Search Results (84)

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Background: Human cytomegalovirus (HCMV) is the leading cause of congenital and acquired viral infections in newborns. While acquired infections are often asymptomatic, premature infants—especially those born before 30 weeks of gestation or with a very low birth weight (<1500 g)—are at an increased risk for severe infections. These can manifest as thrombocytopenia, liver failure, sepsis-like symptoms, and, in rare cases, death. HCMV is transmitted through various human secretions, including breast milk, which is the optimal feeding method for premature infants. Methods: We present five premature neonates, born between 23 and 26 weeks of gestation, each with a distinct clinical presentation of acquired HCMV infection. Results: All infants tested negative for congenital CMV infection via molecular urine testing within the first three weeks of life. Acquired infection was diagnosed between the second and third month of life, with symptoms such as septic shock, persistent thrombocytopenia, and signs of liver failure. Each infant received antiviral treatment along with regular viral load monitoring. Unfortunately, one patient died due to complications of prematurity. The remaining infants were discharged and continue to receive follow-up care in an outpatient clinic. Conclusions: These cases of postnatally acquired CMV infection aim to increase awareness of its highly heterogeneous and nonspecific clinical presentation, which may result in an incorrect, delayed, or concealed diagnosis. Currently, there are no clear guidelines on how to manage the presence of the virus in maternal breast milk, particularly for premature infants. It should be recommended to perform a molecular CMV test in all breast-fed preterm infants who present with sepsis-like symptoms, thrombocytopenia, liver failure, or other organ involvement. In case of a confirmed aCMV diagnosis, appropriate treatment should be introduced. Full article

Background/Objectives: To identify the risk factors and clinical outcomes of persistent pulmonary hypertension of the newborn (PPHN) in very low birth weight (VLBW) infants in a resource-limited setting. Methods: We conducted a 1:4 matched case–control study in a Thai neonatal unit between 2014 and 2023. Neonates born at a gestational age (GA) < 32 weeks and with a birth weight (BW) < 1500 g were included. Neonates who died in the delivery room or had major congenital anomalies were excluded. Matching was based on GA, BW, year of birth, and endotracheal intubation at birth. Conditional logistic regression analysis was performed. Results: Over the 10-year study period, the incidence of PPHN among VLBW neonates was 4.6% (31/667). After matching, there were 31 cases and 124 controls. In univariable analysis, PPHN was significantly associated with lower 1 min and 5 min Apgar scores; however, no significant association remained in multivariable analysis. PPHN was significantly associated with composite adverse outcomes—including mortality and major morbidities (adjusted odds ratio [aOR] = 7.51, 95% confidence interval [CI]: 2.41–23.40), mortality alone (aOR = 2.88, 95% CI: 1.06–7.63), major morbidities (aOR = 2.99; 95% CI: 1.29–6.95), and severe neurological injury (aOR = 4.44, 95% CI: 1.56–12.59). Daily hospital costs were also higher in PPHN cases, with an average increase of 97.1 USD. Conclusions: In VLBW infants, PPHN was associated with a lower Apgar score and surfactant administration. PPHN was significantly linked to adverse outcomes, particularly mortality, major morbidities, and severe neurological injury. Full article

Background/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul’s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that >13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of >60 mL/kg/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of >60 mL/kg/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes. Full article

Background: Recently, vitamin D deficiency (VDD) has been described as a pandemic, affecting all groups of the population. Pregnant women and preterm infants are particularly vulnerable to vitamin D deficiency. Objectives: We aimed to evaluate the maternal and neonatal vitamin D status in relation with maternal vitamin D supplementations during pregnancy and to identify demographic, social, and healthcare risk factors for maternal VDD and vitamin D insufficiency in women delivering at ≤32 weeks of gestation. Methods: This prospective observational study was developed in the regional level III maternity unit of the Clinical County Emergency Hospital Sibiu. It included all admitted mothers who delivered at ≤32 weeks of gestation and their infants between 1 March 2022 and 28 February 2025. Infant deaths in the first 24 h of life, major congenital defects, chromosomal abnormalities, the admission of outborn infants without their mothers, or the transfer of the mother more than 48 h after birth were used as exclusion criteria. Maternal and neonatal data were collected from medical records. Data on maternal vitamin D supplementation were collected through interviews. Univariate and multivariate logistic regressions, linear regression, and predictive models were performed for data analysis. Results: A total of 146 mothers (median (IQR) age 30 (24–35) years) and their 164 preterm infants born at ≤32 weeks of gestation (median gestational age of 30 (27–31) weeks and birth weight of 1200 (900–1527) g) were included in this study. Only 43.15% of the mothers used multivitamins containing vitamin D during pregnancy, and 10.96% used specific vitamin D supplements. Vitamin D supplementation was used for a median of 4 (3–5) months at a median dose of 800 (250–1500) IU/day. Severe VDD (25(OH)D < 10 ng/mL), VDD (25(OH)D < 20 ng/mL), VDI (25(OH)D 20–29 ng/mL) were found in 19.86%, 55.48%, and 23.97% of the mothers and 16.46%, 58.53%, and 25.61% of their infants, respectively. A significant correlation was found between the maternal and neonatal status (r = 0.684, r² = 0.468, p < 0.001, B = 0.62). Both the maternal and neonatal vitamin D status were correlated with the vitamin D duration and dose used for supplementation during pregnancy. The logistic regression analysis showed that birth during a cold season and increased parity are independently associated with severe maternal VDD, while birth during the cold season and a lower educational status were independently associated with maternal VDD. Only an absent vitamin D supplementation (in the form of a multivitamin or specific vitamin D supplements) has been proven as an independent risk factor for VDI. Conclusions: Our findings revealed a worrisome prevalence of severe VDD, VDD, and VDI in mothers delivering very prematurely and in their infants. Additionally, less than half of the mothers in this study used vitamin D supplements during pregnancy despite the national recommendations. The professionals involved in advising pregnant women and policymakers should find solutions to improve the vitamin D status in these vulnerable groups of the population. Full article

Background/Objectives: Maternal milk feeding in the NICU (neonatal intensive care unit) for very low birth weight (VLBW) infants mitigates the effects of preterm birth. This single-center retrospective study analyzed data from VLBW infants born between 2005 and 2019 and investigated the impact on morbidity of exposure to Mother’s Own Milk (MOM), donor human milk (DHM), preterm formula (PF), during NICU hospitalization. The assessed outcomes included necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and late-onset sepsis (LOS). The study also examined the impact of a human milk-based feeding protocol on these outcomes, adjusting for confounding factors. Methods: Statistical analysis involved correlation tests and odds ratios to assess associations between feeding types and outcomes. Results: Surgical NEC occurred in 10% of infants fed exclusively with PF, 1.3% of those fed with DHM, and was completely absent in infants fed exclusively or partially with MOM. ROP across all stages was observed in 24.3% of cases, with severe ROP at 4.7%, and PF feeding was associated with a higher risk of severe ROP; the incidence of LOS was lower in infants fed human milk (−22%/−66%) compared to 10% in formula-fed infants. BPD affected 25.5% of infants, with moderate-to-severe BPD in 22.2%. The association between NEC, LOS, and feeding was statistically significant, even after adjusting for covariates. The type of milk had a significant impact on the incidence of severe forms of all outcomes (p < 0.001). The rate of exclusive MOM feeding increased over time, reaching 45% in 2018–2019. Conclusions: These findings highlight the role of human milk in preventing NEC and LOS, in reducing the risk of severe ROP and BPD, and in promoting MOM feeding, with rates increasing significantly when DHM is available. Full article

Background/Objectives: There has been an increase in the incidence of comorbidities among very-low-birth-weight infants (VLBWIs), including periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Parenteral nutrition is essential for very-low-birth-weight infants (VLBWIs) who are born with a birth weight of less than 1500 g, but a longer duration of parenteral nutrition is known to have a risk of comorbidity, such as ROP. This study aims to investigate the relationship between the duration of parenteral nutrition and the comorbidities of the VLBWIs. Methods: Using the prospective cohort of Korean neonatal network, we analyzed the perinatal and postnatal data before discharge of the total 2490 subjects born in 2021 and 2022. The primary outcomes were the diagnoses of PVL, BPD, and ROP. The secondary outcomes were the severity of BPD and ROP, treatment of ROP, and proposing the predictive model of comorbidities using the duration of parenteral nutrition. Results: This study found that prolonged parenteral nutrition exceeding 28 days was associated with a higher risk of PVL (odds ratio [OR] 1.71, 95% confidence interval [CI] [1.11, 2.64], p = 0.002) and BPD (OR 1.51, 95% CI [1.10, 2.08], p = 0.011). Furthermore, an intermediate duration of parenteral nutrition was found to be significantly associated with an increased risk of ROP in male subjects. Additionally, a prolonged duration of parenteral nutrition was observed to be linked to greater severity of BPD. Predictive models incorporating the duration of parenteral nutrition demonstrated a high degree of explanatory power in relation to both BPD and ROP. Conclusions: Longer duration of parenteral nutrition has a risk of critical comorbidities in VLBWIs. The nutrition strategy for shorter parenteral nutrition should be encouraged for the prevention of comorbidities. Full article

Preterm birth represents a nutritional emergency and a sudden dissociation of the maternal–placental–fetal unit that regulates metabolic and endocrine physiology. Growth demonstrates health and is a signal of physiological well-being. Growth is expensive for a critically ill infant and possible only after other homeostasis energy demands are met. Despite an expert-stated goal that preterm infants should grow at a similar rate to their gestational age-matched fetal counterparts, this is not the reality for many preterm infants. Other investigators have proposed new metrics for growth quality in the neonatal intensive care unit. This review discusses growth assessment and standards in very-low-birth-weight infants and attempts to address the knowledge gap of which growth metrics are the most important to monitor. Full article

Background/Objectives: Postnatal growth faltering (PGF) is a risk factor for adverse neurodevelopment in very preterm neonates. The aim of this retrospective study was to determine which infants’ baseline characteristics, prenatal risk factors and neonatal morbidities are associated with two definitions of PGF: defined as loss of >2 weight z-scores (severe PGF) or as loss of >1 weight, length, and head circumference z-scores between birth and discharge (complex PGF); Methods: 146 premature newborns (<32 weeks of gestational age, <1500 g) were included in the study. Anonymized data including anthropometric measurements (weight, length, and head circumference), perinatal and neonatal data (demographics, maternal morbidities and previous pregnancies, and neonatal and perinatal morbidities) were extracted from the clinical electronic database. Changes in anthropometric age- and sex-specific z-scores using the Fenton 2013 preterm growth charts were calculated to diagnose severe PGF and complex PGF; Results: The incidence of severe PGF was 11% and complex PGF was 24%. Both PGF definitions were associated with bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP), longer respiratory support, and longer hospital stay. Severe PGF was associated with surgical necrotizing enterocolitis at 25% vs. 1.5%, p = 0.001. Complex PGF was associated with severe brain injury at 51% versus 27%, p = 0.007. Complex PGF was more common in newborns born most prematurely, while severe PGF was more common in newborns born small for gestational age (SGA); Conclusions: Both severe and complex PGF are associated with several important neonatal morbidities, which might explain why growth faltering is associated with suboptimal neurodevelopment. Appropriate early identification of faltered growth may influence medical and nutrition interventions which in turn could improve the outcome of very preterm newborns. Full article

The global evolution of pathogens causing early-onset sepsis (EOS), a critical condition in preterm infants, necessitates a re-evaluation of risk factors to develop updated prevention and treatment strategies. This nationwide case–control study in Taiwan analyzed data from the National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database from 2010 to 2019. The study included 176,681 mother–child pairs with preterm births. We identified 2942 clinical EOS cases from 5535 diagnosed sepsis cases, excluding unlikely cases. A control group of 14,710 preterm neonates without EOS was selected at a 1:5 ratio. Clinical EOS increased since 2017. Adjusted logistic regression identified significant EOS risk factors in preterm infants, including maternal fever, chorioamnionitis, maternal diabetes mellitus, maternal antibiotic usage, very preterm birth, birth weight (all with p < 0.001), maternal pneumonia (p = 0.002), and maternal CS (p = 0.004). Effective treatment of maternal conditions like diabetes, fever, and infections is essential to prevent EOS in preterm infants. Key measures include reducing unnecessary antibiotics or steroids, minimizing unnecessary cesarean sections, avoiding premature or prolonged rupture of membranes (PPROM), and increasing gestational age and neonatal birth weight. High-risk preterm neonates should be closely monitored for EOS and considered for antibiotics when warranted. Full article

Background: No consensus exists on the management of hemodynamic impairment in very premature neonates. At level 3 NICU, the protocol involves an initial infusion of crystalloids, followed by a cardiac ultrasound if the infusion fails to restore appropriate hemodynamics. Based on the ultrasound findings, a decision is then made regarding a second infusion or the prescription of vasopressor amines. The aim of the present study was to assess the effect of and compliance with this management practice in neonates born prematurely between 26 and 31 completed weeks of gestation following a plan-do-study-act design. Methods: Data were collected retrospectively from patient records for all neonates who were managed for hemodynamic impairment within the first 24 h of life. Results: Of 604 neonates born during the study period, 68 were included in this study, but only eight cases followed the protocol. Reasons for non-compliance were the absence of cardiac ultrasound and variations in the duration and dosage of fluid administration. There was a significant relationship between blood pressure and positive inspiratory pressure levels at the time of management and compliance with the protocol. Conclusions: A revision of the protocol will emphasize the importance of echocardiography assessment, as all neonates responded to the ultrasound-guided therapy. As a quality improvement measure, attending neonatologists will be trained to thoroughly adhere to the protocol before the next evaluation. Full article

It is documented that maternal diseases or treatments influence a newborn’s clinical status at birth. If a prenatal medical history is not available, or if signs or symptoms of a mother’s disease are revealed for the first time during pregnancy or postpartum, their effects on the newborn may be misattributed. Objective: The objective of this study is to emphasize the paramount importance of prenatal care, for both mothers and newborns, as a lack of maternal signs and symptoms during pregnancy does not exclude a potential severe neonatal condition. Materials and methods: We present a series of three cases of pregnant women who gave birth to very sick preterm newborns that required admission to the Neonatal Intensive Care Unit (NICU). The mothers were asymptomatic during pregnancy and unaware of their subclinical disease. The newborns’ complications, considered initially as consequences of prematurity or infection, subsequently revealed transient autoimmune disease in two of the cases (myasthenia gravis and hyperthyroidism) and a severe form of thrombophilia in the third case. Results: The newborns’ diagnosis preceded maternal diagnosis and contributed to the identification of the maternal pathology; adequate treatment was prescribed, with favorable short- and long-term outcomes. Conclusions: Prenatal exams and investigations throughout pregnancy are a good opportunity to detect subclinical diseases or predispositions. As newborns usually develop non-specific signs, one should have experience and pay attention to differentiating among etiologies. Our paper takes a reversed approach to the usual medical diagnosis pathway: from infant to mother instead of from mother to infant, proving that inter-specialty collaboration can work bi-directionally. Full article

Background/Objectives: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI). Methods: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive care units (1995–2019) were included. Risk factors and outcomes were assessed by logistic regression and adjusted for gestational age (GA). Results: In total, 4271 VPI with a mean GA of 28.7 ± 2.3 weeks were evaluated. Pneumothorax was diagnosed in 174 patients (4.1%, 95% Confidence Interval (CI) 3.5–4.7) with its incidence inversely proportional to GA: 9.9% in 23–25 w and 2.1% in 30–31 w (p < 0.001), but stable over the years 1995–1999 (5.2%) and 2015–2019 (4.2%) (p = 0.309). Patients with pneumothorax exhibited higher rates of severe intraventricular hemorrhage (IVH) (Odds Ratio (OR) = 2.0 (95%CI 1.3–3.1), p = 0.003), bronchopulmonary dysplasia (OR = 2.7 (95%CI 1.7–4.4), p < 0.001), and death (OR = 8.5 (95%CI 6.2–11.6), p < 0.001). Independent risk factors for pneumothorax were GA, prolonged premature rupture of membranes, and intubation in the delivery room. The composite outcome of death or severe IVH was higher in patients with pneumothorax with an adjusted OR = 6.7 (95%CI 4.7–9.6), p < 0.001. Although VPI mortality has significantly decreased over the years (20.3% 1995–1999 and 11.7% 2015–2019, p < 0.001), we found no significant difference in pneumothorax-related deaths. Conclusion: Pneumothorax remains a serious threat to VPI, leading to a higher incidence of morbidity, and mortality attributable to this complication has not decreased. Preventive strategies and early recognition are essential for improving disability-free survival in VPI. Full article

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality data to understand causes and risk factors, helping in prevention efforts. This study includes 140 cases collected during 2018–2022. Demographic, maternal, and thanatogenetic data were statistically analyzed. We observed an upward slope of stillborn babies. In the case of live-born premature, the average survival was 301.76 h. The multivariate analysis noted that extremely low birth weight (HR = 5.141) and very low birth weight (HR = 4.177) are risk factors involved in mortality. Increased parity was associated with premature births with low and very low birth weight (p = 0.019). We observed that a mother’s age of over 30 years is predictable for the development of pregnancy-induced hypertension. Cerebral and pulmonary hemorrhages were the most common intermediate morbid conditions, with prematurity and plurivisceral hemorrhages serving as their root causes. We have identified that anthropometric measurements have a high predictability on malformed babies. The identified associations indicate a shared mechanism for certain lesion processes, which can help optimize resources for predicting and preventing preterm neonatal issues. Full article

Congenital pulmonary airway malformations (CPAMs) represent a well-known cluster of rare lung malformations affecting 1 in 2500 live births. The natural history of many CPAMs is to increase their size in the second trimester, reach a plateau, and, in about 50% of cases, regress and to become barely detectable during the third trimester. Little is known about cases of affected neonates born prematurely: only six cases are described in the literature, recording different conduct and outcomes. Herein, we report the case of a very low birth weight infant born at GW 28 without antenatal findings and presenting at birth with severe respiratory distress, requiring ventilation. Chest X-rays and a CT scan showed the presence of a solid mass in the left lung. An initial conservative approach was adopted as the baby gained respiratory stability within the first days of life. Routine ultrasound (US) showed a progressive reduction of the lesion, mimicking the process of involution that CPAM can exhibit during late gestation. The rarity of the condition does not allow the formulation of any suggestions regarding one type of management over the other. An initial conservative approach seems to be appropriate with regards to the outcome and possible intra- and post-operative complications. Full article