencephalographic (EEG) power in the frontal polar region at term age. New aims were to quantify developmental changes in EEG power in all brain regions and frequencies and correlate developmental changes in EEG power among regions. EEG (128 electrodes) was obtained at 34-44 weeks postmenstrual age from preterm infants born 26-34 weeks. Forty-four infants were treated with Standard Care and 53 with FNI. EEG power was computed in 10 frequency bands (1-48 Hz) in 10 brain regions and in active and quiet sleep. Percent change/week in EEG power was increased in FNI in 132/200 tests (p < 0.05), 117 tests passed a 5% False Discovery Rate threshold. In addition, FNI demonstrated greater regional independence in those developmental rates of change. This study strengthens the conclusion that FNI promotes cerebral cortical development of preterm infants. The findings indicate that developmental changes in EEG may provide biomarkers for risk in preterm infants as well as proximal markers of effects of FNI.

Clinical analysis of 52 cases of neuromuscular examination for early screening of cerebral palsy in high risk premature infants

Objective To investigate the effect of 52 neurological tests on early screening of cerebral palsy in high-risk premature infants. Methods 52 Neurological examination were conducted to 363 cases of 28 to 32 weeks of high-risk preterm children at 1 month, 3 months, 6 months respectively after they were birthed from 2009 to 2012. If the children were checked with abnormal items (2 items of checked results were abnormal), they will be closely observed and urge their parents to recheck 1 month later, if the check results were still abnormal, the children would start to be early intervention treated immediately in our department; if the children were checked to have more than 3 items abnormal , he will start to be early intervention treated immediately. Meanwhile, 302 cases of heath premature children without early screening were set up as control group. All children were followed up for 36 months. With the Gesell scale to evaluate the child’s intelligence and sports development. Results 81 Cases of suspected cerebral palsy were found by this method, including 52 cases of early intervention group and 10 cases of untreated group. Another 10 cases were developed for a transient exercise. The positive rate of screening was 92.85%, and the incidence of cerebral palsy was 3.0%. After early intervention, early intervention in the preterm children group were diagnosed cerebral palsy in 5 cases to 36 months later, 17 cases of non-intervention group. Conclusion 52 Neurobehavioral examinations are a effective method for early detection of cerebral palsy in premature children, and it is helpful for early detection of cerebral palsy in premature children, early intervention, as well as to significantly reduce the incidence of cerebral palsy in premature children.

Viral Respiratory Infections in Preterm Infants during and after Hospitalization

ObjectiveTo determine the burden of viral respiratory infections in preterm infants both during and subsequent to neonatal intensive care unit (NICU) hospitalization and to compare this with term infants living in the community.Study designFrom March 2013 through March 2015, we enrolled 189 newborns (96 term and 93 preterm) into a prospective, longitudinal study obtaining nose/throat swabs within 7 days of birth, weekly while hospitalized and then monthly to 4 months after hospital discharge. Taqman array cards were used to identify 16 viral respiratory pathogens by real-time polymerase chain reaction. Demographic, clinical, and laboratory data were gathered from electronic medical records, and parent interview while hospitalized with interval histories collected at monthly visits. The hospital course of all preterm infants who underwent late-onset sepsis evaluations was reviewed.ResultsOver 119 weeks, we collected 618 nose/throat swabs from at risk preterm infants in our level IV regional NICU. Only 4 infants had viral respiratory infections, all less than 28 weeks gestation at birth. Two infants were symptomatic with the infections recognized by the clinical team. The daily risk of acquiring a respiratory viral infection in preterm infants in the NICU was significantly lower than in the full term cohort living in the community. Once discharged from the hospital, viral respiratory infections were common in all infants.ConclusionsViral respiratory infections are infrequent in a NICU with strict infection prevention strategies and do not appear to cause unrecognized illness. Both preterm and term infants living in the community quickly acquire respiratory viral infections.

Vojta therapy in the reduction of perinatal risk in preterm infants with respiratory distress syndrome and bronchopulmonary dysplasia

Vojta therapy in the reduction of perinatal risk in preterm infants with respiratory distress syndrome and bronchopulmonary dysplasia

Risk factors and morbidity of infantile haemangioma: preterm birth promotes ulceration

We identified the characteristics of an infantile haemangioma (IH) that predispose children to complications, interventions and long-term morbidity and examined perinatal risk factors for IH. We studied children with IHs admitted to Helsinki University Hospital's paediatric vascular anomaly clinic in Finland in 2004-2007 and registered perinatal records, IH characteristics, complications and interventions. These patients received a questionnaire on perinatal data and long-term morbidity resulting from IH. We analysed factors related to complications, interventions and morbidity and compared our cohort's perinatal data to the Finnish Medical Birth Register (FMBR) figures. We approached 185 families, of which 136 replied to the questionnaire. Children with facial, segmental and indeterminate IHs showed more complications, interventions and higher long-term morbidity. Preterm birth predisposed infants to ulceration of IHs, with a 95% confidence interval (CI) of 1.02-5.14 and odds ratio (OR) of 2.29. In addition to earlier known risks, maternal gestational diabetes mellitus rate was higher in our IH cohort than the rate in the FMBR (95% CI 1.39-4.95, OR 2.62). Physicians treating IHs should consider the elevated ulceration risk in preterm infants. The association between gestational diabetes mellitus and child's risk for an IH is uncertain and requires further research.

Insurance Status and the Risk of Severe Respiratory Syncytial Virus Disease in United States Preterm Infants Born at 32-35 Weeks Gestational Age.

Background. Database studies have identified that public health insurance status is associated with an increased risk of severe respiratory syncytial virus (RSV) disease in US infants. However, these studies did not adjust for the presence of other risk factors and did not evaluate the risk in preterm infants. Methods. In this study, we evaluate the independent association between public insurance and severe RSV disease outcomes adjusting for other risk factors. The prospective, observational RSV Respiratory Events among Preterm Infants Outcomes and Risk Tracking (REPORT) study was conducted over 2 consecutive RSV seasons at 188 US clinical sites that enrolled preterm infants born at 32-35 wGA who had not received RSV immunoprophylaxis with palivizumab. Adjusted incidence rates per 100 infant-seasons of the RSV-associated endpoints of outpatient lower respiratory tract infection (LRI), emergency department (ED) visits, RSV hospitalizations (RSVHs), and intensive care unit admissions during peak RSV season (November-March) were compared for infants with private and public insurance. Results. Of 1642 evaluable infants enrolled in the REPORT study, 50.1% had private insurance and 49.9% had public health insurance. Adjusted rates of RSV outpatient LRIs were similar; however, rates of ED visits (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20-3.45) were higher for subjects with public insurance, with a similar but nonsignificant trend observed for hospitalization (HR, 1.61; 95% CI, .93-2.78). Conclusions. Socioeconomic status, as evaluated by public versus private healthcare insurance, is a significant independent risk factor for ED use in US preterm infants and may contribute to increased RSVHs in this population.

Antenatal factors modulate hearing screen failure risk in preterm infants

ObjectiveThe objective of this study was to characterise the effects of antenatal inflammatory factors and maternal therapies on neonatal hearing screen outcomes in very low birthweight infants.MethodsWe conducted a retrospective...