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Advances in neonatal intensive care have significantly reduced mortality and morbidity in extremely preterm infants (EPIs). However, the incidence of bronchopulmonary dysplasia (BPD) remains similar or is even increasing. This study examines trends in mortality, BPD, and composite outcome of BPD or mortality among EPIs in Korea. We analyzed data from the Korean Neonatal Network, a nationwide cohort of preterm infants in Korea. EPIs with gestational ages of 23–27 weeks born between 2014 and 2021 were included. Among 4,450 survivors (mean gestational age 25.7 ± 1.2 weeks, mean birth weight 870.7 ± 194.2 g), the incidence of BPD rose from 51.2 to 62.7% ( P  < 0.001), while mortality declined from 28.3 to 19.5% ( P  < 0.001). The composite outcome of BPD or mortality also increased, from 63.6 to 66.9% ( P  = 0.006). The duration of invasive ventilation, rates of endotracheal intubation at birth, and intubation for surfactant administration decreased, whereas the duration of non-invasive ventilation and overall ventilatory support increased. Despite decreasing mortality, the incidence of BPD among survivors and composite outcome of BPD or mortality increased, potentially driven by longer ventilatory support. This suggests a trade-off where improved survival rates in EPIs lead to a higher incidence of BPD.

ObjectiveTo investigate the characteristics of persistent pulmonary hypertension of the newborn (PPHN) in extremely preterm infants and its impact on neurodevelopmental outcomes at 3 years of age.DesignA retrospective multicentre cohort study.Settings202 tertiary perinatal centres registered in the Neonatal Research Network of Japan (NRNJ).PatientsInfants born at <28 weeks of gestational age (GA), between 2003 and 2012, were extracted from tertiary perinatal centres participating in NRNJ.Main outcome measuresDemographic characteristics, morbidity, interventions and mortality were compared for infants with and without PPHN. Multivariable logistic analysis was performed to evaluate the impact of PPHN on long-term neurodevelopmental outcomes (the prevalence rate of cerebral palsy, need for home oxygen therapy, and visual, hearing and cognitive impairment) at 3 years of age.ResultsThe prevalence of PPHN among the 12 954 extremely preterm infants enrolled was 8.1% (95% CI 7.7% to 8.6%), with the trend increasing annually, and a higher proportion as GA decreased: 18.5% (range, 15.2% to 22.4%) for infants born at 22 weeks compared with 4.4% (range, 3.8% to 5.2%) for those born at 27 weeks. Clinical chorioamnionitis and premature rupture of membranes were associated with PPHN. On multivariate analysis of the data from 5923 infants followed up for 3 years, PPHN was a significant independent risk factor for visual impairment (adjusted OR, 1.42, 95% CI 1.03 to 1.97).ConclusionsThe prevalence of PPHN in extremely preterm infants has been increasing over the past decade in Japan. Clinicians should be aware of visual impairments as a neurodevelopmental abnormality among infants with PPHN.

ObjectiveTo explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden.Design/SettingData on all births at 22 and 23 weeks’ gestational age (GA) were prospectively collected in 2004–2007 (T1) or obtained from national registers in 2014–2016 (T2) and 2017–2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions.Main outcomeOne-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3–4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3–5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined.Results977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks’ infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4).ConclusionIncreased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.

Background Despite the associated major morbidities, advances in neonatal care units have improved the survival rates of extremely preterm infants. However, the varying survival rates make it challenging to set policy decisions around the standardization of care. Therefore, this study aimed to determine the global survival rate of extremely preterm infants and to compare it across different income levels and over time during the last two decades. Method A comprehensive systematic search was conducted across major databases, including PubMed/Medline, EMBASE, CINAHL, Web of Science, Scopus, AJOL, Google Scholar and Google, to identify relevant articles. All peer-reviewed studies reported the survival rate of extremely preterm infants (born before 29 weeks’ gestation) between January 1 st, 2000, and June 25th, 2024, were included. Outcomes were compared between Epoch 1 (2000–2015, Millennium Developmental Goals period) and Epoch 2 (2016–2024, Sustainable Developmental Goals period). DerSimonian‒Laird random effects model was fitted to estimate the pooled weighted outcomes. Results A total of 217 studies involving 917,176 infants were included. Based on published data, 61.4% (95% CI: 58.13–64.81) of extremely preterm infants survived to discharge, and 51.7% (95% CI: 44.25–59.22) of survivors were discharged without major morbidity. Survival rate was significantly lower in low- and middle-income countries (44.3%) compared to high-income countries (69.3%). Among low- and middle-income countries, survival improved from 38% during the epoch 1 to 44.8% during the epoch 2. While in high-income countries it was 69.9% during epoch 1 and 64.2% during epoch 2. These findings are based on reported literature; may not fully reflect outcomes in low-resource settings where data are limited and underreported. Variability in the inclusion and care of borderline viable infants also contributes to the heterogeneity and uncertainty of the estimates. Conclusion Survival of extremely preterm infants varies widely across settings, with fewer than half surviving in low- and middle-income countries. While some improvement was observed in these regions during the Sustainable Developmental Goals period, comparisons across epochs and regions should be interpreted cautiously due to differences in data availability and population characteristics. These variations underscore the need for context-specific strategies that balance available resources, cultural values, and ethical considerations. Further population-level data, particularly from low-and middle-income countries, are essential to inform equitable global neonatal care policies. Registration PROSPERO (CDR42023447612 (PROSPERO (york.ac.uk)). Clinical trial number Not applicable.

To investigate the respiratory and related health outcomes at 18 months for extremely preterm (EP) infants diagnosed with bronchopulmonary dysplasia (BPD). This retrospective cohort study aims to investigate the respiratory and related health outcomes at 18 months for extremely preterm (EP) infants diagnosed with bronchopulmonary dysplasia (BPD). Also, rephrase the second sentence to be: We reviewed post-hospital discharge outcomes for EP infants with BPD from Women’s Health and Research Centre, Doha, Qatar (January 2018 – December 2019). We compared 86 BPD infants with 102 preterm controls without BPD. EP infants with BPD were more often male (70% vs. 46%, p  < 0.001), had lower birth weights (797 g vs. 920 g) and gestational ages (25.3 vs. 25.9 weeks, both p  < 0.001). They required more surfactant, longer ventilation, and experienced higher rates of complications. Post-discharge, infants with BPD had significantly higher rates of oxygen dependence, steroid use (both systemic and inhaled), gastric tube feeding, and sleep study evaluations compared to those without BPD. Regression analysis revealed that moderate and severe BPD were significantly associated with increased risk of pediatric intensive care unit admissions, pulmonary hypertension, any patent ductus arteriosus closure procedure, and neurodevelopmental impairment. Specifically, severe BPD was strongly associated with home gastric tube feeding (OR 67.3; 95% CI: 6.48–699.67; p  < 0.001), motor delays (OR 6.29; 95% CI: 1.61–24.54; p  < 0.001), and expressive language delays (OR 4.39; 95% CI: 1.15–16.77; p  = 0.031). BPD infants have significantly poorer respiratory and neurodevelopmental outcomes, highlighting the need for intensive monitoring and follow-up care. While this retrospective study provides valuable insights, further prospective research is warranted to validate these findings and explore targeted interventions.

The first hours after birth entail a window of opportunity to decrease morbidity and mortality among extremely preterm infants. The availability of staff and its tiredness vary depending on the timing and day of the week. We hypothesized that these circumstances may impact neonatal outcomes. We have conducted a multicenter cohort study with data obtained from the Spanish neonatal network database SEN1500, where staff doctors are in the house 24/7. The main study exposure was the time of birth; secondary exposures were cumulative work hours from the medical and nurses’ shifts and day of the week. The primary outcome was survival to hospital discharge. Secondary outcomes included common preterm infants’ in-hospital complications. Univariate and multivariate analysis adjusting for potential confounders was performed. All extremely preterm infants ( N  = 8798) born between 2011 and 2019 were eligible; 35.7% of them were admitted during the night shift. No differences were found between day and night births regarding survival or morbidity. No differences were found between weekdays and weekends or when considering cumulative worked hours in the shifts. Infants born during the night shift were more likely to be intubated at birth (OR 1.20, CI95% 1.06–1.37), receive surfactant (OR 1.24, CI95% 1.08–1.44), and having anemia requiring transfusion (OR 1.23, CI 95% 1.08–1.42). Conclusion : the time of birth did not seem to affect mortality and morbidity of extremely preterm infants. What is Known: • The first hours after birth in extremely preterm infants are a very valuable opportunity to decrease mortality and morbidity. • Time and day of birth have long been linked to outcomes in preterm infants, with night shifts and weekends classically having higher rates of mortality and morbidity. What is New: • In this study, no differences were found between day and night births regarding survival or major morbidity. • Infants born during the night shift were more likely to be intubated at birth, receive surfactant and having anemia requiring transfusion.

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.

This study aims to assess the predictive capability of synthetic MRI in assessing neurodevelopmental outcomes for extremely preterm neonates with low-grade Germinal Matrix-Intraventricular Hemorrhage (GMH-IVH). The study also investigates the potential enhancement of predictive performance by combining relaxation times from different brain regions. In this prospective study, 80 extremely preterm neonates with GMH-IVH underwent synthetic MRI around 38 weeks, between January 2020 and June 2022. Neurodevelopmental assessments at 18 months of corrected age categorized the infants into two groups: those without disability ( = 40) and those with disability ( = 40), with cognitive and motor outcome scores recorded. T , T relaxation times, and Proton Density (PD) values were measured in different brain regions. Logistic regression analysis was utilized to correlate MRI values with neurodevelopmental outcome scores. Synthetic MRI metrics linked to disability were identified, and combined models with independent predictors were established. The predictability of synthetic MRI metrics in different brain regions and their combinations were evaluated and compared with internal validation using bootstrap resampling. Elevated T and T relaxation times in the frontal white matter (FWM) and caudate were significantly associated with disability (  < 0.05). The T -FWM, T -Caudate, T -FWM, and T -Caudate models exhibited overall predictive performance with AUC values of 0.751, 0.695, 0.856, and 0.872, respectively. Combining these models into T -FWM + T -Caudate + T -FWM + T -Caudate resulted in an improved AUC of 0.955, surpassing individual models (  < 0.05). Bootstrap resampling confirmed the validity of the models. Synthetic MRI proves effective in early predicting adverse outcomes in extremely preterm infants with GMH-IVH. The combination of T -FWM + T -Caudate + T -FWM + T -Caudate further enhances predictive accuracy, offering valuable insights for early intervention strategies.

Objective To investigate the physical growth and neurodevelopmental indicators of Gestational age(GA)< 32 weeks infants at 6 months corrected age. Methods This study included 116 infants, retrospectively analyzing GA<32 weeks infants who discharged from Tianjin Central Hospital of Gynecology and Obstetrics between April 2023 and August 2024. General movements (GMs) assessment was performed at 1 month corrected age. Physical Growth Indicators, GMs and Gesell Developmental Diagnosis Scale (GDDS) assessments were conducted at 3 and 6 months corrected age. Results The proportion of abnormal GMs at 3 months corrected age (3.44%) was lower than that at 1 month corrected age (86.21%).At 6 months corrected age, the proportion of infants with a developmental quotient (DQ) ≤ 75 was 43.10%, lower than 69.82% at 3 months corrected age. GA and multiple births were independent risk factors for DQ ≤ 75 at 3 months corrected age. GA, early intervention, and intracranial hemorrhage were independent risk factors for DQ ≤ 75 at 6 months corrected age. Conclusion At 6 months corrected age, GA<32 weeks infants exhibited greater neurodevelopmental outcome. Standardized follow-up and early neurodevelopmental interventions should be further strengthened for preterm infants to reduce the occurrence of adverse outcomes.

Survival outcomes for infants born at 22–23 weeks’ gestation vary widely across neonatal units. This national, prospective cohort study evaluated 919 infants born at 22–23 weeks’ gestation in South Korea between 2013 and 2022, using Korean Neonatal Network data. Infants were categorized based on the level of neonatal care: 785 in lower-level centers (Group A) and 134 in higher-level centers (Group B). Survival was significantly higher in Group B (64.9%) compared to Group A (29.3%) (P < 0.0001). Early deaths occurred more frequently and earlier in Group A. Proactive care—including antenatal corticosteroids, antenatal antibiotics, and immediate surfactant administration—was more common in Group B. Antenatal corticosteroid was significantly associated with reduced risk of death (hazard ratio 0.58; 95% confidence interval, 0.49–0.69; P < 0.0001). The timing of rapid decline in survival was delayed in higher-level centers. In addition, classifying institutions into higher- and lower-level groups according to the survival of infants born at 22–23 weeks’ gestation (≥50% vs. <50%) provides a good reflection of the quality of neonatal care. These findings highlight the importance of proactive care and timely in utero transfer to higher-level units in improving survival for peri-viable infants.