Background: Very low birth weight (VLBW) neonates are especially susceptible to environmental stressors such as excessive noise, which can disturb physiological stability. Despite the American Academy of Pediatrics (AAP) recommendations to maintain neonatal intensive care unit (NICU) sound levels below 45 decibels (dB), these levels often exceed these limits, potentially affecting neonatal outcomes. Aims and Objectives: This study aimed to evaluate the impact of ambient noise on key physiological parameters – heart rate, respiratory rate, and oxygen saturation (SpO2) – in VLBW neonates and to highlight the importance of optimizing auditory environments in NICUs. Materials and Methods: A prospective observational study was conducted over 1 year in the NICU of Gauhati Medical College and Hospital. Hemodynamically stable VLBW neonates (<1500 g) were enrolled. Ambient sound levels were measured during the morning, afternoon, and night shifts using the iNVH Android application. Simultaneously, physiological parameters including heart rate, respiratory rate, and SpO2 were recorded. Data from the NICU were compared with values obtained from the Kangaroo Mother Care (KMC) unit. Results: Noise levels in the NICU frequently surpassed the AAP-recommended thresholds, with peak recordings reaching up to 105.4 dB. A statistically significant increase in heart rate and respiratory rate was observed during higher noise exposure compared to the quieter KMC setting. However, SpO2 did not show any significant variation across settings. Conclusion: The study underscores a clear association between elevated ambient noise and altered physiological responses in VLBW neonates. While SpO2 remained unaffected, increased heart and respiratory rates suggest a stress response to excessive noise. Implementing effective noise-reduction strategies in NICUs is critical to improving care and outcomes of VLBW infants.

Mortality in very-low birth-weight (VLBW) infants accounts for up to 50%-70% of the neonatal mortality and up to 25%-30% of infant mortality. Despite the global increase in survival rates, this population remains at heightened risk for developing long-term neurodevelopmental delays, chronic lung disease, malnutrition, and visual and hearing disabilities. The gut microbial composition of VLBW differs from full-term infants and is typically dominated by pathobionts. In this study, we characterized the bacterial composition of the VLBW infant microbiota born at Pereira Rossell Children's Hospital (academic, tertiary referral center) in Montevideo, Uruguay by sequencing the full-length 16S rRNA gene using Oxford Nanopore Technologies. We describe a high predominance of Klebsiella pneumoniae and Escherichia coli in these infants. By sequencing stool samples from two time points, we show that the microbial community diversity increases over time with a higher relative abundance of Bacteroides and Veillonella. Moreover, we describe the effect on the microbial composition of long antibiotic exposure. Different species of the Klebsiella genus, along with Escherichia coli, Enterobacter cloacae, Citrobacter freundii, and Veillonella parvula were observed at a higher relative abundance in patients with more than 5 days of antibiotic treatment. Taken together, our findings shed light on the development and establishment of microbial communities in early-life microbial communities in South America. Our results point to postnatal antibiotics as a major factor orchestrating this process. The integration of microbial community health considerations into preterm clinical care is crucial for improving long-term infant development.

Total parenteral nutrition (TPN) is essential for growth in very-low-birthweight (VLBW) infants. The worldwide variation in TPN dosing strategies warrants investigation. This study compared clinical outcomes of aggressive, rapid-increase, and standard TPN dosing strategies in VLBW infants. A systematic review and network meta-analysis were conducted following the PRISMA NMA guideline. Searches were performed in PubMed, Scopus, Web of Science, CINAHL, CENTRAL, and ProQuest. Dosing strategies were classified as aggressive (higher starting dose), rapid-increase (standard start with rapid escalation), and standard (NICE-based). Outcomes were analyzed using a Frequentist model in RStudio v4.4.1. Nine randomized controlled trials were included. Compared with aggressive and standard strategies, the rapid-increase strategy was associated with a shorter time to regain birth weight (MD = -1.43 days; 95% CI -2.82 to -0.05; P-score = 0.80). The rapid-increase strategy was also associated with a shorter length of hospitalization (MD = -0.38 days; 95% CI -6.56 to 5.80; P-score = 0.54). Regarding safety outcomes, the rapid-increase strategy had the lowest proportions of mortality (Prop = 0.043), retinopathy (Prop = 0.124), and sepsis (Prop = 0.141), but a higher proportion of patent ductus arteriosus (PDA) (Prop = 0.508). The rapid-increase approach demonstrated the most favorable balance between efficacy and safety outcomes among the included trials, although the small number of studies is a limitation. Rapid-increase TPN, using the recommended starting dose but achieving maintenance more quickly, may offer clinical advantages for VLBW infants. Further long-term studies are needed to confirm developmental and metabolic impacts.

Impact of early parenteral amino acid on preterm infant: A multicenter study.

Despite availability of advanced monitoring tools, most neonatologists still primarily rely on nursing documentation of desaturation and bradycardia events to assess the respiratory status of very low birth weight (VLBW) premature infants. We aimed to compare oxygenation instability as recorded in nursing charts versus SpO2 histograms in VLBW infants during their first weeks of life.An observational study including VLBW premature infants who required respiratory support on day 1 of life. We recorded the daily number of desaturation events <90% from nursing charts and the cumulative duration of SpO2 <90% from 24 hours SpO2 histograms. Data were collected from birth until respiratory support was discontinued.Data from 1,749 chart days of 77 VLBW infants (mean ± SD birth weight 1,040 ± 243 g; gestational age: 28.5 ± 2.1weeks) were analyzed. A strong Pearson correlation was found between the number of desaturation events and total time in SpO2 <90% (r = 0.8). However, similar event counts often reflected different hypoxemia burden. Eight or more daily desaturation events predict an unstable SpO2 histogram (sensitivity: 90.3%, specificity: 76.1%).Nursing charts and SpO2 histograms strongly correlate but offer unique insights-charts capture the frequency and distribution of desaturation events, while histograms quantify overall hypoxemic exposure. Used together, they provide a more comprehensive assessment of respiratory status in VLBW infants. · Oxygenation instability is common among VLBW premature infants.. · We compared oxygenation instability documentation in the NICU by nursing charts versus SpO2 histograms.. · Strong Pearson correlation was found between documented desaturation events and time with SpO2 <90%.. · However, for a given number of desaturation events, the time in SpO2 <90% varied significantly.. · Combining charts and SpO2 histograms gives a more complete respiratory assessment in VLBW infants..

Multiple perinatal factors influence hemodynamically significant patent ductus arteriosus (HS PDA) in preterm infants. This study aimed to identify the risk factors associated with HS PDA in very low birth weight infants (VLBWIs) and determine the predictors of surgical ligation. This retrospective study included VLBWIs born at 23-32 weeks' gestation whose HS PDA properties could be identified using echocardiography. The infants were stratified into 2 groups based on gestational age (23- 27 and 28-32 weeks). Among the 496 included VLBWIs, 171 had no PDA, 90 had non-HS PDA, and 235 had HS PDA. In infants born at 23-27 weeks' gestation, risk factors for HS PDA included low birth weight, the absence of histological chorioamnionitis, and premature rupture of membranes. For VLBWIs born at 28-32 weeks' gestation, HS PDA was associated with lower birth weight, frequent surfactant treatment, and maternal hypertension. Within the HS PDA group, infants with a lower birth weight or who received incomplete antenatal steroid administration had an increased likelihood of requiring surgical ligation, whereas those with a small-for-gestational-age status had a decreased need for surgical ligation. Recognizing these risk factors can aid the development of targeted treatment strategies for HS PDA in VLBWIs, enabling early ligation and potentially reducing the need for surgical management.

To examine the incidence of hypervitaminosis D in very low birth weight (VLBW) infants and any associated maternal or neonatal factors. In this single center retrospective study, we studied serum vitamin D (25[OH]D) levels, maternal and neonatal demographic and clinical factors. We included VLBW infants (≤32 weeks gestational age (GA) and≤1500 g birthweight, n=130) born between 2021 and 2023. VLBWs receive 400 IU/day cholecalciferol once TPN is discontinued. Hypervitaminosis D was defined as 25[OH]D levels >60 ng/ml. We considered 11 variables with plausibility to influence this outcome. Variables with p<0.20 in univariate logistic regression were entered into a multivariable logistic model to assess associations with the primary outcome. A linear mixed model assessed the association between calcium and 25[OH]D levels, with time as a fixed effect and subject as a random effect. 63 VLBWs (48 %) developed hypervitaminosis D. Maternal age > 35 years (OR=2.2, 95 % CI 0.96-5.06) associated with excess 25[OH]D approached statistical significance (p=0.06). Our findings indicate that in GA≥28 weeks (OR=0.77, 95 % CI 0.64-0.92) and maternal hypertension (OR=0.32, 95 % CI 0.14-0.73) were associated with reduced likelihood of hypervitaminosisD. 25[OH]D supplementation of 400 IU/day in VLBWs is associated with a high incidence of hypervitaminosis D. The above findings reveal a significant effect of maternal demographic and clinical factors on newborn metabolic health. Further work is needed to identify causes of hypervitaminosis D. Long term prospective studies are needed to understand the impact of hypervitaminosis D in VLBWs.

Hypocapnia and hypercapnia are associated with significant morbidity in preterm infants. Continuous transcutaneous CO₂ (tCO₂) monitoring may reduce pCO₂ fluctuations and blood sampling requirements. A before-and-after study compared very low birth weight (VLBW) infants on high-frequency oscillatory ventilation (HFOV) before and after introducing tCO₂ monitoring. Primary outcomes were the incidences of hypercapnia (pCO₂ > 60 mmHg) and hypocapnia (pCO₂ < 40 mmHg) per day in HFOV. Secondary outcomes included the number of blood extractions per day and associations between tCO₂ monitoring and common neonatal morbidities. The pre-tCO₂ group comprised 28 patients and the tCO₂ group 50 patients. Baseline characteristics were comparable. The tCO₂ group showed reductions in hypocapnia: 1 (IQR 0.35-2) vs. 0.15 (IQR 0-0.5), p < 0.01, and hypercapnia: 1.6 (IQR 0.87-2.6) vs. 0.5 (IQR 0.25-1), p < 0.01, as well as fewer blood samples per day: 5 (IQR 3.5-7) vs. 3 (IQR 2.5-4), p < 0.01. The tCO₂ group also showed a lower incidence of IVH, with no differences in mortality, transfusions, or other morbidities. Continuous tCO₂ monitoring in VLBW infants on HFOV was associated with fewer episodes of hypo- and hypercapnia and reduced blood sampling. An association with lower IVH rates was observed; however, causality cannot be established. This study evaluates the impact of transcutaneous CO₂ monitoring using a before-and-after design, analyzing its association with blood gas stability and neonatal outcomes. The use of transcutaneous CO₂ monitoring was associated with fewer episodes of hypocapnia and hypercapnia, as well as a reduced need for frequent blood sampling. A lower incidence of intraventricular hemorrhage was also observed in the group with transcutaneous CO₂ monitoring. These findings support the potential value of integrating continuous transcutaneous CO₂ monitoring into neonatal intensive care practices to enhance patient safety and reduce complications related to CO₂ fluctuations.

The limbic system is a brain structure involved in emotional regulation. Since nutritional interventions in very low birth weight (VLBW) infants may be associated with measurable differences in brain structure and function, we designed this prospective study to evaluate the impact of early nutritional support in VLBW infants on the volume of the regions that comprise the limbic system, as well as on the emotional and neuropsychological development of these infants. This is a prospective observational study of a historical cohort of children with a history of prematurity. 74 preterm infants, with a mean age of 11.1 ± 2.9 years, underwent neuropsychological assessment using the Wechsler Intelligence Scale for Children (WISC-V) and functional magnetic resonance imaging (fMRI). We recorded the nutritional intake during the first week of the neonatal period, as well as data related to neonatal morbidity. The association between the results of the brain structural analysis, psychometrics variables and nutritional intake was determined using simple and multivariate linear regression adjusted for child age and body mass index in the structural analysis of fMRI. Lipids intake was also associated with the volume of the left thalamus (b=50.7; p=0.014), the right thalamus (b=47.4; p=0.018) and the left nucleus accumbens (b=5.02; p=0.031). We conclude that lipids intake in the first week of life in VLBW newborns is associated with the volume of various structures of the limbic system, namely the thalamus and the nucleus accumbens.

BackgroundAccurate blood pressure (BP) measurement is crucial for assessing hemodynamic features in infants with very low birth weight (VLBW). Various methods are available to monitor BP, including both invasive arterial blood pressure (IBP) and non-invasive blood pressure (NIBP). IBP monitoring, although accurate, poses risks due to its invasive approach, while NIBP monitoring, despite being safer, may lack precision.ObjectiveTo evaluate the agreement between IBP and NIBP measurements and assess the reliability of NIBP in diagnosing hypotension among VLBW infants.MethodsThis study was conducted in the neonatal intensive care unit (NICU) of King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia. VLBW infants (n = 40) with IBP measured via an umbilical arterial catheter (UAC) or peripheral arterial line (PAL) were included. Simultaneous NIBP measurements were taken using appropriately sized cuffs.ResultsAcross 3260 paired measurements, NIBP showed a mean bias of -6 ± 10 mmHg compared to IBP, with 95% limits of agreement from -25.6 to 13.6 mmHg. NIBP overestimated systolic, diastolic, and mean arterial pressures (MAP) by 8.9 mmHg, 7.47 mmHg, and 6.76 mmHg, respectively (all p < 0.001). Overall, 58% of pairs exceeded ±15% of invasive MAP. Invasive hypotension prevalence was 4.3% (MAP < gestational age) and 21.7% (MAP <30 mmHg). Receiver operating characteristics analysis showed modest diagnostic accuracy of NIBP (area under the curve = 0.627 and 0.707), with specificity >90% but sensitivity only 26.6%.ConclusionsNIBP overestimates blood pressure, and IBP is the gold standard method for accurate BP assessment in VLBW infants.

BackgroundPost-traumatic growth (PTG) can guide parents to cherish life more deeply, thereby improving the quality of care they provide to their children. However, despite evidence linking a psychological resilience with PTG, the processes through which aspects of resilience influences PTG remain unclear. This study investigated the mediating role of perceived social support and coping styles in the relationship between resilience and PTG.MethodsIn this cross-sectional study, 344 parents of very low birth weight (VLBW) infants admitted to the neonatal intensive care units of nine hospitals at level two or above in Fujian Province were selected by convenience sampling. Five self-reported questionnaires were completed by the participants. The data were analyzed using SAS 9.4. Structural equation modeling was employed to determine the relationships between the components using AMOS 24.0.ResultsPsychological resilience can directly influence PTG (effect = 1.598, 95% CI = 1.388–1.824, p < 0.05) or indirectly affect it through the mediating role of positive coping style (effect = 0.039, 95% CI = 0.009–0.079, p < 0.05). Meanwhile, perceived social support can only influence PTG through a positive coping style (effect = 0.020, 95% CI = 0.004–0.047, p < 0.05).ConclusionThis study provides further insight into the importance of strengthening resilience, providing support, and developing positive coping strategies from nurses and healthcare providers for promoting PTG among VLBW infants’ parents. It is especially important to implement interventions directly targeting the enhancement of resilience among parents of VLBW infants.

To study the cognitive outcome of Chinese very-low-birth-weight (VLBW) infants and its relationship to brain magnetic resonance imaging (MRI), we conducted a prospective cohort design including 104 VLBW and 110 full-term (FT) infants born in 2020. The mean Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores of VLBW infants were significantly lower than those of FT infants (all P < .001). The MDI and PDI scores of VLBW infants with MRI abnormalities were significantly lower than those of infants with normal MRI and FT infants (all P < .01). The brain MRI findings were correlated with the incidence of neurodevelopmental impairments (NDI) (OR = 5.05, 95% CI = 1.378-18.478; P = .015). In conclusion, VLBW infants are at high risk for neonatal brain MRI abnormalities and NDI at 24 months, and neonatal MRI abnormality is a strong predictor for later NDI.

Increase in Necrotizing Enterocolitis with Cessation of Bifidobacteriumlongum ssp. infantis Administration in Very Low Birthweight Infants: A Single Center Retrospective Cohort Study.

Tracheal intubation in very low birth weight (VLBW) infants is a high-risk procedure associated with tracheal intubation adverse events (TIAEs). Premedication for non-emergent intubations typically includes a vagolytic and analgesic agent. Rapid sequence intubation (RSI), defined as premedication with a vagolytic, analgesic, and paralytic agent, is used to enhance procedural safety and reduce complications. Premedication without paralysis was used for infants receiving surfactant with immediate extubation. To increase the use of premedication and RSI in VLBW infants and reduce adverse events. A QI initiative targeting VLBW infants at a level IV NICU undergoing non-emergent intubations. Interventions included forming a multidisciplinary team, education, and implementing an EHR-pathway with embedded orders. Premedication use increased from 25.7% to 93.4%, and RSI use from 14.6% to 77.3%. TIAEs decreased from 41.4% to 14.4%, and severe desaturations from 32% to 11.2%. Standardizing premedication practices, including RSI,can improve neonatal safety.

Acute kidney injury (AKI) is common in very-low-birthweight (VLBW) infants. Both fluid overload and dehydration can lead to AKI. Our aim was to examine the associations between early fluid and sodium intake and AKI. This retrospective cohort study comprised 421 VLBW infants born at < 32weeks. Detailed data on fluid management during the first 24h of life, diuresis and weight changes during the first postnatal week and plasma creatinine measurements during the first 2 postnatal weeks were acquired from an electronic patient information system. AKI was defined according to the KDIGO definition modified for neonates. The incidence of AKI was 8.6%, and on average, it was diagnosed on the fifth postnatal day. Higher total fluid intake (mL/kg/24h) during the first day of life was associated with an increased risk of AKI (OR, 1.015; 95% CI, 1.005-1.025; p < 0.01), analysis adjusted for gestational age and being small-for-gestational age. The highest fluid intake quartile had a 5.6-fold risk of developing AKI when compared with the lowest quartile (p = 0.01). A higher total sodium intake (mmol/kg/24h) was associated with an increased risk of AKI (OR, 1.12; 95% CI, 1.03-1.21; p < 0.01). Among infants with AKI, a substantial proportion of early fluid and sodium intake (median 27% and 59% of total intake, respectively) originated from volume expanders. Infants diagnosed with AKI exhibited an average weight gain of + 2.8% by the second day of life. As part of efforts to minimize the risk of AKI, avoiding excessive fluid and sodium administration during the first postnatal hours may be beneficial.

We assessed the risk factors of post-neonatal anti-epileptic medications after neonatal intensive care unit discharge (PD-AED) and neurodevelopmental (ND) outcomes by age three in very-low-birth-weight infants (VLBWIs), with 7,292 VLBWIs born in 2013-2020 using the Korean Neonatal Network data. We assessed the risk factor of PD-AED and compared the risks for cerebral palsy (CP), blindness, deafness, and ND impairments between five groups: group 1, no seizure; group 2, neonatal seizure only; group 3, neonatal seizure + PD-AED before age three; group 4, neonatal seizure + PD-AED up to age three; group 5, PD-AED without neonatal seizure. By age three, 515 infants (7.1%) had seizures and 241 infants (3.8%) had PD-AED. Higher GA, intra-ventricular hemorrhage ≥ grade 3, post-hemorrhagic hydrocephalus, neonatal seizures, cystic periventricular leukomalacia, necrotizing enterocolitis ≥ stage 2, and moderate to severe bronchopulmonary dysplasia increased the risk of PD-AED. Compared to other groups, group 1 had the lowest risk of CP, while group 4 had the highest. The risk of hearing loss was higher in group 4 compared to groups 1, 2, and 5. Seizures at any time point increased the risk of CP. In infants with neonatal seizures, longer time on anti-epileptic medications also increased the CP risk.

Background/objectivesOptimal nutrition in very low birth weight (VLBW) infants is associated with improved clinical outcomes. When parenteral nutrition (PN) with a marketing authorisation is not appropriate, hospital pharmacies can prepare more suitable PN preparation. This corresponds to standard preparations (i.e., available at any time with a fixed composition) or individualised ones (i.e., available after a period of prescription, preparation, and pharmaceutical control). In France, 12 standard formulas to be compounded were proposed by a national consortium in 2018. The objective of the present study was to evaluate whether individualised PN preparations ordered in our hospital are substitutable by one of the 12 standard formulas.MethodsAll PN prescriptions for VLBW infants made in 2021 in our hospital were retrospectively extracted. For each prescription, the theoretical intakes that an infant would have received if a standard preparation had been administered were calculated. Standard and individualised preparations were compared using the Mann-Whitney U test for each component. Secondly, the relative difference between the expected intakes and effectively intakes was calculated for each component.Results/DiscussionOver the study period, 1708 prescriptions were identified (corresponding to 1708 PN individualised preparations). Most infants were extremely low birth weight infants. Based on the methods of comparison, none of the 12 standard formulas fitted with targeted intakes achieved with individualised PN preparations ordered, whereas prescriptions did fit with international guidelines.ConclusionThe study highlights how it is difficult to establish nationally standard PN formulas for VLBW infants; the development of local standard formulas seems therefore relevant.

Twin pregnancies contribute disproportionately to neonatal morbidity and mortality, primarily due to preterm birth and very low birth weight (VLBW). While studies have yielded conflicting findings on VLBW twins versus singletons, limited research exists in Ireland. This study examines whether survival, neonatal characteristics, and outcomes differ between VLBW twins and singletons in a national cohort. A secondary analysis was conducted using anonymised data from the National Perinatal Epidemiology Centre (NPEC) VLBW audit. The study included all liveborn VLBW infants (401-1500g and/or 22 + 0 to 29 + 6weeks' gestation) from singleton and twin pregnancies in Ireland between 2014 and 2022. Maternal and neonatal characteristics were compared using descriptive statistics. Chi-square and t-tests assessed group differences. Poisson regression computed crude and adjusted relative risks (RR). Of 4766 infants, 29% (n = 1380) were twins and 71% (n = 3386) singletons. Twins were born at higher gestational age (28.38 vs 27.9weeks, p < 0.001) and had higher birth weight (1087.76g vs 1059.66g, p = 0.006). Mortality was lower in twins (15.6% vs 18.9%, p = 0.014), but not after adjustment. Adjusted analyses showed higher risk in twins for delivery room death (RR 1.45, p = 0.013) and severe retinopathy of prematurity (RR 1.47, p = 0.047). Although VLBW twins appeared to have better crude outcomes than singletons, adjusted analyses showed broadly comparable survival and morbidity, with specific vulnerabilities. These findings reinforce that twins remain a high-risk population requiring intensive surveillance and proactive management. They also highlight the importance of structured models of care and support the need for updated national guidelines in Ireland to optimise outcomes for both groups.

This is a population-based study from the Korean Neonatal Network (KNN) for very low birth weight infants (VLBWIs) born at 23+0 and 31+6 weeks of gestation between 2013 and 2019. This study aims to evaluate the effect of sex on neurological outcomes at 18–24 months corrected age, stratified with gestational age (GA) in VLBWIs. A total of 1,829 infants (15.7%) who completed Bayley Scales of Infant and Toddler Development, third edition (BSID-III) assessments at 18–24 months corrected age were included and were further stratified into three GA groups: 23+0 to 25+6 weeks, 26+0 to 28+6 weeks, and 29+0 to 31+6 weeks. The primary outcomes were the BSID-III composite scores and neurodevelopmental delay defined as BSID-III composite scores lower than 80. Male sex was an independent risk factor for neurodevelopmental delay, particularly in infants born over 26 weeks of gestation. Among VLBW preterm infants born over 26 weeks of gestation, male infants of the younger GA group were associated with a higher risk of cognitive and motor delay, whereas those of the older GA group had a higher risk of language delay. The extremely low GA group (below 25 weeks of gestation) did not exhibit sex differences in neurodevelopmental outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-23735-z.

Background/Objectives: Systemic hydrocortisone (HCS) in very low birth weight (VLBW) infants is commonly used to treat early hypotension or prevent bronchopulmonary dysplasia. This study evaluated the associations between postnatal HCS exposure and neurodevelopment in VLBW infants by comparing regional brain volume at term-equivalent age (TEA) with neurodevelopmental outcomes in early infancy. Methods: This retrospective cohort study included VLBW infants admitted to a neonatal intensive care unit (NICU) between 2013 and 2019. The cumulative HCS dose during hospitalization was recorded, and regional brain volumes were analyzed using magnetic resonance imaging at TEA. Neurodevelopmental outcomes were assessed at a corrected age for prematurity of 18–24 months. Results: Among 146 infants, 57 were classified in the high HCS group (>90 mg/kg) and 89 in the low HCS group (≤90 mg/kg HCS). Bronchopulmonary dysplasia, periventricular leukomalacia, and sepsis were more frequent in the high HCS group. Ninety-five infants underwent magnetic resonance imaging, which revealed reduced brain volumes in the high HCS group. At follow-up, cerebral palsy (35.9% vs. 9.1%, p = 0.003), neurodevelopmental impairment (54.0% vs. 23.6%, p = 0.002), and head circumference <10th percentile (64.3% vs. 19.5%, p < 0.001) were more common in the high HCS group. After adjustment, HCS > 90 mg/kg remained independently associated with cerebral palsy (adjusted odds ratio [aOR] 5.44, p = 0.016) and reduced head circumference (aOR 4.45, p = 0.016). Conclusions: High cumulative HC exposure correlated with reduced brain volume at TEA and adverse neurodevelopmental outcomes at 24 months of age. Careful monitoring of dose and treatment duration is essential to balance therapeutic benefits against potential risks.