Search Results (1,150)

Background and Objectives: Donor human milk (DHM) from a human milk bank (HMB) is used to feed low-birthweight (LBW) and preterm infants when mothers cannot provide their own breastmilk. The misuse of DHM could interfere with mothers’ breastmilk and weaken breastfeeding efforts. This study aimed to identify factors behind prolonged DHM usage during the first six years of Vietnam’s first HMB. Methods: Data were extracted from the Da Nang HMB’s digital monitoring system. We defined prolonged DHM use as four or more days in the neonatal unit and two or more days in postnatal wards. Results: Over six years, 25,420 infants received DHM, with 45.3% of the infants being female, 54.7% being male, 70.0% being born via cesarean section, and 77.2% being full-term. In the neonatal unit (n = 7001), 38.0% of infants used DHM for ≥4 days. Adjusted odds ratios (aORs) for prolonged use were 0.14 for infants weighing <1000 g, 0.78 for infants weighing 1000–<1500 g, and 0.67 for infants weighing ≥2000 g (p < 0.01), compared to those weighing 1500–<2000 g. Compared to gestational ages of 32–<34 weeks, the aORs were 0.26 for <28 weeks, 0.71 for 34–<37 weeks, and 0.35 for ≥37 weeks (p < 0.01). In postnatal wards (n = 18,419), 53.1% of infants used DHM for ≥2 days. Compared to term, normal-weight infants, the aORs were 1.25 for LBW–preterm, 1.17 for LBW–term, and 1.21 for normal-weight–preterm infants (p < 0.05). Prolonged DHM use was associated with cesarean births in neonatal units (aOR 2.24, p < 0.01) and postnatal wards (aOR 1.44, p < 0.01). Conclusions: DHM is used briefly to bridge nutritional gaps and transition to mothers’ breastmilk, but LBW, preterm births, and cesarean births are linked to prolonged use. Healthcare providers should support those at risk of prolonged DHM use and prioritize reducing unnecessary cesarean births. Full article

Background: Longer duration of deferred cord clamping (DCC), at least 120 s, is associated with the highest reduction in mortality compared to shorter durations of DCC or immediate cord clamping in preterm infants. We compared the neonatal outcomes of very preterm infants who received at least 60 s to those who received at least 120 s of DCC. Methods: This is a retrospective single-center study including preterm infants born <33 weeks of gestational age (GA) between 2014 and 2019. The intended duration of DCC was 60 s in Period 1 (January 2014 to June 2016, n = 139) and 120 to 180 s in Period 2 (July 2016 to December 2019, n = 155). We compared the demographics, delivery room measures, and neonatal outcomes between the two periods as intent-to-treat analysis and per protocol analysis. Results: The intended duration of DCC was completed in 75% of infants in Period 1 (n = 106) and 76% of infants in Period 2 (n = 114). There was an increase in survival without major morbidities in the infants that received at least 120 s of DCC, which remained significant after adjusting for GA and erythropoietin use (Odds ratio 8.6, 95% CI 1.6 to 45.7). Conclusions: Longer duration of DCC is associated with improved survival without major morbidities in preterm infants <33 weeks GA. Full article

Extremely premature infants are at significant risk for developing bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI). Although BPD is a predictor of poor neurodevelopmental outcomes, it is currently unknown how BPD contributes to brain injury and long-term NDI in pre-term infants. Extracellular vesicles (EVs) are small, membrane-bound structures released from cells into the surrounding environment. EVs are involved in inter-organ communication in diverse pathological processes. Inflammasomes are large, multiprotein complexes that are part of the innate immune system and are responsible for triggering inflammatory responses and cell death. Apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) is pivotal in inflammasome assembly and activating inflammatory caspase-1. Activated caspase-1 cleaves gasdermin D (GSDMD) to release a 30 kD N-terminal domain that can form membrane pores, leading to lytic cell death, also known as pyroptosis. Activated caspase-1 can also cleave pro-IL-1β and pro-IL-18 to their active forms, which can be rapidly released through the GSDMD pores to induce inflammation. Recent evidence has emerged that activation of inflammasomes is associated with neonatal lung and brain injury, and inhibition of inflammasomes reduces hyperoxia-induced neonatal lung and brain injury. Additionally, multiple studies have demonstrated that hyperoxia stimulates the release of lung-derived EVs that contain inflammasome cargos. Adoptive transfer of these EVs into the circulation of normal neonatal mice and rats induces brain inflammatory injury. This review focuses on EV–inflammasomes’ roles in mediating lung-to-brain crosstalk via EV-dependent and EV-independent mechanisms critical in BPD, brain injury, and NDI pathogenesis. EV–inflammasomes will be discussed as potential therapeutic targets for neonatal lung and brain injury. Full article

Background/Objectives: To obtain bioelectrical data to assess nutritional status for extremely low-birth-weight (ELBW) infants upon reaching term-corrected age. Methods: A descriptive, observational, prospective, and single-center study, which included ELBW preterm infants was performed. The study variables collected were gestational age, sex, and anthropometry at birth and at term-corrected age. Bioelectrical impedance vector analysis (BIVA) was performed by a phase-sensitive device (BIA 101 BIVA PRO AKERN srl, Pisa, Italy). The components of the impedance vector—resistance (R) and reactance (Xc)—were normalized for body height (H). For each subject, the measurement was taken between the 36th and 44th weeks of postmenstrual age (PMA). A semi-quantitative analysis of body composition was performed using the vector modality of the BIA. Using the RXc graph method, the bivariate 95% confidence intervals of the mean vectors were constructed. From the bivariate normal distribution of R/H and Xc/H, the bivariate 95%, 75%, and 50% tolerance intervals for this cohort were drawn. The individual impedance vectors were compared with the distribution of the vectors from other populations. Results: 85 ELBW infants (40 male, 45 female) were included, with a mean gestational age at birth of 26 + 6 weeks (±1.76). Mean R/H was 870.33 (±143.21) Ohm/m and Xc/H was 86.84 (±19.05) Ohm/m. We found differences in the bioelectrical data with regard to gender, with resistance values being significantly higher in females. Our ellipses align closely with those from other term neonatal cohorts. Conclusions: Bioelectrical data and the confidence and tolerance ellipses of an ELBW infant cohort are presented and can be used as a reference standard for nutritional assessment at discharge. Full article

Background: The COVID-19 pandemic highlighted the global challenge of inadequate data on SARS-CoV-2’s effects on pregnant women and their infants. In response, Slovakia, along with other countries, launched a nationwide study to assess the incidence, characteristics, and outcomes of SARS-CoV-2 infection during pregnancy. Methods: We conducted a national observational descriptive study of SARS-CoV-2 positive cases among pregnant women from the pandemic’s onset to its conclusion. In collaboration with the Public Health Office of the Slovak Republic, we identified 1184 pregnant women who tested positive for SARS-CoV-2 and contacted them for participation. Results: Among the 240 participating SARS-CoV-2-positive pregnant women, 13 required hospitalizations, with an increased need for intensive care and respiratory support. However, the absolute risk of poor outcomes remained low. Higher maternal age and infection during the third trimester emerged as key risk factors for hospitalization. A symptomatic course was dominant, with fatigue (70%), headache (58%), and fever (56%) as the leading symptoms. While maternal and neonatal outcomes were generally favourable, a slight increase in caesarean sections and preterm births suggests an indirect impact on maternity care. Vaccination during pregnancy correlated with reduced symptoms and no hospitalizations. Elevated CRP levels were common among infected women, while ultrasound findings remained normal. Conclusions: This study offers a multi-dimensional view of pregnancy during the pandemic, capturing both the mother’s personal concerns and the objective insights from prenatal and labour care settings. The findings suggest that most pregnant women with SARS-CoV-2 experience mild to moderate illness, offering reassurance to clinicians about generally favourable maternal and neonatal outcomes while underscoring the need for vigilance in rare severe cases. Full article

Bovine colostrum (BC), the first milk secreted by mammals after birth, is a trending alternative source for supplementing infants and children, offering benefits for gut and immune health. Its rich components, such as proteins, immunoglobulins, lactoferrin, and glycans, are used to fortify diets and support development. Preterm development is crucial, especially in the maturation of essential systems, and from 2010 to 2020, approximately 15% of all premature births occurred at less than 32 weeks of gestation worldwide. This review explores the composition, benefits, and effects of BC on general infants and children, along with preterm infants who require special care, and highlights its role in growth and development. BC is also associated with specific pediatric diseases, including necrotizing enterocolitis (NEC), infectious diarrhea, inflammatory bowel disease (IBD), short-bowel syndrome (SBS), neonatal sepsis, gastrointestinal and respiratory infections, and some minor conditions. This review also discusses the clinical trials regarding these specific conditions which are occasionally encountered in preterm infants. The anti-inflammatory, antimicrobial, immunomodulatory, and antiviral properties of BC are discussed, emphasizing its mechanisms of action. Clinical trials, particularly in humans, provide evidence supporting the inclusion of BC in formulas and diets, although precise standards for age, feeding time, and amounts are needed to ensure safety and efficacy. However, potential adverse effects, such as allergic reactions to caseins and immunoglobulin E, must be considered. More comprehensive clinical trials are necessary to expand the evidence on BC in infant feeding, and glycans, important components of BC, should be further studied for their synergistic effects on pediatric diseases. Ultimately, BC shows promise for pediatric health and should be incorporated into nutritional supplements with caution. Full article

Neonatal respiratory distress syndrome (RDS) is a common and potentially life-threatening condition in preterm infants, primarily due to surfactant deficiency. Early and accurate diagnosis is critical to guide timely interventions such as surfactant administration and respiratory support. Traditionally, chest X-rays have been used for diagnosis, but lung ultrasound (LUS) has gained prominence due to its non-invasive, radiation-free, and bedside applicability. Compared to chest X-rays and CT scans, LUS demonstrates superior sensitivity and specificity in diagnosing RDS, particularly in identifying surfactant need and predicting CPAP failure. Additionally, LUS offers real-time imaging without radiation exposure, an advantage over other modalities. However, its broader adoption is limited by challenges in standardizing training, ensuring diagnostic reproducibility, and validating scoring systems, especially in resource-limited settings. This narrative review aims to evaluate the role of LUS in the diagnosis and management of neonatal RDS over the past decade, focusing on its clinical utility, scoring systems, and emerging applications. We reviewed the literature from 2013 to 2023, focusing on studies evaluating LUS’ diagnostic accuracy, scoring systems, and its potential role in guiding surfactant therapy and predicting CPAP failure. Despite its benefits, addressing the variability in operator expertise and integrating artificial intelligence to enhance usability are crucial for ensuring LUS’ efficacy across diverse clinical environments. Future research should prioritize standardizing training and scoring protocols to facilitate wider implementation and optimize neonatal respiratory care outcomes. Full article

Despite the increasing number of placenta accreta spectrum (PAS) cases in recent years, its impact on neonatal outcomes and respiratory morbidity, as well as the underlying pathogenetic mechanism, has not yet been extensively studied. Moreover, no study has yet demonstrated the effectiveness of antenatal corticosteroid therapy (CT) for the prevention of respiratory distress syndrome (RDS) in newborns of mothers with PAS at the molecular level. In this regard, microRNA (miRNA) profiling by small RNA deep sequencing and quantitative real-time PCR was performed on 160 blood plasma samples from preterm infants (gestational age: 33–36 weeks) and their mothers who had been diagnosed with or without PAS depending on the timing of the antenatal RDS prophylaxis. A significant increase in hsa-miR-199a-3p and hsa-miR-382-5p levels was observed in the blood plasma of the newborns from mothers with PAS compared to the control group. A clear trend toward the normalization of hsa-miR-199a-3p and hsa-miR-382-5p levels in the neonatal blood plasma of the PAS groups was observed when CT was administered within 14 days before delivery, but not beyond 14 days. Direct correlations were found among the hsa-miR-382-5p level in neonatal blood plasma and the hsa-miR-199a-3p level in the same sample (r = 0.49; p < 0.001), the oxygen requirements in the NICU (r = 0.41; p = 0.001), the duration of the NICU stay (r = 0.31; p = 0.019), and the severity of the newborn’s condition based on the NEOMOD scale (r = 0.36; p = 0.005). Logistic regression models based on the maternal plasma levels of hsa-miR-199a-3p and hsa-miR-382-5p predicted the need for cardiotonic therapy, invasive mechanical ventilation, or high-frequency oscillatory ventilation in newborns during the early neonatal period, with a sensitivity of 95–100%. According to the literary data, these miRNAs regulate fetal organogenesis via IGF-1, the formation of proper lung tissue architecture, surfactant synthesis in alveolar cells, and vascular tone. Full article

Proper selection and application of preprocessing steps are crucial for obtaining accurate segmentation in brain Magnetic Resonance Imaging (MRI). The aim of this study is to evaluate the impact brain extraction (BE) and bias field correction (BFC) methods have on regional brain volume (RBV) measurements of preterm neonates’ T2w MRI at term-equivalent age (TEA). Five BE methods (Manual, BET2, SWS, HD-BET, SynthStrip) were applied together with two BFC methods (SPM-BFC and N4ITK), before segmenting the neonatal brain into eight tissue classes (cortical grey matter, white matter, cerebral spinal fluid, deep nuclear grey matter, hippocampus, amygdala, cerebellum, and brainstem) using an automated segmentation software (MANTiS). Quantitative assessments were conducted, including the coefficient of variation (CV), coefficient of joint variation (CJV), Dice coefficient (DC), and RBV. HD-BET, together with N4ITK, showed the highest performance (mean ± standard deviation) regarding CV of 0.047 ± 0.005 (white matter) and 0.070 ± 0.005 (grey matter), CJV of 0.662 ± 0.095, DC of 0.942 ± 0.063, and RBV without significant differences (except in the brainstem) from the manual segmentation. Therefore, such combination of methods is recommended for improved skull-stripping accuracy, intensity homogeneity, and reproducibility of RBV of T2w MRI at TEA. Full article

Background/Objectives: The optimal anesthetic technique for category 2 and 3 cesarean deliveries remains debated, with concerns about impacts on decision-to-delivery interval (DDI) and perinatal outcomes. This study examined the influence of epidural, spinal, and general anesthesia on DDI, surgical and postoperative complications, and neonatal outcomes. Methods: This prospective cohort study at a tertiary perinatology center enrolled parturient women undergoing category 2 and 3 cesarean deliveries. Three DDI phases were assessed for each anesthetic modality: transfer time (decision for cesarean section to admission in the operation room), anesthetic time (admission to incision), and delivery time (incision to delivery of the neonate). The surgical procedure time (incision to closure), neonatal (5 min Apgar score, umbilical artery pH/base excess, neonatal intensive care unit (NICU) admission) and maternal (blood loss, surgical and postoperative complications) outcomes were also analyzed for each group. Results: There were 215 women (122 category 2 and 93 category 3) included. The use of epidural and general anesthesia was associated with significantly shortened DDI compared to spinal anesthesia (p < 0.001). This difference was due prolonged transfer (p < 0.05) and anesthetic times (p < 0.001), respectively. No cases of umbilical artery pH below 7 were observed in any group. No significant differences were observed in the incidence of umbilical artery pH between 7 and 7.10 or in base excess below −12 nmol/L (p = 0.416 and p = 0.865, respectively). NICU admission was higher with both general and spinal anesthesia (p = 0.021), but mainly due to a higher proportion of preterm births, both before the 32nd week (p = 0.033) and between the 32nd and 37th week of pregnancy (p < 0.001). General anesthesia was associated with higher maternal blood loss (p = 0.026) and a higher rate of postoperative complications (p = 0.006). Conclusions: In category 2 and 3 cesarean deliveries, general and epidural anesthesia were associated with shorter DDI compared to spinal anesthesia with no differences in neonatal outcomes. General anesthesia was associated with a higher risk of maternal complications compared to neuraxial anesthetic techniques. Full article

Background/Objectives: Maternal skin-to-skin contact (MSSC) in neonates has been shown to reduce nosocomial infections. In preterm infants, exposure to maternal skin commensals within the first 24 h may prevent colonization by hospital-acquired pathogens. However, the impact of early MSSC on skin colonization in preterm infants is unknown. Our aim was to compare skin colonization patterns on days 2, 3, and 7 of life in preterm infants (28^0/7 to 31^6/7 weeks gestational age) who received MSSC within the first 24 h from birth with those who did not. The primary outcome was the rate of skin colonization with bacterial pathogens. The secondary outcome was the rate of Staphylococcus aureus colonization. Methods: This prospective pre- and post-implementation study was conducted at Mount Sinai Hospital, Toronto. Skin swabs were obtained at 24–36 h, 48–72 h, and day 7 of life. Infant mouth and rectal swabs were collected on day 7. Maternal nasal–rectal swabs were obtained at any time from recruitment to day 7. Results: Twenty-seven infants were included in the pre-implementation group and seventeen were included in the post-implementation group, respectively. Post-implementation infants received an increased duration of SSC during the first week. No differences in colonization with pathogens vs. commensals or Staphylococcus aureus colonization were observed between groups at any time point. Skin was fully colonized in both groups by day 7. Conclusions: No differences in skin colonization patterns were identified in the first week of life for preterm infants receiving early MSSC. Larger studies with longitudinal data are needed to further evaluate the impact of MSSC on skin colonization. Full article

Background/Objectives: One of the most effective strategies to mitigate morbidity associated with preterm birth is the use of human milk. The first choice is the mother’s milk; if that is not available, human milk donated to milk banks is the second choice. The recruitment of milk donors is essential for enhancing the effectiveness and efficiency of donation. This study aims to profile the donors of a southern Italian milk bank, examine how maternal and neonatal factors impacted the volume and duration of donation and analyze the trend over the last ten years. Materials and Methods: Data were collected from the milk bank database and hospitalization medical records, encompassing 593 donors and 13 years of activity of the Human Milk Bank from 2010 to 2022. Several variables were assessed: maternal characteristics—maternal age, employment status and the type of profession; pre and perinatal characteristics—type of delivery, parity, previous breastfeeding experience, birth weight and gestational age; milk donation characteristics—volume of milk donated and duration of donation. The trend of the characteristics was studied over time. Statistical correlations were conducted to assess the relationships between variables and the volume and duration of the milk donation. Results: In our cohort of donors, the most prevalent category consists of women over 30 years of age who are multiparous, have prior breastfeeding experience, are workers and have given birth to full-term babies. Maternal age and gestational age significantly influence both the volume and duration of milk donation. The type of delivery and occupation impact the volume of donated milk. There has been a decline in the number of donors over time. However, the trends in both the quantity and duration of milk donations have remained stable over the past decade, with the exception of the year immediately following the COVID-19 pandemic. Conclusions: We have outlined the prevailing average profile of the milk donor to a milk bank in Southern Italy. Factors impacting the volume and duration of donation, such as maternal age, occupation, type of delivery and gestational age, were identified. The volume and duration of donations have remained largely stable, with the exception of 2021, when the pandemic significantly reduced milk donations to the milk bank. Full article

Background: Small vulnerable newborns (SVNs), including those born preterm, small for gestational age, or with low birth weight, are at higher risk of neonatal mortality and long-term health complications. Early exposure to maternal vaginal microbiota and breastfeeding plays a critical role in the development of the neonatal microbiota and immune system, especially in low-resource settings like Burkina Faso, where neonatal mortality rates remain high. Objectives: The DenBalo study aims to investigate the role of maternal and neonatal factors, such as vaginal and gut microbiota, immune development, and early nutrition, in shaping health outcomes in SVNs and healthy infants. Methods: This prospective cohort observational study will recruit 141 mother-infant pairs (70 SVNs and 71 healthy controls) from four health centers in Bobo-Dioulasso, Burkina Faso. The mother-infant pairs will be followed for six months with anthropometric measurements and biospecimen collections, including blood, breast milk, saliva, stool, vaginal swabs, and placental biopsies. Multi-omics approaches, encompassing metagenomics, metabolomics, proteomics, and immune profiling, will be used to assess vaginal and gut microbiota composition and functionality, immune cell maturation, and cytokine levels at critical developmental stages. Conclusions: This study will generate comprehensive data on how microbiota, metabolomic, and proteomic profiles, along with immune system development, differ between SVNs and healthy infants. These findings will guide targeted interventions to improve neonatal health outcomes and reduce mortality, particularly in vulnerable populations. Full article

Premature rupture of membranes (PROM) and cervical incompetence (CI) are major contributors to preterm birth, a leading cause of neonatal morbidity and mortality. Background/Objectives: Disorders of the vaginal microbiota, such as bacterial vaginosis, have been associated with an increased risk of PROM, CI, and subsequent preterm birth. Probiotics, particularly Lactobacillus strains, have been proposed as a preventive strategy to restore and maintain a healthy vaginal microbiome. This review aims to summarize the latest evidence on the role of probiotics in the prevention of PROM and CI. Methods: A comprehensive review was conducted to evaluate the effectiveness of probiotic interventions in the prevention of PROM and CI, yielding 1809 records from 2005 to 2024. Seven relevant studies were selected by searching medical databases and focusing on studies that investigated the restoration of healthy vaginal flora, the reduction of pathogenic bacteria colonization, and the modulation of immune responses by probiotics. Results: The studies analyzed suggest that probiotics may help restore healthy vaginal flora, reduce pathogenic bacterial colonization, and modulate immune responses, thereby reducing the risk of membrane rupture and cervical insufficiency. Evidence from randomized controlled trials and observational studies shows that the use of probiotics is associated with a lower incidence of PROM and preterm birth, especially in high-risk groups. Conclusions: Probiotics emerge as a potential non-invasive and cost-effective strategy to improve pregnancy outcomes in women at risk of preterm birth due to PROM. According to our research, probiotic prophylaxis of cervical insufficiency has not yet been sufficiently investigated. Despite the promising findings, further research is needed to determine standardized probiotic formulations, optimal timing, and routes of administration. Personalized probiotic therapies may represent the future of preterm birth prevention as they offer targeted interventions based on individual microbiome composition. Full article

Background/Objectives: Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. Methods: A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks’ gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge. Serum folate levels were measured near NICU discharge (T1) and at 2–3 months corrected age (T2). Folate status was categorized per WHO (World Health Organization) guidelines: deficiency (<6.8 nmol/L), possible deficiency (6.8–13.4 nmol/L), normal (13.5–45.3 nmol/L), and elevated (>45.3 nmol/L). Nutritional information on feed and supplements was collected from hospital notes and maternal interviews. Results: Thirty-two infants (71%) received parenteral nutrition. Twelve infants (32%) remained exclusively breastfed at T2. No infant from the whole cohort had a serum folate concentration <13.5 nmol/L at either time point. A proportion of infants had serum folate concentrations >45.3 nmol/L: 14/45 (31%) at T1, 19/37 (42%) at T2, and 7/37 (16%) at both time points. Elevated concentrations were seen particularly in infants who received folic acid supplements or nutrition containing folic acid, such as parenteral nutrition and breastmilk fortifiers. Conclusions: Folate deficiency was not observed in this cohort; folate concentrations were high and in line with those observed in healthy term infants. Further research is needed to assess the high folate concentrations in premature babies and whether they may have any adverse clinical impact. Full article