Search Results (1,874)

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is among the most common inherited enzymatic disorders worldwide and is an important risk factor for neonatal hyperbilirubinemia. Regional data from Western Saudi Arabia based on universal newborn screening remain limited. Objectives: To determine the prevalence of G6PD deficiency among newborns delivered at a tertiary center in Jeddah, Saudi Arabia, and to evaluate its association with clinically relevant outcomes, including early-onset jaundice (<24 h), need for phototherapy, admission for hyperbilirubinemia management, and readmission after discharge. Methods: We conducted a retrospective cohort study at King Abdulaziz Medical City, Western Region, Jeddah, Saudi Arabia, between January 2020 and May 2025. Cord blood samples from live-born infants were screened using a qualitative fluorescent spot test. Demographic variables (sex, gestational age, birth weight) and jaundice-related outcomes were extracted from the electronic medical record. Categorical variables were compared using chi-square testing, with p < 0.05 considered statistically significant. Results: Among 14,964 screened newborns, 489 were identified as G6PD deficient, yielding a prevalence of 3.3%. Prevalence was higher in males than in females (5.6% vs. 0.9%). Among the G6PD-deficient infants, early-onset jaundice occurred in 17.2%, phototherapy was required in 36.0%, and 16.5% were admitted for hyperbilirubinemia management. Readmission for worsening jaundice requiring phototherapy occurred in 11.0%, and no exchange transfusions were required. Compared with term infants, late preterm infants had higher rates of early-onset jaundice (11/49, 22.4% vs. 73/440, 16.6%) and phototherapy use (22/49, 45.0% vs. 154/440, 35.0%) (p < 0.01). Conclusions: G6PD deficiency was identified in a substantial proportion of newborns in this large screened cohort and was associated with clinically significant jaundice-related outcomes, particularly among late preterm infants. These findings underscore the importance of universal screening and structured postnatal follow-up to reduce the risk of severe hyperbilirubinemia and its complications. Early identification of G6PD-deficient infants should be accompanied by careful bilirubin monitoring, clear discharge planning, and timely post-discharge follow-up, especially for those born late preterm. Full article

Background/Objectives: To compare long-term refractive and anterior segment outcomes among preterm infants with retinopathy of prematurity (ROP) who underwent laser photocoagulation (LP), untreated preterm infants, and term-born controls. Methods: This study included 285 eyes of 144 patients aged 6–10 years, categorized into three groups: LP-treated type 1 ROP (Group 1), untreated preterms without type 1 ROP (Group 2), and full-term controls (Group 3). Data were collected, including birth weight (BW), gestational age (GA), ROP status, LP parameters (if required), as well as all ophthalmologic findings. Corneal tomography assessed keratometry, corneal thickness, corneal volume, anterior chamber metrics, and keratoconus indices. Optical biometry evaluated axial length (AL), keratometry, astigmatism (Ast), and anterior chamber depth (ACD). Cycloplegic autorefractometry measured spherical equivalent (SE), astigmatism (KAst), and keratometry. Results: Among 144 patients (63 female, 43.8%), the mean age was 8.7 ± 1.2 years, with a median GA of 34 weeks and BW of 2165 g. Significant differences were observed in corneal tomography parameters (Kh, Kv, Km, Kmax, astigmatism, and thickness metrics, p < 0.001), keratoconus indices (p < 0.001), optical biometry (AL, lens power, and ACD, p < 0.001), and cycloplegic autorefractometry (astigmatism and keratometry, p < 0.001) among the three groups. Refractive errors, including myopia and astigmatism, were most pronounced in laser-treated ROP cases (p < 0.036 and p < 0.001, respectively). Conclusions: Children with laser-treated ROP had steeper and thinner corneas, higher posterior astigmatism, and shallower ACD than preterm and term-born children. These findings likely reflect developmental anterior segment differences related to prematurity and treatment-requiring ROP, supporting careful long-term ophthalmologic follow-up. Full article

Background/Objectives: Abnormalities in the partial pressure of carbon dioxide (PCO₂) can occur during respiratory support and may contribute to adverse neonatal outcomes. This study aimed to assess the incidence of early hypocapnia and hypercapnia in mechanically ventilated preterm infants and their major associated outcomes. Methods: A single-center retrospective cohort study (2017–2024) was conducted in preterm infants < 32 weeks’ gestation who required > 24 h of invasive ventilation within the first 3 days of life. Perinatal–neonatal data were retrieved from the medical database. Admission blood gas values (arterial and capillary–venous) and the maximum and minimum PCO₂ in the first 72 h were evaluated. Normocapnia was defined as PCO₂ 35–45 mmHg, hypocapnia as < 35 mmHg, and hypercapnia as > 45 mmHg. Primary outcomes were the incidence of PCO₂ abnormalities; secondary outcomes included death or severe brain injury (SBI), SBI alone, and bronchopulmonary dysplasia (BPD) among survivors. Logistic regression identified independent predictors of the secondary outcomes. Results: Among the 134 infants evaluated, most experienced both hypercapnia and hypocapnia. Hypercapnia occurred in 81.3% of infants, and hypocapnia in 93.2%. Death or SBI was observed in 51.5%, and SBI alone in 42.5%. Gestational age < 28 weeks, air-leak syndromes, and pulmonary hemorrhage were independent predictors of death or SBI. Among survivors, hypercapnia and gestational age < 28 weeks independently predicted BPD. Infants with adverse outcomes had higher maximum PCO₂ values and greater PCO₂ variability, although these were not independent predictors of SBI or death. Conclusions: PCO₂ instability is highly prevalent in ventilated preterm infants, underscoring the need for individualized ventilation strategies. Extreme prematurity emerged as the primary risk factor for adverse outcomes, while hypercapnia was independently associated with BPD. Full article

Objective: This retrospective observational four-year review (2019–2022) evaluated neonatal admissions to Malta’s NICU and their outcomes. Study Design: Data from neonates up to 28 days meeting NICU admission criteria with available EMRs were analyzed, focusing on demographic data such as gestation and birth weight, need for resuscitation at birth, admission reasons, and outcomes related to nutrition, respiratory support, congenital anomalies, prematurity-related complications, phototherapy, and infection. Results: Total admissions numbered 1303 (7.3% of total births), out of which 1234 had available electronic medical records and were included in the final analysis. The main reasons for admission were respiratory distress syndrome (27.7%), transient tachypnoea (16.3%), and sepsis (13.5%). Among preterm infants, conditions related to prematurity were observed at expected frequencies and are reported descriptively. Feeding practice resulted in delayed attainment of full enteral nutrition compared to international standards, with an exclusive breastfeeding rate below the EU average. Sepsis and CLABSI rates were low, indicative of robust infection prevention and control measures. Conclusions: This study provides a descriptive overview of NICU admissions and outcomes stratified by gestational age at a single tertiary center in Malta, and highlights areas for improvement. The findings highlight expected patterns of prematurity-related morbidity and differences in clinical management, particularly in nutritional and respiratory support. Future prospective studies incorporating standardized data collection and detailed maternal and demographic variables are needed to better inform neonatal care and service planning. Full article

Background: Chorioamnionitis (CA) is a major pathological cause of preterm labor and is associated with both short- and long-term adverse outcomes in neonates, including early-onset sepsis (EOS) and late-onset sepsis (LOS). Neonatal sepsis remains a significant contributor to morbidity and mortality in neonatal intensive care units (NICUs). Aim: This study aimed to evaluate the association between maternal chorioamnionitis and the incidence of early-onset and late-onset neonatal sepsis in preterm neonates born at <32 weeks’ gestation. Furthermore, the study investigated maternal and neonatal factors affecting the presentation of sepsis. Methods: A retrospective cohort study was conducted on the medical records of preterm neonates born between 2020 and 2022. Inclusion criteria were gestational age < 32 weeks, available microbiological or histological examination for chorioamnionitis, and complete maternal medical records. Infants were categorized into two groups based on the presence (CA group) or absence (non-CA group) of histological and/or microbial chorioamnionitis. Descriptive statistical analyses were performed, including calculation of frequencies and percentages for categorical variables and means with standard deviations and ranges for continuous variables. Results: A total of 189 neonates were included, with a mean birth weight of 1286 ± 405 g and a mean gestational age of 29.2 ± 2.1 weeks. The CA group consisted of 55 neonates (29.1%), while 134 (70.9%) were in the non-CA group. Early-onset sepsis (EOS) occurred in 23 neonates (12.2%), with a significantly higher incidence in the CA group compared to the non-CA group (21% vs. 8%, p = 0.014). Late-onset sepsis (LOS) developed in 66 neonates (34.9%), but no significant difference in incidence was observed between the two groups (p = 0.402). Parsimonious logistic regression analysis identified maternal chorioamnionitis as an independent predictor of EOS (Odds Ratio 2.07, 95% CI 1.85–5.08; p = 0.009). Conclusions: Intrauterine infection and inflammation caused by chorioamnionitis are linked to an increased risk of early-onset sepsis in neonates born before 32 weeks’ gestation. However, chorioamnionitis does not appear to significantly influence the incidence of late-onset sepsis, which appears to be more closely associated with postnatal factors. Full article

Background: The first 1000 days of life, from conception to 2 years of age, represent a critical window during which nutrition can exert long-lasting effects on neurodevelopment, immune maturation, and susceptibility to prematurity-related morbidity. Docosahexaenoic acid (DHA) is a key structural n-3 long-chain polyunsaturated fatty acid of the brain and retina, characterized by rapid fetal accretion during the third trimester. Methods: We conducted a narrative review of studies published from March 2015 up to December 2025, including randomized controlled trials, follow-up studies, and systematic reviews/meta-analyses about DHA supplementation during pregnancy, lactation, infancy and early childhood, and its role on development. Results: Across the first 1000 days, DHA supplementation improves biochemical DHA status, particularly in populations with low baseline levels (moderate to high level of evidence), while clinical outcomes remain heterogeneous. During pregnancy, some benefits in specific cognitive and behavioral domains have been demonstrated, whereas effects on global cognition and long-term behavior are frequently null (moderate evidence). Visual outcomes appear favorable, with improvements in visual acuity (moderate evidence). In preterm infants, enteral DHA—often combined with arachidonic acid (ARA)—is feasible and well tolerated. DHA may reduce inflammatory markers and necrotizing enterocolitis risk when in equilibrium with ARA (low to moderate evidence), while no evidence supports the link between DHA and reduced risk of bronchopulmonary dysplasia and retinopathy of prematurity (moderate evidence). Neurodevelopmental outcomes are mixed: neuroimaging studies suggest enhanced white matter maturation with DHA + ARA, whereas most trials show no clear benefit regarding standardized developmental scores (moderate evidence). Conclusions: DHA is biologically essential during the first 1000 days, but its clinical impact depends on timing, dose, baseline status, and prematurity-related context. The balance between DHA and ARA, rather than DHA supplementation alone, emerges as a key determinant of clinical efficacy, supporting a shift toward precision-based nutritional strategies in early life. Full article

Background and Clinical Significant: Patent ductus arteriosus (PDA) is a common cardiovascular disorder in extremely low-birth-weight (ELBW) infants, for which surgical ligation is indicated when pharmacologic closure fails. Sudden increases in afterload combined with immature myocardial contractility can lead to post-ligation cardiac syndrome (PLCS), which usually occurs within hours after surgery. However, acute intraoperative hemodynamic collapse during PDA ligation has rarely been described. Case Presentation: A preterm infant born at 24 weeks and 3 days of gestation with a birth weight of 890 g underwent emergency PDA ligation for a hemodynamically significant PDA (hs-PDA) refractory to pharmacological treatment. Fifteen minutes after skin incision, the infant developed desaturation, bradycardia, and non-measurable noninvasive blood pressure, which required immediate hemodynamic resuscitation with manual ventilation, fluid administration, and dopamine and dobutamine infusions. Hemodynamics gradually recovered after completion of ductal ligation, whereas oxygen saturation did not fully recover. Postoperative chest radiography revealed a left-sided pneumothorax, and oxygen saturation stabilized after pleural air aspiration. The subsequent clinical course was uneventful, and typical PLCS did not develop. Conclusions: This case suggests that intraoperative hemodynamic collapse during PDA ligation may share pathophysiologic features with PLCS, and that concomitant pneumothorax can further aggravate hemodynamic instability by worsening hypoxemia and reducing venous return. Full article

Background: The evaluation of renal function in neonates is challenging due to maternal creatinine transfer, reduced muscle mass, and non-steady-state physiology. Cystatin C emerged as a promising biomarker for assessing neonatal glomerular filtration rate. This review summarizes evidence from studies evaluating serum and urine cystatin C in healthy neonates and high-risk groups, including preterm newborns, neonates with acute kidney injury, and those with congenital kidney and urinary tract defects. Methods: Twenty studies were included and qualitatively synthesized following PRISMA guidelines. Results: In the included studies, serum cystatin C exhibited consistent postnatal patterns independent of maternal influence and showed a strong correlation with gestational age and renal development. Cystatin C enabled earlier detection of renal dysfunction compared to serum creatinine, especially in preterm infants and critically ill neonates. In babies with congenital renal abnormalities, cystatin C levels were associated with disease severity and clinical outcomes, while the cystatin C-based estimated glomerular filtration rate surpassed creatinine-based estimations. Urinary cystatin C correlated with tubular damage and increased risk of chronic kidney disease during follow-up. Conclusions: Cystatin C is a reliable biomarker for evaluating neonatal renal function, although further standardization and validation are required for clinical implementation. 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

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness characterized by disrupted physiologic vascularization followed by pathologic neovascularization, classically organized around the insulin-like growth factor-1 (IGF-1)–vascular endothelial growth factor (VEGF) axis in the retina. Increasing evidence suggests that early-life gut dysbiosis may act as an upstream modifier of this biphasic process. In this review, we synthesize human cohort studies, multi-omics analyses, and experimental animal models examining associations between the neonatal gut microbiome and ROP. Preterm infants who develop severe ROP demonstrate enrichment of facultative anaerobes and reduced acquisition of obligate anaerobes, alongside altered predicted metabolic capacity. Microbiome-derived metabolites, including short-chain fatty acids, bile acid derivatives, and lipid mediators, have been shown in experimental systems to influence systemic IGF-1 production, hypoxia-inducible factor-1α stabilization, and VEGF signaling. Rodent oxygen-induced retinopathy models offer a translation framework to assess the functional link between microbial perturbation and retinal angiogenic responses. Collectively, these findings support a conceptual microbiome–IGF-1–VEGF–retina axis in which early intestinal dysbiosis may modulate inflammatory tone, metabolic signaling, and retinal vascular development. Although current evidence remains largely associative, integrating microbiome profiling with mechanistic and longitudinal studies may clarify potential causal pathways and identify novel biomarkers or preventive strategies for severe ROP. Full article

Human milk fat globules (MFGs)’ size characterization is key for evaluating milk quality and processing effects. Laser diffraction (LD) is widely used for particle size analysis but provides limited morphological information. This study applied image-based morphometric analysis (IBMA) to characterize MFGs’ size and shape distributions in human milk and compared the results with LD measurements. Milk samples from 12 women delivering term and preterm infants were analyzed. LD was performed using a Mastersizer 3000 (Malvern Panalytical, Malvern, UK) and IBMA using a Morphologi 4 (Malvern Panalytical, Malvern, UK), acquiring 2D images at 20× magnification covering particle sizes from ~1.5 to 130 µm. IBMA classified MFGs as individual particles (IP) (HS circularity ≥ 0.920; circle equivalent diameter < 25 µm) or agglomerates (HS circularity < 0.920; solidity < 0.970), extracting descriptors including circularity, elongation, and solidity. IP predominated, while agglomerates represented ~15% of particles. Number-mean diameters (D[1,0]) were 4.91 µm (total), 4.36 µm (IP), and 8.00 µm (agglomerates). Volume-weighted particle diameters (D[4,3]) were 7.21 µm for IP and 14.02 µm for agglomerates. The highest level of agreement between methods was observed for IP D[4,3], although minor differences may be clinically relevant. IBMA and LD provide complementary information; however, IBMA uniquely enables the characterization of MFG structural organization, including the identification of agglomerates, which cannot be resolved by LD. This added level of structural detail may have important implications for understanding the digestibility of human milk, particularly in preterm populations. Full article

Changes in microbial composition during early infancy by various factors (mode of delivery, nutritional practices, antibiotic usage, and environmental influences) have been correlated with observable variances in cognitive abilities, temperament, stress response, and the predisposition to neurodevelopmental disorders. Consequently, microbiota-targeted interventions such as probiotics, prebiotics, and synbiotics are being explored as avenues to enrich beneficial microbial taxa, enhance short-chain fatty acid production, fortify mucosal immunity, and mitigate inflammatory responses during these critical periods. Preclinical research, primarily in experimental animal models, has demonstrated a causal link between microbiota composition and developmental processes such as myelination, synaptic plasticity, and socio-emotional behaviors, whereas human evidence remains largely associative and heterogeneous. A notable gap exists in the current literature, which typically centers on gastrointestinal, psychiatric, or preterm outcomes, without a focused investigation into neurodevelopmental assessments within the first three years. To bridge this gap, we conducted a systematic review and meta-analysis of randomized controlled trials assessing the impact of probiotics, prebiotics, and synbiotics on neurodevelopment and behavior in infants aged 0–36 months. Our primary objective was to establish whether microbiota-targeted strategies confer discernible neurodevelopmental benefits, alongside elucidating the mechanisms underpinning the relationship between microbial modulation and early brain development. Full article

Background/Objectives: Breast milk is recommended as primary enteral nutrition for preterm infants, but the quantitative association between early breast milk feeding proportion and short-term growth remains unclear. We examined the relationship between early breast milk feeding proportion and discharge weight z-score in preterm infants. Methods: This single-center retrospective cohort study included preterm infants admitted to a neonatal intensive care unit between January 2024 and December 2025. Early breast milk feeding proportion was defined as the percentage of breast milk intake among total enteral nutrition during the first 14 days of life. The primary outcome was discharge weight z-score based on the Fenton growth reference. Linear regression, restricted cubic spline analysis, and exploratory mediation analysis were performed. Results: Among 1174 preterm infants, a higher early breast milk feeding proportion was independently associated with a higher discharge weight z-score in the primary multivariable model adjusted for gestational age, sex, and initial mechanical ventilation. A 10% increase in breast milk feeding proportion was associated with an increase of 0.18 in discharge weight z-score (β = 0.18; 95% CI, 0.09–0.26; p < 0.001). Restricted cubic spline analysis showed an approximately linear association. In sensitivity analyses additionally adjusted for late-onset sepsis and necrotizing enterocolitis, the association was no longer statistically significant. Exploratory mediation analysis suggested that the association may be partly explained through pathways involving late-onset sepsis, whereas the mediating role of necrotizing enterocolitis appeared to be more limited. Conclusions: In baseline-adjusted analyses, a higher early breast milk feeding proportion was associated with a higher discharge weight z-score; however, this association was attenuated and no longer statistically significant after additional adjustment for major neonatal complications. These findings should be interpreted cautiously and should not be considered evidence of a causal relationship, given the substantial potential for residual confounding by prematurity and illness severity. Full article

(1) Background: Hospitalized preterm infants often require months of vital signs monitoring in the neonatal intensive care unit. Today, wired sensors are essential for survival, but are associated with numerous disadvantages including sensor dislocations, skin trauma and hygiene risks. Non-contact vital sign monitoring would therefore represent a significant improvement in the care of hospitalized neonates. (2) Objective: This study aims to lay the foundation for non-contact radar-based monitoring of the respiratory rate, which could be used in the neonatal intensive care unit. (3) Methods: We developed a radar-based vital parameter monitoring system for recording the respiratory rate of premature infants in a pediatric incubator. The novel system employs a four-channel I/Q FMCW radar with compact, application-specific antennas optimized to cover the defined area of interest on the infant’s thorax. As a proof-of-principle study, the system was tested in six anesthetized newborn piglets. (4) Results: Using the radar-based system, thorax movements were detected and the respiratory rate was calculated. We observed a high accordance between the signals of respiration detected by the novel radar sensor with the signals of the cable-bound monitor in resting piglets. (5) Conclusions: The novel radar sensor is suited for measuring respiration in the piglet model. In future, the sensor should be optimized in order to improve its robustness against disturbances body movements and in order to allow detection of heartbeat. Full article

Necrotizing enterocolitis (NEC) is a major cause of illness and death in preterm infants and is increasingly linked to long-term neurodevelopmental issues among survivors. Usually seen as a gastrointestinal disease, NEC is rarely viewed from a brain-centered perspective. In this Perspective, we suggest that NEC should be understood as a disorder of the gut–brain axis affecting neurodevelopment. We combine clinical and experimental evidence showing that intestinal inflammation, microbial imbalance, epithelial barrier failure, and systemic immune activation during NEC all contribute to the disruption of early brain development. We contend that neurodevelopmental damage is a key feature of NEC rather than just a secondary effect of prematurity. Recognizing NEC as a gut–brain axis disorder is crucial for research models, treatment approaches, and assessing long-term outcomes in affected infants. Full article