Gut microbiota in preterm infants receiving breast milk or mixed feeding

BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.

Application of prolonging small feeding volumes early in life to prevent of necrotizing enterocolitis in very low birth weight preterm infants

Objective:To study the effects of prolonging small feeding volumes early in life on the incidence of necrotizing enterocolitis(NEC)in very low birth weight(VLBW)preterm infants.Methods:A total of 128 VLBW infants who could not be breastfed were assigned into the experimental group(63 cases)and the control group(65 cases)using a random number table.The experiment group was fed 12 mL/(kg·d)on day 1 which was increased to 24 mL/(kg·d)for the first 10 study days.The control group was fed 12 mL/(kg·d)for the first 14e48 hours.Then,the feeding volume increased by 24-36 mL/(kg·d)up to 140e160 mL/(kg·d)and maintained until the 10th day after birth.The incidence of feeding intolerance and NEC,duration of hospitalization,time to full enteral feedings,incidence of intrahepatic cholestasis,and the levels of gastrin and motilin in serum were assessed.Results:The incidence of feeding intolerance was significantly lower in the experimental group compared with the control group(15.87% vs.33.84%).There was a significant reduction in the incidence of NEC between the experimental and control groups(7.9% vs.16% in the control group).Conclusion:A protocol that prolongs small feeding volumes early in life can reduce the incidence and severity of NEC,but still warrants further study.

Rescue case of low birth weight infant with acute hepatic failure

We report a case involving a rescued low birth weight infant(LBWI) with acute liver failure. Case: The patient was 1594 g and 32^(3/7) gestational wk at birth. At the age of 11 d, she developed acute liver failure due to gestational alloimmune liver disease. Exchange transfusion and high-dose gamma globulin therapy were initiated, and body weight increased with enteral nutrition. Exchange transfusion was performed a total of 33 times prior to living donor liver transplantation(LDLT). Her liver dysfunction could not be treated by medications alone. At 55 d old and a body weight of 2946 g, she underwent LDLT using an S2 monosegment graft from her mother. Three years have passed with no reports of intellectual disability or liver dysfunction. LBWIs with acute liver failure may be rescued by LDLT after body weight has increased to over 2500 g.

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P < 0.05), the multivariate logistic regression analysis of neonatal nosocomial infection showed that nurse staffing was significantly related to the incidence of urinary tract infection (OR = 1.78;95% confidence interval, 1.17 - 2.35, P < 0.05). However, there was no significant correlation between nurse staffing and bloodstream infection (OR = 0.91;95% confidence interval, 0.74 - 1.06, P > 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17;95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

Prevention of peripherally inserted central catheter-related infections in very low-birthweight infants by using a central line bundle guideline with a standard checklist

Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CRIs)in very low-birth-weight infants(VLBWIs).Methods:Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao,China,between November 2012 and June 2013,were monitored with the CLB guideline and a standard checklist.Fifty-three VLBWIs who underwent PICC insertion were monitored by standard hospital procedures.The incidence of CRIs was compared between the two groups.Results:The incidence of infection significantly decreased from 10.0%catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The indwelling catheter time significantly increased in the study group compared to the control group(31.9±15.0days vs.24.8±7.4 days,respectively,p<0.05).Colonization infections also decreased from 6.9% catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The incidence of catheter-related bloodstream infections decreased from 3.1%catheter days in the control group to 0%catheter days in the study group.Conclusion:The use of a CLB guideline with a standard checklist could be an effective and feasible protocol for preventing CRIs and prolonging indwelling catheter timein VLBWIs.

An association between maternal lead and cadmium levels and birth weight of the babies in North Indian population

Lead is listed as the 2nd and Cadmium as the 7th hazardous substance by the Agency for Toxic Substances and Disease Registry (ATSDR). Exposure to Lead and Cadmium above the permissible levels among pregnants may cause adverse effects on newborns in the form of Low Birth Weight and Preterm Labor, etc. The objectives of this study were to find out the level of Lead and Cadmium in maternal venous blood and cord blood and to find out the association of the levels of these metals with birth weight of babies. For this, the venous blood and cord blood were collected and quantitative estimation of Lead and Cadmium was carried out by Double Beam Atomic Absorption Spectrophotometer in 1000 women with average Body Mass Index. Results showed higher mean maternal blood Lead level (11.08 μg/dl with range of 2.6 - 21.3) than the normal recommended by Centre of Disease Control and Prevention (10 μg/dl). On the contrary, the mean Cadmium level was 0.095 μg/dl, which was below the normal value as assigned by WHO (0.1 μg/dl). In high Lead exposure group (>10 μg/dl), 43.7% of babies and in high Cadmium exposure group (>0.1 μg/dl), 46.2% of babies were found to have low birth weight. However, this was not statistically significant. Further research in this area in a larger sample size may provide information relevant enough to be transferred to decision makers to implement measures to effectively reduce heavy metals from the environment, thereby protecting future generations from their deleterious effects.

Bronchopulmonary Dysplasia in Premature Infants with Very Low Birth Weight: A Single Centre Retrospective Study in China

To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.

A Clinical Analysis of Physical and Neurological Development in very Low Birth Weight Infants with MEIR(Massage,Exercises,Intelligence training,and Rehabilitation training)

Objective:This study aimed to investigate the application of MEIR(Massage,Exercises,Intelligence training,and Rehabilitation training)in Chinese VLBW infants and to observe its effects on infants’growth and deve1opment.Methods:Clinical data of 92 VLBW infants who were treated at the neonatal intensive care unit(NICU)of Loudi Centra1 Hospital were retrospectively analyzed.The patients were grouped as the MEIRgroup(n=47)and controls(n=45).Physical and neurodevelopment deve1opment were compared between the two groups.Results:There were differences in height and weight and head circumference between the two groups at all corrected ages(all P<0.05).Abnormal motions,reflexes,muscular tension,audio-visual reactions,and posture,and the total numbers of abnormalities of 3-,6-,9-and 12-corrected month-old infants in the MElRgroup were 1ower than in the control group(all P<0.05).The mental development index and psychomotor development index of 6-and 12-corrected month infants in the MEIR group were higher than in the control group(all P<0.05).Conclusion:MEIR could improve the physical and neurological developments of VLBW infants,reduce the incidence of adverse events,and improve their growth and development.

Lead-Zinc-Silver Metallogenic Prediction Based on Weights of Evidence Approach:A case Study in Tuotuohe Region,Qinghai,China

Tuotuo River region(E91°-E93°,N33°-N 35°) is located in southwest Qinghai Province,P.R.China.It lies in one of the most important metallogenic belts in China—Northwest Sanjiang Metallogenic Belt,due to which Tuotuo River region can be of very high metal mineral potential not only in Qinghai Province but also nationwide.In this research,multisource data sets including geological,geochemical,geophysical, and remotely sensed images were integrated for mineral potential analysis with GIS technology.Under the guidance of regional metallogenic features and deposit-forming geologic anomaly theories,evidential layers were obtained from these sets,which

Neonatal Nutrition and Later Outcomes of Very Low Birth Weight and Preterm Infants <32 Gestational Age at a Tertiary Care Hospital of Portugal

Premature infants, especially those born with less than 1500 g, often exhibit slow overall growth. Lack of early nutritional support is an important element. The present authors describe parenteral nutritional practices in a tertiary hospital and evaluate postnatal growth of preterm infants under 32 weeks of gestational age or with a birth weight < 1500 g. For population study, we examined 431 newborn files. Their median gestational age was 29.7 weeks. Of them, 25.4% were small for gestational age (SGA). 77.5% received parenteral nutrition (PN), 54.5% of which was provided on the first day. The average time was 14.7 days. The average weight gain by the 30th day was 425 g. At discharge, 37% were rd month 20% had their weight under P3, decreasing to 10% by the 12th month. Children who initiated PN in the first 24 hours of life had significantly better weight on the 30th day of their life (p th month of corrected age (p = 0.038). And they had better Body Mass Index (BMI) in the 3rd (p = 0.012) and 12th (p = 0.023) months. Despite better feeding practices, there is still significant failure in post natal growth. Early introduction of PN was associated with an improved weight gain, which suggests that nutrition that included amino acids may be critical during the first 24 hours of life.

Effect of Aggressive Early High-Dose Intravenous Amino Acid Infusion and Early Trophic Enteral Nutrition on Very Low Birth Weight Infants

Objective: Very-low-birth-weight (VLBW) preterm infants are at risk of growth delay if they do not receive adequate nutritional support. This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life. Study Design: The effect of a high-dose 3 g amino acid (HAA)/kg/d regimen beginning on the first day of life was compared with that of low-dose amino acid (LAA) supplementation at a dose of 0.5 or 1.0 g/kg/d. The primary outcome measures were the days of regained birth weight and achieved full enteral feeding. Result: Compared with the 19 infants in the LAA group, the 17 infants in the HAA group achieved significantly earlier full enteral feeding (7.8 ± 3.6 vs. 15.2 ± 8.9, p = 0.003) and regained birth weight (13.3 ± 3.8 vs. 17.5 ± 7.9, p = 0.047). In addition, shorter parenteral nutrition time was achieved by HAA administration (p Conclusion: Aggressive early simultaneous amino acid administration plus enteral feeding during the first few days of life for preterm infants was associated with improved weight gain and earlier full enteral feeding.

Influence of nutritional care during pregnancy on weight control and maternal and infant outcomes in patients with pregnancy-induced hypertension

Background Preeclampsia is a common disease in pregnant women,characterized by clinical manifestations such as hypertension and proteinuria,which not only seriously affect the safety of pregnant women,but also jeopardize the safety of the fetus,threatening maternal and infant safety.Currently,in addition to routine hypoglycemic and antihypertensive treatments,auxiliary treatment methods such as exercise and diet are gradually gaining clinical recognition.Therefore,this study aimed to observe the effects of comprehensive nutrition care during pregnancy on weight control during pregnancy and maternal and infant outcomes in patients with pregnancy-induced hypertension syndrome.Methods A total of 100 cases of preeclampsia patients in our hospital from August 2021 to May 2022 were selected and randomly divided into a nutrition group and a conventional group,with 50 cases in each group.The conventional group received routine care,while the nutrition group received additional comprehensive nutrition care during pregnancy based on routine care.The weight control and blood pressure control during pregnancy and maternal and infant outcomes of the two groups were observed.Results The weight control during pregnancy in the nutrition group was significantly better than that in the conventional group(P<0.05).There was no significant difference in systolic and diastolic blood pressure between the two groups before intervention(P>0.05),but both systolic and diastolic blood pressure in both groups were lower after intervention,with the nutrition group significantly lower than the conventional group(P<0.05).The incidence of neonatal asphyxia,placental abruption,postpartum hemorrhage,and cesarean section in the nutrition group was significantly lower than that in the conventional group(P<0.05).Conclusions Comprehensive nutrition care during pregnancy can effectively control weight and blood pressure levels in patients with preeclampsia,and improve maternal and infant outcomes.[S Chin J Cardiol 2024;25(3):156-161]

Neurodevelopmental in Relation to Breastfeeding–Experiences among Hungarian Preterm Infants at 12 Months of Corrected Age:Empirical Study

Preterm and low birth weight infants are at higher risk of neurodevelopmental outcomes;breastfeeding offers sev-eral beneficial aspects for them.This study aimed to describe the average neurodevelopmental outcomes of pre-term infants and examine the associations between neurodevelopment and breastfeeding among Hungarian preterm infants at 12 months of corrected age.154 preterm infants with low birth weight(<2500 g)and their mothers were participated in this study.Bayley-III Screening Test(Bayley Scales of Infant and Toddler Develop-ment Screening Test,Third Edition)was administered to measure the cognitive,language and motor skills of infants;breastfeeding data was obtained through parental anamnesis.To analyze data,independent sample t-test or the Welch t-test,Mann-Whitney tests,Chi-square tests of independence and Spearman’s rank correlation test were used to.Concerning the risk of developmental delay,Receptive and Expressive language and Fine motor subscales were the lowest.Examination of the associations between breastfeeding and neurodevelopmental per-formance identified significantly higher cognitive(U=2047.5;P=0.023)andfine motor(U=2096.0;P=0.037)skills in infants who were breastfed.We found significant positive correlations between the duration of breastfeeding and cognitive,expressive language andfine motor skills.The study draws the attention to the importance of breastfeeding and early screening.Further research is required to examine the casual relationship between neurodevelopmental outcomes and breastfeeding.

The effect of an early oral stimulation program on oral feeding of preterm infants

Purpose:To evaluate the effect of an oral stimulation program on preterm infants.Methods:Preterm infants(n=72)were randomly assigned to experimental and control groups.Controls(n=36)received routine care while the experimental group(n=36)received oral stimulation in addition to routine care.Postmenstrual age,total intake volume,body weight,the transition time from initiation of oral feeding to full oral feeding and feeding efficiency were calculated.Results:Postmenstrual age and full oral feeding weight were significantly lower in the experimental group(p<0.05).The time from initiation of oral feeding to full oral feeding was significantly shorter in the experimental group(p<0.05)while feeding efficiency was higher in the experimental group(p<0.05)compared to controls.No significant differences existed in hospital stay length or weight gain rate.Conclusions:An early oral stimulation program is beneficial in preterm infants.

The status of infant health in India

This paper investigates the present status of infant health in India through percentages of infants who are undernourished, not immunized or diseased and finds its relationship with socio-demographic variables. The relevant data have been obtained from the Third National Family Health Survey which was carried out in 2005-2006 in India. The sample consists of 7562 infants (i.e., children of less than 1 year). For socio-demographic data, places of residence, sex of infants, ethnic composition, religion and wealth index were considered. Considering the different types of under-nutrition, it has been found from our data that the percentages of undernourished infants range from 22 to 28 only. There are considerable variations in the different types of immunization status ranging from 17.9% opting for measles vaccination to 73.2% taking BCG vaccination. Prevalence of morbidity also varies from 15 to 22 percent depending on the three types of morbidity considered in this paper. Among the socio-economic variables, mother’s education and wealth index have been found to have profound effect on the nutritional status and also on morbidity of infants but there is no impact found on the status immunization. Thus it gives clear cut indications for the government and NGOs to take actions to ameliorate poverty and to improve the level of education, especially of female population in India.

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants:a meta-analysis

Background The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis(PNAC)in very low birth weight(VLBW)infants is not known.Thus,we conducted a meta-analysis to identify any preven-tion effect.Methods PubMed,EMBASE,and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants.Revman 5.3 was used to synthesize the results.A fixed-effect model was used to summarize the data when the heterogeneity was non-significant(I2<50%),and a random-effects model was used when the heterogeneity was significant(I2>50%).Results Of 728 articles,11 randomized controlled trials met the inclusion criteria.The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio(RR)=0.53,95%confidence interval(CI)0.36-0.80,P=0.002.The heterogeneity was non-significant with I2=23%.Subgroup analysis based on par-enteral nutrition duration and median birth weight was performed.The synthesis results for patients with parenteral nutri-tion duration exceeding 14 days revealed I2=35%(P=0.15)and pooled RR=0.47,95%CI 0.30-0.73,P=0.0008;and for patients with duration less than 14 days revealed I2=0%(P=0.72)and pooled RR=1.14,95%CI 0.39-3.35,P=0.81.The synthesis for patients with birth weight more than 1000 g revealed I2=0%(P=0.41)and pooled RR=0.55,95%CI 0.26-1.18,P=0.12;and for patients with birth weight below 1000 g revealed I2=44%(P=0.11)and pooled RR=0.53,95%CI 0.33-0.85,P=0.009.Conclusions The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the avail-able original randomized controlled trial studies,especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants.Future studies should be performed before a definitive conclusion can be established.

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants,especially extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI),in breathing support,while it potentially exerts a negative impact on the lungs and outcomes of preterm infants.This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI(gestational age[GA]<28 weeks)and ELBWI(birth weight[BW]<1000 g),admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018,were analyzed.The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation(DRI).The secondary outcomes were survival rates,incidence of bronchopulmonary dysplasia(BPD),and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled.The incidence of DRI,chest compressions,and administration of epinephrine was 55.9%(532/952),12.5%(119/952),and 7.0%(67/952),respectively.Multivariate analysis revealed that the risk factors for DRI were GA<28 weeks(odds ratio[OR],3.147;95%confidence interval[CI],2.082–4.755),BW<1000 g(OR,2.240;95%CI,1.606–3.125),and antepartum infection(OR,1.429;95%CI,1.044–1.956).The survival rate was 65.9%(627/952)and was dependent on GA.The rate of BPD was 29.3%(181/627).Multivariate analysis showed that the risk factors for BPD were male(OR,1.603;95% CI,1.061–2.424),DRI(OR,2.094;95% CI,1.328–3.303),respiratory distress syndrome exposed to≥2 doses of pulmonary surfactants(PS;OR,2.700;95%CI,1.679–4.343),and mechanical ventilation≥7 days(OR,4.358;95% CI,2.777–6.837).However,a larger BW(OR,0.998;95% CI,0.996–0.999),antenatal steroid(OR,0.577;95%CI,0.379–0.880),and PS use in the delivery room(OR,0.273;95%CI,0.160–0.467)were preventive factors for BPD(all P<0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Respiratory management of extremely low birth weight infants: survey of neonatal specialists

Background:To investigate strategies used for the management of respiratory distress syndrome(RDS)and bronchopulmonary dysplasia(BPD)in extremely low birth weight(ELBW)infants.Methods:A survey of neonatal specialists working in US academic institutions with fellowship training programs.Results:Eighty percent(72/89)of the identifi ed academic institutions had at least one physician who responded to the survey.Among respondents,85%(171/201)agreed or strongly agreed to use continuous positive airway pressure(CPAP)initially for the management of RDS,and the majority agreed or strongly agreed to use a fraction of inspired oxygen(FiO2)≥0.4 and a mean airway pressure(MAP)≥10 cm H2O as a criteria for surfactant therapy;and 73%(146/200)sometimes or always used caffeine to prevent BPD.Only 25%(50/202)sometimes or almost always used steroids to prevent or treat BPD.Identified indications to use steroids were 3 or more extubation failures or inability to extubate beyond 8 weeks of age.Conclusions:Variability in treatment strategies of ELBW is common among neonatal specialists.However,the majority of the respondents agreed or strongly agreed to use early CPAP for the management of RDS,consider a FiO2≥0.4 and a MAP≥10 cm H2O as criteria for surfactant therapy,and sometimes or almost always used caffeine to prevent BPD.Steroids continue to have a role in the management of BPD in infants who are diffi cult to extubate.

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China： A Multi-center Study

Background： With the progress ofperinatal medicine and neonatal technology, more and more extremely low birth weight （ELBW） survived all over the world. This study was designed to investigate the short-term ontcomes of ELBW infants during their Neonatal Intensive Care Unit （NICU） stay in the mainland of China. Methods： All infants admitted to 26 NICUs with a birth weight （BW） 〈1000 g were included between January 1,2011 and December 31,2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors. Results： A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age （GA） was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants （23.3%） died and another 69 infants （26.7%） died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas （53.6% vs. 35.3%, P = 0.019）. BW 〈750 g and GA 〈28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization. Conclusions： Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.

Nutritional status of Vietnamese infants assessed by Fenton growth chart and related factors:A cross-sectional study

Importance:Nutritional status of infants,measured by birth weight and length,is an essential factor in neonatal development.Malnutrition in newborns may lead to a higher risk of mortality,neurological and cognitive impairment,and poor language development.Objective:This study aims to assess the nutritional status of infants and related factors regarding maternal anthropometric characteristics and medical history.Methods:A cross-sectional study was conducted at the National Hospital of Obstetrics and Gynecology,Vietnam from May 2021 to May 2022 on 340 infants and mothers.Low birth weight was defined following the Intergrowth-21 standards.Stunting was evaluated using the Fenton growth chart when the length was below the 10%percentile line of the gestational week.Multivariate regression models were applied to identify factors associated with the nutritional status of infants.Results:We found that 12.4%and 14.1%of infants in our study fell into stunted and underweight categories,respectively.Infants of mothers over 35 years old,having a height lower than 150 cm or experiencing anemia during pregnancy were more likely to be stunted or have low birth weight.Serum albumin deficiency during pregnancy was strongly associated with the infant being underweight(odds ratio[OR]=2.8,95%confidence interval[95%CI]1.1–7.3).Newborns were more likely to be stunted if their mothers had a history of preterm birth(OR=3.3,95%CI 1.1–10.2).Interpretation:Maternal nutritional status is closely related to infant malnutrition,particularly in preterm infants.Improving the understanding of mothers regarding prenatal care,reproductive healthcare,adequate nutritional diet,and multi-micronutrient supplements during pregnancy is therefore important.