To investigate fluid balance, sodium intake, and hyperglycemia during the first 2 weeks of life in infants born at 22-23 weeks of gestational age, and to examine their associations with hospital outcomes. Retrospective, single-center, cohort study of all infants surviving beyond 72 hours (22-23 weeks; January 2019-June 2024). Total fluid intake, weight, and urine output were collected during the first 14 days, and used to calculate daily insensible water loss. Daily intake of sodium, plasma sodium and glucose levels, and the occurrence of acute kidney injury (AKI) were recorded. Relationships with bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, and death were analyzed. Survival until discharge was 57% (39/69). The nadir weight loss was -15 ± 6% (mean ± SD) at median 3 (IQR 2-5) days. Average total fluid intake during the first week of life was 176 ± 25 mL/kg/day; peak mean urine output (119 ± 39 mL/kg/day) and insensible water loss (87 ± 54 mL/kg/day) occurred at days 2 and 5, respectively. The median daily sodium intake was 4.6 and 4.5 mmol/kg/day in the first and second weeks, respectively. Hypernatremia (plasma sodium >150 mmol/L) occurred in 42% and prolonged (>2 days) hyperglycemia (plasma glucose >10 mmol/L) was frequent (87%). AKI occurred in 28%. Mortality was independently associated with weight loss >15% (OR: 3.9, 95% CI: 1.4-11.1, P = .013), and AKI (OR: 3.5, 95% CI: 1.1-11.3, P = .034). In infants born at 22-23 weeks of gestation, a large loss of body weight and AKI are prevalent during the first 2 weeks of life and are associated with increased mortality. Preventing excessive weight loss might improve outcomes.

Background: Malnutrition of preterm infants may negatively affect brain growth and later neurocognitive function. We aimed to investigate the association between very preterm infants’ macronutrient intakes, and brain MRI at term and neurodevelopment at 2 years. Methods: Single-center, retrospective cohort including extremely (22–27w) and very (28–31w) preterm infants born 2011–2014. The intakes of fluid, protein, carbohydrate, fat, and total calories during days 0–28 together with body weights were assessed in relation to brain MRI (morphology, volumetry, diffusion-weighted imaging) at term, and cognition (BSID-III) at 2 years, using adjusted multivariable regression analyses. Results: Seventy-two infants were included. A lower (p < 0.001) caloric intake in extremely preterm (n = 26) than in very preterm (n = 46) infants did not translate to any differences in brain volumes. While bivariate correlations (p < 0.01) were found between the enteral intakes of all macronutrients, and white matter volume and apparent diffusion coefficients, none of the correlations remained significant after adjusting for covariates in the multivariable analysis. Similarly, no associations between nutrient intakes and cognitive development remained after covariate adjustment. Conclusion: In a cohort of preterm infants receiving macronutrient intakes meeting current recommendations, individual variations in nutrition did not influence brain growth or neurodevelopment. Impact: Early postnatal macronutrient intake was not associated with brain volumes at term or neurocognitive outcomes at 2 years in very preterm infants All infants received nutritional intakes meeting current recommendations Adequate macronutrient intake based on a standardized protocol may eliminate the need for further minor adjustments in the pursuit of supporting brain growth and neurodevelopment in preterm infants.

Background: Recommendations are limited regarding the placement of oral endotracheal tube (ETT), and umbilical arterial/venous catheter (UAC/UAC) in the tiniest extremely preterm infants. We aimed to determine optimal insertion depths, and assess the impact of a too deep ETT position on outcomes. Methods: All infants born at 22-23 weeks gestation in 2019-2024 at Uppsala University Hospital, Sweden, were evaluated radiologically for accurate positions defined as: ETT (not right-sided/in main bronchus), UAC (T6-9 or L3–4), and UVC (right atrium/inferior vena cava junction). ETT position was further analyzed in relation to time to first extubation, respiratory severity score, duration of mechanical ventilation, bronchopulmonary dysplasia, and mortality. Results: The cohort ( n = 75; 22w n = 39; 23w n = 36) had a survival rate of 41 and 64%, respectively. The ETT was accurately placed in 75%, and lower birth weight was associated with a too deep tip position ( p = 0.018). The optimal median (IQR) insertion depths were: ETT 5.5 (5.5–6.0); low UAC 6.0 (5.5–6.5); high UAC 9.6 (9.2–10.3), and UVC 5.5 (5.0–6.1) cm. ETT position was not associated with respiratory outcomes or mortality. Conclusion: The suggested insertion depths can be expected to result in accurate positioning of ETTs and umbilical lines in infants born at 22-23 weeks gestation. Impact: There is limited information to guide delivery room placement of endotracheal tube (ETT) and umbilical catheters (UC) in infants born at a gestational age (GA) of 22–23 weeks. An evaluation standardized insertion depths for ETT and UC, with use of x-ray based measurements of their positions, demonstrate the feasibility of using GA-based insertion depths. The suggested insertion depths can be expected to result in accurate ETT and UC tip positions in infants born at 22-23 weeks.

Neonatal magnetic resonance imaging (MRI) is essential for identifying brain injuries, dysmaturation and understanding neurodevelopment in preterm infants. This study aimed to evaluate the associations between qualitative and quantitative neonatal brain MRI findings, alongside perinatal clinical variables, with neurodevelopmental outcomes across cognitive, language, and motor domains at 2 years' corrected age in preterm infants. Retrospective cohort study of 50 very preterm infants (<32 weeks) who underwent brain MRI scans at term-equivalent age. MRI assessment included Kidokoro scores, morphometric measurements (biometric and volumetric), and apparent diffusion coefficients. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition. Correlations and regression analysis were used to evaluate associations with neurodevelopmental outcomes. Multivariable models explained a substantial variance in cognitive (51.5%), language (32.3%), and motor (37.9%) outcomes. The Kidokoro deep grey matter (DGM) score emerged as the most consistent independent factor associated with all three domains. Additional factors linked to cognitive outcomes included DGM area and biparietal diameter, while DGM area was associated with language outcomes, and the 10-min Apgar score with motor outcomes. Both DGM and white matter Kidokoro scores were significantly associated with the likelihood of neurodevelopmental impairment classification. Combining neonatal brain MRI assessments with perinatal clinical data correlates with neurodevelopmental outcomes at 2 years' corrected age. Reduced or abnormal DGM is associated with altered cerebral development across multiple domains, suggesting it is a relevant marker of early neurodevelopmental status in very preterm infants.

Proper selection and application of preprocessing steps are crucial for obtaining accurate segmentation in brain Magnetic Resonance Imaging (MRI). The aim of this study is to evaluate the impact brain extraction (BE) and bias field correction (BFC) methods have on regional brain volume (RBV) measurements of preterm neonates’ T2w MRI at term-equivalent age (TEA). Five BE methods (Manual, BET2, SWS, HD-BET, SynthStrip) were applied together with two BFC methods (SPM-BFC and N4ITK), before segmenting the neonatal brain into eight tissue classes (cortical grey matter, white matter, cerebral spinal fluid, deep nuclear grey matter, hippocampus, amygdala, cerebellum, and brainstem) using an automated segmentation software (MANTiS). Quantitative assessments were conducted, including the coefficient of variation (CV), coefficient of joint variation (CJV), Dice coefficient (DC), and RBV. HD-BET, together with N4ITK, showed the highest performance (mean ± standard deviation) regarding CV of 0.047 ± 0.005 (white matter) and 0.070 ± 0.005 (grey matter), CJV of 0.662 ± 0.095, DC of 0.942 ± 0.063, and RBV without significant differences (except in the brainstem) from the manual segmentation. Therefore, such combination of methods is recommended for improved skull-stripping accuracy, intensity homogeneity, and reproducibility of RBV of T2w MRI at TEA.