Preterm birth and low birth weight (PBLBW) persist as critical public health concerns worldwide, significantly contributing to the global disease burden [1]. Preterm birth (PTB) is characterised by the delivery of an infant before reaching 37 weeks of gestation. Low birth weight (LBW) is defined as a birth weight of less than 2500 g, irrespective […]

Objective: Preterm birth is a major global public health issue. However, sex difference in incidence and the potential association with air pollution in these disparities have not been fully explored globally. Methods: This study is a retrospective, cross-sectional secondary analysis based on the Global Burden of Disease (GBD) 2021 database. Indicators included incidence, disability-adjusted life years (DALYs), years of life lost (YLLs), age-standardized rates, age-standardized YLL rate, age-standardized DALY rate, age-standardized YLL percent (ASYP), and age-standardized DALY percent (ASDP). Analyses were stratified by sex, socio-demographic index (SDI), and 21 GBD regions. Results: From 1990 to 2021, male infants consistently experienced higher rates of preterm birth and greater disease burden than females, though the male-to-female ratio gradually narrowed. Particulate matter pollution significantly contributed to the burden of preterm birth, with males experiencing a higher burden than females. In 2021, particulate matter pollution accounted for roughly 1.3 times the burden observed in females and contributed to 31.1% of male ASYP and 26.7% of ASDP. Household air pollution was a major contributor, and its impact on males and females was similar in proportional terms. Regional variation was marked, with low-SDI regions, particularly sub-Saharan Africa and South Asia, experiencing the highest burden. Sex-stratified analyses revealed that air pollution, particularly household air pollution, had a more pronounced impact on males in some regions. Conclusions: Male infants consistently face a higher risk and burden of preterm birth worldwide. Particulate matter pollution, particularly household air pollution, appears to be linked to these disparities, especially in low-SDI regions. These findings underscore the need for targeted interventions to reduce indoor air pollution and mitigate sex-based inequalities in preterm birth burden.

Background: Bronchopulmonary dysplasia (BPD) is a major complication affecting the survival rate and long-term outcomes of preterm infants. A large, prospective, multicenter cohort study was conducted to evaluate early nutritional support during the first week of life for preterm infants with a gestational age < 32 weeks and to verify nutritional risk factors related to BPD development. Methods: A prospective multicenter cohort study of very preterm infants was conducted in 40 tertiary neonatal intensive care units across mainland China between January 1, 2020, and December 31, 2021. Preterm infants who were born at a gestational age < 32 weeks, < 72 h after birth and had a respiratory score > 4 were enrolled. Antenatal and postnatal information focusing on nutritional parameters was collected through medical systems. Statistical analyses were also performed to identify BPD risk factors. Results: The primary outcomes were BPD and severity at 36 weeks postmenstrual age. A total of 1410 preterm infants were enrolled in this study. After applying the exclusion criteria, the remaining 1286 infants were included in this analysis; 614 (47.7%) infants were in the BPD group, and 672 (52.3%) were in the non-BPD group. In multivariate logistic regression model, the following six factors were identified of BPD: birth weight (OR 0.99, 95% CI 0.99–0.99; p = 0.039), day of full enteral nutrition (OR 1.03, 95% CI 1.02–1.04; p < 0.001), parenteral protein > 3.5 g/kg/d during the first week (OR 1.65, 95% CI 1.25–2.17; p < 0.001), feeding type (formula: OR 3.48, 95% CI 2.21–5.49; p < 0.001, mixed feed: OR 1.92, 95% CI 1.36–2.70; p < 0.001; breast milk as reference), hsPDA (OR 1.98, 95% CI 1.44–2.73; p < 0.001), and EUGR ats 36 weeks (OR 1.40, 95% CI 1.02–1.91; p = 0.035). Conclusions: A longer duration to achieve full enteral nutrition in very preterm infants was associated with increased BPD development. Breastfeeding was demonstrated to have a protective effect against BPD. Early and rapidly progressive enteral nutrition and breastfeeding should be promoted in very preterm infants. Trial registration: The trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000030125 on 24/02/2020) and in www.ncrcch.org (No. ISRCTN84167642 on 25/02/2020).

Background: Feeding intolerance (FI) following surgery for neonatal necrotizing enterocolitis (NEC) can impact recovery and prognosis, making the early identification of FI risk essential for optimizing management and improving outcomes. Methods: We retrospectively collected data from patients who underwent surgery for NEC between January 2013 and December 2023. Multivariate binary logistic regression was performed to identify independent factors influencing postoperative feeding intolerance. Results: Of the 519 infants enrolled in this retrospective study, 155 (29.9%) were diagnosed with feeding intolerance, while 364 (70.1%) were identified as having feeding tolerance. Compared to infants with feeding tolerance, those with feeding intolerance had lower birth weight, smaller gestational age, and lower Apgar scores (all p < 0.01). A 5 min Apgar < 7 (OR 4.794; 95%CI 1.339–17.156), the interval between diagnosis and surgery (OR 0.973; 95%CI 0.947–1.000), and primary anastomosis resection (OR 0.278, 95%CI 0.139–0.555) were identified as significant factors influencing postoperative feeding intolerance. The results remained consistent after performing propensity score matching analysis. Feeding intolerance may result in prolonged hospital stays, and more complications such as retinopathy of prematurity, intestinal failure-associated liver disease, and intraventricular hemorrhage. Conclusions: A lower 5 min Apgar score, shorter interval from diagnosis to surgery and intestine resection with ostomy are associated with a higher incidence of FI after surgery. FI after NEC surgery can prolong recovery and increase family burden.