Prevalência de nascimentos prematuros como desfechos de infecções pela COVID-19 na gestação / Prevalence of Preterm Birth as an Outcome of COVID-19 Infections during Pregnancy / Prevalencia de nacimientos prematuros producto de la infección por COVID-19 durante el embarazo

Objetivo: estimar a prevalência de nascimento prematuro em gestantes infectadas pela Covid-19, comparar índices de prematuridade entre infectadas e não infectadas e elucidar fatores associados à prematuridade. Métodos: coorte retrospectiva, com coleta de dados por inquérito online, de abril a dezembro de 2022, com mulheres que estiveram gestantes durante a pandemia, com acesso à internet, idade superior a 18 anos e que preencheram o primeiro inquérito online. Protocolo de pesquisa aprovado pelo Comitê de Ética. Resultados: primeiro inquérito respondido por 304 gestantes/puérperas, e o segundo por 82 (27%), compondo a amostra final. O índice de prematuridade no primeiro inquérito foi de 7,2% (n=14), já no segundo, 8,5% (n=7). A infecção pela Covid-19 não foi associada à prematuridade. A prematuridade associou-se a baixo peso, à necessidade de internação em centros de terapia intensiva neonatal e internações após o nascimento. Conclusão: a infecção pela Covid-19 não influenciou no aumento de nascimentos prematuros.

Objective: to estimate the prevalence of preterm birth in pregnant women infected with Covid-19, compare prematurity rates between infected and non-infected, and elucidate factors associated with prematurity. Methods: a retrospective cohort study was conducted using online survey data collected from April to December 2022, involving women who were pregnant during the pandemic, had internet access, were over 18 years old, and completed the initial online survey. The research protocol was approved by the Ethics Committee. Results: the initial survey was completed by 304 pregnant/postpartum women, and the follow-up survey by 82 (27%), comprising the final sample. The preterm birth rate in the initial survey was 7.2% (n=14), and in the follow-up survey, it was 8.5% (n=7). Covid-19 infection was not associated with prematurity. Prematurity was associated with low birth weight, the need for neonatal intensive care unit admission, and postnatal hospitalizations. Conclusion: Covid-19 infection did not influence an increase in preterm births.

Objetivo: estimar la prevalencia de partos prematuros en gestantes infectadas por Covid-19, comparar las tasas de prematuridad entre gestantes infectadas y no infectadas y determinar los factores asociados a la prematuridad. Métodos: estudio de cohorte retrospectivo, con recolección de datos mediante encuesta online, de abril a diciembre de 2022, con mujeres que estuvieron embarazadas durante la pandemia, con acceso a internet, mayores de 18 años y que completaron la primera encuesta online. El protocolo de investigación fue aprobado por el Comité de Ética. Resultados: la primera encuesta fue respondida por 304 gestantes/puérperas, y la segunda por 82 (27%), que conformaron la muestra final. La tasa de prematuridad en la primera encuesta fue del 7,2% (n=14), en la segunda, del 8,5% (n=7). La infección por Covid-19 no se asoció con la prematuridad. La prematuridad se asoció con bajo peso, necesidad de internación en centros de cuidados intensivos neonatales e internaciones después del nacimiento. Conclusión: La infección por Covid-19 no influyó en el aumento de nacimientos prematuros.

A dynamic flow fetal membrane organ-on-a-chip system for modeling the effects of amniotic fluid motion.

Fetal membrane (amniochorion), the innermost lining of the intrauterine cavity, surround the fetus and enclose amniotic fluid. Unlike unidirectional blood flow, amniotic fluid subtly rocks back and forth, and thus, the innermost amnion epithelial cells are continuously exposed to low levels of shear stress from fluid undulation. Here, we tested the impact of fluid motion on amnion epithelial cells (AECs) as a bearer of force impact and their potential vulnerability to cytopathologic changes that can destabilize fetal membrane functions. A previously developed amnion membrane (AM) organ-on-chip (OOC) was utilized but with dynamic flow to culture human fetal amnion membrane cells. The applied flow was modulated to perfuse culture media back and forth for 48 h to mimic fluid motion. A static culture condition was used as a negative control, and oxidative stress (OS) condition was used as a positive control representing pathophysiological changes. The impacts of fluidic motion were evaluated by measuring cell viability, cellular transition, and inflammation. Additionally, scanning electron microscopy (SEM) imaging was performed to observe microvilli formation. The results show that regardless of the applied flow rate, AECs and AMCs maintained their viability, morphology, innate meta-state, and low production of pro-inflammatory cytokines. E-cadherin expression and microvilli formation in the AECs were upregulated in a flow rate-dependent fashion; however, this did not impact cellular morphology or cellular transition or inflammation. OS treatment induced a mesenchymal morphology, significantly higher vimentin to cytokeratin 18 (CK-18) ratio, and pro-inflammatory cytokine production in AECs, whereas AMCs did not respond in any significant manner. Fluid motion and shear stress, if any, did not impact AEC cell function and did not cause inflammation. Thus, when using an amnion membrane OOC model, the inclusion of a dynamic flow environment is not necessary to mimic in utero physiologic cellular conditions of an amnion membrane.

Retrospective analysis of reference intervals for dried blood spot based ms/ms newborn screening programs in Chinese preterm neonates: a nationwide study.

OBJECTIVES: Although recent discoveries regarding the biomarkers of newborn screening (NBS) programs by tandem mass spectrometry (MS/MS) highlight the critical need to establish reference intervals (RIs) specifically for preterm infants, no such RIs has been formally published yet. This study addressed the gap by offering a comprehensive set of reference intervals (RIs) for preterm neonates, and illustrating the dynamic changes of each biomarker with age. DESIGN AND METHODS: The NBS data of 199,693 preterm newborns (< 37 weeks of gestation) who met the inclusion and exclusion criteria from the NNSCP database were included in study analysis. The birth weight stratified dynamic trend of each biomarker were captured by their concentrations over age. Reference partitions were determined by the method of Harris and Boyd. RIs, corresponding to the 2.5th and 97.5th percentiles, as well as the 0.5th, 25th, 50th, 75th and 99.5th percentiles were calculated using a non-parametric rank approach. RESULTS: Increasing birth weight is associated with an elevation in the levels of arginine, citrulline, glycine, leucine and isobarics, methionine, ornithine, phenylalanine, and valine, whereas the levels of alanine, proline and tyrosine decrease. Additionally, two short-chain acylcarnitines (butyrylcarnitine + isobutyrylcarnitine and isovalerylcarnitine + methylbutyrylcarnitine) and a median-chain acylcarnitine (octenoylcarnitine) decrease, while four long-chain acylcarnitines (tetradecanoylcarnitine, palmitoylcarnitine, palmitoleylcarnitine and oleoylcarnitine) increase with increasing birth weight. Age impacts the levels of all MS/MS NBS biomarkers, while sex only affects the level of malonylcarnitine + 3-hydroxybutyrylcarnitine (C3-DC + C4-OH) in very low birth weight preterm neonates. CONCLUSION: The current study developed reference intervals (RIs) specific to birth weight, age, and/or sex for 35 MS/MS biomarkers, which can help in the timely evaluation of the health and disease of preterm neonates.

Instructional guidelines and group discussion effects on new nurses' competency regarding nursing care of preterm infants.

Background: Premature birth was once one of the leading causes of infant mortality. Premature infants require improved medical and nursing skills from a highly competent nursing team. Purpose: This investigation aimed to assess the effects of instructional guidelines and group discussion on new nurses' competency in preterm infants caring at the Neonatal Intensive Care Unit (NICU). Methods: A single-anonymized, two-group pre-test and post-test study design was accompanied in 2022. The study was accompanied for 50 newly graduated nurses concerned with competence in nursing management of preterm infants at the Neonatal Intensive Care Unit (NICU) in two hospitals: Al-Namas General Hospital, KSA, and the Pediatric Hospital of Assiut University, Egypt. Two groups were randomly selected from among the nurses to be trained on preterm infant nursing care competence either through an instructional guideline or group discussion. Nursing attitudes and practices were measured before and after training using questionnaires and checklists. Results: There was no significant difference between the instructional guideline group and the group discussion in the mean total score of attitudes (11.72 and 14.65, P = 0.455) and practices (14.36 and 14.80, P = 0.494) towards caring for preterm infants before intervention. While mean nurses' attitude and practice scores increased significantly in both groups after the intervention, in the discussion group, nurses' practice scores increased significantly (p = 0.001). Still, there were no significant changes in the instructional guideline group (P = 0.202). Conclusion: Both methods were effective on the newly graduated nurses' attitude; however, the instructional guidelines did not affect their practice regard nursing care of preterm infants. However, group discussion training techniques can effectively improve the nurses' attitude and practice toward nursing care of preterm infants. Relevance to clinical practice: The group discussion training method should be the approved and proven method for hospitals to train new nurses to increase clinical practices, especially during nursing care for premature infants, because this method has proven its worth in increasing the skill of nurses. It enables a group to talk about a specific subject and exchange personal stories. This approach involves a group leader facilitating communication and interaction between participants.

Factors affecting parental role adaptation in parents of preterm infants after discharge: a cross-sectional study.

Background: Parenting a preterm infant can be incredibly challenging and stressful, particularly in the first year after discharge. Desirable parental role adaptation leads to appropriate parenting behaviors and parent-infant interaction, which are essential to child health and development. Aim: To investigate the level of parental role adaptation and its influencing factors among parents of preterm infants in the first year after hospital discharge according to Belsky's parenting process model among parents of preterm infants in the first year after hospital discharge. Methods: A cross-sectional study design was adopted using convenience sampling. Data were collected using the Parental Role Adaptation Scale (PRAS) in parents with preterm infants, the Perceived Social Support Scale (PSSS), the Coping Adaptation Processing Scale (CAPS-15), and a sociodemographic questionnaire. Descriptive statistics, non-parametric tests, Spearman correlation analyses, and multivariate linear regression were used to analyze the data. Results: In total, 300 Chinese parents were included in the analysis. In the multivariate analysis, first-time parent (p = 0.003), master's degree and above (p = 0.042), coping adaptation processing (p = 0.000), residence location (towns: p = 0.019, city: p = 0.028), monthly family income (6000-10,000: p = 0.000, >10,000: p = 0.000), and perceived social support (p = 0.001) were all significant predictors of parental role adaptation and collectively accounted for 56.8% of the variation in parental role adaptation of parents with preterm infants (F = 16.473, p < 0.001). Coping adaptation processing mediated the relationship between perceived social support and parental role adaptation (95% bootstrap CI = 0.022, 0.130). Conclusion: Chinese parents of preterm infants experience a moderate level of parental role adaptation when their child is discharged from the hospital to home. Parents who are not first-time parents, have master's degrees or above, live in towns or cities, have higher coping and adaptation abilities, have high monthly family income, and greater perceived social support have a higher level of parental role adaptation. Healthcare providers should pay more attention to parents with low socioeconomic status and encourage them to improve their coping and adaptation abilities and to utilize their formal and informal social support networks.

A cross-sectional analysis of preterm birth incidence and survival in Al Kharj, Saudi Arabia.

OBJECTIVES: To understand the prevalence and survival rates of preterm birth (PTB) is of utmost importance in informing healthcare planning, improving neonatal care, enhancing maternal and infant health, monitoring long-term outcomes, and guiding policy and advocacy efforts. METHODS: The medical records of preterm infants admitted to the Neonatal Intensive Care Unit (NICU) with a diagnosis of prematurity at the Maternity and Children's Hospital (MCH), Al Kharj, Saudi Arabia, were reviewed between January 2018 and December 2022. Data were collected on birth weight (BW), gender, number of live births, gestational age, mortality, nationality, APGAR score, length of stay in the NICU, and maternal details. RESULTS: A total of 9809 live births were identified between 2018 and 2022, of which 139 (3.9%) were born preterm. The overall mortality rate of the included sample was 7.19%, whereas the mortality rate according to BW was 38.4% of those born with extremely low birth weight (ELBW). The most common intrapartum complications were malpresentation (15.1%), placental complications (4.3%), and cord complications (3.6%). CONCLUSION: This study provides valuable insights into the prevalence of PTB in the country, particularly focusing on the vulnerability of extremely preterm babies.

Randomized Controlled Trial of Enteral Vitamin D Supplementation (ViDES) in Infants <28 Weeks Gestational Age or <1000 Grams Birth Weight: Study Protocol.

Background: Vitamin D is necessary to develop healthy lungs and other organs early in life. Most infants born before 28 weeks' gestation have low vitamin D levels at birth and a limited intake during the first month. Enteral vitamin D supplementation is inexpensive and widely used. The appropriate supplementation regimen for extremely preterm infants is controversial, and the effect of different regimens on their blood levels and outcomes is unclear. Methods: Randomized, blinded comparative effectiveness trial to compare two vitamin D supplementation regimens for inborn infants <28 weeks gestation or <1000 grams birth weight at a large academic center in the United States.Infants are stratified by birth weight and randomized within 96 hours after birth to either routine supplementation (400 IU/day with established feedings) or increased supplementation (800 IU/day with any feedings) during the first 28 days after birth.We hypothesize that the higher and early vitamin D dose (800 IU/d with early feeding) compared to placebo plus routine dose (400 IU/d with established feeding) will substantially increase total 25-hydroxyvitamin D3 levels measured as state-of-art at one month, reduce respiratory support at 36 weeks' postmenstrual age (on an ordinal scale predictive of later adverse outcomes) and improve or at least not worsen other important secondary outcomes. The infants in the study will follow up at 22-26 months' corrected age (~2 years) with blinded certified examiners to evaluate neurodevelopmental outcomes.The sample size of a minimum of 180 infants provides >90% power to detect a >95% posterior probability of a 33% increase in serum 25-hydroxy vitamin D3 and >80% power to detect a >80% posterior probability of a relative risk decrease of 20% of reducing respiratory support by intention-to-treat Bayesian analyses using a neutral prior probability. Discussion: Our study will help clarify the uncertain relationship of vitamin D supplementation and its associated serum metabolites to clinical outcomes of extremely preterminfants. Confirmation of our hypotheses would prompt reconsideration of the supplementation regimens used in extremely preterm infants and justify a large multicenter study to verify the generalizability of the results. Trial registration: ClinicalTrials.gov registered on July 14, 2022 (NCT05459298).

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre.

OBJECTIVE: Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide, and cervical incompetence (CIC) is a significant contribution. Cervical cerclage (CC) is an effective obstetric intervention. However, many clinical factors affect the success rate of surgery. The objective was to investigate and compare the pregnancy and neonatal outcomes of patients who underwent ultrasound- and physical examination-indicated cervical cerclage and to explore the influencing factors of preterm delivery before 34 weeks. METHODS: The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Continuous variables were compared using Student's t test (for normally distributed data) or the Mann-Whitney U test (for nonnormally distributed data). Categorical variables were analysed using the chi-square test or Fisher's exact test. Additionally, logistic regression analyses and receiver operating characteristic curves were used to evaluate the associations of inflammatory markers with maternal and neonatal outcomes. RESULTS: This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to those in the ultrasound-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score in the physical examination-indicated cerclage group were significantly lower, and the rates of delivery at < 28 weeks, < 32 weeks, < 34 weeks, and < 37 weeks of gestation and neonatal mortality were significantly higher (all P < 0.05). Compared to those in the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein (CRP), the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) were significantly higher (P < 0.05). Additionally, maternal blood inflammatory markers, such as the CRP, white blood cell count, platelet to lymphocyte ratio (PLR), SII, and SIRI were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR = 3.829; 95% CI 1.413-10.373; P = 0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P = 0.003) and CRP level (OR = 1.083; 95% CI 1.038-1.131; P = 0.022). The risk factors for preterm delivery before 34 weeks of gestation were twin gestation, an increased SII level and an increased CRP level, which had good combined predictive value. CONCLUSION: In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with preterm delivery before 34 weeks of gestation.

From Warm to Cold: Feeding Cold Milk in Preterm Infants with Uncoordinated Oral Feeding Patterns.

Objective: Premature infants frequently face feeding challenges due to disrupted coordination of sucking, swallowing, and breathing, increasing their risk of dysphagia. There are few effective treatment options available for these infants. In adults experiencing dysphagia, consuming cold foods or liquids can be an effective strategy. This method stimulates the sensory receptors in the pharyngeal mucosa, promoting safer and more effective swallowing. We have previously demonstrated that short-duration feeding (5 swallows) with cold liquid significantly reduces dysphagia in preterm infants; however, the impact of extended cold milk feeding remains unexplored. This study aims to assess the safety of cold milk feedings in preterm infants diagnosed with uncoordinated feeding patterns and its effect on feeding performance. Study Design: Preterm infants with uncoordinated feeding patterns (n=26) were randomized to be fed milk at either room or cold temperatures using an experimental, randomized crossover design. We monitored axillary and gastric content temperatures, mesenteric blood flow, and feeding performance. Result: The findings suggest that preterm infants can safely tolerate cold milk without any clinically significant changes in temperature or mesenteric blood flow, and it may enhance certain aspects of feeding performance. Conclusion: These results suggest that cold milk feeding could be a safe therapeutic option for preterm infants. These results highlight the potential for further comprehensive studies to explore the use of cold milk as an effective therapeutic approach for addressing feeding and swallowing difficulties in preterm infants. Registered at clinicaltrials.org #NCT04421482.

Effect of in-line filtration in newborns: study protocol of the Intravenous Neonatal Central Access Safety (INCAS) randomized controlled trial.

BACKGROUND: Particulate contamination due to infusion therapy (administration of parenteral nutrition and medications) carries a potential health risk for infants in neonatal intensive care units (NICUs). This particulate consists of metals, drug crystals, glass fragments, or cotton fibers and can be generated by drug packaging, incomplete reconstitution, and chemical incompatibilities. In-line filters have been shown to remove micro-organisms, endotoxin, air, and particles in critically ill adults and older infants, but its benefits in newborn remain to be demonstrated. Moreover, 50% of inflammatory episodes in the setting of NICUs are blood culture-negative. These episodes could be partly related to the presence of particles in the infusion lines. METHODS: A multicenter randomized single-blind controlled trial was designed. All infants admitted to NICUs for which prolonged infusion therapy is expected will be enrolled in the study and randomized to the Filter or Control arm. All patients will be monitored until discharge, and data will be analyzed according to a "full analysis set." The primary outcome is the frequency of patients with at least one sepsis-like event, defined by any association of suspected sepsis symptoms with a level of c-reactive protein (CRP) > 5 mg/L in a negative-culture contest. The frequency of sepsis, phlebitis, luminal obstruction, and the duration of mechanical ventilation and of catheter days will be evaluated as secondary outcomes. The sample size was calculated at 368 patients per arm. DISCUSSION: This is the first multicenter randomized control trial that compares in-line filtration of parenteral nutrition and other intravenous drugs to infusion without filters. Sepsis-like events are commonly diagnosed in clinical practice and are more frequent than sepsis in a positive culture contest. The risk of these episodes in the target population is estimated at 30-35%, but this data is not confirmed in the literature. If the use of in-line filters results in a significant decrease in sepsis-like events and/or in any other complications, the use of in-line filters in all intravenous administration systems may be recommended in NICUs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05537389, registered on 12 September 2022 ( https://classic. CLINICALTRIALS: gov/ct2/show/results/NCT05537389?view=results ).

Adolescent behavioral problems, preterm/low birth weight children and adult life success in a prospective Australian birth cohort study.

BACKGROUND: Preterm and/or low birthweight (PT/LBW) is predictive of a range of adverse adult outcomes, including lower employment, educational attainment, and mental wellbeing, and higher welfare receipt. Existing studies, however, on PT/LBW and adult psychosocial risks are often limited by low statistical power. Studies also fail to examine potential child or adolescent pathways leading to later adult adversity. Using a life course framework, we examine how adolescent problem behaviors may moderate the association between PT/LBW and a multidimensional measure of life success at age 30 to potentially address these limitations. METHODS: We analyze 2044 respondents from a Brisbane, Australia cohort followed from birth in1981-1984 through age 30. We examine moderation patterns using obstetric birth outcomes for weight and gestation, measures of problem behaviors from the Child Behavioral Checklist at age 14, and measures of educational attainment and life success at 30 using multivariable normal and ordered logistic regression. RESULTS: Associations between PT/LBW and life success was found to be moderated by adolescent problem behaviors in six scales, including CBCL internalizing, externalizing, and total problems (all p < 0.01). In comparison, associations between LBW and educational attainment illustrate how a single-dimensional measure may yield null results. CONCLUSION: For PT/LBW, adolescent problem behaviors increase risk of lower life success at age 30. Compared to analysis of singular outcomes, the incorporation of multidimensional measures of adult wellbeing, paired with identification of risk and protective factors for adult life success as children develop over the lifespan, may further advance existing research and interventions for PT/LBW children.

Routine transabdominal cervical length screening in mid-pregnancy for the prevention of preterm birth: Is it good enough to use as a screening test?

BACKGROUND: Preterm birth (PTB) is a major pregnancy complication. There is evidence that a short cervical length in mid-pregnancy may predict women at increased risk of PTB. AIMS: To evaluate the utility of population-based, transabdominal cervical length (TACL) measurement screening in mid-pregnancy for PTB prediction in women. MATERIALS AND METHODS: A transabdominal approach was initially performed, with a transvaginal (TVCL) approach offered when the TACL was <35 mm, could not be accurately measured, or the pregnancy had risk factors for PTB. TACL was compared to the directly related TVCL, when both were performed at the same assessment. Women with risk factors of PTB were included when they had both TACL and TVCL measurements performed at the same visit. RESULTS: Data were provided for 9355 singleton pregnancies from 13 participating imaging centres. A transabdominal approach was used in 9006 (96.3%), including 682 (7.3%) TVCL combined with TACL. There were 349 (3.7%) women who had TVCL only. The median TACL was longer (40 mm) than the TVCL (38 mm). In 682 paired TACL and TVCL measurements, TACL <35 mm correctly identified 96.2% of pregnancies with TVCL <25 mm, compared with 65.4% of cases when using a TACL <30 mm. A TVCL <25 mm occurred in 59 (0.6%) women. A TACL <35 mm was associated with birth <37 weeks of gestation in 12.1% of women and birth <32 weeks of gestation in 3.9%. CONCLUSIONS: Universal TACL is a feasible option for population screening of cervical length in a low-risk population, progressing to TVCL if the TACL is <35 mm or the cervix cannot be transabdominally accurately measured.

Challenges of parenting children born before 24 weeks of gestation.

AIM: To assess experience of care, well-being of parents and children's development in a cohort of extremely premature infants born <24 weeks of gestation in Sweden from 2007 to 2018. METHODS: A survey based on multiple questionnaires answered by 124/349 (35.5%) parents. RESULTS: The median age of parents and children was 43 and 9 years, respectively; 74.2% were mothers. Parents expressed high healthcare satisfaction. Following discharge from neonatal care, the satisfaction with the infant's treatment, support from personnel and being respected as a parent significantly declined but remained high. The criteria for suspected developmental deviation according to the screening test early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire was fulfilled by 84.3%, 55.6% had suspected avoidant restrictive food intake disorder and 47.9% had visual perception problems. Parents experienced severe fatigue (48.6%) despite strong social support and family self-efficacy. Economic support was provided to 30.6%, and 37.9% of children were enrolled in habilitation services. CONCLUSION: This study highlighted the substantial challenges faced by parents of infants born before 24 weeks of gestation, including decreased satisfaction post-discharge, fatigue and concerns about children's well-being. The findings underscore the need for comprehensive family-centred support and long-term multi-professional follow-up centres.

Alteration of fractional anisotropy in preterm-born individuals: a systematic review and meta-analysis.

BACKGROUD: Neurological disorders are common in preterm (PT) born individuals. Diffusion tensor imaging (DTI) studies using tract-based spatial statistics (TBSS) effectively detect microstructural white matter (WM) abnormalities in the brain. We conducted this systematic review to integrate the findings of TBSS studies to determine the most consistent WM alterations in PT born individuals. METHODS: PubMed, Embase, Web of Science and Science Direct were searched. DTI studies using TBSS in PT born individuals were screened up to October 2022. The systematic review included studies reporting alterations in FA values for the entire brain in a stereotactic space, with three coordinates (x, y, z), according to the seed-based d mapping method. RESULTS: The search strategy identified seventeen studies that fulfilled our inclusion criteria, with a total of 911 PT-born individuals and 563 matched controls were analysed. Of the seventeen studies, eight were dedicated to 650 adults, five to 411 children and four to 413 infants. Ten studies recruited 812 individuals born very prematurely (GA <29 weeks), six studies recruited 386 moderately premature individuals (GA = 29-32 weeks) and one study recruited 276 individuals born late prematurely (GA >32 weeks). This meta-analysis of six studies including 388 individuals highlighted four brain regions in which fractional anisotropy (FA) was lower in PT group than in people born at term. The quantitative meta-analysis found that the most robust WM alterations were located in the corpus callosum (CC), the bilateral thalamus and the left superior longitudinal fasciculus (SLF) II. Significant changes in FA reflect WM abnormalities in PT born individuals from infant to young adulthood. CONCLUSIONS: Significant changes in FA reflect WM abnormalities in individuals born PT from infancy to young adulthood. The abnormal development of the CC, bilateral thalamus and left SLF may play a vital role in the neurodevelopment of PT individuals.

Neurological disorders are prevalent in preterm (PT) born individuals. The use of tract-based spatial statistics (TBSS) in diffusion tensor imaging (DTI) studies has proven effective in detecting microstructural abnormalities of the white matter (WM) of the brain. In order to determine the most consistent alterations in WM among those born prematurely, we have screened DTI studies using TBSS in this PT born population up until October 2022. The meta-analysis identified four brain regions where fractional anisotropy (FA) was lower in the PT group than in those born at term. The quantitative meta-analysis identified the corpus callosum, the bilateral thalamus and the left superior longitudinal fasciculus II. As the most robust WM alterations. Various studies have demonstrated the links between PT birth, intelligence quotient, gestational age and subject age.

The influence of previous preterm birth with singleton pregnancy on the risk of recurrence in subsequent twin pregnancy: a meta-analysis.

BACKGROUND: Preterm birth is a significant obstetrical concern around the globe. With this study, we aimed to determine whether a prior singleton pregnancy preterm birth increases the likelihood of preterm birth in subsequent twin pregnancies. We designed his systematic review to provide valuable information for pregnant women and obstetricians during counselling and for individuals involved in the planning of preventive strategies. METHODS: We comprehensively searched the PubMed, Embase and Scopus databases to identify relevant studies published until October 2023 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We applied a random-effects meta-analysis to the data gathered from the selected studies. RESULTS: Among the 460 initially identified studies, only eight met the eligibility criteria. The analysis of incidence revealed an event rate of 9.5% (95% CI, 4.4-19.5%) for a history of preterm singleton birth in the cohort of women with subsequent twin pregnancies. Subgroup analyses focused on the risk of preterm twin births (<37 weeks, <34 weeks and <32 weeks) in women with prior preterm singleton births. Our results revealed a significantly elevated risk of subsequent preterm twin births associated with prior preterm singleton births at <37 weeks (OR, 2.94; 95% CI, 1.99-4.33; p < .001), <34 weeks (OR, 1.89; 95% CI, 1.67-2.14; p < .001) and <32 weeks (OR, 2.51; 95% CI, 1.58-3.99; p < .001), without heterogeneity in the included studies. CONCLUSIONS: Our systematic analysis indicates a consistent and statistically significant association between a history of preterm singleton births and preterm twin births at various gestational ages. These findings underscore the importance of the obstetric history during assessments to predict the risk of preterm births in twin pregnancies. Clinicians should monitor pregnancies with a history of preterm singleton births, as targeted interventions and improved prenatal care can mitigate the risk of preterm birth during twin pregnancies.

Preterm birth, a global concern, prompted a study examining whether a prior preterm singleton birth raises the risk of preterm birth in subsequent twin pregnancies. Conducting a systematic review of 460 studies, only eight met the eligibility criteria. The meta-analysis revealed a 9.5% incidence of preterm singleton births in subsequent twin pregnancies. Further analysis demonstrated a significantly elevated risk of preterm twin births at <32 weeks for those with a history of preterm singleton births. The study concludes that a consistent and statistically significant association exists between prior preterm singleton births and increased preterm twin birth risk at various gestational ages. This underscores the importance of considering obstetric history in assessing preterm birth risk in twin pregnancies. Clinicians are advised to closely monitor pregnancies with a history of preterm singleton births for interventions targeted and improved prenatal care.

Socioeconomic inequities during COVID 19 pandemic increase preterm birth and low birth weight in the most underprivileged.

BACKGROUND: The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality. OBJECTIVE: To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic). METHODS: A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP). RESULTS: In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes. CONCLUSIONS: In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Neighborhood mobility and racial disparities in preterm birth: A sibling study in California.

Recent work finds that upward neighborhood mobility-defined as reductions in neighborhood socioeconomic disadvantage due to moving-may improve birth outcomes. Less work, however, explores whether changes in socioeconomic context differentially impact birth outcomes by maternal race and ethnicity. In the US, mothers of minoritized racial and ethnic identity often experience worse neighborhood conditions and pregnancy outcomes than White mothers. Using a sibling-linked dataset, we examined whether neighborhood mobility corresponds with changes in preterm birth risk among Asian (N = 130,079), Black (N = 50,149), Hispanic (N = 429,938), and White (N = 233,428) mothers who delivered multiple live births in California between 2005 and 2015. We linked residential addresses at each birth to census-derived indices of neighborhood disadvantage and defined levels of neighborhood mobility as moving-induced changes in disadvantage between pregnancies. We mapped neighborhood mobility patterns and fit conditional logistic regression models estimating the odds of preterm birth in the sibling delivered after moving, controlling for the risk of preterm birth in the sibling delivered before moving, by maternal race and ethnicity. Dot density maps highlight racialized patterns of neighborhood mobility and segregation between Black and White mothers. Regression results show that Black and, in some cases, Asian and Hispanic mothers who experienced upward mobility (moves away from neighborhood disadvantage) exhibited reduced odds of preterm birth in the second delivery. Upward mobility did not reduce the odds of preterm birth among White mothers. Findings suggest that policies and programs that enable opportunities for neighborhood mobility may reduce persistent racial and ethnic disparities in adverse birth outcomes.

Women's experience of preterm birth in an East African context: a qualitative study.

Background: Approximately 15 million children are born each year prematurely, representing more than 10 percent of all childbirths worldwide. Prematurity is an acute event and the leading cause of death among newborns and children under five. Sixty percent of these premature deaths occur in Sub-Saharan Africa and Southeast Asia. Objective: The current study aimed to explore and understand women's experiences and perceptions regarding giving birth prematurely at the National Hospital of Muhimbili in Dar es Salaam, Tanzania. Method: A qualitative method, using Interpretive Phenomenological Analysis approach was chosen to understand and describe the women's experiences. A semi-structured guide was used during the interviews. All interviews were audio-recorded and transcribed verbatim. Findings: Eight in-depth interviews were conducted. The analysis revealed three superordinate themes: (a) Emotional turmoil: unmet expectations shattering maternal identity, emotional distress, and loss of hope; (b) Adapting to preterm birth and challenges: the unexpected situation, lack of proper care, strenuous breastfeeding routines, and socioeconomic challenges; (c) Significance of proper care and emotional support: good maternal care, mother-to-mother and family support. Conclusion: This study provided a deeper understanding of women's experiences and perceptions of premature childbirth. The current study indicated the importance of caregivers' awareness of the women's emotional distress, their need to adapt to a sudden unexpected situation, and the necessity of emotional support.

The use of antenatal corticosteroids in preterm labour for the prevention of perinatal mortality in hospitals in Tanzania.

Background: Antenatal corticosteroids (ACS) are given to pregnant women at risk of preterm delivery to hasten the maturation of the lungs, lowering the risk of newborn respiratory distress syndrome (RDS) and perinatal mortality. Objective: The aim of this study was to determine whether exposure to ACS was associated with lower rates of perinatal mortality and RDS in preterm infants delivered by women with preterm labour. Methods: This is a secondary analysis of data from four hospitals in Mwanza, Tanzania. All singletons and twins born to women who were in preterm labour between July 2019 and February 2020 and delivered in-hospital between 24 and 34 weeks of gestation were included. Data were recorded from participants' medical records and analysed using STATA Version 14. Results: Over an eight-month period, 588 preterm infants were delivered to 527 women. One hundred and ninety (36.1%) women were given ACS. Infants who were exposed to ACS in utero had a lower rate of perinatal mortality (6.8% vs 19.1%) and RDS (12.3% vs 25.9%) compared to those not exposed to ACS. In adjusted multivariable models, ACS exposure was related to a lower risk of perinatal mortality, aRR 0.23 (95% CI 0.13 - 0.39), and RDS, aRR 0.45 (95% CI 0.30 - 0.68). Conclusion: ACS significantly reduced the risk of perinatal mortality and RDS among preterm infants exposed to ACS in utero and delivered by women in preterm labour. The use of ACS should be encouraged in low-resource settings where preterm birth is prevalent to improve perinatal outcomes.

Curosurf surfactant application on preterm babies with respiratory complications-health-economic benefits.

Background: The implementation of surfactant for respiratory syndrome approbates the therapy as a revolutionary method in intensive neonatal therapy and respiratory resuscitation. It is important to investigate the costs of this treatment. Objective: The aim of the study is to analyze the data by the application of the surfactant Curosurf to preterm babies with respiratory complications and describe the treatment costs, healthcare resource utilization and evaluate economic benefits of surfactant use in the treatment of neonates with respiratory distress syndrome (RDS) and hyaline-membrane disease (HDM). Methods: A retrospective survey was performed covering 167 babies based on respiratory complications due to preterm birth and the necessity to apply a surfactant therapy. A documentary method was implemented and for each patient, an individual research protocol was filled out - a questionnaire created specifically for the purposes of the study. Results and discussion: An analysis of the data from the application of CUROSURF was made and the obtained therapeutic results were compared to expenditures for the therapy, short-term therapeutic effect, benefits and consequences of the therapy of preterm newborns with respiratory complications. The application of CUROSURF to babies with RDS resulted in the realization of net savings due to the elimination of the necessity of conducting several diagnostic and therapeutic procedures as well as their duration reduction of hospital stay, thus defining its health-economic benefits. Conclusions: The models of evaluation of cost effectiveness reveal that the medicinal product is expensive but effective from the aspect of short-term therapeutic results.