Very Low Birth Weight Infants Research Articles

Evaluation of Hospital Outcomes Among Very Low Birth Weight Babies in a Community-Level Medical College Hospital

Introduction: Very low birth weight (VLBW) babies are at increased risk from a wide range of hazards resulting from immaturity of structure and functions of many organs, which may cause death or permanent damage. Objective: The objective of this study was to evaluate immediate outcomes in VLBW babies. Materials and Methods: This hospital-based prospective cohort study was conducted in the Department of Paediatrics, Kumudini Women’s Medical College and Hospital, Mirzapur, Tangail from August 2008 to July 2009. At enrollment VLBW babies (birth weight <1500 grams) were assessed for gestational age and weight. Patients were followed up daily till discharge or death. The outcome in terms of survival till discharge was recorded. Informed verbal consent from the caregiver was taken before enrolment. Results: A total of 60 VLBW neonates were enrolled in the study. Eight (13.3%) neonates had weights below 1000 grams and 52 (86.7%) had 1000-1499 grams. Five (8.3%) neonates had gestational age <28 weeks, 44 (73.3%) were 29-32 weeks, and 11(18.3%) were 33-36 weeks. Maternal age, place, and mode of delivery were significant contributory factors. In the present study, 35(59%) of VLBW babies expired; 100% of babies died below 1000 grams. Neonatal mortality showed an inverse relationship with birth weight and gestational age. Conclusion: Proper antenatal care should be encouraged throughout the country to prevent the neonatal mortality associated with VLBW infants. Management of labor is important and facilities for the management of high-risk pregnancy should be made available widely. Immediate management of newborns after birth can prevent the worst hospital outcomes in our country. The Journal of Ad-din Women's Medical College; Vol. 12 (2), July 2024; p 21-25

Case-control study on long-term kidney outcomes in very low birth weight infants: impact of growth restriction and maternal preeclampsia.

To identify factors, particularly neonatal acute kidney injury, associated with an increased risk of developing chronic kidney disease (CKD) within the first 10 years of life in children with a history of prematurity and very low birth weight (VLBW). This nested case-control study was conducted on VLBW infants (> 500 g and < 1.500 g) born between 2012 and 2022. The population (n = 119) included children who developed CKD (n = 55) and controls with normal findings (n = 64). CKD was defined by abnormal blood pressure, reduced glomerular filtration rate, or elevated urinary albumin excretion. Data on neonatal and maternal factors were analyzed using logistic regression to identify predictors of CKD. Of the 267 eligible children 119 were included, with a median age of 32 months, and median gestational age and birth weight of 30 weeks and 1170 g, respectively. Children with CKD had lower birth weight Z-scores (-1.06 vs. -0.89), a higher occurrence of extrauterine growth restriction (EUGR) (72 % vs. 51 %), and an increased likelihood of maternal preeclampsia exposure. Maternal preeclampsia was identified as an independent predictor of CKD, associated with a 5 % increase in the odds of developing the condition (OR 1.05, 95 % CI 1.01-1.66). Maternal preeclampsia was associated with CKD in children with a history of VLBW. This finding highlights the importance of long-term follow-up and early identification of at-risk individuals.

Does Gastric Lavage with Expressed Breastmilk Reduce the Incidence of Necrotizing Enterocolitis among Very-Low-Birth Weight Infants? – A Randomized Controlled Trial

Objectives: The objectives of this study were to evaluate whether gastric lavage with expressed breastmilk (EBM) decreases the incidence of necrotizing enterocolitis (NEC) among very low-birth-weight (VLBW) infants compared to standard care. Material and Methods: This open-label randomized controlled trial included VLBW infants who were randomized to receive either gastric lavage with EBM (intervention group) or standard care (control group). The primary outcome assessed was the incidence of NEC. Secondary outcomes were mortality, duration of hospital stay, days to achieve full feeds, and weight gain at discharge. Results: A total of 99 neonates were enrolled (51 in the intervention group and 48 in the control group). NEC rates were similar in both groups (5.9% vs. 4.2%; P = 0.39). However, there was a significant reduction in mortality in the intervention group (1.9% vs. 14.6%, P = 0.04). Conclusion: Gastric lavage with EBM did not reduce the incidence of NEC in the population studied, but there was a significant reduction in mortality in the intervention group.

Case Report: The first Korean familial case of BCAP31-related deafness, dystonia, and cerebral hypomyelination

Deafness, dystonia, and central hypomyelination (DDCH) syndrome (OMIM #300475) is a rare X-linked genetic disorder characterized by developmental delays, deafness, central hypomyelination, and dystonia. We report the first Korean familial case involving twin boy and girl carrying a novel pathogenic BCAP31 variant which was inherited from their mother. The male proband, born prematurely with very low birth weight (VLBW), exhibited severe global developmental delay, microcephaly, failure to thrive, dystonia, seizures, sensorineural hearing loss (SNHL) requiring cochlear implantation, and mild facial dysmorphism. A brain MRI revealed white matter atrophy, thinning of the corpus callosum, and delayed myelination. The twin sister presented with mild developmental delays and bilateral SNHL but did not experience seizures or dystonia. Their mother also had bilateral SNHL. Whole genome sequencing identified a hemizygous pathogenic variant, c.247C&amp;gt;T (p.Gln83Ter), in the BCAP31 in the proband. The variant was also found in his mother and twin sister, who exhibited less severe symptoms. Early genetic evaluation via next-generation sequencing is crucial for timely diagnosis and intervention, particularly in VLBW infants with genetic disorders. This report expands the understanding of genotype-phenotype correlations in DDCH syndrome and highlights the variable phenotypes in manifesting females.

The use of premedication for intubating very low birth weight infants in the neonatal intensive care unit: Results of a national survey.

To explore barriers and perspectives of premedication use for non-emergent intubations of very low birth weight (VLBW) infants (less than 1,500 g). A cross-sectional, online survey was distributed from January to April 2023 to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. Data was analyzed using descriptive statistics and chi-square tests. Of the 521 respondents, the majority (81%, n=415) were neonatologists. Over half of respondents (69%, n=359) consider patient weight when selecting premedication. Most providers (78%, n=407) agreed that premedication should be used for non-emergent intubation of VLBW infants, while only 41% (n=216) felt similarly that muscle relaxants should be used. For infants over 1,500 g, 43% (n=153) reported frequent or regular muscle relaxant use compared with 28% (n=101) for VLBW infants. The most cited barrier to muscle relaxant use was surfactant delivery with planned return to non-invasive support. Unit guidelines were associated with significantly more premedication and muscle relaxant use (56% vs. 44%; OR 5.2, 95% CI 3.4-7.7, p<0.0001). Most neonatal providers favor premedication for non-emergent intubation but are hesitant to use muscle relaxants for VLBW infants. Premedication guidelines may facilitate the use of both premedication and muscle relaxants for this population.

Impact of Omega-3 Enriched Lipid Emulsions on Retinopathy of Prematurity in Very Low Birth Weight Infants: A Retrospective Cohort Analysis.

To assess the effects of ω-3 long-chain polyunsaturated fatty acid (LCPUFA)-enriched lipid emulsions (SMOFlipid) vs. traditional soybean oil-based lipid emulsions (Intralipid) on the occurrence and severity of retinopathy of prematurity (ROP) in infants with very low birth weight (VLBW). In this retrospective cohort study, 301 VLBW infants who received either SMOFlipid or Intralipid for a minimum of 14 d were included. The main outcome measured was the frequency and severity of ROP, with secondary outcomes covering other complications associated with preterm birth. Of the infants studied, 180 were administered SMOFlipid, while 121 received Intralipid. The incidence of ROP was notably lower in the SMOFlipid group (32.8% vs. 45.5%; RR 0.59; 95% CI 0.36-0.94; P = 0.026). Additionally, the occurrence of severe ROP was reduced by 66.06% in infants given SMOFlipid (5.6% vs. 16.5%; RR 0.30; 95% CI 0.13-0.66; P = 0.002). Multivariate logistic regression suggested that using SMOFlipid was linked to a reduced risk of both ROP (OR 0.44; 95% CI 0.24-0.82; P = 0.010) and severe ROP (OR 0.09; 95% CI 0.03-0.30; P < 0.001). There were no considerable differences noted in other complications associated with preterm birth between the two groups. Compared to Intralipid, SMOFlipid treatment reduced both the risk and severity of ROP. Parenteral supplementation with fish oil-containing emulsions might offer a novel approach to lowering the incidence and severity of ROP in VLBW infants.

Transitional nutrition for very low birth weight infants in neonatal intensive care units: Where do we stand now?

The role of nutrition in managing preterm infants, particularly those classified as very low birth weight (VLBW), is pivotal. Optimal nutrition is vital, as early growth deficits and inadequate neonatal nourishment have been linked to significant long-term developmental issues. In the neonatal intensive care units (NICU), tailored nutritional interventions are necessary to meet the unique dietary needs of these infants. Despite advances in neonatal nutrition, gaps remain in understanding the ideal composition and duration of parenteral nutrition, the process of transitioning to enteral feeding, and the need for breast milk augmentation. This review explores current insights and methodologies in the nutritional management of VLBW infants during the critical transition phase. It addresses existing challenges, recent progress, and future directions in enhancing nutritional care for these at-risk infants, aiming to improve outcomes.

Risk factors and adverse outcomes of initial non-invasive ventilation failure in very low birth weight infants: a multicenter retrospective cohort study

Objective: To investigate the risk factors of initial non-invasive ventilation(NIV) failure and its association with adverse outcomes in very low birth weight infants (VLBWI). Methods: A retrospective cohort study was conducted, collecting clinical data of 2 102 VLBWI who received NIV within 30 minutes after birth, admitted to 18 NICU of Suxinyun Neonatal Perinatal Collaboration Network (SNPN) from January 1st, 2019 to December 31st, 2022. According to the outcome of NIV within the first 72 hours, the study cohort was divided into success group and failure group. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for NIV failure and its association with adverse outcome. Results: A total of 2 102 VLBWI were included, consisting of 1 078 males (51.3%). The gestational age was 29 (28, 31) weeks, and the birth weight was 1 250 (1 090, 1 380) g. The initial NIV failure rate was 15.3%(321/2 102). Multivariate Logistic regression analysis showed that smaller gestational age (OR=0.67, 95%CI 0.61-0.74, P<0.001), maternal hypertensive disorders during pregnancy (OR=10.31, 95%CI 7.48-14.21, P<0.001), Apgar score at the first minute ≤7 (OR=1.40, 95%CI 1.01-1.93, P=0.042), grade 3-4 respiratory distress syndrome (RDS)(OR=2.85, 95%CI 1.69-4.81, P<0.001), ≥2 times pulmonary surfactant (PS) treatment (OR=3.78, 95%CI 2.09-6.83, P<0.001), fraction of inspired oxygen (FiO2)>0.30 (OR=2.21, 95%CI 1.64-2.98, P<0.001) were all independent risk factors for initial NIV failure. The failure group had higher risks of mortality (OR=10.19, 95%CI 6.50-15.97, P<0.001), pneumothorax (OR=4.33, 95%CI 1.59-11.79, P=0.004), neonatal pulmonary hemorrhage (OR=8.48, 95%CI 4.08-17.64, P<0.001), moderate to severe bronchopulmonary dysplasia (BPD)(OR=1.75, 95%CI 1.19-2.56, P=0.004), and intraventricular hemorrhage (IVH) ≥grade Ⅲ (OR=2.18, 95%CI 1.27-3.73, P=0.004) compared to the success group. Conclusions: Small gestational age, maternal hyertensive disorders during pregnancy, Apgar score at the first minute ≤7, grade 3-4 RDS, PS treatment ≥2 times and FiO2 >0.30 are risk factors for initial NIV failure in VLBWI. Initial NIV failure is associated with increased risk of mortality, pneumothorax, pulmonary hemorrhage, moderate to severe BPD, and IVH ≥grade Ⅲ.

Efficacy and safety of nasal high-frequency oscillation in preventing intubation in very-low-birth-weight infants with respiratory distress syndrome.

Invasive mechanical ventilation in very-low-birth-weight infants (VLBWI) was associated with immediate and long-term complications. Nasal high-frequency oscillation (nHFO) has recently become a new non-invasive ventilation (NIV) mode for treating respiratory failure in VLBWI. This study aimed to investigate the safety and efficacy of nHFO as an alternative respiratory support to prevent intubation in VLBWI. A retrospective analysis was conducted using the clinical data of 42 VLBWIs with respiratory distress syndrome (RDS) who were treated in our department from August 2018 to August 2020 and met the selection criteria. nHFO was used as a rescue strategy in 32 infants and a prophylactic strategy in 10 infants. It was observed that out of 42 cases, 30 cases (71.4%) were able to avoid intubation within 72h, while 23 cases (54.8%) were successfully switched to another NIV mode from nHFO. There was a significant decrease in pCO2 and an increase in pH 1h after using nHFO in the success group. Two cases (4.8%) of feeding intolerance associated with nHFO were noted. This study showed that nHFO as alternative respiratory support for preterm infants with RDS might be safe and effective in reducing the need for intubation.

Greater and Earlier Exposure of Mother's Own Milk Compared to Donor Human Milk Moderates Risk and Severity of Bronchopulmonary Dysplasia.

Background: Bronchopulmonary dysplasia (BPD) is a common complication of preterm very low birth weight (VLBW) infants. Mother's own milk (MOM) may mitigate the severity of BPD. Pasteurized donor human milk (PDHM) is often used as an alternative when MOM is unavailable with limited information on the influence of PDHM on BPD risk and severity. Objective: To compare the influence of MOM to PDHM on risk and severity of BPD in preterm VLBW infants. Design/Methods: A retrospective chart review of preterm (<34 weeks) and VLBW (<1,500 g) infants born at the Children's Hospital of Richmond from 2019 to 2021 was performed. The analysis included demographics, type and timing of nutrition received (MOM, PDHM, Formula), and incidence/severity of BPD based on National Institute of Child Health & Human Development (NICHD) definition. Data analysis used chi-square, linear regression, and a multinomial logistic regression test. Results: A total of 200 infants met inclusion criteria, of which 116 (58%) had no BPD, 34 (17%) had mild BPD, 32 (16%) had moderate BPD, and 18 (9%) had severe BPD. Infants exposed to MOM within the first 3 days and within the first 7 days of life had lower incidence of moderate to severe BPD when compared to those with no MOM exposure (p = 0.02, p = 0.04). The percent of MOM received throughout hospitalization moderated the incidence of BPD (p = 0.01, 95% Confidence Interval (CI) [-0.14, -0.02]), such that as the percent of MOM received increased, the effect of gestational age on severity of BPD decreased. In contrast, the percent of PDHM received throughout hospitalization did not moderate BPD incidence (p = 0.61, 95% CI [2.28, 3.43]). Conclusion: These results identify that earlier and greater total exposure to MOM, but not PDHM, was associated with decreased moderate to severe BPD in <34-week preterm VLBW infants.

Risk Factors for Necrotizing Enterocolitis in Very Low Birth Weight Infants in a Tertiary Care Hospital

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition correlated with increased morbidity and mortality in very low birth weight (VLBW) infants. The pathophysiology of NEC remains elusive due to its multifactorial nature. However, the identification and prevention of significant factors that cause NEC can improve the outcome of these neonates. Objective: To identify factors associated with the development of definite NEC, based on the modified Bell staging criteria stage II and III, in VLBW infants in a setting of tertiary care hospital. Materials and Methods: A single-center, case-control study was conducted in VLBW infants who were admitted to the neonatal intensive care unit (NICU) of Bhumibol Adulyadej Hospital, Bangkok, Thailand, between January 2008 and December 2022. Clinical data were collected from the electronic medical records. For each case of NEC, two controls without NEC, as non-NEC, were matched based on gestational age and period of hospitalization in the department. Data of mothers, infants, feeding patterns, and comorbidities prior to the diagnosis of NEC were analyzed. Results: There were 65 and 130 infants in the NEC and the non-NEC group, respectively. Infants in both groups had similar baseline characteristics. Multiple logistic regression showed the amount of human milk at the age of 14 days (adjusted OR 0.08, p&lt;0.001) was a protective factor against NEC. Conversely, prolonged parenteral nutrition (PN) use (adjusted OR 4.81, p&lt;0.001) and septic shock (adjusted OR 4.36, p=0.02) were risk factors for NEC. Conclusion: Early initiation of human milk may reduce the incidence of NEC. On the other hand, infants requiring extended PN and suffering septic shock were at an increased risk of developing NEC.

Impact of antibiotic duration and type on short- and long-term outcomes in very-low-birthweight infants.

To determine the association between the duration and types of antibiotic exposure and the occurrence of short- and long-term outcomes among preterm, very-low-birthweight (VLBW) infants. Retrospective cohort study of VLBW infants born <32 weeks gestation between January 2017-December 2021. Association between antibiotic exposure and the occurrence of death and/or major morbidities, and neurodevelopmental impairment (NDI) at 18-24 months corrected age, was evaluated. A total of 728 infants were included-median gestation 28 weeks (IQR 26, 30) and median birthweight 1070g (IQR 850, 1300). Compared to no antibiotics, antibiotics exposure >3 days was significantly associated with increased risk of mortality and/or bronchopulmonary dysplasia (BPD)-adjusted odds ratio (AOR) 2.0 (95% CI 1.1-3.8; p=0.03), 3.5 (95% CI 1.6-7.8; p=0.01) and 3.8 (95% CI 1.6-9.0; p<0.001) corresponding to antibiotic exposure of 4-7 days, 8-14 and >14 days, respectively. Additional exposure to broad-spectrum antibiotics was associated with AOR of 3.2 (95% CI 1.6-6.5; p<0.01) for death and/or BPD. There was no significant association between antibiotic exposure and NDI. Infants who received >3 days of antibiotics and/or additional broad-spectrum antibiotics had significantly increased odds of death and/or BPD compared to no exposure. Antibiotic exposure was not significantly associated with NDI in our population.

Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status.

Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Under-standing the impact of workload and regional differences on these rates is crucial for improving outcomes. This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities. Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters: capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates. This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with 2 rather than 1 neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates. Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

Effect of nutrition on the nutritional status in preterm infants with very low birth weight

Introduction. Postnatal growth retardation in premature infants with very low birth weight (VLBW) remains an unresolved problem. There are different approaches regarding the duration of use of breast milk fortifiers during breastfeeding and specialized formulas during formula feeding, as well as the timing of the appointment of complementary feeding. Objective: to evaluate the physical development and component body composition in VLBW infants, depending on nutritional support over the first year of life. Materials and methods. The study included ninety three VLBW premature infants of 2 to 11 months postnatal age (PNA). The main (1st) group included infants (n = 74) who received dietary correction depending on the nutritional status, while no such intervention was performed in the (2nd) comparison group (n = 19). Up to 64 weeks of postconceptional age (PCA), weight, body length, and head circumference were assessed using INTERGROWTH-21st international growth standards, then in the software “WHO Anthro (2009)”. Fat and fat-free (lean) mass were determined using the air plethysmography method (PEA POD, LMi, USA). Results. The analysis of the nutritional status revealed a moderate deviation, not exceeding 1 sigma, decrease in indices (Z-scores) of anthropometric indices in infants of the 1st and 2nd groups by PNA of 2–3 months. Further in infants of the 1st group on the background of prolonged use of fortified nutrition (breast milk fortifier or specialized formulas for preterm infants) and timely introduction of complementary foods, nutritional deficiencies throughout the first year of life in general were not revealed. In the 2nd group of infants without additional correction of nutrition by 4–5 months of age, the development of mild nutritional deficiency was noted by 6–7 months of age. By 6–7 months of age, it turned into moderate nutritional deficiency, which persisted until 8–9 months of age and then turned into mild nutritional deficiency. Analysis of the component body composition showed that during the observation period, the fat-free body mass (FFM) gain in infants in the 1st group was 3.40 kg, in Group 2 infants — 2.2 kg. At the same time, % body fat mass (FM) in infants in groups 1 and 2 had no significant differences (%FM 1 = 19.3 [15.3–22.5], %FM 2 = 19.9 [16.7–24.6], p = 0.769) and did not exceed the values characteristic of preterm infants. Conclusion. A comprehensive assessment of the nutritional status of VLBW infants during the first year of life allowed us to eva­luate the positive impact of long-term use of fortified diets and timely introduction of certain complementary foods. Optimization of nutrition made it possible to prevent the development of nutritional deficiency, which can have a significant positive impact on their further growth, development, and health status.

Thermal equilibrium as a predictor of growth efficiency in preterm infants.

Providing adequate nutrition to preterm infants to achieve postnatal growth similar to intrauterine growth remains challenging due to the unpredictability of individual determinants. We 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). A 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. Determining personalized incubator settings by means of a calculation program could help improve nutrition and growth in preterm infants.

Analysis of the Association between In Vitro Fertilization/Assisted Conception and the Development of Retinopathy of Prematurity in Very-Low-Birth Weight Newborns.

The objective is to study to what extent the development of retinopathy of prematurity (ROP) is associated with assisted conception (AC) and in vitro fertilization (IVF) in a tertiary referral hospital. This study is a retrospective observational cohort study. Very-low-birth weight (VLBW) infants with gestational age (GA) <32 weeks or birth weight <1500 g were admitted to the neonatal unit of a tertiary care hospital between January 1, 2011, and December 31, 2021. The study determined the degree of ROP developed according to the type of fertilization used for conception. Main outcome measures were ROP prevalence in pregnancies obtained after IVF/intracytoplasmic sperm injection (ICSI) in the period from January 1, 2011, to December 31, 2021, in a tertiary hospital. Of the 408 infants included in the study sample, 105 (25.7%) were born following AC and 12.4% of these developed ROP. In our sample, the practice of IVF was not associated with an increase in the incidence of VLBW infants (R2 = 0.12; P = .29). Conception achieved via AC or IVF is not significantly associated with ROP in any degree of severity.

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.

Association between Ureaplasma colonization and bronchopulmonary dysplasia defined by different criteria in very low birth weight infants: A retrospective cohort study.

To study the association between Ureaplasma colonization and bronchopulmonary dysplasia (BPD) with different definitions in very low birth weight (VLBW) infants. A retrospective cohort study was performed with VLBW infants admitted from January 2019 to October 2021. Neonates with a positive respiratory tract Ureaplasma culture were included in the study group. Control group infants, matched for gestational age (±1 week), birth weight (±100 g), and birth year, had a negative respiratory tract Ureaplasma culture during the same period. The primary outcomes included the incidence and severity of BPD, defined by various criteria. The study included 302 neonates (151 in the study group and 151 in the control group). After adjusting for confounders, Ureaplasma colonization was not associated with BPD as defined by the National Institutes of Health (NIH) in 2001 (adjusted odds ratio [aOR]: 0.820, 95% confidence interval [CI]: 0.362-1.860, p = .635). However, it was associated with BPD as defined by the NIH in 2018 (aOR: 2.490, 95% CI: 1.128-5.497, p = .024) and the Neonatal Research Network (NRN) in 2019 (aOR: 2.352, 95% CI: 1.077-5.134, p = .032). Additionally, VLBW infants with Ureaplasma colonization had a higher risk of moderate-severe BPD according to the NIH 2001 (aOR: 2.352, 95% CI: 1.077-5.134, p = .032), NIH 2018 (aOR: 6.339, 95% CI: 1.686-23.836, p = .006), and NRN 2019 definitions (aOR: 3.542, 95% CI: 1.267-9.904, p = .016). Ureaplasma colonization is not associated with BPD by the NIH 2001 definition, but is associated with an increased incidence by the NIH 2018 or NRN 2019 definitions.

A budget impact analysis of exclusive human milk diet in very low birth weight infants in United Arab Emirates

Introduction Very low birth weight (VLBW) infants have the highest rate of neonatal intensive care unit (NICU) admissions owing to the higher comorbidities associated with premature birth and long hospital stays. VLBW infants fed a bovine (BOV)-based diet have higher mortality rates, necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and other comorbidities than those fed 100% human milk-based products. This study aims to evaluate the budgetary impact of adopting an exclusive human milk diet (EHMD) instead of a BOV-based diet in VLBW infants from Al-Ain Hospital, Sheikh Shakhbout Medical City, and Dubai Health Authority (DHA) in the United Arab Emirates (UAE). Methods We use a decision-tree model to estimate the budget impact of adopting EHMD versus the current local practice (BOV) over 5 years. Patients enter the tree model and have a probability of transitioning to one of the following mutually exclusive health states: NEC, which may be treated medically or surgically; LOS, NEC, and LOS; or neither NEC nor LOS. Depending on the feeding strategy, infants in the aforementioned health states are likely to develop any of the following complications: retinopathy of prematurity, bronchopulmonary dysplasia, or short bowel syndrome. The model accounts for the costs associated with diet, management of health states and complications, and the follow-up period. Results Al-Ain Hospital saved United Arab Emirates Dirham (AED) 3.3 million ($1.4million) in the first year of the EHMD feeding arm and AED 16.6 million ($7.1million) over the course of 5 years. In comparison to Sheikh Shabout Medical City and DHA, AED 36.7 million ($15.8million) and AED 24 million ($10.3million) were saved over 5 years, respectively, with AED 7.3 million ($3.1million) and 4.8 million ($2million) saved in the first year. The estimated pooled results across the three institutions were AED 5.1 million ($2.2million) and AED 25.7 million ($11million) savings in the first year and over 5 years, respectively. Conclusion Implementing the EHMD feeding scheme in VLBWs that has significant clinical benefits has resulted in substantial budget savings from the payer’s perspective in the UAE owing to fewer comorbidities associated with premature birth and shorter hospital stays. It is highly recommended for the Emirati health care settings to evaluate the real-world neonatal complication rates.

Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants

BackgroundThe objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).MethodThe data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.ConclusionMaternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.