Background: Lung ultrasound (LUS) is a useful tool for assessing the severity of lung disease, without radiation exposure. However, there is little data on the practicality of LUS in assessing the severity of bronchopulmonary dysplasia (BPD) and evaluating short-term clinical outcomes. We adapted a LUS score to evaluate BPD severity and assess the reliability of mLUS score correlated with short-term clinical outcomes. Methods: Prospective diagnostic accuracy study was designed to enroll preterm infants with gestational age < 34 weeks. Lung ultrasonography was performed at 36 weeks postmenstrual age. The diagnostic and predictive values of new modified lung ultrasound (mLUS) scores based on eight standard sections were compared with classic lung ultrasound (cLUS) scores. Results: A total of 128 infants were enrolled in this cohort, including 30 without BPD; 31 with mild BPD; 23 with moderate BPD and 44 with severe BPD. The mLUS score was significantly correlated with the short-term clinical outcomes, superior to cLUS score. The mLUS score well correlated with moderate and severe BPD (AUC = 0.813, 95% CI 0.739–0.888) and severe BPD (AUC = 0.801, 95% CI 0.728–0.875), which were superior to cLUS score. The ROC analysis of mLUS score to evaluate the other short-term outcomes also showed significant superiority to cLUS score. The optimal cutoff points for mLUS score were 14 for moderate and severe BPD and 16 for severe BPD. Conclusions: The mLUS score correlates significantly with short-term clinical outcomes and well evaluates these outcomes in preterm infants.

Early-onset sepsis (EOS) poses a substantial risk to very preterm infants, necessitating the prevalent administration of empirical antibiotics in the neonatal intensive care unit (NICU). Puopolo et al¹ reported that more than one-third of the extremely preterm infants in their study were categorized as low risk for EOS, with an incidence of 0.5%. In these low-risk groups, prolonged empirical antibiotic treatment (≥5 days) was observed in approximately 35% of cases.¹ Recent studies^1-3 have suggested a potential association of prolonged antibiotic therapy with both increased mortality and a higher incidence of adverse neonatal outcomes, including bronchopulmonary dysplasia (BPD), within this vulnerable population. However, these studies often relegated BPD as a secondary outcome, lacking comprehensive consideration of relevant confounding factors. Moreover, the literature has reported inconsistent results in this domain.^4-6 The reported association may be influenced by factors such as culture-proven sepsis bacteremia, illness severity, and early respiratory disease.

The causal relationship between Packed red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) remains uncertain. This study aims to provide an exploration of transfusion and NEC in very preterm infants. Using data from the Chinese Neonatal Network cohort study between 2019 and 2021, the analysis focused on very preterm infants (with a birth weight of < 1500 g or a gestational age of < 32 weeks) who developed NEC after receiving transfusions. The time interval between the prior transfusion and NEC was analyzed. An uneven distribution of the time interval implies an association of transfusion and NEC. Additionally, multivariable logistic analysis was conducted to detect the prognosis of defined transfusion-associated NEC(TANEC). Of the 16,494 infants received RBC transfusions, NEC was noted in 1281 (7.7%) cases, including 409 occurred after transfusion. Notably, 36.4% (149/409) of post-transfusion NEC occurred within 2 days after transfusion. The time interval distribution showed a non-normal pattern (Shapiro–Wilk test, W = 0.513, P < 0.001), indicating a possible link between transfusion and NEC. TANEC was defined as NEC occurred within 2 days after transfusion. Infants with TANEC had a higher incidence of death (adjusted OR 1.69; 95% CI 1.08 to 2.64), severe bronchopulmonary dysplasia (adjusted OR 2.03; 95% CI 1.41 to 2.91) and late-onset sepsis (adjusted OR 2.06; 95% CI 1.37 to 3.09) compared with infants without NEC after transfusion. Unevenly high number of NEC cases after RBC transfusions implies transfusion is associated with NEC. TANEC is associated with a poor prognosis. Further research is warranted to enhance our understanding of TANEC.

A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general pediatrics. However, PICC-related complications are concerning and warrant further investigations. To share the experience of a nurse-inserted peripherally inserted central catheters (PICC) program initiated in a general pediatric department. A retrospective descriptive cohort study based on a prospectively collected database was conducted. All PICCs inserted in the departments of gastroenterology and pulmonology in a tertiary pediatric center from Dec. 2015 to Dec. 2019 were included in the study. Complications and risk factors were analyzed by comparing cases with and without complications. We also reported arm movements in correcting mal-positioned newly-inserted PICCs. There were 169 cases with a median (IQR) age of 42(6, 108) months who received PICC insertion during a 4-year period. Inflammatory bowel disease was the leading diagnosis accounting for 25.4% (43/169) of all cases. The overall complication rate was 16.4 per 1000 catheter days with malposition and occlusion as the two most common complications. Multivariate models performed by logistic regression demonstrated that young age [p = 0.004, OR (95%CI) = 0.987(0.978, 0.996)] and small PICC diameter (1.9Fr, p = 0.003, OR (95%CI) = 3.936(1.578, 9.818)] were risk factors for PICC complications. Correction of malpositioned catheters was attempted and all succeeded in 9 eligible cases by using arm movements. The nurse-inserted PICC program in general pediatrics is feasible with a low rate of complications. PICC tip malposition and occlusion were two major PICC-related complications when low age and small catheter lumina were major risk factors. Furtherly, arm manipulation potentially is an easy and effective approach for correcting malpositioned newly-inserted PICC catheters.