Adults born preterm have lower peripheral skeletal muscle area and strength.

Prematurity is associated with lower exercise capacity, which relies on the integrity of the cardiovascular, pulmonary, and skeletal muscle systems. Our animal model mimicking prematurity-associated conditions showed altered muscle composition and atrophy in adulthood. This study aimed to compare muscle composition and strength in adults born preterm versus full-term controls. This observational cohort study recruited 55 adults born preterm, ≤ 29 weeks' of gestation and 53 full-term controls who underwent musculoskeletal ultrasound imaging to assess morphology of the rectus femoris at rest and during a maximal voluntary contraction. Maximal voluntary contraction of the hands and legs were measured by manual dynamometry. In adults born preterm, there was lower muscle strength (handgrip: - 4.8 kg, 95% CI - 9.1, - 0.6; knee extensor: - 44.6 N/m, 95% CI - 63.4, - 25.8) and smaller muscle area (- 130 mm2, 95% CI - 207, - 53), which was more pronounced with a history of bronchopulmonary dysplasia. Muscle stiffness was increased in the preterm versus term group (0.4 m/s, 95% CI 0.04, 0.7). Prematurity is associated with alterations in skeletal muscle composition, area, and function in adulthood. These findings highlight the necessity to implement preventive and/or curative approaches to improve muscle development and function following preterm birth to enhance overall health in this population.

Respiratory and chest wall mechanics in very preterm infants.

Data on static compliance of the chest wall (Ccw) in preterm infants are scarce. We characterized the static compliance of the lung (CL) and Ccw to determine their relative contribution to static compliance of the respiratory system (Crs) in very preterm infants at 36 wk postmenstrual age (PMA). We also aimed to investigate how these compliances were influenced by the presence of bronchopulmonary dysplasia (BPD) and impacted breathing variables. Airway opening pressure, esophageal pressure, and tidal volume (VT) were measured simultaneously during a short apnea evoked by the Hering-Breuer reflex. We computed tidal breathing variables, airway resistance (R), and dynamic lung compliance (CL,dyn), inspiratory capacity (IC), and Crs, CL, and Ccw. Functional residual capacity was assessed by the multiple breath washout technique (FRCmbw). Breathing variables, compliances, and lung volumes were adjusted for body weight. Twenty-three preterm infants born at 27.2 ± 2.0 wk gestational age (GA) were studied at 36.6 ± 0.6 wk PMA. Median and interquartile range (IQR) Crs/kg is 0.69 (0.6), CL/kg 0.95 (1.0), and Ccw/kg 3.0 (2.4). Infants with BPD (n = 11) had lower Crs/kg (P = 0.013), CL/kg (P = 0.019), and Ccw/kg (P = 0.027) compared with infants without BPD. Ccw/CL ratio was equal between groups. FRCmbw/kg (P = 0.044) and IC/kg (P = 0.005) were decreased in infants with BPD. Infants with BPD have reduced static compliance of the respiratory system, the lungs, and chest wall. Decreased Crs, CL, and Ccw in infants with BPD explain the lower FRC and IC seen in these infants.NEW & NOTEWORTHY Data on chest wall compliance in very preterm infants in the postsurfactant era are scarce. To our knowledge, we are the first group to report data on static respiratory system compliance (Crs), lung compliance (CL), and chest wall compliance (Ccw) in preterm infants with and without bronchopulmonary dysplasia (BPD) in the postsurfactant era.

Differences in the swallowing process of newborns and healthy preterm infants: first results with a non-invasive bioimpedance and electromyography measurement system.

PURPOSE: Preterm infants (PI) have difficulty coordinating sucking, swallowing and breathing, and there is a risk of aspiration. The causes of this are not yet sufficiently understood. The aim of this study was to test a novel measurement device to measure breathing and pharyngeal processes involved in swallowing externally in everyday life to identify possible differences in neonates (NB) and PI. METHODS: Forty healthy NB were studied at 4-8 weeks of age (mean: 6.7 weeks) and 20 healthy PI (mean gestational age 30.5 weeks) at postmenstrual age (PMA) 34/35 weeks (mean PMA 35.1 weeks) during a single feeding. Surface electrodes were used to measure bioimpedance and electromyography reflecting swallow-related changes in the pharynx and muscle activation of the tongue and submental muscles. A respiratory belt was combined with recording of the depth of chest movements and the occurrence of pauses in breathing. RESULTS: Velocity and extent of pharyngeal closure did not differ significantly across the feeding period (velocity: p=0.09, closure: p=0.17), but during the first two suck-swallow bursts PI had greater velocity (p<0.001*) and extent of pharyngeal closure (p=0.004*) than NB. The duration of swallowing phases was significantly longer in PIs (p<0.001*), their muscle activation decreased faster (p<0.001*), and they had more pauses in breathing than NBs. CONCLUSIONS: The novel measurement device allowed, for the first time in everyday life, the measurement of factors influencing swallowing and breath-swallow coordination in NBs and PIs. PIs showed differences from NBs most likely due to differences in muscle strength and condition.

Cerebral and intestinal oxygen saturation of different volumes of red blood cell transfusion in preterm infants.

OBJECTIVES: The purpose of this study was to investigate and compare the effects of 20 ml/kg and 15 ml/kg red blood cell transfusion (RBCT) on cerebral and intestinal tissue oxygenation, the number of administered transfusions, and neonatal complications in premature infants with anemia. METHODS: This prospective, randomized, partially blinded observational study investigated anemic neonates of gestational age < 32 weeks (Registration ID: ChiCTR 1,900,026,672). The infants were randomly assigned to receive 15 or 20 ml/kg red blood cell transfusion. Cerebral and intestinal tissue oxygen saturation (cer rSO2 and int rSO2) were collected 2 h before transfusion, 2, 4, 6, 12, 24, and 48 h after the beginning of transfusion by Near-infrared spectroscopy (NIRS). We also collected vital signs including heart rate (HR), peripheral oxygen saturation (SpO2), and mean arterial blood pressure (MABP) 2 h before infusion, 2 h, and 6 h after the beginning of transfusion. Then we analyzed and compared regional oxygen saturation(rSO2), fractional tissue oxygen extraction (FTOE), and other outcome readouts (blood transfusion numbers, changes in hematocrit and hemoglobin, hospitalization days, HR, SpO2, MABP, and complications) between the two groups. The intraindividual comparisons of the above readouts before transfusion and those after transfusion were also evaluated within each group. RESULT: 73 newborns received 20 ml/kg (large volume group) and 78 newborns received 15 ml/kg transfusion (small volume group). There was no significant difference in cer rSO2, int rSO2, Cerebral fractional tissue oxygen extraction (cFTOE), and intestinal fractional tissue oxygen extraction (iFTOE) between the two groups. rSO2, MABP, and SpO2 increased; HR, cFTOE, and iFTOE decreased following transfusion in both groups. The transfusion number of the large volume group is significantly less than that of the small volume group (1.9 ± 0.3 vs. 2.6 ± 0.9, p < 0.01) and hospitalization days were also less than those in the low volume group (44.3 ± 8.2 vs. 47.6 ± 9.8, p < 0.05). The increases in hematocrit and hemoglobin were higher in the large volume group than those in small volume (hematocrit increment (%),10.7 ± 4.2 vs. 10.1 ± 5.9, p = 0.015; Hb concentration after blood transfusion (g/L) 132.3 ± 11.1 vs. 127.4 ± 15.4, p = 0.028). CONCLUSION: After the transfusion, cer rSO2 and int rSO2 increased significantly, FTOE decreased and vital signs improved in both the 15 ml/kg and 20 ml/kg groups, and these changes were not significantly different between the two groups. However, the larger group showed a more pronounced increase in hematocrit and hemoglobin, a reduction in the total number of transfusions, and a shorter duration of hospitalization after transfusion in preterm infants without increasing complications.

Potenciales evocados auditivos de tronco en neonatos nacidos a gran altitud / Brainstem auditory evoked potentials in newborn infants born in a high-altitude area

Introducción. Una forma no invasiva y segura de evaluar los parámetros neurofisiológicos en recién nacidos es la evaluación de los potenciales evocados auditivos del tronco encefálico (PEAT). Objetivo. Evaluar las latencias e intervalos de ondas de los PEAT en neonatos sanos nacidos a gran altitud (Cusco, 3399 msnm). Población y métodos. Estudio transversal y prospectivo. Se incluyeron neonatos menores a 14 días de vida, dados de alta a menos de 7 días de nacidos, evaluados para determinar los valores de los PEAT a intensidades sonoras de 70 dB, 80 dB y 90 dB. Se incluyeron las variables edad gestacional, peso al nacer, tipo de parto. Se calcularon las diferencias de las medianas de las latencias e intervalos de las ondas según edad gestacional y peso al nacer. Resultados. Se evaluaron 96 neonatos (17 pretérminos). Las medianas de las latencias de las ondas I a V a 90 dB fueron las siguientes: onda I 1,56 ms; onda II 2,74 ms; onda III 4,37 ms; onda IV 5,62 ms, onda V 6,63 ms. La latencia de la onda I para 80 dB fue de 1,71 ms y para 70 dB de 1,88 ms. Los intervalos para las ondas (I-III), (III-V) y (I-V) fueron de 2,8 ms, 2,2 ms y 5,0 ms respectivamente, sin diferencias entre intensidades (p >0,05). La prematuridad y el bajo peso estuvieron asociados a latencias de la onda I más prolongadas (p <0,05). Conclusiones. Se presentan valores ajustados de latencias e intervalos de los PEAT en neonatos nacidos a gran altitud. Se identificó que, a distintas intensidades sonoras, se ven diferencias en las latencias de las ondas, pero no en los intervalos entre ondas.

Introduction. A non-invasive and safe way to assess neurophysiological parameters in newborn infants is the evaluation of brainstem auditory evoked potentials (BAEPs). Objective. To assess the latencies and wave intervals of BAEPs in healthy newborn infants born in a high-altitude area (Cusco, 3399 MASL). Population and methods. Cross-sectional and prospective study. Newborn infants younger than 14 days of age, discharged less than 7 days after birth, were assessed to determine BAEP values at intensities of 70 dB, 80 dB, and 90 dB. The study variables were gestational age, birth weight, and type of delivery. The median differences in wave latencies and intervals were estimated according to gestational age and birth weight. Results. A total of 96 newborn infants (17 preterm infants) were assessed. The median latencies of waves I­V at 90 dB were for wave I: 1.56 ms, wave II: 2,74 ms, wave III: 4.37 ms, wave IV: 5.62 ms, and wave V: 6.63 ms. The latency of wave I for 80 dB was 1.71 ms and for 70 dB, 1.88 ms. Wave intervals (I­III, III­V, I­V) were 2.8 ms, 2.2 ms, and 5.0 ms, respectively, without differences among intensities (p > 0.05). Prematurity and low birth weight were associated with a longer wave I latency (p < 0.05). Conclusions. Here we describe adjusted BAEP latency and interval values for newborn infants born at high altitude. At different sound intensities, we identified differences in wave latencies, but not in interwave intervals.

Incubator-based active noise control device: comparison to ear covers and noise reduction zone quantification.

BACKGROUND: Noise exposure in the neonatal intensive care unit (NICU) is consistently higher than current recommendations. This may adversely affect neonatal sleep, weight gain, and overall health. We sought to evaluate the effect of a novel active noise control (ANC) system. METHODS: An ANC device's noise reduction performance was compared to that of adhesively affixed foam ear covers in response to alarm and voice sounds in a simulated NICU environment. The zone of noise reduction of the ANC device was quantified with the same set of alarm and voice sounds. RESULTS: The ANC device provided greater noise reduction than the ear covers in seven of the eight sound sequences tested in which a noise reduction greater than the just noticeable difference was achieved. For noise in the 500 Hz octave band, the ANC device exhibited consistent noise reduction throughout expected patient positions. It provided better performance for noise below 1000 Hz than above 1000 Hz. CONCLUSIONS: The ANC device provided generally superior noise reduction to the ear covers and provided a zone of noise reduction throughout the range where an infant would be placed within an incubator. Implications for patient sleep and weight gain are discussed. IMPACT: Active noise control device can effectively reduce noise inside an infant incubator due to bedside device alarms. This is the first analysis of an incubator-based active noise control device and comparison to adhesively affixed silicone ear covers. A non-contact noise reduction device may be an appropriate means of reducing noise exposure of the hospitalized preterm infant.

Thoracoabdominal asynchrony in a virtual preterm infant: computational modeling and analysis.

Thoracoabdominal asynchrony (TAA), the asynchronous volume changes between the rib cage and abdomen during breathing, is associated with respiratory distress, progressive lung volume loss, and chronic lung disease in the newborn infant. Preterm infants are prone to TAA risk factors such as weak intercostal muscles, surfactant deficiency, and a flaccid chest wall. The causes of TAA in this fragile population are not fully understood and, to date, the assessment of TAA has not included a mechanistic modeling framework to explore the role these risk factors play in breathing dynamics and how TAA can be resolved. We present a dynamic compartmental model of pulmonary mechanics that simulates TAA in the preterm infant under various adverse clinical conditions, including high chest wall compliance, applied inspiratory resistive loads, bronchopulmonary dysplasia, anesthesia-induced intercostal muscle deactivation, weakened costal diaphragm, impaired lung compliance, and upper airway obstruction. Sensitivity analyses performed to screen and rank model parameter influence on model TAA and respiratory volume outputs show that risk factors are additive so that maximal TAA occurs in a virtual preterm infant with multiple adverse conditions, and addressing risk factors individually causes incremental changes in TAA. An abruptly obstructed upper airway caused immediate nearly paradoxical breathing and tidal volume reduction despite greater effort. In most simulations, increased TAA occurred together with decreased tidal volume. Simulated indices of TAA are consistent with published experimental studies and clinically observed pathophysiology, motivating further investigation into the use of computational modeling for assessing and managing TAA.NEW & NOTEWORTHY A novel model of thoracoabdominal asynchrony incorporates literature-derived mechanics and simulates the impact of risk factors on a virtual preterm infant. Sensitivity analyses were performed to determine the influence of model parameters on TAA and respiratory volume. Predicted phase angles are consistent with prior experimental and clinical results, and influential parameters are associated with clinical scenarios that significantly alter phase angle, motivating further investigation into the use of computational modeling for assessing and managing thoracoabdominal asynchrony.

Hemodynamic Changes with Umbilical Cord Milking in Nonvigorous Newborns: A Randomized Cluster Cross-over Trial.

OBJECTIVE: To assess the hemodynamic safety and efficacy of umbilical cord milking (UCM) compared with early cord clamping (ECC) in nonvigorous newborn infants enrolled in a large multicenter randomized cluster-crossover trial. STUDY DESIGN: Two hundred twenty-seven nonvigorous term or near-term infants who were enrolled in the parent UCM vs ECC trial consented for this substudy. An echocardiogram was performed at 12 ± 6 hours of age by ultrasound technicians blinded to randomization. The primary outcome was left ventricular output (LVO). Prespecified secondary outcomes included measured superior vena cava (SVC) flow, right ventricular output (RVO), peak systolic strain, and peak systolic velocity by tissue Doppler examination of the RV lateral wall and the interventricular septum. RESULTS: Nonvigorous infants receiving UCM had increased hemodynamic echocardiographic parameters as measured by higher LVO (225 ± 64 vs 187 ± 52 mL/kg/min; P < .001), RVO (284 ± 88 vs 222 ± 96 mL/kg/min; P < .001), and SVC flow (100 ± 36 vs 86 ± 40 mL/kg/min; P < .001) compared with the ECC group. Peak systolic strain was lower (-17 ± 3 vs -22 ± 3%; P < .001), but there was no difference in peak tissue Doppler flow (0.06 m/s [IQR, 0.05-0.07 m/s] vs 0.06 m/s [IQR, 0.05-0.08 m/s]). CONCLUSIONS: UCM increased cardiac output (as measured by LVO) compared with ECC in nonvigorous newborns. Overall increases in measures of cerebral and pulmonary blood flow (as measured by SVC and RVO flow, respectively) may explain improved outcomes associated with UCM (less cardiorespiratory support at birth and fewer cases of moderate-to-severe hypoxic ischemic encephalopathy) among nonvigorous newborn infants.

Survey on human milk feeding and enteral feeding practices for very-low-birth-weight infants in NICUs in China Neonatal Network.

BACKGROUND: The breastfeeding rate in China is lower than that in many other countries and the extent of adoption of the "Feeding Recommendations for Preterm Infants and Low Birth Weight Infants" guideline in NICUs remains unclear. METHOD: A web-based survey about the current status of human milk feeding and enteral feeding practices at NICUs was sent to all China Neonatal Network's cooperation units on September 7, 2021, and the respondents were given a month to send their responses. RESULTS: All sixty NICUs responded to the survey, the reply rate was 100%. All units encouraged breastfeeding and provided regular breastfeeding education. Thirty-six units (60.0%) had a dedicated breastfeeding/pumping room, 55 (91.7%) provided kangaroo care, 20 (33.3%) had family rooms, and 33 (55.0%) routinely provided family integrated care. Twenty hospitals (33.3%) had their own human milk banks, and only 13 (21.7%) used donor human milk. Eight units (13.3%) did not have written standard nutrition management guidelines for infants with body weight < 1500 g. Most units initiated minimal enteral nutrition with mother's milk for infants with birth weight ˂1500 g within 24 h after birth. Fifty NICUs (83.3%) increased the volume of enteral feeding at 10-20 ml/kg daily. Thirty-one NICUs (51.7%) assessed gastric residual content before every feeding session. Forty-one NICUs (68.3%) did not change the course of enteral nutrition management during drug treatment for patent ductus arteriosus, and 29 NICUs (48.3%) instated NPO for 1 or 2 feeds during blood transfusion. CONCLUSION: There were significant differences in human milk feeding and enteral feeding strategies between the NICUs in CHNN, but also similarities. The data obtained would be useful in the establishment of national enteral feeding guidelines for preterm infants and quality improvement of cooperation at the national level.

Pharyngeal biorhythms during oral milk challenge in high-risk infants: Do they predict chronic tube feeding?

BACKGROUND: Eating difficulties are common in high-risk neonatal intensive care unit (NICU) infants; mechanisms remain unclear. Crib-side pharyngo-esophageal motility testing is utilized to assess contiguous swallowing physiology, and cross-system interplay with cardio-respiratory rhythms. Aims were to: (1) identify whether distinct pharyngeal rhythms exist during oral milk challenge (OMC), and (2) develop a chronic tube feeding risk prediction model in high-risk infants. METHODS: Symptomatic NICU infants (N = 56, 29.7 ± 3.7 weeks birth gestation) underwent pharyngo-esophageal manometry with OMC at 40.9 ± 2.5 weeks postmenstrual age (PMA). Exploratory cluster data analysis (partitioning around k-medoids) was performed to identify patient groups using pharyngeal contractile rhythm data (solitary swallows and swallows within bursts). Subsequently, (a) pharyngeal-esophageal, cardio-respiratory, and eating method characteristics were compared among patient groups using linear mixed models, and (b) chronic tube feeding prediction model was created using linear regression. RESULTS: Three distinct patient groups were identified with validity score of 0.6, and termed sparse (high frequency of solitary swallows), intermediate, or robust (high swallow rate within bursts). Robust group infants had: lesser pharyngeal and esophageal variability, greater deglutition apnea, pharyngeal activity, and esophageal activity (all p < 0.05), but less frequent heart rate decreases (p < 0.05) with improved clinical outcomes (milk transfer rate, p < 0.001, and independent oral feeding at discharge, p < 0.03). Chronic tube feeding risk = -11.37 + (0.22 × PMA) + (-0.73 × bronchopulmonary dysplasia) + (1.46 × intermediate group) + (2.57 × sparse group). CONCLUSIONS: Robust pharyngeal rhythm may be an ideal neurosensorimotor biomarker of independent oral feeding. Differential maturation of cranial nerve-mediated excitatory and inhibitory components involving foregut, airway, and cardiac rhythms distinguishes the physiologic and pathophysiologic basis of swallowing and cardio-respiratory adaptation.

Left ventricular diastolic function and respiratory outcomes in preterm infants: a retrospective study.

BACKGROUND: The role of left ventricular (LV) diastolic pressure in the pathophysiology of bronchopulmonary dysplasia (BPD) is unclear. We evaluated the trajectory of echocardiographic parameters of LV diastolic function and the association with respiratory outcomes in preterm infants. METHODS: We retrospectively analysed measurements of LV diastolic function (E, e', A, Ee' and E/A ratios) in infants below 32 weeks' gestation (GA). We compared infants with and without BPD by two-way RM ANOVA. We considered Ee' ratio as a proxy of LV filling pressure and identified a cut-off value using ROC analysis. We divided infants using such threshold and compared respiratory outcomes between groups by Mann-Whitney or Chi-square tests. RESULTS: We included 72 infants. Ee' ratio at 28 days was significantly associated with the duration of respiratory support (beta (std. error) = 5.32 (1.82), p = 0.005) and BPD (beta = 0.27 (0.10), p = 0.008). Infants with Ee' ratio > 12 at 28 days had longer respiratory support, oxygen requirement, and higher BPD rates than infants with Ee' ratio ≤ 12. CONCLUSION: LV diastolic function associated with elevated LV filling pressure may contribute to the pathophysiology of BPD. Serial echocardiographic measurements could identify infants at risk of worse respiratory outcomes. IMPACT: In very preterm infants, we assessed the trajectory of left ventricular diastolic function by serial echocardiographic evaluations and evaluated its association with respiratory outcomes. On average, infants who developed bronchopulmonary dysplasia had higher Ee' at 28 postnatal days and 36 weeks postmentrual age than infants who did not develop the disease. Infants with elevated Ee' at 28 postnatal days, suggestive of elevated left atrial pressure, required longer respiratory support.

Comparação da intervenção fisioterapêutica precoce com a orientação de pais na aquisição do sentar em lactentes pré-termo / Comparison of early physiotherapeutic intervention with parental guidance in the acquisition of sitting in preterm infants / Comparación de la intervención fisioterapéutica temprana con la orientación de los padres en la adquisición de la posición de sentado en los bebés prematuros

A prematuridade pode causar déficits de desenvolvimento motor nos lactentes apresentando assim a necessidade de intervenção precoce, neste sentido o objetivo deste trabalho foi comparar o desenvolvimento motor de lactentes prematuros na aquisição da habilidade do sentar independente após um programa de intervenção motora e de orientação de pais para estímulos domiciliares. Estudo longitudinal e avaliativo sobre o marco motor sentar em 11 lactentes, de ambos os sexos, com diagnóstico de prematuridade e idade cronológica de 6 a 8 meses. Os participantes foram divididos em dois grupos, o grupo intervenção que recebeu tratamento fisioterapêutico três vezes por semana durante seis semanas; e o grupo orientação, com encontros semanais durante o mesmo período com a fisioterapeuta que disponibilizou uma cartilha estruturada de exercícios a serem realizados pelos cuidadores durante a semana, sendo ambos os grupos com foco no sentar independente e avaliados com a escala AIMS. Foram encontradas diferenças significativas entre os resultados antes e após intervenção (t: -6.8571; p: 0,0012) assim como antes e após orientação (t: - 4.5995; p: 0.0029), sendo que ao analisar a porcentagem do ganho na dimensão sentar pela AIMS, o grupo intervenção teve maior ganho. Conclui-se que a intervenção fisioterapêutica apresentou melhores resultados para a aquisição do marco motor sentar. Apesar disso, a estimulação feita pelos pais após orientação profissional também apresentou valores positivos.

Prematurity can cause motor development deficits in infants, thus presenting the need for early intervention, in this sense the objective of this study was compare the motor development of preterm infants in the acquisition of the ability to sit independently after a motor intervention program and of orientation of parents for home stimuli. A longitudinal and evaluative study on the motor frame sit in 11 infants, of both sexes, with diagnosis of prematurity and chronological age of 6 to 8 months. Participants were divided into two groups, the intervention group that received physiotherapeutic treatment three times a week for six weeks; and the orientation group, with weekly meetings during the same period with the physiotherapist who provided a structured workbook of exercises to be performed by the caregivers during the week, both groups being focused on independent sitting and evaluated with the AIMS scale. There were significant differences between the results before and after intervention (t: -6.8571; p: 0.0012) as well as before and after orientation (t: -4.5995; p: 0.0029); when analyzing the percentage of gain in dimension by the AIMS, the intervention group had greater gain. It was concluded that the physiotherapeutic intervention presented better results for the acquisition of the motor frame sit. Despite this, the stimulation done by the parents after professional orientation also presented positive values.

La prematuridad puede causar déficits de desarrollo motor en los bebés, por lo que se requiere una intervención temprana. El objetivo de este estudio fue comparar el desarrollo motor de los bebés prematuros en la adquisición de la capacidad de sentarse de forma independiente después de un programa de intervención motora y la orientación de los padres para la estimulación en el hogar. Se trata de un estudio longitudinal y evaluativo del hito motor de la sedestación en 11 bebés de ambos sexos, diagnosticados como prematuros y con una edad cronológica que oscila entre los 6 y los 8 meses. Los participantes se dividieron en dos grupos, el grupo de intervención que recibió tratamiento fisioterapéutico tres veces por semana durante seis semanas; y el grupo de orientación, con reuniones semanales durante el mismo periodo con el fisioterapeuta que proporcionó un folleto estructurado de ejercicios que debían realizar los cuidadores durante la semana, ambos grupos centrados en la sedestación independiente y evaluados con la escala AIMS. Se encontraron diferencias significativas entre los resultados antes y después de la intervención (t: -6,8571; p: 0,0012), así como antes y después de la orientación (t: -4,5995; p: 0,0029), y al analizar el porcentaje de ganancia en la dimensión de sentarse por el AIMS, el grupo de intervención tuvo mayor ganancia. Concluimos que la intervención fisioterapéutica presentó mejores resultados para la adquisición del hito motor sentado. Sin embargo, la estimulación realizada por los padres tras la orientación profesional también mostró valores positivos.

[Features of the formation of interzonal connections of the brain according to quantitative electroencephalography in full-term and premature infants]. / Osobennosti formirovaniya mezhzonal'nykh svyazei mozga po dannym kolichestvennoi elektroentsefalografii u donoshennykh i nedonoshennykh mladentsev.

OBJECTIVE: To study the features of functional interzonal integration and its dynamics in infants from 0 to 9 months during prospective observation, taking into account the timing gestation, clinical picture and morphological changes on neurosonography (NSG). MATERIAL AND METHODS: A comprehensive unified examination was carried out in dynamics in 89 infants three times at the age of 3, 6, 9 months and included, in addition to assessing the neurological status, the Denver Developmental Screening Test (DDST), transfontanellar ultrasonography with a vector sensor according to the generally accepted method. We also evaluated the parameters of electroencephalography (EEG) recorded in the waking state with an analysis of background parameters, zonal differences, and the identification of pathological types of activity and calculation of the average coherence power (ACP). In accordance with the gestational age, infants are divided into two groups of full-term and premature babies. RESULTS: In the group of premature babies, the clinical picture in the neonatal period was dominated by cerebral ischemia of I and II degrees. The DDST parameters throughout the entire observation period did not reveal any deviations from the optimal development in all children. There were significant changes in functional connectivity (FC) in premature infants, which were more pronounced by 9 months. Functional hyperintegration was recorded in the intrahemispheric occipital-temporal and occipital-central regions bilaterally, in the anterofrontal-temporal leads on the left and in the interhemispheric anterofrontal regions. The ACP indicators were affected by changes in the NSG. An increase in ACP values in the occipitotemporal leads was associated with the presence of subependymal cysts in both preterm and full-term infants. Intraventricular hemorrhages and increased echogenicity in the periventricular zones in preterm infants were associated with an increase in coherence in the anterior frontal, left occipito-central, and temporo-anterofrontal leads. CONCLUSION: Thus, in preterm infants with cerebral ischemia of grades I and II, as well as in children with subependymal cysts, ACP indicators indicate hyperintegration of brain areas that are of fundamental importance for speech development and the formation of cognitive functions. Changes in the level of FC in the areas of the cerebral cortex in children with low gestational age, cerebral ischemia I and II, even at the optimal rate of motor and preverbal development, require further study, as it can reflect both the physiological processes of maturation in the postnatal period with transient deviations, and act as the role of possible early markers of future variants of deviant development.

Intraventricular hemorrhage prediction in premature neonates in the era of hemodynamics monitoring: a prospective cohort study.

Unstable hemodynamics and prematurity are the main players in intraventricular hemorrhage (IVH) development. Our objective was to study 8 the use of superior vena cava flow (SVCF), left ventricular output (LVO), and right ventricular output (RVO), and anterior cerebral artery (ACA) Doppler measures in prediction of IVH in the first week of life in preterm infant ≤ 32 weeks and birth weight ≤ 1500 g. This prospective cohort study was conducted in 55NICU of Alexandria University maternity hospital. Of 147 enrolled patients, 132 infants born ≤ 32 weeks GA and birth weight ≤ 1500 g were eligible for- the study. One hundred twenty-seven infants completed the study. Infants were scanned for ACA-RI using transfontanellar ultrasound, and SVCF, LVO, and RVO using functional echocardiography in the first 24 h after birth. Patients had another two scans on DOL3 and 7 to detect IVH development. Low SVCF and high ACA-RI significantly increased the risk of IVH using logistic regression models with OR, 3.16; 95%CI, 1.19-8.39; P = 0.02 and OR, 1.64; 95%Cl, 1.10-2.44; P = 0.02, respectively. Low SVCF and high ACA-RI significantly increased risk of catastrophic IVH P = 0.025 and 0.023, respectively. Combined use of low SVCF < 55 ml/kg/min and ACA-RI > 0.75 is predictor of IVH with sensitivity 40.8% and 82.1% specificity. CONCLUSIONS: There are strong relations between both low SVCF and high ACA-RI, and IVH development in premature neonates ≤ 32 weeks and birth weight ≤ 1500 g, with more significance towards catastrophic IVH. Admission RSS and LVO are the strongest factors affecting SVCF. Maternal anemia, patent ductus arteriosus size (mm/kg), and capillary refill time were significantly associated with high ACA-RI. These findings help in more understanding of pathophysiological factors affecting central perfusion that might affect the longer term neurodeveopmental outcome. TRIAL REGISTRATION: This work was registered in clinical trial.gv no NCT05050032. WHAT IS KNOWN: •Whether SVCF and RI-ACA can predict IVH in preterm neonates is still debatable. WHAT IS NEW: •Low SVC flow and high ACA-RI significantly increased risk of IVH, confirming the role of hypoperfusion-reperfusion cycle in IVH development. The most striking result that combined metrics using the cut-off value of < 41 ml/kg/min for SVCF and > 0.85 for ACA-RI "in the first day of life" can correctly reject the presence of IVH in 98% of patients "during the first week of life."

Lung ultrasound score parallels trends in systemic haemodynamics after PDA ligation: a case series.

B-lines in lung ultrasound (LU) are non-specific but highly informative sign of interstitial pulmonary oedema (iPE). Sustained exposure to a high-volume left-to-right patent ductus arteriosus (PDA) shunt is associated with iPE. Cardiorespiratory deterioration, named post-ligation cardiac syndrome (PLCS), may follow surgical ligation between 6 and 12 h post-operatively. We conducted a pilot longitudinal evaluation of peri-procedural LU score change. Infants < 32-week gestational age or < 1500-g birthweight undergoing PDA ligation, where pre-, 1 h and 6-12 h LU were performed, were included. Two independent raters evaluated LU score (LUS). Neonatologist performed echocardiography (NPE) was performed concurrently to appraise changes in left ventricular output (LVO). Milrinone was initiated if LVO was < 200 mL/kg/min 1 h after surgery, to prevent PLCS. The primary outcome was peri-procedural LUS change. Secondary outcomes included PLCS. Five infants were included (birthweight 787(88) g; gestational age 25.6(0.7) weeks). Postnatal age and weight at the intervention were 41(14) days and 1175(295) g. All infants, but one, received milrinone prophylaxis. None of the patients developed PLCS or required rescue HFOV. Post-interventional LUS were lower compared to pre-operative LUS (p = 0.041 vs 1 h, p = 0.042 vs 6-12 h). A concurrent fall post-operative LVO was noted (p < 0.05 vs pre-operative). CONCLUSION: A sustained fall in LUS after PDA ligation was identified, which most likely reflects reduction in pulmonary blood flow and interstitial edema. Changes in LUS paralleled changes in LVO, suggesting physiologic linkage. These data suggest that LU may be a useful tool to guide monitoring the biologic nature of pulmonary disease after PDA ligation. WHAT IS KNOWN: • Sustained exposure to a high-volume left-to-right patent ductus arteriosus (PDA) shunt is associated with interstitial pulmonary oedema. • In the most immature patients, cardiorespiratory deterioration, named post-ligation cardiac syndrome, presents 6-12 h post-operatively. WHAT IS NEW: • An early and sustained fall in lung ultrasound score (LUS) after PDA ligation most likely reflects reduction in pulmonary blood flow and interstitial oedema. LUS changes parallel changes in left ventricular output, suggesting linkage. • LU is a promising adjunctive tool in the post-operative management of PDA ligation.

Neonatal diseases and oxidative stress in premature infants: an integrative review.

OBJECTIVE: To describe the relationship of oxidative stress and antioxidant biomarkers in cord blood of premature newborns and the prognosis of diseases in the neonatal period. SOURCES: This study consists of an integrative review. Searches were conducted in electronic databases Scopus, PubMed, Web of Science, and Medline/Lilacs through the Virtual Library on Health Issues, using the descriptors: "premature infants", "preterm infants", "preterm birth", "preterm", "oxidative stress", "antioxidants", "infant, premature, diseases" and "cord blood". Original articles published between 2016 and 2021 in Portuguese, English, or Spanish, which analyzed oxidative stress and/or antioxidant levels through cord blood of premature newborns and evaluated clinical outcomes, were included. SUMMARY OF THE FINDINGS: Of the 1,003 studies reviewed, after exclusion of duplicate articles, analysis of titles, abstracts, and full texts, 18 articles were included. 72.2% (n = 13) of analyzed studies reported a positive association between oxidative stress and the development of prematurity-related diseases; 27.7% (n = 5) showed no significant relation. Outcomes that showed a positive association were: intrauterine growth restriction, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular hemorrhage, fetal inflammatory response syndrome, early-onset neonatal sepsis, retinopathy of prematurity, morbidity, and mortality. CONCLUSION: The analysis of oxidative stress and antioxidants in cord blood of premature newborns may be useful in the prognosis of some pathologies. The consequences of oxidative damage are known to be associated with increased morbidity in the short and long term. Further investigation is needed in this population in order to define normality parameters of biomarkers, clinical manifestations, diagnosis and treatment of these conditions.

Effects of neurodevelopmental risk factors on brainstem maturation in premature infants.

BACKGROUND: Interpeak latencies (IPL), as measured by the auditory brainstem-evoked responses (ABR) test, represent the conduction time, and therefore the maturation of the brainstem auditory pathway. We aimed to study the effect of various risk factors for the neurodevelopmental delay on the conduction time in the auditory pathway among normal hearing premature infants, at term postmenstrual age (PMA). METHODS: Retrospective analysis of 239 premature infants (gestational age 32.5 ± 2.1 weeks, birth weight 1827 ± 483 g). Interpeak latencies, demographic data, and risk factors were recorded. RESULTS: Sex, PMA at ABR test, being small for gestational age (SGA), intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), and days of invasive ventilation were found to significantly affect the IPL's in the auditory pathway in a univariate analysis. Multivariable regression analysis revealed that male sex and less advanced PMA at the examination were independent factors associated with prolonged IPL's, while bronchopulmonary dysplasia, IVH or PVL and being SGA shortened the IPL's. Non-invasive mechanical ventilation, did not affect the caudal part of the auditory pathway, despite its high noise level. CONCLUSIONS: Among various risk factors for the neurodevelopmental delay, male sex was associated with delayed, while IVH or PVL, BPD and SGA could be associated with accelerated auditory brainstem maturation. IMPACT: Auditory brainstem-evoked response (ABR) test, among normal hearing infants, can serve as a clinical tool to assess brainstem auditory maturation. Different neurodevelopmental risk factors could have different effects on the maturity of the auditory pathway. Male sex is significantly associated with prolonged interpeak latencies (IPL) among preterm and term infants, while intraventricular hemorrhage or periventricular leukomalacia, bronchopulmonary dysplasia, and being small for gestation age may be associated with shortened IPL The corrected age at ABR testing is of significance, among preterm and term infants.

Early detection and treatment of attention deficits in preterm and at term infants with risk factors for brain damage.

Cognitive deficits in infants born preterm and infants at term with risk factors for brain damage are a common outcome. Attention deficits in preterm infants are related to the development of attention-deficit/hyperactivity disorder (ADHD), and therefore, there is a need for earlier evaluations and treatment procedures that are implemented before the presence of signs of ADHD. METHODS: We studied preterm (74%) and term infants with the Infant Scale of Selective Attention (ISSA, Escala de Evaluación de la Atención Selectiva (EEAS), in Spanish). This scale evaluates both visual- and auditory-orienting attention. Two groups participated, one with attention deficits (n = 26) and another with regular performance (n = 36). An early attention-stimulation program (EASP) was implemented in the infant group with attention deficits from three to eight months of age. All infants underwent magnetic resonance imaging (MRI), and visual and auditory evoked responses were assessed. RESULTS: All infants had prenatal and perinatal risk factors for brain damage and abnormal MRI findings, and the majority had abnormalities compatible with white matter injury. However, there were four infants with porencephalic cysts; 3 of them were in the treated group. At the beginning of the treatment, ISSA values showed differences between groups. These differences persisted for five months in the visual test and up to the sixth month in the auditory evaluation. Afterward, there were no significant differences, indicating that infants with attention deficits had satisfactorily responded to the treatment. CONCLUSIONS: The ISSA is helpful for the early evaluation of visual and auditory attention. Infants with attention deficits react well enough after six months of EASP.

A Mixed-Lipid Emulsion Containing Fish Oil for the Parenteral Nutrition of Preterm Infants: No Impact on Visual Neuronal Conduction.

Fish oil is rich in omega-3 fatty acids and essential for neuronal myelination and maturation. The aim of this study was to investigate whether the use of a mixed-lipid emulsion composed of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF-LE) compared to a pure soybean oil-based lipid emulsion (S-LE) for parenteral nutrition had an impact on neuronal conduction in preterm infants. This study is a retrospective matched cohort study comparing preterm infants <1000 g who received SMOF-LE in comparison to S-LE for parenteral nutrition. Visual evoked potentials (VEPs) were assessed longitudinally from birth until discharge. The latencies of the evoked peaks N2 and P2 were analyzed. The analysis included 76 infants (SMOF-LE: n = 41 and S-LE: n = 35) with 344 VEP measurements (SMOF-LE: n= 191 and S-LE n = 153). Values of N2 and P2 were not significantly different between the SMOF-LE and S-LE groups. A possible better treatment effect in the SMOF-LE group was seen as a trend toward a shorter latency, indicating faster neural conduction at around term-equivalent age. Prospective trials and follow-up studies are necessary in order to evaluate the potential positive effect of SMOF-LE on neuronal conduction and visual pathway maturation.

Infant gut strain persistence is associated with maternal origin, phylogeny, and traits including surface adhesion and iron acquisition.

Gut microbiome succession affects infant development. However, it remains unclear what factors promote persistence of initial bacterial colonizers in the developing gut. Here, we perform strain-resolved analyses to compare gut colonization of preterm and full-term infants throughout the first year of life and evaluate associations between strain persistence and strain origin as well as genetic potential. Analysis of fecal metagenomes collected from 13 full-term and 9 preterm infants reveals that infants' initially distinct microbiomes converge by age 1 year. Approximately 11% of early colonizers, primarily Bacteroides and Bifidobacterium, persist during the first year of life, and those are more prevalent in full-term, compared with preterm infants. Examination of 17 mother-infant pairs reveals maternal gut strains are significantly more likely to persist in the infant gut than other strains. Enrichment in genes for surface adhesion, iron acquisition, and carbohydrate degradation may explain persistence of some strains through the first year of life.