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Keywords = extremely low birthweight

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12 pages, 821 KiB  
Article
The Effect of the COVID-19 Pandemic and the Establishment of a Ronald McDonald House on Skin-to-Skin Times in the Neonatal Intensive Care Unit: A Retrospective Study
by Stephanie Schaible, Edda Hofstätter, Wanda Lauth and Martin Wald
Children 2025, 12(6), 803; https://doi.org/10.3390/children12060803 - 19 Jun 2025
Viewed by 391
Abstract
Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, [...] Read more.
Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, considering factors like the COVID-19 pandemic, the opening of Ronald McDonald House, and sibling presence. Methods: We retrospectively analyzed data from the first eight weeks of life of 93 extremely preterm infants (<28 gestational weeks, <1500 g birth weight) treated at the Salzburg NICU from 2019 to 2023. Skin-to-skin times were recorded to the minute. Results: The mean value skin-to-skin time per visiting day was 241 min (±83), skin-to-skin was performed on 79.0% (±16.8) of the days of stay examined. During the pandemic, skin-to-skin care was performed on 64% of visit days, after the pandemic on 91% (p < 0.001). Before the Ronald McDonald House opened, the skin-to-skin time per visiting day was 215 min (±57.9), afterwards it was 273 min (±97) (p = 0.001). For Primipara the Kangaroo-Care time per day of visit was 257 min (±93), for Multipara 217 min (±52) (p = 0.043). Conclusions: Skin-to-skin is crucial for extremely premature infants and can be implemented for many hours a day. It is an integral part of parent-child interaction in a neonatal intensive care unit. External factors such as infrastructure, pandemic restrictions or siblings have a significant impact on skin-to-skin. Full article
(This article belongs to the Special Issue Providing Care for Preterm Infants)
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9 pages, 483 KiB  
Article
The Association Between Perinatal Pharmacologic Treatments and Spontaneous Intestinal Perforation in Extremely Preterm Infants: A Propensity Score Matching Study
by Wei-Hsin Cheng, Lo-Hsuan Tu, Ming-Chou Chiang, Yu-Ning Chen, Wei-Hung Wu and Kai-Hsiang Hsu
Children 2025, 12(2), 142; https://doi.org/10.3390/children12020142 - 27 Jan 2025
Viewed by 1036
Abstract
Background: The impact of perinatal pharmacologic agents on spontaneous intestinal perforation (SIP) in extremely low-birthweight (ELBW, <1000 g) preterm infants remains inconclusive based on findings from retrospective cohort or case–control studies. This study aims to address this uncertainty by using propensity score [...] Read more.
Background: The impact of perinatal pharmacologic agents on spontaneous intestinal perforation (SIP) in extremely low-birthweight (ELBW, <1000 g) preterm infants remains inconclusive based on findings from retrospective cohort or case–control studies. This study aims to address this uncertainty by using propensity score matching (PSM) to reduce bias. Methods: We retrospectively reviewed ELBW infants in our unit between 2014 and 2023 to identify SIP cases. Confirmed through medical notes, surgical consultation, and author review, each SIP case was matched at a 1:3 ratio using propensity scores on factors including the gestational age (GA), birthweight, gender, and birth year. Pharmacologic agents commonly given antenatally and postnatally were analyzed. Only medications that were started 24 h before the onset of SIP or the corresponding age (PSM-controls) were included. Results: A total of 858 ELBW infants were reviewed, 28 SIP cases (GA 25.3 ± 2.1 weeks, BW 735 ± 167 g) were identified, and 84 PSM-controls were matched. The SIP cases received hydrocortisone (25% (7/28) vs. 9.5% (8/84), p = 0.037) and combined inotropic agents (17.9% (5/28) vs. 2.4% (2/84), p = 0.020) to a significantly greater extent. No differences were observed in the use of other medications. In logistic regression, the use of hydrocortisone and combined inotropes remained independent risks for SIP, with ORs (95% CIs) of 3.4 (1.1–10.9) and 2.1 (1.2–3.8), respectively. Conclusions: This first PSM-based study supported postnatal hydrocortisone and combined inotrope use as independent risks for SIP in ELBW infants. Clinicians should be aware of these risks and remain vigilant for SIP when administering hydrocortisone and inotropes. Full article
(This article belongs to the Special Issue Care and Outcome of the Extreme Preterm Infant)
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14 pages, 438 KiB  
Article
Oral Health of 7- to 9-Year-Old Children Born Prematurely—A Case–Control Observational Study with Randomized Case Selection
by Heide L. Schlesinger, Roswitha Heinrich-Weltzien and Ina M. Schüler
Dent. J. 2024, 12(12), 421; https://doi.org/10.3390/dj12120421 - 23 Dec 2024
Viewed by 1062
Abstract
Background: Along with the long-term sequelae of preterm birth for general health, oral health is potentially influenced by prematurity due to developmental and behavioral peculiarities. Objectives: This study aimed to compare oral health parameters in the mixed dentition of prematurely and full-term born [...] Read more.
Background: Along with the long-term sequelae of preterm birth for general health, oral health is potentially influenced by prematurity due to developmental and behavioral peculiarities. Objectives: This study aimed to compare oral health parameters in the mixed dentition of prematurely and full-term born children. Methods: Dental caries, developmental defects of enamel (DDE), and gingival inflammation were assessed in 7-to-9-year-old children (n = 38) born preterm (PT) compared to a matched control group born full-term (FT) in Germany. Dental caries was recorded using the International Caries Detection and Assessment System (ICDAS II) and DMFT/dmft-criteria. DDE was scored with modified DDE-Index and periodontal health by Periodontal Screening Index (PSI). Statistical analysis included McNemar’s test and Poisson regression. The significance level was p ≤ 0.05. Results: Caries prevalence was 47.4% in PT and 57.9% in FT. In the primary dentition, FT children were significantly more affected than PT children (1.6 dmft vs. 2.7 dmft; p = 0.035). PT children with extremely low birthweight (ELBW) had the highest caries experience (3.2 dmft; 1.0 DMFT). Prevalence of DDE in primary teeth was significantly higher in PT (55.3%) than in FT children (28.9%; p = 0.008). PSI was 3.8 in PT and 3.3 in FT children, but significantly higher in PT children with ELBW (7.4; p = 0.125). Conclusions: PT children are at higher risk for DDE in primary teeth and compromised periodontal health than FT children. Children with ELBW are most susceptible for dental caries and gingivitis. Full article
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12 pages, 234 KiB  
Article
Mental Health Outcomes of a National Cohort of Adults Born with Very Low Birthweight
by Georgina L. Moody, John Horwood, Sarah L. Harris, Brian A. Darlow and Lianne J. Woodward
J. Clin. Med. 2024, 13(24), 7591; https://doi.org/10.3390/jcm13247591 - 13 Dec 2024
Viewed by 957
Abstract
Background: Children born with a very low birthweight (VLBW; <1500 g) and/or very preterm (VPT; <32 weeks) are at increased risk of mental health problems, but adult data are inconsistent. Objectives: We examined the prevalence of a range of mental health disorders in [...] Read more.
Background: Children born with a very low birthweight (VLBW; <1500 g) and/or very preterm (VPT; <32 weeks) are at increased risk of mental health problems, but adult data are inconsistent. Objectives: We examined the prevalence of a range of mental health disorders in a national cohort of adults born with a VLBW, as well as associations between gestational age and mental health outcomes. Methods: All infants born with a VLBW in New Zealand in 1986 were followed prospectively from birth. The 12-month prevalence of mental health outcomes, in addition to substance use and violent/property offending were assessed at a median age of 28 years in this cohort relative to 100 full-term (FT) controls. Outcomes were assessed using structured interview methods. Results: There was a modest increase in the overall rate of mental health problems in VLBW adults compared to controls (ARR 1.33 [95% CI 0.83, 2.12]), reflecting slightly higher rates of anxiety disorders, notably agoraphobia (ARR 2.98 [0.64, 13.85]), social phobia (ARR 1.61 [0.71, 3.65]), and suicidal ideation/attempt (ARR 1.66 [0.45, 6.08]), but not depression (ARR 1.02 [0.57, 1.81]). There were no clear differences in substance use/offending outcomes. VLBW individuals born extremely preterm (<28 weeks) were most vulnerable to later mental health problems relative to controls (overall rate of mental health problems ARR 1.54 [0.86, 2.73]). Effect sizes for any anxiety disorder were also higher for VLBW females than VLBW males compared to same-sex controls. Conclusions: This population-based longitudinal cohort study showed that adults born preterm with a VLBW reported more mental health problems than FT controls; however, this difference was small. Pooled analyses involving larger sample sizes are needed, but findings suggest only modest individual and public health impacts of preterm birth on adult mental health functioning. Full article
(This article belongs to the Section Clinical Pediatrics)
16 pages, 1797 KiB  
Article
Growth and Eating Behaviours at 2 Years Corrected Age in Extremely Low-Birthweight Babies; Secondary Cohort Analysis from the ProVIDe Trial
by Morgan J. Easton, Frank H. Bloomfield, Yannan Jiang and Barbara E. Cormack
Nutrients 2024, 16(23), 4095; https://doi.org/10.3390/nu16234095 - 27 Nov 2024
Viewed by 1032
Abstract
Early postnatal growth following extremely preterm birth may have long-term effects on growth, eating behaviours and health. Background/Objectives: To determine whether growth to age two years is conditional on growth in the NICU, a conditional growth analysis was performed in a cohort of [...] Read more.
Early postnatal growth following extremely preterm birth may have long-term effects on growth, eating behaviours and health. Background/Objectives: To determine whether growth to age two years is conditional on growth in the NICU, a conditional growth analysis was performed in a cohort of 330 extremely low-birthweight (ELBW; birthweight < 1000 g) participants in the ProVIDe trial who were followed-up at 2 years corrected age (CA); Methods: We used z-score change for weight, length and head circumference from 36 weeks post-menstrual age to 2 years CA as the end-point-adjusted for birth z-score and z-score change from birth to 36 weeks. Growth and body composition were assessed using bioimpedance analysis. Relationships between eating behaviours and body mass index (BMI) at 2 years CA and growth were assessed using a Child Eating Behaviour Questionnaire (CEBQ) completed by parents at 2 years CA; Results: Growth, or change in z-score, from 36 weeks PMA was conditional upon growth in the NICU, with slower neonatal growth associated with faster early childhood growth (weight: R2 = 0.27, ß-coefficient −0.81 (95% CI: −0.96, −0.66), p < 0.0001; length: R2 = 0.28, ß-coefficient −0.64 (95% CI: −0.76, −0.51), p < 0.0001; head circumference: R2 = 0.18, ß-coefficient −0.61 (95% CI: −0.76, −0.46), p < 0.0001). Fat-free mass index, adjusted for confounding factors, was positively correlated with z-score change from NICU discharge to 2 years CA for weight, but not length (weight: R2 = 0.50, ß-coefficient = 0.87 (95% CI: 0.56, 1.18), p < 0.0001; length: R2 = 0.32, ß-coefficient = 0.01 (95% CI: −0.40, 0.42), p = 0.95). At 2 years CA, CEBQ scores for enjoyment were significantly higher and satiety and slowness significantly lower in children with a BMI ≥ 90th percentile than in children with a BMI ≤ 10th percentile or between the 10th−90th percentile.; Conclusions: Growth from NICU discharge to 2 years CA is conditional upon growth in the NICU, with slower NICU growth linked to faster early childhood growth, and weight z-score changes positively correlated with fat-free mass index. At age 2, children with a BMI ≥ 90th percentile have significantly different eating behaviour assessments by caregivers compared to children with a BMI ≤ 10th percentile or between the 10th–90th percentile; further RCTs are needed to confirm links between nutrition factors and growth outcomes in ELBW infants. Full article
(This article belongs to the Section Pediatric Nutrition)
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15 pages, 2301 KiB  
Article
Adjusted versus Targeted Fortification in Extremely Low Birth Weight Preterm Infants: Fortin Study—A Randomized Clinical Trial
by Maria Sanchez-Holgado, Miguel Saenz de Pipaon, Maria Concepcion Jimenez, Gema Crespo Sanchez, Marta Molero-Luis, Maria Teresa Montes, Cristina Segovia, Itsaso Losantos-García, María Jimenez-Gonzalez, Esperanza Escribano and Marta Cabrera-Lafuente
Nutrients 2024, 16(17), 2904; https://doi.org/10.3390/nu16172904 - 30 Aug 2024
Viewed by 2357
Abstract
Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth [...] Read more.
Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of <1000 g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomized to AF group and 23 to TF group. AF was based on blood urea nitrogen (BUN) concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day). No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge, nor during the intervention. Protein intake was significantly higher in the AF group (5.02 g/kg/day vs. 4.48 g/kg/day, p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants. Full article
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10 pages, 841 KiB  
Article
Impact of the Choice of Diagnostic Criteria and Growth Reference on the Prevalence of Extrauterine Growth Restriction in Extremely-Low-Birthweight Infants
by Clara González López, Gonzalo Solís Sánchez, Belén Fernández Colomer, Laura Mantecón Fernández, Sonia Lareu Vidal, Sara Fernández Castiñeira, Ana Rubio Granda, Alicia Pérez Pérez and Marta Suárez Rodríguez
Children 2024, 11(8), 934; https://doi.org/10.3390/children11080934 - 31 Jul 2024
Cited by 1 | Viewed by 1312
Abstract
Background and objectives: Variable diagnostic criteria and growth charts have been used for extrauterine growth restriction (EUGR). The objective was to assess the prevalence and concordance of EUGR in extremely-low-birthweight (ELBW) infants with the most frequent diagnostic criteria and growth charts. Materials and [...] Read more.
Background and objectives: Variable diagnostic criteria and growth charts have been used for extrauterine growth restriction (EUGR). The objective was to assess the prevalence and concordance of EUGR in extremely-low-birthweight (ELBW) infants with the most frequent diagnostic criteria and growth charts. Materials and methods: An observational, retrospective and multicenter study was conducted from 2011 to 2020 including ELBW infants from the Spanish SEN1500 Network. EUGR prevalence was calculated at discharge using different definitions: cross-sectional (anthropometry less than the 10th centile), longitudinal (decrease of more than 1 SD from birth to discharge), “true” cross-sectional and “true” longitudinal (using the criteria previously described, excluding infants small for gestational age at birth). Concordance among Fenton, Olsen and INTERGROWTH-21st was assessed with Fleiss’ Kappa coefficient. Results: The prevalence of EUGR was variable with the different definitions and growth references studied in the 7914 ELBW infants included. Overall, it was higher with Fenton for all the EUGR criteria studied by weight and length. The agreement among growth charts was substantial (κ > 0.6) for all the definitions except for longitudinal EUGR by weight (moderate, κ = 0.578). Conclusions: The prevalence of EUGR was variable in our cohort with the different diagnostic criteria and growth charts. The agreement among charts was good for all the definitions of EUGR except longitudinal EUGR by weight. Full article
(This article belongs to the Section Pediatric Neonatology)
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12 pages, 632 KiB  
Article
Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia
by Hayfaa Wahabi, Hala Elmorshedy, Yasser S. Amer, Elshazaly Saeed, Abdul Razak, Ibrahim Abdelaziz Hamama, Adnan Hadid, Samia Ahmed, Sarah A. Aleban, Reema Abdullah Aldawish, Lara Sabri Alyahiwi, Haya Abdullah Alnafisah, Raghad E. AlSubki, Norah Khalid Albahli, Aljohara Ayed Almutairi, Layan Fahad Alsanad and Amel Fayed
Medicina 2024, 60(2), 193; https://doi.org/10.3390/medicina60020193 - 23 Jan 2024
Cited by 5 | Viewed by 3584
Abstract
Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes [...] Read more.
Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother’s age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62–7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46–0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67–8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24–8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32–0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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19 pages, 1966 KiB  
Article
Prenatal Metal Exposure Alters the Placental Proteome in a Sex-Dependent Manner in Extremely Low Gestational Age Newborns: Links to Gestational Age
by Anastasia N. Freedman, Kyle Roell, Eiona Engwall, Catherine Bulka, Karl C. K. Kuban, Laura Herring, Christina A. Mills, Patrick J. Parsons, Aubrey Galusha, Thomas Michael O’Shea and Rebecca C. Fry
Int. J. Mol. Sci. 2023, 24(19), 14977; https://doi.org/10.3390/ijms241914977 - 7 Oct 2023
Cited by 2 | Viewed by 2347
Abstract
Prenatal exposure to toxic metals is associated with altered placental function and adverse infant and child health outcomes. Adverse outcomes include those that are observed at the time of birth, such as low birthweight, as well as those that arise later in life, [...] Read more.
Prenatal exposure to toxic metals is associated with altered placental function and adverse infant and child health outcomes. Adverse outcomes include those that are observed at the time of birth, such as low birthweight, as well as those that arise later in life, such as neurological impairment. It is often the case that these adverse outcomes show sex-specific responses in relation to toxicant exposures. While the precise molecular mechanisms linking in utero toxic metal exposures with later-in-life health are unknown, placental inflammation is posited to play a critical role. Here, we sought to understand whether in utero metal exposure is associated with alterations in the expression of the placental proteome by identifying metal associated proteins (MAPs). Within the Extremely Low Gestational Age Newborns (ELGAN) cohort (n = 230), placental and umbilical cord tissue samples were collected at birth. Arsenic (As), cadmium (Cd), lead (Pb), selenium (Se), and manganese (Mn) concentrations were measured in umbilical cord tissue samples via ICP-MS/MS. Protein expression was examined in placental samples using an LC-MS/MS-based, global, untargeted proteomics analysis measuring more than 3400 proteins. MAPs were then evaluated for associations with pregnancy and neonatal outcomes, including placental weight and gestational age. We hypothesized that metal levels would be positively associated with the altered expression of inflammation/immune-associated pathways and that sex-specific patterns of metal-associated placental protein expression would be observed. Sex-specific analyses identified 89 unique MAPs expressed in female placentas and 41 unique MAPs expressed in male placentas. Notably, many of the female-associated MAPs are known to be involved in immune-related processes, while the male-associated MAPs are associated with intracellular transport and cell localization. Further, several MAPs were significantly associated with gestational age in males and females and placental weight in males. These data highlight the linkage between prenatal metal exposure and an altered placental proteome, with implications for altering the trajectory of fetal development. Full article
(This article belongs to the Special Issue Molecular Mechanisms of Reproductive and Developmental Toxicology)
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13 pages, 474 KiB  
Review
Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn Phototherapy—Safety Considerations
by Finn Ebbesen, Hendrik Jan Vreman and Thor Willy Ruud Hansen
Int. J. Mol. Sci. 2023, 24(1), 461; https://doi.org/10.3390/ijms24010461 - 27 Dec 2022
Cited by 10 | Viewed by 6227
Abstract
We have previously shown that the phototherapy of hyperbilirubinemic neonates using blue-green LED light with a peak wavelength of ~478 nm is 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm. Based [...] Read more.
We have previously shown that the phototherapy of hyperbilirubinemic neonates using blue-green LED light with a peak wavelength of ~478 nm is 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm. Based on these results, we recommended that the phototherapy of hyperbilirubinemic newborns be practiced with light of ~480 nm. Aim: Identify and discuss the most prominent potential changes that have been observed in the health effects of phototherapy using either blue fluorescent- or blue LED light and speculate on the expected effects of changing to blue-green LED light phototherapy. Search the phototherapy literature using the terms neonate, hyperbilirubinemia, and phototherapy in the PubMed and Embase databases. Transitioning from blue fluorescent light to blue-green LED light will expose neonates to less light in the 400–450 nm spectral range, potentially leading to less photo-oxidation and geno-/cytotoxicity, reduced risk of cancer, and decreased mortality in extremely low-birthweight neonates. The riboflavin level may decline, and the increased production and retention of bronze pigments may occur in predisposed neonates due to enhanced lumirubin formation. The production of pre-inflammatory cytokines may rise. Hemodynamic responses and transepidermal water loss are less likely to occur. The risk of hyperthermia may decrease with the use of blue-green LED light and the risk of hypothermia may increase. Parent–neonate attachment and breastfeeding will be positively affected because of the shortened duration of phototherapy. The latter may also lead to a significant reduction in the cost of phototherapy procedures as well as the hospitalization process. Full article
(This article belongs to the Special Issue Bilirubin)
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12 pages, 1473 KiB  
Article
Prevalence and Implications of Low Reticulocyte–Hemoglobin Levels among Extreme Preterm Neonates: A Single-Center Retrospective Study
by Jhanahan Sriranjan, Christine Kalata, Gerhard Fusch, Karen Thomas and Ipsita Goswami
Nutrients 2022, 14(24), 5343; https://doi.org/10.3390/nu14245343 - 16 Dec 2022
Cited by 2 | Viewed by 2946
Abstract
This retrospective cohort study aims to determine the epidemiology of iron deficiency among extreme preterm neonates and the association of iron-deficient status during the NICU stay with neurodevelopmental outcomes at 18–24 months. Neonates ≤29 weeks gestational age (GA) born between June 2016 and [...] Read more.
This retrospective cohort study aims to determine the epidemiology of iron deficiency among extreme preterm neonates and the association of iron-deficient status during the NICU stay with neurodevelopmental outcomes at 18–24 months. Neonates ≤29 weeks gestational age (GA) born between June 2016 and December 2019, who received routine iron supplementation were enrolled. Iron deficiency was defined as reticulocyte–hemoglobin (Ret-Hb) levels ≤ 29 pg at 36 weeks corrected age. A subcohort of neonates completed standardized developmental assessment at 18–24 months corrected age. Significant neurodevelopmental impairment (sNDI) was defined as either Bayley Scales of Infant Development score < 70 or cerebral palsy or blindness or hearing aided. Among a cohort of 215 neonates [GA 25.8 (1.7) weeks, birthweight 885 (232) g], prevalence of iron deficiency was 55%, 21%, 26%, and 13%, in neonates <24 weeks, 24–25 + 6 weeks, 26–27 + 6 weeks, and ≥ 28 weeks GA, respectively. Male sex and receipt of corticosteroid therapy were associated with iron-deficiency. In the subcohort analysis (n = 69), there was no statistically significant association between Ret-Hb levels at 36 weeks corrected age and the risk of sNDI [OR 0.99 (95% CI 0.85–1.2)]. Male infants and those who received postnatal corticosteroids are likely to have iron-limited erythropoiesis at corrected term despite routine iron-supplementation; however, low Ret-Hb levels during the neonatal period were not associated with significant neurological disability in early childhood. Full article
(This article belongs to the Special Issue Biomarkers of Nutritional Exposure and Nutritional Status)
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12 pages, 1035 KiB  
Article
Effect of a Multi-Strain Probiotic on Growth and Time to Reach Full Feeds in Preterm Neonates
by Marwyn Sowden, Evette van Niekerk, Andre Nyandwe Hamama Bulabula, Jos Twisk and Mirjam Maria van Weissenbruch
Nutrients 2022, 14(21), 4658; https://doi.org/10.3390/nu14214658 - 3 Nov 2022
Cited by 3 | Viewed by 2977
Abstract
Background: The main nutritional goal for premature neonates is to achieve a postnatal growth rate that the neonate would have experienced in utero. Postnatal growth failure is, however, very common in very and extremely low birth weight neonates. The use of probiotics shows [...] Read more.
Background: The main nutritional goal for premature neonates is to achieve a postnatal growth rate that the neonate would have experienced in utero. Postnatal growth failure is, however, very common in very and extremely low birth weight neonates. The use of probiotics shows promising results in reducing the time for full feeds, as well as in increased weight gain. The optimal probiotic strain has, however, not been elucidated. The aim of the present study was to evaluate the difference in the growth and time to reach full feeds between the two treatment arms, using LabinicTM as a multi-strain probiotic and a placebo. Methods: We conducted a double-blind, placebo-controlled, randomized clinical trial investigating the effect of a multi strain probiotic (LabinicTM) on various outcomes in preterm neonates. The results on the time to reach full feeds and the growth will be discussed in this paper. A probiotic or placebo was given once daily to the neonates for 28 days. Weight and feeding volume were measured daily, and length and head circumference were measured weekly. Results: The probiotic group reached full feeds earlier 8.7 days; ± 2.0 than the placebo group 9.7 days; ±4.3 (p = 0.04) and regained their birthweight earlier than the placebo group 11.5 days ± 6.3 vs. 13.3 days ± 6.3 (p = 0.06). From day 21 onwards, the probiotic group showed a significantly greater crude gain in weight (p < 0.001) than the placebo group (estimated difference between the two groups day 21: 56.7 g and at day 28: 83.7 g. There was a significant improvement observed in the weight Z-score change in the probiotic group over the 28-day period. Conclusion: The use of a multi-strain probiotic (LabinicTM) shows great potential as a low-cost, low-risk intervention in reducing the time to reach full feeds as well as shortening the time to regain birthweight. The probiotic had an additional beneficial impact on Z-score change in weight potentially decreasing post-natal growth restriction. Full article
(This article belongs to the Section Pediatric Nutrition)
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11 pages, 533 KiB  
Article
Risk Factors for Sensorineural Hearing Loss and Auditory Maturation in Children Admitted to Neonatal Intensive Care Units: Who Recovered?
by Pietro Salvago, Angelo Immordino, Fulvio Plescia, Marianna Mucia, Andrea Albera and Francesco Martines
Children 2022, 9(9), 1375; https://doi.org/10.3390/children9091375 - 12 Sep 2022
Cited by 5 | Viewed by 2983
Abstract
Background: Newborns admitted to neonatal intensive care units (NICUs) are at higher risk of developing sensorineural hearing loss (SNHL), which may improve over time. The aim of this study was to describe the prevalence of the main risk factors for SNHL in a [...] Read more.
Background: Newborns admitted to neonatal intensive care units (NICUs) are at higher risk of developing sensorineural hearing loss (SNHL), which may improve over time. The aim of this study was to describe the prevalence of the main risk factors for SNHL in a NICU cohort, focusing on children who underwent auditory maturation. Methods: An observational study of 378 children admitted to NICUs, who were followed for at least 18 months, with periodic audiologic assessments. Results: Out of 378 patients, 338 had normal hearing and 40 were hearing-impaired; we found a higher percentage of extremely preterm (EPT) and extremely low-birthweight (ELBW) infants in SNHL children (p < 0.05). Seventeen infants presented auditory improvement, with a mean maturation time of 6.17 months. A significant difference emerged between patients with stable SNHL and those who improved only in the case of hyperbilirubinemia (p = 0.005). The initial hearing threshold was a predictor of auditory improvement and moderately correlated to the time of auditory maturation (p = 0.02). Conclusions: Our study supports the trend toward recognizing worse prognoses and slower maturation processes among NICU children who suffer from severe to profound SNHL. Caution must be taken when deciding on earlier cochlear implantation. Full article
(This article belongs to the Section Global Pediatric Health)
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7 pages, 649 KiB  
Case Report
Non-Obese Type 2 Diabetes with a History of Being an Extremely Preterm Small-for-Gestational-Age Infant without Early Adiposity Rebound
by Nobuhiko Nagano, Chizuka Kaneko, Shoko Ohashi, Megumi Seya, Itsuro Takigawa, Ken Masunaga and Ichiro Morioka
Int. J. Environ. Res. Public Health 2022, 19(14), 8560; https://doi.org/10.3390/ijerph19148560 - 13 Jul 2022
Cited by 6 | Viewed by 2072
Abstract
Adiposity rebound (AR), which is defined as a situation in which the body mass index (BMI) starts to increase after infancy, is a predictive marker of future development of type 2 diabetes. The patient was a 20-year-old male. He was born at 28 [...] Read more.
Adiposity rebound (AR), which is defined as a situation in which the body mass index (BMI) starts to increase after infancy, is a predictive marker of future development of type 2 diabetes. The patient was a 20-year-old male. He was born at 28 gestational weeks with a birthweight of 642 g (−3.20 standard deviation, small-for-gestational age [SGA]). AR during early childhood or obesity in later childhood was not observed. At the onset of type 2 diabetes (20 years of age), his BMI, body fat percentage, and body fat mass were within normal ranges (20.4, 18.4% and 10.8 kg, respectively). However, his muscle mass was 44.7 kg, with low muscle mass of the trunk and upper limbs, which was lower than the standard reference, indicating that myogenic insulin resistance was involved in the development of non-obese type 2 diabetes. This case report describes a patient with no presentation of AR and obesity during childhood, who was born extremely preterm SGA, developed non-obese type 2 diabetes with low muscle mass. We suggest that patients born extremely preterm SGA should be carefully observed for the development of type 2 diabetes, even if they did not have AR in early childhood or had not become obese. Full article
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11 pages, 1468 KiB  
Article
Prevalence and Initial Diagnosis of Cerebral Palsy in Preterm and Term-Born Children in Taiwan: A Nationwide, Population-Based Cohort Study
by Hsin-Hua Wang, Yea-Shwu Hwang, Chung-Han Ho, Ming-Chi Lai, Yu-Chin Chen and Wen-Hui Tsai
Int. J. Environ. Res. Public Health 2021, 18(17), 8984; https://doi.org/10.3390/ijerph18178984 - 26 Aug 2021
Cited by 6 | Viewed by 3466
Abstract
The aim of this long-term longitudinal study in Taiwan was to estimate and compare the prevalence of cerebral palsy (CP) and to identify the age of CP diagnosis of term-born and preterm children with different birthweights. Records of 1494 extremely low birth weight [...] Read more.
The aim of this long-term longitudinal study in Taiwan was to estimate and compare the prevalence of cerebral palsy (CP) and to identify the age of CP diagnosis of term-born and preterm children with different birthweights. Records of 1494 extremely low birth weight (ELBW, <1000 g), 3961 very low birth weight (VLBW, 1000–1499 g), 19,612 low birth weight (LBW, 1500–2499 g) preterm, and 100,268 matched term-born children were retrieved from Taiwan′s National Health Insurance Research Database. According to a 12-year retrospective data review, the results showed the highest prevalence of CP in preterm ELBW children (147.3 cases per 1000 neonatal survivors), followed by preterm VLBW (97.2 cases), preterm LBW (27.7 cases), with the lowest prevalence in term-born children (2.5 cases). Regardless of the birthweight group, 90% of preterm children with CP were diagnosed by 4 years of age, but it was 7 years before 90% of term-born children with CP were diagnosed. After removing the children whose CP was caused by brain infections, injuries, or cerebrovascular accidents after 4 months of age, there were similar mean ages at the initial CP diagnosis (1.58–1.64 years of age) across birthweight groups born prematurely, but initial diagnosis occurred at an older age (2.41 years of age) in term-born children. The results indicate that birthweight is reversely correlated with the prevalence of CP in preterm children. Although the three preterm birthweight groups received different types of developmental follow-up programs after birth, it did not influence their age at the initial diagnosis of CP. Furthermore, we suggest that follow-up for at least 4 years after birth for preterm children, and 7 years for term-born children, is optimal for estimating CP prevalence. In order to identify and provide early intervention for term-born children with CP earlier, it is suggested that parents routinely fill out a self-reported motor developmental screening questionnaire and pediatricians conduct a motor developmental examination on term-born children at each time of scheduled vaccination injections. Full article
(This article belongs to the Section Children's Health)
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