The global evolution of pathogens causing early-onset sepsis (EOS), a critical condition in preterm infants, necessitates a re-evaluation of risk factors to develop updated prevention and treatment strategies. This nationwide case–control study in Taiwan analyzed data from the National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database from 2010 to 2019. The study included 176,681 mother–child pairs with preterm births. We identified 2942 clinical EOS cases from 5535 diagnosed sepsis cases, excluding unlikely cases. A control group of 14,710 preterm neonates without EOS was selected at a 1:5 ratio. Clinical EOS increased since 2017. Adjusted logistic regression identified significant EOS risk factors in preterm infants, including maternal fever, chorioamnionitis, maternal diabetes mellitus, maternal antibiotic usage, very preterm birth, birth weight (all with p < 0.001), maternal pneumonia (p = 0.002), and maternal CS (p = 0.004). Effective treatment of maternal conditions like diabetes, fever, and infections is essential to prevent EOS in preterm infants. Key measures include reducing unnecessary antibiotics or steroids, minimizing unnecessary cesarean sections, avoiding premature or prolonged rupture of membranes (PPROM), and increasing gestational age and neonatal birth weight. High-risk preterm neonates should be closely monitored for EOS and considered for antibiotics when warranted.

Background: Children of mothers with chronic-hypertension in pregnancy have high rates of preterm-birth (<37 weeks of gestation) and small-for-gestational-age (SGA), both of which are risk factors of cerebral palsy (CP). This study investigated the cumulative risks of CP in children exposed to maternal chronic-hypertension vs. other types of hypertensive-disorders-of-pregnancy (HDP), and whether preterm-birth and SGA potentiate the antenatal impact of chronic-hypertension to increase CP hazards. Methods: This population-based cohort study enrolled 1,417,373 mother-child pairs with singleton live births between 2004 and 2011 from the Taiwan Maternal and Child Health Database. A total of 19,457 pairs with HDP were identified and propensity-score-matched with 97,285 normotensive controls. Children were followed up for CP outcome until age 6-13 years. HDP were classified into chronic-hypertension, gestational-hypertension, preeclampsia, and preeclampsia-with-chronic-hypertension. Using the normotensive group as the reference, the associations between chronic-hypertension and CP hazard were assessed with adjusted hazard ratios (HR) and 95% confidence intervals (CI) in Cox proportional hazards regression models, and the effects of preterm-birth and SGA on the associations were examined. Results: The HDP group had higher rates of CP (0.8%) than the normotensive group (0.5%), particularly the subgroup of preeclampsia-with-chronic-hypertension (1.0%), followed by preeclampsia (0.9%), chronichypertension (0.7%) and gestational-hypertension (0.6%). Preterm-birth, but not SGA, exerted moderating effects to increase CP risks in children exposed to maternal chronic-hypertension. Before adjustments, chronichypertension alone had no substantial contribution to CP hazard (HR 1.35, 95% CI 1.00-1.83), while preeclampsia alone (1.64, 1.28-2.11) or with superimposed-chronic-hypertension (1.83, 1.16-2.89) had significant effects. After including preterm-birth in the multivariable model, the CP hazard for chronic-hypertension alone rather than other types of HDP was raised and became significant (1.56, 1.15-2.12), and the significance remained after stepwise adjustments in the final model (1.74, 1.16-2.60). Conclusions: Preterm-birth might potentiate CP hazards in children of mothers with chronic-hypertension in pregnancy.

Early nutrition is essential for the growth and neurodevelopment of preterm infants, especially those with very low birth weight (VLBW). This multicenter retrospective cohort study aimed to evaluate the effects of early parenteral amino acid (AA) administration on growth outcomes, feeding patterns, and short-term neonatal outcomes. This study included VLBW infants ( 24 h after birth) and initial dose (≤2.5 g/kg/day or > 2.5 g/kg/day). Clinical outcomes and nutritional practices were compared across the groups. Among the 959 infants, who received AAs earlier, the time to achieve full feeding was significantly shorter (23.4 ± 13.3 days vs. 26.2 ± 11.4 days, p = 0.035) compared to those who received AAs later. Among the 973 infants, infants receiving higher doses of AAs reached full feeding earlier (21.6 ± 14 days vs. 25.5 ± 12 days, p < 0.001) and had higher nadir body weights (981.1 ± 247.5 g vs. 941.8 ± 264.4 g, p = 0.028). Short-term outcomes, such as patent ductus arteriosus (PDA) requiring treatment (13.3 % vs. 19 %, p = 0.019), pulmonary hemorrhage (2.9 % vs. 5.7 %, p = 0.036), and moderate to severe bronchopulmonary dysplasia (BPD) (45.6 % vs. 54.3 %, p = 0.01), were significantly lower in the high-dose group. Multivariate logistic regression analysis revealed that the initial AA dose was independently associated with decreased risks of BPD and PDA. Early initiation and higher doses of parenteral AAs were associated with improved feeding efficiency and reduced morbidities, such as PDA and BPD, in VLBW infants. Further large-scale and long-term studies are required to confirm these findings and determine the optimal dosing strategies.

This cohort study aimed to investigate the impact of early onset sepsis (EOS) on preterm-very-low-birth-weight neonates (PVLBW) before discharge. This study utilized data from the Taiwan Neonatal Network (TNN) and focused on neonates weighing less than 1500 g at a gestational age between 22 and 32 + 6 weeks, from 2016 to 2021. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid within three days of birth. Multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (AOR) to identify independent risk factors for EOS while controlling for factors present at birth. Out of the 7349 eligible PVLBW neonates, 208 (2.83%) experienced EOS, with a mortality rate of 29.3% (61/208). The independent risk factors for EOS included maternal chorioamnionitis (AOR: 4.10), male sex (AOR: 1.38), and a lower 1-min Apgar score (AOR: 0.83). Neonates with EOS exhibited significantly higher rates of severe outcomes, including severe intraventricular hemorrhage (25.26% vs. 8.05%), periventricular leukomalacia (8.25% vs. 3.42%), chronic lung disease (48.94% vs. 31.43%), severe retinopathy of prematurity (23.13% vs. 12.81%), necrotizing enterocolitis (8.33% vs. 4.69%), and late-onset sepsis (31.58% vs. 8.96%) compared to the non-EOS group. This study provides the first nationwide epidemiological data on early onset sepsis in neonates with PVLBW. Our findings indicate that EOS in neonates with PVLBW significantly increases the risk of mortality and severe adverse outcomes. Further investigations of the pathogens involved are warranted to develop strategies and predictive tools to improve patient outcomes.

After the Coronavirus Disease 2019 (COVID-19) outbreak, there was an increasing number of febrile young infants concurrent with COVID-19. Urinary tract infection (UTI) is an important source of severe bacterial infections in febrile young infants. Accurate data on the incidence of pyuria and UTI in febrile young infants with or without COVID-19 in the post-pandemic period remains unclear. We conducted a retrospective analysis of clinical and laboratory data from febrile young infants less than 120 days old, admitted to the Sick Baby Room of a tertiary referral hospital in Taiwan, between March 1, 2023, and February 29, 2024. These infants underwent COVID-19 testing either in the emergency department or during hospitalization. Among the 265 febrile young infants who underwent COVID-19 testing, 124 (46.8 %) tested positive. Infants with COVID-19 had a significantly lower incidence of UTI compared with those testing negative [10/124 (8.1 %) vs 47/141 (33.3 %), p < 0.001]. The incidence of sterile pyuria was relatively high in the COVID-19 positive group compared with those testing negative [45/124 (36.3 %) vs 33/141 (23.4 %), p = 0.022]. Among those with COVID-19, more patients with sterile pyuria were exposed to antibiotics than those without pyuria [12/45 (26.7 %) vs 6/69 (8.6 %), p = 0.010]. In febrile young infants with COVID-19, the incidence of pyuria is high, but the occurrence of definite UTI was low compared with those without COVID-19. Routine empirical antibiotic administration in febrile young infants concurrent with COVID-19 may not be necessary. These findings highlight the importance of cautious antibiotic prescribing practices in this population.