Search Results (337)

Bronchopulmonary dysplasia (BPD) remains the most common chronic respiratory complication of extremely preterm infants despite major advances in neonatal intensive care. Although contemporary therapies have improved survival by reducing secondary lung injury, they have had limited impact on the disrupted lung development that characterizes modern BPD. This has renewed interest in developmental therapeutics that seek to restore physiologic signaling pathways interrupted by premature birth rather than treat established disease. Among the developmental pathways disrupted by premature birth, observational studies consistently demonstrate that low postnatal IGF-1 concentrations in extremely preterm infants are associated with an increased risk of BPD and other complications of prematurity. Although these associations do not establish causality, they provide a biologically plausible basis for investigating physiologic IGF-1 replacement. This review summarizes the developmental biology of the IGF axis and the translational pathway supporting the clinical development of OHB-607, a recombinant human IGF-1/IGF-binding protein-3 complex intended to restore physiologic IGF-1 concentrations in extremely preterm infants at high risk for BPD. The program provides one example of how developmental biology, translational animal models, developmental pharmacology, and clinical implementation can be integrated into a framework for advancing mechanism-based therapies aimed at preserving normal lung development after extremely premature birth. Whether this approach improves clinically meaningful outcomes remains to be determined in adequately powered randomized clinical trials. Full article

Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article

Background and objectives: Children born prematurely are more likely to have altered sensory profiles, which can affect family and school functioning. This scoping review aimed to analyze the relationship between prematurity and the development of atypical sensory profiles. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), including studies evaluating children aged 1 to 12 years who were born at a gestational age of ≤32 weeks. The data sources were PubMed, Scopus, and Web of Science. The search was limited to English-language studies published in the previous 10 years. The keywords “Sensory Processing”, “Child Development”, “Perception”, “Sensory Profile”, “Sensory Integration”, “Preterm”, “Infant Premature”, “Infant Extremely Low Birth Weight”, and “Infant Low Birth Weight” were used to search the databases. Articles with outcomes related to cerebral palsy, blindness, low vision, hearing impairment, behavioral disorders, and autism were excluded. After article selection, the atypical sensory profiles identified were organized into thematic categories and evaluated according to frequency of occurrence. Results: Seven articles were included and showed frequent atypical sensory profiles in very preterm children, especially in sensory processing, particularly hyporesponsiveness, and visual perception. Conclusions: These findings indicate altered sensory performance among very preterm children, which may negatively affect motor, cognitive, and behavioral development. Early sensory screening may improve detection and guide interventions to minimize adverse developmental outcomes. Full article

Owing to its inherent flight safety, low takeoff and landing requirements, and favorable economic efficiency, the autogyro UAV, especially its electric and hybrid-electric variants, has become a core platform for low-altitude aviation missions such as transportation, inspection, and surveillance in plateau and offshore regions. However, the low air density and low Reynolds number conditions encountered in plateau regions can induce aerodynamic issues such as premature laminar flow separation, dynamic stall, and increased induced drag, which directly reduce payload capacity and endurance of small electric autogyro UAVs. In offshore environments, strong winds, turbulence, and gust disturbances intensify rotor–wake interactions, cause abrupt variations in aerodynamic loads, and reduce control margins, which severely restricts the mission reliability and flight safety of low-altitude unmanned platforms. These environmental effects collectively degrade rotor performance, including reduced aerodynamic efficiency and insufficient lift generation, and further amplify the energy constraint of electric/hybrid-electric propulsion systems. In response to bottlenecks that restrict the practical application of autogyro UAVs in extreme environments, this paper systematically reviews research progress on lift vector control for autogyro UAV rotors operating under such conditions. First, the typical aerodynamic problems encountered by autogyro UAVs in plateau and offshore environments are summarized, and their underlying physical mechanisms are analyzed from both system-level and local-flow perspectives, with a focus on how environmental factors affect the autorotation stability of unmanned platforms. Subsequently, the development of passive lift vector control technologies is reviewed, with an emphasis on the aerodynamic benefits of passive pitch mechanisms, vortex generators, and blade-tip winglets, as well as their engineering feasibility for small autogyro UAV blades. Active lift vector control technologies are then examined, including air-jet flow control, synthetic jets, and trailing-edge flaps, with discussions of their potential to delay flow separation and stall, enhance rotor aerodynamic efficiency, and an assessment of their adaptability to the energy and structural constraints of unmanned platforms. Finally, a lift vector control strategy suitable for autorotating rotors of autogyro UAVs is proposed, based on careful consideration of energy consumption, structural constraints, and control effectiveness. It provides a reference for aerodynamic optimization and flight control research on electric and hybrid-electric autogyro UAVs operating in extremely low-altitude environments. Full article

Vehicle-to-grid (V2G) integration in commercial building microgrids (CBMGs) offers a promising path for grid support, economic arbitrage, and resilience enhancement. However, practical implementation is hindered by the optimization–execution gap, where high-level aggregated commands fail to match low-level physical charger capacities and individual battery boundaries, as well as by the lack of sociotechnical coupling under extreme weather events, where vehicle owner range anxiety dominates. To address these challenges, a closed-loop multi-timescale energy management system for V2G-enabled CBMGs under exogenous meteorological conditions is proposed. The framework features an integrated four-layer cyber–physical control architecture connecting macroscopic day-ahead scheduling, receding-horizon model predictive control (MPC), discrete real-time parking slot allocation with hardware safety boundary constraints, and equipment-level power flow execution. To handle extreme events, an exogenous meteorological stress index is formulated to quantify ambient structural hazards and temperature deviations, which are then mapped to owner range anxiety and loss-aversion behaviors using prospect theory. Rather than relying on heuristic rule-switching, the optimizer executes a smooth and continuous transition from normal economic peak-shaving to active pre-disaster energy reservation and load demand survival. The cyber–physical system is validated using high-fidelity simulations under typical summer and winter blizzard scenarios. The results demonstrate that the proposed hierarchical architecture successfully eliminates optimization–execution mismatches and guarantees zero load shedding. Furthermore, sensitivity analyses establish the optimal system configuration with the critical defense tolerance of 0.6 and the baseline anxiety ratio of 4, which successfully resolves the trade-off between premature defensive actions and insufficient energy reserves while considering human behavioral uncertainty. Full article

Background and Clinical Significance: Skin-limited Langerhans cell histiocytosis (LCH) is a clinically heterogeneous disease, ranging from self-healing forms to fulminant multi-organ failure, the latter being more often described in infants, especially preterm neonates. The optimal therapy for cutaneous LCH remains controversial; the possibilities vary from a watchful waiting approach to systemic chemotherapy. Case Presentation: This case report describes an exceptionally rare and clinically challenging course of skin-limited LCH in a prematurely born infant treated at the Department of Oncology and Hematology, Children’s Hospital Zagreb, Croatia. At presentation, the patient exhibited several features suggestive of aggressive disease biology. However, therapeutic decision-making was complicated by extreme prematurity and young age, both of which significantly increased vulnerability to treatment-related toxicity. Following failure of topical therapy, systemic treatment was initiated according to the LCH-IV trial, primarily due to concerns regarding potential evolution into multisystem LCH. During treatment, the patient developed multiple life-threatening complications, namely severe infections (Staphylococcus aureus endocarditis, Pneumocystis jirovecii pneumonia, and Enterobacter cloacae sepsis), aggravated by secondary hypogammaglobulinemia, neutropenia, and iatrogenic adrenal insufficiency. Conclusions: The varied nature of cutaneous LCH underscores the necessity for a tailored treatment approach. When deciding on the treatment modality, clinicians should weigh the benefits of aggressive therapies, ensuring better disease control, against the potential for severe adverse effects, particularly in young, fragile infants with immature immunity. Full article

Objective: The aim of this study was to explore the diagnostic value of lung ultrasound (LUS) for bronchopulmonary dysplasia (BPD) in extremely premature infants. Methods: This was a prospective observational cohort study in which infants with gestational age (GA) ≤ 28⁺⁶ weeks were included. LUS was performed at least once a week until 36 weeks of postmenstrual age. The LUS characteristics of infants with moderate–severe BPD were compared with those of infants with non–mild BPD. Results: A total of 114 infants were included, of which 69 (60.5%) had non–mild BPD, and 45 (39.5%) had moderate–severe BPD. The mean GA and birth weight of infants with non–mild BPD and moderate–severe BPD were 27.0 ± 1.4 and 26.3 ± 1.6 weeks and 969 ± 184 and 802 ± 228 g, respectively. The proportions of rough pleural lines, fused B-lines, patch-like anechoic appearance on the pleural surface, subpleural speckled hyperechoic appearance, lung consolidation (≥0.5 cm), fuzzy or invisible A-lines, and pleural insect erosion (PIE)-like changes in the moderate–severe BPD group were significantly greater than those in the non–mild BPD group (100% vs. 37.7%, 88.9% vs. 13.0%, 84.4% vs. 7.2%, 73.3% vs. 8.7%, 80.0% vs. 11.6%, 86.7% vs. 10.1%, and 75.6% vs. 5.8%, respectively; p < 0.001). In evaluating moderate–severe BPD, rough pleura had 100.0% (95% CI: 0.921–1.000) in sensitivity, 63.4% (95% CI: 0.518–0.736) in PPV, and 62.3% (95% CI: 0.505–0.728) in specificity. PIE-like changes had 75.6% (95% CI: 0.613–0.858) in sensitivity, 89.5% (95% CI: 0.759–0.958) in PPV, and 94.2% (95% CI: 0.860–0.977) in specificity. Pleura surface irregular patch-like anechoic had 84.4% (95% CI: 0.712–0.923) in sensitivity, 88.4% (95% CI: 0.755–0.949) in PPV, and 92.8% (95% CI: 0.841–0.969) in specificity. Subpleural speckled hyperechogenicity had 73.3% (95% CI: 0.592–0.840) in sensitivity, 84.6% (95% CI: 0.704–0.930) in PPV, and 91.3% (95% CI: 0.824–0.960) in specificity. Conclusions: LUS is a valuable tool for evaluating and diagnosing BPD. Full article

Apert syndrome is a rare genetic disorder characterized by premature fusion of the cranial sutures, syndactyly of the extremities, and distinct craniofacial deformities. The condition results from mutations in the FGFR2 gene, which disrupt normal craniofacial growth and lead to complex functional and morphological abnormalities. Patients with Apert syndrome commonly present with stomatognathic abnormalities, which significantly affect oral function and facial development. The management of Apert syndrome requires a multidisciplinary therapeutic approach. Surgical treatment strategies are typically staged according to the patient’s age and clinical severity. Early interventions focus on cranial vault expansion procedures, such as fronto-orbital advancement and posterior vault distraction osteogenesis, aiming to relieve intracranial pressure and improve cranial morphology. During childhood and adolescence, midface advancement techniques are commonly performed to address midfacial hypoplasia and associated functional impairments. Early diagnosis and appropriate surgical planning play a crucial role in preventing complications and improving the functional, aesthetic, and psychosocial outcomes of patients with Apert syndrome. This narrative review summarizes current evidence while highlighting areas of ongoing controversy, particularly regarding surgical sequencing, orthodontic management and the integration of digital technologies into multidisciplinary care. Full article

Introduction: Bronchopulmonary dysplasia (BPD) remains the most significant complication of extreme prematurity, affecting long-term respiratory outcomes. Because current diagnostic criteria identify only established lesions at 36 weeks postmenstrual age, early non-invasive biomarkers are needed. This pilot study aimed to identify a candidate salivary miRNA panel associated with BPD risk and to explore its pathogenetic relevance through in silico analysis. Methods: Saliva was collected from 20 preterm infants (10 with BPD and 10 controls), and miRNA expression was profiled using the GeneChip™ miRNA 4.1 Array Plate. Discriminatory performance was explored by ROC analysis within this discovery cohort, together with power and Spearman correlation analyses. Results: Expression of hsa-let-7b-5p, hsa-let-7c-5p, and hsa-miR-4454 was significantly elevated in the BPD group (p < 0.05, log₂FC ≥ 1.0), with no significant correlation with gestational age or birth weight. Bootstrap-corrected AUC values ranged from 0.905 to 0.937 and were supported by leave-one-out cross-validation. All three miRNAs showed very large effect sizes exceeding the minimum detectable effect at 80% power. Conclusions: In this pilot study, salivary miRNAs represent a hypothesis-generating candidate biomarker signal for BPD that requires external validation in larger, independent cohorts before any diagnostic or prognostic application can be considered. Full article

Dynamic comparators are key building blocks in low-power successive-approximation-register (SAR) analog-to-digital converters (ADCs), where energy efficiency, decision speed, and reliable operation under process, voltage, and temperature (PVT) variations are essential design requirements. This paper presents a 0.8 V subthreshold double-tail dynamic comparator incorporating a threshold-controlled latch activation mechanism for differential 10-bit SAR ADC applications. By delaying latch regeneration until sufficient differential voltage amplification is established by the dynamic amplifier stage, the proposed architecture suppresses premature regeneration, reduces kickback-induced disturbances, and improves comparator operation under low-voltage conditions. To comprehensively evaluate robustness under extreme operating conditions, a dedicated Input Test Pattern (ITP)-based validation methodology was developed and applied across 45 PVT corners comprising TT, SS, FF, FS, and SF process conditions, ±10% supply-voltage variation (0.72–0.88 V), and temperatures ranging from 0 °C to 100 °C. The comparator was implemented in a 180 nm CMOS technology and evaluated through schematic and post-layout simulations. Under nominal operating conditions, the proposed comparator resolved a minimum differential input voltage of 0.8 mV while achieving a post-layout regeneration delay of 327 ps, an average power consumption of 41.4 nW, and an energy efficiency of 20.7 fJ/comparison-step. In addition, the proposed architecture achieved a peak-to-peak kickback noise of 197 mV and successfully passed all 45 post-layout PVT corner simulations, demonstrating reliable functionality under wide process, voltage, and temperature variations. These results validate the effectiveness of the proposed threshold-controlled latch activation mechanism and the ITP-based validation methodology, demonstrating that the proposed JRR2 comparator provides an effective balance among low-voltage operation, decision speed, ultra-low-power consumption, energy efficiency, and robustness for differential 10-bit SAR ADC applications. Full article

Background: Chlorodontia is a rare condition characterized by intrinsic green discoloration of teeth. It is most often reported in association with bilirubin pigment deposition during teeth development, in cases of severe and/or prolonged neonatal hyperbilirubinemia. In extremely preterm infants, this condition may be complicated by other developmental enamel defects (DDE), such as hypoplasia or hypomineralization, linked to prematurity, systemic diseases, nutritional disturbances, and intensive care exposures. That overlap of enamel abnormalities can make diagnosis more difficult, necessitate a complex treatment plan, and increase the unpredictability of dental treatment efficacy. Case Presentation: This report presents the case of a child born at 25 weeks’ gestation with a birth weight of 910 g. Her neonatal course was complicated by, among others, recurrent episodes of hyperbilirubinemia, first neonatal (treated with phototherapy between the second and fifth day of life), and afterwards due to cholestasis from day 30 of life, with coexisting bacterial sepsis and metabolic disturbances. The available neonatal medical documentation indicated that total bilirubin level peak took place on the 40th day of life with levels approaching approximately 30 mg/dL, as well as levels of conjugated bilirubin being 19.0 mg/dL, but the exact peak values, duration, and bilirubin fractionation were not given in the patient’s discharge form. At 15 months of chronological age (11.5 months corrected age), she was referred for an assessment of abnormal morphology and green discoloration of the erupted primary incisors. Clinical examination revealed intrinsic green discoloration of the teeth, rough incisal edges and enamel breakdown on the incisal third. During follow-up, less intensity of the green pigmentation in the subsequent groups of erupted teeth was noticed. Despite excellent oral hygiene and adherence to a low-cariogenic diet, the primary first molars probably developed post-eruptive enamel loss with exposed dentin tissue. Minimally invasive management was introduced using atraumatic restorative treatment with glass-ionomer cement, combined with intensive preventive care. Conclusions: Despite the fact that, in the presented case, the diagnosis of presumptive bilirubin-related green pigmentation relies exclusively on the clinical picture and the complex neonatal medical history, it shows that, in extremely preterm infants, chlorodontia may coexist with hypomineralization or hypoplasia. This requires the introduction of dental treatment and prophylaxis, adjusted to the child’s age, to lower the risk of further complications of DDEs. Full article

Background: Bronchopulmonary dysplasia (BPD) is a leading chronic lung complication in extremely premature newborns. The etiological factors contributing to of BPD include both prenatal and postnatal risk factors, as well as activation of innate immunity. Innate immunity and its bioactive mediators play a central role in orchestrating the inflammatory response. Among these, interleukin-1β (IL-1 β) and IL-8 (CXCL8) are particularly prominent. Methods: A structured literature search was conducted across major biomedical databases (PubMed, Scopus, Web of Science, and Ovid MEDLINE) to identify relevant studies published between 1993 and November 2025. Article selection was guided by predefined inclusion criteria focusing on studies that examined IL-1β and IL-8 (CXCL8) in relation to bronchopulmonary dysplasia. Evidence from both human and animal studies was narratively synthesized. Results: This review provides a detailed description of the role of the innate immune system in BPD, including mechanisms of inflammatory initiation, evidence from human and animal studies on IL-1β and IL-8 (CXCL8), and the interaction between these two cytokines in the development of chronic lung disease. Conclusions: Both human and animal studies generally suggest that elevated levels of IL-1β and IL-8 (CXCL8) are closely associated with the development of bronchopulmonary dysplasia in premature infants. Full article

Ultraviolet (UV) radiation is a major environmental risk associated with skin cancer, premature skin aging, and ocular damage. In the context of climate variability, changes in cloud cover and ozone-layer dynamics increase the need for reliable short-term UV forecasting systems in highly exposed urban areas. This study proposes a comparative forecasting framework for UV radiation intensity in Lima, Peru, using more than 827,000 records from a meteorological station. Statistical models, recurrent deep learning architectures, and hybrid neural models were evaluated under a unified protocol including 5 min aggregation, daytime filtering, a fixed 60 min forecasting horizon, chronological train–test partitioning, temporal cross-validation, statistical significance testing, and quantitative residual diagnostics. The results show that recurrent and hybrid deep learning models substantially outperformed traditional statistical approaches. Hybrid Model 2 achieved the best holdout performance, obtaining the lowest RMSE and the highest R² value. Statistical testing confirmed its superiority over classical forecasting models. Residual diagnostics showed limited systematic bias, although extreme UV radiation peaks remained the principal source of forecasting uncertainty. These findings provide a reproducible artificial intelligence framework for short-term UV radiation forecasting and support intelligent early warning systems for public health protection, environmental monitoring, and climate resilience, contributing to Sustainable Development Goal 13 on Climate Action. Full article

Background/Objectives: Post-hemorrhagic hydrocephalus (PHH) is a major complication of extreme prematurity associated with significant neurodevelopmental morbidity. Although post-hemorrhagic ventricular dilatation (PHVD) is a recognized consequence of intraventricular hemorrhage (IVH), progression from an apparently low-grade IVH to severe shunt-dependent disease with imaging features suggestive—but not diagnostic—of a non-communicating hydrocephalus pattern is uncommon and presents important diagnostic and management challenges. We report such a case. Case Presentation: A male infant born at 26 weeks’ gestation developed an initially documented Grade II intraventricular hemorrhage that subsequently evolved into progressive post-hemorrhagic ventricular dilatation. Serial cranial ultrasonography demonstrated progressive ventriculomegaly, later confirmed by computed tomography showing marked dilatation of the lateral and third ventricles with severe cortical mantle thinning and a relatively preserved fourth ventricle, raising suspicion of a non-communicating hydrocephalus pattern. Clinical deterioration with progressive macrocephaly and neurological manifestations necessitated temporizing ventricular cerebrospinal fluid drainage, followed by ventriculoperitoneal shunt placement after stabilization and management of secondary complications. Management throughout the clinical course relied on serial neuroimaging, multidisciplinary decision-making, and individualized neurosurgical intervention. Conclusions: This case illustrates that an apparently low-grade neonatal intraventricular hemorrhage may evolve into severe shunt-dependent PHVD and emphasizes the importance of serial neuroimaging surveillance, objective assessment of ventricular progression, and cautious interpretation of imaging findings suggestive—but not diagnostic—of a non-communicating hydrocephalus pattern. It further highlights the diagnostic and therapeutic challenges encountered when atypical radiological evolution complicates the management of PHVD in extremely premature infants. Full article

Background/Objectives: Chorioamnionitis (CA), an inflammation, with or without infection, involving the amniotic fluid, placenta, fetal membranes or decidua, can significantly impact fetal and neonatal development. This study aimed to determine the prevalence of chorioamnionitis and confirm its correlation with neonatal morbidity and mortality, in a single tertiary center. Methods: This observational, retrospective study was conducted over three years (2019–2021) in a tertiary neonatal intensive care unit, examining 80 preterm infants born at 23–28 weeks of gestation. Spearman rank correlation, χ² tests, and multivariate logistic regression were used to assess associations between chorioamnionitis exposure and neonatal outcomes. Results: Among the 80 newborns analysed, clinical chorioamnionitis was identified in 12 preterm infants, while 65 (81.3%) presented histological chorioamnionitis. No significant association was found between histological chorioamnionitis stage and gestational age at birth (Spearman ρ = −0.15, p = 0.195). Premature rupture of membranes was significantly more frequent in the CA-exposed group (46.2% vs. 13.3%, p = 0.019). In unadjusted analyses, histological chorioamnionitis exposure was associated with higher rates of adverse neonatal outcomes, including early-onset sepsis (46.2% vs. 26.7%), intraventricular haemorrhage (73.8% vs. 60.0%), bronchopulmonary dysplasia (15.9% vs. 6.7%), and retinopathy of prematurity (11.3% vs. 0.0%); however, most of these differences did not reach statistical significance. After multivariate adjustment, histological chorioamnionitis remained independently associated with severe respiratory distress syndrome (adjusted OR 25.84, 95% CI 2.49–268.44, p = 0.006). Mortality was numerically lower in the CA-exposed group (27.7% vs. 46.7%); however, this difference did not reach statistical significance (p = 0.216). Conclusions: Histological chorioamnionitis was independently associated with severe respiratory distress syndrome. Associations with early onset sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity were observed in unadjusted analyses but were not independently significant after adjustment for perinatal confounders. No significant association was found between chorioamnionitis and neonatal mortality. While clinical diagnostic criteria for chorioamnionitis demonstrated good specificity, their poor sensitivity underscores the urgent need for improved diagnostic tools, including routine histological examination of the placenta. Full article