Bronchopulmonary dysplasia (BPD) is associated with changes in pulmonary angiogenesis. However, the role of the vascular endothelial growth factor/placental growth factor (VEGF/PlGF) heterodimer, an ...antiangiogenic factor, remains unknown in this disease.
To compare VEGF/PlGF levels in preterm infants with and without BPD.
This study was approved by the Institutional Review Board. Preterm neonates with birth weight <2,000 g and gestational age ≤ 34 weeks were included. Exclusion criteria were: neonates transferred from other institutions after 72 hours of life; death before blood collection; presence of major congenital malformations, inborn errors of metabolism, and early sepsis; and mothers with multiple pregnancies, TORCH infections, HIV infection, or autoimmune diseases. BPD was defined as the need for oxygen therapy for a period equal to or greater than 28 days, accompanied by radiographic changes compatible with the disease. Blood was collected from neonates in the first 72 hours of life. VEGF/PlGF levels were measured using the enzyme-linked immunosorbent assay method. The chi-square test, t-test, Mann-Whitney test, analysis of variance, and Kruskal-Wallis test were used for statistical analysis. Variables found to be significant in the univariate analysis were included in the multivariate analysis.
Seventy-three patients were included (19 with BPD, 43 without BPD, and 11 neonates who died in the first 28 days of life), with a mean (SD) gestational age of 30.32 (2.88) weeks and birth weight of 1,288 (462) g. Median VEGF/PlGF levels were higher in the groups with BPD and death in the first 28 days of life than in the group without BPD (16.46 IQR, 12.19-44.57 and 20.64 IQR, 13.39-50.22, respectively, vs. 9.14 IQR, 0.02-20.64 pg/mL, p < 0.001). Higher VEGF/P1GF levels remained associated with BPD and death in the first 28 days of life in the multivariate analysis.
Higher plasma VEGF/PlGF levels were found in preterm neonates with BPD and in those who died in the first 28 days of life, suggesting an important role of this substance in pulmonary vascular development.
To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities.
...Pragmatic prospective cohort study.
20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded.
Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome.
1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695).
This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.
Abstract Background Long term effects of massage therapy in very preterm newborns infants are still to be described. Few studies evaluated neurodevelopment just at six months, and included late ...preterm infants. Objective To study the effect of massage therapy on neurodevelopment of very low birth weight infants at two years corrected age. Study design Newborns with birth weight between ≥ 750 and ≤ 1500 g and gestational age ≤ 32 weeks were randomly assigned to massage therapy by mothers plus skin-to-skin care (Intervention Group) or just skin-to-skin care (Control Group) during their hospital stay. Growth and neurodevelopment outcome were evaluated at 2 years corrected age. Results We followed 73 newborns (35 in Intervention Group, and 38 in Control Group). Both groups were similar in neonatal data. Growth at 2 years corrected age was similar in both groups. Intervention Group had borderline higher Psychomotor Development Index and significantly higher Mental Development Index scores than Control Group. Conclusions We suggest that massage therapy by mothers combined to skin-to-skin care during neonatal hospital stay improves neurodevelopment outcome at 2 years corrected age.
Bronchopulmonary dysplasia (BPD) is a frequent, long-term complication in very low-birth-weight (VLBW) newborns. Its etiology is multifactorial and the oxidative stress is one of its main causes. ...Breast milk (BM) reduces oxidative stress and provides antioxidant protection, therefore, BM may have a protective effect against BPD.
This study aims to assess the possible protective effects of BM on BPD.
This is a cohort study including infants with a birth weight below 1,500 g and/or gestational age of less than 32 weeks, born between January 2011 and October 2014. BPD was defined as the need for supplementary oxygen for 28 days or more.
The incidence of BPD was 29.1%. The median amount of BM received by the patients in the first 6 weeks of life was significantly higher in patients without BPD (10.8 mL/kg/day) than in those with BPD (2.3 mL/kg/day). The amount of BM received was inversely associated with the incidence of BPD, even after multivariate analysis. The cutoff point at which the protective effect emerged was an average amount of 7 mL/kg/day of BM during the first 42 days of life.
Feeding VLBW infants with BM is associated with a lower risk of developing BPD.
In this pilot study, we aimed to evaluate the feasibility of whole genome sequencing (WGS) as a first-tier diagnostic test for infants hospitalized in neonatal intensive care units in the Brazilian ...healthcare system. The cohort presented here results from a joint collaboration between private and public hospitals in Brazil considering the initiative of a clinical laboratory to provide timely diagnosis for critically ill infants. We performed trio (proband and parents) WGS in 21 infants suspected of a genetic disease with an urgent need for diagnosis to guide medical care. Overall, the primary indication for genetic testing was dysmorphic syndromes (n = 14, 67%) followed by inborn errors of metabolism (n = 6, 29%) and skeletal dysplasias (n = 1, 5%). The diagnostic yield in our cohort was 57% (12/21) based on cases that received a definitive or likely definitive diagnostic result from WGS analysis. A total of 16 pathogenic/likely pathogenic variants and 10 variants of unknown significance were detected, and in most cases inherited from an unaffected parent. In addition, the reported variants were of different types, but mainly missense (58%) and associated with autosomal diseases (19/26); only three were associated with X-linked diseases, detected in hemizygosity in the proband an inherited from an unaffected mother. Notably, we identified 10 novel variants, absent from public genomic databases, in our cohort. Considering the entire diagnostic process, the average turnaround time from enrollment to medical report in our study was 53 days. Our findings demonstrate the remarkable utility of WGS as a diagnostic tool, elevating the potential of transformative impact since it outperforms conventional genetic tests. Here, we address the main challenges associated with implementing WGS in the medical care system in Brazil, as well as discuss the potential benefits and limitations of WGS as a diagnostic tool in the neonatal care setting.
Objective To evaluate plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α in newborn infants immediately before and after 2 hours of mechanical ventilation. ...Study design Term and late preterm neonates with no history of mechanical ventilation and/or ventilatory support were studied prospectively. Exclusion criteria were congenital malformations, congenital infections, use of nitric oxide, resuscitation with positive-pressure ventilation, and any procedure in the delivery room or neonatal intensive care unit that resulted in tracheal intubation. Blood samples for IL-1β, IL-6, IL-8, IL-10, and TNF-α levels were collected before intubation and mechanical ventilation and 2 hours later. Results Nineteen newborn infants with gestational age 35.8 ± 1.9 weeks and birth weight 2280 ± 370 g were included. Pro-inflammatory cytokines increased: IL-8 (2.5-fold), IL-1β (7.5-fold), and TNF-α (10-fold), and the anti-inflammatory cytokine IL-10 decreased by 90%. Although median IL-6 levels were similar between before and after ventilation, IL-6 increased in 89.4% of infants. Conclusions A short period of mechanical ventilation promotes an imbalance of plasma levels of pro-inflammatory and anti-inflammatory cytokines. The systemic alteration of cytokines in response to mechanical ventilation may lead to ventilator-induced lung injury.
The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether ...guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country.
Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio2) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment.
For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio OR, 1.52 95% confidence interval (CI) 1.44-1.61 and 1.45 1.38-1.52) and PPV with a T-piece (OR, 1.45 95% CI 1.37-1.55 and 1.41 1.32-1.51). The probability of receiving PPV with Fio2 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93).
Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio2 1.00 were translated into clinical practice.
Purpose:
To evaluate the relationship between abnormal early amplitude integrated electroencephalography (EEG) and severe lesions in imaging tests performed during the neonatal period in very low ...birth weight infants.
Methods:
An amplitude-integrated EEG was performed in 70 patients with a mean birth weight of 1226 g during the first 48 hours of life. Severe lesions on magnetic resonance imaging (MRI) or ultrasonography (US) during the neonatal period were considered as adverse conditions. Variables were compared using the χ2 test or analysis of variance. Sensitivity, specificity, and positive likelihood ratio were calculated.
Results:
Adverse outcomes were observed in 6 patients. There was a significant relationship (P < .001) between abnormal amplitude-integrated EEG background and severe lesions on MRI and US. Sensitivity and specificity were 100% and 89%, respectively.
Conclusion:
Early amplitude-integrated EEG with moderate/severe abnormalities in the background is associated with severe structural lesions detected in imaging studies and should be considered as an auxiliary screening tool for the detection of neonatal brain lesions in very low birth weight infants.
Angiogenic and antiangiogenic factors are altered in pregnant women with preeclampsia (PE), but the pattern of expression of these factors in their newborns remains unknown.
This study aims to ...measure vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) levels in preterm neonates born to mothers with PE.
Neonates with birth weight<2,000 g and gestational age≤34 weeks were included and divided into the following two groups: born to mothers with PE and without PE. Blood was collected from neonates within the first 72 hours of life. VEGF and sFlt-1 levels were measured using the enzyme-linked immunosorbent assay method.
A total of 88 neonates were included (37 born to mothers with PE and 51 born to mothers without PE), with a mean gestational age of 29.12±2.96 weeks and birth weight of 1,223.80±417.48 g. In the multivariate analysis, VEGF was 80% lower and sFlt-1 was 13.48 times higher in the group with PE. sFlt-1 concentration was higher in neonates small for gestational age (SGA) than in those appropriate for gestational age.
Higher sFlt-1 and lower VEGF levels in the group with PE, as well as higher sFlt-1 levels in SGA neonates, reflect a predominance of antiangiogenic mechanisms in PE and growth restriction.
Preterm birth remains the main contributor to early childhood mortality. The vaginal environment, including microbiota composition, might contribute to the risk of preterm delivery. Alterations in ...the vaginal microbial community structure might represent a risk factor for preterm birth. Here, we aimed to (a) investigate the association between preterm birth and the vaginal microbial community and (b) identify microbial biomarkers for risk of preterm birth. Microbial DNA was isolated from vaginal swabs in a cohort of 69 women enrolled at hospital admission for their delivery. Microbiota was analyzed by high-throughput 16S rRNA sequencing. While no differences in microbial diversity measures appeared associated with the spontaneous preterm and full-term outcomes, the microbial composition was distinct for these groups. Differential abundance analysis showed
Lactobacillus
species to be associated with full-term birth whereas an unknown
Prevotella
species was more abundant in the spontaneous preterm group. Although we studied a very miscegenated population from Brazil, our findings were similar to evidence pointed by other studies in different countries. The role of
Lactobacillus
species as a protector in the vaginal microbiome is demonstrated to be also a protector of spontaneous preterm outcome whereas the presence of pathogenic species, such as
Prevotella
spp., is endorsed as a factor of risk for spontaneous preterm delivery.
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