Naveed Hussain

Background: Congenital anomalies are influenced by genetic and environmental factors. While interventions including folic acid supplementation have reduced neural tube defects, data on modifiable socio-demographic risk factors remain limited. Aim: This study aimed to assess variation in the prevalence of selected congenital anomalies across the United States according to socio-demographic factors. Methods: A population-based analysis was conducted using CDC-WONDER natality data from 2016 to 2023. Included anomalies were anencephaly, spina bifida, cyanotic heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb reduction, cleft lip/palate, Down syndrome, chromosomal disorders, and hypospadias. Associations with maternal age, BMI, race, tobacco use, diabetes, and fertility treatments were analyzed. Prevalence rates were calculated per 1000 live births. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Joinpoint regression was used to assess annual percent changes (APCs), with p < 0.05 considered significant. Results: Among 3,482,944 singleton live births in 2023, the overall prevalence of the selected congenital anomalies was 3.3 per 1000. Compared to Caucasian mothers, risk was lower in Asian (RR 0.57; 95% CI: 0.52–0.63) and Black (RR 0.81; 95% CI: 0.76–0.85) infants and higher in American Indian/Alaska Native infants. Significant risk factors included pre-pregnancy diabetes (RR 2.41; 95% CI: 2.16–2.69), maternal age > 45 (RR 2.95; 95% CI: 2.36–3.69), and tobacco use (RR 1.78; 95% CI: 1.64–1.94). A significant decline in prevalence was observed from 2016 to 2023 (APC: −0.6%; 95% CI: −1.1 to −0.2; p = 0.006). Conclusions: Significant disparities and modifiable maternal risk factors were associated with the prevalence of selected congenital anomalies in the U.S. from 2016 to 2023. A modest statistically significant decline in overall prevalence was observed during the study period, supporting the importance of continued national surveillance and targeted preconception and prenatal interventions to reduce risk and address inequities.

Objective To investigate the association between lung ultrasound score (LUS) and left ventricular eccentricity index at end-systole (LVEI-s) and end-diastole (LVEI-d) in preterm infants with respiratory failure. Study Design This prospective pilot study included 38 ultrasounds on 20 premature infants with Transient Tachypnea of the Newborn (TTN) and Respiratory Distress Syndrome (RDS) requiring non-invasive ventilation at birth. LUS, LVEI-s, and LVEI-d were obtained daily for 72 h. Linear regression analysis was performed to determine correlation. Results LUS positively correlated with LVEI-s (r = 0.47, p = p = p = p = <0.01) in the RDS group. Conclusion As LUS increases, both LVEI-s and LVEI-d demonstrate measurable changes in infants with RDS. This association may enhance precision in diagnostic stratification and optimizing fluid management in neonatal lung disease.

Background/Objectives: Determine the appropriate duration for multichannel sleep studies in former preterm infants with cardio-respiratory events beyond term equivalent age. Hypothesis: A sleep study of 10 h will provide equivalent information compared to a 20-h study to detect significant cardio-respiratory abnormalities in this population. Methods: Single-center retrospective study of 50 infants with 20-h sleep study. Studies were evaluated for periodic breathing, obstructive, central, mixed apnea, desaturations, and bradycardia. Each study was partitioned into two 10-h epochs, compared to one another and the 20-h study. Results: Differences were detected at the level of individual sleep studies when each epoch was compared to each other and a total 20-h study. 10-h study missed 17–31% of breathing abnormalities detected over 20 h adjusted for study time. Group analysis showed no statistical difference in the number and duration of events between epochs. Conclusions: A 20-h sleep study improves the detection of breathing abnormalities missed with a 10-h study.

Introduction: The incidence of severe BPD (sBPD), defined as needing oxygen or positive pressure at 36 weeks corrected gestational age (CGA), has remained unchanged. These infants are at risk for developing late pulmonary hypertension (LPHN) or needing surgical interventions such as Gastrostomy Tubes (GT) or Tracheostomy Tubes (TT). The finding of pepsin in the lungs of infants who were extremely low birth weight (ELBW) with sBPD has led to the speculation that gastroesophageal reflux (GER) and aspiration could contribute to their lung disease. Micro-aspiration-reducing strategies such as Transpyloric feeds (TpF) have not been well studied.Objectives: To compare ELBW infants with sBPD managed with or without TpF and determine the difference between the two groups for (i) illness severity, (ii) LPHN, (iii) need for GT, and (iv) TT; the secondary aim was to study the TpF group to (i) evaluate the change in Respiratory Severity Score (RSS) before and after TpF, and (ii) evaluate the time taken to affect the change in RSS.Methods: In this retrospective study there were 229 ELBW infants with sBPD (78 in the TpF group, 151 in the non-TpF group). SPSS software was used for univariate analyses.Results: There was no difference in sex or race. TpF group had (i) a lower BW, GA, higher severity of illness (ii) higher incidence of LPHN (p < 0.05), (iii) higher need for GT (p < 0.001) and TT (p < 0.001). In the TpF group, 60 who were on TpF for pulmonary protection from micro aspiration (lung protection group), had significantly improved RSS (p < 0.05), and symptoms within 45 days in 57 out of 60 infants (95%). They improved their respiratory status by 14 days, and 80% of responders could be identified by 21 days after initiation. In the 18 that TpF was started for documented airway protection (airway protection group), there was a higher need for GT or TT.Conclusions: TpF could play an essential role in the management of ELBW infants with sBPD. Considering the limitations of a single center retrospective study, prospective randomized control trials are needed to confirm these findings.

Challenging the assumption of uniform nutritional needs in preterm feeding, this study identifies crucial sex-specific disparities in formula milk intake and growth among late preterm infants. Premature infants have difficulty regulating their oral intake during feeds, which is why clinicians prescribe feeding volume, calories, and protein via the nasogastric route. However, premature male and female infants have different body compositions at birth, and, subsequently, there is no evidence to suggest that male and female preterm infants differ in their nutritional consumption once they begin feeding ad libitum. This study investigates whether there are any differences in the volume and nutrient intake between the sexes when fed formula ad libitum. Methods: The study involved a retrospective analysis of preterm infants admitted to the NICU and evaluated between 34 0/7 and 36 6/7 weeks of corrected gestation. Late preterm infants appropriate for gestational age who were spontaneously fed formula milk ad-lib and free of any respiratory support for at least two days were included. The study excluded infants with short gut syndrome, severe chromosomal anomalies, or congenital heart conditions. We included 85 male and 85 female infants in this study. The data collected included sex, gestational age, birth weight, anthropometric data at birth, maternal data, nutritional intake, and neonatal morbidity. Results: This study found that female infants consumed more volume, protein, and calories than male infants. The mean formula intake in female and male infants was 145.5 ± 20.8 mL/kg/d and 135.3 ± 19.3 mL/kg/d, respectively, with p = 0.002. However, ad-lib feeding duration was not different between the sexes. Growth velocity was also higher in female infants. Conclusions: This study is the first to demonstrate differences in formula milk intake among late preterm infants fed ad libitum. Additional research is needed to confirm our findings and understand sex-specific differences in neonatal nutrition in extremely early preterm infants.

Objectives: We aimed to determine if testing with thickened and non-thickened feeds during a single pH-MII (Multiple Intraluminal Impedance) study yields clinically actionable information regarding gastroesophageal reflux disease (GERD) in infants. Methods: This was a retrospective cohort study of premature infants who underwent pH-MII testing - half performed during Mother’s Milk or Formula (MMoF) and the other half with Similac for Spit-up® formula (SSUF) feeds. Results: There were fewer total impedance events following SSUF feedings than MMoF (17.6 ± sd vs 25 ± sd, p = 0.001). There were fewer episodes of acid impedance with SSUF feeds than MMoF (5 ± sd vs 11.9 ± sd p < 0.001). Conclusions:In premature infants, SSUF reduced both total reflux episodes and the number of acid reflux episodes. We also report a novel strategy of combining GERD evaluation with a trial of therapy during a single pH-MII test.

Objective To investigate seasonality and temporal trends in the incidence of NEC. Study design A retrospective cohort study from two tertiary NICUs in northern and central Connecticut involving 16,761 infants admitted over a 28-year period. Various perinatal and neonatal risk factors were evaluated by univariate, multivariate, and spectral density analyses. Results Incidence of NEC was unchanged over the 28 years of study. Gestational age, birth weight, and birth-months (birth in April/May) were independently associated with stage II or III NEC even after adjusting for confounding factors (p < 0.05). Yearly NEC incidence showed a multi-modal distribution with spectral density spikes approximately every 10 years. Conclusion(s) Temporal and seasonal factors may play a role in NEC with a peak incidence in infants born in April/May and periodicity spikes approximately every 10 years. These trends suggest non-random and possibly environmental factors influencing NEC.

The information regarding fetal effects of acetazolamide use during pregnancy and lactation is sparse. We report the clinical and pharmacodynamic characteristics of maternal acetazolamide use and the timing of its effects on acid-base balance in three cases who presented with metabolic acidosis in the newborn period. We found that the infants’ clinical status soon after birth was inconsistently correlated with maternal drug dose and concentrations of medication in maternal serum. However, there was low transfer of the drug in breast milk and its use did not affect clinical symptomatology. We also present a review of literature on this subject to help consolidate our current knowledge on this topic.