Low Birth Weight Infants Research Articles

Epigenetic modifications in the ferroptosis pathway in cord blood cells from newborns of smoking mothers and their influence on fetal growth

Maternal smoking during pregnancy increases oxidative stress and decreases antioxidant capacity in newborns. Uncontrolled oxidative stress plays a role in fetal development disorders and in adverse perinatal outcomes. In order to identify molecular pathways involved in low fetal growth, epigenetic modifications in newborns of smoking and non-smoking mothers were examined. Low birth weight newborns of mothers who smoked more than 10 cigarettes per day during the first trimester of pregnancy and normal birth weight newborns of mothers who did not smoke during pregnancy were included in the study. DNA was extracted from umbilical cord blood of term newborns. 125 differentially methylated regions were identified by MeDIP-Seq. Functional analysis revealed several pathways, such as ferroptosis, that were enriched in differentially methylated genes after prenatal smoke exposure. GPX4 and PCBP1 were found to be hypermethylated and associated with low fetal growth. These epigenetic modifications in ferroptosis pathway genes in newborns of smoking mothers can potentially contribute to intrauterine growth restriction through the induction of cell death via lipid peroxidation of cell membranes. The identification of epigenetic modifications in the ferroptosis pathway sheds light on the potential mechanisms underlying the pathophysiology of low birth weight in infants born to smoking mothers.

Immediate postnatal prediction of death or bronchopulmonary dysplasia among very preterm and very low birth weight infants based on gradient boosting decision trees algorithm: A nationwide database study in Japan.

Bronchopulmonary dysplasia (BPD) poses a substantial global health burden. Individualized treatment strategies based on early prediction of the development of BPD can mitigate preterm birth complications; however, previously suggested predictive models lack early postnatal applicability. We aimed to develop predictive models for BPD and mortality based on immediate postnatal clinical data. Clinical information on very preterm and very low birth weight infants born between 2008 and 2018 was extracted from a nationwide Japanese database. The gradient boosting decision trees (GBDT) algorithm was adopted to predict BPD and mortality, using predictors within the first 6 h postpartum. We assessed the temporal validity and evaluated model adequacy using Shapley additive explanations (SHAP) values. We developed three predictive models using data from 39,488, 39,096, and 40,291 infants to predict "death or BPD," "death or severe BPD," and "death before discharge," respectively. These well-calibrated models achieved areas under the receiver operating characteristic curve of 0.828 (95% CI: 0.828-0.828), 0.873 (0.873-0.873), and 0.887 (0.887-0.888), respectively, outperforming the multivariable logistic regression models. SHAP value analysis identified predictors of BPD, including gestational age, size at birth, male sex, and persistent pulmonary hypertension. In SHAP value-based case clustering, the "death or BPD" prediction model stratified infants by gestational age and persistent pulmonary hypertension, whereas the other models for "death or severe BPD" and "death before discharge" commonly formed clusters of low mortality, extreme prematurity, low Apgar scores, and persistent pulmonary hypertension of the newborn. GBDT models for predicting BPD and mortality, designed for use within 6 h postpartum, demonstrated superior prognostic performance. SHAP value-based clustering, a data-driven approach, formed clusters of clinical relevance. These findings suggest the efficacy of a GBDT algorithm for the early postnatal prediction of BPD.

Screening T4 and TSH in Early Detection of Congenital Hypothyroidism in Newborns: What’s the Dilemma?

Untreated congenital hypothyroidism (CH) leads to intellectual disability. Newborn screening (NBS) for CH should be done on all infants. Prompt diagnosis by NBS leads to early and adequate treatment outcomes in very normal neurocognitive outcomes in adulthood. Newborn screening (NBS) for congenital hypothyroidism (CH) is one of the major achievements in preventive medicine. Most neonates born with CH have a normal appearance and no detectable physical signs. Blood spot thyroid stimulating hormone (TSH), thyroxine (T4), or both can be used for CH screening. The latter is more sensitive but not cost-effective, so screening by TSH or T4 is used in various programs worldwide. TSH screening is more specific in the diagnosis of CH. T4 screening is more sensitive in detecting newborns with rare hypothalamic-pituitary-hypothyroidism, but it’s less specific with a high frequency of false positives especially in low birth weight and premature infants. NBS alone is not sufficient to prevent adverse outcomes from CH in a pediatric population. In addition to NBS, the management of CH requires timely confirmation of the diagnosis and accurate interpretation of thyroid function testing, effective treatment, and consistent follow-up. Doctors need to consider hypothyroidism in the face of clinical symptoms, even if NBS thyroid test results are normal. When clinical symptoms and signs of hypothyroidism appear (such as large posterior fontanelles, large tongue, umbilical hernia, prolonged jaundice, constipation, lethargy, and/or hypothermia), measurement of serum thyroid hormone and free thyroxine is indicated, regardless of NBS results. So all these babies should be treated as having CH during the first 3 years of life, taking into account the risk of mental retardation. Re-evaluation after 3 years is required in such patients.

Effect of behavior change communication through the health development army on birth weight of newborns in Ambo district, Ethiopia: a cluster randomized controlled community trial

BackgroundPoor behavior change communication on maternal nutrition and health throughout pregnancy is thought to be to blame for Ethiopia’s high rate of low birthweight babies, and this has implications for neonatal morbidity and mortality. The effect of behavior change communication on birth weight in the study district was not examined. This study was to determine whether improving neonatal birthweight using nutrition and health behavior change communication (NHBCC) interventions was successful.MethodsA cluster randomized controlled trial was conducted in the Ambo district of Ethiopia from May 5, 2018–January 30, 2019. At the beginning of the study, 385 women in the 24 intervention groups and 385 women in the 24 control groups were recruited. In the intervention group, health development armies delivered the NHBCC core message every two weeks for four months by grouping pregnant women in specific clusters. Pregnant women in the control group received the routine treatment offered by the healthcare system during their ANC visits. Within 24 h of birth, the birthweights of 302 and 292 neonates in the intervention and control groups, respectively, were measured at the end point of the study. A binary generalized linear model analysis was employed.ResultThe control group had a larger absolute risk of neonates with low birthweight (0.188 vs. 0.079, p < 0.001) than the intervention group. Pregnant women in the intervention group had an absolute risk difference of 10.9% for low birthweight. Pregnant women who received the intervention were 62% less likely to have low-risk birthweight compared to pregnant women who were in the control group (ARR = 0.381, 95% CI: 0.271–0.737).ConclusionNutrition and health behavior change Communication by health development armies improves birthweight. The findings demonstrated that to improve birthweight, NHBCC must be administered to pregnant women in groups via health development armies in their communities.Trial registration numberPACTR201805003366358.

Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism.

Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure. We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers. In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile. ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.

The Relationship Between Blood Culture, C-reactive Protein, and Neonatal Sepsis: A Cross-Sectional Study.

Background Sepsis is one of the most common causes of morbidity and mortality in newborns. Diagnosis of neonatal sepsis may be difficult because the clinical presentations are often nonspecific. Neonatal sepsis may have an early onset (zero to three days) or a late onset (four days or later). Onset is most rapid in premature neonates. In this study, we aimed to assess the correlation between positive cultures, high C-reactive protein (CRP) levels, and the diagnosis of neonatal sepsis. Methodology This descriptive, prospective, cross-sectional study was undertaken over four months starting from December 15, 2019, to April 15, 2020, in Atbara Teaching Hospital, Sudan. Data were collected from 71 patients. CRP levels were measured, and blood cultures were performed. Results High CRP level >10 mg/L was seen in patients having positive blood culture (55.3%), mainly in preterm babies (CRP >10 mg/dL (61.1%), positive culture (55.6%)) and very low birth weight babies (CRP >10 mg/dL (83.3%) and positive culture (67%)). Conclusions Our findings suggest that Klebsiella is an important cause of neonatal sepsis. CRP was positive in babies mainly with proven sepsis. There is a high correlation between CRP and blood culture in patients with neonatal sepsis which may give access to remodeling the prioritization of the management options in the clinical setting.

The Effectiveness of Oral Stimulation on the Suction Reflex in LBW Babies in the Perinatology Room at RSUD dr. Abdul Rivai Berau

Efforts to treat Low Birth Weight (LBW) babies to increase body weight while in hospital is by providing direct breast milk; however, there is a weakness in suction power in LBW babies. Oral stimulation is necessary to increase the suction reflex to overcome this. This study aimed to determine the effectiveness of oral stimulation on the sucking reflex in LBW babies. This was a pre-experimental study and One Group Pre-Test – Post-Test design without a control group. The population was LBW babies in the Perinatology Room at dr. Abdul Rivai Hospital has 30 babies, based on the Roscoe formula, and has a sample of 20 people. Data analysis used the Friedman test. Characteristics of respondents: mostly gestational age 28-36 weeks (60%), female gender (60%), baby weight between 1,500-2,499 grams (55%), mother's age &gt; 35 years (50%), mother's education graduated from high school (47.1%), parity of multiparous mothers (60%) and mother's occupation as housewife (60%). The sucking reflex in LBW babies before being given oral stimulation was completely lacking by 20 respondents (100%). The sucking reflex in LBW babies after being given oral stimulation was perfect for 20 respondents (100%). Oral stimulation was influential on the sucking reflex in LBW babies (p-value = 0.000 &lt; ?: 0.05). This indicates that oral stimulation is effective on the sucking reflex in LBW babies. Hospitals are expected to make oral stimulation of Standard Operational Procedure for routine activities carried out by nurses and physiotherapists to improve the sucking reflex in LBW and LBW babies.

Effect of probiotics on the intestinal microbiota of preterm and low birth weight infants: systematic review

Premature infants have an immature intestinal microbiota when compared to a full-term baby, colonized with a reduced number of beneficial bacterial species and, therefore, are more likely to have their microbiota populated by pathogenic species. The administration of probiotics can positively influence the intestinal colonization of premature babies. Thus, this study aimed to systematically review evidences of the effect of administering probiotics on the microbiota of premature newborns and their safety. It was designed as follows: population (premature newborns), intervention (probiotics), comparison (placebo or no treatment), outcome (changes in the microbiota of premature newborns), study type (randomized clinical trials). The studies were searched in the Cochrane Library, Medline via PubMed and Embase databases and, in a complementary way, through manual searches on Google Scholar and the Brazilian CAPES journal portal (www.periodicos.capes.gov.br). We included 23 studies involving 3,670 preterm infants, of which 65.2% (n=15) were classified as having a low risk of bias, 17.4% (n=4) with some risk of bias and 17.4% (n= 4) with high risk of bias. Probiotics have been used in order to colonize the intestinal microbiota. Finally, some Lactobacillus and Bifidobacterium strains tested seem to have benefits and safety for the microbiota and health of premature newborns.

Examination of changes in the breathing intolerance index to determine the respiratory support needs of very low birth weight infants.

The breathing intolerance index (BITI) is used to evaluate respiratory muscle tolerance. The higher the ratio of the inspiratory time to the total breathing time and the ratio of the tidal volume to the vital capacity, the more easily the respiratory muscles become fatigued. The BITI is high with chronic respiratory failure, and values of 0.15 or more indicate the need for assisted ventilation. This study aimed to examine the changes in the BITI of very low birth weight infants (VLBWIs) and determine whether it is possible to use the BITI as an objective indicator of the timing of noninvasive respiratory support (NRS) withdrawal. VLBWIs admitted to our neonatal intensive care unit between July 2020 and July 2022 under NRS at 36 weeks' postmenstrual age (PMA). If the BITI was less than 0.15, then we attempted to determine whether NRS could be withdrawn. Sixteen infants with a median gestational age and birth weight of 30.9 weeks and 1249 g, respectively, were eligible. The median PMA at the time of the first examination was 36.6 weeks. The BITI of two VLBWIs was less than 0.15. For 11 of the other VLBWIs, the BITI decreased over time to less than 0.15 at 39 weeks' PMA. After confirming that the BITI was less than 0.15, weaning from NRS was attempted. Weaning from NRS was possible except one VLBWI. The BITI can help evaluate respiratory tolerance and could be an objective indicator of the timing of NRS withdrawal.

DSOG Guideline Bulletin: Vegetarian and vegan diets during pregnancy

Vegetarian and vegan diets are becoming increasingly common among Danish women of reproductive age. We reviewed the available literature via PubMed and concluded that varied and well-balanced vegetarian and vegan diets are safe and sufficient during pregnancy and lactation, provided that dietary supplements for folate, vitamin B12, and vitamin D are taken regularly. Additionally, it is important to ensure adequate intake of calcium, protein, and iron. Protein requirements may be higher for vegetarians and especially for vegans, though evidence is limited regarding the recommendation for increased protein intake if the diet is exclusively plant-based. Routine blood tests are not recommended unless there has been insufficient supplementation leading up to or during pregnancy, or if symptoms suggest a deficiency. We found no evidence to support supplementation with docosahexaenoic acid (DHA). There is no indication of an increased risk of malformations for pregnant Danish women on a vegetarian or vegan diet compared to omnivores. The risk of delivering small for gestational age and low birthweight infants (&lt;2500 grams) may be increased, but the evidence is conflicting and of poor quality. Vegetarian and vegan diets may offer benefits, such as a lower risk of excessive gestational weight gain and women consuming the lowest amounts of meat have a significantly lower risk of gestational diabetes. Vegans may face a lower risk of having large for gestational age infants. Vegetarian and vegan lifestyles are also compatible with breastfeeding, and provided women take the recommended supplements, there is no difference in the micronutrient content of the breast milk of vegetarian/vegan women compared to that of omnivores. Children of vegans and vegetarians with limited or no consumption of milk products or eggs are recommended to breastfeed or receive baby formula for at least the first two years of life.

Physical Intimate Partner Violence in Pregnant Women and its Risk on Low Birth Weight: A Meta-Analysis

Background: Intimate Partner Violence (IPV) is a significant public health problem that affects women, including pregnant women. During pregnancy, pregnant women experiencing IPV will have an impact on the health of the mother and fetus, including an increased risk of premature birth and low birth weight babies. This study aims to analyze and estimate the influence of physical intimate partner violence in pregnant women on low birth weight infants. Subjects and Method: Meta-analysis was carried out according to the PRISMA flow diagram and PICO Model. Population: pregnant women, Intervention: Intimate partner violence, Comparison: No intimate partner violence, Outcome: low birth weight babies. Search for articles in this research through databases including PubMed, Google Scholar, ScienceDirect by selecting articles published in 2015-2023. With the keywords "Intimate Partner Violence" OR "Domestic Violence" AND "Low Birth Weight" AND "Pregnancy" AND "Adjusted Odds Ratio". Inclusion criteria are full paper articles with an observational study design, articles are in English. Results: Nine studies of cohort and cross-sectionals were included for meta-analysis. Meta-analysis of 5 cohort studies showed that physical intimate partner violence in pregnant women increased the risk of infants low birth weight (aOR= 3.66; 95% CI= 2.31 to 5.79; p&lt;0.001). Meta-analysis of 4 cross-sectional studies showed that physical intimate partner violence in pregnant women increased the risk of infants low birth weight (aOR= 3.60; 95% CI= 2.05 to 6.32; p&lt; 0.001). Conclusion: Physical intimate partner violence in pregnant women increases the risk of infants with low birth weight.

Comparing Healthcare Needs in Extremely Low Birth Weight Infants With NEC and Spontaneous Intestinal Perforation

BackgroundNecrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6–8% of extremely low birth weight (ELBW) infants. SIP has lower mortality than NEC, but with similar short-term morbidity in length of stay, growth failure, and supplemental oxygen requirements. Comparative long-term neurodevelopmental outcomes have not been clarified. MethodsData were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401–1000 g or 22–27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16–26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated. ResultsOf 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09–1.86), rehospitalization (ARR 1.46; 1.17–1.82), and post-discharge surgery (ARR 1.82; 1.48–2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34–2.00) compared to infants without NEC or SIP. ConclusionsELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs. Levels of EvidenceLevel II.

Alginate oligosaccharides improve hepatic metabolic disturbance via regulating the gut microbiota

Alginate oligosaccharides (AOS) derived from sodium alginate are novel prebiotics with multiple biological functions. Low birth weight (LBW) is a public health concern worldwide. However, the benefits of AOS in LBW mammals have not been determined. In this study, we found that AOS significantly improved the growth performance, colonic mucosal immunity, and jejunal nutrient digestion and transport of LBW piglets. Moreover, AOS alleviated liver injury by alleviating oxidative stress and pro-inflammatory responses, and improved hepatic lipid accumulation and insulin resistance by decreasing the levels of genes involved in lipid transport, de novo lipogenesis, and the insulin signaling. Integrated 16S rDNA, transcriptome, and metabolome analyses revealed that AOS alleviated the disruption of colonic mucosal immunity by increasing the abundance of Lactobacillus and short-chain fatty acids, and improved hepatic dysfunction via the tryptophan metabolites and aryl hydrocarbon receptor signaling. These findings revealed the effects and mechanisms of AOS in intestinal and hepatic dysfunction in LBW piglets, and broadened the potential application of AOS in improving postnatal maldevelopment in LBW infants.

A Narrative Review on Managing Retinopathy of Prematurity: Insights Into Pathogenesis, Screening, and Treatment Strategies.

Retinopathy of prematurity (ROP) is a rare proliferative ocular condition that can happen in premature babies (born preterm<36 weeks)or who weigh <1.5 kgat birth (low birth weight babies). ROP is a major cause of childhood blindness. It is a premature diseasesince retina vascularization is completed only by 40 weeks of life. The survivability for preterm infants has increased owing to recent improvements in neonatal care during the past decade. As a result, the prevalence of ROP has risen concurrently. The abnormal development of blood vessels in the retina is the cause of this illness. It occurs in two phases, phases 1 and 2. Most preterm infants weighing <1.5 kg need supplemental oxygen for respiratory support at birth. This leads to the initiation of phase 1 (vasoconstrictive phase). Phase 1 is characterized by loss of maternal-fetal connection and hyperoxia due to supplemental oxygen therapy.Oxygen's vasoconstrictive and obliterative action is primarily observed in developing retinal vessels. The inhibition of vascular endothelial growth factorfollows from this.Phase 2 (vasoproliferative phase) showsthe dilatation and tortuosity of the bigger existing vessels together with neovascularization and proliferation of new vessels into the vitreous when the baby is shifted from respiratory support to room air. Now, the retina gets hypoxic, where the retina becomes more metabolically active but is yetminimally vascularized, leading to VEGF-induced vasoproliferation, which might result in retinal detachment. Patients with ROP face the danger of loss of vision. If correct and quick treatment is not provided, they might land into permanent blindness. Yet, ROP remains one of themost preventablecauses of childhoodblindnessworldwide. Blindness caused by ROP can only be avoided if screening programs are readily available, pertinent, and appropriate.The initial stage in the therapy of ROP is the screening ofpremature neonates. Timely screening and management for ROP is important to avoidthis irreversible loss of vision. The treatment is based on the severity of the disease. Management may include pharmacological interventions like intravitrealand anti-vascular endothelial growth factor and non-pharmacological interventions like laser surgery, vitrectomy, and scleral buckling. We conducted athorough literature search of studies onpathogenesis, risk factors, classification, and various treatment options for retinopathy of prematurity in infants, using a mixture of pertinent keywords.Only those studies published in peer-reviewed journals between 2010 and 2023 and written in English were included.Duplicate studies, unavailable in full-text for free, or studies unrelated to our subject matter were excluded. After thoroughly evaluating the selected studies, the results were synthesized and presented narratively. This article sheds light on the pathogenesis of ROP, particularly its relation to oxygen use, screening, and potential therapeutic management of ROP. Today advances in screening techniques have improved the outcomes for infants with ROP. Still, ongoingresearch is needed to optimize management strategies and reduce the burden of this condition.

Effectiveness of Postnatal Maternal or Caregiver Interventions on Outcomes among Infants under Six Months with Growth Faltering: A Systematic Review.

The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of 'low' to 'very low' quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001).

Gestational Age and Neurodevelopmental Delay in Term Births at 6 and 12 Months: The Japan Environment and Children’s Study (JECS)

BackgroundIn the recent years, a high risk of developmental delay not only in very low birth weight infants and late preterm infants but also in early term infants (37–38 weeks) have increasingly been reported. However, in Japan, there are virtually no studies regarding the development delays in early term infants.MethodsThis study used the data from the Japan Environment and Children’s Study (JECS), a birth cohort study conducted in Japan. Data were selected for analysis from the records of 104,065 fetal records. The risk of neurodevelopmental delays at 6 months and 12 months after birth was evaluated using multivariate analysis for infants of various gestational ages, using the 40th week of pregnancy as a reference value. Neurodevelopment was evaluated at 6 months and 12 months after birth using the Ages and Stages Questionnaires, Japanese translation (J-ASQ-3).ResultsThe proportion of infants born at a gestational age of 37 to 38 weeks who did not reach the J-ASQ-3 score cutoff value was significantly higher in all areas at both 6 months and 12 months after birth, when compared to that of infants born at 40 weeks. The odds ratio decreased at 12 months after birth compared to that at 6 months after birth.ConclusionEarly term infants in Japan are at an increased risk of neurodevelopmental delay at 12 months after birth.

Neonatal respiratory care practice among level III and IV NICUs in New England.

To assess respiratory care guidelines and explore variations in management of very low birth weight (VLBW) infants within a collaborative care framework. Additionally, to gather clinical leaders' perspectives on guidelines and preferences for ventilation modalities. Leaders from each NICU participated in a practice survey regarding the prevalence of unit clinical guidelines, and management, at many stages of care. Units have an average of 4.3 (±2.1) guidelines, of 9 topics queried. Guideline prevalence was not associated with practice or outcomes. An FiO2 requirement of 0.3-0.4 and a CPAP of 6-7 cmH2O, are the most common thresholds for surfactant administration, which is most often done after intubation, and followed by weaning from ventilatory support. Volume targeted ventilation is commonly used. Extubation criteria vary widely. Results identify trends and areas of variation and suggest that the presence of guidelines alone is not predictive of outcome.

Paritas, Age, and Education Are Associated with the Level of Anxiety in Facing the Childbirth Period in PMB Komang Seni Rahayu, A.Md.Keb

Pregnancy-related anxiety is a condition that arises from the subjective experience of unsettling mental tension as a general reaction and the inability to deal with issues or feelings of insecurity that affect pregnant women and are related to the mother's concern for the welfare of herself and her fetus. The pregnant woman's age, education level, and prior pregnancies and deliveries are risk factors that contribute to anxiety in pregnant women. Particularly throughout the third trimester of pregnancy up until delivery, anxiety can strike pregnant women. Pregnant women experience anxiety during this time, including worry about having a healthy baby or worrying about the discomfort they are experiencing. These diseases can raise the risk of bleeding wounds and uterine atony, while also raising the likelihood of preterm birth and low birth weight in babies. This study's main goal was to find out how third-trimester pregnant women at PMB Komang Seni Rahayu, A.Md.Keb related to parity, age, and education. This study is quantitative and cross-sectional in nature. A questionnaire that was distributed to a specified group of respondents was used to collect data using the purposive sampling technique. 32 samples total were used in this study. Both univariate and bivariate data analysis are used in this study. Results of the correlations statistical test (= 0.05). The findings revealed a correlation between parity, age, and education with the degree of anxiety associated with giving birth in third-trimester pregnant women at PMB Komang Seni Rahayu, A.Md.Keb, with a significance of p = 0.139 at parity, age with p = 0.005, and level of education with 0.628.&#x0D; &#x0D; Keywords : Characteristics, Pregnant Women, Anxiety

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya.

Preterm (born < 37 weeks' gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes.

Higher fluid and lower caloric intakes: associated risk of severe bronchopulmonary dysplasia in ELBW infants.

To examine nutritional intake profiles and growth trajectories of extremely low birth weight (ELBW) infants who develop severe bronchopulmonary dysplasia (BPD). Case-control study using multiple logistic regression analysis with generalized estimating equations (GEE) to adjust for matching. Cumulative and mean fluid intakes were higher (p = 0.003) and caloric intakes lower (p < 0.0001) through week two in infants who developed severe BPD (n = 120) versus those without severe BPD (n = 104). Mean caloric intake through week 12 was lower in infants who developed severe BPD (102 ± 10.1 vs. 107 ± 8.5 kcal/kg/day, p < 0.0001). In the logistic regression models, lower mean caloric intake through week 12 was associated with increased risk of developing severe BPD. Linear growth reduced the odds of BPD by ~30% for each Z-score point. Higher fluid and lower total caloric intakes and reductions in linear growth were independently associated with an increased risk of developing severe BPD in ELBW infants.