Nicolina Hilda Anagnostatou

Background/Objectives: Melatonin, produced by the placenta and pineal gland, regulates circadian timing and has antioxidant and immunomodulatory actions. After birth, neonatal secretion is low and its circadian pattern matures over months; evidence in preterm neonates is mixed. We longitudinally monitored morning blood melatonin from birth to 38 weeks’ postmenstrual age (PMA) in breast milk-fed preterm neonates, assessing differences by time of birth (day vs. night), PMA, and weight-for-gestational-age (WfGA). Methods: A prospective NICU cohort, conducted within the ProMote study. In total, 132 preterm neonates were recruited from 112 mothers. For infants ≥33 weeks’ GA, three samples were obtained: umbilical cord (available in 94; otherwise at the first NICU admission), day of life (DOL) 4–7, and DOL 10–14; for infants <33 weeks’ GA, an additional sample at 35–36 weeks’ PMA. Melatonin was measured by ELISA. Primary analyses used raw melatonin concentrations in linear mixed-effects models; sensitivity analyses checked robustness. Results: A final sample comprised 122 neonates. Concentrations were low to modest with wide between-neonate variation and no monotonic change across PMA. Mixed models showed no consistent differences by time of birth and no stable WfGA effect; occasional PMA-specific contrasts did not recur at adjacent time points. Umbilical cord concentrations were low, and gestational age at birth did not materially influence levels at a given PMA. Sensitivity analyses led to the same inference. Conclusions: In breast milk-fed preterm neonates, morning serum melatonin from 26–38 weeks’ PMA shows substantial individual variability without consistent differences by time of birth, PMA, or WfGA.

Background/Objectives: Postnatal growth faltering (PGF) significantly affects premature neonates, leading to compromised neurodevelopment and an increased risk of long-term health complications. Methods: This retrospective study at a level III NICU of a tertiary hospital analyzed 650 preterm neonates born before 33 weeks. Postnatal growth was evaluated using the Fenton2013 and INTERGROWTH-21st growth charts, with changes in weight z-scores from birth to discharge classified as normal growth (ΔZ ≥ −1), non-severe PGF (−2 ≤ ΔZ < −1), and severe PGF (ΔZ < −2). Results: Mean gestational and postmenstrual age at discharge was 30 weeks (SD 1.9) and 37.1 weeks (SD 2.7), respectively. Fenton2013 growth curves revealed a higher prevalence of non-severe and severe PGF (43% and 14.6%) compared to INTERGROWTH-21st (24.5% and 10.3%). A more rapid establishment of full enteral feeds was strongly associated with reduced severe PGF prevalence in both growth charts (p < 0.001), as was shorter hospitalization. Late-onset sepsis was associated with an increased risk of severe PGF, while being small for gestational age (SGA) was protective against severe PGF across both growth charts (p < 0.001). A trend of decreasing PGF prevalence was noted over the study years, most probably attributed to the implementation of updated nutritional guidelines. Interestingly, when machine learning classification models were evaluated in our Greek cohort, a notable decline in predictive accuracy depending on the growth standard applied was observed. Conclusions: Our study highlights the need for standardizing PGF definition in an attempt to enhance nutritional management and further investigate the long-term impacts of nutritional interventions on growth, neurodevelopment, and overall health outcomes.

Monitoring the growth of neonates in the Neonatal Intensive Care Unit (NICU) using growth charts constitutes an essential part of preterm infant care. Preterm infants are at increased risk for extrauterine growth restriction (EUGR) due to increased energy needs and clinical complications. This retrospective study compares the prevalence of small for gestational age (SGA) at birth and EUGR at discharge in extremely and very preterm neonates hospitalized in the NICU of a tertiary hospital in Greece, using different growth curves, and it examines the associated nutritional and clinical factors. Fenton2013 and INTERGROWTH-21st growth curves were used to calculate z-scores of birth weight (BW) and weight, length, and head circumference at discharge. The study includes 462 newborns with a mean BW of 1341.5 g and mean GA of 29.6 weeks. At birth, 6.3% of neonates were classified as SGA based on Fenton2013 curves compared to 9.3% with INTERGROWTH-21st growth curves. At discharge, 45.9% of neonates were characterized as having EUGR based on the Fenton2013 weight curves and 29.2% were characterized based οn INTERGROWTH-21st curves. Nutritional factors such as the day of initiation, attainment of full enteral feeding, and the duration of parenteral nutrition were associated with EUGR by both curves. The prevalence of SGA and EUGR neonates differs between the two growth references. This shows that further evaluation of these charts is needed to determine the most appropriate way to monitor infant growth.

Background: The way postpartum parents’ COVID-19-related concerns are associated with the family environment, support resources and depressive symptoms areunder-investigated. Methods: Two hundred and forty-three new parents (132 mothers, 111 fathers) completed self-report questionnaires within an 8-week period after birth. Parental concerns for COVID-19-related life changes were assessed with the COVID-19 Questionnaire, perceived social support with the Multidimensional Scale of Perceived Social Support, perceived family functioning with the Family Adaptability and Cohesion Evaluation Scales IV Package, dyadic coping behaviors with the Dyadic Coping Inventory and maternal/paternal postnatal depression with the Edinburgh Postnatal Depression Scale. Results: (a) Higher levels of COVID-19-related concerns about daily life were associated with lower levels of family communication, satisfaction and increased depressive symptomatology in both parents, and with lower levels of family functioning in mothers; (b) Maternal health care COVID-19-related concerns were linked with lower levels of family communication, lower perceived social support and with an increase in maternal depressive symptoms; and (c) COVID-19-related concerns about neonate hospitalization were associated with increased maternal depressive symptoms. Conclusion: Τhese findings suggest that COVID-19-related concerns had a common negative effect on both postpartum mothers’ and fathers’ mental health and on certain aspects of family functioning.