Enhanced Survival of 22-25 Week Preterm Infants After Proactive Care Implementation: A Comparative Analysis of Two Time Periods.

OBJECTIVES: To investigate the impact of proactive perinatal care on periviable preterm infants before and after its implementation. METHODS: This retrospective cohort study was conducted over a period of 10 y, from 2013 to 2019, referred to as Phase I, and from 2020 to 2022, referred to as Phase II. A total of 162 eligible infants born between 220/7 and 256/7 wk of gestation were included in this analysis. RESULTS: A total of 125 infants were born in phase I, and 37 infants in phase II received proactive care with minimal handling. The mortality decreased from 54.4% to 24.3% (P = 0.001). The composite outcomes of severe brain injury or death, sepsis or death and necrotizing enterocolitis or death were also improved with proactive care. Gestational age [adjusted odds ratio (aOR) 0.900; 95% confidence interval (CI), 0.836-0.970], air leak syndrome (aOR 4.958; 95% CI, 1.681-14.624), massive pulmonary hemorrhage (aOR 4.944; 95% CI, 2.055-11.893), and birth in phase II (aOR 0.324; 95% CI, 0.115-0.912) were independently associated with mortality. CONCLUSIONS: The implementation of proactive care with minimal handling resulted in an increased survival rate and a reduction in the combined morbidities between the two time periods. The provision of proactive perinatal care with minimal handling is crucial for improving both the survival rates and clinical outcomes of these vulnerable infants.

Postnatal Growth Assessment and Prediction of Neurodevelopment and Long-Term Growth in Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea.

Background/Objectives: Extrauterine growth restriction (EUGR) is associated with high mortality and an increased incidence of poor neurodevelopmental outcomes in preterm infants. In this study, we aimed to compare the Intergrowth-21ST (IG-21ST) and Fenton charts in predicting long-term neurodevelopmental and anthropometric outcomes of very low birth weight (VLBW) infants. Methods: Data were collected from 2649 VLBW infants registered in the Korean Neonatal Network born between 240/7 and 316/7 weeks of gestational age from January 2013 to December 2017. Follow-up assessments were conducted at 18-24 months of age, corrected for prematurity. Multiple logistic regression analysis was performed to evaluate the association between EUGR and long-term outcomes. Results: Among the 2649 VLBW infants, 60.0% (1606/2649) and 36.9% (977/2649) were diagnosed as having EUGR defined by the Fenton chart (EUGRF) and by the IG-21ST chart (EUGRIG), respectively. The EUGRIG group exhibited a higher proportion of infants with cerebral palsy, neurodevelopmental impairment (NDI), and growth failure. In multiple logistic regression analysis, adjusted for risk factors for long-term outcome, the EUGRIG group showed higher risk of cerebral palsy (adjusted odds ratio [aOR], 1.66; 95% confidence interval [CI], 1.04-2.65), NDI (aOR, 2.09; 95% CI, 1.71-2.55), and growth failure (aOR, 1.57; 95% CI, 1.16-2.13). Infants with EUGRF tended to develop NDI (aOR, 1.29; 95%CI, 1.03-1.63) and experience growth failure (aOR, 2.44; 95% CI, 1.77-3.40). Conclusions: The IG-21ST chart demonstrated a more effective prediction of long-term neurodevelopmental outcomes, whereas the Fenton chart may be more suitable for predicting growth failure at 18-24 months.

Factors affecting length of stay according to bronchopulmonary dysplasia severity: a nationwide cohort study in Korea.

BACKGROUND: Longer hospitalizations for preterm infants with bronchopulmonary dysplasia (BPD) delay developmental outcomes, increase the risk for hospital-acquired complications, and exert a substantial socioeconomic burden. This study aimed to identify factors associated with an extended length of stay (LOS) at different levels of severity of BPD. METHODS: A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis. RESULTS: A total of 4263 infants were diagnosed with BPD. For mild BPD, infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS [eadjusted ß coefficients (adj ß) 1.041; 95% confidence interval (CI): 0.01-0.08] and hydrocephalus (eadj ß 1.094; 95% CI 0.01-0.17). In moderate BPD, infants administered steroids or with intraventricular hemorrhage required a longer LOS (eadj ß 1.041; 95% CI 0.00-0.07 and eadj ß 1.271; 95% CI 0.11-0.38, respectively). In severe BPD, infants with comorbidities required a longer LOS: pulmonary hypertension (eadj ß 1.174; 95% CI 0.09-0.23), administrated steroid for BPD (eadj ß 1.116; 95% CI 0.07-0.14), sepsis (eadj ß 1.062; 95% CI 0.01-0.11), patent ductus arteriosus requiring surgical ligation (eadj ß 1.041; 95% CI 0.00-0.08), and intraventricular hemorrhage (eadj ß 1.016; 95% CI 0.05-0.26). Additionally, the higher the clinical risk index score, the longer the LOS needed for infants in all groups. CONCLUSIONS: The factors affecting LOS differed according to the severity of BPD. Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.

The effect of minimizing central line days for very low birth weight infants through quality improvement.

Blood culture proven sepsis is associated with increased mortality and morbidity. Given the extended hospitalization of very preterm infants, catheter-related blood stream infections (CRBSIs) play a substantial role in sepsis. The reported incidence of CRBSIs in neonates varies from 3.2 to 21.8 CRBSIs per 1000 catheter line days. Moreover, discrepancies in neonatal practices and potential neglect may lead to the unwarranted prolongation of central lines. This study aims to compare two distinct periods (Pre-QI vs. Post-QI) in relation to the central line insertion rate and duration, as well as blood culture proven sepsis, duration of total parenteral nutrition (TPN), and the progression of feeding. These factors are known to be associated with prolonged hospitalization and increased morbidities. A total of 210 very low birth weight infants (VLBWIs), defined as either less than 32 weeks of gestational age (GA) or weighing less than 1500 g, were admitted to the Neonatal Intensive Care Unit (NICU) at Seoul St. Mary's Hospital, The Catholic University of Korea, between January 2020 and June 2023. Fourteen infants were excluded from the study as they did not survive beyond 1 month of life, and one was excluded due to a congenital anomaly. Consequently, the analysis included 195 VLBWIs. The Quality Improvement (QI) initiative began in January 2022, marking the division into two distinct epochs: the Pre-QI period, encompassing the years 2020 to 2021, and the Post-QI period, spanning from 2022 to 2023. The primary outcome measures included PICC insertion rates, duration, and feeding advancement or feeding-related complications. The hospital outcome measures were also compared between the two periods. A total of 195 VLBWI were included in the analysis. The birth weight was significantly lower in the pre-QI period, with an average of 1023 g compared to 1218 g (P < 0.001). Severe BPD ≥ moderate was significantly lower in the post-QI period (36.2% vs. 53.9%) (P < 0.001) along with shorter mechanical ventilation days (12 ± 29 vs. 22 ± 27) (P = 0.046). The PICC insertion rate was significantly decreased from 95.6% in pre-QI period compared to 55.2% in post-QI period (P < 0.001) along with a notable reduction in blood culture-proven sepsis (25.6% vs. 10.5%, P = 0.008). CRBSI rate was reduced from 1.3 to 1.1 per 1000 catheter days in the post-QI period. Moreover, the time required to achieve full enteral feeding of 100 mL/kg/day was significantly shorter in the post-QI (24 ± 23 vs. 33 ± 25) (P = 0.006). Multivariable logistic regression analysis for sepsis revealed that both birth weight and pre/post QI consistently demonstrated an association with lower sepsis rates in the Post-QI period. QI has the potential to reduce the burden of unnecessary interventions and blood culture proven sepsis rate along with CRBSI rate, thereby, optimizing the better care of very preterm babies.

INSANet: INtra-INter Spectral Attention Network for Effective Feature Fusion of Multispectral Pedestrian Detection.

Pedestrian detection is a critical task for safety-critical systems, but detecting pedestrians is challenging in low-light and adverse weather conditions. Thermal images can be used to improve robustness by providing complementary information to RGB images. Previous studies have shown that multi-modal feature fusion using convolution operation can be effective, but such methods rely solely on local feature correlations, which can degrade the performance capabilities. To address this issue, we propose an attention-based novel fusion network, referred to as INSANet (INtra-INter Spectral Attention Network), that captures global intra- and inter-information. It consists of intra- and inter-spectral attention blocks that allow the model to learn mutual spectral relationships. Additionally, we identified an imbalance in the multispectral dataset caused by several factors and designed an augmentation strategy that mitigates concentrated distributions and enables the model to learn the diverse locations of pedestrians. Extensive experiments demonstrate the effectiveness of the proposed methods, which achieve state-of-the-art performance on the KAIST dataset and LLVIP dataset. Finally, we conduct a regional performance evaluation to demonstrate the effectiveness of our proposed network in various regions.

Fast and rigorous optical simulation of periodically corrugated light-emitting diodes based on a diffraction matrix method.

Increasing the light extraction efficiency has been widely studied for highly efficient organic light-emitting diodes (OLEDs). Among many light-extraction approaches proposed so far, adding a corrugation layer has been considered a promising solution for its simplicity and high effectiveness. While the working principle of periodically corrugated OLEDs can be qualitatively explained by the diffraction theory, dipolar emission inside the OLED structure makes its quantitative analysis challenging, making one rely on finite-element electromagnetic simulations that could require huge computing resources. Here, we demonstrate a new simulation method, named the diffraction matrix method (DMM), that can accurately predict the optical characteristics of periodically corrugated OLEDs while achieving calculation speed that is a few orders of magnitude faster. Our method decomposes the light emitted by a dipolar emitter into plane waves with different wavevectors and tracks the diffraction behavior of waves using diffraction matrices. Calculated optical parameters show a quantitative agreement with those predicted by finite-difference time-domain (FDTD) method. Furthermore, the developed method possesses a unique advantage over the conventional approaches that it naturally evaluates the wavevector-dependent power dissipation of a dipole and is thus capable of identifying the loss channels inside OLEDs in a quantitative manner.

Prevalence of asthma in preterm and associated risk factors based on prescription data from the Korean National Health Insurance database.

We retrospectively analyzed National Health Insurance claims data (January 2002-December 2018) to determine the asthma prevalence and risk factors among preterm infants born in Korea. Patients with asthma were defined as those with a history of asthma medication prescriptions at least twice per year with International Classification of Diseases, Tenth Edition codes J45 and J46. We enrolled 99,139 preterm infants. The prevalence of asthma among preterm and term infants was 32.7% and 26.9%, 21.2% and 19.1%, 6.7% and 5.9%, 2.0%, and 1.6%, and 2.4% and 1.6% at 2, 5, 10, 15, and 16 years of age, respectively. The relative risk (RR) of asthma in preterm infants was 1.1-fold that in female preterm infants. The RR of asthma medication prescriptions for infants with extreme prematurity was 1.92-fold that of infants with moderate/late pre-term status. Among preterm with bronchopulmonary dysplasia (BPD) and respiratory distress syndrome (RDS) without comorbidities, the RRs for the number of asthma medication prescriptions were 1.34 and 1.06, respectively. This study revealed a higher prevalence of asthma among preterm infants than that in term infants. Male sex, extreme prematurity, BPD, and RDS were identified as risk factors for asthma medication prescriptions in preterm infants.

Multispectral Benchmark Dataset and Baseline for Forklift Collision Avoidance.

In this paper, multispectral pedestrian detection is mainly discussed, which can contribute to assigning human-aware properties to automated forklifts to prevent accidents, such as collisions, at an early stage. Since there was no multispectral pedestrian detection dataset in an intralogistics domain, we collected a dataset; the dataset employs a method that aligns image pairs with different domains, i.e. RGB and thermal, without the use of a cumbersome device such as a beam splitter, but rather by exploiting the disparity between RGB sensors and camera geometry. In addition, we propose a multispectral pedestrian detector called SSD 2.5D that can not only detect pedestrians but also estimate the distance between an automated forklift and workers. In extensive experiments, the performance of detection and centroid localization is validated with respect to evaluation metrics used in the driving car domain but with distinct categories, such as hazardous zone and warning zone, to make it more applicable to the intralogistics domain.

Neonatal seizures: diagnostic updates based on new definition and classification.

Neonatal seizures are the most common neurological symptoms caused by various etiologies in the neonatal period, but their diagnosis and treatment are challenging because their pathophysiology and electroclinical manifestations differ from those of patients in older age groups. Many seizures present as electrographic-only events without clinical signs or as obscure clinical manifestations that are difficult to distinguish from other neonatal behaviors. Accordingly, a new definition and classification of neonatal seizures was recently proposed by the International League Against Epilepsy Task Force on neonatal seizures, highlighting the role of electroencephalography in diagnosing and treating neonatal seizures. Neonatal seizures are defined as electrographic events with sudden, paroxysmal, and abnormal alteration of activity and divided into electroclinical seizures and electrographic-only seizures according to their clinical signs, thus excluding clinical events without an electrographic correlation. Seizure types are described by their predominant clinical features and divided into motor (automatisms, clonic, epileptic spasms, myoclonic, tonic, and sequential), nonmotor (autonomic and behavioral arrest), and unclassified. Although many neonatal seizures are acute reactive events caused by hypoxic-ischemic encephalopathy or vascular insults, structural, genetic, or metabolic etiologies of neonatal-onset epilepsy should also be thoroughly evaluated to determine their appropriate management.

The association of low body mass index with neonatal morbidities in preterm infants.

Little is known about the association between body proportionality at birth and neonatal outcomes in preterm infants. Body mass index (BMI) is one of the weigh-for-length ratios that represent body proportionality. The objective of this study was to examine whether BMI at birth affects neonatal outcomes in preterm infants. We assessed 3115 preterm (< 30 weeks), very low birth weight (< 1500 g) infants born between January 2013 and December 2016 and registered in the Korean Neonatal Network database. Using gender-specific BMI for gestational age curves, z-scores of BMI at birth were calculated. Low-, normal-, and high-BMI were defined as BMI z-scores of less than - 1, from - 1 to 1, and greater than 1, respectively. Neonatal morbidities and mortality in low- and high-BMI groups were compared to those in normal-BMI group. The low-BMI group had an increased risk of bronchopulmonary dysplasia, bronchopulmonary dysplasia or death, and necrotizing enterocolitis after adjusting for baseline characteristics and the birth weight z-score. High-BMI group had comparable neonatal outcomes to those of normal-BMI group. Low BMI at birth was associated with an increased risk of bronchopulmonary dysplasia and necrotizing enterocolitis, whereas High BMI at birth was not associated with adverse neonatal outcomes.

Cystic dysplasia of the kidneys in extremely preterm infants following acute kidney injury.

BACKGROUND: Various perinatal morbidities may adversely affect postnatal nephrogenesis in preterm infants. Kidney ultrasonographic findings following acute kidney injury (AKI) have not been well described in preterm infants. Herein, we describe three cases of extremely preterm infants who showed abnormal kidney ultrasonographic findings resembling dysplasia of the kidneys following AKI. CASE-DIAGNOSIS/TREATMENT: Their median gestational age and birth weight were 25+6 (range 23+3-26+6) weeks and 620 (480-840) g, respectively. All infants suffered severe AKI during their third to seventh week of life. Their kidney function recovered with conventional management. Kidney ultrasonographies performed after AKI revealed increased kidney echogenicity, loss of corticomedullary differentiation, and multiple cortical cysts, which were similar to cystic dysplasia of the kidneys and were absent in previous kidney imaging. Three infants eventually developed at least one of the long-term kidney sequelae following AKI, including proteinuria, hypertension, and elevated levels of serum creatinine or cystatin C as determined during the last follow-up at the corrected age of 9-18 months. CONCLUSIONS: Based on these cases, we can infer that AKI occurring during the early postnatal period may result in dysplasia of the kidneys with cortical cysts in extremely preterm infants, which may lead to chronic kidney disease in their later life. It is useful to follow up not only laboratory parameters but also kidney ultrasonographic findings in extremely preterm infants who suffered AKI during their early postnatal periods.

Interleukin-1 receptor antagonist-mediated neuroprotection by umbilical cord-derived mesenchymal stromal cells following transplantation into a rodent stroke model.

The human umbilical cord is a promising source of mesenchymal stromal cells (MSCs). Intravenous administration of human umbilical cord-derived MSCs (IV-hUMSCs) showed a favorable effect in a rodent stroke model by a paracrine mechanism. However, its underlying therapeutic mechanisms must be determined for clinical application. We investigated the therapeutic effects and mechanisms of our good manufacturing practice (GMP)-manufactured hUMSCs using various cell doses and delivery time points in a rodent model of stroke. IV-hUMSCs at a dose of 1 × 106 cells at 24 h after stroke improved functional deficits and reduced neuronal damage by attenuation of post-ischemic inflammation. Transcriptome and immunohistochemical analyses showed that interleukin-1 receptor antagonist (IL-1ra) was highly upregulated in ED-1-positive inflammatory cells in rats treated with IV-hUMSCs. Treatment with conditioned medium of hUMSCs increased the expression of IL-1ra in a macrophage cell line via activation of cAMP-response element-binding protein (CREB). These results strongly suggest that the attenuation of neuroinflammation mediated by endogenous IL-1ra is an important therapeutic mechanism of IV-hUMSCs for the treatment of stroke.

Impacts of sensory attributes and emotional responses on the hedonic ratings of odors in dairy products.

Consumers often decide to purchase certain items as a result of prompt emotional responses evoked by the products; therefore, it is important to investigate the emotional responses stimulated by food samples, as well as the sensory attributes of the products. The aim of this study was to examine influences of sensory attribute and emotional response on olfactory hedonic ratings of dairy products. Additionally, we compared this effect between women and men subjects. Sensory attributes of six natural odors produced by commercial dairy products were evaluated by 9 trained panelists. In addition, 100 untrained panelists (50 women and 50 men) rated the emotional response stimulated by the 6 odors using 25 paired semantic differential scales and the hedonicity using a 9 cm line scale, respectively. Untrained panelists more liked "sweet aromatics," "sour aromatics," "fermented aromatics," and "rich aromatics" over the other sensory attributes of dairy products. The olfactory hedonic ratings were increased when the odor was more characterized as "fragrant," "attractive," "comfortable," "familiar," "faint," "natural," or "modern." Specific sensory attributes were found to be related to specific adjective pairs representing the emotional response. Moreover, the ratings of adjective pairs representing emotional response of odors and their influences on hedonic ratings differed significantly between sexes. In conclusion, our findings suggest that the emotional responses as well as the sensory attributes affect the hedonic ratings of odors in dairy products.