Search Results (163)

Background: Nutrition is of paramount importance during early development, since suboptimal growth in this period of life is linked to adverse long- and mid-term outcomes. This is particularly relevant for preterm infants, who fail to thrive during the first weeks of life and develop extrauterine growth restriction (EUGR). This group of premature babies represents an interesting population to investigate using a metabolomic approach to optimize nutritional intake. Aims: To analyse and compare the urinary metabolomic pattern at birth of preterm infants with and without growth restriction at 36 weeks of postmenstrual age or at discharge, searching for putative markers of growth failure. Methods: We enrolled preterm infants between 23 and 32 weeks of gestational age (GA) and/or with a birth weight <1500 g, admitted to the Neonatal Intensive Care Unit (NICU) at the Department of Women’s and Children’s Health of Padova University Hospital. We collected urinary samples within 48 h of life and performed untargeted metabolomic analysis using mass spectrometry. Results: Sixteen EUGR infants were matched with sixteen non-EUGR controls. The EUGR group showed lower levels of L-cystathionine, kynurenic acid, L-carnosine, N-acetylglutamine, xanthurenic acid, aspartylglucosamine, DL5-hydroxylysine-hydrocloride, homocitrulline, and L-aminoadipic acid, suggesting a lower anti-inflammatory and antioxidant status with respect to the non-EUGR group. Conclusions: Metabolomic analysis suggests a basal predisposition to growth restriction, the identification of which could be useful for tailoring nutritional approaches. Full article

Background/Objectives: Obstetrical monitoring following radical trachelectomy (RT) for cervical cancer is marked by the lack of a standardized protocol, which may lead to delays in the intervention for cervical shortening. In light of the typical cervical remodeling process that occurs at the onset of labor, we hypothesized that the onset of premature cervical shortening in patients who have undergone radiotherapy commences at the internal ostium. Methods: We introduced the concepts of internal distance (distance between internal cervical ostium and cerclage thread) and the latent shortening of internal distance, which is characterized as a painless reduction in the internal distance, serving as an early marker of preterm contractions, thus enabling timely tocolytic intervention. Results: Three patients spontaneously conceived after RT. They were obstetrically followed-up after RT, using a combined approach of transvaginal ultrasound cervical markers and cardiotocography. Active tocolysis was used if internal distance shortening was observed. All patients delivered term healthy babies. Conclusions: The consistent ultrasound evaluation of both internal and external distances permits the proactive diagnosis of premature contractions and enables swift therapeutic measures. Full article

Perinatal depression is one of the most common mental illnesses in women. The aim of this study was to assess the association of life stressors, perceived stress, obstetric and neonatal complications, and depressive symptoms in the early postpartum period and to compare these variables in two groups of women (preterm and term deliveries). Methods: A case–control study was conducted among 300 women who gave birth in 2019 at the University of Szeged. Cases included women with preterm deliveries (<37 weeks, n = 100), and the controls included women with term deliveries (≥37 weeks, n = 200). Data were collected during postpartum hospital stays through a self-administered questionnaire (containing validated questionnaires: the Holmes–Rahe Life Stress Inventory, the Perceived Stress Scale (PSS-14), and the Edinburgh Postnatal Depression Scale (EPDS)) and the medical records of women and newborns. A descriptive statistical analysis and logistic regression were used to identify predictors of high EPDS scores (≥10). Results: Perceived stress levels were significantly higher among cases than controls (p < 0.001). Higher perceived stress was associated with a higher risk of depression in cases (OR: 1.31, 95% CI: 1.17–1.48, p < 0.001) and controls (OR: 1.33, 95% CI: 1.21–1.45, p < 0.001), too. Newborn complications were associated with an increased perinatal depression risk in the controls (OR: 2.48, 95% CI: 1.05–5.91; p = 0.039) but not in the cases (OR: 2.79, 95% CI: 0.79–9.85; p = 0.111). It is supposed that premature birth was stressful itself, and women with preterm babies were less sensitive to any complications occurring in their newborns compared to women with term newborns. Neither maternal age, education, nor obstetric complications predicted depressive symptoms. Conclusions: Our findings highlight the impact of maternal perceived stress and newborns’ health status on the risk of developing depression during the early postpartum period. These results emphasize the need for ongoing screening and follow-up measures, especially for women with higher EPDS scores. Full article

Intraventricular hemorrhage (IVH) is a common complication encountered in extremely-low-birth-weight (ELBW) and very-low-birth-weight (VLBW) premature babies. The neurologic outcome of these patients is influenced by the magnitude of the hemorrhagic process that damages the involved anatomic structures but also by the impaired circulation of cerebrospinal fluid (CSF) through the ventricular system, leading to posthemorrhagic ventriculomegaly (PHVM). Cranial ultrasound (CUS) performed by neonatologists (point-of-care ultrasound—POCUS) facilitates the early diagnosis of IVH and PHVM and can objectively quantify structural alterations. Our aim was to identify the best sonographic criteria to follow-up with ventricular dilatation and predict the need for neurosurgery and neurologic deterioration. We performed a literature review in search of the most relevant ventricular measurements considered by neurosurgeons, neonatologists, and pediatric neurologists to reflect the risk of white matter injury and high intracranial pressure (HIP), thus anticipating neurologic developmental impairment (NDI). The tridimensional picture of ventricular dilatation is best captured if more than one index (ventricular index and anterior horn width) or ratio (Evans ratio, fronto-occipital horn ratio, and fronto-temporal horn ratio) is used. Conclusions: If performed using the correct protocol, serially and comprehensively, CUS is an indispensable tool for the diagnosis and follow-up of neurologic complications of preterm babies, and it can make a difference in guiding adequate intervention and improving long-term developmental outcomes. Full article

Background/Objectives: Traditional diagnostic criteria for SBS include subdural, subarachnoid, and retinal hemorrhages. While intentional shaking is a known cause, the potential for similar forces acting on the head resulting from accidental trauma has not been fully explored. This study investigated the biomechanical forces on a model infant’s head during improper handling to determine if such forces could contribute to SBS without malicious intent. Methods: A realistic silicone infant model was equipped with an inertial measurement unit (IMU) to quantify head accelerations during two conditions: (1) placement of the infant model on a table with the head unsupported, and (2) manual shaking at maximum effort by 2 participants holding the model by the torso. Peak head accelerations were recorded for both conditions, and the results were analyzed for comparative assessment of the forces involved. Results: The average peak head acceleration when placing the infant model on a table with the head unsupported was +31,000 ± 7000 mg, with a range of +19,000.00 to +43,000 mg across trials. The average peak head accelerations during maximum effort shaking were significantly lower than placing the infant on the table, averaging 11,000 ± 10,000 vs. 31,000 ± 7000 mg, p < 0.0001). There were no significant differences in head accelerations between participants when placing the infant model on the table with the head unsupported (p = 0.89) nor with shaking the baby with maximum effort (p = 0.96). Conclusions: The study highlights that even accidental non-recommended handling of infants can result in high G-forces to the head, potentially leading to injuries similar to those observed in SBS. These findings highlight the necessity of supporting an infant’s head during handling and warrants caution against prematurely attributing physical abuse in SBS cases without considering unintentional causes. Full article

Background: Docosahexaenoic acid (DHA) is the most important fatty acid (FA) for the development and function of brain and retina. Mother’s milk is the predominant source of DHA for the baby’s postnatal life, and the omega 3 FA content of a mother’s diet is highly correlated with the cognitive and visual functions of the infant. However, clinical trials aimed at increasing the DHA content of mother’s milk and thereby improving infant cognitive function have been inconclusive. Methods: In this study, we tested the hypothesis that the molecular form of dietary DHA is important in enriching DHA in mother’s milk as well as in pup tissues. Lactating dams were fed defined diets containing DHA either in the form of triacylglycerol (TAG) or lysophosphatidylcholine (LPC), and the FA composition of mother’s milk and pup tissues was determined on postnatal day 16. Results: The results showed that LPC-DHA was 5-fold more efficient than TAG-DHA in enriching milk DHA. Moreover, DHA content was increased by 31% in the brain, 56% in the retina, and 14% in the liver of the pups by LPC-DHA in the maternal diet, whereas no increases were observed with TAG-DHA. The DHA content of the pup adipose tissue, however, was increased equally by the DHA supplements. Conclusions: These results show that dietary LPC-DHA is a promising new strategy to increase milk DHA content and to potentially improve brain and retinal health in infants. This strategy may be more important in the care of premature infants who miss the critical prenatal period of DHA accretion in the last trimester of pregnancy. Full article

Background and purpose: Perforator stroke (PS) is a subtype of perinatal arterial ischemic stroke (PAIS), in which injuries occur in the territory of the perforator branches of the main cerebral arteries. This study aims to explore the incidence, timing, risk factors, and clinical presentation of PS in both preterm and full-term neonates. Material and methods: We retrospectively analyzed data about all the neonatal brain MRIs carried out in our hospital from March 2012 to March 2023. Criterium of inclusion was the radiologically confirmed diagnosis of perforator stroke involving one or more arterial districts. Results: A total of 1928 patients underwent brain MRIs during the period considered. PAIS was present in 50 patients, of which 19 had PS (38%). Among the patients with PS, nine were preterm babies (47%), and six suffered from perinatal asphyxia (31.5%). PS cUS diagnosis preceded MRI diagnosis in 88% of preterm babies. The mean age at cUS diagnosis was 20 ± 7 days. Preterm babies were often asymptomatic, whereas term babies showed neurological symptoms (mainly seizures). The outcome was favorable as long as PS was isolated. Conclusions: PS is surprisingly frequent among PAIS. It represents the most common form of PAIS in preterm babies and in babies suffering from birth asphyxia. Prenatal and perinatal factors suggesting a possible thromboembolic etiology leading to PAIS are rare in our population of preterm babies, in which the diagnosis was always preceded by negative cUS. These assumptions suggest a postnatal development of PS in premature babies more than a perinatal one. Full article

Background/Objective: Actinomyces is a genus of anaerobic gram-positive bacteria. It forms part of human body microbiota commonly in the oral cavity and genital tract. During pregnancy, the organism may cause the rare chorioamnionitis, where the maternal genital tract or other sites such as the oral cavity will be the likely source of the pathogen. This condition may increase the risk of foetal morbidity and mortality, and preterm birth. Methods: The placenta of a 33-year-female, primigravida, who presented with preterm labour and eventual delivery of baby at 20 weeks gestation was sent for histopathological examination. Her antenatal and clinical history were reviewed, to identify possible aetiology for her preterm birth. Results: She is noted to have presented with sudden per-vaginal creamy coloured discharge with no associated odour and no irritation. The discharge became blood staining associated with labour pain, this followed by premature spontaneous rupture of membrane and pre-mature labour. Laboratory tests revealed leucocytosis, neutrophilia, monocytosis, high CRP and elevated derived fibrinogen. The patient was delivered of a live male baby weighing 0.35 kg, who died shortly after birth. Placenta microscopic examination revealed patchy severe acute chorioamnionitis and prominent clusters of Gram-positive filamentous bacteria with histopathologic features of Actinomyces spp. The mother before discharged was treated with oral antibiotic. Conclusions: The intrauterine Actinomyces spp. infection is associated with preterm birth and neonatal mortality, early diagnosis during ante-natal could perhaps prevent preterm birth and reduce the associated neonatal mortality. Full article

For many genetic disorders, there are no specific metabolic biomarkers nor analytical methods suitable for newborn population screening, even where highly effective preemptive treatments are available. The direct measurement of signature peptides as a surrogate marker for the protein in dried blood spots (DBSs) has been shown to successfully identify patients with Wilson Disease (WD) and three life-threatening inborn errors of immunity, X-linked agammaglobulinemia (XLA), Wiskott–Aldrich syndrome (WAS), and adenosine deaminase deficiency (ADAD). A novel proteomic-based multiplex assay to detect these four conditions from DBS using high-throughput LC-MS/MS was developed and validated. The clinical validation results showed that the assay can accurately identify patients of targeted disorders from controls. Additionally, 30,024 newborn DBS samples from the Washington State Department of Health Newborn Screening Laboratory have been screened from 2022 to 2024. One true presumptive positive case of WD was found along with three false positive cases. Five false positives for WAS were detected, but all of them were premature and/or low-birth-weight babies and four of them had insufficient DNA for confirmation. The pilot study demonstrates the feasibility and effectiveness of utilizing this multiplexed proteomic assay for newborn screening. Full article

This study investigates the process of planning for future inpatient resources (beds, staff and costs) for maternity (pregnancy and childbirth) services. The process of planning is approached from a patient-centered philosophy; hence, how do we discharge a suitably rested healthy mother who is fully capable of caring for the newborn baby back into the community? This demonstrates some of the difficulties in predicting future births and investigates trends in the average length of stay. While it is relatively easy to document longer-term (past) trends in births and the conditions relating to pregnancy and birth, it is exceedingly difficult to predict the future nature of such trends. The issue of optimum average bed occupancy is addressed via the Erlang B equation which links number of beds, average bed occupancy and turn-away. Turn-away is the proportion of times that there is not an immediately available bed for the next arriving inpatient. Data for maternity units show extreme and unexplained variation in turn-away. Economy of scale implied by queuing theory (and the implied role of population density) explains why many well intended community-based schemes fail to gain traction. The paper also addresses some of the erroneous ideas around the dogma that reducing length of stay ‘saves’ money. Maternity departments are encouraged to understand how their costs are calculated to avoid the trap where it is suggested by others that in reducing the length of stay, they will reduce costs and increase ‘efficiency’. Indeed, up to 60% of calculated maternity ‘costs’ are apportioned from (shared) hospital overheads from supporting departments such as finance, personnel, buildings and grounds, IT, information, etc., along with depreciation charges on the hospital-wide buildings and equipment. These costs, known as ‘the fixed costs dilemma’, are totally beyond the control of the maternity department and will vary by hospital depending on how these costs are apportioned to the maternity unit. Premature discharge, one of the unfortunate outcomes of turn-away, is demonstrated to shift maternity costs into the pediatric and neonatal departments as ‘boomerang babies’, and then require the cost of avoidable inpatient care. Examples are given from the English NHS of how misdirected government policy can create unforeseen problems. Full article

Background/Objectives: Zika disease is caused by the Zika virus (ZIKV) and represents a major public health problem because of the complications in newborn babies from mothers who were infected during pregnancy. It is estimated that 80% of infected pregnant women are asymptomatic, which complicates the identification of infected individuals. In this study, we aimed to detect ZIKV in asymptomatic pregnant women and the effects in the newborns were analyzed. Methods: The presence of ZIKV was evaluated through endpoint reverse transcription–polymerase chain reaction (RT-PCR) in 114 blood samples from pregnant women treated at two hospitals in the state of Veracruz, Mexico. There was a follow-up of the participants until the birth of their newborns. Results: ZIKV RNA was detected in 4.4% (n = 5) of cases. In two positive cases, two consecutive samples were obtained, and one case of persistence of ZIKV in serum after 90 days after delivery was identified. A total of 80% of the positive cases were identified after the third trimester of pregnancy and 20% after the second trimester. Although ZIKV was shown to be a risk factor for low weight and low size at birth and prematurity, after adjustment for other variables, it did not show a significant association. In contrast, preeclampsia/eclampsia was identified as a significant risk factor for low birth weight. Conclusions: The prevalence of ZIKV found in this study suggests a latent circulation of this virus and highlights the importance of epidemiological surveillance in endemic zones. The prolonged viremia that was found suggests the need for more research because of the high impact which can mean the possible dissemination of the virus to the vector. Full article

Objective: To assess the birth weight of newborns whose mothers gave birth during the COVID-19 pandemic. Methods: A cross-sectional study based on data collected from medical records and through postnatal interviews to assess maternal and neonatal health outcomes (n = 470) during the pandemic. All participants were assisted in three Brazilian public hospitals in 2020. Multinomial logistic regression was performed to assess factors associated with birth weight. Results: Low and insufficient birth weight reached 9.8% and 25.7% prevalence, respectively. COVID-19 symptoms were reported by 8% of participants. Low birth weight was more often observed in premature children (OR: 70.9; 95% CI: 16.4–305.8) delivered by cesarean sections (OR: 7.70; 95% CI: 2.33–25.4). Insufficient weight was more frequent in premature children (OR: 5.59; 95% CI: 1.53–20.4) and children whose mothers did not exercise during pregnancy (OR: 2.85; 95% CI: 1.38–5.89). Women presenting higher gestational weight gain had a lower chance of delivering babies with insufficient weight (OR: 0.94; 95% CI: 0.90–0.99). Conclusions: Inadequate birth weight was associated with prematurity, delivery type, lower gestational weight gain, and maternal physical inactivity during the pandemic. According to the results, it is necessary to have adequate prenatal care and promote a healthy lifestyle during pregnancy. Full article

Parenteral nutrition (PN) is a nutrient solution administered intravenously (IV) to premature babies. PN causes elevations of some amino acids in blood samples that are also biomarkers used in newborn screening (NBS). Therefore, PN status must be annotated by clinicians on dried blood spot (DBS) cards to reduce NBS laboratory burdens associated with potential false results; however, NBS laboratories continue to receive DBSs with misannotated PN status. N-acetyltyrosine (NAT), a water-soluble tyrosine analog used to increase tyrosine bioavailability in PN solutions, can be used as a blood-based biomarker of PN administration in NBS assays. Residual DBS specimens and manufactured DBSs were used in analyses. The assay was developed and validated using flow injection analysis tandem mass spectrometry (FIA-MS/MS) for the detection of NAT. NAT was only present in neonate DBSs with annotated PN administration and was multiplexed into first-tier newborn screening assays. NAT was highly correlated with amino acids present in PN solutions, such as arginine, leucine, methionine, phenylalanine, and valine. In our sample cohort, we determined an NAT cutoff could aid the identification of misannotated neonates administered PN. We also report the Amadori rearrangement product valine–hexose (Val-Hex) was quantifiable in neonates administered PN, which we suspect forms in the PN solution and/or IV lines. Here, we present the first known use of NAT as a biomarker of PN administration, which is currently being piloted by two U.S. NBS laboratories. NAT and Val-Hex can aid the identification of misannotated DBSs from neonates administered PN, thus decreasing false positive rates. Full article

Background/Objectives: Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. Methods: A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks’ gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge. Serum folate levels were measured near NICU discharge (T1) and at 2–3 months corrected age (T2). Folate status was categorized per WHO (World Health Organization) guidelines: deficiency (<6.8 nmol/L), possible deficiency (6.8–13.4 nmol/L), normal (13.5–45.3 nmol/L), and elevated (>45.3 nmol/L). Nutritional information on feed and supplements was collected from hospital notes and maternal interviews. Results: Thirty-two infants (71%) received parenteral nutrition. Twelve infants (32%) remained exclusively breastfed at T2. No infant from the whole cohort had a serum folate concentration <13.5 nmol/L at either time point. A proportion of infants had serum folate concentrations >45.3 nmol/L: 14/45 (31%) at T1, 19/37 (42%) at T2, and 7/37 (16%) at both time points. Elevated concentrations were seen particularly in infants who received folic acid supplements or nutrition containing folic acid, such as parenteral nutrition and breastmilk fortifiers. Conclusions: Folate deficiency was not observed in this cohort; folate concentrations were high and in line with those observed in healthy term infants. Further research is needed to assess the high folate concentrations in premature babies and whether they may have any adverse clinical impact. Full article

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole. Full article