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.

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.

Background : Pyruvate kinase deficiency (PKD) is the most prevalent enzymatic defect of the glycolytic pathway, causing chronic congenital non-spherocytic hemolytic anemia. Clinical severity ranges from mild anemia to transfusion-dependent diseases. Severe neonatal presentations, including liver failure, have rarely been reported. Case presentation: We report a preterm female neonate with PKD who developed early-onset hemolytic anemia, conjugated hyperbilirubinemia, hepatosplenomegaly, coagulopathy, and progressive transaminitis. Imaging demonstrated hepatomegaly with diffuse parenchymal involvement. Whole-genome sequencing identified compound heterozygous pathogenic mutations in the PKLR gene, confirming the diagnosis of PKD. The patient required continuous transfusion support and was discharged following clinical stabilization. Discussion: Although PKD most often manifests as isolated hemolytic anemia, this case illustrates a rare neonatal phenotype with concurrent liver dysfunction. We investigated the potential underlying mechanism. Recognition of hepatic involvement in PKD is essential because liver failure is associated with considerable morbidity and mortality, and it may necessitate interventions such as liver transplantation. Conclusions: This case highlights the importance of considering PKD in neonates presenting with hemolysis and liver failure. Early genetic confirmation enables timely management, including transfusion support, iron overload surveillance, and anticipatory guidance for potential hepatic complications.

Background/Objectives: Vitamin D deficiency is common in children, but its associations with growth and organ function remain unclear. This cross-sectional secondary analysis of two prospective cohort studies evaluated vitamin D status and multisystem health outcomes in very-low-birth-weight preterm and term children aged 5–6 years. Methods: Serum 25-hydroxyvitamin D [25(OH)D] was categorized as deficiency (30 ng/mL). Assessments included anthropometry, blood pressure, body composition and bone mineral density, pulmonary function, cardiac indices, kidney and metabolic biomarkers, and cognitive function (preterm children only). Results: Overall, 213 children (144 preterm, 69 term) were included; only 17.8% achieved sufficient vitamin D levels. No statistically significant associations were detected between serum 25(OH)D and any of these outcomes. In contrast, 25(OH)D levels were positively correlated with physical activity, sun exposure, and vitamin D supplementation (all p < 0.05; second cohort only). Conclusions: Vitamin D deficiency was common, but no statistically significant associations with multisystem health measures were detected; several features of this analysis limit the strength of these null findings. Sun exposure, physical activity, and vitamin D supplementation were associated with higher 25(OH)D concentrations. These exploratory cross-sectional findings require confirmation in prospectively designed studies.