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This study of temporal trends in mortality among extremely premature infants receiving care in U.S. centers showed declines in overall mortality and in deaths from pulmonary causes, immaturity, infection, and CNS injury. Deaths from necrotizing enterocolitis increased. Although survival among premature infants has improved, prematurity is a leading contributor to neonatal mortality in the United States. 1 Approximately one in four extremely premature infants born at 22 to 28 weeks of gestation does not survive the birth hospitalization; mortality rates decrease with each additional week of completed gestation. 2 Historically, most extremely premature infants died within a few days after birth. 3 – 5 Among extremely-low-birth-weight infants born at centers in the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network between 1993 and 1997, immaturity was the leading cause of death within 12 hours after birth, and . . .

Objective: To examine the timing and microbiology of neonatal sepsis in a population-based surveillance in the Indian community setting. Study Design: All live born infants in 223 villages of Odisha state were followed at home for 60 days. Suspect sepsis cases were referred to study hospitals for further evaluation including blood culture. Results: Of 12 622 births, 842 were admitted with suspected sepsis of whom 95% were 4 to 60 days old. Culture-confirmed incidence of sepsis was 6.7/1000 births with 51% Gram negatives ( Klebsiella predominating) and 26% Gram positives (mostly Staphylococcus aureus ). A very high level of resistance to penicillin and ampicillin, moderate resistance to cephalosporins and extremely low resistance to Gentamicin and Amikacin was observed. Conclusion: The bacterial burden of sepsis in the Indian community is not high. Judicious choice of empiric antibiotics, antibiotic stewardship and alternate modalities should be considered for the management or prevention of neonatal sepsis in India.

Background Extremely preterm infants (EPT, <29 weeks’ gestation) represent only 0.9% of births in the United States; yet these infants are the focus of most published research. Moderately preterm neonates (MPT, 29–33 6/7 weeks) are an understudied group of high-risk infants. Methods To determine the neonatal outcomes of MPT infants across the gestational age spectrum, and to compare these with EPT infants. A prospective observational cohort was formed in 18 level 3–4 neonatal intensive care units (NICUs) in the Eunice Kennedy Shriver NICHD Neonatal Research Network. Participants included all MPT infants admitted to NICUs and all EPT infants born at sites between January 2012 and November 2013. Antenatal characteristics and neonatal morbidities were abstracted from records using pre-specified definitions by trained neonatal research nurses. Results MPT infants experienced morbidities similar to, although at lower rates than, those of EPT infants. The main cause of mortality was congenital malformation, accounting for 43% of deaths. Central Nervous System injury occurred, including intraventricular hemorrhage. Most MPT infants required respiratory support, but sequelae such as bronchopulmonary dysplasia were rare. The primary contributors to hospitalization beyond 36 weeks’ gestation were inability to achieve adequate oral intake and persistent apnea. Conclusions MPT infants experience morbidity and prolonged hospitalization. Such morbidity deserves focused research to improve therapeutic and prevention strategies.

ObjectivesThe objectives describe the frequency that inadequate oral feeding (IOF) is the reason why moderately preterm (MPT) infants remain hospitalized and its association with neonatal morbidities.Study designProspective study using the NICHD Neonatal Research Network MPT Registry. Multivariable logistic regression was used to describe associations between IOF and continued hospitalization at 36 weeks postmenstrual age (PMA).ResultA total of 6017 MPT infants from 18 centers were included. Three-thousand three-seventy-six (56%) remained hospitalized at 36 weeks PMA, of whom 1262 (37%) remained hospitalized due to IOF. IOF was associated with RDS (OR 2.02, 1.66–2.46), PDA (OR 1.86, 1.37–2.52), sepsis (OR 2.36, 95% 1.48–3.78), NEC (OR 16.14, 7.27–35.90), and BPD (OR 3.65, 2.56–5.21) compared to infants discharged and was associated with medical NEC (OR 2.06, 1.19–3.56) and BPD (OR 0.46, 0.34–0.61) compared to infants remaining hospitalized for an alternative reason.ConclusionIOF is the most common barrier to discharge in MPT infants, especially among those with neonatal morbidities.

ObjectiveIndomethacin prophylaxis (IP) reduces the risk of intraventricular haemorrhage (IVH) and patent ductus arteriosus (PDA) in preterm infants. However, the optimal time to administer IP has not been determined. We hypothesised that IP at ≤6 h is associated with a lower incidence of IVH or death than if administered at >6–24 h of age.MethodsWe performed a retrospective cohort study of extremely low birth weight infants (≤1000 g birth weight) treated in the neonatal intensive care units in the Neonatal Research Network from 2003 to 2010 and who received IP in the first 24 h of age. Infants were dichotomised based upon receipt of IP at ≤6 or >6–24 h of age. The primary outcomes were IVH alone and IVH or death. Secondary outcomes were PDA alone and PDA or death. We used multivariable analyses to determine associations between the age of IP and the study outcomes expressed as an OR and 95% CI.ResultsIP was given at ≤6 h to 2340 infants and at >6–24 h to 1915 infants. Infants given IP at ≤6 h had more antenatal steroid exposure, more inborn and less cardiopulmonary resuscitation (p<0.01). After multivariable analyses, age of IP receipt was not associated with IVH, and IVH or death but PDA receiving treatment/ligation or death was lower among IP at ≤6 h compared with IP at >6–24 h (OR 0.83, 95% CI 0.71 to 0.98).ConclusionsIP at ≤6 h of age is not associated with less IVH or death, but is associated with less PDA receiving treatment/ligation or death.

Cardiac morbidity and mortality increases during December and January 1- 3 even in regions with mild climates. 4 Uniquely increased levels of stress, anxiety, and overindulgence at the turn of the millennium led us to hypothesise that the millennium changeover was associated with an increased number of deaths attributable to cardiac causes. [...]we analysed data from death certificates in Los Angeles County, California, to discover if the millennium changeover was associated with increased cardiovascular mortality. [...]mortality attributable to IHD in the two weeks before the turn of the millennium compared with the two post-millennium weeks was increased beyond the levels of New Year's changeovers before and after the millennium, suggesting that circumstantial factors specific to the millennium hype were related to an excess risk of IHD death.