Outcomes of Preterm Infants Born at 22 to 23 Weeks' Gestation in 11 International Neonatal Networks.

Importance: Postnatal intensive care for preterm infants born at 22 to 23 weeks' gestation is increasing, although survival rates remain low. Information on outcomes for multiple countries or regions can be important for research, benchmarking, quality improvement, and parental counseling.

Objective: To evaluate survival and major morbidities and their between-network variations in infants born at 22 to 23 weeks' gestation in 11 neonatal networks participating in the International Network for Evaluation of Outcomes (iNeo) in neonates in 12 countries or regions.

Probiotic Receipt and Neurodevelopmental Outcomes of Infants <29 Weeks' Gestation: A Cohort Study.

Objective: To examine neurodevelopment and growth following probiotic receipt in neonatal intensive care units.

Study Design: A national, population-representative, multi-center, retrospective cohort study was conducted on children born at <29 weeks' gestation between January 1, 2014, and December 31, 2020, from 21 neonatal units in Canada who survived and then underwent follow-up between ages 18-30 months. Children who received vs did not receive probiotics were compared for the primary outcome of significant neurodevelopmental impairment defined as any of: Bayley-III cognitive, language, or motor score <70; cerebral palsy with Gross Motor Function Classification System III-V; hearing aid or cochlear implant; or bilateral visual impairment.

Resistance Pattern of Gram-negative Bacilli from Tertiary Neonatal Intensive Care Units in Canada.

We utilized antibiograms from 10 Canadian Neonatal Intensive Care Units to assess antimicrobial susceptibility patterns among Gram-negative bacilli during 2015-2021. Escherichia coli was the most prevalent isolate, with >85% susceptible to third-generation cephalosporin. The resistance to carbapenems was identified in <1% of the isolates.

Severity of Bronchopulmonary Dysplasia Using a Contemporary Canadian Definition and Early Childhood Outcomes: A Population-Based Cohort Study.

Objectives: To determine the association between a bronchopulmonary dysplasia (BPD) definition used by the Canadian Neonatal Network (CNN) for grading and childhood outcomes and to compare that with the Neonatal Research Network (NRN) 2019 BPD definition.

Study Design: We conducted a population-level, retrospective cohort study of neonates born at <29 weeks' gestational age and admitted to Canadian tertiary neonatal intensive care units within the CNN for whom follow-up data were available. Eligible neonates admitted between 2016 and 2020 were categorized as having no, mild, moderate, or severe BPD.

Environmental and Maternal Imprints on Infant Gut Metabolic Programming.

Early life is a critical period for immune and metabolic programming, but developmental patterns remain underexplored in populations from low- and middle-income countries. Here, we profiled the microbiome and metabolome of 55 Bangladeshi mother-infant dyads over the first six months of life. Importantly, we observed an increase in microbially-derived bile amidates and -acyl lipids with age in conjunction with reads matching the bile salt hydrolase/transferase () gene.

COVID-19 vaccination around the time of conception and risk of placenta-mediated adverse pregnancy outcomes.

Introduction: Although numerous studies have documented no association between COVID-19 vaccination during pregnancy and maternal and fetal health outcomes, fewer studies have evaluated fetal health effects after COVID-19 vaccination around the time of conception and early pregnancy, a time when maternal exposures may affect early placentation and the subsequent risk of placenta-mediated adverse pregnancy outcomes.

Material And Methods: We used province-wide databases in Ontario to conduct a population-based cohort study including all live and stillbirths ≥20 weeks' gestation with a last menstrual period (LMP) between April 1 and December 31, 2021. We deterministically linked birth registry data to the vaccine registry for all 80 253 eligible pregnancies; 31 209 (38.

Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study.

Introduction: Heterogeneity in definitions of severe infection, sepsis and serious bacterial infection (SBI) in infants limits the comparability of randomised controlled trials (RCTs) of infection prevention interventions. To inform the design of infection prevention RCTs for infants in low-resource settings, we estimated the incidence of severe infection and death among Bangladeshi infants aged 0-60 days using variations in case definitions.

Methods: Among 1939 infants born generally healthy in Dhaka, Bangladesh, severe infection was identified through up to 12 scheduled community health worker home visits from 0 to 60 days of age or through caregiver self-referral.

Outcomes with cesarean delivery vs vaginal birth in extremely preterm breech singletons.

Background: Decision-making regarding breech extremely preterm mode of birth is difficult. Seeming benefits with cesarean delivery in previous studies may have been due to other factors that had not been adequately accounted for.

Objective: To determine the association of cesarean delivery vs vaginal birth with neonatal outcomes among live-born, extremely preterm, breech singletons who received active care at birth.

Factors associated with rates and durations of cord clamping practice compliance in preterm neonates of <33 weeks' gestation.

Objectives: To determine maternal, neonatal, and hospital factors influencing deferred cord clamping (DCC) compliance rates in preterm neonates.

Methods: Neonates born <33 weeks' gestational age (GA) within the Neonatal Intensive Care Units of Canadian Neonatal Network during 2018-2022 were included. Units' DCC quality improvement (QI) efforts were surveyed.

Brief Report: Trends of Congenital Syphilis among Neonates in Canada 2012-2023.

In Canada, incidence of congenital syphilis significantly increased from 2018 to 2023. Supporting enhanced public health preventive interventions such as early screening and treatment, particularly for younger women in lower socioeconomic strata and those with a history of addictive substance use, may reduce congenital syphilis.

International Variation and Trends of Intraventricular Hemorrhage in Very Preterm Infants.

Introduction: We aimed to investigate international variation in gestational age (GA) specific severe intraventricular hemorrhage (IVH) rates, among infants of <30 weeks' GA from the neonatal networks of 11 high-income countries/region.

Methods: Retrospective cohort study of outcomes of grade 3/4 IVH rates and composite of g3/4 IVH or death in GA groups of 22-23, 24-25, 26-27, and 28-29 weeks infants admitted to networks of Australia and New Zealand, Canada, Finland, Israel, Italy (Tuscany), Japan, Spain, Sweden, Switzerland, and the UK. Their risk adjusted trends across 3 epochs (2007-11, 2012-15, and 2016-19) were also evaluated.

Transfusion Practices in 12 Neonatal Networks: Are We Closer to Adopting a Restrictive Transfusion Approach?

Introduction: Recent evidence suggests a restrictive approach toward blood transfusions for management of preterm infants. Objective was to survey blood transfusion practises in preterm neonates <29 weeks' gestation among 12 population-based neonatal networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo).

Methods: An online survey based on 2023 practices was sent to 608 neonatal intensive care units (NICUs): Australia/New Zealand (30), Brazil (20), Canada (32), Finland (5), France (70), Israel (26), Japan (292), Poland (56), Spain (55), Sweden (9), Switzerland (9), and Tuscany, Italy (4).

Association of lung ultrasound score with large patent ductus arteriosus in preterm neonates during the transitional period.

Unlabelled: Recent studies suggested lung ultrasound (LU) as a useful, non-invasive bedside tool for assessing pulmonary edema; however, its utility in identifying preterm neonates with large patent ductus arteriosus (L-PDA) is limited. The objective of the study is to evaluate the association of LU score (LUS) in preterm neonates with L-PDA during the transitional period and explore correlation of LUS with echocardiographic indicators. Among 152 neonates born < 29 weeks' gestation and had LU performed at day-of-life (DOL) three for a previous prospective study, 54 neonates had concomitant echocardiography (Echo) documenting PDA presence, diameter, and variables for shunt volume.

Timing of Antenatal Corticosteroid Administration and Neonatal Outcomes.

Importance: Antenatal corticosteroids (ACS) are accepted to be most effective in reducing prematurity-related neonatal mortality and morbidity when administered 1 to 7 days before birth. However, precise data on the optimal timing of administration are scarce.

Objective: To investigate the association between ACS administration to birth interval as a continuous variable and neonatal outcomes among preterm neonates.

Digital twins, synthetic patient data, and in-silico trials: can they empower paediatric clinical trials?

Randomised controlled trials are the gold standard to assess the effectiveness and safety of clinical interventions; however, many paediatric trials are discontinued early due to challenges in patient enrolment. Hence, most paediatric clinical trials suffer from lack of adequate power. Additionally, trials are expensive and might expose patients to unproven therapies.

Association of Cytomegalovirus Infection in Preterm Infants and Neonatal Outcomes: A Matched Cohort Study.

This study aimed to explore the association of cytomegalovirus (CMV) infection in preterm infants of ≤32 weeks' gestation and neonatal morbidities.This was a matched cohort study of preterm infants born between 22 and 32 weeks gestation age and <1,500 g in birth weight who were admitted to participating tertiary NICUs within the Canadian Neonatal Network between April 2009 and December 2018. Infants were randomly matched in a 1:4 ratio (73 CMV-positive to 292 CMV-nonpositive infants) based on gestational age (in weeks), sex, birth weight (± 50 g), and number of days of oxygen exposure within the first 28 days after birth (± 2 days).

Fetal Endoscopic Tracheal Occlusion (FETO) for Left and Right Congenital Diaphragmatic Hernia in Canada.

Objective: To describe perinatal and short-term pediatric outcomes and procedural safety of fetal endoscopic tracheal occlusion (FETO) in a Canadian national referral centre.

Methods: Retrospective study including all consecutive FETO cases at the Ontario Fetal Centre between 2010 and 2024. Maternal and fetal baseline characteristics, technical aspects and short-term outcomes until 6 months are described.

Association of Enteral Feed Type with Neurodevelopmental and Neonatal Outcomes among Infants Born Preterm.

Objective: To examine associations between enteral feed type with neurodevelopmental and neonatal outcomes among infants born preterm.

Study Design: This was a retrospective study of enteral feeds in the first 28 postnatal days in infants born <29 weeks of gestation from 2015 through 2020 in neonatal units of the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network. Feeds were examined as a compositional variable comprised of the proportion of days fed mother's milk, donor milk, mixed feeds, and nil per os (NPO), the proportions of which sum to 1.

Consensus Approach for Standardization of the Timing of Brain Magnetic Resonance Imaging and Classification of Brain Injury in Neonates With Neonatal Encephalopathy/Hypoxic-Ischemic Encephalopathy: A Canadian Perspective.

Background: Neonatal encephalopathy (NE) and hypoxic-ischemic encephalopathy (HIE) are linked to significant neurodevelopmental impairments. Magnetic resonance imaging (MRI) is the preferred modality for classifying brain injury severity in HIE, yet considerable variability exists among institutions in terms of MRI timing, protocols, injury classification, and scoring systems for predicting long-term outcomes.

Methods: A Canadian taskforce comprising radiologists and neonatologists was established to develop a consensus on the optimal timing of brain MRI, appropriate MRI protocols, and a unified approach to the classification and scoring of brain injury in infants with NE secondary to hypoxic-ischemic insult.

Outcomes of Preterm Infants Admitted to Canadian NICUs Before and During the SARS-COV Pandemic.

Background: To better elucidate the impact of the SARS-COV pandemic on neonatal outcomes, we compared the health outcomes of infants born preterm requiring care in a Canadian NICU before and during the SARS-COV pandemic.

Methods: Using a retrospective cohort study, infants born between 23 and 32 weeks gestation who were admitted to tertiary Canadian NICUs before and during the pandemic were included. A total of 7280 infants were in the pre-pandemic cohort (admitted 1 April 2018-31 December 2019), and 7088 infants were in the pandemic cohort (admitted 1 April 2020-31 December 2021).

Neonatal administration of ATCC 202195 with or without fructooligosaccharide in Bangladesh: a placebo-controlled randomized trial.

Unlabelled: ATCC 202195 (LP202195) plus fructooligosaccharide (FOS) for 7 days was previously shown to colonize the infant intestine up to 6 months of age and reduced sepsis rates among young infants in rural India. In a phase 2 randomized controlled trial in Dhaka, Bangladesh ( = 519), neonatal administration of LP202195 for 1 or 7 days, with or without FOS, increased LP202195 stool abundance from 14 to 60 days of age, versus placebo. Abundance progressively declined in the post-administration period and did not persist beyond 2 months of age.