Chien-Chung Lee

Background/Objectives: Pediatric emergency departments (PEDs) experience abrupt fluctuations in patient volume that can prolong waiting times and compromise timely care for critically ill children. The aim of this study was to evaluate whether implementation of a triage-based emergency alarm was associated with time to electronic documentation of initial physician evaluation and clinical outcomes during the 2022 COVID-19 Omicron wave in Taiwan. Methods: We conducted a single-center retrospective before-and-after observational study of PED visits from 1 April to 31 October 2022. The emergency flashing-light alarm was implemented on 1 August 2022 to alert physicians to triage level 1 patients requiring immediate evaluation. Propensity scores were estimated using age group (p < 0.001). Among triage level 2 visits, medians were 12.4 and 11.8 min, respectively (p = 0.088). Hospital admission and PICU admission or planned admission were more frequent after implementation. Conclusions: The alarm was associated with a shorter median time to documented initial physician evaluation among triage level 1 visits. No statistically significant difference was detected for triage level 2 waiting time in the matched-pair analysis. Residual differences in triage mix and secular trends preclude causal inference.

Background: While early-life cytokine profiles have been linked to neurodevelopmental outcomes in preterm infants, their prognostic value is limited by clinical instability and inflammatory comorbidities in the immediate postnatal period. This study explores cytokine levels measured during a more stable developmental window—near term-equivalent age [postmenstrual age (PMA) 34–38 weeks]—and their association with neurodevelopmental outcomes.Methods: We prospectively enrolled 35 preterm infants (birth weight, 500–1,500 g). Serum cytokine levels were measured at PMA 34, 36, and 38 weeks. Neurodevelopment was assessed at 12 months’ corrected age using standardized tools (BSID-III). Infants were classified into neurodevelopmental impairment (NDI) and non-NDI groups. Cytokine levels and their changes were compared between groups.Results: Elevated IFN-γ levels at PMA 34 weeks were associated with a higher risk of NDI. Conversely, higher levels of Eotaxin-2, IL-2, IL-11, IL-16, MIP-1δ, PDGF-BB, TIMP-2, and TNF-β at PMA 36–38 weeks were observed more frequently in the non-NDI group. The trends also differed: increased IL-17 and decreased Eotaxin-1, Eotaxin-2, IL-7, IL-16, MIP-1α, MIP-1β, PDGF-BB, and TIMP-2 between PMA 34–36 weeks, and further declines in ICAM-1, IL-7, MIP-1α, and MIP-1β by PMA 38 weeks were associated with adverse outcomes. All identified biomarkers demonstrated good discriminatory ability, particularly changes in Eotaxin-2 between PMA 34 and 36 weeks and PDGF-BB between PMA 34 and 38 weeks.Conclusions: Serum cytokine levels and their trajectories during PMA 34–38 weeks may serve as potential biomarkers for identifying preterm infants at risk of neurodevelopmental impairment. Further studies with larger cohorts are needed to clarify their interplay with preterm morbidities.

Background: Preterm birth significantly contributes to mortality and morbidities, with recent studies linking these issues to gut microbiota imbalances. Probiotic supplementation shows promise in mitigating adverse outcomes in preterm infants, but optimal timing and guidelines remain unclear. This study assesses the benefits of probiotic supplementation for preterm infants without consistent guidelines. Methods: This retrospective study examined extremely low-birth-weight (ELBW) infants in neonatal intensive care units from 2017 to 2021. Mortality and preterm-related outcomes were compared between infants receiving probiotics and those not. Subgroup analyses based on probiotic initiation timing were conducted: early (≤14 days), late (>14 days), and non-probiotic groups. Results: The study included 330 ELBW infants: 206 received probiotics (60 early, 146 late), while 124 did not. Probiotic supplementation was associated with lower overall mortality (adjusted OR 0.22, 95% CI 0.09–0.48) and decreased mortality from necrotizing enterocolitis (NEC) or late-onset sepsis (LOS) (adjusted OR 0.12, 95% CI 0.03–0.45). Early probiotics reduced overall mortality, NEC/LOS-related mortality, and NEC/LOS-unrelated mortality. Late probiotics decreased overall mortality and NEC/LOS-related mortality. Early probiotic use also expedited full enteral feeding achievement. Conclusions: Probiotic supplementation reduces mortality and improves feeding tolerance in preterm infants. Establishing guidelines for probiotic use in this population is crucial.

The gut microbiota undergoes substantial development from birth, and its development in the initial years of life has a potentially lifelong effect on the health of the individual. However, various factors can disrupt the development of the gut microbiota, leading to a condition known as dysbiosis, particularly in preterm infants. Current studies involving adults have suggested that the gut microbiota not only influences the gut but also has multidimensional effects on remote organs; these pathways are often referred to as the gut–organ axis. Imbalance of the gut microbiota may lead to the development of multiple diseases. Recent studies have revealed that gut dysbiosis in preterm infants may cause several acute morbidities—such as necrotizing enterocolitis, late‐onset sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity—and it may also influence long‐term outcomes including neurodevelopment and somatic growth. This review mainly presents the existing evidence regarding the relationships between the gut microbiota and these morbidities in preterm infants and explores the role of the gut–organ axis in these morbidities. This paper thus offers insights into the future perspectives on microbiota interventions for promoting the health of preterm infants.