Extra-uterine growth restriction (EUGR) is a condition caused by the failure of very preterm infants to reach their potential growth during the NICU hospital stay. Despite improvements in nutritional supports, their growth pattern is still far from that expected. EUGR is now recognized as a major risk factor for long-term metabolic, anthropometric, and cognitive outcomes. Aim of our study was to evaluate anthropometric and metabolic outcome at peripubertal age in a population of ex-preterm VLBW infants and to detect the possible influence of EUGR on short stature. Retrospective cohort study of children born in a single centre between 2005 and 2009 with VLBW (birth weight < 1500g). Families were recruited by telephone. During the clinical evaluation at peri-pubertal age, we measured height, head circumference, weight, and Body Mass Index (BMI), and clinical laboratory tests. Data were analyzed using SPSSv10.0 (SPSS Inc., Chicago, IL, USA). The Mann-Whitney U test was used for inter-group comparisons of continuous variables, and the Spearman test was used for correlations between variables. For intra-group comparisons, the paired t-test was used. Differences among three or more groups were assessed using the non-parametric Kruskal-Wallis test. We enrolled 78 patients, 21 (27%) born Small for Gestational Age (SGA). Comparing anthropometrics at discharge with those at birth, a significant impairment was found in the whole population for weight, length, and head circumference SDS (p < 0.001). EUGR was detected in all the children born SGA and in 50% of the children born AGA. At peripubertal age four subjects presented with short stature (5.19%): all were EUGR, and three were on rhGH treatment. Patients who developed asymmetric EUGR had lower HDL cholesterol (p:0.049) and higher fasting blood glucose value at peripubertal age, compared to our population (p:0.049). Our data confirm SGA infants at birth develop EUGR at discharge and are associated with metabolic development noted at the peripubertal age. Recording anthropometric parameters during the NICU hospital stay is crucial, as they are related to weight, BMI, and metabolic risk factors at peripubertal age. Local Ethics Committee approved the protocol (AVEN CE N. 124/2018).

Objective To assess the cost-utility of an exclusive human milk diet (EHMD) compared to conventional nutrition for very low birthweight (VLBW, <1500 g) infants from Japan’s healthcare payer perspective. Methods We conducted a cost-utility analysis using used a Markov state-transition model built with TreeAge. Effectiveness was assessed using Quality-Adjusted Life Years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per QALY gained. Using 2024 prices, EHMD cost was JPY 2,000,000 (USD 13,220), varying up to JPY 4,000,000 (USD 26,440) in sensitivity analyses. Deterministic and probabilistic sensitivity analyses were performed. Results Base case analysis showed an ICER of JPY 2,949,278 (USD 19,495) per QALY gained, well below the hypothetical willingness-to-pay threshold value of JPY5,000,000 to JPY7,500,000 (USD 33,050 to USD 49,575). Sensitivity analysis indicated EHMD remained cost-effective up to JPY 4,750,000 (USD 31,398) per course against a revised JPY 7,500,000 (USD 49,575) per QALY threshold. Conclusion This cost-utility analysis demonstrated that an EHMD may be a cost-effective option for VLBW infants in Japan at 2024 costs, and provides evidence to inform decision makers considering its adoption.

Prevalence of seizures is 1 to 5/1,000 neonates. The most common causes of neonatal seizures are hypoxic-ischemic encephalopathy (HIE), vascular events (hemorrhages, stroke), and infections. We assessed prevalence and etiology of seizures defined according to the recent Brighton and International League of Epilepsy (ILAE) criteria in a neonatology monocenter cohort.In a retrospective cross-sectional cohort study of all 12,154 neonates born in our three maternities from January 1, 2022 to December 31, 2023 seizures were categorized by frequency, etiology, risk profile, semiology, and EEG. A total of 19 neonates (male: n = 11 [57.9%]; full-term: n = 11 [57.9%]; preterm very low birth weight [VLBW]: n = 6 [31.6%]; preterm >1,500 g birth weight: n = 2 [10.5%]) were identified.In 19/12,154 neonates, seizures were confirmed by application of the ILAE criteria. Preterm VLBW was found in 174 neonates with birth weight <1,500 g. Seizure incidence was 1.6/1,000 in all neonates and 3.4% in VLBW infants. HIE was the most frequent etiology in term infants (30.8%), followed by vascular events in preterm >1,500 g and term infants (30.8%). Vascular events were the most common cause in preterm VLBW infants (83.3%). Whole exome sequencing (WES) was performed in four cases (21.1% of neonates with seizures).Incidence of neonatal seizures in our center is in the lower range and leading seizure etiologies are comparable to the literature. Early recognition of neonatal seizures including the detection of electrographic-only seizures and early WES to identify rare genetic defects possibly offering tailored treatment options have the potential to further raise the standard of neonatal care and improve neurodevelopmental outcome.

To determine the effects of empiric antibiotic therapy within the first 72 hours after birth, in cases of suspected early-onset sepsis without positive blood cultures, on the neurodevelopment of VLBW infants.Cohort study conducted from January 2014 to December 2021, included neonates from 24 to 32 weeks' gestation. They were categorized based on receiving early antibiotics. Outcomes measured included neonatal morbidities and scores on the Bayley Scales of Infant Development, Third Edition (BSID-III), at 12 to 36 months corrected age.Of 261 VLBW infants 52.9% (n = 138) received empiric antibiotics within the first 72 hours, while 47.1% (n = 123) did not. Multivariate analysis revealed no association between early antibiotics and neurodevelopmental delay. Severe intraventricular hemorrhage independently correlated with delays, while late-onset sepsis and bronchopulmonary dysplasia contributed to specific motor and cognitive delays. Propensity score matching (PSM) was conducted using various models that included gestational age, late-onset sepsis, severe intraventricular hemorrhage, bronchopulmonary dysplasia, and clinical chorioamnionitis. However, antibiotic use was not independently associated with an increased risk of developmental delay in the applied models.Although the use of antibiotics did not emerge as an independent factor contributing to developmental delay, VLBW infants who received antibiotics had more morbidities during their NICU stay.

To meet the elevated nutritional requirements of very low birthweight (<1500 g, VLBW) infants during hospitalisation, many neonatal units routinely add a fixed dose of multinutrient fortifier to human milk. Individualised approaches that either tailor macronutrient additions to routine analysis of milk composition (target fortification) or an infant's metabolic response to nutrition (blood urea nitrogen (BUN) adjustable fortification) show short-term improvement in growth, but important outcomes such as longer-term neurodevelopment and major in-hospital morbidity have not been systematically assessed. The aim of our study is to determine whether target or BUN adjustable fortification of human milk, compared with standard fortification, during hospitalisation improves cognitive (primary), language and motor development of VLBW infants at 18-24 months corrected age (CA). Secondary outcomes include growth, body composition, mortality and serious morbidity. This is a three-arm, pragmatic, multicentre, double-blind, randomised clinical trial of 615 human milk-fed infants born either (1) ≤1250 g or (2) <30 weeks and <1500 g. Once enteral feeds reach 100 mL/kg/day, and until 36 weeks corrected gestational age (CGA), infants are fed according to one of three fortification protocols: (1) standard fortification, in which a fixed dose of nutrients is added to human milk; (2) target fortification, in which values from twice weekly direct analysis of mother's milk and each batch of donor milk are used to provide 4 and 4.8 g/kg/day true protein and fat, respectively; and (3) BUN adjustable fortification, in which weekly BUN values are used to adjust protein fortification of milk. Neurodevelopment is assessed using the Bayley-IV scale at 18-24 months CA. Growth, morbidities and nutrient intakes are recorded daily during hospitalisation, and skinfolds are measured at 36 weeks CGA and at 4 months CA. At 4 months CA, body composition is determined by air displacement plethysmography on a subset of infants. Ethical approval was obtained from Clinical Trials Ontario (CTO) and local research ethics boards that are not CTO members. Study findings will be disseminated to clinicians at seminars and conferences and in peer-reviewed publications. NCT05308134.

Caregiver feeding practices, dietary intake and weight status of very low birthweight infants compared to term-born peers at school-entry.

Describe racial and ethnic differences in delivery hospital NICU risk-adjusted mortality and morbidity rates (RAMMR), stratified by volume and level of care. Cross-sectional analysis of all very low birthweight (<1500 g; VLBW) infants born in Michigan, Oregon, and South Carolina between 2010 and 2020 and Pennsylvania between 2010 and 2018 (n = 37,784). Lorenz concentration curves and indices were used to describe differences in NICU RAMMR by race and ethnicity. Analysis was performed for overall cohort; high-level, high-volume NICUs; and low-level and/or low-volume NICUs. Despite being most frequently born at high-level, high-volume centers, Non-Hispanic Black (NHB) neonates were overrepresented at hospitals with high RAMMR and all other groups were overrepresented at hospitals with lower RAMMR. Differences were most pronounced in the low-level and/or low-volume cohort. NHB VLBW infants born at hospitals with low-level and/or low-volume NICUs are disproportionately exposed to adverse outcomes and must be the focus of future policy interventions.

IntroductionVery-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.MethodsWe designed a randomized controlled trial to determine whether an enhanced method of fortification (EF) improved growth in VLBW infants compared to standard fortification (SF). VLBW infants admitted to our tertiary-level neonatal intensive care unit were randomized to receive a bovine powdered human milk fortifier (HMF) added to PDHM (SF), or specially selected high-fat PDHM (fat concentration ≥3.8 g/dL) with bovine powdered HMF and a liquid protein fortifier providing an additional 0.67 g/dL protein (EF). Primary outcome was impaired weight gain defined as weight z-score drop of ≥0.8 from birth at 37 weeks or hospital discharge, whichever earlier. Secondary outcomes included change in length and head circumference (HC) z-scores from birth, requirement for high calorie formula, and rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP).ResultsA total of 61 infants were randomized (31 SF, 30 EF). Impaired weight gain was not significantly different (SF 83.9% vs. EF 73.3%, p = 0.347), with similar declines in weight z-scores from birth in both groups SF −1.27 [interquartile range (IQR) −1.71, −0.87] vs. EF −1.13 (IQR −1.46, −0.78), p = 0.403. However, the EF group had a smaller decline in length and HC z-scores from birth to discharge compared to the SF group [Length z-score change: −0.92 (IQR −1.64, −0.48) vs. −1.64 (IQR −2.21, −0.89), p = 0.007; HC z-score change: −0.08 (IQR −0.74,0.58) vs. −0.86 (IQR −1.81, −0.21), p = 0.014]. The EF group also required less high calorie formula supplementation [0% (IQR 0-4.1) vs. 3.8% (IQR 0 −16.9), p = 0.032]. Rates of BPD and ROP were not significantly different between groups.ConclusionAmong VLBW infants, EF did not improve weight gain, but reduced declines in HC and linear growth compared to SF.

ABSTRACTInfants born with a very low birth weight (VLBW, < = 1.500 g) have an increased risk for medical complications and long‐term impairments. Feeding these infants with their mother's own milk (MOM) reduces the risk for adverse outcomes, but many VLBW infants are not fed with MOM for the recommended duration of at least 6 months postpartum. This study examines factors associated with early cessation during the VLBW infants' neonatal intensive care unit (NICU) stay and after discharge. Data were collected from an anonymous, nationwide survey as part of the Neo‐MILK study. Logistic regressions and Cox proportional hazard models were used to identify factors associated with early cessation of MOM feeding. Among the 304 mothers analysed, 19.4% of all mothers ceased MOM feeding during the infants' NICU stay. The total cessation rate before 6 months was 53.9%. An early milk volume of over 500 mL/day compared to less or equal to 500 mL/day was negatively associated with MOM feeding cessation during the infants' NICU stay (Adjusted OR: 0.14). Exclusive pumping was associated with a higher cessation rate after discharge (Adjusted HR: 2.01). Early sufficient milk volume and mixed feeding (pumping and breastfeeding) inform longer MOM feeding duration. Interventions targeting early lactation practices and promoting direct breastfeeding while helping with the transition from pumping to breastfeeding are essential for improving MOM feeding outcomes in VLBW infants.Trial Registration: German Register of Clinical Trials, ID: DRKS00024799, https://drks.de/search/en/trial/DRKS00024799.

Systemic inflammation in preterm infants is associated with an increased risk of adverse neurodevelopmental outcomes. This study aimed to investigate the impact of single versus multiple episodes of sepsis and/or necrotizing enterocolitis (NEC) on neurodevelopmental impairment (NDI) in this population. This cohort study used data from a nationwide registry, including very low-birth-weight infants born before 32 weeks of gestation from 2013 to 2020. The study population was categorized according to the occurrence of sepsis and/or NEC. Neurodevelopmental assessments at 18-24 months of corrected age were performed using various tools. Any NDI or death was used as the primary outcome. In the multivariate logistic regression analysis, infants with multiple episodes of sepsis (aOR = 1.43; 95% CI [1.02-2.01]) or both sepsis and NEC (aOR = 1.91; 95% CI [1.26-2.90]) had a significantly higher risk of NDI compared to those without sepsis and NEC. A single sepsis episode without NEC was not associated with an increased risk of NDI. Multiple episodes of sepsis and/or NEC significantly increased the risk of NDI in VLBW infants, whereas a single episode of sepsis did not. These findings highlight the need to distinguish between single and multiple episodes of systemic inflammation when assessing neurodevelopmental outcomes. Multiple episodes of sepsis and/or necrotizing enterocolitis (NEC) significantly increase the risk of neurodevelopmental impairment (NDI) and death in preterm infants. However, a single episode of sepsis alone was not associated with the risk of NDI and NDI or death in the study population. When evaluating the neurodevelopmental outcomes of preterm infants, it is crucial to recognize that a single episode of sepsis may have a lesser impact on NDI compared to recurrent systemic inflammation or NEC episodes.

Background: Necrotizing enterocolitis is the leading gastrointestinal cause of morbidity and mortality in neonatal intensive care units. Despite advancements in neonatal care, the incidence of NEC remains unchanged. This study evaluated trends in NEC incidence and severity over the past decade and identified associated risk factors in our NICU population. Methods: This was a retrospective cohort study comparing the prevalence and severity of NEC among VLBW infants born before 32 weeks of gestation across the following two periods: 2012-2016 and 2017-2021. Clinical data were extracted from medical records, with NEC diagnosis and grading based on the modified Bell's criteria. Results: A total of 299 infants were included. Those born in the later period were significantly more preterm and had lower birth weights. While the overall NEC incidence increased in the later cohort, the rate of surgical NEC was lower. Logistic regression identified hemodynamic instability requiring pressor support, late-onset sepsis, and earlier gestational age as significant risk factors for NEC. Conclusions: Although the incidence of NEC was higher in the later cohort, its severity was lower compared to the earlier cohort. These findings suggest that advancements in neonatal care and feeding protocols may contribute to improved outcomes. Early NEC stages may represent alternative intestinal or systemic conditions warranting further research for better diagnosis.

Continuous non-contact recording of heart rate, respiratory rate and body temperature of VLBW and ELBW premature infants using photoplethysmography-imaging (PPGI) and infrared thermography (IRT)

INTRODUCTION: Enteral nutrition is an important part of neonatal care. To make enteral feeding as effective as possible, nurses must have sufficient knowledge, positive attitudes, and effective techniques. This study sought to assess the knowledge, attitudes, and practices of nurses regarding the nutrition of low and very-low birth weight infants (LBW and VLBW) in Rwanda. METHODS: The study took place in three tertiary referral hospitals in Rwanda from January to February 2020. A questionnaire was developed to facilitate the survey among neonatal nurses. Several items were used to evaluate their knowledge, attitudes, and practices concerning infant enteral feeding. Answers to knowledge questions were graded on their accuracy. Other items were rated on a Likert scale. RESULTS: There was a total of 47 respondents. The vast majority of them (83%) were female and aged 31 to 40 years. The average knowledge score for feeding LBW and VLBW infants was 65.9% (SD=24.3%). Nurses were excellent at understanding the benefits of breast milk, but there were discrepancies in caloric requirements for growth (21.3%), gastric residuals (38.3%), and feeding methods (8.5%). The vast majority of nurses had neutral or negative attitudes toward nasogastric tube (NGT) feeding. NGT feeding was a common practice, with 76.6% adhering to safety protocols and 74.5% assessing nutritional status regularly. Almost half of the nurses (48.9%) reported feeding delays due to workload. The majority emphasized early feeding and valued their role in neonatal care. CONCLUSION: In Rwandan tertiary referral hospitals, most nurses demonstrated adequate knowledge, neutral or negative attitudes, and relatively high levels of NGT infant feeding practices. Strategies are needed to improve and sustain this performance.

Historically, Staphylococcus aureus has been a leading cause of morbidity and mortality in the neonatal intensive care unit (NICU). The current incidence and attributable mortality of late-onset invasive S aureus infection in hospitalized infants is unknown. To estimate the incidence and attributable mortality of late-onset S aureus infection among hospitalized infants in the US. This retrospective cohort study included an emulated trial among a national convenience sample of 315 NICUs within the US between 2016 and 2021. Participants were infants aged at least 4 postnatal days who were hospitalized in a participating NICU. Data were analyzed from May to August 2024. The primary exposures were birth weight and postnatal age. The outcomes were the incidence and attributable mortality of late-onset invasive S aureus infection. Methicillin-resistant and methicillin-sensitive S aureus classification was not universally available; thus, all invasive S aureus infections were pooled. From 468 201 infants (260 491 [55.6%] male; median [IQR] gestational age, 36 [33-38] weeks) eligible for analysis, 1724 infants experienced 1762 infections for an overall incidence of 37.6 (95% CI, 35.9-39.4) invasive S aureus infections per 10 000 infants. Most infants with invasive infections were 32 weeks' gestational age or younger (1394 infants [80.9%]), very low birth weight (VLBW; ie, <1500 g) (1318 infants [76.5%]), and/or had a central line during their hospital stay (1509 infants [87.5%]). Invasive infections mostly included bloodstream infections (1505 infections [85.4%]), and 1160 infections (65.8%) occurred within 4 to 28 postnatal days. Birth weight inversely correlated with incidence: infants with VLBW experienced a more than 20-fold higher incidence relative to infants born weighing at least 1500 g (227.1 [95% CI, 215.3-239.4] vs 10.1 [95% CI, 9.1-11.1] infections per 10 000 infants). Most deaths following invasive infection occurred among VLBW infants (189 of 209 deaths [90.4%]). Compared with matched infants without a late-onset invasive S aureus infection, infected infants had an absolute difference in mortality rate of 5.3% (95% CI, 3.8%-6.8%). This cohort study found late-onset invasive S aureus infection and subsequent attributable mortality disproportionally affected infants with VLBW. Targeted infection prevention and control measures are necessary to reduce morbidity and mortality from invasive S aureus infections in this vulnerable population.

A very low birth weight infant (VLBW) with a birth weight of &lt;1500 grams has extremely low nutrient reserves, such as calcium, phosphate, iron, zinc, and vitamins, with little to no subcutaneous fat and glycogen stores. The management of VLBW infants focuses on providing nutrition through fortification, formula milk, or breast milk if lactation is sufficient. This study aims to examine the impact of weight management in VLBW infants through the administration of fortification, formula milk, and breast milk.This research employs a case study method by administering fortified breast milk, formula milk, and breast milk over ten days to a VLBW infant treated in the PICU-NICU of Temanggung Regional Hospital. The results show that after receiving fortified breast milk, the infant’s weight increased by 70 grams. When given formula milk, there was no weight gain, while breast milk administration resulted in a weight gain of 75 grams. These findings indicate that breast milk provides the most significant weight gain without causing weight loss, although the increase occurs gradually.It is recommended that parents of VLBW infants optimize weight gain by providing exclusive breastfeeding, either directly or indirectly, if the infant has difficulty nursing.

Hydrolyzed protein formulas (HPFs) are used in full-term infants to treat cow's milk protein allergy but can result in suboptimal weight gain as compared to standard infant formulas. In preterm infants, HPF may be used to promote feeding tolerance after necrotizing enterocolitis. There is limited evidence on HPF use in preterm infants after NICU discharge. The primary objective of this study was to determine predictors of HPF use at four, eight, and 20 months corrected age (CA) post-NICU discharge, and the secondary objective was to evaluate the association between HPF use at four and eight months CA and neurodevelopmental (ND) outcome (cognitive, language, and motor indices on the Bayley Scales of Infant and Toddler Development-III) at 20 months CA in very-low-birth-weight (VLBW; birth weight < 1,500 g) infants. This was a retrospective chart review of 419 VLBW infants born in 2008-2012. Infants were categorized by diet at four and eight months into one of three groups: any maternal breast milk (MBM), HPF, and non-HPF. ND outcome was assessed with the Bayley-III. Multiple regression adjusted for the effect of risk factors on formula use and the effect of four- and eight-month diets on 20-month ND. Forty-three (10.3%), 45 (10.7%), and 350 (83.5%) infants at four months and 22 (5.5%), 41 (10.3%), and 297 (74.4%) infants at eight months were on a diet of MBM, HPF, and non-HPF, respectively. HPF use was predicted by multiple gestation (odds ratio (OR) 3.01 (95% CI 1.57-5.99)) and stage 2-3 necrotizing enterocolitis (OR 2.54 (95% CI 1.09-5.94)) at four and eight months, respectively. In multiple regression, infants on non-HPF at eight months had worse language/receptive language scores than the other two groups. In our retrospective analysis of VLBW infants, we did not observe any statistically significant difference in 20-month ND outcomes among infants who received HPF as compared to those who received non-HPF or MBM.

Pasteurized donor human milk (PDHM) is the recommended supplement when there is inadequate volume of mother's own milk (MOM) for very low birth weight (<1500 g, VLBW) infants. Differences in the composition of these milks may impact growth, morbidities or long-term development of infants. The aim of this review is to highlight current trends in understanding compositional differences between MOM and PDHM, technological advances in processing PDHM, and infant outcomes when VLBW infants are fed these milks. Reported differences in the composition between MOM and PDHM are due to several factors including when and how milk is collected, sampled for analysis, and processed. Systematic reviews and primary research studies demonstrate that PDHM reduces the risk of necrotizing enterocolitis in VLBW infants but is also associated with slower postnatal growth. Work is ongoing to determine if alternative approaches to processing PDHM can improve milk composition and thereby infant growth and neurodevelopment and reduce morbidity. PDHM is a key component of feeding VLBW infants when there is inadequate volume of MOM. Recent developments aim to optimize this source of nutrition and bioactive compounds for VLBW infants while further understanding limitations of its use.

BackgroundStudies evaluating the optimal intake of amino acids for preterm infants have often not considered the effect of the non-protein calorie to grams of amino acids ratio (NPKcal:g AA) in parenteral nutrition solutions. The objectives of this study were to document the ratio in a group of preterm infants and explore any associations of the ratio to AA and acylcarnitine levels.MethodsThis was descriptive cohort study of data collected from a previously published prospective study evaluating the influence that gestational age had on amino acid and acylcarnitine profiles in preterm infants ≤31weeks postmenstrual age. Acylcarnitine and AA levels on day of life 7 of three study groups, based upon terciles of the NPKcal:g AA, who were receiving minimal enteral feedings and an enterally fed comparison group were measured. Growth velocities and changes in z-scores were also evaluated.ResultsNPKcal:g AA terciles were: 6.3-17.6:1 (low, N = 153), 17.7-21.2:1 (mid, N = 150), and 21.3-36.2:1 (high, N = 159). Higher levels of ornithine, citrulline, blood urea nitrogen, isovalerylcarnitine + methylbutyrylcarnitine, and octenoylcarnitine were found in the low versus the high group. From day 1-42 of life, the low group had a lower head circumference (HC) growth velocity and the low and mid groups had more negative HC changes in z-scores versus the enteral group.ConclusionsThis study suggests that preterm infants may receive parenteral nutrition solutions containing inadequate energy to prevent oxidation of administered AA. The impact of inadequate non-protein caloric intake needs to be considered when evaluating growth and outcomes in nutritional studies of VLBW infants.

BackgroundHuman milk, especially mother’s own milk (MOM), is vital for newborns and crucial for very low birthweight (VLBW, <1500 g) preterm infants, who face increased vulnerability. As the production of...

Abstract Background Apnea of prematurity is nearly universal among very low birth weight infants (VLBW). In VLBW infants, changes in clinical status usually occur due to sepsis or non-infectious causes and it is challenging to differentiate between the two. We as clinicians use irregularities in vital signs as an early warning sign of sepsis to facilitate early treatment and improve patient outcomes. Adults have used RDW as a marker of worsening respiratory status and mortality from acute respiratory distress syndrome (ARDS). In this study, we seek to investigate elevations in Red Cell Distribution Width (RDW) as markers for culture positive sepsis and need for escalation of respiratory support in VLBW neonates. Association between RDW values and positive cultures Methods We did a retrospective chart review using the Electronic Medical Records (EMR) of VLBW infants (&amp;lt; 1500g) admitted to the Neonatal Intensive Care Unit (NICU) of a community hospital over 3 years. We included all babies who had True apnea (apnea &amp;gt; 20 seconds) or apnea with bradycardia and desaturations, after day seven of life and had CBC tests sent and were being managed for presumed late onset sepsis secondary to this vital sign instability. Other demographic data was gathered and tabulated. The data was analyzed to check for association between increased red cell distribution width (RDW) and need for escalation of respiratory support. Escalation in respiratory support included an increased need of assisted ventilation to support breathing. We also looked at positive blood / urine cultures and RDW values. Association between RDW values and change in baseline respiratory support Results 50 babies matched our inclusion criteria. 31 babies had a positive blood /urine culture. 21 of the 31 had elevated RDW which was statistically significant at p&amp;lt; 0.05 (Table1), hence showing that positive culture late onset sepsis had elevated RDW. Also, we saw increased need for escalation in respiratory support amongst culture positive babies with an elevated RDW at p &amp;lt; 0.05 (Table 2). Conclusion We conclude from this, that elevations in RDW is a marker for VLBW babies needing escalation in respiratory support. Elevations were also seen in culture positive sepsis. More studies need to be done as most of the available data is in adults. We can look more associations in babies with RDS (respiratory distress syndrome) and predict respiratory distress and for early interventions and better outcomes. Disclosures All Authors: No reported disclosures