Search Results (3,255)

Cytomegalovirus (CMV) is the leading infectious cause of birth defects and has been linked to increased risk of preterm birth (PTB). CMV establishes lifelong latency and is more prevalent among Black and Hispanic/Latina women, populations already at higher risk for adverse pregnancy outcomes. Vitamin D deficiency, also common in these groups, has been linked to impaired immune function and increased susceptibility to infections, including CMV. In this cross−sectional study of 63 pregnant minority women (50 CMV+, 13 CMV−), we evaluated associations among serum 25(OH)D levels, CMV serostatus, and cmvIL−10, the CMV−encoded interleukin−10 homolog that modulates host immune responses. While vitamin D insufficiency and CMV seropositivity were both highly prevalent, we found no statistically significant associations between 25(OH)D levels and CMV serostatus or cmvIL−10 levels. These findings highlight the need for further investigation into how vitamin D deficiency and CMV infection may independently or synergistically contribute to maternal and neonatal health disparities. Full article

Background/Objectives: Preterm infants without neurological damage are at greater risk of developing specific difficulties due to the unpredictable effects of the interaction between biological immaturity and characteristics of physical and social environment. This paper discusses the potential advantages and limitations of placing premature infants in daycare in the first three years. Methods: In light of the scientific literature, the article discuss-es the topic through a critical comparison of studies on the developmental outcomes of preterm infants, on the characteristics of nurseries and on the role of educators. Results: Nursery placement must be evaluated in an integrated and multifactorial perspective, taking into account the specific vulnerabilities of each individual preterm child and the characteristics of the nursery. The role of educators is to structure a quality educational environment that meets the specific needs of each individual preterm child, in close collaboration with parents and specialists. Conclusion: This article provides suggestions to parents, educators, and specialists for the assessment and intervention with preterm children without neurological impairment in the educational setting, with a multidisciplinary view to prevention and early intervention. Full article

Objectives: The aim of this study is to investigate the changes in quantitative indices of brain volume and cortex development in preterm infants with enlarged subarachnoid space (ESS). Methods: A single-center retrospective cohort study was performed in Hong Kong University–Shenzhen Hospital from November 2014 to November 2023, involving 200 preterm infants whose brain MRI images were available. Parameters including the volume of cerebrospinal fluid (CSF), brain tissues, total intracranial cavity (ICC), and key indices of cortex maturation (surface area, cortical thickness, cortical volume, mean curvature) were compared between the groups with ESS and without ESS. The retrospective nature of this study may introduce selection bias in the process of enrolling preterm infants with ESS. Results: The groups with severe and mild ESS had a significantly greater ICC volume than the group without ESS (severe: 384.66 ± 30.33 [p < 0.001]; mild: 374.25 ± 26.45 [p < 0.001] vs. no ESS: 356.78 ± 26.03), and the difference was mostly due to the gap in extra-CSF volume among the three groups (severe: 74.20 ± 5.1 and mild: 55.36 ± 3.8 vs. no ESS: 40.54 ± 4.3, p ≤ 0.001). Only the volume of parenchyma of the severe-ESS group was significantly different (severe: 302.35 ± 26.43 vs. no ESS: 312.27 ± 20.75, p = 0.003). Regarding indices of cortex maturation, only the mean curvature showed a significant difference between the three groups, and most of the significant clusters were located around the parietal and temporal lobes. Conclusions: ESS may be associated with impaired early brain maturation in preterm infants after birth. A further neurodevelopmental follow-up study is needed. Full article

Background/Objectives: Preterm infants in the neonatal intensive care unit (NICU) are subjected to clinically essential painful procedures including peripherally inserted central catheter (PICC) placement. Pharmacological interventions are inconsistently used for procedural analgesia due to concerns of adverse events. Intranasal (IN) fentanyl is a promising pharmacological alternative that delivers rapid targeted analgesia. The objectives of this blinded randomized controlled trial (RCT) were to assess the feasibility of conducting a definitive RCT of IN fentanyl for PICC placement in preterm infants and evaluate the acceptability and adoption of IN fentanyl for procedural pain management in the NICU. Methods: Infants admitted to the NICU (Mount Sinai Hospital, Toronto) with a gestational age (GA) at birth < 32 weeks undergoing their first PICC placement were randomized to IN fentanyl or placebo as an add-on to standard of care. The primary feasibility outcomes were recruitment and completeness of data collection for pain assessment. The pre-specified targets were recruitment of 24 participants and at least 80% of video-recordings being suitable for pain assessment. Secondary outcomes were adverse events, and IN fentanyl acceptability and adoption by healthcare providers. (ClinicalTrials.gov ID NCT06590870). Results: Between August 2024 and January 2025, 16 parents/guardians were approached resulting in eight enrollments for a consent rate of 50% (95% CI 28, 72). The target recruitment of 24 participants was not achieved. Out of six infants that received study interventions, all video-recordings were suitable for pain assessment by outcome assessors with a success rate of 100% (95% CI 61, 100). There were no adverse events. Fifteen healthcare providers completed the survey and reported acceptability of IN fentanyl but barriers with its adoption in clinical practice. Conclusions: Major modifications to the recruitment strategy would be required to progress to a definitive RCT. Strategies facilitating IN fentanyl adoption for procedural analgesia in the NICU are needed. Full article

We investigated the association between gestational diabetes mellitus (GDM) and the rate of peripartum infections (chorioamnionitis and/or endometritis). A retrospective cohort study was conducted using data collected between January 2014 and July 2021. The study group comprised women with GDM, while the control group consisted of women without GDM, matched for age ≥ 35 Y, primiparity, pre-gestational body mass index (BMI), cesarean and vacuum deliveries, and preterm deliveries. The primary outcome was the rate of peripartum infections. Data from 1683 GDM women and 1683 matched controls were analyzed. No significant difference was observed in the rate of peripartum infections between the GDM and control groups (26 (1.5%) versus 14 (0.8%), respectively; p = 0.056), nor in the rates of other infections. After controlling for epidural analgesia rate, BMI, age, and delivery week in multivariable logistic regression, the rate of peripartum infections remained statistically insignificant between the GDM group and controls (OR 1.8, 95% CI 0.9–3.4). The main pathogens isolated in cases of peripartum infections were similar in both groups, primarily consisting of Escherichia coli and Group B Streptococcus. No difference in the rate of study outcomes was observed when vaginal and cesarean deliveries were analyzed separately. Altogether, GDM was not associated with an increased risk for peripartum infections. Full article

Background and Objectives: Human breast milk contains essential nutrients for infant growth, as well as bioactive molecules such as exosomes and miRNAs, which play a key role in the maturation of the infant’s immune system. Breast milk from mothers of preterm and term infants shows significant differences in its nutrient contents and bioactive components. This preliminary study aimed to compare the expressions of 13 immunomodulatory microRNAs present in breast milk from the mothers of preterm and term infants. Materials and Methods: Breast milk samples were obtained from 5 breastfeeding mothers of term infants and 5 breastfeeding mothers of preterm infants. Every mother provided morning, noon, and evening milk samples. The total protein, fat, and lactose concentrations were measured. In addition, miRNAs were extracted from the exosomal fraction of each sample. The expression levels of the 13 miRNAs were compared and analyzed at the three time points each day. Results: The preterm infants’ milk had higher average fat and lactose levels. There were no differences in the total protein concentrations. The expressions of miRNAs in the preterm infants’ milk showed significantly higher variations in miR-17-5p, miR-24, miR-29b, miR-30a-5p, and miR-146a. The other miRNAs did not show variations. Interestingly, the highest miRNA expression was only observed in breast milk from the nighttime. The morning and midday samples showed distinct expression patterns. Conclusions: We identified the immunomodulatory microRNA components and their changes in expression levels at different times of the day, as well as those most strongly expressed in breast milk consumed by preterm infants. Full article

Background: Deferred cord clamping (DCC) is beneficial for preterm infants, but there are concerns about the safety of DCC during Cesarean deliveries (CD) under general anesthesia (GA). We evaluated maternal and neonatal outcomes in preterm CD under GA vs. regional anesthesia (RA) after implementing 180 s of DCC. Methods: This retrospective single-center observational study included CD at <33 weeks gestation, delivered between January 2018 and December 2023. The cord was clamped before 180 s for concerns of maternal bleeding or infant apnea after 30–45 s stimulation. Data was collected from reports from electronic medical records, neonatal intensive care unit database, and manually from the medical records of the patient. Multivariable regression analysis was used to assess the effect of anesthesia type and DCC on outcomes, adjusting for confounders. Results: This study included 170 mothers and 194 infants, and 84.9% of the infants received DCC ≥ 60 s. The GA group had a higher percentage of emergency CD and a lower median duration of DCC (105 s vs. 180 s, p ≤ 0.001) compared to RA. In multivariate regression analysis, GA was associated with lower odds (95% CI) of umbilical artery pH < 7 [0.1, (0.0, 0.6)], base deficit ≥ 16 [0.0, (0.0, 0.5)], and higher odds of necrotizing enterocolitis [28.2, (1.4, 560.0)]. GA was not associated with maternal hemorrhage, delivery room (DR) resuscitation, or other major neonatal morbidities or mortality. DCC ≥ 60 s was associated with lower maternal blood loss [Regression coefficient −698, (−1193, −202)], lower odds of transfusion [0.4, (0.1, 1.0)], DR resuscitation [0.4, (0.2, 0.8)], and chronic lung disease [0.4, (0.2, 0.9)], and higher survival without major morbidities [2.8, (1.2, 6.8)]. Conclusions: DCC was performed in a majority of CD under GA by adhering to protocols to shorten DCC in cases where maternal or fetal safety was threatened. GA with DCC was not associated with increased neonatal resuscitation or major neonatal morbidities and was associated with lower maternal hemorrhage and transfusion. Full article

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common reversible liver disorder linked to pregnancy, characterised by pruritus and elevated serum bile acids (BAs). Condition severity correlates with increased maternal and neonatal complications, and recent evidence highlights a significantly elevated risk of adverse perinatal outcomes, including stillbirth, when BA > 100 µmol/L. Methods: This retrospective study, conducted at a tertiary perinatology centre between 2019 and 2023, was performed in two phases. In the first phase, baseline group characteristics and pregnancy outcomes were compared between ICP and non-ICP (control) groups. In the second phase, outcomes were analysed across three ICP severity subgroups: mild (BA < 40 µmol/L), moderate (BA 40–99 µmol/L), and severe (BA ≥ 100 µmol/L). Results: A total of 210 patients diagnosed with ICP and 24,177 controls were included in the analysis. After multivariable regression, the results indicated that patients with severe ICP (BA ≥ 100 µmol/L) experienced significantly worse perinatal outcomes compared to those with mild or moderate disease: spontaneous preterm birth occurred in 26.7% of cases (p = 0.002), iatrogenic preterm birth in 36.7% (p < 0.001), meconium-stained amniotic fluid in 43.3% (p = 0.001), and neonatal intensive care unit (NICU) admission in 23.3% (p = 0.006). This subgroup also had the lowest mean birth weight (2830 g, p < 0.001). Notably, no stillbirths were recorded in any of the subgroups. Compared to controls, no major differences in maternal characteristics were noted, except in pregnancies conceived via in vitro fertilisation (IVF, p = 0.012) and those complicated by gestational diabetes (p = 0.040), both showing elevated risk for ICP development. Conclusions: This study confirms an association between ICP and increased perinatal complications, with severity of disease correlating with poorer outcomes. The findings highlight the need for standardised BA testing and improved strategies for perinatal management. Full article

Background: Preterm birth is associated with increased risk for neurodevelopmental disorders. Although standardized tools such as the Bayley Scales of Infant and Toddler Development—Third Edition (BSID-III) are widely used for early developmental assessment, parent-report measures may offer complementary and cost-effective alternatives. The Developmental Profile 3 (DP-3) is a parent questionnaire with potential utility in preterm follow-up programs. Objective: To compare developmental outcomes of preterm infants at 12 months corrected age assessed using the BSID-III and the DP-3 questionnaires and to evaluate the agreement between these tools across cognitive, language-communication, motor, and social-emotional domains. Methods: Fifty-five preterm infants (mean GA = 30.3 weeks; mean BW = 1388 g) were assessed using both the BSID-III (administered by professionals) and the DP-3 (completed by parents) at 12 months corrected age. Mean scores were computed for each domain, and infants were assigned to the corresponding descriptive categories. The agreement between BSID-III and DP-3 scores was statistically evaluated. Results: Both instruments identified similar developmental trends, with motor development emerging as the most vulnerable domain for preterm infants. DP-3 scores were higher than BSID-III scores in virtually all domains, and absolute intraclass correlation coefficients showed a generally moderate agreement between measurements. The BSID-III identified significantly more infants at risk in the cognitive and social-emotional areas compared to the DP-3. Conclusions: The DP-3 showed fair convergence with the BSID-III, supporting its use as a complementary tool in preterm follow-up. Extending follow-up assessments into later developmental stages will be essential to more accurately determine the predictive validity of the DP-3. Full article

Introduction: Preterm birth is associated with a 3.3-fold increased likelihood of autism diagnosis, with lower gestational age conferring higher likelihood. In Australia, autism is typically diagnosed at around age four, potentially missing the optimal neuroplasticity window before age two. The Social Attention and Communication Surveillance—Revised (SACS-R) tool identifies early autism signs in children aged 11–30 months, enabling pre-emptive intervention. Aims: This quality improvement (QI) study assessed the acceptability, and feasibility of SACS-R for early detection of autism traits in 12-month-old infants born very preterm/VP (gestation < 32 weeks), from both caregiver and clinician perspectives. Methods: From September 2024 to February 2025, 47 VP infants attending the 12-month Neonatal Follow-up Clinic (NNFU) at King Edward Memorial Hospital (KEMH), Western Australia, were assessed using SACS-R. Caregivers completed acceptability and feasibility questionnaires; clinicians completed similar surveys. Forty-seven infants met inclusion criteria; 12 clinicians provided responses. Results: Of 47 infants, 4 (8.5%) were identified as having a high likelihood of autism and referred for early intervention. Among caregivers, 29 (61%) provided complete acceptability responses and 28 (59%) feasibility responses, both predominantly positive. Clinicians reported high satisfaction (83%) and ease of use (91%), with 74% supporting routine implementation. Concerns included parental understanding and overlap with other assessments. Conclusions: Our QI study indicates that the SACS-R is highly acceptable and feasible in neonatal follow-up for preterm infants. Larger-scale evaluation of diagnostic accuracy and practical refinements based on feedback are warranted to support routine integration in early surveillance programs. Full article

Background and Clinical Significance: Left ventricular hypoplasia is often repaired surgically in sequence to a Fontan circulation, which is a physiologic state that presents unique challenges during pregnancy. Although women with Fontan physiology can achieve successful pregnancy outcomes, they remain at elevated risk for cardiac, thrombotic, and obstetric complications. Case Presentation: We describe a 38-year-old woman with Fontan physiology and acquired von Willebrand syndrome (AVWS) who was admitted at 23 weeks gestation for preterm premature rupture of membranes. The patient had history of prior classical cesarean delivery and two previous miscarriages. Her pregnancy was further complicated by abnormal placental vasculature and uterine arteriovenous malformation. Given her bleeding diathesis, hematology advised against anticoagulation or antiplatelet therapy, and she ultimately underwent a successful low transverse cesarean delivery under general anesthesia at 24 weeks. Postpartum hemorrhage was managed with clotting factor replacement and supportive care. Conclusions: This case illustrates how AVWS may mitigate thrombotic risk in Fontan physiology and how early activation of a cardio-obstetrics team can enable tailored planning. As more patients with complex congenital heart disease reach reproductive age, multidisciplinary coordination, shared infrastructure, and individualized birth plans will be essential to achieving optimal maternal–fetal outcomes. Full article

Background: Threatened preterm labor is associated with heightened emotional distress in pregnant women, including anxiety, guilt, and depressive symptoms. Effective coping relies on psychosocial resilience, particularly emotional suppression and perceived social support. This study examined the mediating role of social support in the relationship between anxiety and emotional suppression. Methods: The study was conducted in Poland between December 2024 and June 2025 among 213 women hospitalized due to threatened preterm labor. Participants completed the Berlin Social Support Scales, the State–Trait Anxiety Inventory, the Courtauld Emotional Control Scale, and a structured interview. Results: Women hospitalized for threatened preterm labor have moderate levels of anxiety as a state (M = 44.08 ± 10.59) and trait (M = 39.75 ± 9.99). Mediation analyses revealed that two dimensions of social support—perceived available support and Buffering–Protective support—significantly influenced the relationship between anxiety and emotional suppression (anger, depression and anxiety). In contrast, need for support, support seeking, and Currently Received Support were not significant mediators. Conclusions: The results indicate a complex interplay between anxiety, perceived support, and emotional suppression. The hypothesized simple buffering model was not confirmed. However, perceived available support was associated with reduced emotional suppression, suggesting a protective role. Buffering–Protective Support showed an activating effect, possibly encouraging emotional inhibition in stressful situations. These results underscore the importance of assessing perceived social support in clinical settings and tailoring psychological interventions for pregnant women at risk of preterm labor. Full article

Background/Objectives: Intrahepatic cholestasis of pregnancy (ICP) is the most prevalent hepatobiliary disorder unique to gestation, characterized by maternal pruritus and elevated serum bile acids. While maternal prognosis is favorable, mounting evidence links ICP to a range of neonatal complications. This narrative review aims to synthesize the current knowledge on the pathophysiological mechanisms, clinical impact and management strategies related to neonatal outcomes in ICP. Methods: A narrative review approach was employed, drawing on recent clinical guidelines, observational studies, mechanistic investigations and meta-analyses. Emphasis was placed on evidence exploring the relationship between maternal bile acid concentrations and neonatal morbidity, as well as on established and emerging therapeutic interventions. No systematic search strategy or formal quality appraisal was undertaken. Results: ICP is associated with an increased risk of adverse neonatal outcomes, including spontaneous and iatrogenic preterm birth, meconium-stained amniotic fluid, respiratory distress syndrome and stillbirth, particularly when bile acid concentrations exceed 100 μmol/L. Proposed mechanisms include placental vasoconstriction, arrhythmogenic effects and surfactant inhibition. Ursodeoxycholic acid remains the most widely used pharmacologic agent for maternal symptom relief, although evidence supporting neonatal benefit is inconclusive. Delivery by 36–37 weeks is generally recommended in cases of severe cholestasis to mitigate fetal risk. Conclusions: Severe ICP confers substantial neonatal risk, requiring individualized, bile-acid-guided management. While current therapies offer symptomatic maternal benefit, optimization of fetal outcomes requires timely diagnosis, vigilant surveillance and evidence-based delivery planning. Further research is warranted to refine therapeutic targets and standardize clinical practice. Full article

Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, methamphetamines, and other synthetic drugs. All major psychoactive substances readily cross the placenta and can remain detectable in breast milk, leading to a shared cascade of obstetric complications (hypertensive disorders, placental abruption, pre-term labor), fetal consequences (growth restriction, structural malformations), and neonatal morbidities such as neonatal abstinence syndrome and sudden infant death. Mechanistically, trans-placental diffusion, oxidative stress, inflammatory signaling, and placental vascular dysfunction converge to disrupt critical neuro- and cardiovascular developmental windows. Early identification hinges on the combined use of validated screening questionnaires (4 P’s Plus, CRAFFT, T-ACE, AUDIT-C, TWEAK) and matrix-specific biomarkers (PEth, EtG, FAEE, CDT), while effective treatment requires integrated obstetric, addiction, and mental health services. Medication for opioid use disorders, particularly buprenorphine, alone or with naloxone, confers superior neonatal outcomes compared to methadone and underscores the value of harm-reducing non-punitive care models. Public-health strategies, such as Mexico’s “first 1 000 days” framework, wrap-around clinics, and home-visiting programs, demonstrate the potential of multisectoral interventions, but are hampered by structural inequities and punitive legislation that deter care-seeking. Research gaps persist in polysubstance exposure, culturally tailored therapies, and long-term neurodevelopmental trajectories. Multigenerational, omics-enabled cohorts, and digital longitudinal-care platforms represent promising avenues for closing these gaps and informing truly preventive perinatal health policies. Full article

Background: Acute kidney injury (AKI) in critically ill neonates is usually of pre-renal origin and, often, pharmacological treatment is not sufficient for resolution, requiring kidney replacement therapy (KRT). Due to the small body size and the unavailability of adequate devices for these patients, peritoneal dialysis (PD) appears to be the most easily achievable procedure. However, guidelines for PD management are lacking in this population. Objective: We aimed to report a single-center experience with preterm infants who underwent PD, describing the technical issues and the outcomes, and to review the existing literature. Methods: This retrospective study included preterm infants undergoing PD because of AKI unresponsive to pharmacological treatment. Data were compared to those available in the current literature. Results: Neonatal outcomes of twelve preterm infants were reported. PD was started before the onset of anuria in two oliguric patients, while it was started within 60 h of anuria in four patients, and between 72 and 144 h of anuria in the remaining six patients. One oliguric patient and one who started PD after 60 h of anuria had a complete recovery of kidney function with normalization of diuresis and renal function parameters. The other infants did not achieve complete resolution of AKI. The mortality rate was 91.7%, and even one of the two infants who had recovered kidney function later died due to an infectious complication. Conclusions: Our experience with a limited sample size did not allow us to obtain definitive conclusions. Our data and the current literature suggested that the prognosis is still negative, with a high mortality rate. Further research is needed to develop guidelines to optimize the management of preterm infants with AKI. Full article