Search Results (59)

Background/Objectives: Follow-up studies in very preterm infants are common, but fewer studies are situated in low- or middle-income countries. In a prospective cohort study, we explored longitudinal motor performance trajectories and influencing factors, including an early motor intervention program. Very preterm infants (gestational age < 32 weeks and/or very-low-birth-weight < 1500 g) in the middle-income country of Suriname were included. Methods: We assessed 149 (49.7% boys) infants (mean gestational age 29⁺⁶, mean birth weight 1271 g) at 3, 12, and 24 months with the Bayley Scales of Infant and Toddler Development for fine motor (FM), gross motor (GM), and composite scores (CSs). Influencing perinatal and environmental factors were explored. Delayed-scoring infants were referred to a motor intervention program. Data were analyzed using mixed-model linear regression. Results: The Bayley mean FM and GM scores decreased between 3 and 12 months and stabilized at 24 months. The mean CS at 3, 12, and 24 months was 102.3, 92.7, and 92.2, respectively. The latter two were significantly below the reference values (100, SD 15, p < 0.01). Birth weight z-scores significantly influenced FM (p = 0.013) and CS (p = 0.009); a lower birth weight was associated with initially lower scores and a smaller decline over time than a higher birth weight. The motor intervention program (n = 54) showed no significant interaction effects at all time points after correction for frequency of interventions (no; 1–5; >5 interventions). Conclusions: Motor performance was normal at 3 months and delayed at 12 and 24 months. Birth weight, but not the early intervention program, influenced longitudinal motor trajectories. We recommend follow-up of motor performance and suggest adding the Prechtl General Movement assessment at 3 months of age. The clinical implementation of the early motor invention program needs additional studies to reach an adequate training level. 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: Very-low-birth-weight infants (VLBWIs; birth weight < 1500 g) are at an increased risk of complicated influenza infection, which frequently includes pneumonia, encephalitis or even death. Data on influenza immunization and its outcome in VLBWIs are scarce. This study aimed to provide epidemiological data on influenza immunization for German VLBWIs and hypothesized that immunization would protect VLBWIs from infection-mediated neurodevelopmental impairment and preserves lung function at early school age. Methods: In this observational population-based German Neonatal Network (GNN) study, infants born between 2009 and 2015 were invited to partake in a 6-year follow-up investigation including lung function and developmental testing. Uni- and multivariate analyses were performed to evaluate the clinical characteristics and outcomes of influenza-immunized VLBWIs compared to non-immunized VLBWIs. Results: Influenza immunization was performed in 871 out of the 3358 VLBWIs (26%) with six-year follow-up. Immunized infants were characterized by a low gestational age and higher rates of morbidity, particularly bronchopulmonary dysplasia. Although early immunization showed no safety signals and had protective effects on the long-term risk of bronchitis (OR: 0.2; CI: 0.1–0.6; p = 0.002), most VLBWIs (88.0%) were unimmunized in their first influenza season. Conclusions: Influenza immunization was not associated with improved lung function (forced expiratory volume in one second and forced vital capacity) or a better neurocognitive outcome (intelligence quotient and strengths and difficulties questionnaire) at early school age. In Germany, only one quarter of 6-year-old VLBWIs were immunized against influenza, particularly those born <28 gestational weeks and/or BPD. Specific influenza immunization guidelines that define evidence-based recommendations are needed for this vulnerable group. Full article

Background: Children born with a very low birthweight (VLBW; <1500 g) and/or very preterm (VPT; <32 weeks) are at increased risk of mental health problems, but adult data are inconsistent. Objectives: We examined the prevalence of a range of mental health disorders in a national cohort of adults born with a VLBW, as well as associations between gestational age and mental health outcomes. Methods: All infants born with a VLBW in New Zealand in 1986 were followed prospectively from birth. The 12-month prevalence of mental health outcomes, in addition to substance use and violent/property offending were assessed at a median age of 28 years in this cohort relative to 100 full-term (FT) controls. Outcomes were assessed using structured interview methods. Results: There was a modest increase in the overall rate of mental health problems in VLBW adults compared to controls (ARR 1.33 [95% CI 0.83, 2.12]), reflecting slightly higher rates of anxiety disorders, notably agoraphobia (ARR 2.98 [0.64, 13.85]), social phobia (ARR 1.61 [0.71, 3.65]), and suicidal ideation/attempt (ARR 1.66 [0.45, 6.08]), but not depression (ARR 1.02 [0.57, 1.81]). There were no clear differences in substance use/offending outcomes. VLBW individuals born extremely preterm (<28 weeks) were most vulnerable to later mental health problems relative to controls (overall rate of mental health problems ARR 1.54 [0.86, 2.73]). Effect sizes for any anxiety disorder were also higher for VLBW females than VLBW males compared to same-sex controls. Conclusions: This population-based longitudinal cohort study showed that adults born preterm with a VLBW reported more mental health problems than FT controls; however, this difference was small. Pooled analyses involving larger sample sizes are needed, but findings suggest only modest individual and public health impacts of preterm birth on adult mental health functioning. Full article

Background: Very-low-birth-weight (VLBW) infants often experience feeding intolerance owing to organ immaturity, and the most frequent sign is the presence of abdominal distention. Daikenchuto (DKT), a traditional Japanese herbal medicine, is used to improve gastrointestinal function, particularly in adults. The aim of this study was to investigate the effectiveness of DKT in reducing abdominal distention and intestinal gas in VLBW infants. Methods: This study involved a retrospective chart review of 24 VLBW infants treated with DKT at Hamamatsu University Hospital between April 2016 and March 2021. The effects of DKT treatment at a dose of 0.3 g/kg/day were evaluated through clinical parameters and abdominal radiography. Results: Before treatment, marked abdominal distention was observed in 46% of the infants, which reduced to 4% within a week of DKT administration. The gas volume score (GVS) decreased in 92% of the patients within the first week of treatment and markedly decreased by ≥20% in 46% of the patients. The effects of improving abdominal distention and decreasing the GVS on radiography persisted for 1–2 weeks after treatment initiation. No clinical parameters affecting a GVS reduction of ≥20% and no notable adverse effects were observed. Conclusions: While the preliminary findings suggest that DKT may help manage abdominal distention in VLBW infants, further studies with placebo-controlled trials, larger sample sizes, use of advanced image processing software, and consideration of additional influencing factors are required to substantiate these results and identify predictors of treatment response. Full article

Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014–2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at <28 weeks of age and extremely low birth weight infants (ELBWI) were more likely to receive physical rehabilitation interventions. The length of stay at the NICU and hospital, as well as the rate of discharge, were higher in patients who received physical rehabilitation than those in infants who did not. Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU. Full article

Background: while most gut microbiota research has focused on term infants, the health outcomes of preterm infants are equally important. Very-low-birth-weight (VLBW) or extremely-low-birth-weight (ELBW) preterm infants have a unique gut microbiota structure, and probiotics have been reported to somewhat accelerate the maturation of the gut microbiota and reduce intestinal inflammation in very-low preterm infants, thereby improving their long-term outcomes. The aim of this study was to investigate the structure of gut microbiota in ELBW neonates to facilitate the early identification of different types of low-birth-weight (LBW) preterm infants. Methods: a total of 98 fecal samples from 39 low-birth-weight preterm infants were included in this study. Three groups were categorized according to different birth weights: ELBW (n = 39), VLBW (n = 39), and LBW (n = 20). The gut microbiota structure of neonates was obtained by 16S rRNA gene sequencing, and microbiome analysis was conducted. The community state type (CST) of the microbiota was predicted, and correlation analysis was conducted with clinical indicators. Differences in the gut microbiota composition among ELBW, VLBW, and LBW were compared. The value of gut microbiota composition in the diagnosis of extremely low birth weight was assessed via a random forest-machine learning approach. Results: we briefly analyzed the structure of the gut microbiota of preterm infants with low birth weight and found that the ELBW, VLBW, and LBW groups exhibited gut microbiota with heterogeneous compositions. Low-birth-weight preterm infants showed five CSTs dominated by Enterococcus, Staphylococcus, Klebsiella, Streptococcus, Pseudescherichia, and Acinetobacter. The birth weight and clinical indicators related to prematurity were associated with the CST. We found the composition of the gut microbiota was specific to the different types of low-birth-weight premature infants, namely, ELBW, VLBW, and LBW. The ELBW group exhibited significantly more of the potentially harmful intestinal bacteria Acinetobacter relative to the VLBW and LBW groups, as well as a significantly lower abundance of the intestinal probiotic Bifidobacterium. Based on the gut microbiota’s composition and its correlation with low weight, we constructed random forest model classifiers to distinguish ELBW and VLBW/LBW infants. The area under the curve of the classifiers constructed with Enterococcus, Klebsiella, and Acinetobacter was found to reach 0.836 by machine learning evaluation, suggesting that gut microbiota composition may be a potential biomarker for ELBW preterm infants. Conclusions: the gut bacteria of preterm infants showed a CST with Enterococcus, Klebsiella, and Acinetobacter as the dominant genera. ELBW preterm infants exhibit an increase in the abundance of potentially harmful bacteria in the gut and a decrease in beneficial bacteria. These potentially harmful bacteria may be potential biomarkers for ELBW preterm infants. Full article

The placenta is the largest fetal organ, which connects the mother to the fetus and supports most aspects of organogenesis through the transport of nutrients and gases. However, further studies are needed to assess placental pathology as a reliable predictor of long-term physical growth or neural development in newborns. The Consensus Statement of the Amsterdam Placental Workshop Group (APWGCS) on the sampling and definition of placental lesions has resulted in diagnostic uniformity in describing the most common pathological lesions of the placenta and contributed to the international standardization of descriptions of placental pathology. In this narrative review, we reclassified descriptions of placental pathology from previously published papers according to the APWGCS criteria and comparatively assessed the relationship with infantile physical and/or neural development. After reclassification and reevaluation, placental pathology of maternal vascular malperfusion, one of the APWGCS criteria, emerged as a promising candidate as a universal predictor of negative infantile neurodevelopmental outcomes, not only in term and preterm deliveries but also in high-risk groups of very low birthweight newborns. However, there are few studies that examined placental pathology according to the full categories of APWGCS and also included low-risk general infants. It is necessary to incorporate the assessment of placental pathology utilizing APWGCS in the design of future birth cohort studies as well as in follow-up investigations of high-risk infants. Full article

Ductus arteriosus closure may be delayed in preterm infants, and prostaglandin, a vasodilator, can affect ductal patency. Furosemide can increase renal prostaglandin synthesis, so its net effect on patent ductus arteriosus (PDA) is uncertain. Our goal is to explore the relationship between furosemide and spontaneous ductal closure in very-low-birth-weight preterm infants. Our treatment for PDA involves fluid restriction initially and furosemide administration for hemodynamically significant PDA until closure is confirmed by the echocardiogram. We enrolled 105 infants from 1 January 2019 to 30 June 2022 and evaluated the impact of furosemide on ductal closure, including exposure duration and cumulative dose. There is no correlation between furosemide exposure and spontaneous ductal closure (p = 0.384). Furosemide exposure does not delay the postmenstrual age at which spontaneous ductal closure occurs (p = 0.558). The time for spontaneous ductal closure is positively associated with furosemide prescription days (coefficient value = 0.547, p = 0.026) and negatively with gestational age (coefficient value = −0.384, p = 0.062). The prescription of furosemide does not impact the probability or time duration of ductus arteriosus spontaneous closure. The cumulative dose of furosemide has minimal impact on ductal closure. The correlation between furosemide exposure duration and ductal patency duration is likely due to our treatment protocol, with gestational age being a significant factor. Full article

Background: There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants. Methods: We extended a single-centre observational study carried out in an Italian NICU. Three periods were compared: I. “baseline” (2011–2012), II. “intervention” (2016–2017), and III. “maintenance” (2020–2021). Intensive training of medical and nursing staff on AS occurred between periods I and II. AS protocols and algorithms were maintained and implemented between periods II and III. Results: There were 111, 119, and 100 VLBW infants in periods I, II, and III, respectively. In the “intervention period”, there was a reduction in antibiotic use, reported as days of antibiotic therapy per 1000 patient days (215 vs. 302, p < 0.01). In the “maintenance period”, the number of culture-proven sepsis increased. Nevertheless, antibiotic exposure of uninfected VLBW infants was lower, while no sepsis-related deaths occurred. Our restriction was mostly directed at shortening antibiotic regimens with a policy of 48 h rule-out sepsis (median days of early empiric antibiotics: 6 vs. 3 vs. 2 in periods I, II, and III, respectively, p < 0.001). Moreover, antibiotics administered for so-called culture-negative sepsis were reduced (22% vs. 11% vs. 6%, p = 0.002), especially in infants with a birth weight between 1000 and 1499 g. Conclusions: AS is feasible in preterm VLBW infants, and antibiotic use can be safely reduced. AS interventions, namely, the shortening of antibiotic courses in uninfected infants, can be sustained over time with periodic clinical audits and daily discussion of antimicrobial therapies among staff members. Full article

The lung microbiota is a complex community of microorganisms that colonize the respiratory tract of individuals from, or even before, birth. Although the lungs were traditionally believed to be sterile, recent research has shown that there is a diversity of bacterial species in the respiratory system. Knowledge about the lung microbiota in newborns and its relationship with bacterial infections is of vital importance to understand the pathogenesis of respiratory diseases in neonatal patients undergoing mechanical ventilation. In this article, the current evidence on the composition of the lung microbiota in newborns will be reviewed, as well as the risks that an altered microbiota can impose on premature newborns. Although advances in neonatal intensive care units have significantly improved the survival rate of preterm infants, the diagnosis and treatment of ventilator-associated pneumonia has not progressed in recent decades. Avoiding dysbiosis caused by inappropriate use of antibiotics around birth, as well as avoiding intubation of patients or promoting early removal of endotracheal tubes, are among the most important preventive measures for ventilator-associated pneumonia. The potential benefit of probiotics and prebiotics in preventing infectious, allergic or metabolic complications in the short or long term is not clearly established and constitutes a very important field of research in perinatal medicine. Full article

Aware of the utmost importance of feeding premature babies—especially those of lower weight—with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk. Full article

Metabolic bone disease (MBD) predominantly affects preterm infants, particularly very-low-birth-weight (VLBW) infants weighing <1500 g. However, there are limited reports on MBD and neurodevelopmental outcomes. This study aimed to analyze the risk factors for MBD and understand its impact on neurodevelopmental outcomes at 2 years of corrected age. Overall, 749 VLBW infants weighing <1350 g at birth were enrolled. Exclusion criteria were major congenital abnormalities, chromosomal abnormalities, and loss of follow-up on the Bayley Scales of Infant Development, Third Edition (BSID-III) test at 24 months of corrected age. Infants were retrospectively assessed by a trained case manager using the BSID-III test at 6, 12, and 24 months old. Infants were categorized as with or without MBD according to radiographic signs. Of those enrolled, 97 VLBW infants were diagnosed with MBD, compared to 362 VLBW infants without MBD. The proportion of infants that completed three follow-ups was 86%. At the assessment at 2 years of age, infants with MBD had lower and more significant differences in motor, language, and cognitive composites. MBD is associated with poor neurodevelopmental outcomes in cognitive, motor, and language composites for VLBW infants at 24 months of corrected age. Full article

Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity of clinical presentation. Currently, there is no definitive treatment available for extremely premature very-low-birth-weight infants with BPD, and challenges in finding targeted preventive therapies persist. However, innovative stem cell-based postnatal therapies targeting BPD-free survival are emerging, which are likely to be offered in the first few days of life to high-risk premature infants. Hence, we need easy-to-use noninvasive tools for a standardized, precise, and reliable BPD assessment at a very early stage, to support clinical decision-making and to predict the response to treatment. In this non-systematic review, we present an overview of strategies for monitoring preterm infants with early and evolving BPD-PPRD, and we make some remarks on future prospects, with a focus on near-infrared spectroscopy (NIRS). Full article