Search Results (3,779)

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that commonly begins in early childhood and substantially impairs quality of life. Patient-Oriented Eczema Measure (POEM) is a validated patient-reported outcome, whereas SCORing Atopic Dermatitis (SCORAD) is a widely used clinician-assessed severity index for AD. Methods: In this single-center observational analytical pilot study, 90 pediatric patients (1 month–15 years) diagnosed with AD, according to Hanifin and Rajka criteria, were recruited at Saint Constantin Hospital, Brașov, Romania (September 2025–February 2026). During one visit, caregivers and/or children completed the Romanian version of the POEM, and a dermatologist assessed disease severity using SCORAD. Demographic and clinical data were recorded. Descriptive statistics, group comparisons, linear regression, and correlation analyses (Pearson/Spearman) were performed (significance p < 0.05). The main objectives of the study were to translate and adapt the POEM questionnaire into Romanian for use in children with AD and to assess the relationship between POEM and SCORAD scores. Secondary objectives were to explore the influence of clinical and perinatal factors (sex, prematurity, mode of delivery, in vitro fertilization, breastfeeding) and the presence of other atopic diseases on AD severity. Results: POEM and SCORAD scores showed a strong positive correlation (rho = 0.841, p < 0.001), indicating that patient-reported symptom burden closely paralleled clinician-assessed disease severity. The presence of another atopic condition was independently associated with higher POEM (B = 4.31, p < 0.001) and SCORAD scores (B = 15.34, p < 0.001). No other demographic or perinatal factor showed a consistent independent association with disease severity. No significant independent associations were found for sex, age, prematurity, in vitro fertilization, or breastfeeding. Conclusions: This first Romanian pilot study in pediatric AD demonstrates a strong correlation between POEM and SCORAD and supports the concurrent use of POEM as a practical patient-reported tool alongside SCORAD in clinical practice, while recognizing the limitations of a relatively small cohort and single-visit design. Full article

Background and Clinical Significance: Lues remains a global health concern despite the well-known nature of its symptoms, the availability of diagnostic methods, and the existence of effective therapy. The recent increase in maternal syphilis has been accompanied by a rise in congenital infections, which are associated with stillbirth, prematurity, neonatal mortality, and severe multisystemic disorder. In newborns, it may present with highly variable clinical manifestations, making timely diagnosis and treatment essential. We report a case of severe early congenital syphilis in a premature newborn with extensive multiorgan involvement; Case Presentation: We present a case of a male infant born at 31 + 6 weeks of gestation to a 26-year-old mother with inadequate antenatal care and no documented screening or treatment for syphilis during pregnancy. Prenatal ultrasound revealed fetal ascites. At birth, the infant presented with severe respiratory failure requiring immediate resuscitation, endotracheal intubation, and intensive care support. Clinical findings included hepatosplenomegaly, generalized edema, ascites, petechial rash, palmoplantar desquamation, severe thrombocytopenia, anemia, coagulopathy, liver dysfunction, and hemorrhagic syndrome. Maternal and neonatal serologic testing confirmed syphilis infection. The clinical course was complicated by pneumonia with prolonged mechanical ventilation, cardiovascular involvement impairing cardiac function, and heart failure. Treatment consisted of intravenous penicillin G, broad-spectrum antimicrobial therapy, antifungal medication, respiratory support, transfusion therapy, cardiovascular management, and intensive multidisciplinary care; Conclusions: This report presents consequences of untreated maternal syphilis and underscores the importance of timely diagnosis, early initiation of penicillin therapy, and close multidisciplinary follow-up to optimize outcomes in neonates. Full article

Background: Placental abruption (PA) is an unpredictable obstetric complication associated with substantial maternal and fetal/neonatal morbidity and mortality in the index and subsequent pregnancies. The previous PA severity classification categorizes more than two-thirds of cases as severe, which limits its clinical utility despite its association with adverse maternal outcomes. Objective: We aimed to develop a novel, clinically applicable PA severity classification and to determine its ability to predict its recurrence in subsequent pregnancies. Study design: This retrospective, population-based cohort study included medical records of all women who delivered at our medical center from 2001 to 2021. Pregnancies complicated by chromosomal abnormalities or major congenital anomalies were excluded. The novel PA severity classification included maternal (transfusion of ≥4 units of red blood cells, admission to an intensive care unit, DIC, hysterectomy, or maternal death) and neonatal (birth asphyxia, hypoxic–ischemic encephalopathy, umbilical cord blood acidosis defined as pH < 7.0, neonatal intensive care unit admission at ≥35 weeks gestation, or perinatal death) complications. Maternal characteristics, clinical features, and perinatal outcomes were compared between the novel and the existing PA severity classifications. A multivariate regression model was used to determine the association between PA severity and the risk of its recurrent in subsequent pregnancies. Results: Our cohort included 298,281 deliveries; of them, 1567 (0.5%) had PA. The rate of severe PA was lower in the novel vs. the existing classification (p < 0.001). Within the novel classification, severe PA was associated with higher rates of mild and severe preeclampsia and lower mean fibrinogen concentrations and platelet counts compared with mild abruption (all p < 0.001). Severe PA was independently associated with an increased risk of recurrence in subsequent pregnancies (OR 1.82, 95% CI 1.05–3.14). Conclusions: We propose a novel, clinically relevant PA severity classification that accurately identifies severe disease providing prognostic information regarding the risk of PA recurrence in future pregnancies. Full article

Objectives: Human milk composition changes across lactation, but paired within-subject proteomic analyses comparing longitudinal trajectories in term and preterm milk remain limited. We aimed to characterize stage-associated proteomic changes within each cohort and determine whether longitudinal remodeling is shared or divergent between term and preterm lactation. Methods: In this single-center prospective study conducted at the Neonatal Intensive Care Unit, Jagiellonian University Medical College, Kraków, Poland (October 2020–November 2021), 40 lactating mothers (20 preterm, <32 weeks’ gestation, mean age 29.4 ± 6.1 years; 20 term, 37–42 weeks, mean age 30.2 ± 5.5 years) provided paired milk samples at ≤10 days postpartum and week 5. Milk serum proteomes were analyzed by quantitative data-independent acquisition mass spectrometry; differential abundance was assessed using two-sample t-tests with Storey false discovery rate correction (q < 0.05) and fold-change >1.5, followed by ClueGO pathway enrichment. Results: Stage-associated differential abundance was identified for 108 proteins in term milk (58 increased, 50 decreased) and 103 in preterm milk (64 increased, 39 decreased). Of these, 87 were shared between cohorts (80.6% of term, 84.5% of preterm set) with concordant directionality. Shared upregulated pathways included oxidative stress response and glycolysis (e.g., PRDX5, fold change 2.49, q = 0.044); shared downregulated pathways related to mucosal immunity (e.g., tenascin, fold change 9.61–11.41, q < 0.0001). Cohort-specific pathway signals were limited relative to shared remodeling. Conclusions: The human milk serum proteome undergoes substantial longitudinal remodeling in both term and preterm lactation, with most changes following a common temporal pattern; prematurity-related differences appear selective rather than global. These findings support lactation stage as a key determinant of milk proteomic composition and underscore the value of longitudinal, stage-aware study designs, although formal time-by-group interaction testing was not performed. Full article

The postnatal period involves significant emotional and relational shifts that can challenge early mother–infant interactions, particularly under conditions of psychosocial vulnerability (e.g., maternal anxiety/depression) or infant-related risk (e.g., preterm birth). Maternal mentalization, operationalized as Parental Reflective Functioning (PRF), is a key protective factor for sensitive caregiving and dyadic regulation. Objectives: This protocol describes a multicenter, open-label, single-arm feasibility study evaluating a brief, fully online, mentalization-based video-feedback intervention (VFI-RF). The study is designed to assess the feasibility and acceptability of the intervention, rather than its efficacy. We aim to recruit 48 mothers, 24 in each of two risk groups, through socio-health services and neonatal intensive care units. Risk Group 1 will include mothers with clinically significant depressive and/or anxiety symptoms, defined as EPDS > 9 and/or GAD-7 ≥ 10, whereas Risk Group 2 will include mothers of preterm infants, defined as infants born before 37 weeks of gestation. Methods: The intervention consists of 8 + 2 synchronous online sessions over approximately 5 months. Mothers record brief everyday caregiving interactions (~5 min) to review with a trained clinician, focusing on the infant’s internal states and reflective meaning-making. Assessments occur at baseline (T0, infant age ~3 months), post-intervention (T1, ~8 months), and follow-up (T2, ~12 months). Primary feasibility outcomes include recruitment/referral metrics, uptake, retention, assessment completion, missing data, and participant-reported acceptability. Secondary exploratory clinical outcomes include maternal PRF, symptoms, parenting stress, social support, and mother–infant attachment, evaluated via validated self-report questionnaires. Results: The study is designed to evaluate referral and recruitment patterns, intervention uptake, and participant retention, as well as the acceptability and suitability of study procedures and outcome measures for a future controlled trial. Preliminary trajectories of change in maternal reflective functioning and early relational indicators will be examined descriptively and exploratorily. Conclusions: Findings will inform the feasibility and refinement of a brief online mentalization-based video-feedback intervention to support at-risk mother–infant dyads during the first postnatal year. Trial registration: Registered on Open Science Framework, osf.io/6g9ja, date of registration 4th March 2026. Full article

Background: Type 2 diabetes mellitus (T2DM) in pregnancy is increasingly recognized as a high-risk metabolic condition, frequently accompanied by overweight, obesity, insulin resistance, and adverse maternal and neonatal outcomes. This systematic review and meta-analysis aimed to evaluate body weight-related parameters in pregnancies complicated by T2DM compared with those in non-T2DM control groups. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to 19 August 2025. Original studies reporting body weight, body mass index (BMI), or gestational weight gain (GWG) in pregnant women with T2DM and different control groups were included. Data were synthesized using standardized mean differences (SMDs) with fixed or random-effects models. Maternal, metabolic, delivery, and neonatal outcomes were summarized descriptively. Results: Eighty-seven studies were included in the systematic review and seventy-two were included in the meta-analysis. Pregnant women with T2DM had significantly higher pre-pregnancy body weight and first-trimester body weight than normoglycemic and T1DM controls. Pre-pregnancy BMI was also significantly higher in T2DM pregnancies compared with normoglycemic, T1DM, and gestational diabetes controls. In contrast, GWG did not differ significantly between T2DM and normoglycemic or gestational diabetes pregnancies, while it was significantly lower in T2DM than in type 1 diabetes pregnancies. Adverse maternal and neonatal outcomes, including hypertensive disorders, preterm delivery, fetal growth abnormalities, macrosomia, congenital anomalies, and fetal/neonatal loss, were frequently reported across the included studies. Conclusions: Pregnancies complicated by T2DM are characterized by an unfavorable preconception anthropometric profile. The contrasting patterns across diabetes types suggest different periods for weight-related care: preconception weight optimization appears particularly relevant in T2DM, whereas the higher gestational weight gain observed in T1DM relative to T2DM supports individualized monitoring of gestational weight trajectories during pregnancy. These strategies should be incorporated into comprehensive preconception and antenatal care alongside glycemic optimization and assessment of diabetes-related complications. Full article

This systematic review assessed transcriptomic evidence on the molecular mechanisms underlying spontaneous preterm birth (sPTB). Major electronic databases were searched from inception to October 2025. Eligible studies examined RNA transcriptomic profiles from maternal pregnancy-related tissues or biofluids in spontaneous preterm labor (sPTL) or preterm prelabor rupture of membranes (PPROM), while indicated or iatrogenic preterm births were excluded. Two reviewers independently screened studies, extracted differentially expressed genes (DEGs), and assessed study quality. DEGs were summarized by tissue type, and recurrent concordant genes were analyzed using Gene Ontology, Reactome, and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, with false discovery rate < 0.05 considered significant. Twenty studies were included. Transcriptomic data were derived from placental villi, maternal peripheral blood, decidua, fetal membranes, myometrium, amniotic fluid, and vaginal secretions. Placental villi findings suggested proliferative-metabolic reprogramming and impaired maternal–fetal immune–structural homeostasis, whereas maternal blood profiles reflected systemic immune–inflammatory activation and dysregulated lipid-metabolic pathways. sPTL and PPROM showed potentially distinct signatures involving extracellular matrix disruption, collagen remodeling, matrix degradation, and myeloid/neutrophil-associated inflammation. Transcriptomic profiling may support non-invasive sPTB risk assessment, but standardized, phenotype-specific longitudinal studies are needed to confirm predictive value and clinical utility. Full article

Seasonal influenza remains an important public health concern worldwide, and pregnant women represent a particularly vulnerable population due to physiological and immunological changes associated with gestation. Influenza infection during pregnancy has been associated with adverse maternal, fetal and neonatal outcomes. This narrative review summarizes current evidence regarding maternal influenza infection and influenza vaccination during pregnancy. A structured literature search was conducted using PubMed, Embase and Cochrane Library databases. Studies published between 2020 and 2025 addressing maternal influenza infection, pregnancy outcomes and influenza vaccination were reviewed. Current evidence suggests that maternal influenza infection is associated with increased risks of spontaneous abortion, preterm birth, hospitalization and congenital malformations, especially neural tube defects and congenital heart defects when infection occurs during the first trimester. In contrast, evidence regarding long-term neurodevelopmental outcomes remains inconsistent. Influenza vaccination during pregnancy demonstrates moderate-to-high effectiveness in preventing maternal and neonatal influenza infection and shows a favorable safety profile. Available evidence also suggests that neuraminidase inhibitors, particularly oseltamivir, can be used safely during pregnancy without increasing the risk of congenital malformations or adverse neonatal outcomes. Influenza vaccination during pregnancy should continue to be promoted as a safe and effective public health strategy to protect both mothers and infants. Full article

Background/Objectives: Evidence suggests that assessment of neonatal body fat mass (FM) may provide additional insight into the relationship between disrupted fetal growth and neonatal health outcomes. Our objective was to determine whether neonatal body composition parameters are associated with hypoglycemia, hypothermia, and respiratory distress syndrome. Methods: We conducted a prospective study of preterm neonates born at ≤37 weeks of gestational age. Body composition was measured in the first week of life with bioelectrical impedance analysis (BIA). Results: We studied 101 neonates of mean gestational age 32.2 ± 3.2 weeks and mean birth weight 1792 ± 706 g. Neonates with intrauterine growth restriction (IUGR) had a significantly lower FM percentage (6.8 ± 3.6 compared with 8.3 ± 3.6%, p = 0.038), and higher free-FM percentage (93.1 ± 3.6 compared with 91.6 ± 3.4%, p = 0.041), compared with non-IUGR neonates. Compared with neonates with normal FM, neonates with decreased FM presented higher rates of hypothermia (35% compared with 9%, p = 0.005), hypoglycemia (46% compared with 9%, p < 0.001), and respiratory distress syndrome (58% compared with 27%, p = 0.008). Decreased FM percentage was significantly associated with hypoglycemia (OR 8.06, 95%CI 2.49–26.08, p < 0.001), hypothermia (OR 8.11, 95%CI 2.24–29.32, p = 0.001), and respiratory distress syndrome (OR 13.90, 95%CI 4.07–27.42, p < 0.001) after adjusting for gestational age, sex, and antenatal steroid administration. Conclusions: Lower FM percentage showed stronger associations with common neonatal morbidities, compared with standard anthropometric measurements alone. When a low FM percentage is detected, even when birth weight is normal, neonates at risk of undernutrition-related morbidity may benefit from closer nutritional and metabolic monitoring. Full article

Human Bocavirus 1 (HBoV1) is one major pathogen that has been associated with wheezing illnesses. However, there is still a lack of effective clinical predictive indicators for wheezing illnesses in children infected with HBoV1. A retrospective cohort study was conducted among pediatric patients with single-HBoV1 infection from September 2016 to August 2023. Then, univariate logistic regression was used to screen potential predictors for wheezing illness, and Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to minimize overfitting and select key predictors. Finally, a multivariate logistic regression model was constructed in a training dataset comprising 80% of patients and validated in an independent test dataset comprising 20% of patients. Then, its performance was evaluated using the Area Under the Curve (AUC). A total of 330 pediatric patients were enrolled, including 228 in the wheezing-illness group and 102 in the non-wheezing group. Three independent predictors, including abnormal NK cell percentage (OR = 1.101, 95 %CI 1.03–1.27), preterm birth (OR = 1.65, 95 %CI 1.49–1.82) and personal history of allergy (OR = 1.25, 95 %CI 1.11–1.41), were identified. The model achieved AUCs of 0.904 and 0.876 in the training and test sets, respectively. Using a Youden-derived threshold (0.382), the high-risk group in the test set had an observed wheezing rate of 85.3%, compared with 18.7% in the low-risk group (p < 0.001). Calibration was satisfactory (Hosmer–Lemeshow p = 0.324 and 0.576). A validated predictive model incorporating abnormal NK cell percentage, preterm birth and personal history of allergy accurately stratifies the risk of wheezing illness after HBoV1 infection in children, facilitating early clinical intervention. Full article

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. This significant burden necessitates effective early identification of pregnancies at high-risk for preeclampsia. Accurate prediction is essential in order to develop and optimize preventive strategies. The evolution of preeclampsia screening has progressed from a traditional checklist-based approach to individualized, multivariable models. The first-trimester triple test, which was developed by the Fetal Medicine Foundation (FMF), represents this advancement. It utilizes Bayes’ theorem to calculate patient-specific risks by integrating maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. This model, called “first trimester FMF triple test”, has undergone successful internal and external validation for the prediction of preterm preeclampsia. To ensure the reliability of biomarker measurements and achieve an optimal screening performance, it is essential to implement standardized measurement protocols and rigorous quality control processes in biomarker testing. The triple test could also be utilized in the 2nd and 3rd trimester, and the addition of biomarkers such as soluble fms-like tyrosine kinase-1 further improves risk stratification assessment and continued surveillance of high-risk pregnancies. Full article

Adverse pregnancy outcomes (APOs), including preterm birth, preeclampsia, low birth weight, recurrent miscarriage, gestational diabetes mellitus, and fetal growth restriction, remain major threats to maternal and offspring health. Increasing evidence links the maternal microbiome to pregnancy health, but most studies have examined individual microbial niches rather than their interactions. The oral cavity and gut are anatomically and immunologically connected and form a bidirectional oral–gut microbiota axis through microbial trafficking, immune signaling, and metabolite-mediated feedback. Emerging studies suggested that oral dysbiosis, periodontal inflammation, and gut microbial remodeling were associated with APOs, although direct causal evidence in human pregnancy remains limited. This review summarizes pregnancy-related remodeling of the oral–gut microbiota axis, evaluates clinical and experimental evidence linking oral and gut dysbiosis to APOs, and discusses potential mechanisms, including microbial translocation, immune and inflammatory activation, metabolic remodeling, epigenetic regulation, and outer membrane vesicle-mediated signaling. Candidate biomarkers, probiotic and dietary intervention strategies, and current translational limitations are also discussed. Overall, the oral–gut microbiota axis offers a useful framework for understanding microbiome-associated APOs, but standardized sampling, longitudinal cohorts, and mechanistic validation are required before clinical application. Full article

Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of ≤34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 µg/g in the first week to 65 µg/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population. Full article

Background: Very-low-birth-weight (VLBW) infants require ongoing medical follow-up and coordinated family support after discharge due to their immature physiological development and a high risk of complications. Fragmented transitional care and caregiver burden may compromise follow-up adherence and infant health outcomes. This study aimed to describe the implementation, feasibility, and service-level outcomes of a multidisciplinary transitional home care program designed to support continuity of care and family-centered transitional support for high-risk infants through a retrospective descriptive program evaluation. Methods: Since 2022, our hospital has implemented a government-supported transitional home care program for low and VLBW infants. A multidisciplinary team provided individualized discharge planning, risk stratification, home-based follow-up, telehealth consultations, developmental monitoring, caregiver education, and psychosocial support. Program outcomes were evaluated using enrollment coverage, follow-up completion, developmental assessment attendance, caregiver stress scores, and service utilization. Results: From 2022 to September 2025, enrollment coverage reached 97.7–100% for infants ≤ 1500 g and 100% for preterm infants > 1500 g. A total of 949 video consultations and 2168 telephone or in-person follow-ups were conducted, totaling 3117 service encounters. Developmental assessment attendance rates reached 95%, 93%, and 88% at scheduled corrected-age intervals. Mean caregiver stress scores showed favorable observational trends, decreasing from 14.64 to 10.81. Fifty-two referrals to social resources enhanced service accessibility and family support. Conclusions: This multidisciplinary transitional home care program demonstrated high enrollment coverage and sustained follow-up engagement within a tertiary medical center setting. The findings support the feasibility and potential applicability of integrated and family-centered transitional care models in supporting continuity of care and caregiver support for high-risk infants after discharge. Due to the descriptive retrospective design and absence of a control group, causal relationships cannot be established. Full article

Objective: This study evaluated hepatitis B vaccine (HepB) uptake, associated influencing factors, and post-vaccination immune responses among preterm infants residing in Fujian Province. The findings can support targeted improvements in hepatitis B prevention and control strategies tailored for this high-risk neonatal population. Methods: We conducted a multicenter cross-sectional study combined with short-term prospective serological follow-up across five counties, cities and districts of Fujian Province between 2022 and 2023. A total of 779 eligible preterm infants were enrolled in this study. We collected demographic information of participating mothers and infants, as well as complete HepB vaccination records throughout the study period. For 363 enrolled infants, we performed serological tests to detect hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) at 1–2 months after they completed the full HepB vaccination series. To explore factors linked to timely administration of the first HepB dose (HepB1), completion of the full vaccination course and HBsAb serostatus, we adopted a set of statistical approaches including descriptive statistics, the chi-square test (Fisher’s exact test was used for groups with small sample sizes) and binary logistic regression. Results: The timely HepB1 vaccination rate among all preterm infants was 78.18%, while 63.80% completed the full vaccination schedule as required. In the serology cohort, the HBsAb positive rate was 90.91%, and 8.82% of infants showed double-negative HBsAg and HBsAb results, indicating susceptibility to HBV infection. Multivariate analysis identified multiple risk factors for delayed vaccination. Preterm infants were more likely to receive vaccinations late if their mothers tested HBsAg-negative (HepB1: OR = 25.231, 95%CI: 4.997–127.406; full-course HepB: OR = 2.440, 95%CI: 1.395–4.269), were delivered in county-level or lower-tier medical facilities (HepB1: OR = 3.724, 95%CI: 2.107–6.580), or were born via cesarean section (HepB1: OR = 3.460, 95%CI: 2.169–5.520; full-course HepB: OR = 1.954, 95%CI: 1.411–2.704). Additional risk factors included a gestational age below 34 weeks (HepB1: OR = 4.369, 95%CI: 1.894–10.081; full-course HepB: OR = 2.237, 95%CI: 1.148–4.359) and a birth weight less than 2500 g (HepB1: OR = 2.251, 95%CI: 1.397–3.629; full-course HepB: OR = 1.513, 95%CI: 1.065–2.150). Conclusions: Preterm infants enrolled from five regions in Fujian Province achieved robust immune protection following standard HepB vaccination. However, timely first-dose coverage and on-schedule full-course vaccination remain suboptimal in this cohort. Observed gaps in routine vaccination management at primary care settings highlight a key area for improvement in local hepatitis B prevention. Targeted standardized training for maternity care staff at county-level facilities, paired with a full-cycle follow-up system for preterm infant vaccination, may further strengthen hepatitis B mother-to-child transmission (MTCT) interruption in the study regions. Full article