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Birth asphyxia, defined by the World Health Organization as the failure to initiate and sustain breathing at birth, is the second cause of neonatal mortality and leads to about 25% of neonatal deaths or about 600,000 deaths per year.\" Death from prematurity, the most common cause of neonatal mortality overall and during the rest of the first week, accounts for another 900,000 deaths per year. [...]effective resuscitation at birth can be one of the most effective interventions to reduce neonatal mortality as it targets 1.5 million neonatal deaths per year due to birth asphyxia and/or prematurity. The National Institutes of Child Health and Human Development Global Network for Maternal and Child Health Research simplified versions of the World Health Organization Essential Newborn Care (ENC) program, which included basic resuscitation, and the American Academy of Pediatrics Neonatal Resuscitation Program (NRP). [...]training in a simplified NRP resulted in an additional one-third reduction in early neonatal mortality. Because most neonatal deaths occur in the lowest resource settings, a second trial was conducted in Africa, Southeast Asia, Central America, and South America with most births occurring at home and attended by traditional birth attendants or nurses.

ObjectiveTo characterise the effects of early and exclusive enteral nutrition with either maternal or donor milk in infants born very preterm (280/7–326/7 weeks of gestation).DesignParallel-group, unmasked randomised controlled trial.SettingRegional, tertiary neonatal intensive care unit.Participants102 infants born very preterm between 2021 and 2022 (51 in each group).InterventionInfants randomised to the intervention group received 60–80 mL/kg/day within the first 36 hours after birth. Infants randomised to the control group received 20–30 mL/kg/day (standard trophic feeding volumes).Main outcome measuresThe primary outcome was the number of full enteral feeding days (>150 mL/kg/day) in the first 28 days after birth. Secondary outcomes included growth and body composition at the end of the first two postnatal weeks, and length of hospitalisation.ResultsThe mean birth weight was 1477 g (SD: 334). Half of the infants were male, and 44% were black. Early and exclusive enteral nutrition increased the number of full enteral feeding days (+2; 0–2 days; p=0.004), the fat-free mass-for-age z-scores at postnatal day 14 (+0.5; 0.1–1.0; p=0.02) and the length-for-age z-scores at the time of hospital discharge (+0.6; 0.2–1.0; p=0.002). Hospitalisation costs differed between groups (mean difference favouring the intervention group: −$28 754; −$647 to −$56 861; p=0.04).ConclusionsIn infants born very preterm, early and exclusive enteral nutrition increases the number of full enteral feeding days. This feeding practice may also improve fat-free mass accretion, increase length and reduce hospitalisation costs.Trial registration number NCT04337710.

Background The current study evaluated the hypothesis that the COVID-19 pandemic is associated with higher stillbirth but lower neonatal mortality rates. Methods We compared three epochs: baseline (2016–2019, January–December, weeks 1–52, and 2020, January–February, weeks 1–8), initial pandemic (2020, March–December, weeks 9–52, and 2021, January–June, weeks 1–26), and delta pandemic (2021, July–September, weeks 27–39) periods, using Alabama Department of Public Health database including deliveries with stillbirths ≥20 weeks or live births ≥22 weeks gestation. The primary outcomes were stillbirth and neonatal mortality rates. Results A total of 325,036 deliveries were included (236,481 from baseline, 74,076 from initial pandemic, and 14,479 from delta pandemic period). The neonatal mortality rate was lower in the pandemic periods (4.4 to 3.5 and 3.6/1000 live births, in the baseline, initial, and delta pandemic periods, respectively, p  < 0.01), but the stillbirth rate did not differ (9 to 8.5 and 8.6/1000 births, p  = 0.41). On interrupted time-series analyses, there were no significant changes in either stillbirth ( p  = 0.11 for baseline vs. initial pandemic period, and p  = 0.67 for baseline vs. delta pandemic period) or neonatal mortality rates ( p  = 0.28 and 0.89, respectively). Conclusions The COVID-19 pandemic periods were not associated with a significant change in stillbirth and neonatal mortality rates compared to the baseline period. Impact The COVID-19 pandemic could have resulted in changes in fetal and neonatal outcomes. However, only a few population-based studies have compared the risk of fetal and neonatal mortality in the pandemic period to the baseline period. This population-based study identifies the changes in fetal and neonatal outcomes during the initial and delta COVID-19 pandemic period as compared to the baseline period. The current study shows that stillbirth and neonatal mortality rates were not significantly different in the initial and delta COVID-19 pandemic periods as compared to the baseline period.

Effective health communication between healthcare providers and patients is a cornerstone of quality healthcare. It underpins trust, comprehension, and patient-informed care. Robust research shows that effective communication, including the use of text messaging for communication can improve maternal/fetal and neonatal outcomes and patient satisfaction, particularly among vulnerable patients. Health information privacy laws that do not evolve with technological advances can inadvertently create barriers to effective health communication, reinforcing perinatal disparities. This is particularly true regarding maternal and child health, where the use of text messaging for patient communication has the potential to make a substantial impact on health disparities. This article explores the complex interplay between health information privacy laws and text messaging, highlighting challenges and examining potential solutions. It stresses the need for consistent health information privacy laws that protect the privacy security of health information for pregnant patients and new mothers, while also aligning with evolving communication technologies.

ObjectiveThis study investigates whether and to what extent cerebral injury is associated with bilateral blindness in extremely preterm infants, which has been attributed mainly to retinopathy of prematurity (ROP).DesignMulticentre analysis of children born from 1994 to 2021 at gestational age 22 0/7 to 28 6/7 weeks with follow-up at 18–26 months. Logistic regression examined the adjusted association of bilateral blindness with severe ROP and/or cerebral injury among extremely preterm infants.ExposuresSevere ROP and cerebral injury, the latter defined as any of the following on cranial imaging: ventriculomegaly; blood/increased echogenicity in the parenchyma; cystic periventricular leukomalacia.Main outcome measuresBilateral blindness, defined as a follow-up examination meeting criteria of ‘blind—some functional vision’ or ‘blind—no useful vision’ in both eyes.ResultsThe 19 863 children included had a mean gestational age of 25.6±1.7 weeks, mean birth weight of 782±158 g and 213 (1%) had bilateral blindness. Multiplicative interaction between ROP and cerebral injury was statistically significant. For infants with only severe ROP (n=3130), odds of blindness were 8.14 times higher (95% CI 4.52 to 14.65), and for those with only cerebral injury (n=2836), odds were 8.38 times higher (95% CI 5.28 to 13.28), compared with the reference group without either condition. Risks were not synergistic for infants with both severe ROP and cerebral injury (n=1438, adjusted OR=28.7, 95% CI 16.0 to 51.7, p<0.0001).ConclusionsIn a group of extremely preterm infants, severe ROP and cerebral injury were equally important risk factors for blindness. Besides ROP, clinicians should consider cerebral injury as a cause of blindness in children born extremely preterm.Trial registration numberNCT00063063.

Active postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care. To determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants. This cohort study included live births from 22 to 25 weeks' gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022. Regional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test. We included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks' gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks' gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks' gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks' gestation (both P < .05). Regional rates of antenatal corticosteroids exposure were also positively correlated with regional rates of survival at 22 weeks' gestation (rτ[8] = 0.60; r2 = 0.36; P = .02). In this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks' gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.

ObjectiveTo determine the impact of neuroprotection interventions bundle on the incidence of severe brain injury or early death (intraventricular hemorrhage grade 3/4 or death by 7 days or ventriculomegaly or cystic periventricular leukomalacia on 1-month head ultrasound, primary composite outcome) in very preterm (270/7 to ≤ 296/7 weeks gestational age) infants.Study designProspective quality improvement initiative, from April 2017-September 2019, with neuroprotection interventions bundle including cerebral NIRS, TcCO2, and HeRO monitoring-based management algorithm, indomethacin prophylaxis, protocolized bicarbonate and inotropes use, noise reduction, and neutral positioning.ResultThere was a decrease in the incidence of the primary composite outcome in the intervention period on unadjusted (N = 11/99, pre-intervention to N = 0/127, intervention period, p < 0.001) and adjusted analysis (adjusted for birthweight and Apgar score <5 at 5 min, aOR = 0.042, 95% CI = 0.003–0.670, p = 0.024).ConclusionsNeuroprotection interventions bundle was associated with significant decrease in severe brain injury or early death in very preterm infants.

ObjectiveTo compare skin-to-skin care (SSC) and oral sucrose for preterm neonatal pain control.MethodsPreterm neonates (28–36 weeks gestation) requiring heel-stick were eligible. In group-A, SSC was given 15-min before first heel-stick, and sucrose was given 2-min before second heel-stick. In group-B, the sequence was reversed. Blinded premature infant pain profile (PIPP) score assessment was done at 0, 1, and 5-min of heel-stick by two assessors.ResultsA hundred neonates were enrolled. The inter-rater agreement for the PIPP score was good. The behavior state component was significantly lower in the sucrose group at all assessment points. The mean (SD) difference between 1-min and 0 min was similar [SSC 3.58(3.16) vs. sucrose 4.09(3.82), p = 0.24] between groups. The PIPP score attained baseline values at 5-min in both groups.ConclusionAlbeit sucrose indicated instantaneous action, SSC and sucrose have comparable clinical efficacy for preterm neonatal pain control. Multisensory stimulation with SSC may result in a higher behavioral state component of the PIPP score.