Background/Objectives: Preterm infants have higher fat mass and lower lean mass at term-corrected age; however, whether these differences persist into preschool age remains unclear. This prospective observational cohort study aimed to compare body composition between very-low-birth-weight (VLBW) preterm (gestational age < 33 weeks) children and their term-born counterparts aged 5-6 years. Methods: Anthropometric data, body composition, blood biochemical parameters, and insulin resistance (HOMA-IR index) were compared between the preterm and term groups. Results: The study included 96 children (57 preterm and 39 term-born). Although lean mass index and fat mass index were comparable between groups, preterm children exhibited significantly higher insulin levels and HOMA-IR values after adjustment (p = 0.003 and p = 0.004, respectively). Within the preterm cohort, overweight/obesity was associated with higher trunk and total fat percentages, as well as higher HOMA-IR, compared with those of normal-weight or underweight children (all adjusted p < 0.001). Weight growth velocity from 2 to 5 years was positively associated with serum insulin, HOMA-IR, and both trunk and total body fat percentages. Additionally, girls in both groups displayed significantly higher trunk and total body fat percentages than boys. Conclusions: Children born very preterm with VLBW had higher fasting insulin levels and HOMA-IR, despite generally comparable DXA-derived LMI, FMI, and fat distribution at preschool age. Overweight status and rapid early childhood weight gain may contribute to increased metabolic risk in this population, highlighting the need for early metabolic monitoring and growth management. Future large-scale, long-term studies are required to confirm these findings.

OBJECTIVE:This study aimed to compare various respiratory therapies for diagnosing bronchopulmonary dysplasia (BPD) at different postmenstrual ages (PMA), and to undertake a retrospective review at the adverse respiratory outcomes at preschool age to identify the optimal predictors. METHODS:This retrospective cohort study was conducted at a tertiary neonatal intensive care unit enrolling preterm very-low-birth-weight (VLBW) infants. Respiratory status was classified based on modes of respiratory therapy required (supplemental oxygen, oxygen, and/or positive-pressure respiratory support [oxygen/PRS], and PRS alone) at the prespecified time points. The frequency of preschool-age pulmonary morbidity, defined as either a Z-score lower than -1.64 on any lung function test, or a diagnosis of asthma and/or at least three admissions for respiratory causes, was compared using regression models, assessing the predictive values of these respiratory supports. RESULTS:Of the 70 VLBW neonates born at a mean gestational age of 27.6 weeks, 57.1 % had composite respiratory morbidities at follow-up. Among the respiratory support modes, oxygen use at 36 and 40 weeks', oxygen/PRS at 36 and 40 weeks', and PRS alone at 36 weeks PMA were significantly associated with undesirable outcomes. Oxygen/PRS use at 36 weeks' PMA showed a numerically higher effect estimate for predicting the effect and area under the curve (AUC) (adjusted odds ratio 7.46, P = 0.01; AUC 0.841). CONCLUSIONS:Supplemental oxygen and/or positive-pressure respiratory support are good predictors of respiratory morbidity. Thirty-six weeks' PMA appears to be a clinically relevant time point for predicting future pulmonary outcomes in this cohort.

Background During the COVID-19 pandemic, parental involvement in NICU and post-discharge follow-up for preterm infants in Taiwan were limited. This study aimed to investigate the impact of the pandemic on the neurodevelopmental outcomes of preterm infants in Taiwan. Method This was a retrospective study enrolling very-low-birth weight (VLBW) preterm infants born between January 2018 and December 2021 from two hospitals. The pre-COVID-19 group (PCG) consisted of VLBW infants born between January 2018 and April 2019, before the pandemic. VLBW infants born after May 2019 and followed-up for at least 24 months during the pandemic were assigned to the COVID-19 group (CG). The antenatal, perinatal, and postnatal data, and neurodevelopmental outcomes at 12 and/or 24 months corrected age (CA) of the participants were collected and compared. Results A total of 547 VLBW infants were born during the study period. CG had significantly longer hospital stay and delayed follow-up time compared to PCG. No significant differences were observed in the composite cognitive, language, and motor scores between two groups. The percentages of moderate neurodevelopmental impairment (NDI) were higher at 12 months CA, but not at 24 months. The severe NDI also presented no significant difference between the groups. Conclusion VLBW preterm infants during the pandemic had extended hospital stays and delayed follow-ups, with higher moderate NDI at 12 months CA. Long-term monitoring and care are essential for this at-risk group.

Introduction: The aim of this study was to explore the outcomes, home use of medical assistive devices, and interdisciplinary medical needs of very-low-birth-weight (VLBW) infants at a corrected age of 2 years. METHODS:Analyses were performed using perinatal, neonatal, and 2-year follow-up data from VLBW infants registered in the Taiwan Premature Infant Follow-up Network (TPFN) between 2011 and 2017. Basic information, survival, and disease conditions during hospitalization were recorded. Medical needs at discharge, outcomes at a corrected age of 2 years, active involvement in outpatient healthcare services, and referrals were investigated. RESULTS:From 2011 to 2017, a total of 9,243 VLBW preterm neonates were enrolled in the TPFN. Of these neonates, 140 had severe congenital anomalies, 8,044 survived to discharge, and 6,150 returned for follow-up evaluation. At discharge, 10.2% of infants received home oxygen therapy (HOT), and 6.5% used home monitoring devices. Among the infants diagnosed with chronic lung disease, 26.6% received HOT. At a corrected age of 2 years, the most common interventions and recommended referrals were rehabilitative treatments (34.5%), followed by early intervention system services (16.5%), ophthalmology/otolaryngology management (4.4%), neurological follow-up (4.1%), and mental health assessment and treatment (2.5%). CONCLUSION:After hospital discharge, VLBW preterm infants exhibit substantial healthcare needs, with significant demands of HOT, rehabilitation, and early intervention services by a corrected age of 2 years. These findings highlight the importance of coordinated outpatient care and long-term follow-up to address the developmental and medical challenges faced by this vulnerable population. .

Antenatal magnesium sulfate (MgSO4) may provide neuroprotective benefits in preterm infants. This study examined the impact of antenatal MgSO4 on the neurodevelopmental outcomes of very low birth weight (VLBW) preterm infants at the corrected age of 2 years. This retrospective follow-up study included preterm infants with a birth weight ≤ 1500 g and gestational age ≤ 36 weeks who participated in a follow-up program. Antenatal MgSO4 was administered to treat maternal preeclampsia or for neuroprotection or tocolysis. Neurodevelopmental outcomes, including cerebral palsy (CP), neurodevelopmental impairment (NDI), and audiologic and visual assessments, were evaluated at a corrected age of 2 years. Infants exposed to MgSO4 were compared with unexposed controls. Among 328 VLBW infants (2007-2015), 133 were exposed to MgSO4, and 195 were not. Follow-up data were available for 93.3% of the infants. CP occurred in 6.0% of MgSO4 exposed infants versus 13.8% of controls (odds ratio: 0.39; 95% confidence interval: 0.18-0.91; P = .03). NDI was observed in 19.5% of exposed infants compared with 31.3% of controls (odds ratio: 0.53; 95% confidence interval: 0.32-0.90; P = .02). Multivariate logistic regression showed that low parental educational level (<college), birth weight (<1000 g), and periventricular leukomalacia were significantly associated with an increased rate of CP. Similarly, independent factors such as preeclampsia, low socioeconomic status, birth weight < 1000 g, male sex, and periventricular leukomalacia were significantly associated with an increased risk of NDI. Antenatal MgSO4 administration in pregnant women may have neuroprotective effects in VLBW preterm infants, reducing the risk of CP and NDI at the corrected age of 2 years.

Very-low-birth-weight (VLBW) infants have significant risk factors for adverse health outcomes. Previous studies have focused on neurological, pulmonary, and cardiovascular complications, but the long-term outcomes of other organ functions particularly kidney function warrant further investigation. This prospective study aimed to compare kidney function between VLBW preterm and term infants at 5–6 years of age. Participants underwent comprehensive assessments of kidney function and blood pressure. Estimated glomerular filtration rates (eGFR) for serum creatinine (Cr) and cystatin C (CysC) were calculated using the CKiD-U25 equations, and comparative analyses conducted between preterm and term groups. In the preterm group, perinatal growth rates of weight and height at various stages were monitored to investigate their potential association with kidney function. A total of 61 VLBW preterm and 40 term children participated in the study. The preterm group exhibited significantly higher serum CysC levels (0.97 vs. 0.87 mg/L, p = 0.001), lower eGFR-CysC (82.3 vs. 93.0 mL/min/1.73 m2, p < 0.001), and smaller kidney length compared to the term group. Notably, 72

AIM:This study aimed to explore whether microRNAs (miRNAs) could serve as biomarkers of perinatal asphyxia and whether they were correlated with severity of brain magnetic resonance imaging. METHODS:We prospectively enrolled 26 full-term newborns, including 10 with perinatal asphyxia and 16 healthy controls. Plasma samples were collected at 0-6 h and 7 days of age. Encephalopathy was classified according to modified Sarnat staging. Magnetic resonance imaging was performed in surviving infants within 30 days of birth, and a score was established. We used next-generation sequencing to explore differentially expressed miRNAs, which were then further validated using quantitative reverse transcription real-time polymerase chain reaction (RT-PCR). RESULTS:A significantly lower expression of miR-486-5p was found at 0-6 h of age in the asphyxiated newborns compared with the healthy controls (p = 0.005). The area under the receiver operating characteristic curve (AUC) of miR-486-5p at 0-6 h of age to differentiate the perinatal asphyxia group from the healthy control group was 0.831, and the AUC to differentiate newborns eligible for therapeutic hypothermia from others was 0.782. In addition, a lower expression of miR-486-5p at 7 days of age was noted in the asphyxiated newborns with adverse outcomes compared to those with normal outcomes. CONCLUSION:MiR-486-5p may be a biomarker of perinatal asphyxia in newborns, and further research is warranted to clarify its role.

Language delays are often underestimated in very-low-birth-weight (VLBW) preterm infants. We aimed to identify the risk factors of language delay at two years of corrected age in this vulnerable population. VLBW infants, who were assessed at two years of corrected age using the Bayley Scale of Infant Development, third edition, were included using a population-based cohort database. Language delay was defined as mild to moderate if the composite score was between 70 and 85 and severe if the score was < 70. Multivariable logistic regression analysis was used to identify the perinatal risk factors associated with language delay. The study comprised 3797 VLBW preterm infants; 678 (18%) had a mild to moderate delay and 235 (6%) had a severe delay. After adjusting for confounding factors, low maternal education level, low maternal socioeconomic status, extremely low birth weight, male sex, and severe intraventricular hemorrhage (IVH) and/or cystic periventricular leukomalacia (PVL) were found to be significantly associated with both mild to moderate and severe delays. Resuscitation at delivery, necrotizing enterocolitis, and patent ductus arteriosus requiring ligation showed significant associations with severe delay. The strongest factors predicting both mild to moderate and severe language delays were the male sex and severe IVH and/or cystic PVL; thus, early targeted intervention is warranted in these populations.

Ultrasound has been used to observe lung aeration and fluid clearance during the neonatal transition period, but there is no consensus regarding the optimal timing of lung ultrasound. We aimed to monitor the trend of the serial lung ultrasound score (LUS) and extended LUS (eLUS) throughout the neonatal transition period (≤1, 2, 4, 8, 24, and 48 h after birth), assess any correlation to the clinical presentation (using the Silverman Andersen Respiratory Severity Score (RSS)), and determine the optimal time of the ultrasound. We found both LUS and eLUS decreased significantly after 2 h of life and had similar statistical differences among the serial time points. Although both scores had a positive, moderate correlation to the RSS overall (Pearson correlation 0.499 [p < 0.001] between LUS and RSS, 0.504 [p < 0.001] between eLUS and RSS), the correlation was poor within 1 h of life (Pearson correlation 0.15 [p = 0.389] between LUS and RSS, 0.099 [p = 0.573] between eLUS and RSS). For better clinical correlation, the first lung ultrasound for the neonate may be performed at 2 h of life. Further research is warranted to explore the clinical value and limitations of earlier (≤1 h of life) lung ultrasound examinations.

Background: To assess whether the number of extremely low birth weight (ELBW) infants treated annually in neonatal intensive care units (NICUs) in Taiwan affects the mortality and morbidity of this patient population.Methods: This retrospective cohort study included preterm infants with ELBW (<= 1000 g). NICUs were divided into three subgroups according to the annual admissions of ELBW infants (low, <= 10; medium, 11-25; and high, >25). Perinatal characteristics, mortality, and short-term morbidities were compared between groups.Results: A total of 1945 ELBW infants from 17 NICUs were analyzed (low-volume, n = 263; medium-volume, n = 420; and high-volume, n = 1262). After risk adjustments, infants from NICUs with low patient volumes were at a higher risk of death. The risk-adjusted odds ratios (aOR) for mortality were 0.61 (95% CI, 0.43-0.86) in the high-volume NICUs and 0.65 (95% CI, 0.43-0.98) in medium-volume NICUs, compared with infants admitted to low-volume NI -CUs. Infants in medium-volume NICUs had the lowest incidence of prenatal steroid exposure (58.1%, P < 0.001) and were associated with the highest risk of necrotizing enterocolitis (aOR, 2.35 [95% CI, 1.48-3.72 ]), severe intraventricular hemorrhage (aOR, 1.55 [95% CI, 1.01-2.28]), and bronchopulmonary dysplasia (aOR, 1.61 [95% CI, 1.10-2.35]). However, survival without major morbidity did not differ between the groups.Conclusion: The mortality risk was higher among ELBW infants admitted to NICUs with a low annual patient volume. This may emphasize the importance of systematically referring pa-tients from these vulnerable populations to appropriate care settings.

BACKGROUND:Probiotic supplementation is increasingly being given to very low birth weight (VLBW) preterm infants. This preliminary observational study aimed to investigate the effects of multiple-strain probiotics on the gut microbiota of VLBW preterm infants. METHODS:We collected meconium and stool samples on days 14, 30, and 60 after birth from 49 VLBW infants with a gestational age of <32 weeks. The infants were divided into the probiotics (n = 24) and control (n = 25) groups. The microbial composition and diversity in the gut of the two groups were analyzed using 16 S rRNA gene sequencing. RESULTS:The relative abundance of Bifidobacterium and Lactobacillus was significantly higher in the probiotics group than in the control group on days 14, 30, and 60 (Bifidobacterium: p = 0.002, p < 0.0001, and p < 0.0001, respectively; Lactobacillus: p = 0.012, p < 0.0001, and p < 0.0001, respectively). The control group exhibited a significantly higher proportion of participants with a low abundance (<1%) of Bifidobacterium or Lactobacillus on days 14, 30, and 60 than those in the probiotic group. Moreover, the probiotics group exhibited a significantly lower abundance of Klebsiella on days 14 and 30 (2.4% vs. 11.6%, p = 0.037; and 7.9% vs. 16.6%, p = 0.032, respectively) and of Escherichia-Shigella on day 60 than the control group (6.1% vs. 12.3%, p = 0.013). Beta diversity analysis revealed that the microbiota profile was clearly divided into two groups on days 30 and 60 (p = 0.001). CONCLUSION:Probiotic supplementation significantly increased the relative abundance of Bifidobacterium and Lactobacillus and inhibited the growth of potential pathogens. Furthermore, probiotic supplementation led to a distinct gut microbiota profile. Further research is needed to identify probiotic strains that exert significant influence on the gut microbiome and their long-term health implications in preterm infants.

BackgroundThe impact of small-for-gestational-age (SGA) on very-low-birth-weight (VLBW) premature infants remains inconclusive. This study aimed to assess the effects of being born SGA status on the short-term and long-term outcomes in VLBW preterm infants.MethodsWe conducted a population-based, prospective cohort study on VLBW preterm infants born in Taiwan between 2012 and 2017. Sociodemographic, neonatal, growth and neurological data at 2 years of corrected age were collected. A total of 4243 VLBW infants born at 24 through 32 completed weeks' gestation participated in this study, of whom 1,005 had SGA status defined as a birth weight <10th percentile of gestation, and 3,238 did not (the non-SGA group).We compared the risks of short-term outcomes (neonatal mortality and morbidities), long-term outcomes (growth status, including weight, height, and head circumference <10th percentile, and neurodevelopmental impairments at 2 years of age). Subgroup analysis was performed by stratification of gestation age (GA): GA 24–26, 27–29 and 30–32 weeks.ResultsIn the analysis of short-term outcomes, the SGA group had an increased risk of neonatal mortality [adjusted odds ratio (OR) = 2.66, 2.99, and 2.19, respectively] in all GA subgroups in comparison with the non-SGA group (p < 0.05). The SGA group had a significantly increased risk of bronchopulmonary dysplasia in GA 27–29 and 30–32 weeks (adjusted OR = 2.11 and 1.86, respectively). We also found that there was an increased risk of severe retinopathy of prematurity in GA 24–26 and 27–29 weeks in the SGA group compared with the non-SGA group (adjusted OR = 1.68 and 1.59, respectively).In the analysis of long-term outcomes, the SGA group had a significantly increased risk of NDI throughout all GA subgroups (adjusted = 1.94, 1.33, and 1.35, respectively) in comparison with the non-SGA group. The SGA groups also had an increased risk of growth status <10th percentile at 2 years of age (p < 0.05).ConclusionsSGA VLBW premature infants had higher risks of neonatal death, growth status <10th percentile, and NDI at 2 years of corrected age compared with the non- SGA premature infants. Prenatal surveillance, postnatal attention, and long- term follow-up are warranted to improve the outcomes of VLBW SGA premature infants.

ObjectiveTo evaluate the association of mode of delivery (MOD) with short-term and neurodevelopmental outcomes at 2 years of corrected age (CA) in periviable singleton infants. MethodsThis retrospective cohort study of the Taiwan Premature Infant Follow-up Network database between 2010 and 2016 compared non-anomalous singleton deliveries (cesarean delivery [CD] vs vaginal delivery [VD]) between 22 0/7 and 25 6/7 gestational weeks. Major morbidities, mortality, and neurodevelopmental outcomes were evaluated at 2-year CA. ResultsThe CD and VD groups included 354 and 472 infants, respectively. The intraventricular hemorrhage (IVH) rate was lower in the CD group (54% vs 66%, P = 0.001), but severe IVH differed non-significantly between groups (20% vs 26%, P = 0.057). In the small-for-gestational age subgroup, CD was associated with lower IVH (56% vs 84%, adjusted odds ratio [aOR] 0.17, 95% confidence interval [CI] 0.04-0.69) and better survival without neurodevelopmental impairment (29% vs 8%, aOR, 6.64, 95% CI 1.02-43.29) after controlling for potential confounders. ConclusionThe optimal MOD for periviable singleton birth and its impact are unclear. CD in periviable singleton births is associated with a decreased IVH risk, without improvement in severe IVH, mortality, or neurodevelopment at 2-year CA. The small-for-gestational age subgroup may benefit from CD for better survival without neurodevelopmental impairment.

The effects of early-life metal exposure on neurodevelopment in very low birth weight preterm (VLBMP) children (with a birth weight of <1500 g and a gestational age of <37 weeks) have not been clearly established. We aimed to investigate associations of childhood exposure to multiple metals and preterm low birth weight with neurodevelopment among children at 24 months of corrected age. VLBWP children (n = 65) and normal birth weight term (NBWT) children (n = 87) were enrolled from Mackay Memorial Hospital in Taiwan between December 2011 and April 2015. Lead (Pb), cadmium (Cd), arsenic (As), methylmercury (MeHg), and selenium (Se) concentrations in the hair and fingernails were analyzed as biomarkers for metal exposure. The Bayley Scale of Infant and Toddler Development, Third Edition, was used to determine neurodevelopment levels. VLBWP children had significantly lower scores in all development domains compared to NBWT children. We also investigated preliminary exposure levels of VLBWP children to metals as reference values for future epidemiological and clinical survey. Fingernails are a useful biomarker for metal exposure to evaluate the effects on neurological development. A multivariable regression analysis revealed that fingernail Cd concentrations were significantly negatively associated with cognition (β = −0.63, 95

Purpose: This study examined the efficacy of prescribing antibiotics, specifically a single dose of vancomycin, in reducing the incidence of culture-positive and culture-negative sepsis prior to the removal of peripherally inserted central catheters (PICCs). Materials and methods: We retrospectively reviewed charts of infants who had PICCs in a ter-tiary level hospital during the period from 2010 to 2019. The incidence of post-catheter removal clinical sepsis between the groups with or without antibiotics was compared. The anti-biotic group was defined by receiving a single dose of vancomycin or any other antibiotic prior to line removal. Results: We enrolled 585 PICC removal episodes in 546 infants for analysis. Antibiotics were given prior to removal in 257 cases (43.9% ) and not given prior to removal in 328 cases (56.1%). There were 13 episodes of post-catheter removal clinical sepsis detected within 72 h (2.2%), 2 of which were culture-positive (0.3%). A 9.3-fold decrease in the odds for clinical sepsis was observed in the antibiotic group (p Z 0.01). The incidence of post-catheter removal sepsis was decreased by a single prophylactic dose of vancomycin (p = 0.02), whereas the use of other antibiotics showed no effect (p = 0.35). Logistic regression analysis demonstrated that comorbidities with gastrointestinal diseases (p = 0.01), PICC insertion sites in the scalp and neck (p = 0.04), and no vancomycin administration prior to line removal (p = 0.02) were independent risk factors for subsequent clinical sepsis.Conclusion: A single prophylactic dose of vancomycin prior to PICC line removal might reduce clinical sepsis events in infants.Copyright 2021, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The present study included the first case of mucopolysaccharidosis (MPS) type VII in Taiwan. During pregnancy, the patient was diagnosed with hydrops fetalis and had ascites aspiration 4 times. In the following years, she presented gradually with chronic lung disease, developmental delay, short stature, dysmorphic features of coarse face, macroglossia and pigeon chest with scoliosis. Upon referral at age 4 years, she had corneal clouding, mild limitation of range of motion (ROM) and hepatosplenomegaly. X-ray showed paddle ribs and dysplastic vertebral bodies. MPS was suspected and urine glycosaminoglycans (GAGs) elevated were noted. The leukocyte enzymatic analyses for MPS I, MPS II, MPS IIIB, MPS IVA, and MPS VI were all normal. Afterward, the molecular analysis showed two heterozygous genetic variants of c.104C > A and c.1454C > T in trans in the GUSB gene (NM_000181.4) which were the causes for MPS VII. Then, we checked the leukocyte β-glucuronidase activity for MPS VII and showed extremely low, therefore confirmed the diagnosis. Clinicians should increase the awareness on the early signs of MPS to have a prompt diagnosis and offer the correct treatment like enzyme replacement therapy (ERT) as early as possible.

Small for gestational age (SGA) birth is associated with high rates of mortality and morbidity in preterm infants. The aim of this preliminary observational study was to investigate the difference in gut microbiota between SGA and appropriate for gestational age (AGA) preterm infants with very low birth weight (VLBW). We included 20 VLBW preterm infants (SGA, n = 10; AGA, n = 10) in this study. Stool samples were collected on days 7, 14, and 30 after birth. We performed 16S ribosomal DNA sequencing to compare microbiota composition between both groups. The SGA group exhibited a lower abundance of Klebsiella on day 14 (SGA, 0.57%; AGA, 7.42%; p = 0.037). On day 30, the SGA group exhibited a lower abundance of Klebsiella (SGA 3.76% vs. AGA 16.05%; p = 0.07) and Enterobacter (SGA 5.09% vs. AGA 27.25%; p = 0.011) than the AGA group. Beta diversity demonstrated a separation of the bacterial community structure between both groups on day 30 (p = 0.019). The present study revealed that a distinct gut microbiota profile gradually develops in SGA preterm infants with VLBW during the early days of life. The role of changes in gut microbiota structure warrants further investigation.

BackgroundSurvivors of preterm birth are at risk of long-term cardiovascular consequences. The objective of this prospective observational study was to assess left heart function at preschool age in preterm children with very low birth weight (VLBW).MethodsWe recruited children aged 5–6 years from preterm infants and full-term children. All subjects underwent conventional echocardiography and speckle-tracking echocardiography. The results were compared between the preterm and term groups.ResultsEighty-seven VLBW preterm children and 29 term controls were included in the study. After adjusting for body surface area, the preterm group compared to the full-term group had significantly smaller left ventricular (LV) end-diastolic and end-systolic internal dimensions (31.2 vs. 33.5 mm, p = 0.048; and 20.0 vs. 21.6 mm, respectively; p = 0.024), lower LV end-diastolic and end-systolic volumes (38.8 vs. 46.3 mL, p = 0.024; and 12.8 vs. 15.6 mL, respectively; p = 0.008). Left atrial (LA) maximal and minimal volume were also significantly smaller in the preterm group (15.4 vs. 18.9 mL, p = 0.017; and 6.2 vs 7.5 mL, respectively; p = 0.018). LV global longitudinal strain (−21.4 vs. −23.2%, p < 0.0001) and systolic strain rate (−1.30 vs. −1.37 /s, p = 0.001) were significantly lower in the preterm group than in the term control group. LA longitudinal strain was decreased (43.9 vs. 52.8%, p < 0.0001) and left atrial stiffness index (0.17 vs. 0.14, p < 0.0001) was increased in preterm infants. However, all the measurements in both groups were within normal range.ConclusionsSubclinical changes of left heart structure and function were found in VLBW infants at preschool age. Additional long-term follow-ups of the cardiovascular outcomes are needed in this vulnerable population.

Background: Omphalocele and gastroschisis are the two most common congenital abdominal wall defects; however, no previous study has focused on gastrointestinal and hepatobiliary tract malformations in these two conditions. This study aimed to investigate the demographic characteristics, coexisting congenital gastrointestinal and hepatobiliary tract anomalies, hos-pital course, and outcomes of patients with gastroschisis and omphalocele.Methods: This is retrospective chart review of all patients admitted to one tertiary medical center in Taiwan between January 1, 2000 and June 30, 2020 with a diagnosis of gastroschisis or omphalocele. The medical records were reviewed to obtain demographic data regarding co-existing gastrointestinal and hepatobiliary tract anomalies and outcomes.Results: Of the 51 patients included, 21 had gastroschisis and 30 had omphalocele. Gastroschi-sis was associated with a significantly younger maternal age and a higher incidence of small for gestational age. Of the 30 patients with omphalocele, twelve had associated gastrointestinal and hepatobiliary anomalies. Seven of the 21 patients with gastroschisis had gastrointestinal anomalies, and none had hepatobiliary anomalies. Among the omphalocele patients, three (10%) had documented malrotation, and one developed midgut volvulus. Among gastroschisis patients, four patients (19%) had malrotation, and two developed midgut volvulus. There were no statistically significant differences in postoperative complications or mortality rates be-tween those with and without gastrointestinal/hepatobiliary tract anomalies.Conclusion: The diversity of coexisting gastrointestinal and hepatobiliary tract anomalies is higher in the omphalocele than in gastroschisis. In addition, we demonstrate that patients with gastroschisis or omphalocele have a higher rate of intestinal malrotation and midgut volvulus.Copyright 2022, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Background/Purpose: To evaluate whether a shorter length (20 cm) of C-UCM has potential benefits, compared to immediate cord clamping (ICC), in very preterm babies. Methods: Inborn preterm infants less than 30 weeks of gestational age (GA) were randomly assigned to the 20-cm C-UMC and ICC groups. The primary outcome was the need for packed red blood cell (pRBC) transfusion before the 21st day of life. The secondary outcomes were short and long-term outcomes related to premature birth. Results: Seventy-six neonates were randomized to the two groups. GA were 27.2 +/- 1.8 and 27.5 +/- 1.7 weeks (p = 0.389) and birth weights were 987 +/- 269 and 1023 +/- 313 g (p = 0.601) in the 20-cm C-UCM and ICC groups, respectively. There was no significant difference between the groups in terms of the need for pRBC transfusion before the 21st day of life (59.4% versus 71.8%, adjusted odds ratio [aOR] 0.311, 95% confidence interval [CI] 0.090-1.079). An increased prevalence of late-onset sepsis was observed in the 20-cm C-UCM group compared to the ICC group (21.6% versus 5.1%, aOR 5.434, 95% CI 1.033-23.580). The mortality rates were 13.5% and 2.6% in the 20-cm C-UCM and ICC groups, respectively (aOR 5.339, 95% CI 0.563-50.626). The neurodevelopmental outcomes at 2 years of corrected age between the groups were also not statistically significant.Conclusion: A 20-cm C-UCM showed no effect on reducing the incidence of pRBC transfusion in pre term babies with GA less than 30 weeks compared with ICC in this small-scale randomized controlled trial. Copyright 2021, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).