New Ballard Score, expanded to include extremely premature infants

Pregnancy outcomes following unintentional exposure to TAK-003, a live-attenuated tetravalent dengue vaccine

BACKGROUND

The tetravalent dengue vaccine TAK-003 is contraindicated during pregnancy. Pregnant women were excluded from TAK-003 clinical studies; however, some pregnancies occurred unintentionally.

RESEARCH DESIGN AND METHODS

This post-hoc analysis of phase 2 and 3 studies, evaluated pregnancy outcomes and neonatal adverse events (AEs) following unintentional vaccination during the time period ('exposure window') when women could be pregnant (within 44 days before last menstrual period until the outcome of pregnancy).

RESULTS

Of the 557 reported pregnancies, 38 (TAK-003, n = 28/375; placebo, n = 10/182) occurred inside the exposure window. Of these, 28 (TAK-003, n = 23; placebo, n = 5) resulted in live births, four resulted in elective terminations (TAK-003, n = 2; placebo, n = 2), five in spontaneous abortions (TAK-003, n = 3; placebo, n = 2) and one unknown outcome (placebo).Of the spontaneous abortions, there was no significant difference between TAK-003 and placebo recipients, or between those occurring within or outside the exposure window. Six participants who received TAK-003 in the exposure window and two neonates experienced serious AEs; none were considered TAK-003 related.

CONCLUSIONS

This post-hoc analysis found no evidence of increased adverse pregnancy outcomes following unintentional TAK-003 vaccination occurring inside the exposure window compared with placebo.

CLINICAL TRIAL REGISTRATION

The clinical trials from which data were extracted are registered at www.clinicaltrials.gov (identifiers are NCT02193087, NCT01511250, NCT02302066, NCT02425098, NCT03746015, NCT02747927, NCT03999996, NCT03423173, NCT03342898, NCT03771963, NCT04313244, NCT02948829, NCT035252119, NCT03341637).

Impact of the Transition of Neonatal Body Temperature from Resuscitation to Admission on Prematurity Complications: A Retrospective Observational Study

This study aimed to investigate the correlation between body temperature change from postbirth resuscitation (Tr) to admission (Ta), the impact of the transition of Tr to Ta, and the rate of Ta normalization on prematurity-related complications.A single-center retrospective observational study was conducted on inborn infants < 33 weeks gestational age, born between January 1, 2017, and May 31, 2021. Linear regression and multivariate logistic regression were used to evaluate the Tr-Ta relationship and to assess other associations. Normal body temperature was 36.5 to 37.5°C.From 568 eligible infants, 517 (91%) had both Tr and Ta records. Of these, 336/517 (65.0%) had normal Ta. And 80/336 infants (23.8%) with normal Ta had preceding abnormal Tr. Tr and Ta had a positive linear correlation (R 2 = 0.23, p < 0.01). After adjusting for birth-to-NICU-admission time and perinatal factors, Tr hypothermia was associated with bronchopulmonary dysplasia (BPD; adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.26-3.65, p < 0.01) and Ta hypothermia was associated with death before discharge (aOR: 2.98, 95% CI: 1.18-7.53, p = 0.02). Infants experiencing hypothermia during Tr to Ta transition were at a higher risk for periventricular leukomalacia (PVL), specifically, transition from Tr hypothermia to Ta normothermia/hyperthermia (aOR: 5.35, CI: 1.27-22.53, p = 0.02) and Tr hypothermia to Ta hypothermia (aOR: 4.72, CI: 1.13-19.79, p = 0.03). Transitioning from Tr hypothermia to Ta hypothermia was associated with a higher incidence of BPD (aOR: 1.84, 95% CI: 0.91-3.73, p = 0.09) and death (aOR: 2.96, 95% CI: 0.89-9.91, p = 0.08), though not statistically significant. Ta normalization at a rate of ≥0.5°C/hour was associated with a reduced risk of developing BPD.Hypothermia during Tr-to-Ta transition was associated with an increased risk of PVL. Future research should explore the effects of abnormal temperature duration and magnitude on neonatal outcomes. · Impact of neonatal temperature transition on prematurity outcomes.. · Importance of early and continuous temperature monitoring.. · Hypothermia resulted in a higher chance of developing PVL..

Initiation of enteral feeding as per current protocol (at 24 h) versus as per clinical status (from 6 h onwards) in neonates born with antenatal reversed end diastolic flow (REDF) in the umbilical artery Doppler: a pilot randomized controlled trial

OBJECTIVE

To compare the effects of initiating feeds at 24 h versus at 6 h in neonates with reversed end-diastolic flow (REDF) and determine the incidence of feed intolerance (FI) and necrotizing enterocolitis (NEC).

DESIGN

Pilot randomized controlled trial.

METHODS

Neonates with REDF (n = 52) were randomized to start feeds at 6 h (n = 26) or 24 h (n = 26) to assess FI, NEC, time to full feeds, sepsis, mortality, weight and gestation at discharge, and hospital stay.

RESULTS

FI was observed in 14 (54%) neonates in 6 h group and 17 (65%) in 24 h group, with comparable NEC rates. Neonates in the 6 h group achieved full feeds faster (8 vs. 11 days) and had shorter hospital stay (17 vs. 32 days). Death and sepsis rates were similar.

CONCLUSIONS

Feed initiation at 6 h in REDF neonates did not increase the risk of FI or NEC.

TRIAL REGISTRATION

Clinical trial registry of India (CTRI/2023/02/050025); 23/02/2023.

Maternal dietary patterns as predictors of neonatal body composition in Ethiopia: the IABC birth cohort study

BACKGROUND

Malnutrition during pregnancy is associated with adverse birth outcomes, but the importance of maternal diet during pregnancy for neonatal body composition remains inconclusive. This study investigated the role of maternal diet during pregnancy for neonatal body composition in the Ethiopian iABC birth cohort.

METHODS

The data stemmed from the first visit at birth comprising 644 mother-child pairs. Shortly after delivery, the diet of the last week of pregnancy was assessed by a non-quantitative and non-validated 18-items food frequency questionnaire. Multiple imputation was used to handle missing data. Twin births and implausible values were excluded from analysis (n = 92). The Dietary Diversity Score (0-9 points) was constructed and exploratory dietary patterns were derived via principal component analysis. Neonatal fat mass and fat-free mass were assessed by air-displacement plethysmography. The associations of maternal Dietary Diversity Score and exploratory dietary patterns with gestational age, neonatal anthropometric measures and body composition were investigated using multiple-adjusted linear regression analysis.

RESULTS

In this cohort (n = 552), mean ± standard deviation (SD) mother's age was 24.1 ± 4.6 years and the median maternal Dietary Diversity Score was 6 (interquartile range = 5-7). An 'Animal-source food pattern' and a 'Vegetarian food pattern' were identified. The mean ± SD birth weight was 3096 ± 363 g and gestational age was 39.0 ± 1.0 weeks. Maternal adherence to the Animal-source food pattern, but not Vegetarian food pattern, was related to birth weight [79.5 g (95% confidence interval (CI): -14.6, 173.6)]. In the adjusted model, adherence to the Animal-source food pattern was associated with higher neonatal fat-free mass [53.1 g (95% CI: -20.3, 126.6)], while neonates of women with high compared to low adherence to Dietary Diversity Score and Vegetarian food pattern had higher fat mass [19.4 g (95% CI: -7.4, 46.2) and 33.5 g (95% CI: 2.8, 64.1), respectively].

CONCLUSIONS

In this Ethiopian population, maternal diet during pregnancy was associated with neonatal body composition. The analysis of body composition adds important detail to the evaluation of maternal dietary habits for the newborn constitution.

Amplitude-Integrated Electroencephalogram in Premature Infants: A Prospective Cohort Study

OBJECTIVE

 The study aimed to interpret and establish patterns of amplitude-integrated electroencephalogram (aEEG) in stable preterm neonates and compare the aEEG among different gestational age groups using three standard classifications.

METHODS

 This prospective cohort study included stable preterm neonates between 240/7 and 366/7 weeks of gestation. aEEG was recorded in the first and second week of life and interpreted using the L. Hellström-Westas, Burdjalov, and Magalhães classification for background pattern, continuity, upper and lower margin amplitude, sleep-wake cycle, bandwidth, and presence of seizures. Subgroup analysis was performed based on ≤30 and >30 weeks' gestation.

RESULTS

 A total of 76 aEEG recordings were analyzed from 45 preterm neonates. In the first week, 60% of the neonates had normal voltage patterns, which increased to 80% in the second week. All infants ≤30 weeks displayed discontinuous wave patterns during the first week, and half transitioned to continuous waves in the second week. The lower margin amplitude increased, and the upper margin amplitude decreased with increased gestational age. Additionally, 65% of neonates had a mature sleep-wake cycle in the second week compared with 22% in the first week. The median (interquartile range) CFM score in the second week was 12 (4.5) compared with 8 (4) in the first week, and the CFM score positively correlated with gestation (Spearman correlation coefficient, 0.8; 95% confidence interval, 0.7-0.86). Magalhães grading in both groups was predominantly normal.

CONCLUSION

 aEEG is predominantly a continuous normal voltage pattern in >30 weeks' gestation and discontinuous in ≤30 weeks' gestation. CFM score correlates positively with advancing gestation gestational age.

Prevalence of feeding difficulties in children aged six months to six years who were born prematurely

PURPOSE

To describe the prevalence of feeding difficulties in preterm children aged six months to six years and eleven months, and to analyze the relationships with perinatal and neonatal conditions.

METHODS

This cross-sectional ambispective study applied the Brazilian Infant Feeding Scale to the parents of 129 children followed in preterm outpatient clinics to assess the prevalence of feeding difficulties. Additional variables were collected retrospectively from medical records.

RESULTS

Fifteen children (11.62%) out of 129 exhibited feeding difficulties. Significant influencing variables were being born small for gestational age, having a mother with gestational diabetes mellitus, and undergoing phototherapy. Ventilatory support duration correlated with the Motor-Oral domain, and phototherapy duration correlated with the Sensory-Oral domain of the Brazilian Infant Feeding Scale.

CONCLUSION

The Brazilian Infant Feeding Scale showed that the prevalence of long-term Feeding Difficulty in preterm infants was 11.62%. Small for Gestational Age newborns showed a higher prevalence. Children undergoing phototherapy and offspring of mothers with gestational diabetes showed a lower prevalence. The other variables studied did not significantly affect the prevalence of Feeding Difficulties, but the duration of ventilatory support affected the Oral-motor domain, and the duration of phototherapy also affected the Oral-Motor. This study marks the first application of the Brazilian Infant Feeding Scale in Brazilian preterm infants.

The Role of Neutrophil CD11b Compared to Neutrophil CD64 as an Early Diagnostic, Monitoring, and Prognostic Sepsis Marker in Neonatal ICUs: Case-Control-Methodological Study

Background: Early diagnosis and treatment of neonatal sepsis are crucial to cut off its major medical consequences: lifelong morbidities, neurodevelopmental disabilities, and a high number of neonatal mortalities. Aim of the Work: This study is aimed at determining the diagnostic and prognostic performance of CD11b as a sepsis biomarker for detecting neonatal sepsis at early stages compared to nCD64 and the other conventional sepsis parameters. Methods: Two hundred eleven neonates were enrolled from three Egyptian neonatal ICUs (NICUs), and they were classified into two main groups: the control group (n = 101) and the sepsis group (n = 110). Enrolled neonates were subjected to full sepsis screening, including complete blood count (CBC), C-reactive protein (CRP), blood cultures, and flow cytometry analysis for both CD64 and CD11b on the neutrophil surface (results represented as a percentage (percent) and mean fluorescent intensity (MFI) units for either biomarker). Results: nCD64% (median = 44.15%) was significantly enhanced in the sepsis group compared to the controls (median = 25%), achieving 90.8% specificity, 92.8% sensitivity, and AUC = 0.894, respectively. CD64 MFI and CD11b MFI could differentiate between sepsis and control groups but with low undesirable diagnostic performance (sensitivity: 72.5% and 59.1%; specificity: 54.4% and 69.4%; AUC: 0.634 and 0.144, respectively). CD11b% could not discriminate between sepsis and control neonates (sensitivity and specificity of 31.8% and 73.6%, respectively) with an AUC of 0.405. hs-CRP had moderate diagnostic performance, achieving sensitivity and specificity of 69% and 78.15%, respectively, and AUC = 0.586. ROC analysis showed that combined hs-CRP and CD64% results had the highest sensitivity and specificity in the current study, being 93.9% and 97.2%, with AUC = 0.938, respectively. Conclusion: CD64%, CD64 MFI, CD11b MFI, and hs-CRP are increased in neonates with sepsis comparable to the controls. CD64% has a superior diagnostic performance comparable to nCD11b and hs-CRP. Combined nCD64 with hs-CRP measurement can provide rapid and accurate diagnostic modality for sepsis diagnosis in correlation with the patient's clinical condition and context with the results of other hematological indices; neutrophil CD64 can be routinely applicable in NICUs for better sepsis management. It is statistically evident that nCD11b is less ideal compared to nCD64 as a diagnostic, prognostic, or monitoring sepsis marker.

Retinopathy of Prematurity in Very Low Birthweight Neonates of Gestation Less Than 32 weeks in Malaysia

OBJECTIVES

To determine the screening rates and incidence of retinopathy of prematurity (ROP), and risk factors associated with ROP in very low birthweight (VLBW, <1500 g) neonates of gestation <32 wk admitted to neonatal intensive care units (NICUs) in a middle-income country.

METHODS

It was a retrospective cohort study of prospectively submitted data by 44 Malaysian NICUs participating in the Malaysian National Neonatal Registry. All VLBW neonates of gestation <32 wk born in 2015-2020 and survived to discharge were included.

RESULTS

Of 11768 survivors, 90.5% (n = 10436) had ROP screening; 16.1% (1685/10436) had ROP. ROP was significantly more common in neonates <28 wk gestation (extremely preterm, EPT) than ≥28 wk gestation (37.7% vs. 9.7%; p <0.001), and more common in those with birthweight <1000 g (extremely low birthweight, ELBW) than ≥1000 g (32.9% vs. 9.1%; p <0.001). Multiple logistic regression analysis showed that the significant independent factors associated with increased risk of ROP were ELBW, EPT, Indian ethnic group, vaginal delivery, mechanical ventilation >5 d, high frequency ventilation, total parenteral nutrition, late-onset sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage. Receiving oxygen therapy at birth was associated with significantly lower risk of ROP.

CONCLUSIONS

The incidence and severity of ROP increased with decreasing gestation and birthweight. Prolonged duration of oxygen therapy, infection, invasive respiratory support, and conditions commonly causing fluctuations of oxygenation were significant factors associated with increased risk of ROP. Receiving oxygen at birth did not increase risk.

Short Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants

Importance

When preterm delivery is imminent, it remains unclear whether the timing from administration of antenatal betamethasone to birth may reduce mortality and morbidity among extremely preterm infants.

Objective

To evaluate the association of duration from exposure to first dose of antenatal betamethasone with outcomes among extremely preterm infants.

Design, Setting, and Participants

This cohort study enrolled infants born at 22 0/7 to 27 6/7 weeks' gestation from January 2016 to February 2021 at National Institute of Child Health and Human Development Neonatal Research Network centers. Infants exposed to multiple doses of antenatal betamethasone, infants who did not receive intensive care, and infants with congenital anomalies were excluded. Data were analyzed from October 2021 to December 2024.

Exposure

Time in hours from anenatal betamethasone administration to birth.

Main Outcomes and Measures

The primary outcome was survival to discharge. Secondary outcomes included survival without major morbidity and composites of individual morbidities and death. The association of time from antenatal betamethasone administration to birth with neonatal survival and morbidity was assessed using generalized linear models, adjusting for gestational age, infant sex, maternal race, education, small for gestational age, mode of delivery, multiple birth, prolonged rupture of membranes, and center of birth.

Results

Of 7464 infants born during the study period, 1806 infants (928 [51.3%] boys) were included in the cohort: 475 with no betamethasone and 1331 with exposure to a single dose of betamethasone within 24 hours before birth. The median (IQR) administration-to-birth interval for infants born after a single dose of betamethasone was 3.8 (1.4-9.5) hours. The administration-to-birth interval was independently associated with survival (adjusted relative risk [aRR] per 1-hour increase, 1.01 [95% CI, 1.00-1.01]; aRR per 6-hour increase, 1.04 [95% CI, 1.01-1.07]) and survival without severe neonatal morbidity (aRR per 1-hour increase, 1.01 [95% CI, 1.01-1.02]; aRR per 6-hour increase, 1.09 [95% CI, 1.04-1.14].

Conclusions and Relevance

In this cohort study, for women at risk of imminent preterm birth, even short duration of exposure to antenatal betamethasone was associated with improved neonatal survival and survival without severe neonatal morbidity.

Stretched penile length for Syrian children aged 0-5 years: Cross-sectional study

BACKGROUND

The early detection of the anatomical anomalies (e.g. micropenis) of the male external genital organs is crucial for both medical and psychological reasons. During routine pediatric visits, careful inspection using standards of penis size is beneficial for the diagnosis of micropenis and macropenis. Stretched penile length (SPL) has been shown to be more dependable than the flaccid penis length. Consequently, the SPL must be measured and compared to age-appropriate normal values.

OBJECTIVE

This cross-sectional study aimed to determine the normal range of stretched penile length in newborns and children aged 1 month to 5 years in Syria and explore the correlation between SPL, height, and weight.

STUDY DESIGN

Data was collected from 300 Syrian males aged 0-5 years. SPL measurements were taken using a standardized procedure. Participants were divided into eight age groups. Statistical analysis determined the mean SPL, standard deviation, range, and rate of increase in SPL for each group. The distribution of SPL data was assessed using the Shapiro-Wilk test. Pearson correlation analysis examined the relationship between SPL and height, weight, and BMI.

RESULTS

Mean SPL increased with age, ranging from 2.36 cm in newborns to 4.29 cm in children aged 48-60 months. The 48-60 months group exhibited the largest range of SPL. The rate of SPL increase was highest in children aged 1-2.9 months. SPL values followed a normal distribution. Significant positive correlations were found between SPL and weight in the 36-47.99 months group and between SPL and height in the 6-11.9 months and 36-47.99 months groups.

CONCLUSION

This study establishes the normal reference range of SPL in Syrian newborns and children aged 1 month to 5 years. The findings indicate that SPL is influenced significantly by height and weight in certain age groups. These results contribute to understanding penile development and can assist in the diagnosis and treatment of conditions affecting penile size.

Effect of application of the thoracoabdominal rebalancing (TAR) method in moderate premature children: randomized and controlled clinical trial

OBJECTIVE

To analyze the effect of the thoracoabdominal rebalancing (TAR) method on respiratory biomechanics, respiratory discomfort, pain sensation, and physiological parameters in moderate preterm newborns, compared to a control group.

METHODS

This randomized clinical trial was conducted in a neonatal intensive care unit. The evaluation included: Neonatal Infant Pain Scale, physiological parameters, Silverman-Andersen score, and biomechanics (thoracic cirtometry and Charpy angle). The newborns were randomized into the TAR group (n=17) or control group (n=13) and subjected to the slow expiratory flow acceleration technique (SEFA). The evaluation of a single session was performed three times: before, after, and 30 minutes after the intervention.

RESULTS

In the intergroup comparison, there was a significant difference in respiratory rate 30 minutes after the intervention. There was no significant difference in intra- and intergroup comparisons for pain and respiratory discomfort. Regarding biomechanics, there was a significant difference in the TAR group in the Charpy angle (between assessments 1 and 2), in the axillary cirtometry (between assessments 1 and 3), and in the xiphoid process (between assessments 2 and 3). In the control group, a significant difference was observed in the axillary line (between assessments 1 and 2; 2 and 3).

CONCLUSIONS

The TAR method showed a positive effect on respiratory rate and respiratory biomechanics when compared to the control group. In both groups, the techniques did not promote respiratory discomfort or pain sensation, making them safe techniques for this population.

Oxidative stress in infants of diabetic mothers: Role of ischemia modified albumin in relation to lipid peroxidation, antioxidant status and essential trace elements

BACKGROUND

Oxidative stress plays an important role in the pathogenesis of maternal and fetal complications of diabetic pregnancies.

AIM

To assess oxidative stress status in infants of diabetic mothers (IDMs) through measurement of ischemia modified albumin (IMA) and to examine its relation to lipid peroxidation, antioxidant status, essential trace elements, and maternal glycemic control.

METHODS

This study was conducted on 100 full-term infants; 50 infants were born to diabetic mothers and another 50 age- and sex-matched healthy infants were enrolled as controls. Maternal laboratory investigations included random blood glucose (RBG) and HbA1c. Cord blood RBG, total antioxidant capacity (TAC), malondialdehyde (MDA), IMA, and trace elements (copper [Cu] and zinc [Zn]) were measured.

RESULTS

Cord blood TAC, Cu, and Zn were significantly lower (p < 0.05 for all) while MDA and IMA levels were higher among IDMs compared with the control group (p < 0.001 for both). Maternal HbA1c was negatively correlated to TAC (r = -0.351, p = 0.013) while positively correlated to MDA (r = 0.305, p = 0.031) and IMA (r = 0.755, p < 0.001). IMA was also positively related to maternal RBG (r = 0.493, p < 0.001) while there were negative correlations between IMA and each of TAC (r = -0.491, p < 0.001) and Cu (r = -0.480, p = 0.001).

CONCLUSIONS

Oxidative stress is enhanced in IDMs as indicated by increased lipid peroxidation and IMA levels. This is accompanied by decreased antioxidant defense, reflected by decreased TAC, Cu, and Zn levels. Oxidant-antioxidant balance is related to maternal glycemic control. Proper glycemic control among diabetic mothers is mandatory to avoid oxidative stress and its potentially harmful effects on their infants.

Laser-Based Length-Measuring Board for the Measurement of Infant Body Length from Outside an Incubator: Proposal and Assessment of a Model

INTRODUCTION

Opening the incubator side wall to insert a non-sterile length-measuring device carries the risk of microbial contamination and thermal instability for preterm infants. To reduce this inconvenience, a laser-based length-measuring board is proposed to measure body length from outside the incubator.

METHODS

This device has two laser-line-shaped cursors which can be pointed to opposite ends of a segment to be measured. It is attached to the outer side of one of the incubator's side walls in such a manner as to ensure that its axis is parallel to the longitudinal axis of the segment. To validate the measurements made with this model, a calibrated caliper consisting of a conventional rigid length-measuring board with a resolution of 0.05 mm was constructed to serve as a reference. Crown-heel length was measured in a sample of 45 infants, including 32 preterm and 13 term infants of corrected gestational age at the time of measurement.

RESULTS

Good intra-observer variability was obtained. Near-perfect statistical agreement was found between measurements with both devices, with concordance correlation coefficients of 0.994 (95% CI: 0.990; 0.996) in preterm infants and 0.994 (95% CI: 0.988, 0.998) in infants at term. The clinical relevance of the agreement between measurements was assessed by a Bland-Altman plot, and the difference may reach clinical relevance (up to 1 cm) but without evidence of proportional bias.

CONCLUSION

The proposed validated laser-based length-measuring board offers a suitable alternative to conventional length-measuring boards for contactless measurement of infant body length.

Association between birth length, linear growth velocities, and primary school achievement at age 10 years: evidence from the Ethiopian iABC birth cohort

BACKGROUND

Childhood is a period marked by dynamic growth. Evidence of the association between childhood linear growth and school achievement comes mostly from cross-sectional data. We assessed associations between birth length, childhood linear growth velocities, and stunting with school achievement.

METHODS

Newborns were recruited into the Ethiopian infant Anthropometry and Body Composition (iABC) birth cohort and followed from birth to 10 years. Velocities from 0 to 6 years were computed using linear spline mixed effect modelling. Stunting (height-for-age < -2 z-scores) was assessed at the ages of 1, 2, 4, 5, and 6 years. School achievement was measured by having a high (≥ 80%) combined high math, English, and science (MES) score and being at appropriate grade-for-age. Logistic regression models assessed associations between birth length, linear growth velocities and stunting with school achievement.

RESULTS

Children's mean age was 9.8 years (standard deviation, SD 1.0, range 7-12 years). A 1 SD greater birth length increased the odds of achieving a high MES combined score by 1.42 (95% CI: 0.99, 2.03). A 1 SD increase in linear growth velocity from 6 to 24 months increased the odds of being in the appropriate grade-for-age by 1.66 (95% CI: 1.14, 2.43). Stunting at ages 4 and 6 years was associated with lower odds of achieving a high MES combined score: 0.43 (95% CI: 0.20, 0.93) and 0.31 (95% CI: 0.11, 0.89), respectively. Faster post-natal linear growth was not associated with school achievement.

CONCLUSION

Greater birth length and higher growth velocity from 6 to 24 months were associated with higher school achievement and being in the appropriate grade-for-age, respectively. Children who experienced growth failure were less likely to achieve a high MES score. Interventions aimed at improving school achievement should address maternal and fetal nutrition and health, and monitor post-natal growth.

Maternal and neonatal risks and outcomes after bariatric surgery: a comparative population based study across BMI categories in Qatar

The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18-2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06-2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33-15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153-2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09-2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23-2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women.

Early postnatal growth failure in infants <1500 g in a Ugandan referral hospital: a retrospective cohort study

BACKGROUND

Postnatal growth failure (PGF), a multifactorial condition is common in preterm infants and infants born weighing <1500 g and is associated with impaired neurodevelopmental and growth outcomes. In low-resource settings, like Uganda, parenteral nutrition and breastmilk fortifier are often unavailable, and preterm infants rely solely on their mother's expressed breastmilk, which can be inadequate. This retrospective cohort study, conducted in a level II neonatal unit in eastern Uganda, aimed to evaluate the incidence of and risk factors for postnatal growth failure among infants <1500 g.

METHODS

The study included infants with birthweight <1500 g, admitted within 24 h of birth, and who spent 7 or more days in the neonatal unit. Major congenital malformations or a diagnosis of hypoxic ischemic encephalopathy were exclusion criteria. PGF was defined as a decrease in weight Z score between birth and discharge of more than - 1.28. Data on feeding, anthropometry, co-morbidities, and clinical measures were extracted from medical records. Statistical analyses were performed using Stata 17.0 with crude and adjusted relative risks (RR) were reported.

RESULTS

One hundred and four infants were recruited, including 47 (45.2%) male and 57 (54.8%) female, with a mean birth weight of 1182 g (SD 18 g, 95% CI: 1140, 1210). Almost half were small for gestational age, most were singletons (66.3%), and most were born by spontaneous vaginal delivery (82.7%). PGF was observed at discharge in 75.9% (N = 79). Clinical risk factors for PGF included: small for gestational age (cRR 1.25, 95% CI: 1.01, 1.53), respiratory distress syndrome (aRR 1.30 95% CI: 1.01, 1.67), duration of bubble continuous positive airway pressure use (aRR 1.35, 95% CI: 1.10, 1.66), sepsis requiring second line (aRR 1.58, 95% CI: 1.22, 2.04) and third line treatment (aRR 1.46, 95% CI: 1.20, 1.77), prolonged time to achieve full feeds (aRR 1.30, 95% CI: 1.01, 1.66) and prolonged hospitalisation (aRR 1.85, 95% CI: 1.31, 2.61).

CONCLUSION

PGF was common among infants <1500 g in this hospitalised cohort who were primarily fed on their mother's own milk. Urgent action is needed to enhance postnatal growth in this vulnerable patient group. Future research should focus on exploring multidisciplinary interventions that can improve growth outcomes in this population and understanding the long-term implications and need for care for these infants.

Association of cytochrome P450 CYP2C9 (rs1057910) gene polymorphism and ibuprofen response in preterm neonates diagnosed with patent ductus arteriosus

BACKGROUND

Patent ductus arteriosus (PDA) closure is one of the most significant changes necessary to transition to extrauterine life. The failure of closure in preterm infants has been associated with a variety of complications.

AIM AND OBJECTIVES

This study aim to investigate the correlation between cytochrome P450 CYP2C9 gene polymorphism and the response to ibuprofen treatment in preterm neonates with PDA.

SUBJECTS AND METHODS

This prospective study was conducted on 64 preterm neonates with patent ductus arteriosus (hsPDA). The neonates were treated with ibuprofen and diagnosed using clinical and echocardiographic examinations. The study was carried out at the Neonatal Intensive Care Unit (NICU), Pediatric Department, Kasr Alainy and ElMounira Pediatric Hospitals, Cairo University, in June 2018.

RESULTS

A statistically significant difference in respiratory rate was observed between both groups (p = 0.047). Additionally, there was a significant difference in the duration of treatment with ibuprofen (p = 0.021). Treatment with ibuprofen had no impact on renal function parameters. The platelet count decreased after treatment with no statistical difference.

CONCLUSION

Use of Oral ibuprofen is a highly effective treatment for HsPDA in preterm neonates, demonstrating a remarkable success rate of 92.2% and fewer adverse effects. Whilst no correlation between the CYP2C9 (rs1057910) gene polymorphism and the efficacy of oral ibuprofen response, Other factors affecting the response of oral ibuprofen and subsequent PDA closure include gestational age, birth weight, Apgar score at 5 min, ductal diameter, RDS, and sepsis.

Association of neonatal outcome with birth weight for gestational age in Chinese very preterm infants: a retrospective cohort study

BACKGROUND

The neonatal outcomes across different percentiles of birth weight for gestational age are still unclear.

METHODS

This retrospective cohort study was conducted within 57 tertiary hospitals participating in the Chinese Neonatal Network (CHNN) from 25 provinces throughout China. Infants with gestational age (GA) 24+0-31+6 weeks who were admitted within 7 days after birth were included. The composite outcome was defined as mortality or any one of neonatal major morbidities, including necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (cPVL), severe retinopathy of prematurity (ROP), and sepsis. Multivariable logistic regressions using generalized estimating equation approach were conducted.

RESULTS

A total of 8380 infants were included with a mean GA of 30 (28-31) weeks. Of these, 1373 (16.5%) were born at less than 28 weeks, while 6997 (83.5%) had a GA between 28 and 32 weeks. Our analysis indicated that the risk of composite outcomes was negatively associated with birth weight for gestational age, and compared to the reference group, the multiple-adjusted ORs (95%CI) of composite outcomes were 4.89 (3.51-6.81) and 2.16 (1.77-2.63) for infants with birth weight for gestational less than 10th percentile and 10th -30th percentile, respectively. The ORs (95%CI) of mortality, NEC, BPD, severe ROP, and sepsis in infants with birth weight for gestational age at 10th-30th percentile were 1.94 (1.56-2.41), 1.08 (0.79-1.47), 2.48 (2.03-3.04), 2.35 (1.63-3.39), and 1.39 (1.10-1.77), respectively.

CONCLUSION

Our study suggested that the risk of adverse neonatal outcomes increased significantly when the birth weight for gestational age was below the 30th percentile. Regular monitoring and early intervention are crucial for these high-risk infants.

Applicability of the External Genitalia Score (EGS) in Indian neonates and children up to 2 years of age

OBJECTIVES

To generate normative data and validate the recently developed, gender-neutral, External Genitalia Score (EGS) in Indian preterm and term neonates and children up to 2 years of age with normal and atypical genitalia.

METHODS

This observational study included 1,040 neonates born between 28 and 42 weeks of gestation and 152 children between 1 and 24 months of age. In addition, 50 children with disorders of sex development (DSD) were also enrolled in the study. The Prader stage/external masculinization score (EMS) (as applicable), anogenital ratio (AGR) and EGS were assessed for all neonates and children with typical and atypical genitalia.

RESULTS

Median EGS values in newborn males with typical genitalia were 9.5 at 28-31 weeks, 10.5 at 32-33 weeks, 11 at 34 weeks and 11.5 in males at 35-42 weeks of gestation. For all females with typical genitalia, the EGS was 0. EMS and EGS showed a positive correlation in males with typical genitalia (r=0.421, p=0.000**) and all children with DSD (r=0.857, p=0.000**). Mean AGR in males and females with typical genitalia and those with DSD were 0.52±0.07, 0.31±0.05 and 0.47±0.13, respectively. EGS correlated with AGR in all males with typical genitalia (r=0.107, p=0.008**), and in all children with DSD (r=0.473, p=0.001**).

CONCLUSIONS

The EGS enables accurate, gender-neutral and comprehensive assessment of external genitalia in Indian neonates and children with typical and atypical genitalia/DSD. Evaluation for DSD is recommended in any child with EGS greater than 0 and ≤10th percentile for gestation or age (10.5 in a term neonate).

Impact of prematurity on LINE-1 promoter methylation

Aim: Promoter methylation of LINE-1 may be affected by prematurity, but there is little evidence in the literature.Materials & methods: Blood from premature and full-term neonates on days 0, 5, 30 and 90 was analyzed for DNA methylation percentage in a promoter region of the LINE-1, after bisulfite conversion and pyrosequencing.Results: Premature infants, as a whole, showed significantly lower methylation percentage at birth, but this difference diminished over time. However, the subgroup of extremely premature (<28 weeks gestational age) had higher methylation percentages, similar to full-term newborns.Conclusion: This research underscores the critical role of prematurity on the methylation pattern of LINE-1. These findings underline the complexity of epigenetic regulation in prematurity and emphasize the need for further studies.

Prenatal stress impacts foetal neurodevelopment: Temporal windows of gestational vulnerability

Prenatal maternal stressors ranging in severity from everyday occurrences/hassles to the experience of traumatic events negatively impact neurodevelopment, increasing the risk for the onset of psychopathology in the offspring. Notably, the timing of prenatal stress exposure plays a critical role in determining the nature and severity of subsequent neurodevelopmental outcomes. In this review, we evaluate the empirical evidence regarding temporal windows of heightened vulnerability to prenatal stress with respect to motor, cognitive, language, and behavioural development in both human and animal studies. We also explore potential temporal windows whereby several mechanisms may mediate prenatal stress-induced neurodevelopmental effects, namely, excessive hypothalamic-pituitary-adrenal axis activity, altered serotonin signalling and sympathetic-adrenal-medullary system, changes in placental function, immune system dysregulation, and alterations of the gut microbiota. While broadly defined developmental windows are apparent for specific psychopathological outcomes, inconsistencies arise when more complex cognitive and behavioural outcomes are considered. Novel approaches to track molecular markers reflective of the underlying aetiologies throughout gestation to identify tractable biomolecular signatures corresponding to critical vulnerability periods are urgently required.

Impact of early caffeine administration on respiratory outcomes in very preterm infants initially receiving invasive mechanical ventilation

OBJECTIVE

The guidelines recommend early caffeine administration for preterm infants requiring non-invasive mechanical ventilation since earlier treatment is associated with better outcomes. The objective was to evaluate the impact of early caffeine therapy (within 24 hours after birth) on respiratory outcomes in very preterm infants who were initially receiving invasive mechanical ventilation.

METHODS

This was an observation cohort study from 1 January 2018 to 31 December 2022 based on a database that was prospectively collected and maintained. Infants who initially received invasive mechanical ventilation were divided into two groups based on the timing of caffeine initiation: within the first 24 hours after birth (early) and within 48 hours of birth or later (late). Generalised linear mixed models with a random effect model for the centre were used to assess the impact of different caffeine initiation times on neonatal outcomes.

RESULTS

Among the cohort of 9880 infants born at <32 weeks gestation, 2381 were eligible for this study (early initiation: 1758 (73.8%) and late initiation: 623 (26.2%)). For infants born at more than 28 weeks of gestation, the adjusted generalised linear mixed model showed that the duration of invasive mechanical ventilation was 1.34 (95% CI -2.40 to -0.27) days shorter and the incidence of moderate-to-severe bronchopulmonary dysplasia (BPD) was lower (adjusted OR 0.63; 95% CI 0.41 to 0.96) in the early caffeine group compared with the late caffeine group.

CONCLUSION

In very preterm infants who initially receive invasive mechanical ventilation, early administration of caffeine within 24 hours after birth can shorten the duration of invasive mechanical ventilation, reduce the incidence of moderate-to-severe BPD and improve respiratory outcomes. The very early initiation of caffeine treatment does not appear to be associated with any adverse outcomes.

TRIAL REGISTRATION NUMBER

ChiCTR1900025234.

Cytokine Levels in Neonates: Unveiling the Impact of Perinatal Inflammation on Prematurity

OBJECTIVE

This study aimed to investigate the association between variations in cytokine levels in the first 72 hours of life and prematurity.

STUDY DESIGN

In this prospective study, we examined the cytokine levels of 110 newborns in the first 72 hours of life. The participants were divided into two groups based on gestational age (66 very preterm and 44 term newborns), and cytokine levels (interleukin [IL]-6, IL-8, and IL-10, tumor necrosis factor-α [TNF-α], and transforming growth factor-β [TGF-β]) were evaluated.

RESULTS

Premature newborns exhibited higher levels of IL-6, IL-8, and IL-10, while TNF-α and TGF-β levels were lower comparing to term newborns. Even after adjusting for maternal and peripartum factors, the significant differences persisted.

CONCLUSION

Our study underscores significant cytokine profile differences between full-term and very preterm newborns in early life. Elevated IL-6 and IL-8 levels in preterm infants suggest potential perinatal inflammation links to prematurity.

KEY POINTS

· There is a direct association between cytokine levels and prematurity.. · Knowledge of the variation of cytokines in newborns enhances personalized interventions.. · Cytokine levels are early associated with gestational age.

Effects of preterm birth, maternal ART and breastfeeding on 24-month infant HIV-free survival in a randomized trial

BACKGROUND

IMPAACT 1077BF/FF (PROMISE) compared the safety/efficacy of two HIV antiretroviral therapy (ART) regimens to zidovudine (ZDV) alone during pregnancy for HIV prevention. PROMISE found an increased risk of preterm delivery (<37 weeks) with antepartum triple ART (TDF/FTC/LPV+r or ZDV/3TC/LPV+r) compared with ZDV alone. We assessed the impact of preterm birth, breastfeeding, and antepartum ART regimen on 24-month infant survival.

METHODS

We compared HIV-free and overall survival at 24 months for liveborn infants by gestational age, time-varying breastfeeding status, and antepartum ART arm at 14 sites in Africa and India. Kaplan-Meier survival probabilities and Cox proportional hazards ratios were estimated.

RESULTS

Three thousand four hundred and eighty-two live-born infants [568 (16.3%) preterm and 2914 (83.7%) term] were included. Preterm birth was significantly associated with lower HIV-free survival [0.85; 95% confidence interval (CI) 0.82-0.88] and lower overall survival (0.89; 95% CI 0.86-0.91) versus term birth (0.96; 95% CI 0.95-0.96). Very preterm birth (<34 weeks) was associated with low HIV-free survival (0.65; 95% CI 0.54-0.73) and low overall survival (0.66; 95% CI 0.56-0.74). Risk of HIV infection or death at 24 months was higher with TDF-ART than ZDV-ART (adjusted hazard ratio 2.37; 95% CI 1.21-4.64). Breastfeeding initiated near birth decreased risk of infection or death at 24 months (adjusted hazard ratio 0.05; 95% CI 0.03-0.08) compared with not breastfeeding.

CONCLUSION

Preterm birth and antepartum TDF-ART were associated with lower 24-month HIV-free survival compared with term birth and ZDV-ART. Any breastfeeding strongly promoted HIV-free survival, especially if initiated close to birth. Reducing preterm birth and promoting infant feeding with breastmilk among HIV/antiretroviral drug-exposed infants remain global health priorities.

Post-natal gestational age assessment using targeted metabolites of neonatal heel prick and umbilical cord blood: A GARBH-Ini cohort study from North India

Background

Accurate assessment of gestational age (GA) and identification of preterm birth (PTB) at delivery is essential to guide appropriate post-natal clinical care. Undoubtedly, dating ultrasound sonography (USG) is the gold standard to ascertain GA, but is not accessible to the majority of pregnant women in low- and middle-income countries (LMICs), particularly in rural areas and small secondary care hospitals. Conventional methods of post-natal GA assessment are not reliable at delivery and are further compounded by a lack of trained personnel to conduct them. We aimed to develop a population-specific GA model using integrated clinical and biochemical variables measured at delivery.

Methods

We acquired metabolic profiles on paired neonatal heel prick (nHP) and umbilical cord blood (uCB) dried blood spot (DBS) samples (n = 1278). The master data set consists of 31 predictors from nHP and 24 from uCB after feature selection. These selected predictors including biochemical analytes, birth weight, and placental weight were considered for the development of population-specific GA estimation and birth outcome classification models using eXtreme Gradient Boosting (XGBoost) algorithm.

Results

The nHP and uCB full model revealed root mean square error (RMSE) of 1.14 (95% confidence interval (CI) = 0.82-1.18) and of 1.26 (95% CI = 0.88-1.32) to estimate the GA as compared to actual GA, respectively. In addition, these models correctly estimated 87.9 to 92.5% of the infants within ±2 weeks of the actual GA. The classification models also performed as the best fit to discriminate the PTB from term birth (TB) infants with an area under curve (AUC) of 0.89 (95% CI = 0.84-0.94) for nHP and an AUC of 0.89 (95% CI = 0.85-0.95) for uCB.

Conclusion

The biochemical analytes along with clinical variables in the nHP and uCB data sets provide higher accuracy in predicting GA. These models also performed as the best fit to identify PTB infants at delivery.

Correlation of Zinc and Copper Levels In Mothers and Cord Blood of Neonates With Prematurity and Intrauterine Growth Pattern

Background Trace elements like zinc and copper are indispensable for human growth and development, exerting significant influence on a multitude of physiological processes. Acting as pivotal components for transcription factors and catalytic cofactors for enzymes, these elements play essential roles in cellular differentiation and maturation Objective The objective of this study was to study serum zinc and copper levels in mothers and neonates in relation to prematurity and intrauterine growth retardation (IUGR). Methods This was a cross-sectional study that included 100 mothers who met the inclusion criteria. Maternal history was recorded, and gestational age was estimated using the New Ballard scoring system. Maternal and cord blood samples were taken for zinc and copper analysis. Results The comparison of maternal copper and zinc levels between term and preterm neonates revealed a statistically significant difference with both trace elements found in less concentration in preterm when compared to the term patients (p= 0.03 for Zinc; 0.0001 for copper). We also report a statistically significant difference in maternal and cord blood copper and zinc levels in cases with IUGR compared to normal neonates. Conclusion The findings show that maternal zinc and copper levels are critical for the intrauterine growth of the fetus and for appropriate gestational age.

Systemic inflammation in pregnant women with HIV: relationship with HIV treatment regimen and preterm delivery

OBJECTIVE

HIV treatment regimen during pregnancy was associated with preterm delivery (PTD) in the PROMISE 1077 BF trial. Systemic inflammation among pregnant women with HIV could help explain differences in PTD by treatment regimen. We assessed associations between inflammation, treatment regimen, and PTD.

DESIGN/METHODS

A nested 1 : 1 case-control study ( N  = 362) was conducted within a multicountry randomized trial comparing three HIV regimens in pregnant women: zidovudine alone, or combination antiretroviral therapy (ART) with lopinavir/ritonavir and either zidovudine or tenofovir. Cases were women with PTD (<37 weeks of gestational age). The following inflammatory biomarkers were measured in plasma samples using immunoassays: soluble CD14 (sCD14) and sCD163, intestinal fatty acid-binding protein, interleukin (IL)-6, interferon γ, and tumor necrosis factor α. We fit regression models to assess associations between second trimester biomarkers (measured before ART initiation at 13-23 weeks of gestational age and 4 weeks later), treatment regimen, and PTD. We also assessed whether inflammation was a mediator in the relationship between ART regimen and PTD.

RESULTS

Persistently high interleukin-6 was associated with increased PTD. Compared with zidovudine alone, the difference in biomarker concentration between week 0 and week 4 was significantly higher ( P  < 0.05) for both protease inhibitor-based regimens. However, the estimated proportion of the ART effect on increased PTD mediated by persistently high biomarker levels was 5% or less for all biomarkers.

CONCLUSION

Persistently high IL-6 during pregnancy was associated with PTD. Although protease inhibitor-based ART was associated with increases in inflammation, factors other than inflammation likely explain the increased PTD in ART-based regimens compared with zidovudine alone.

Determination of Anterior Fontanelle Size among Apparently Healthy Term Newborns in North Central Nigeria

BACKGROUND

Anterior fontanelles (AFs) of healthy newborn infants vary widely in size, this being a function of race, geographical location, gender, birth weight, mode of delivery and gestation. Abnormal variations in AF size portend a serious pathology of the cranium or intracranial structures. The established reference value for normal AF size is, therefore, an essential diagnostic tool. This study was conducted to determine the mean AF size and factors that are associated with its variability among apparently healthy term neonates in Lokoja, North Central Nigeria.

METHODS

AF size was measured in 200 healthy inborn term neonates between 24 and 48 h post-delivery using a modified version of Mattur's method. Other parameters measured were head circumference, birth weight and length. Relevant statistical methods were used for data analysis, and P < 0.05 at a confidence interval of 95% was considered statistically significant.

RESULTS

Eighty-six (43%) of the babies were males, and the mean birth weight and gestation were 3.09 (0.37) kg and 38.8 (1.2) weeks, respectively. Majority (72%) were delivered spontaneously per vagina. The mean (± SD) AF size of the study neonates was 2.62 (0.72) cm (2.53 [0.61] cm in males and 2.69 [0.79] cm in females). Neither gender nor mode of delivery affected AF size significantly. There was no significant correlation between AF size and occipitofrontal circumference.

CONCLUSION

AF size for term babies in our hospital differs from AF sizes reported from other parts of the world, further reiterating the utility of local/regional neonatal AF reference values.

Epidemiology and Outcomes of Neonatal Sepsis: Experience from a Tertiary Australian NICU

INTRODUCTION

Neonatal sepsis is associated with significant mortality and morbidity. Low-middle-income countries are disproportionately affected, but late-onset sepsis (LOS) still occurs in up to 20% of infants <28 weeks in high-income countries. Understanding site-specific data is vital to guide management.

METHODS

A retrospective cohort study was conducted at King Edward Memorial Hospital (KEMH), Perth. Infants admitted between January 2012 and June 2022 were included. Data were extracted from routine electronic databases. Incidence and aetiology of sepsis were determined and the association of sepsis with neonatal outcomes analysed.

RESULTS

During the study period, 23,395 newborns were admitted with a median gestation of 37 weeks and birth weight of 2,800 g. There were 370 sepsis episodes in 350 infants; 102 were early-onset sepsis (EOS) (1.6 per 1,000 live births), predominantly Streptococcus agalactiae (35, 34.3%) and Escherichia coli (27, 26.5%); 268 were LOS (0.9 per 1,000 inpatient days), predominantly coagulase-negative staphylococci (CONS) (156, 57.6%) and E. coli (30, 11.1%). The incidence of LOS declined from 2012 to 2022 (p = 0.002). Infants with EOS had increased brain injury (25.7% vs. 4.1%; p = 0.002) and mortality (18.8% vs. 1.6%; p < 0.001). Those with LOS had increased hospital stay (median 95 vs. 15 days; p < 0.001), mortality (15.3% vs. 1.6%; p = 0.018), necrotising enterocolitis (NEC) (7.4% vs. 0.5%; p < 0.001), and chronic lung disease (CLD) (58.1% vs. 5.9%; p = 0.005). Infants <28 weeks with sepsis were at increased risk of neurodevelopmental impairment compared to those without infection (43.2% vs. 30.9%, p = 0.027).

CONCLUSIONS

While we observed a reduction in LOS incidence, sepsis remains associated with higher mortality, and in survivors with longer hospital stay and increased risk of brain injury, NEC, CLD, and neurodevelopmental impairment.

Effectiveness of kangaroo mother care before clinical stabilisation versus standard care among neonates at five hospitals in Uganda (OMWaNA): a parallel-group, individually randomised controlled trial and economic evaluation

BACKGROUND

Preterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends kangaroo mother care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing up to 2000 g.

METHODS

We conducted a parallel-group, individually randomised controlled trial in five hospitals across Uganda. Singleton or twin neonates aged younger than 48 h weighing 700-2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver's chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432.

FINDINGS

Between Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74-1·28]; p=0·85). From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71-1·09]; p=0·23). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care.

INTERPRETATION

KMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa.

FUNDING

Joint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Estimation of Reference Values for External Genitalia Parameters in North Indian Preterm and Term Female Newborns

OBJECTIVES

To establish gestation-wise normative data of external genitalia measurements in North Indian term and preterm female newborns.

METHODS

In this cross-sectional descriptive study, institutionally-born female neonates between 28-42 wk gestation were consecutively enrolled between 24-72 h of life. Newborns with major congenital malformations, chromosomal anomalies, multifetal gestation and birth injuries were excluded. Data on various genital measurements were collected [Clitoral length (CL), clitoral width (CW), ano-clitoral distance (AGDAC), ano-fourchette distance (AGDAF) and anogenital ratio (AGR)].

RESULTS

One hundred ninety-eight of 508 neonates (39%) were preterm and 310 (61%) were term. Mean (± SD) CL and CW were 4.6 ± 1.8 mm and 3.9 ± 1.6 mm, respectively. Mean (± SD) values for AGDAF, AGDAC and AGR were 9.3 ± 1.8 mm, 30.2 ± 3.9 mm, and 0.31 ± 0.05, respectively. According to these results, term female newborns with CL more than 7 mm and/or CW more than 6 mm (95th centile) warrant evaluation for clitoromegaly. An anogenital ratio greater than 0.45 should be considered as a sign of virilization in a female neonate. Gestation-wise percentile charts for CL, CW, AGDAF, AGDAC and AGR were generated.

CONCLUSIONS

The percentile values defined in the study can serve as local normative data for accurate interpretation of genital measurements in North Indian female newborns and enable health care professionals for early identification of genital virilization.

Thoracic fluid content (TFC) using electrical cardiometry versus lung ultrasound in the diagnosis of transient tachypnea of newborn

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm-1)] compared to NLD group [32.95 ± 4.59 (1 KOhm-1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm-1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes' score, TTN score, and duration of oxygen therapy in the TTN group.   Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress. What is Known: • Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. • TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN. What is New: • Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score.

Estimation of Reference Values for External Genitalia Parameters in North Indian Preterm and Term Male Newborns

OBJECTIVES

To generate gestation-wise normative data of external genitalia measurements in North Indian term and preterm male newborns.

METHODS

This was a hospital-based cross-sectional observational study. Male neonates born between 28-42 wk of gestation (at 24-72 h of life) were consecutively recruited in the study. Newborns with major congenital malformations, chromosomal anomalies, multifetal gestation and birth injuries were excluded. Data on various genital measurements were collected [Stretched penile length (SPL), penile width (PW), upper anogenital distance (AGDu), lower anogenital distance (AGDl) and anogenital ratio (AGR)].

RESULTS

Out of 532 newborns, 208 (39.1%) were preterm. Mean (± SD) SPL and PW were 27.9 ± 3.6 mm and 10.6 ± 1.3 mm respectively. The mean values for AGDl, AGDu and AGR were 20.13 ± 4.04 mm, 39.2 ± 5.59 mm, and 0.51 ± 0.07, respectively. SPL less than 21 mm in a term male newborn and 17.5 mm in preterm should be considered micropenis (<2.5 SD) in our population. Gestation-wise percentile charts for SPL, PW, AGDl, AGDu and AGR were generated.

CONCLUSIONS

The reference values and percentile charts generated can serve as local normative data for accurate interpretation of genital measurements in North Indian newborns, assessment of ambiguous genitalia and avoiding diagnostic errors.

Non-invasive high-frequency ventilation in newborn infants with respiratory distress

BACKGROUND

Respiratory distress occurs in up to 7% of newborns, with respiratory support (RS) provided invasively via an endotracheal (ET) tube or non-invasively via a nasal interface. Invasive ventilation increases the risk of lung injury and chronic lung disease (CLD). Using non-invasive strategies, with or without minimally invasive surfactant, may reduce the need for mechanical ventilation and the risk of lung damage in newborn infants with respiratory distress.

OBJECTIVES

To evaluate the benefits and harms of nasal high-frequency ventilation (nHFV) compared to invasive ventilation via an ET tube or other non-invasive ventilation methods on morbidity and mortality in preterm and term infants with or at risk of respiratory distress.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL and three trial registries in April 2023.

SELECTION CRITERIA

Randomised controlled trials (RCTs), cluster- or quasi-RCTs of nHFV in newborn infants with respiratory distress compared to invasive or non-invasive ventilation.

DATA COLLECTION AND ANALYSIS

Two authors independently selected the trials for inclusion, extracted data, assessed the risk of bias, and undertook GRADE assessment.

MAIN RESULTS

We identified 33 studies, mostly in low- to middle-income settings, that investigated this therapy in 5068 preterm and 46 term infants. nHFV compared to invasive respiratory therapy for initial RS We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 0.67, 95% CI 0.20 to 2.18; 1 study, 80 infants) or the incidence of CLD (RR 0.38, 95% CI 0.09 to 1.59; 2 studies, 180 infants), both very low-certainty. ET intubation, death or CLD, severe intraventricular haemorrhage (IVH) and neurodevelopmental disability (ND) were not reported. nHFV vs nasal continuous positive airway pressure (nCPAP) used for initial RS We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 1.00, 95% CI 0.41 to 2.41; 4 studies, 531 infants; very low-certainty). nHFV may reduce ET intubation (RR 0.52, 95% CI 0.33 to 0.82; 5 studies, 571 infants), but there may be little or no difference in CLD (RR 1.35, 95% CI 0.80 to 2.27; 4 studies, 481 infants); death or CLD (RR 2.50, 95% CI 0.52 to 12.01; 1 study, 68 participants); or severe IVH (RR 1.17, 95% CI 0.36 to 3.78; 4 studies, 531 infants), all low-certainty evidence. ND was not reported. nHFV vs nasal intermittent positive-pressure ventilation (nIPPV) used for initial RS nHFV may result in little to no difference in mortality before hospital discharge (RR 1.86, 95% CI 0.90 to 3.83; 2 studies, 84 infants; low-certainty). nHFV may have little or no effect in reducing ET intubation (RR 1.33, 95% CI 0.76 to 2.34; 5 studies, 228 infants; low-certainty). There may be a reduction in CLD (RR 0.63, 95% CI 0.42 to 0.95; 5 studies, 307 infants; low-certainty). A single study (36 infants) reported no events for severe IVH. Death or CLD and ND were not reported. nHFV vs high-flow nasal cannula (HFNC) used for initial RS We are very uncertain whether nHFV reduces ET intubation (RR 2.94, 95% CI 0.65 to 13.27; 1 study, 37 infants) or reduces CLD (RR 1.18, 95% CI 0.46 to 2.98; 1 study, 37 participants), both very low-certainty. There were no mortality events before hospital discharge or severe IVH. Other deaths, CLD and ND, were not reported. nHFV vs nCPAP used for RS following planned extubation nHFV probably results in little or no difference in mortality before hospital discharge (RR 0.92, 95% CI 0.52 to 1.64; 6 studies, 1472 infants; moderate-certainty). nHFV may result in a reduction in ET reintubation (RR 0.42, 95% CI 0.35 to 0.51; 11 studies, 1897 infants) and CLD (RR 0.78, 95% CI 0.67 to 0.91; 10 studies, 1829 infants), both low-certainty. nHFV probably has little or no effect on death or CLD (RR 0.90, 95% CI 0.77 to 1.06; 2 studies, 966 infants) and severe IVH (RR 0.80, 95% CI 0.57 to 1.13; 3 studies, 1117 infants), both moderate-certainty. We are very uncertain whether nHFV reduces ND (RR 0.92, 95% CI 0.37 to 2.29; 1 study, 74 infants; very low-certainty). nHFV versus nIPPV used for RS following planned extubation nHFV may have little or no effect on mortality before hospital discharge (RR 1.83, 95% CI 0.70 to 4.79; 2 studies, 984 infants; low-certainty). There is probably a reduction in ET reintubation (RR 0.69, 95% CI 0.54 to 0.89; 6 studies, 1364 infants), but little or no effect on CLD (RR 0.88, 95% CI 0.75 to 1.04; 4 studies, 1236 infants); death or CLD (RR 0.92, 95% CI 0.79 to 1.08; 3 studies, 1070 infants); or severe IVH (RR 0.78, 95% CI 0.55 to 1.10; 4 studies, 1162 infants), all moderate-certainty. One study reported there might be no difference in ND (RR 0.88, 95% CI 0.35 to 2.16; 1 study, 72 infants; low-certainty). nHFV versus nIPPV following initial non-invasive RS failure nHFV may have little or no effect on mortality before hospital discharge (RR 1.44, 95% CI 0.10 to 21.33); or ET intubation (RR 1.23, 95% CI 0.51 to 2.98); or CLD (RR 1.01, 95% CI 0.70 to 1.47); or severe IVH (RR 0.47, 95% CI 0.02 to 10.87); 1 study, 39 participants, all low- or very low-certainty. Other deaths or CLD and ND were not reported.

AUTHORS' CONCLUSIONS

For initial RS, we are very uncertain if using nHFV compared to invasive respiratory therapy affects clinical outcomes. However, nHFV may reduce intubation when compared to nCPAP. For planned extubation, nHFV may reduce the risk of reintubation compared to nCPAP and nIPPV. nHFV may reduce the risk of CLD when compared to nCPAP. Following initial non-invasive respiratory support failure, nHFV when compared to nIPPV may result in little to no difference in intubation. Large trials, particularly in high-income settings, are needed to determine the role of nHFV in initial RS and following the failure of other non-invasive respiratory support. Also, the optimal settings of nHVF require further investigation.

Thyroid Function Test in Preterm Neonates: Normative Data

Introduction

Initial surge of thyroid-stimulating hormone (TSH) in neonates increases free and total triiodothyronine (T3) and tetraiodothyronine (T4) in 24-36 hours following birth, and the effect then gradually wanes off. As somatic and intellectual development is dependent on normal thyroid function especially in infancy, normative data in these children may be of immense value to diagnose hypothyroidism in this subset of infants. Comprehensive normative values of thyroid function parameters in preterm neonates are scarcely available. The objective of this study was to determine the normative value of thyroid function parameters in preterm neonates.

Methods

Preterm neonates (n = 102) born at 34 and 35 weeks of gestation of euthyroid mothers from an iodine-sufficient population were evaluated for T3, T4, free thyroxine (FT4) and TSH during 3-7 days after birth and again after 1 month. The expected date of delivery (EDD) and Ballard score were used to identify the duration of gestation.

Results

The mean gestational age was 34.7 ± 0.41 weeks. The mean (± SD) for T3 (ng/dl), T4 (μg/dl), FT4 (ng/ml) and TSH (μIU/ml) on days 3-7 following birth was as follows: 156 ± 44.6, 12.8 ± 3.7, 1.50 ± 0.54 and 7.13 ± 6.04, respectively. Around 4 weeks of age, values changed to 104 ± 38.4, 12.1 ± 4.02, 1.46 ± 0.42 and 3.25 ± 2.85, respectively. All parameters changed significantly around 4 weeks, except FT4. None of the parameters were correlated with gestational age or body weight at birth. Normative values for each parameter in percentiles were generated.

Conclusion

This study generated the normative values of the thyroid function test during the first week and after around 4 weeks of life for premature neonates (born at 34-35 weeks).

Safety and efficacy of dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial

BACKGROUND

The cornerstone of malaria prevention in pregnancy, intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine, is contraindicated in women with HIV who are receiving co-trimoxazole prophylaxis. We assessed whether IPTp with dihydroartemisinin-piperaquine is safe and effective in reducing the risk of malaria infection in women with HIV receiving co-trimoxazole prophylaxis and antiretroviral drugs.

METHODS

For this randomised, double-blind, placebo-controlled clinical trial, women with HIV attending the first antenatal care clinic visit, resident in the study area, and with a gestational age up to 28 weeks were enrolled at five sites in Gabon and Mozambique. Participants were randomly assigned (1:1) to receive either IPTp with dihydroartemisinin-piperaquine at each scheduled antenatal care visit plus daily co-trimoxazole (intervention group) or placebo at each scheduled antenatal care visit plus daily co-trimoxazole (control group). Randomisation was done centrally via block randomisation (block sizes of eight), stratified by country. IPTp was given over 3 days under direct observation by masked study personnel. The number of daily IPTp tablets was based on bodyweight and according to the treatment guidelines set by WHO (target dose of 4 mg/kg per day [range 2-10 mg/kg per day] of dihydroartemisinin and 18 mg/kg per day [range 16-27 mg/kg per day] of piperaquine given once a day for 3 days). At enrolment, all participants received co-trimoxazole (fixed combination drug containing 800 mg trimethoprim and 160 mg sulfamethoxazole) for daily intake. The primary study outcome was prevalence of peripheral parasitaemia detected by microscopy at delivery. The modified intention-to-treat population included all randomly assigned women who had data for the primary outcome. Secondary outcomes included frequency of adverse events, incidence of clinical malaria during pregnancy, and frequency of poor pregnancy outcomes. All study personnel, investigators, outcome assessors, data analysts, and participants were masked to treatment assignment. This study is registered with ClinicalTrials.gov, NCT03671109.

FINDINGS

From Sept 18, 2019, to Nov 26, 2021, 666 women (mean age 28·5 years [SD 6·4]) were enrolled and randomly assigned to the intervention (n=332) and control (n=334) groups. 294 women in the intervention group and 308 women in the control group had peripheral blood samples taken at delivery and were included in the primary analysis. Peripheral parasitaemia at delivery was detected in one (<1%) of 294 women in the intervention group and none of 308 women in the control group. The incidence of clinical malaria during pregnancy was lower in the intervention group than in the control group (one episode in the intervention group vs six in the control group; relative risk [RR] 0·12, 95% CI 0·03-0·52, p=0·045). In a post-hoc analysis, the composite outcome of overall malaria infection (detected by any diagnostic test during pregnancy or delivery) was lower in the intervention group than in the control group (14 [5%] of 311 women vs 31 [10%] of 320 women; RR 0·48, 95% CI 0·27-0·84, p=0·010). The frequency of serious adverse events and poor pregnancy outcomes (such as miscarriages, stillbirths, premature births, and congenital malformations) did not differ between groups. The most frequently reported drug-related adverse events were gastrointestinal disorder (reported in less than 4% of participants) and headache (reported in less than 2% of participants), with no differences between study groups.

INTERPRETATION

In the context of low malaria transmission, the addition of IPTp with dihydroartemisinin-piperaquine to co-trimoxazole prophylaxis in pregnant women with HIV did not reduce peripheral parasitaemia at delivery. However, the intervention was safe and associated with a decreased risk of clinical malaria and overall Plasmodium falciparum infection, so it should be considered as a strategy to protect pregnant women with HIV from malaria.

FUNDING

European and Developing Countries Clinical Trials Partnership 2 (EDCTP2) and Medicines for Malaria Venture.

TRANSLATIONS

For the Portuguese and French translations of the abstract see Supplementary Materials section.

Differences When Classifying Small for Gestational Age Preterm Infants According to the Growth Chart Applied

OBJECTIVE

Consensus around the ideal chart to classify preterm babies is scant. It is particularly relevant in small for gestational age (SGA) infants due to its clinical and therapeutic implications. The aim of the study was to compare Olsen, Intergrowth-21st, and Fenton growth charts, regarding the classification at birth and incidence of SGA preterm infants.

STUDY DESIGN

Retrospective study of 529 preterm infants ≤ 32 weeks of gestational age. Birth weight Z-score was calculated applying the three growth charts and ponderal index (PI) was also estimated. Incidence of SGA (birth weight < 10th percentile) and clinical outcome were compared according to the chart used.

RESULTS

Incidence of SGA was significantly higher (p < 0.001) with Olsen (101 cases, 19.1%) compared with Intergrowth-21st (75 cases, 14.2%) and Fenton (53 cases, 10%). Differences were also found with PI of SGA preterm infants, as those infants classified by Olsen were mostly symmetric (PI > 10th percentile), while Fenton and Intergrowth-21st identified less symmetric SGA infants. Kappa concordance between Intergrowth-21st and Fenton was 0.805, Intergrowth-21st versus Olsen 0.824, and Fenton versus Olsen 0.641. No differences were observed on neonatal morbidities or mortality.

CONCLUSION

Significant differences were detected when classifying very preterm infants at birth according to the growth chart, mainly among symmetric SGA. Concordance between Fenton and Olsen was poor, but Intergrowth-21st showed high concordance with Fenton and Olsen. However, further research is needed to select the ideal chart. Variability in the population selected to create the curves and the accuracy dating the pregnancy are factors that may have explained differences.

KEY POINTS

· Very preterm infants are differently classified at birth with various growth charts.. · Higher incidence of small for gestational age infants with Olsen compared with Fenton or Intergrowth.. · Variability in population selection and accuracy in dating pregnancy may have explained differences..

AT, Devadas S, Fattepur S, Basett P, Thayyil S. Development and Validation of a Neonatal Physical Maturity Score for Low- and Middle-Income Countries

OBJECTIVE

Currently available gestational age scoring systems are complex and inaccurate for wider use in low- and middle-income countries (LMIC), particularly in infants with neonatal encephalopathy. Here, we aimed to develop a scoring system based on physical characteristics for identifying late preterm infants from term infants.

STUDY DESIGN

This was a prospective observational study conducted in 2 phases- the discovery phase and validation phase. In the first phase, we examined the accuracy of 10 objective physical characteristics in a prospective cohort of 1,006 infants recruited from three hospitals in South India. A weighted scoring system and a photo card were then developed based on the six best performing characteristics which were validated in another prospective cohort of 1,004 infants.

RESULTS

The final score had a sensitivity of 66.0% (95% confidence intervals [CIs], 58.4-73.8%), specificity of 80.0% (95% CI, 77.2-82.7%), and a negative predictive value of 93.0% (95% CI, 90.5-94.5%).

CONCLUSION

This scoring system may have wider applications in LMIC, particularly in community settings and in infants with neonatal encephalopathy.

KEY POINTS

· This is an easily administered scoring system using physical characters to identify late preterm infants.. · The scoring is not affected by neurological injury and can be used in encephalopathic infants.. · Overall accuracy is better than previous scores encompassing the physical criteria alone..

Evaluating the Clinical Risk Index for Babies (CRIB) II Score for Mortality Prediction in Preterm Newborns: A Prospective Observational Study at a Tertiary Care Hospital

INTRODUCTION

Neonatal mortality is an issue that affects both the developed and developing world. It is very important in the neonatal intensive care unit (NICU) to do the assessment of the severity of neonatal illness, which in turn helps in estimating and preventing mortality in the NICU by improving healthcare control and by rational use of resources. This research was carried out to evaluate how effectively the Clinical Risk Index for Babies (CRIB) II score can predict mortality rates among newborns treated in our NICU.  Methodology: This prospective observational study spanned one year, commencing in October 2021 and concluding in September 2022, within the confines of our NICU. The CRIB II score calculation was performed for included newborns, and the outcomes of the newborns were compared. A receiver operating characteristic (ROC) curve was obtained to ascertain the optimal CRIB II cut-off score for predicting mortality.

RESULTS

Within the designated research timeframe, 292 neonates were admitted to the NICU. Forty-four newborns were enrolled in the study. Preterm neonates who died had higher CRIB II scores than those who survived, and their median (IQR) was 6 (1-12) vs. 9.5 (5-14) (p=0.0003). The estimate for the area under the curve was 0.83 (95% CI 0.68-0.92), and the odds ratio of 2.56 suggests neonates with a higher CRIB II score have higher chances of mortality.

CONCLUSION

The CRIB II score is very good at predicting mortality in preterm newborns.

Agreement between Hammersmith Neonatal Neurological Examination (HNNE) and Test of Infant Motor Performance (TIMP) in neurodevelopmental assessment of preterm infants <32 weeks' gestation at term corrected age

OBJECTIVES

To determine the agreement between HNNE and TIMP at TCA for preterm infants born <32+0 weeks' gestation, and to evaluate their correlation to PDMS-2 at 12-month corrected age (CA).

METHODS

Infants born between November 2013 to June 2022 who had both HNNE and TIMP performed at TCA of 37+0-41+6 weeks gestation, and motor outcome assessed using the PDMS-2 at 12-month old were enrolled. The HNNE and 12-month PDMS-2 findings were categorized as optimal vs sub-optimal. TIMP was categorized as typical vs atypical. Cohen's kappa was used to determine the agreement between HNNE and TIMP. Sensitivity analysis and Receiver Operating Characteristic (ROC) curves were used to evaluate the predictive values of HNNE and TIMP on motor outcome at CA of 12-months.

RESULTS

HNNE and TIMP done on 125 infants at TCA do not show reliable agreement. HNNE demonstrated slight and fair agreement with the 12-month Total Motor Quotient (TMQ) and Fine Motor Quotient (FMQ) of the PDMS-2 respectively. TIMP at TCA demonstrated fair agreement with all sub-domains of motor function on PDMS-2 at 12-months. In comparison with TIMP, HNNE at TCA is more sensitive at predicting suboptimal total, gross and fine motor outcomes at 12-month CA with sensitivity of 68.4 %, 51.9 %, and 83.3 % vs 44.4 %, 31.8 % and 53.3 % respectively. Atypical TIMP at TCA is more specific for suboptimal total, gross and fine motor outcomes at 12-month CA with specificity of 90.3 %, 89 % and 90.5 % respectively. Neurobehavioral assessments at TCA using HNNE and TIMP were predictive of suboptimal fine motor quotient at CA of 12-months with AUC of 0.760 (p = 0.011) and 0.718 (p = 0.032) respectively. The difference in AUC between the 2 instruments of 0.042 was not statistically significant (p = 0.741).

CONCLUSIONS

While the HNNE and TIMP done at TCA did not demonstrate significant agreement, suboptimal HNNE and atypical TIMP at TCA were predictive of suboptimal FMQ on PDMS-2 at 12-month CA.

Assessment of vitamin status; A, E and D in Egyptian neonates with IUGR: a cross sectional study

BACKGROUND

Neonates with intrauterine growth retardation (IUGR) may present with fatal complications and permanent serious consequences. Vitamin status may influence fetal development. In this study we assessed vitamin A, E and D concentrations in umbilical cord blood in newborns with IUGR.

METHODS

Maternal data were obtained. Neonatal assessment included; age of gestation calculated from last menstrual period, Ultrasound (U/S), new Ballard, Apgar scores and anthropometric measurements including; Head circumference, length and weight. WHO growth percentile curves were used. Vitamin A, E and D in cord blood samples were measured by high performance liquid chromatography (HPLC) and ELISA consecutively.

RESULTS

A total of 86 full term newborns were enrolled in this study, 42 (48.8%) with IUGR with gestational age (33.59 ± 1.20) week by U/S and 44 (51.2%) appropriate for gestational age neonates with gestational age (38.70 ± 1.50). Ballard and Apgar scores (p < 0.05) and Z scores for weight, length and head circumference (p < 0.001) at birth were significantly lower in neonates with Intrauterine growth retardation (IUGR) than appropriate for gestational age (AGA) neonates. The levels of Vitamin A, E and D were significantly lower in the IUGR group than the AGA (p < 0.05) for all. Significant positive correlations of weight with vitamin A, and E cord blood levels were found (p < 0.05), while length was significantly positively correlated only with vitamin A (p < 0.05). Head circumference showed significant positive correlations with the three vitamins (p < 0.05) for all.

CONCLUSION

Neonates with IUGR had significantly lower levels of Vitamin A, E and D than AGA neonates. Significant positive correlations of weight with vitamin A, and E cord blood levels was detected, while neonatal length was associated only with vitamin A level. The present study highlights the significance of nutritional policies for inhibiting deficiency of these vitamins during pregnancy and childhood.

Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade

OBJECTIVE

Bronchopulmonary dysplasia (BPD) is one of the most serious complications affecting extremely preterm infants. We aimed to evaluate temporal trends in BPD and administration of respiratory support among extremely preterm infants in China over a decade.

METHODS

This was a retrospective study using data from a multicenter database, which included infants born less than 28 weeks' gestation discharged from 68 tertiary neonatal care centers in China between 2010 and 2019. Changes in rates and severity of BPD, as well as modalities and duration of respiratory support, were evaluated.

RESULTS

Among 4808 eligible infants with gestational age (GA) of 21+6/7  to 27+6/7 weeks and a mean (SD) birth weight of 980 (177) g, no significant change of median GA was found over time. Overall, 780 (16.2%) infants died before 36 weeks' postmenstrual age, 2415 (50.2%) were classified as having no BPD, 917 (19.1%) developed Grade 1 BPD, 578 (12.0%) developed Grade 2 BPD, and 118 (2.5%) developed Grade 3 BPD. The rate of BPD increased from 20.8% in 2010 to 40.7% in 2019 (aRR for trend, 1.081; 95% confidence interval, 1.062-1.099), especially for Grade 1 and Grade 2. Although survival to discharge improved over the decade, the overall survival without BPD did not change during the study period. The use of invasive mechanical ventilation (IMV) remained unchanged. However, the use of noninvasive ventilation (NIV) increased from 71.5% in 2010 to 89.8% in 2019. Moreover, the median duration of NIV increased over time, from 17.0 (4.8, 34.0) days in 2010 to 33.0 (21.0, 44.0) days in 2019, without significant change in the duration of IMV.

CONCLUSIONS

Although survival increased over the decade and respiratory support practices changed significantly between 2010 and 2019 in China, with increased use and duration of NIV, there was an increased rate of BPD and survival without BPD has not improved.

Neonatal Assessment: Put Your Best Foot Forward

BACKGROUND

Assessment of the foot is an essential part of the newborn examination. Foot abnormalities range from an isolated deformity due to intrauterine positioning to a functional impairment due to a structural malformation. The purpose of this article is to review assessment, abnormal findings, and current treatment options of common foot deformities.

EVIDENCE ACQUISITION

A review of literature was conducted using keywords in PubMed, Google Scholar, and CINAHL databases from 2018 to 2023.

RESULTS

Although assessment techniques for the neonatal foot remain the same, recent nonsurgical treatment options are available for a variety of neonatal foot deformities. Early recognition allows for proper evaluation of foot deformities and corrective measures.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Neonatal providers equipped with knowledge of common foot problems can provide support and anticipatory guidance to families.

Predictive values and correlation of CRIB Score II and perfusion index in assessment of severity of illness in sick preterm neonates: An observational study

BACKGROUND

Perfusion index (PI) and CRIB (Clinical risk index of babies) Score II both are minimally invasive tools for prediction of mortality and morbidity in sick neonates. This study aims to know the predictive values of both PI and CRIB Score II in assessment of severity of illness in preterm neonates of 28 to 32 weeks and their correlation.

METHODS

PI and CRIB II Score of 125 sick preterm neonates admitted in NICU were assessed within 12 hours of admission. Severity noted in form of outcome. Correlation between PI and CRIB Score II were observed.

RESULTS

Receiver operating characteristic (ROC) curve were plotted for PI and CIRB Score II with outcome (discharged vs expired). Area under curve for perfusion index was 0.776 at 95% confidence interval. Optimum cutoff point based on ROC curve was 1.65 with sensitivity of 84%., specificity of 37.2% with positive predictive value of 70% and negative predictive value of 57%. Area under curve for CRIB Score II was 0.622 (p value < 0.028), optimum cut off point based on ROC curve for CRIB II score was 3.5 with sensitivity 79.10% of specificity of 40% positive predictive value is 43.03% and negative predictive value of 76.9%. Spearman's correlation coefficient between PI and CRIB II score was -0.272 and p value is 0.002.

CONCLUSION

This study concluded that perfusion index (p < 0.001) is better for predicting the severity compared to CRIB II score (p < 0.028). A weak negative correlation exists between PI and CRIB II score (r = -0.272).

Estimating gestational age using the anthropometric measurements of newborns in North Shewa Zone public hospitals, Oromia, Ethiopia

BACKGROUND

The accurate estimation of gestational age is crucial in identifying prematurity and other health problems in newborns and in providing appropriate perinatal care. Although there are numerous methods for measuring gestational age, they are not always applicable. During these situations, it becomes challenging to ascertain whether a baby has been born prematurely or not. Therefore, this study aims to estimate gestational age by utilizing newborn anthropometric parameters.

PURPOSE

The objective of this study is to estimate the gestational age of newborns in public hospitals located in the North Shewa Zone of the Oromia Region in Ethiopia, by using anthropometric parameters.

METHODS

A cross-sectional study was conducted at a facility from February 2022 to April 2022, using an interview-based questionnaire and anthropometric measurements. The anthropometric parameters that were measured include foot length (FL), mid-upper arm circumference (MUAC), and chest and head circumference (CHC). The study's sample size had a total of 420 participants. The data were cleaned, edited, manually checked for completeness, and entered into Epi-data version 3.1. Subsequently, the data were transferred into SPSS for analysis. The data were analyzed using descriptive analysis, simple linear regression, and multiple linear regressions. Finally, the data were presented using statements and tables.

RESULTS

There is a significant and positive correlation between anthropometric parameters, including head circumference (r: 0.483), MUAC (r: 0.481), foot length (r: 0.457), and chest circumference (r: 0.482) with gestational age. All anthropometric parameters demonstrated positive and significant estimates of gestational age. The combination of the four measurements yielded the strongest estimate of gestational age. Gestational age can be calculated by the formula: Gestational age (Weeks) = 9.78 + 0.209*CHC + 0.607*MUAC + 0.727*FL + 0.322*HC.

CONCLUSION

Gestational age can be measured using head circumference, mid-upper arm circumference, foot length, and chest circumference. Utilizing the four anthropometric parameters in combination exhibits greater efficacy in estimating gestational age than using them individually. Therefore, it is recommended to use these alternative approaches when standard methods are not applicable.

Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series

PURPOSE

To describe the evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy (HIE) during hospitalisation.

METHOD

A longitudinal cohort study was used. Twenty-nine participants (median age 39.0 weeks [IQR = 2.0 weeks]) with mild (n = 7), moderate (n = 19) and severe (n = 3) HIE were included. Clinical swallowing and feeding assessments were conducted at introduction of oral feeds and at discharge using the Neonatal Feeding Assessment Scale (NFAS). Videofluoroscopic swallow studies (VFSS) supplemented the NFAS before discharge.

RESULT

Approximately two thirds of participants showed symptoms of oropharyngeal dysphagia (OPD) during initial NFAS and VFSS. Significantly fewer OPD symptoms occurred at discharge NFAS (p = 0.004). Endurance during non-nutritive sucking (p < 0.001) and nutritive sucking (p < 0.001) significantly improved. Nine participants (31.0%) demonstrated penetration or aspiration. Most aspiration events were silent (60%). Instrumental assessment identified pharyngeal phase dysphagia more effectively than bedside evaluation. High proportions of participants displayed OPD symptoms regardless of HIE severity. The correlation between OPD severity and the length of hospitalisation (p = 0.052) was not significant.

CONCLUSION

All grades of HIE should be considered for early intervention by speech-language pathologists before discharge. Findings may be valuable to neonatal feeding teams.

Influence of umbilical cord vitamin D serum levels on the growth of preterm infants

OBJECTIVE

The aim of this study was to evaluate the influence of serum 25-hydroxyvitamin D [25(OH)D] levels at birth in postnatal growth at discharge and 12 mo of corrected age in preterm infants.

METHODS

This prospective cohort included 63 preterm newborns born before 34 gestational weeks evaluated from birth until 12 mo of corrected age. The serum 25(OH)D levels in umbilical cord blood and from their mothers were evaluated at delivery.

RESULTS

The mean 25(OH)D levels in preterm newborns were higher than maternal levels (24.8 ± 13.3 ng/mL versus 21 ± 10.2 ng/mL, P < 0.001) and showed a moderate correlation between (r = 0.548; P < 0.001). Considering the body mass index Z-score at 12 mo, 3 (10%), 25 (83%), and 2 (7%) of the preterm infants were thin, had normal body mass index, and were overweight, respectively. The 25(OH)D levels in the umbilical cord did not influence the anthropometric indicators at hospital discharge and 12 mo of corrected age. We observed improvement in all anthropometric indicators assessed over the months, and there was no difference between preterm infants with 25(OH)D levels >20 ng/mL and <20 ng/mL in the umbilical cord.

CONCLUSIONS

The results of this study suggested that the 25(OH)D serum levels in the umbilical cord did not influence postnatal growth from birth to the first year of life in preterm infants. There was a direct association between maternal and umbilical cord serum 25(OH)D levels.

Respiratory distress syndrome prediction at birth by optical skin maturity assessment and machine learning models for limited-resource settings: a development and validation study

Background

A handheld optical device was developed to evaluate a newborn's skin maturity by assessing the photobiological properties of the tissue and processing it with other variables to predict early neonatal prognosis related to prematurity. This study assessed the device's ability to predict respiratory distress syndrome (RDS).

Methods

To assess the device's utility we enrolled newborns at childbirth in six urban perinatal centers from two multicenter single-blinded clinical trials. All newborns had inpatient follow-up until 72 h of life. We trained supervised machine learning models with data from 780 newborns in a Brazilian trial and provided external validation with data from 305 low-birth-weight newborns from another trial that assessed Brazilian and Mozambican newborns. The index test measured skin optical reflection with an optical sensor and adjusted acquired values with clinical variables such as birth weight and prenatal corticoid exposition for lung maturity, maternal diabetes, and hypertensive disturbances. The performance of the models was evaluated using intrasample k-parts cross-validation and external validation in an independent sample.

Results

Models adjusting three predictors (skin reflection, birth weight, and antenatal corticoid exposure) or five predictors had a similar performance, including or not maternal diabetes and hypertensive diseases. The best global accuracy was 89.7 (95% CI: 87.4 to 91.8, with a high sensitivity of 85.6% (80.2 to 90.0) and specificity of 91.3% (95% CI: 88.7 to 93.5). The test correctly discriminated RDS newborns in external validation, with 82.3% (95% CI: 77.5 to 86.4) accuracy. Our findings demonstrate a new way to assess a newborn's lung maturity, providing potential opportunities for earlier and more effective care.

Trial registration

RBR-3f5bm5 (online access: http://www.ensaiosclinicos.gov.br/rg/RBR-3f5bm5/), and RBR-33mjf (online access: https://ensaiosclinicos.gov.br/rg/RBR-33rnjf/).

High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

AIM

To assess the inter-rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score-based treatment for preterm infants with respiratory distress.

METHODS

We included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4.

RESULTS

Of the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score-based treatment.

CONCLUSION

Incorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near-perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score-based treatment recommendations. These results highlight an opportunity for task-shifting assessments and empowering nurses.