Objective To assess the healthcare burden of bronchopulmonary dysplasia (BPD) among very preterm infants in China.Design A prospective cohort study between 2022 and 2023.Setting Chinese Neonatal Network (CHNN) participating centres.Patients Infants with gestational age <32 weeks admitted to CHNN neonatal intensive care units.Main outcome measures A composite rate of BPD or mortality at 36 weeks’ postmenstrual age (PMA), major comorbidities, clinical resources utilisation and outcome at discharge. BPD severity was classified by Jensen et al’s criteria.Results Among 17 793 eligible infants, 568 (3.2%) infants died before 36 weeks’ PMA, 1729 (9.7%) were discharged against medical advice before 36 weeks’ PMA, 9895 (55.6%) were classified as no BPD, 2751 (15.5%) developed Grade 1 BPD, 2634 (14.8%) developed Grade 2 BPD and 216 (1.2%) developed Grade 3 BPD. Infants with BPD had significantly longer hospital stays than those without BPD (median (IQR), 67 (52–84) vs 44 (34–56) days) and incurred higher total hospitalisation charges (median (IQR), 127 (91–177) vs 73 (52–103) thousand CNY) and charge per day (median (IQR), 1975 (1638–2361) vs 1714 (1409–2048) CNY). Mortality at discharge increased with BPD severity, with rates of 0.2% (18/9895) for infants without BPD, 0.5% (15/2751) for Grade 1 BPD, 2.1% (56/2634) for Grade 2 and 26.9% (58/216) for Grade 3. Similarly, the rates of major comorbidities and the need for home oxygen therapy increased with BPD severity.Conclusions Greater BPD severity was associated with increased comorbidities, higher in-hospital mortality and greater utilisation of healthcare resources. These findings emphasised the ongoing need to develop cost-saving strategies to reduce the risk and severity of BPD in this vulnerable population and improve overall care.

Necrotising enterocolitis (NEC) is a significant complication for very preterm infants (VPIs). The role of genetic predisposition in the development of NEC among VPIs has not been firmly established. This study aimed to explore the heritability factors in NEC among VPIs. A retrospective cohort study was conducted on 4138 infants from 2069 twin pairs. Twins were categorised based on chorionicity.Chi-square analyses were conducted to compare the incidence of NEC between monochorionic and dichorionic twin pairs. The Pearson chi-square test and ACE modelling appropriate for analysing twin cohorts were utilised. Stratified analyses were conducted for early-onset and late-onset NEC, surgical NEC, and NEC in different gestational age groups. The overall incidence of NEC was 5

BACKGROUND:To investigate whether use, duration, and types of early antibiotics were associated with the risk of necrotizing enterocolitis (NEC) among preterm infants born at <34 weeks' gestation. METHODS:This multicenter prospective cohort study included all infants with gestational age <34 weeks and admitted to neonatal intensive care units across China. Early antibiotic exposure was defined as the antibiotic treatment initiated within the first three postnatal days. The short-term outcomes included death, NEC, death and/or NEC. Propensity score matching was performed to generate matched cohorts. The impacts of early antibiotics exposure on the outcomes were evaluated by univariate and multivariate logistic regression models. RESULTS:Among 24,926 eligible infants, 20164 (80.9%) received early antibiotics. After matching, early antibiotics exposure was not significantly associated with the death and/or NEC (adjusted OR, 0.93; 95%CI, 0.72-1.21), NEC (adjusted OR, 0.81; 95% CI, 0.60 -1.10) or death (adjusted OR, 1.42; 95% CI, 0.90-2.25). However, prolonged antibiotic treatment (adjusted OR, 2.95; 95% CI, 1.67-5.22), especially broad-spectrum antibiotics exposure (adjusted OR, 5.09; 95% CI, 1.84-14.10), was independently associated with death. CONCLUSION:While early antibiotics exposure was not associated with the risks of NEC, prolonged antibiotic duration, especially broad-spectrum antibiotics, was associated with a higher mortality. IMPACT:This multicenter cohort study sheds light on whether use, duration, and types of early antibiotics were associated with the risk of necrotizing enterocolitis among preterm infants <34 weeks of gestation. In preterm infants, early antibiotics exposure was not significantly associated with the risks of death and/or NEC. However, prolonged antibiotic duration, especially broad-spectrum antibiotics, was associated with a higher mortality. Our study emphasizes the importance of neonatal antimicrobial stewardship in improving the prognosis of premature infants.

ObjectiveThis study aimed to investigate the association between antimony (Sb) exposure and glycated hemoglobin (HbA1c) levels in adolescents.MethodsA cross-sectional study of 751 adolescents aged 12–19 years was conducted via the National Health and Nutrition Examination Survey (NHANES, 2013–2016). Survey-weighted linear regression and restricted cubic spline (RCS) analyses were applied to evaluate the relationship of urinary Sb exposure with HbA1c.ResultsA significant relationship was observed between urinary Sb concentrations and HbA1c levels (percent change: 0.93; 95% CI: 0.42, 1.45) after full adjustment. After converting urinary Sb levels to a categorical variable by tertiles (T1–T3), the highest quantile was associated with a significant increase in HbA1c (percent change: 1.45; 95% CI: 0.38, 2.53) compared to T1. The RCS models showed a monotonically increasing relationship of urinary Sb with HbA1c. Subgroup analyses revealed a sex-specific relationship between urinary Sb exposure and HbA1c with a significant positive association in males and a non-significant positive association in females. Sensitivity analyses further confirmed the relationship between urinary Sb and HbA1c, even after excluding participants who were overweight or obese (percent change: 1.58%, 95% CI: 0.88, 2.28) and those with serum cotinine levels ≥ 1 ng/mL (percent change: 1.14%, 95% CI: 0.49, 1.80).ConclusionOur findings indicated that increased Sb exposure may correlate with higher HbA1c levels, especially in male adolescents. More studies are needed to further explore and validate the potential mechanisms.

ObjectiveThis study aimed to develop and validate a model for predicting extrauterine growth restriction (EUGR) in preterm infants born ≤34 weeks gestation.MethodsPreterm infants from Guangxi Maternal and Child Health Hospital (2019–2021) were randomly divided into training (80%) and testing (20%) sets. Collinear clinical variables were excluded using Pearson correlation coefficients. Predictive factors were identified using Lasso regression. Random forest (RF), support vector machine (SVM), and logistic regression (LR) models were then built and evaluated using the confusion matrix, area under the curve (AUC), and the F1 score. Additionally, calibration curves and decision curve analysis (DCA) were plotted to assess the performance and practical utility of the models.ResultsThe study included 387 infants, with no significant baseline differences between training (n = 310) and testing (n = 77) sets. LR identified gestational age, birth weight, premature rupture of membranes, patent ductus arteriosus, cholestasis, and neonatal sepsis as key EUGR predictors. The RF model (19 variables) demonstrated an accuracy of greater than 90% during training, and superior AUC (0.62), F1 score (0.80), and accuracy (0.72) in testing compared to other models.ConclusionsGestational age, birth weight, premature rupture of membranes, patent ductus arteriosus, cholestasis, and neonatal sepsis are significant EUGR predictors in preterm infants ≤34 weeks. The model shows promise for early EUGR prediction in clinical practice, potentially enhancing screening efficiency and accuracy, thus saving medical resources.

Introduction:Early identification and intervention of neurodevelopmental impairment in preterm infants may significantly improve their outcomes. This study aimed to build a prediction model for short-term neurodevelopmental impairment in preterm infants using machine learning method. Methods:Preterm infants with gestational age  < 32 weeks who were hospitalized in The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, and were followed-up to 18 months corrected age were included to build the prediction model. The training set and test set are divided according to 8:2 randomly by Microsoft Excel. We firstly established a logistic regression model to screen out the indicators that have a significant effect on predicting neurodevelopmental impairment. The normalized weights of each indicator were obtained by building a Support Vector Machine, in order to measure the importance of each predictor, then the dimension of the indicators was further reduced by principal component analysis methods. Both discrimination and calibration were assessed with a bootstrap of 505 resamples. Results:In total, 387 eligible cases were collected, 78 were randomly selected for external validation. Multivariate logistic regression demonstrated that gestational age(p = 0.0004), extrauterine growth restriction (p = 0.0367), vaginal delivery (p = 0.0009), and hyperbilirubinemia (0.0015) were more important to predict the occurrence of neurodevelopmental impairment in preterm infants. The Support Vector Machine had an area under the curve of 0.9800 on the training set. The results of the model were exported based on 10-fold cross-validation. In addition, the area under the curve on the test set is 0.70. The external validation proves the reliability of the prediction model. Conclusion:A support vector machine based on perinatal factors was developed to predict the occurrence of neurodevelopmental impairment in preterm infants with gestational age  < 32 weeks. The prediction model provides clinicians with an accurate and effective tool for the prevention and early intervention of neurodevelopmental impairment in this population.

OBJECTIVES:To investigate the difference in intestinal microbiota between preterm infants with neurodevelopmental impairment (NDI) and those without NDI.METHODS:In this prospective cohort study, the preterm infants who were admitted to the neonatal intensive care unit of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from September 1, 2019 to September 30, 2021 were enrolled as subjects. According to the assessment results of Gesell Developmental Scale at the corrected gestational age of 1.5-2 years, they were divided into two groups: normal (n=115) and NDI (n=100). Fecal samples were collected one day before discharge, one day before introducing solid food, and at the corrected gestational age of 1 year. High-throughput sequencing was used to compare the composition of intestinal microbiota between groups.RESULTS:Compared with the normal group, the NDI group had a significantly higher Shannon diversity index at the corrected gestational age of 1 year (P<0.05). The principal coordinate analysis showed a significant difference in the composition of intestinal microbiota between the two groups one day before introducing solid food and at the corrected gestational age of 1 year (P<0.05). Compared with the normal group, the NDI group had a significantly higher abundance of Bifidobacterium in the intestine at all three time points, a significantly higher abundance of Enterococcus one day before introducing solid food and at the corrected gestational age of 1 year, and a significantly lower abundance of Akkermansia one day before introducing solid food (P<0.05).CONCLUSIONS:There are significant differences in the composition of intestinal microbiota between preterm infants with NDI and those without NDI. This study enriches the data on the characteristics of intestinal microbiota in preterm infants with NDI and provides reference for the microbiota therapy and intervention for NDI in preterm infants.

Objectives Neonatal necrotizing enterocolitis (NEC) is a severe gastrointestinal disease that primarily affects preterm and very low birth weight infants, with high morbidity and mortality. We aim to build a reliable prediction model to predict the risk of NEC in preterm and very low birth weight infants. Methods We conducted a retrospective analysis of medical data from infants (gestational age <32 weeks, birth weight <1,500 g) admitted to Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. We collected clinical data, randomly dividing it into an 8:2 ratio for training and testing. Multivariate logistic regression was employed to identify significant predictors for NEC. Principal component analysis was used for dimensionality reduction of numerical variables. The prediction model was constructed through logistic regression, incorporating all relevant variables. Subsequently, we calculated performance evaluation metrics, including Receiver Operating Characteristic (ROC) curves and confusion matrices. Additionally, we conducted model performance comparisons with common machine learning models to establish its superiority. Results A total of 292 infants were included, with 20% ( n = 58) randomly selected for external validation. Multivariate logistic regression revealed the significance of four predictors for NEC in preterm and very low birth weight infants: temperature ( P = 0.003), Apgar score at 5 min ( P = 0.004), formula feeding ( P = 0.007), and gestational diabetes mellitus (GDM, P = 0.033). The model achieved an accuracy of 82.46% in the test set with an F1 score of 0.90, outperforming other machine learning models (support vector machine, random forest). Conclusions Our logistic regression model effectively predicts NEC risk in preterm and very low birth weight infants, as confirmed by external validation. Key predictors include temperature, Apgar score at 5 min, formula feeding, and GDM. This study provides a vital tool for NEC risk assessment in this population, potentially improving early interventions and child survival. However, clinical validation and further research are necessary for practical application.

Background: Narcotics and sedatives are widely used in neonatal intensive care units for very preterm infants. This study aimed to describe the current use of narcotics and/or sedatives among very preterm infants in Chinese neonatal intensive care units, with an emphasis on infants on invasive mechanical ventilation, and to investigate the association of exposure to narcotics and/or sedatives with neonatal outcomes.Methods: This was a retrospective observational cohort study that enrolled all infants born at 24+0-31+6 weeks and admitted to 57 tertiary neonatal intensive care units in the Chinese Neonatal Network in 2019. A multivariate logistic regression model was used to assess the association between narcotics and/or sedatives exposure and major neonatal outcomes.Results: Among 9,442 very preterm infants enrolled, 1,566 (16.6%) received at least one dose of narcotics or sedatives, 111 (1.2%) received only narcotics, 1,301 (13.8%) received sedatives solely, and 154 (1.6%) received both narcotics and sedatives during their hospital stay. Of 4,172 very preterm infants who underwent invasive mechanical ventilation, 1,117 (26.8%) received at least one dose of narcotics or sedatives, with 883 (21.2%) only received sedatives. Significant site variation of narcotics/sedatives use existed among hospitals, with the application rate ranging from 0%-72.5% in individual hospital. The narcotics and/or sedatives use by very preterm infants was independently associated with increased risks for periventricular leukomalacia, severe retinopathy of prematurity, and bronchopulmonary dysplasia.Conclusions: Narcotic and/or sedative administration is relatively conservative for very preterm infants in Chinese neonatal intensive care units, with significant variation among hospitals. Since narcotic and sedative use might be related to adverse neonatal outcomes, a pressing and developing need for national quality improvement initiatives is seen with respect to pain/stress management for very preterm infants.

Objective:To investigate the clinical outcomes of preterm infants who received non-invasive high-frequency oscillatory ventilation following extubation in a neonatal intensive care unit. Methods:Infants born between 25 and 34 weeks of gestation with a birth weight of <1,500 g, who were admitted into the neonatal intensive care unit of Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, China, requiring mechanical ventilation on admission were randomized to the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group following extubation. Their respiratory and neurodevelopmental outcomes were assessed at 12 and 24 months of corrected age. Results:Among 149 preterm infants who underwent randomization, 139 completed their treatment in the neonatal intensive care unit (45, 47, 47 in the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group, respectively), 113 were assessed at 12-month corrected age, and 110 of 113 were assessed again at 24-month corrected age. There were no differences in the number of times bronchitis, pneumonia, wheezing episodes, and re-hospitalization rates appeared due to respiratory diseases among the three groups (P > 0.05); the pulmonary function tests at 12-month corrected age showed respiratory rate, tidal volume, inspiratory time/expiratory time, time to peak expiratory flow/expiratory time, volume at peak expiratory flow/expiratory volume, expiratory flow at 25, 50, and 75% tidal volume were all similar among infants from the 3 groups (P > 0.05). There were no differences in the rates of neurodevelopmental impairment among the three groups at 24-month corrected age (P > 0.05). Conclusion:As post-extubation respiratory support in preterm infants, non-invasive high-frequency ventilation did not increase the rates of long-term respiratory morbidities and neurodevelopmental impairment compared with nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure.

Objective To investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants. Methods This was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks' gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups. Results A total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group. Conclusion As post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.

Objective To investigate influencing factors of neurobehavioral development in extremely low birth weight infants (ELBWI) .Methods From January 1 ,2010 to May 31 ,2015 ,a total of 88 ELBWI in the neonatal intensive care unit (NICU) of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region , were included into this study . They were divided into neurobehavioral development disability group (n=15) and neurobehavioral development normal group (n=73) according to the follow-up results with neurobehavioral development or not .The clinical data between two groups were analyzed ,and influencing factors of neurobehavioral development in ELBWI were analyzed by statistical analysis .① A total of 8 items of maternal information between two groups were compared , including proportion of maternal age >35-year-old and non-exposure to prenatal hormones ,assisted reproductive technology , gestational hypertension disease , gestational diabetes mellitus ,premature rupture of membranes ,and intrauterine infection ,and intrahepatic cholestasis of pregnancy (ICP) .② A total of 18 items of ELBWI between two groups were compared ,including constituent ratio of gestational age ,and proportion of small for age (SGA ) infants ,intraventricular hemorrhage (IVH) grade III-IV ,and so on .Based on the existing studies ,clinical experience and univariate analysis results ,the 4 influencing factors related to neurodevelopmental outcomes of ELBWI were analyzed by multivariate unconditional logistic analysis .The procedures followed in this study were in line with the ethical standards set by Ethical Review Board of Investigation in Human Beings of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region and were approved by the committee .Results ①The univariate analysis showed the following results .The proportion of intrauterine infection of puerperant in neurobehavioral development disability group was higher than that of neurobehavioral development normal group ,the constituent ratio of gestational age of ELBWI in neurobehavioral development disability group was younger than that of neurobehavioral development normal group ,furthermore ,the proportions of SGA infants and IVH grade Ⅲ-Ⅳ in neurobehavioral development disability group were higher than those in neurobehavioral development normal group , and all the above differences were statistically significant (P<0 .05) .② Multivariate unconditional logistic analysis showed the following results .Intrauterine infection (OR=43 .644 ,95％ CI:2 .545-748 .368 ,P=0 .009) and IVH grade Ⅲ-Ⅳ (OR=55 .837 ,95％ CI:3 .422-910 .988 ,P=0 .005) were independent risk factors about neurobehavioral development in ELBWI .Gestational age (OR=0 .067 , 95％ CI:0 .006-0 .821 , P= 0 .035 ) was the independent protective factor about neurobehavioral development in ELBWI . Conclusions It is necessary to take active measures to prevent neurodevelopmental disability by preventing premature delivery ,controlling intrauterine infection and reducing the occurrence of severe IVH .