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This study aimed to identify the risk factors associated with intraventricular hemorrhage (IVH) in extremely preterm infants (EPIs), focusing on early-stage prediction to improve clinical outcomes. A retrospective cohort study was conducted at Guangzhou Women and Children’s Medical Center, including 189 EPIs born between January 2019 and December 2023. Infants were categorized into IVH and non-IVH groups based on head ultrasound findings. Risk factors were assessed using univariate and multivariate analyses, and a predictive model for IVH was developed. Of the 189 EPIs, 80 (42.3%) developed IVH, with 26 (13.8%) experiencing severe IVH. Gestational age was identified as a significant protective factor (OR = 0.565, p  = 0.023), while invasive mechanical ventilation (IMV) was a key risk factor (OR = 2.718, p  = 0.012). The predictive model demonstrated good performance, with an AUC of 0.753 (95% CI: 0.681–0.825). Gestational age and IMV are critical factors in the development of IVH in EPIs. Early identification of high-risk infants based on these factors can aid in timely interventions to reduce IVH incidence and improve outcomes.

Our primary objective for this follow-up study was to compare the neurodevelopmental outcomes of a surviving cohort of infants using a split-week gestational model (early versus late) gestational age (GA) and the standard completed GA categorization. Neurodevelopmental outcomes using a split-week GA model defined as early (X, 0–3) and late (X, 4–6), with X being 23–26 weeks GA, were compared to outcomes using completed weeks GA. In total, 1012 infants were included in the study. Statistically significant differences were noted in outcomes between the early and late split of the gestational week at 23 weeks (early vs. late), with 13.3% vs. 54.5% for no neurodevelopmental impairment, and 53.3% vs. 22.7% for significant impairment (p = 0.034), respectively. There were no differences seen in the split week model for 24, 25, and 26 weeks. A trend towards improved neurodevelopmental outcomes was seen with each increasing gestation week. The split-week model did not provide additional information for pregnancies and infants between 24 and 26 weeks gestation. It did, however, provide information for counsel for infants at 23 weeks gestation, showing benefits in the late versus early half of the week.

Background: Probiotic supplementation for very preterm infants is a common practice in many neonatal units. Assessing the effects of early postnatal exposure to probiotics on long-term neurodevelopment, growth, and atopy-related outcomes is important. Extremely preterm (EP: <28 weeks) infants enrolled in our previously reported randomized trial (SiMPro) comparing short-term effects of single (SS: B. breve M-16V) versus triple-strain (TS: B. breve M-16V, B. longum subsp. infantis-M63, B. longum subsp. longum-BB536) probiotic provided a unique opportunity to study this issue. Methods: This follow-up study assessed the five-year outcomes of SiMPro trial infants, including neurodevelopment (cognition (Full Scale Intelligence Quotient/ FSIQ using WPPSI-IV), behavior (Strengths and Difficulties Questionnaire), executive function (BRIEF–P)), growth (anthropometry) and blood pressure (BP). Atopy-related outcomes were evaluated at six to seven years using the ISAAC questionnaire. A linear mixed model was used for longitudinal outcomes. Impairment indicators were modeled using logistic regression and adjusted for Socio-Economic Indexes for Areas (SEIFA) centiles. Results: Follow-up rates (SS: 89.2% versus TS: 95%), neurodevelopmental outcomes [severe impairment (FSIQ < 70): SS: 7.4% versus TS: 4.3%; p = 0.68], growth, BMI, and BP were comparable between the SS and TS groups. The total difficulty score or BRIEF–P executive indices, disability rates (none: 66.7% versus 55.4%), and atopy-related outcomes were comparable between groups. Conclusions: Both TS and SS Bifidobacterium probiotic formulations were safe, with comparable neurodevelopmental, growth, and atopy-related outcomes at school age.

Very Preterm birth (vPTB) and extreme Preterm birth (xPTB) are the major concerns in maternal and child healthcare and are associated with increased morbidity and mortality. Machine learning methods have traditionally been used to predict preterm births (vPTB and xPTB). However, most medical datasets, including preterm births, are imbalanced in class distribution. Although data-balancing techniques can be employed, complications due to the limited sample size of the minority class are frequently encountered, leading to inconsistent results. This study adopted a novel approach by employing one-class classification (OCC) in conjunction with several strategies to predict instances of vPTB and xPTB within an Emirati pregnant population. We used a well-curated dataset acquired during the first trimester of pregnancy. We employed multiple OCC algorithms and their ensembles involving multiple aggregation strategies to predict vPTB and xPTB in both parous and nulliparous populations. Our approach effectively incorporated only majority class information during training. Our detailed experimental setup demonstrated that the proposed methodology achieved promising performance with a maximum AUC-ROC of 0.823 for the parous population without any explicit modeling of the minority class. Our approach demonstrated robustness and efficacy in identifying at-risk pregnancies within the Emirati population. Our results suggest that one-class classification framework which requires only normal data points for training can be used for early prediction of very preterm and extreme preterm births with reasonable accuracy. In this paper, we applied one-class classification framework only on the Emirati population. Generalizing the proposed approach in this domain requires experimentation on similar datasets from other countries.

Reducing neonatal mortality is a crucial part of health-care programs. We wanted to analyze the in-hospital mortality in the tertiary referral Department of Neonatology and Neonatal Intensive Care of the Medical University of Bialystok. The study was conducted on data of all neonates admitted to the Department between 2015 and 2023 ( N  = 19 171). During the study period the in-hospital mortality rate was 5.16 per 1000 live births and it was the highest in 2021 (8.15 per 1000 live births, p  < 0.05). The leading underlying cause of death was extreme prematurity. 43.75% of the extremely preterm or extremely low birth weight neonates had a congenital/hospital acquired infection and 54.69% were not administered a full course of recommended antenatal corticosteroids. The in-hospital mortality rate in the Department was significantly higher than in Poland and other European countries due to the characteristics of the tertiary care Department and was generated mainly by deaths of premature neonates. It was the highest during the period of strict epidemiological restrictions related to the COVD-19 pandemic. Without detailed analyses of neonatal deaths in individual health care facilities and implementation of procedures to improve quality of care, it will not be possible to reduce the number of neonatal deaths.

Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants’ likelihood of survival.ObjectiveOur aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births.MethodsThe population included 1020 singleton births between 220/6 and 260/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was ‘active antenatal care’ defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics.ResultsAmong the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks’ gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care.ConclusionEven after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions.

Aims: This study assessed the relationship between spatial social polarization measured by the index of the concentration of the extremes (ICE) and preterm birth (PTB) and infant mortality (IM) in New York City. A secondary aim was to examine the ICE measure in comparison to neighborhood poverty. Methods: The sample included singleton births to adult women in New York City, 2010–2014 (n=532,806). Three ICE measures were employed at the census tract level: ICE − Income (persons in households in the bottom vs top 20th percentile of US annual household income), ICE −Race/Ethnicity (black non-Hispanic vs white non-Hispanic populations), and ICE – Income + Race/Ethnicity combined. Preterm birth was defined as birth before 37 weeks’ gestation. Infant mortality was defined as a death before one year of age. A two-level generalized linear model with random intercept was utilized adjusting for individual-level covariates. Results: Preterm birth prevalence was 7.1% and infant mortality rate was 3.4 per 1000 live births. Women who lived in areas with the least privilege were more likely to have a preterm birth or infant mortality as compared to women living in areas with the most privilege. After adjusting for covariates, this association remained for preterm birth (ICE – Income: Adjusted Odds Ratio (AOR) 1.16 (1.10–1.21); ICE – Race/Ethnicity: AOR 1.41 (1.34–1.49); ICE – Income + Race/Ethnicity: AOR 1.36 (1.29–1.43)) and IM (ICE – Race/Ethnicity (AOR 1.80 (1.43–2.28) and ICE – Income + Race/Ethnicity (AOR 1.54 (1.23–1.94)). High neighborhood poverty was associated with PTB only (AOR 1.09 (1.04–1.14). Conclusions: These results provide preliminary evidence for the use of the ICE measure in examining structural barriers to healthy birth outcomes.

Objectives: The aim of this study was to investigate the factors associated with the prediction of perinatal survival in pregnancies with extreme preterm delivery between 24[sup.+0] and 27[sup.+6] weeks’ gestation. Methods: This screening cohort study was undertaken at a large tertiary obstetric and neonatal unit in the United Kingdom. We included singleton pregnancies that booked and delivered at our hospital. Logistic regression analysis was carried out to determine risks of complications in pregnancies delivering preterm after adjusting for maternal and pregnancy characteristics. Effect sizes were expressed as absolute risks (ARs) and odds ratios (ORs) (95% confidence intervals [CI]). Results: The study population included 53,649 singleton pregnancies, including 139 (0.3%) with preterm delivery between 24[sup.+0] and 27[sup.+6] weeks and 47,006 (99.7%) with term delivery ≥37 weeks. Multivariate regression analysis demonstrated that there was a significant contribution of uterine artery pulsatility index (UtA-PI) and cervical length, but not of maternal factors, in the prediction of preterm delivery <28 weeks. The risk of neonatal death and intact neurological survival in pregnancies delivering <28 weeks was 11.5% and 79.1%, respectively. Caesarean compared to vaginal delivery and female compared to male neonates were associated with a lower incidence of neurological morbidity (6.1% vs. 19.3%; p = 0.016 and 13.1% vs. 26.9%; p = 0.036, respectively). In the prediction of intact perinatal survival, the only significant variable was gestational age at delivery, with survival rates of about 50%, 65%, 80% and 90% at 24, 25, 26 and 27 weeks, respectively. Conclusions: In pregnancies with extreme preterm delivery between 24[sup.+0] and 27[sup.+6] weeks, caesarean compared to vaginal delivery and female compared to male neonates are associated with a lower incidence of neurological morbidity. The only significant factor in the prediction of intact perinatal survival is gestational age at delivery.

New Findings What is the topic of this review? Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non‐modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes. What advances does it highlight? Cardiovascular stress tests performed in preterm‐born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. Preterm‐born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro‐ and micro‐physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later‐life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes.

Changes in the preconception ambient temperature (PAT) can affect the gametogenesis, disturbing the development of the embryo, but the health risks of PAT on the developing fetus are still unclear. Here, based on the National Free Preconception Health Examination Project in the rural areas of Henan Province, we evaluate the effects of PAT on preterm birth (PTB). Data of 1,231,715 records from self-reported interviews, preconception physical examination, early gestation follow-up, and postpartum follow-up were collected from 1 January 2013 to 31 December 2016. Generalized additive models were used to assess the cumulative and lag effects of PAT upon PTB. The significant cumulative effects of mean temperature within 2 weeks and 3 weeks on the risk of PTB, especially upon late PTB (34–36 weeks) ( P < 0.05), were observed. Exposure to extreme heat (> 90th percentile) within 2 weeks (RR = 1.470) and 3 weeks (RR = 1.375) before conception could increase the risk of PTB. After stratifying PTB, exposure to extreme heat within 2 weeks before conception can increase the risks of early (< 34 weeks) and late PTB ( P < 0.05). Besides, exposure to extreme cold (< 10th percentile) within 3 weeks or longer before conception can elevate the risk of PTB, especially late PTB. The significant lag effects of temperature changes on the risk of early PTB (lag-8 days or earlier) were observed. In conclusion, the risk of PTB was susceptible to PAT changes within 2 weeks or longer before conception. Our findings provide (i) guidance for rural couples to make pregnancy plans and (ii) scientific evidence for the government to formulate policies to prevent PTB.