Aim: To investigate whether the presence of left ventricular myocardial dysfunction (LVMD) assessed by Tei index (LVTX) impacts the outcomes of healthy infants with Respiratory Syncytial Virus Bronchiolitis (RSVB). To explore whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) increases the accuracy of traditional clinical markers in predicting the outcomes. Methods: A single-centre, prospective, cohort study including healthy infants aged 1–12 months old admitted for RSVB between 1 October 2016 and 1 April 2017. All patients underwent clinical, laboratory and echocardiographic evaluation within 24 h of admission. Paediatric intensive care unit (PICU) admission was defined as severe disease. Results: We enrolled 50 cases of RSVB (median age of 2 (1–6.5) months; 40% female) and 50 age-matched controls. We observed higher values of LVTX in infants with RSVB than in controls (0.42 vs. 0.36; p = 0.008). Up to nine (18%) children presented with LVMD (LVTX > 0.5), with a higher incidence of PICU admission (89% vs. 5%; p < 0.001). The diagnostic performance of NT-proBNP in predicting LVMD was high (area under the receiver operator characteristic curve (AUC) 0.95, CI 95% 0.90–1). The diagnostic yield of the predictive model for PICU admission that included NT-proBNP was excellent (AUC 0.945, CI 95% 0.880–1), and significantly higher than the model without NT-proBNP (p = 0.026). Conclusions: LVMD could be present in healthy infants with RSVB who develop severe disease. NT-proBNP seems to improve traditional clinical markers for outcomes.

Introduction: Children born with very low birth weight are at increased risk of cognitive difficulties and internalizing symptoms, including anxiety, withdrawal, and depressive features. However, the early neurodevelopmental pathways that connect neonatal brain maturation with emotional outcomes remain incompletely understood. This study examined whether internalizing symptoms at preschool age are associated with cognitive performance in children born with very low birth weight, and whether the interaction between cingulate and amygdala volumes is related to these symptoms directly or through cognition. Methodology: This longitudinal cohort included infants born with very low birth weight who were admitted to a neonatal intensive care unit between 2018 and 2021. Participants underwent brain magnetic resonance imaging at term-equivalent age and follow-up assessment at 4 to 6 years. Cognitive performance was evaluated with the Wechsler Preschool and Primary Scale of Intelligence, and internalizing symptoms were assessed with the Child Behavior Checklist. Adjusted linear regression models examined associations between cognition, neonatal regional brain volumes, and internalizing symptom scores. An observed-variable path model tested direct and indirect associations involving cingulate-amygdala interaction and cognition, and receiver operating characteristic analysis evaluated discrimination for clinically relevant internalizing symptoms. Results: Ninety-five children were included; mean gestational age was 29.4 ± 2.1 weeks and mean birth weight 1191.6 ± 350.8 g. Clinically relevant internalizing symptoms were present in 24/95 children (25.3%). Lower internalizing T-scores were associated with Higher IQ after adjustment (B = −0.282; P = 0.020). The cingulate-amygdala interaction was associated with internalizing symptoms (B = −60.377; P = 0.009). In path analysis, IQ was inversely associated with internalizing symptoms (B = −0.315; P < 0.001), and the indirect effect through IQ was significant (B = −19.449; P = 0.003). The MRI-based logistic model showed acceptable discrimination (area under the curve, 0.75). Discussion: Among children born VLBW, preschool internalizing symptoms were associated with poor cognitive performance and neonatal cingulate-amygdala interaction. These findings support interconnected brain-cognition-behavior pathways after preterm birth and underscore the value of integrated neurodevelopmental follow-up.