Purpose:To assess the predictive validity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) cognitive scores at 6 months of corrected age (CA) for cognitive outcomes at 24 months of CA in very-low-birth-weight (VLBW) infants and investigate the predictors of change in cognitive outcomes.Methods:We retrospectively evaluated VLBW children enrolled in the Taiwan Premature Infant Follow-up Network between 2010 and 2015 and completed the Bayley-III at CA of 6 and 24 months. The predictive validity of the cognitive performance at 6-month CA for the cognitive outcomes at 24-month CA was analyzed. The positive and negative predictive factors were also evaluated using logistic regression. Cut-off scores of <70 and <85 were used to identify lower functioning groups based on the Bayley-III definition.Results:A total of 2,972 VLBW children, born with a mean weight of 1116.4 ± 257.5 g and mean gestational age of 29.0 ± 2.8 weeks, were evaluated. A cognitive score of <70 at 6-month CA had a positive predictive value (PPV) of 27.4% (95% confidence interval [CI]: 19.2–35.7%) for a cognitive score of <70 at 24-month CA, while the negative predictive value (NPV) was 97.3% (95% CI: 96.7–97.9%). A cut-off score of 85 had a PPV of 33.6% (95% CI: 28.1–39.0%) and an NPV of 87.7% (95% CI: 86.4–88.9%). Abnormal muscle tone at 6 months was a risk factor for cognitive function decline at 24 months for both Bayley-III cognitive cut-off scores: scores of 70 (adjusted odds ratio [AOR]: 2.8; 95% CI: 1.5–5.5) and 85 (AOR: 2.6; 95% CI: 1.6–4.1). Lower maternal socioeconomic status was associated with a worsening of the cognitive function in infants at 24 months who scored ≥85 at 6 months (AOR: 1.6; 95% CI: 1.2–2.0).Conclusion:Subnormal Bayley-III cognitive scores at 6-month CA were not predictive of subnormal cognitive function at 24-month CA. In children with normal cognition during early infancy, abnormal muscle tone and lower maternal socioeconomic status may influence the cognitive developing process; this highlighted the importance of early identification of high risk infants and complete preterm infant-associated public health policies to promote an improved neurodevelopmental outcome.

Language delays are often underestimated in very-low-birth-weight (VLBW) preterm infants. We aimed to identify the risk factors of language delay at two years of corrected age in this vulnerable population. VLBW infants, who were assessed at two years of corrected age using the Bayley Scale of Infant Development, third edition, were included using a population-based cohort database. Language delay was defined as mild to moderate if the composite score was between 70 and 85 and severe if the score was < 70. Multivariable logistic regression analysis was used to identify the perinatal risk factors associated with language delay. The study comprised 3797 VLBW preterm infants; 678 (18%) had a mild to moderate delay and 235 (6%) had a severe delay. After adjusting for confounding factors, low maternal education level, low maternal socioeconomic status, extremely low birth weight, male sex, and severe intraventricular hemorrhage (IVH) and/or cystic periventricular leukomalacia (PVL) were found to be significantly associated with both mild to moderate and severe delays. Resuscitation at delivery, necrotizing enterocolitis, and patent ductus arteriosus requiring ligation showed significant associations with severe delay. The strongest factors predicting both mild to moderate and severe language delays were the male sex and severe IVH and/or cystic PVL; thus, early targeted intervention is warranted in these populations.

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

This study aimed to compare various respiratory therapies for diagnosing bronchopulmonary dysplasia (BPD) at different postmenstrual ages (PMA), and to undertake a retrospective review at the adverse respiratory outcomes at preschool age to identify the optimal predictors. This retrospective cohort study was conducted at a tertiary neonatal intensive care unit enrolling preterm very-low-birth-weight (VLBW) infants. Respiratory status was classified based on modes of respiratory therapy required (supplemental oxygen, oxygen, and/or positive-pressure respiratory support [oxygen/PRS], and PRS alone) at the prespecified time points. The frequency of preschool-age pulmonary morbidity, defined as either a Z-score lower than -1.64 on any lung function test, or a diagnosis of asthma and/or at least three admissions for respiratory causes, was compared using regression models, assessing the predictive values of these respiratory supports. Of the 70 VLBW neonates born at a mean gestational age of 27.6 weeks, 57.1 % had composite respiratory morbidities at follow-up. Among the respiratory support modes, oxygen use at 36 and 40 weeks', oxygen/PRS at 36 and 40 weeks', and PRS alone at 36 weeks PMA were significantly associated with undesirable outcomes. Oxygen/PRS use at 36 weeks' PMA showed a numerically higher effect estimate for predicting the effect and area under the curve (AUC) (adjusted odds ratio 7.46, P = 0.01; AUC 0.841). Supplemental oxygen and/or positive-pressure respiratory support are good predictors of respiratory morbidity. Thirty-six weeks' PMA appears to be a clinically relevant time point for predicting future pulmonary outcomes in this cohort.

Ultrasound has been used to observe lung aeration and fluid clearance during the neonatal transition period, but there is no consensus regarding the optimal timing of lung ultrasound. We aimed to monitor the trend of the serial lung ultrasound score (LUS) and extended LUS (eLUS) throughout the neonatal transition period (≤1, 2, 4, 8, 24, and 48 h after birth), assess any correlation to the clinical presentation (using the Silverman Andersen Respiratory Severity Score (RSS)), and determine the optimal time of the ultrasound. We found both LUS and eLUS decreased significantly after 2 h of life and had similar statistical differences among the serial time points. Although both scores had a positive, moderate correlation to the RSS overall (Pearson correlation 0.499 [p < 0.001] between LUS and RSS, 0.504 [p < 0.001] between eLUS and RSS), the correlation was poor within 1 h of life (Pearson correlation 0.15 [p = 0.389] between LUS and RSS, 0.099 [p = 0.573] between eLUS and RSS). For better clinical correlation, the first lung ultrasound for the neonate may be performed at 2 h of life. Further research is warranted to explore the clinical value and limitations of earlier (≤1 h of life) lung ultrasound examinations.

Background/Objectives: Preterm infants have higher fat mass and lower lean mass at term-corrected age; however, whether these differences persist into preschool age remains unclear. This prospective observational cohort study aimed to compare body composition between very-low-birth-weight (VLBW) preterm (gestational age < 33 weeks) children and their term-born counterparts aged 5–6 years. Methods: Anthropometric data, body composition, blood biochemical parameters, and insulin resistance (HOMA-IR index) were compared between the preterm and term groups. Results: The study included 96 children (57 preterm and 39 term-born). Although lean mass index and fat mass index were comparable between groups, preterm children exhibited significantly higher insulin levels and HOMA-IR values after adjustment (p = 0.003 and p = 0.004, respectively). Within the preterm cohort, overweight/obesity was associated with higher trunk and total fat percentages, as well as higher HOMA-IR, compared with those of normal-weight or underweight children (all adjusted p < 0.001). Weight growth velocity from 2 to 5 years was positively associated with serum insulin, HOMA-IR, and both trunk and total body fat percentages. Additionally, girls in both groups displayed significantly higher trunk and total body fat percentages than boys. Conclusions: Children born very preterm with VLBW had higher fasting insulin levels and HOMA-IR, despite generally comparable DXA-derived LMI, FMI, and fat distribution at preschool age. Overweight status and rapid early childhood weight gain may contribute to increased metabolic risk in this population, highlighting the need for early metabolic monitoring and growth management. Future large-scale, long-term studies are required to confirm these findings.