Background The short-term and long-term severe complications of preterm infants have brought serious psychological and economic burdens to the society and family. Therefore, our study aimed to investigate the risk factors for the mortality and serious complications in very premature infants less than 32 weeks of gestational age (GA), so as to guide the antenatal and postnatal care of very premature. Methods The very premature infants from 1 January 2019 to 31 December 2021 from 15 member hospitals of the Neonatal Intensive Care Unit (NICU) Multi-center Clinical Research Collaboration Group in Jiangsu Province were recruited. In accordance with the plan of the intensive care unit for unified management, recruitment of premature infants is carried out on the day of admission, and discharge or death is the outcome indicator in 1–2 months by telephone follow-up. The research content mainly includes three aspects: clinical information of mother and infant, outcomes and complications. According to the final outcomes, very premature infants were divided into two categories: survival without severe complications, survival with severe complications and death. Then, univariate and multivariate logistic regression model and receiver operating characteristic (ROC) analyses were used to analyze the independent risk factors. Results A total of 3,200 very premature infants with GA less than 32 weeks were recruited. The median GA is 30.00 (28.57, 31.14) weeks, the average birth weight is 1,350 (1,110, 1,590) g, among whom 375 premature infants survived with severe complications, and 2,391 premature infants survived without severe complications. Then, it was found that GA at birth was a protective factor for death and severe complications, whereas severe neonatal asphyxia and persistent pulmonary hypertension of the newborn (PPHN) were independent risk factors for death and severe complications in very premature infants born at less than 32 weeks of gestation. Conclusions The prognosis of very premature infants in NICU treatment depends not only on GA, but also on various perinatal factors and their clinical management, such as preterm asphyxia and PPHN occurrence, so the next step is necessary for multicenter continuous quality improvement to improve outcomes in very preterm infants.

/pdf/short-time-mortality-and-severe-complications-of-very-3ki9qcr4.pdf

Short-time mortality and severe complications of very premature infants—a multicenter retrospective cohort study from Jiangsu Province during 2019–2021

Growth and maturation of the fetal gastrointestinal tract near term prepares the offspring for the onset of enteral nutrition at birth. Structural and functional changes are regulated by the prepartum rise in cortisol in the fetal circulation, although the role of the coincident rise in plasma tri-iodothyronine (T3) is unknown. This study examined the effect of hypothyroidism on the structural development of the gastrointestinal tract and the activity of brush-border digestive enzymes in the ovine fetus near term. In intact fetuses studied between 100 and 144 days of gestation (dGA; term ∼145 days), plasma concentrations of T3, cortisol and gastrin; the mucosal thickness in the abomasum, duodenum, jejunum and ileum; and intestinal villus height and crypt depth increased with gestational age. Removal of the fetal thyroid gland at 105–110 dGA suppressed plasma thyroxine (T4) and T3 concentrations to the limit of assay detection in fetuses studied at 130 and 144 dGA, and decreased plasma cortisol and gastrin near term, compared to age-matched intact fetuses. Hypothyroidism was associated with reductions in the relative weights of the stomach compartments and small intestines, the outer perimeter of the intestines, the thickness of the gastric and intestinal mucosa, villus height and width, and crypt depth. The thickness of the mucosal epithelial cell layer and muscularis propria in the small intestines were not affected by gestational age or treatment. Activities of the brush border enzymes varied with gestational age in a manner that depended on the enzyme and region of the small intestines studied. In the ileum, maltase and dipeptidyl peptidase IV (DPPIV) activities were lower, and aminopeptidase N (ApN) were higher, in the hypothyroid compared to intact fetuses near term. These findings highlight the importance of thyroid hormones in the structural and functional development of the gastrointestinal tract near term, and indicate how hypothyroidism in utero may impair the transition to enteral nutrition and increase the risk of gastrointestinal disorders in the neonate.

/pdf/hypothyroidism-impairs-development-of-the-gastrointestinal-1tqomre6.pdf

Hypothyroidism impairs development of the gastrointestinal tract in the ovine fetus

BACKGROUND Treatment of antenatal corticosteroids (ACSs) to women at risk of preterm labor can decrease neonatal mortality and morbidity. However, effect of ACS exposure on enteral feeding and body growth of preterm infants remains elusive. METHODS This retrospective study collected information of eligible singleton infants born between 22+0 and 36+6 weeks' gestation from 2017 to 2019. Logistic regression and multivariate linear regression were adopted to examine the associations of the ACS exposure with various outcomes of enteral feeding and growth considering potential confounders. Stratified analysis was performed based on gestational age (GA) (<34 vs ≥34 weeks). RESULTS Of the 1694 preterm infants included, 1222 (72.1%) were exposed to ACSs. Infants with ACS exposure had a higher incidence of feeding intolerance (odds ratio 1.51; 95% CI, 1.05 to 2.20; P = .03), slower advancement of enteral feeding (β coefficient -0.86; 95% CI, -1.48 to -0.25; P = .01), and lower delta body-weight z-scores (β coefficient-0.13; 95% CI, -0.18 to -0.08; P < .001). Unlike in infants with GA <34 weeks, ACS exposure was associated with slower advancement of enteral feeding, longer time to regain birth weight, and lower delta body-weight z-scores in the ones with GA ≥34 weeks. CONCLUSION ACS exposure is associated with poorer enteral feeding process and body growth in our study population, which is more prominent in late preterm infants. A multicenter prospective study and mechanistic studies using animal models are required.

Antenatal corticosteroids affecting enteral feeding and growth of preterm infants: A retrospective cohort study

Abstract Objective To compare the effects of an incomplete course and more than 1 course of dexamethasone, relative to a control of a single complete course, on foetal respiratory problems and other adverse outcomes of preterm birth. Methods This was a retrospective chart review of 1800 women with preterm delivery. Data were collected on newborns whose mothers administered 1 full course of dexamethasone (916/1800; 50.9%), a partial course (716/1800; 39.8%) and more than 1 course (168/1800; 9.3%). Demographic data and adverse maternal and neonatal outcomes were recorded. Results Preterm singleton newborns whose mothers received several steroid hormone courses were significantly more likely to have adverse outcomes than newborns of mothers given 1 course. The negative outcomes were the need for positive pressure ventilation ([aOR] 1.831; 95% CI, (1.185,2.829); P = 0.019), ventilator support ([aOR] 1.843; 95% CI, (1.187,2.861); P = 0.011), and phototherapy ([aOR] 1.997; 95% CI, (1.378,2.895); P &lt; 0.001), transient tachypnoea of the newborn ([aOR] 1.801; 95% CI, (1.261,2.571); P = 0.002), intraventricular haemorrhage ([aOR] 2.215; 95% CI, (1.159, 4.233); P = 0.027), sepsis ([aOR] 1.737; 95% CI, (1.086, 2.777); P = 0.007), and admission to neonatal intensive care ([aOR] 1.822; 95% CI, (1.275,2.604); P = 0.001). In the group of very preterm infants, newborns of mothers administered an incomplete course had developed respiratory distress syndrome (RDS) ([aOR] 3.177; 95% CI, (1.485, 6.795); P = 0.006) and used ventilatory support ([aOR] 3.565; 95% CI, (1.912, 6.650); P &lt; 0.001) more than those of mothers receiving a single course. Conclusions Preterm singleton newborns whose mothers were given multiple courses of dexamethasone had an increased incidence of RDS and other adverse outcomes than those of mothers receiving a full course. However, very preterm newborns whose mothers were administered 1 full dexamethasone course had a significantly lower incidence of RDS than those whose mothers were given partial courses. 

/pdf/a-case-control-study-on-the-effects-of-incomplete-one-and-2kz4lm1r.pdf

A case-control study on the effects of incomplete, one, and more than one dexamethasone course on acute respiratory problems in preterm neonates born between 280 and 366 weeks of gestation

Background Robust evidence has consistently demonstrated the impact of antenatal corticosteroid (ACS) administration on reducing mortality and improving short-term neonatal outcomes in singleton preterm infants. However, its effect on neonatal sepsis, particularly early-onset sepsis (EOS), remains poorly understood and requires further investigation. This study aimed to evaluate the potential association between prenatal dexamethasone exposure (PDE) and incidence of EOS in preterm infants. Methods This retrospective, single-center observational study included singleton preterm neonates with a gestational age less than 32 weeks or a birth weight below 1,500 g between 2022 and 2024. Participates were stratified into four groups based on PDE: no PDE, partial PDE (1–3 doses), PDE 1–7 days (complete course with delivery within 7 days of administration), and PDE ≥8 days (complete course with delivery more than 7 days after administration). The primary outcome was the incidence of EOS, while secondary outcomes encompassed other short-term neonatal complications. Results The analysis revealed that neonates in the PDE 1–7 days group demonstrated a significantly reduced incidence of EOS compared with the no PDE group [adjusted odds ratio[aOR]: 0.299, 95% confidence interval [95%CI]: 0.122–0.731]. Furthermore, this group exhibited superior outcomes, including lower rates of respiratory distress syndrome (RDS), reduced the need for surfactant treated in RDS cases, and decreased extrauterine growth restriction (EUGR). Notably, the PDE ≥8 days group was associated with an elevated risk of EOS when compared with the PDE 1–7 days group. Conclusion PDE, particularly when a complete course is administered 1–7 days prior to delivery, demonstrates a significant protective effect against EOS in preterm infants. Nevertheless, large-scale multicenter prospective studies are warranted to further validated these findings and to comprehensively evaluate the long-term neurodevelopmental and systemic outcomes associated with PDE administration. 

pdf/prenatal-dexamethasone-exposure-and-the-risk-of-early-onset-0ox4lgglnotn.pdf

Prenatal dexamethasone exposure and the risk of early-onset sepsis in preterm infants

BACKGROUND
Limited evidence supports the efficacy of iron-rich foods (IRFs) in improving iron status during pregnancy.


OBJECTIVE
The study aims to evaluate the effect of IRFs on iron status and biomarkers of iron metabolism in the third trimester of pregnancy.


METHODS
A total of 240 pregnant women at 11-13 weeks' gestation without iron-deficiency anemia (IDA) in South China were recruited to this single-blind clinical trial [non-IDA referred to both hemoglobin (Hb)≥110g/L and serum ferritin (SF)≥15ng/mL], randomly assigned to 1) Control, 2) IRFs containing 20 mg iron/day (IRF-20), or 3) IRFs containing 40 mg iron/day (IRF-40). The IRFs were consumed three days a week including pork liver, chicken/duck blood, soybean, and agaric. The IRFs started at recruitment and ended in the predelivery room. Primary outcome included anemia (Hb<110g/L), iron deficiency (ID, definition1: SF<15ng/mL; definition2: SF<12ng/mL), and IDA (ID and Hb<110g/L). Secondary outcome was plasma Hb and iron indices including SF, serum hepcidin, and iron.


RESULTS
All participants who completed the trial with full data (n = 170) were included in the analysis. At the end-line, both intervention groups showed lower ID and IDA rates than Control. Specifically, IRF-40 showed lower ID (SF<12ng/mL) rate than Control (9.0%vs.22.8%, P = 0.022). For IDA by definition1, the incidence in IRF-40 was lower than that in Control (1.9%vs.8.9%, P = 0.045). For IDA by definition2, the incidence in IRF-20 was lower than that in Control (3.9%vs.17.9%, P = 0.049). Moreover, IRF-20 showed higher SF levels than Control (P = 0.039). No effects of IRFs on anemia (P = 0.856), plasma Hb (P = 0.697), serum hepcidin (P = 0.311), and iron (P = 0.253) levels were observed. The assessed iron intakes were 22.2 mg/d in IRF-20 and 25.0 mg/d in IRF-40, respectively.


CONCLUSIONS
Antenatal IRFs reduce the risk of ID and IDA in late pregnancy, though the present results are inadequate to confirm an ideal dosage. (No.ChiCTR1800017574).

Antenatal Iron-Rich Food Intervention Prevents Iron-Deficiency Anemia But Does Not Affect Serum Hepcidin in Pregnant Women.

Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

/pdf/single-course-antenatal-corticosteroids-is-related-to-faster-4tb8hvbmtf.pdf

Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

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Antenatal Iron-Rich Food Intervention Prevents Iron-Deficiency Anemia But Does Not Affect Serum Hepcidin in Pregnant Women.

Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant