In the present study, we aimed to explore gender differences in infant mortality and neonatal morbidity in mixed-gender twin pairs. Data were obtained from the US National Center for Health Statistics Linked Birth-Infant Death Cohort. A total of 108,038 pairs of mixed-gender twins were included in this analysis. Among the mixed-gender twins, no significant difference in the odds of fetal mortality between male twins (1.05%) and female co-twins (1.04%). However, male twins were at increased odds of neonatal mortality (adjusted OR 1.59; 95% CI 1.37, 1.85) and overall infant mortality (adjusted OR 1.43; 95% CI 1.27, 1.61) relative to their female co-twins. Congenital abnormalities (adjusted OR 1.38; 95% CI 1.27, 1.50) were identified significantly more frequently in male than female twins. Moreover, increased odds of having low 5-minute Apgar score (30 minutes (adjusted OR 1.31; 95% CI 1.17, 1.47), and respiratory distress syndrome (adjusted OR 1.45; 95% CI 1.26, 1.66) were identified in male twins relative to their female counterparts. The results of our study indicated that in mixed-gender twin pairs, the odds of infant mortality and neonatal morbidity were higher in male twins than their female co-twins.

It has been suggested that mild hypothermia treatment of hypoxia-ischemic encephalopathy (HIE) should start within 6 h after HIE, but many children are admitted to the hospital > 6 h, particularly in developing areas. We aimed to determine whether hypothermia treatment could remain effective within 12 h after birth. According to their admission, 152 newborns were enrolled in the < 6 h and 6–12 h after HIE groups. All newborns received conventional treatment combined with mild head hypothermia therapy, according to our routine clinical practice. Some newborns only received conventional treatment (lacking informed consent). All newborns received amplitude-integrated electroencephalography (aEEG) monitoring for 4 h and neuron-specific enolase (NSE) measurement before and after 3 days of therapy. Compared to the conventional treatment, hypothermia significantly improved the aEEG scores and NSE values in all newborns of the < 6-h group. In the 6–12-h group, the aEEG scores (F = 5.67, P < 0.05) and NSE values (F = 4.98, P < 0.05) were only improved in newborns with moderate HIE. Hypothermia treatment seems to have no effect in newborns with severe HIE after 6 h (P > 0.05). Hypothermia improved the rates of neonatal death and 18-month disability (all P < 0.01). In newborns with moderate HIE, starting hypothermia therapy < 6 h and 6–12 h after HIE showed curative effects. In those with severe HIE, only starting hypothermia therapy within 6 h showed curative effects.

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.

Background: After the implementation of the universal two-child policy in China, it was more frequent to have long interpregnancy intervals (IPIs) and advanced maternal age. However, the interactions between long IPIs and advanced maternal age on neonatal outcomes are unknown. Methods: The study subjects of this historical cohort study were multiparas with singleton live births between October 1st, 2015, and October 31st, 2020. IPI was defined as the interval between delivery and conception of the subsequent pregnancy. Logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the risks of preterm birth (PTB), low birth weight (LBW), small for gestation age, and 1-min Apgar score ≤ 7 in different IPI groups. Relative excess risk due to interaction (RERI) was used to evaluate the additive interaction between long IPIs and advanced maternal age. Results: Compared with the 24 ≤ IPI ≤ 59 months group, the long IPI group (IPI ≥ 60 months) was associated with a higher risk of PTB (aOR, 1.27; 95% CI: 1.07–1.50), LBW (aOR, 1.32; 95% CI 1.08–1.61), and one-minute Apgar score ≤ 7 (aOR, 1.46; 95% CI 1.07–1.98). Negative additive interactions (all RERIs < 0) existed between long IPIs and advanced maternal age for these neonatal outcomes. Meanwhile, IPI < 12 months was also associated with PTB (aOR, 1.51; 95% CI 1.13–2.01), LBW (aOR, 1.50; 95% CI 1.09–2.07), and 1-min Apgar score ≤ 7 (aOR, 1.93; 95% CI 1.23–3.04). Conclusions: Both short and long IPIs are associated with an increased risk of adverse neonatal outcomes. Appropriate IPI should be recommended to women planning to become pregnant again. In addition, better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.

Hypertensive disorders during pregnancy (HDP) are associated with cardiovascular disease among mothers and offspring. This meta‐analysis was conducted to further explore the associations between maternal HDP and offspring blood pressure (BP). The authors performed a search strategy in PubMed, Embase, Web of Science, and Cochrane library from database inception to January 2022. Twenty‐four studies regarding HDP were included, with pregnancy‐associated hypertension (PAH), preeclampsia (PE), gestational hypertension (GH), and chronic hypertension included in 12, 16, 6, and 3 studies, respectively. Offspring who were exposed to HDP and PAH in utero had higher systolic BP (2.46 mm Hg, 95% CI: 1.88–3.03 mm Hg; 2.70 mm Hg 95% CI: 1.89–3.51 mm Hg) and diastolic BP (1.38 mm Hg 95% CI: 0.94–1.83 mm Hg; 1.39 mm Hg 95% CI: 0.71–2.06 mm Hg) than those birthed to normotensive mothers. The offspring exposure to PE, GH, and chronic hypertension had higher systolic BP by 1.90 mm Hg (95% CI: 1.39–2.40 mm Hg), 2.47 mm Hg (95% CI: 1.59–3.35 mm Hg), and 7.85 mm Hg (95% CI: 4.10–11.61 mm Hg), respectively, and higher diastolic BP by 0.99 mm Hg (95% CI: 0.50–1.49 mm Hg), 1.04 mm Hg (95% CI: 0.60–1.47 mm Hg), and 2.92 mm Hg (95% CI: 0.98–4.86 mm Hg), respectively. An Egger test and funnel plot confirmed no significant publication bias. In conclusion, offspring exposure to all subtypes of HDP in utero led to higher BP than no exposure. It is necessary to investigate the potential mechanisms to clarify the roles of genetic and environmental factors in these associations, which could provide insight on preventing hypertension and related cardiovascular disease.