Search Results (335)

Background/Objectives: The objective of this study is to evaluate whether maternal genetic variants previously associated with gestational duration in European-ancestry populations are associated with gestational duration in Japanese women. Methods: We analyzed 347 women with a history of delivery from a community-based cohort in Aomori Prefecture, Japan. Gestational age at first delivery (weeks) was obtained from the Maternal and Child Health Handbook. Four representative maternal single-nucleotide polymorphisms were analyzed: rs2946169 near EBF1, rs2955117 in/near EEFSEC, rs12037376 in/near WNT4, and rs9861425 in/near ADCY5. Maternal genotype data were obtained from existing Japonica Array data generated as part of the Iwaki Health Promotion Project. Associations with gestational age at first delivery were tested using linear regression under an additive genetic model, adjusted for maternal age at first delivery. A Bonferroni-corrected threshold of p < 0.0125 was applied for four SNPs. Results: Mean gestational age at first delivery was 39.4 weeks. Each additional rs2946169 T allele was nominally associated with shorter gestation (adjusted β = −0.2679 weeks per allele; p = 0.021), but this association did not remain significant after Bonferroni correction. No significant associations were observed for rs2955117, rs12037376, or rs9861425. Conclusions: These findings provide suggestive evidence that maternal variation at the EBF1 locus may be related to gestational duration in Japanese women. However, the association did not remain significant after multiple-testing correction, and larger studies are needed to confirm this finding and clarify population-specific genetic effects. Full article

Background/Objectives: Breast Milk Feeding (BMF) benefits mother and infant. However, women with select risk factors report shorter breastfeeding durations. Our previous prospective cohort observational study of a lactation-consultant-led telephone-based support program in the first month postpartum increased BMF rates up to 6 months. This post hoc study further evaluated the program for mothers at increased risk of early breastfeeding cessation. Methods: We performed secondary analysis involving 762 mothers (control, n = 378; intervention, n = 384), recruited between 2018 and 2019. Infant feeding types, including BMF, were recorded at 1, 3 and 6 months. Feeding outcomes were analyzed in association with maternal risk factors. p-values, odds ratios and 95% confidence intervals were reported via both univariate (UVA) and multivariate regression analysis (MVA). Results: Via MVA, the intervention was associated with increased 6-month BMF rates in these groupings [OR (95%CI), p-value]: European [1.80 (1.07–2.96), p = 0.027]; South Asian [1.93 (1.19–3.13), p = 0.008]; employed [1.47 (1.02–2.12), p = 0.038]; unemployed [2.15 (1.33–3.50), p = 0.002]; married [1.71 (1.22–2.39), p = 0.002]; social support present [1.51 (1.05–2.16), p = 0.026]; chronic illness [1.93 (1.35–2.75), p = 0.001]; gestational diabetes mellitus [2.17 (1.19–3.95), p = 0.11]; overweight and obese [1.48 (1.03–2.12), p = 0.034]. A derived success score across the study period indicated via UVA associated increases in BMF rates with history of depression and anxiety (MI) [p = 0.044] and ongoing MI [p = 0.033], but these increases were smaller than that for no history of MI [p < 0.001]. No effect was observed in East/Southeast Asian mothers, Middle Eastern mothers, single or de facto mothers, older mothers, mothers without social support and mothers of any skill level. Conclusions: Although early postpartum telephone support was associated with a number of positive findings of improved BMF at 6 months and over the course of the study, the results were mixed. This suggests that future breastfeeding telephone-based initiatives need to be multifaceted in order to target mothers at risk of early breastfeeding cessation. Full article

Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent metabolic disorder of pregnancy. Beyond its well-established metabolic consequences, growing evidence suggests that exposure to maternal hyperglycemia during fetal life may influence immune system development and increase the risk of allergic diseases in offspring. Objective: This study aimed to systematically review the available evidence on the association between gestational diabetes mellitus and the development of allergic diseases in children, with particular emphasis on immunological mechanisms and the role of early-life gut microbiota. Methods: A systematic review was conducted using the PubMed and Scopus databases. Original human and animal studies, including cohort, case–control, cross-sectional, and clinical studies, were eligible for inclusion. Study selection followed PRISMA guidelines and was performed independently by three reviewers. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: The included studies suggest that children born to mothers with GDM may have an increased risk of developing allergic diseases, particularly atopic dermatitis, food allergy, allergic rhinitis, and urticaria. Associations with childhood asthma were less consistent and appeared to depend on maternal body mass index, glycemic control, and duration of follow-up. Evidence suggests that maternal hyperglycemia may disrupt fetal immune programming through chronic low-grade inflammation, oxidative stress, altered cytokine profiles, and impaired regulatory T-cell development. Additionally, GDM has been associated with early alterations in neonatal gut microbiota composition and metabolic pathways, which may further contribute to immune dysregulation and increased susceptibility to allergic diseases. Importantly, effective metabolic control during pregnancy was associated with a lower risk of adverse allergic outcomes in offspring. Conclusions: GDM may represent an important prenatal exposure associated with altered immune maturation and a higher risk of allergic diseases in offspring. Early metabolic disturbances, immune dysregulation, and alterations in gut microbiota appear to be key mechanisms underlying this association. Optimizing glycemic control during pregnancy and implementing early-life preventive strategies may reduce the long-term burden of allergic diseases. Further well-designed longitudinal and mechanistic studies are required to clarify causal pathways and identify effective preventive interventions. Full article

Background/Objectives: Peripheral(-muscle) oxygenation assessed with near-infrared spectroscopy might serve as an early marker of infection/inflammation; however, evidence of its clinical relevance is lacking so far. This study aimed to develop a peripheral(-muscle) oxygenation and perfusion score (POP-Score) using the peripheral(-muscle) tissue oxygenation index (pTOI) combined with non-invasive monitoring parameters within six hours after birth. The POP-Score was designed to explore associations with elevated C-reactive protein (CRP), as an early infection/inflammation marker, in term and late-preterm neonates. Methods: Secondary outcome parameters from a prospective observational study were analysed. Included neonates weighed ≥2000 g with respiratory distress, excluding those with umbilical artery pH < 7.20. Neonates with CRP ≥ 20 mg/L were 1:4-matched to those with CRP < 20 mg/L by gestational age (±2 weeks). For pTOI measurements, a sensor was placed for a duration of 30 s, followed by four further reapplications of the sensor, using the NIRO200NX within the first six hours after birth. The POP-Score was established using the following formula: (pTOI [%] × subcutaneous fat layer thickness [cm] × heart rate [bpm])/(arterial oxygen saturation [%] × systolic blood pressure [mmHg]). POP-Score was correlated with the highest CRP within 48 h. Results: Thirty neonates were included (median gestational age: 39.1 weeks [CRP < 20 mg/L group] vs. 37.3 weeks [CRP ≥ 20 mg/L group], p = 0.299; median birth weight: 3561 g vs. 3260 g, p = 0.058, respectively). Median POP-Scores were significantly different: 1.11 (CRP ≥ 20 mg/L) vs. 0.85 (CRP < 20 mg/L), p < 0.001. POP-Score correlated positively with CRP (r = 0.341; p = 0.070). In this small exploratory cohort, a POP-Score cut-off of 1.00 was associated with CRP ≥ 20 mg/L (100% sensitivity and 87% specificity); however, these estimates are uncertain due to the limited sample size. Conclusions: This study is the first to describe a new score for peripheral(-muscle) oxygenation and perfusion (POP-Score), which may represent a potential approach for early, non-invasive assessment but requires validation in adequately powered studies before any clinical application. Trial Registration: Clinicaltrials.gov, Trial registration number: NCT04818762, Date of Registration: 26 March 2021. Full article

Background: Birth asphyxia is a leading cause of neonatal mortality. More than half of these deaths are due to low-quality care. Objectives: To describe the frequency, sequence, timing, and duration of interventions after birth and newborn outcomes. Methods: This prospective observational study in rural Tanzania included newborns ≥28 weeks gestation. Trained research assistants observed and recorded all deliveries and resuscitations 24 h a day, 7 days a week, logging interventions in real time using the Liveborn Observation app. Results: Of 2564 newborns born, 2431 (94.9%) were enrolled in the study. Macerated stillbirth (n = 52), newborns with no parental consent (n = 67) or incomplete Liveborn data (n = 14) were excluded. Additionally, 2193/2431 (90.2%) newborns did not receive bag-mask ventilation (BMV), and 1755/2431 (72.2%) started breathing before 30 s from birth at median (quartiles) 6 (3, 13) s, 438/2431 (18.0%) started breathing beyond 30 s at 49 (38, 67) s. Moreover, 238/2431 (9.8%) received BMV at 82 (54, 120) s after birth, 1/3 within the first min. Finally, 159/238 (66.8%) were suctioned for 26 (17, 40) s. The first suction sequence was initiated at 44 (24, 78) s after birth. In 24/238 (10.1%) newborns, BMV continued for more than 10 min, with an increased risk of dying within 24 h (RR = 4.26, 95% CI; 1.3–10.0, p = 0.016) and seven days (RR = 8.14, 95% CI; 3.5–17.6, p < 0.001) compared to those ventilated for less than 10 min. Conclusions: Almost 10% of newborns received BMV at birth, but only one-third were ventilated within the first recommended minute. Excessive use of suctioning likely delayed the start of BMV, and prolonged ventilation beyond 10 min was associated with higher mortality. Full article

Background/Objectives: Appetite-regulating hormones are bioactive components of human milk. We tested the associations of leptin and adiponectin with infant growth and eating behaviors to age 6 months. Methods: In a cohort of 70 healthy, full-term infants and their mothers, human milk adiponectin and leptin were assayed at age 2 months (m). At infant ages 2, 4, and 6 m, infant anthropometry was obtained, mothers reported feeding frequency, duration, and breastfeeding intensity and completed the Baby Eating Behavior Questionnaire (Enjoyment of Food, Food Responsiveness, and General Appetite), and infant sucking vigor using an artificial nipple (burst duration and sucking frequency) was measured. Mothers reported demographics, gestational diabetes and pre-pregnancy body mass index (BMI), gestational age, and infant birthweight. Multivariate models evaluated predictors of leptin and adiponectin, and associations of leptin and adiponectin with infant growth and eating behaviors. Results: Human milk leptin was predicted by maternal BMI (β = 0.02) and breastfeeding intensity (β = −0.32). Regarding infant growth, infant weight-for-age and weight-for-length z-scores at 6 m were predicted by leptin (β = 0.91 and β = 1.22, respectively) and adiponectin (β = 0.01 and β = 0.01, respectively). Regarding infant eating behaviors, feeding duration at 2 m and feeding frequency at 4 m were predicted by adiponectin (β = 0.03 and β = −0.02, respectively). Conclusions: Human milk leptin and adiponectin may contribute to weight gain in early infancy, but the effect does not appear to be mediated substantially by infant eating behaviors. Further investigation into the metabolic programming of early infant weight gain is warranted. Full article

Using alternative energy sources for animal feed, such as hybrid corn varieties rather than genetically modified ones, is important. Therefore, the objective of this work was to assess the effects of supplementation at the end of gestation with Mexican Puma hybrid corn grain on productive and behavioral parameters in sheep. Twenty Columbia multiparous ewes were used; along with their diet, they were provided 600 g/animal/day of cracked corn during the last 20 days of pregnancy and the first week of lactation. The animals were divided into two groups: one fed commercial cracked corn (n = 11) and the other Mexican Tlaoli Puma hybrid cracked corn (n = 9). The productive parameters evaluated in the mother were: body weight, body condition score (BCS), feed intake, weight change, glucose, and ketone body levels, as well as the estimated quality of milk using Brix refractometer values on days 15 and 30 of lactation. In lambs, their rectal and external temperature was measured 2 h after birth, while their weight was measured 2 h after birth and every week until week 6 postpartum. Behavioral parameters were measured in the first two hours postpartum, including the maternal latency of cleaning the offspring, duration of the first cleaning episode, the lamb’s latencies of standing and nursing, and vocalizations in mother and lamb. Weight, BCS and weight change were not affected by the group but were affected by time; these parameters increased at the end of gestation and decreased significantly after delivery (p < 0.05). Ketone body levels were not affected by group or time (p > 0.05) and remained at low values. Glucose levels were not affected by the group but were affected by time; they increased significantly after birth (p < 0.05). Feed intake was similar in both groups (p > 0.05) and decreased as parturition approached (p < 0.05). The estimated milk quality was not affected by the group, nor by the time (p > 0.05). Mothers in both groups began cleaning their offspring within the first three minutes after giving birth and emitted a similar frequency of vocalizations (p > 0.05). However, mothers in the commercial maize group had a longer cleaning episode than those in the hybrid maize group (p < 0.05). The lambs in both groups stood up within the first half hour of birth, suckled before one hour after birth and emitted a similar number of vocalizations (p > 0.05). Temperatures and lamb weight were similar in both groups (p > 0.05); however, lamb weight increased as they aged (p < 0.05). It is concluded that supplementing sheep at the end of gestation with Puma hybrid Mexican corn grain can yield similar productive and behavioral benefits as supplementing with commercial grain. Full article

Background/Objectives: We aimed to evaluate the association between diabetes mellitus (DM) during pregnancy and retinopathy of prematurity (ROP) in preterm infants younger than 32 gestational weeks or infants with low birthweight (<1500 g). Methods: We conducted a retrospective nested case–control study of all premature infants who were born alive and survived the post-delivery hospitalization period in Soroka Medical Center, with either gestational age younger than 32 weeks or birthweight less than 1500 g, during the years 2013–2021. The infants were divided into two groups according to ROP status. Multivariable Generalized Estimating Equations (GEE) were used to analyze the association between ROP and DM, adjusting for potential confounders, including maternal age, diabetes type (GDM vs. pre-gestational DM), gestational age, birthweight (<1250 g), duration of oxygen supplementation, antenatal corticosteroid courses, and birth plurality. Results: During the study period, there were 881 pairs of women and newborns who met the inclusion criteria. The ROP group included 345 infants (39.1%). Twenty-two (6.4%) of the mothers in the ROP group were diagnosed with DM during pregnancy compared with 52 of 536 (9.7%) in the control group (p = 0.082). ROP was associated with oxygen treatment (OR 1.05; 95% CI, 1.03–1.08; p < 0.001), birthweight < 1250 g (OR 2.70; 95% CI, 1.93–3.78; p < 0.001) and advanced maternal age (OR 1.04; 95% CI, 1.01–1.06; p = 0.006). Prenatal steroid treatment was identified as a significant protective factor against ROP (OR 0.73; 95% CI, 0.60–0.89; p = 0.002). No statistically significant association was observed between maternal DM and ROP (OR 0.62; 95% CI 0.34–1.13; p = 0.12). These findings should be interpreted cautiously given the retrospective design and the limited availability of glycemic control data. Conclusions: Maternal diabetes mellitus was not significantly associated with the risk of ROP in this cohort. Full article

Objective: This study aimed to investigate the effect of hydroxychloroquine (HCQ) application during pregnancy on perinatal outcomes in cases of combined non-specific auto-antibodies. Methods: A retrospective cohort study was carried out. Cases of pregnancy combined with isolated auto-antibody positivity at Peking University Third Hospital from 2016 to 2020 were included. HCQ use during pregnancy was defined as the primary exposure. The impact of HCQ on perinatal outcomes was explored through univariate and multivariate analyses, and stratified analyses of its effects were conducted according to prophylactic anticoagulation use and medication duration. Results: A total of 338 cases were included, accounting for 39.62% (338/853) of pregnancies with autoimmune abnormalities during the same period. Univariate analysis of the overall population showed that HCQ use during pregnancy was associated with a significantly lower incidence of pre-eclampsia (9.13% vs. 25.53%), early-onset pre-eclampsia (1.37% vs. 10.08%), and small for gestational age (SGA) (12.07% vs. 22.88%). In the subgroup without anticoagulation, both multivariate and univariate analyses revealed that HCQ was associated with markedly lower rates of pre-eclampsia (0% vs. 36.67%, p = 0.004), early-onset pre-eclampsia (0% vs. 15.00%, p = 0.046), and SGA (0% vs. 28.33%, p = 0.006), and a significantly longer pregnancy gestational age with a higher birth weight. The timing of HCQ initiation showed no significant impact on adverse pregnancy outcomes. Conclusions: HCQ use during pregnancy is associated with favorable perinatal outcomes among women with isolated non-specific auto-antibody positivity, especially in those not receiving anticoagulation. Strengthened clinical evaluation and careful risk–benefit assessment are warranted to avoid unnecessary interventions. Full article

Objectives: Gestational diabetes is linked to increased inflammatory and metabolic stress during the neonatal period. Among the biomarkers elucidating the relationship between diabetes and inflammation, the interleukin-33 (IL-33)/ST2 signaling pathway is of particular interest. Research on the IL-33/sST2 axis in pregnancies complicated by diabetes indicates that these biomarkers are associated with maternal metabolic disorders and inflammation. Therefore, evaluating sST2 levels in infants of diabetic mothers is essential for identifying a biological marker of systemic inflammation resulting from intrauterine hyperglycemia and for clarifying the specific risks associated with this condition. The objective of this study was to examine sST2 levels in infants born to diabetic mothers and to assess their association with perinatal inflammation, metabolic stress, and clinical outcomes. Methods: This prospective observational study included term infants born at Pamukkale University Medical Faculty Hospital. The study group comprised term infants whose mothers had gestational diabetes, while the control group consisted of term infants born to healthy mothers without diabetes. sST2 levels were measured from serum samples obtained from cord blood at birth using the ELISA method. Factors influencing sST2 levels were analyzed using regression analyses. Results: sST2 levels were significantly higher in the diabetic group than in the control group (p < 0.001). The incidences of large for gestational age (LGA), small for gestational age (SGA), hypoglycemia, postnatal respiratory distress, and both the frequency and duration of neonatal intensive care unit admissions were also significantly elevated in the diabetic group. Multivariate analysis identified gestational diabetes as independent predictor. Conclusions: This study is among the first to demonstrate increased sST2 levels at birth in infants of diabetic mothers. The results indicate that intrauterine exposure to hyperglycemia due to gestational diabetes may be associated with heightened inflammation and metabolic stress in the neonatal period, and that sST2 may serve as a potential biomarker reflecting fetal exposure. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

Background/Objectives: Racial and ethnic disparities in cesarean birth and labor management persist in the United States, including among individuals considered low risk. Understanding variation in labor progression and cesarean indications within low-risk nulliparous, term, singleton, vertex (NTSV) births may help clarify potential contributors to inequities. This study examined differences in cesarean rates, cesarean indications, and labor duration by race and ethnicity in a low-risk NTSV cohort. Methods: We conducted a retrospective secondary analysis of electronic medical record data from 13,231 low-risk NTSV births within a Midwestern academic health system. Multivariable logistic regression models were used to evaluate the likelihood of cesarean birth and cesarean indications by race and ethnicity, adjusting for maternal age, gestational age, body mass index, insurance type, and labor onset. Linear regression models examined differences in first-stage, second-stage, and total labor duration. Interaction terms assessed whether associations varied by labor onset. Results: The overall cesarean rate was 29%. Absolute cesarean rates were higher among non-Hispanic Black and Hispanic individuals compared with non-Hispanic White individuals; however, these differences were not statistically significant after adjustment. Labor duration differed significantly by race and ethnicity. Non-Hispanic Black and Hispanic individuals experienced longer median first-stage and total labor durations compared with non-Hispanic White individuals; however, second-stage duration was markedly shorter among non-Hispanic Black individuals. Among induced labors resulting in cesarean birth, non-Hispanic Black and Hispanic individuals had increased odds of cesarean for early arrest of dilation, although these findings should be interpreted as hypothesis-generating, given data limitations in labor onset documentation. Body mass index was positively associated with likelihood of cesarean. Conclusions: In this low-risk NTSV cohort, adjusted cesarean rates did not differ significantly by race or ethnicity; however, differences in labor duration and cesarean indication were observed. These findings underscore the importance of continued investigation into labor management practices and structural contributors to obstetric inequities. Full article

Background: some consensus guidelines include C-reactive protein (CRP) in the diagnostic workup of early-onset neonatal sepsis (EOS), but its routine use remains debated due to variable diagnostic performance. The experiences and data from individual centers can help clarify its clinical utility and inform local practice. Methods: Retrospective analysis at a level III center assessing the impact of discontinuing routine C-reactive protein (CRP) testing for suspected early-onset sepsis (EOS). Laboratory use, antibiotic therapy, and outcomes in neonates of all gestational ages were compared before (2021–2022) and after (2024–2025) the policy change. Results: A total of 638 neonates were included (period 1, n = 348; period 2, n = 290). CRP testing decreased markedly (218/348 in period 1 vs. 40/290 in period 2; p < 0.001), alongside a significant reduction in the number of complete blood counts performed (285/348 vs. 214/290; p = 0.02). Concurrently, both the proportion of short antibiotic courses (≤48 h) initiated within the first 3 days of life (98/181 vs. 88/133) and the median duration of antibiotic therapy (48.0 h vs. 40.0 h; p < 0.001) decreased without worsening outcomes. The duration of antibiotic therapy was even shorter in infants born before 34 weeks’ gestation (48.0 h vs. 37.5 h; p < 0.001). Conclusions: Restricting the use of CRP in the evaluation of EOS was associated with a reduction in unnecessary antibiotic exposure. This strategy may be considered a core component of neonatal antibiotic stewardship programs. Full article

This study evaluated the effects of dietary protein levels during late gestation on nutrient digestibility, plasma amino acid profiles in jennies, and donkey foal growth performance. Twenty-four pregnant jennies were randomly assigned to one of three diets with different crude protein (CP) contents during late gestation: 12.48% (HP), 11.52% (MP), and 10.54% (LP) on a dry matter basis. All animals received the same diet immediately after parturition for a duration of 30 days. During the trial, two digestion experiments were conducted, blood samples were collected at 28 and 7 days prepartum, and weekly weight measurements of jennies and foals were recorded. The results indicated that the dietary protein level did not significantly affect feed intake in late gestation. However, apparent nutrient digestibility of dry matter (DM), neutral detergent fiber (NDF), acid detergent fiber (ADF), crude protein (CP), and ether extract (EE), and calcium (Ca) and phosphorus (P) was generally higher in the MP and LP groups than in the HP group, with MP showing the most consistent improvements across nutrients and timepoints (p < 0.05). Although the HP diet increased plasma concentrations of certain amino acids, including glutamic acid (Glu), valine (Val), methionine (Met), leucine (Leu), essential amino acids (EAAs), functional amino acids (FAAs), and branched chain amino acids (BCAAs), and elevated serum levels of glucose (GLU), blood urea nitrogen (BUN), and creatinine (CRE), it failed to improve postpartum weight recovery in jennies, highlighting that weight dynamics during this period are governed by factors beyond dietary protein content alone. Specifically, the LP group exhibited significantly higher cumulative postpartum weight loss over weeks 1–4 than the HP group (p = 0.004). Regarding offspring performance, both HP and MP diets improved foal birth weight, weekly body weight up to 4 weeks, average daily gain, and body height compared to the LP group (p < 0.05), with no significant differences observed between the HP and MP groups. In conclusion, for jennies under the current confined feeding system, a late-gestation diet containing 11.52% CP was adequate to support higher nutrient digestibility in the jennies and better growth performance in their foals, compared to a lower protein level (10.54% CP). However, increasing the dietary CP to 12.48% provided no additional benefits in nutrient utilization or overall productivity. Full article

Background/Objectives: Preterm infants with respiratory distress syndrome (RDS) require mechanical ventilation but risk lung injury This study compared neurally adjusted ventilatory assist (NAVA) with conventional modes regarding respiratory mechanics and clinical outcomes. Methods: We analyzed data from 79 preterm infants born at <32 weeks gestation who were invasively ventilated for RDS and classified into three groups: NAVA (n = 26), volume-targeted (VT; n = 29), and pressure-controlled (PC; n = 24). Respiratory parameters for 6 h post-surfactant administration and clinical outcomes were evaluated. Results: Baseline characteristics were similar across groups. The NAVA group demonstrated the most rapid reduction in peak inspiratory pressure over 6 h (F = 4.125, p = 0.023) and the fastest increase in dynamic compliance during the first 4 h (F = 3.273, p = 0.048). Respiratory rates were significantly lower with NAVA than with VT or PC modes, while tidal volumes were significantly higher in PC than in NAVA or VT modes. Invasive mechanical ventilation duration was shorter in NAVA (3.0 [0.9–4.9] days) than in PC modes (15.1 [0.3–38.5] days, p = 0.031), whereas not significantly different from that in VT modes (3.8 [0.9–13.4] days). While bronchopulmonary dysplasia or death was lower in NAVA (19.2%) than in PC modes (41.7%), the difference was not statistically significant (p = 0.092). Conclusions: NAVA resulted in the fastest reduction in ventilator-delivered pressure and earlier improvement in dynamic compliance while maintaining respiratory rates within physiological ranges and was associated with shorter ventilation duration than PC modes. However, VT modes achieved comparable respiratory parameters and ventilation durations to those achieved using NAVA. Full article