Manapat Praditaukrit

Background/Objectives: Preterm (<37 weeks) and very preterm (<32 weeks) infants face considerably higher mortality and morbidity rates than full-term infants. We compared clinical outcomes between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants. Methods: This retrospective cohort study used a prospectively collected database, obtained from 2014 to 2025. Propensity score matching (PSM), multivariate regression, and subgroup analyses of very preterm infants were performed to minimize confounding. Results: Among the 5890 neonatal admissions, 2331 preterm infants met the inclusion criteria. After PSM, 298 SGA and 298 AGA preterm infants were analyzed. Multivariate analysis showed that SGA preterm infants had significantly higher risks of the composite outcome of mortality or major morbidity (adjusted risk ratio [aRR], 1.89; 95% confidence interval [CI], 1.18–3.02), mortality (aRR, 3.53; 95% CI, 1.57–7.95), and mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.13; 95% CI, 1.30–3.48). In the subgroup analysis after PSM, 190 very preterm infants showed similar results, with SGA infants having increased risks of the composite outcome of mortality or major morbidity (aRR, 1.81; 95% CI, 1.02–3.23), mortality (aRR, 3.23; 95% CI, 1.09–9.62), mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.03; 95% CI, 1.10–3.72), and mortality or treated retinopathy of prematurity (aRR, 2.62; 95% CI, 1.03–6.65). Conclusions: SGA status is associated with a higher risk of mortality and major morbidity in preterm and very preterm infants. In resource-limited settings, the focused management of SGA infants is critical to improving short- and long-term outcomes.

Background/Objectives: Ventilator-free days (VFDs) are a useful composite measure to assess both survival and duration of mechanical ventilation in critically ill patients. This study aimed to determine the factors associated with (VFDs) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to compare VFDs according to the etiology and severity of PPHN. Methods: We conducted a retrospective cohort study of neonates diagnosed with PPHN between 2013 and 2023. VFDs were defined as days alive and free of mechanical ventilation within the first 28 days. Severe-to-critical PPHN group was defined as an oxygenation index (OI) > 25. Results: Among 175 neonates, the median (interquartile range [IQR]) VFDs were 20 (9–23) days. The factors independently associated with fewer VFDs included maximum OI > 40 (adjusted hazard ratio [aHR] 3.5, 95% confidence interval [CI]: 2.49–4.9), receiving more than two inotropic drugs (aHR 2.27, 95% CI: 1.49–3.45), acute kidney injury (AKI) (aHR 1.54, 95% CI: 1.1–2.17), and ventilator-associated pneumonia (VAP) (aHR 3.42, 95% CI: 1.8–6.48). The median (IQR) number of VFDs in neonates with PPHN secondary to respiratory distress syndrome (RDS), pneumonia/sepsis, meconium aspiration syndrome, and transient tachypnea of the newborn were 16 (0–22), 17 (7–21), 22 (11–24), and 22 (15–24) d, respectively (p = 0.023). Neonates in the severe-to-critical group had markedly fewer VFDs than those in the mild-to-moderate group (8.5 vs. 22 d, p < 0.001). Conclusions: Infants with PPHN from RDS had the fewest VFDs. A maximum OI > 40, use of multiple inotropic agents, AKI, and VAP were associated with a low number of VFDs. Given the retrospective, single-center design, these findings are associative and hypothesis-generating, requiring prospective multi-center validation. Nonetheless, VFDs remain a comprehensive measure of both mortality and respiratory morbidity in this population.

Background/Objectives: Placenta accreta spectrum (PAS) is associated with substantial maternal and perinatal morbidity and may lead to respiratory distress in newborns. However, limited evidence exists regarding predictors of respiratory compromise (RC) in neonates born to pregnancies complicated by PAS. Methods: This retrospective cohort study included neonates born to pregnancies complicated by PAS between 1 January 2014 and 31 December 2024. Independent predictors of RC were identified using logistic regression, and a weighted scoring model was developed. Model performance and internal validity were assessed using area under the receiver operating characteristic curve, calibration plots, and bootstrap re-sampling. Results: Among 237 neonates born to PAS-complicated pregnancies, 112 (47.3%) experienced RC. Six independent predictors were identified and assigned weighted points: maternal vaginal bleeding within 24 h before delivery (2 points); placenta type—accreta (reference), increta (1 point), and percreta (2 points); absence of antenatal corticosteroid use (1 point); gestational age—29–31 weeks (5 points) and 32–36 weeks (3 points); birth weight < 2500 g (2 points); and male sex (2 points). At a score threshold of 7, the model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.75, sensitivity of 67.6%, and specificity of 72.9%. Conclusions: A predictive score > 7 provides fair discrimination for identifying RC in neonates born to pregnancies complicated by PAS and may assist clinicians in identifying high-risk infants who require closer monitoring and early respiratory support.

Background/Objective: To identify the risks and outcomes of extensively drug-resistant Gram-negative bacilli (XDR-GNB) in neonates. Methods: This retrospective case–control study (1995–2024) included neonates with late-onset sepsis (n = 132) and XDR-GNB bacteremia (n = 26) compared with those without XDR-GNB (n = 106). Results: Median gestational age was 31 weeks and birth weight 1540 g. The prevalence of XDR-GNB was 19.7%. The most common XDR-GNB and non-XDR-GNB pathogens were Acinetobacter baumannii and Klebsiella pneumoniae. Sepsis onset occurred earlier in the XDR-GNB group than in the non-XDR-GNB group (7.0 vs. 12.5 days, p = 0.005). In multivariable analysis using Firth’s penalized likelihood method, the XDR-GNB group was more likely to have gastrointestinal anomalies (adjusted odds ratio 3.81, 95% confidence interval 1.24–12.01, p = 0.02) and history of umbilical arterial catheterization (adjusted odds ratio 3.04, 95% confidence interval 1.21–7.95, p = 0.02) compared to the non-XDR-GNB group. The XDR-GNB group had higher rates of septic shock (50.0% vs. 18.9%, p = 0.002) and inadequate empiric antimicrobial therapy (34.6% vs. 13.2%, p = 0.02). The non-susceptibility rates to third-generation cephalosporins, gentamicin, carbapenems, amikacin, and colistin were 83.3%, 58.3%, 48.1%, 30.4%, and 4.4%, respectively. Conclusions: Empirical colistin treatment is warranted for neonates in high-XDR environments who exhibit septic shock and have specific risk factors, such as gastrointestinal anomalies or the presence of an umbilical arterial catheter. Multimodal interventions, including antimicrobial stewardship programs, have been used to prevent or reduce the incidence of neonatal XDR-GNB sepsis.

Objectives: To identify factors associated with postnatal growth failure (PGF) in very-low-birth-weight (VLBW) infants and to develop a model for the early identification of neonates at risk. Methods: This retrospective cohort study included VLBW infants born between 2014 and 2024. PGF was defined using the 2013 Fenton growth chart. Multivariate logistic regression was used to identify predictors of PGF, and a weighted risk score was derived from their relative contributions. Model performance was evaluated using a receiver operating characteristic (ROC) curve. Results: Among 481 VLBW infants, 334 (69.4%) had PGF. Independent predictors were birth weight < 750 g (adjusted odds ratio [aOR] 8.11; 95% confidence interval [CI], 3.01–21.83), birth weight 750–1000 g (aOR 2.39; 95% CI, 1.35–4.21), multiple births (aOR 2.82; 95% CI, 1.71–4.67), pregnancy-induced hypertension (PIH) (aOR 3.32; 95% CI, 2.02–5.46), oligohydramnios (aOR 4.08; 95% CI, 1.68–9.92), no antenatal corticosteroid exposure (aOR 2.97; 95% CI, 1.65–5.36), and formula or mixed feeding (aOR 1.69; 95% CI, 1.08–2.64). The model showed good discrimination for scores ≥2 (area under the ROC curve, 0.736; sensitivity, 71.6%; specificity, 64.5%). Conclusions: Birth weight < 1000 g, multiple births, PIH, oligohydramnios, no antenatal corticosteroid exposure, and formula or mixed feeding were significant predictors of PGF. The score may support early risk stratification and prompt closer nutritional surveillance.

Background/Objectives: We investigated multimodal strategies to reduce neonatal ventilator-associated pneumonia (VAP) and antimicrobial use across three periods: period 1 (2014–2017), environmental cleaning with sodium hypochlorite, installation of heat and moisture exchangers, elective high frequency oscillatory ventilation (HFOV) as the primary invasive mode, and nasal HFOV after extubation; period 2 (2018–2020), oral care with maternal milk; and period 3 (2021–2024), nasal synchronized intermittent positive pressure ventilation after extubation. Methods: We conducted a quasi-experimental study of all neonates admitted to a neonatal intensive care unit in Thailand. We compared the trends in VAP and antimicrobial use rates using interrupted time-series analysis with segmented regression. Results: During the 11-year study period, 45.6% of neonates were intubated (2470/5414), and the ventilator utilization ratio was 0.19 (17,820 ventilator days/95,151 patient days). The overall VAP incidence was 4.55 per 1000 ventilator days. The yearly VAP incidence density ratio was significantly lower than in 2014. The baseline trend of VAP incidence and colistin use decreased significantly during period 1; nonetheless, the level and slope did not differ significantly between periods 1, 2, and 3. Conclusions: Tailored implementations, namely environmental decontamination, ventilator circuit care, elective HFOV, and nasal HFOV, reduced VAP and colistin use during period 1. Moreover, additive interventions, including oral care in period 2 and nasal synchronized intermittent positive pressure ventilation in period 3, achieved sustained VAP reduction and limited colistin prescriptions in period 1.

Acute kidney injury (AKI) is a significant clinical concern in neonates, threatening optimal outcomes. Early and accurate diagnosis is crucial; however, current methods lack sufficient sensitivity. This meta-analysis aimed to evaluate urinary kidney injury molecule-1 (uKIM-1) for AKI in neonates by quantifying differences in uKIM-1 levels between AKI and non-AKI neonates. We systematically searched major databases for comparative studies. Quality assessment was performed using the Newcastle-Ottawa Scale, and the certainty of the evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. A random-effects meta-analysis estimated the pooled Hedges’ g in uKIM-1 levels, accounting for heterogeneity. Subgroup analyses explored sources of heterogeneity (continent, study design, sampling time, AKI definition). Publication bias was assessed using Egger’s and Begg’s tests, as well as with a funnel plot. Data from 13 studies involving 552 neonates indicated a significant association between elevated uKIM-1 levels and AKI. High heterogeneity was observed (I² = 80.32%). The pooled Hedges’ g was 0.62 (95% CI: 0.16–1.07, p = 0.01). Subgroup analysis showed stronger associations in African studies (Hedges’ g = 2.12), those using KDIGO (Hedges’ g = 0.96), cohort studies, and sampling within 2–4 days (Hedges’ g = 0.76). No publication bias was detected. This meta-analysis synthesizes evidence on uKIM-1 as an AKI biomarker. While uKIM-1 shows promise, high heterogeneity and diagnostic performance warrant further research to improve AKI detection and management in neonates.

Background: Gut-lung crosstalk is a pathway involving interactions between the gastrointestinal, respiratory, and immune systems. The immune responses of the gut and lungs are intricately linked, and previous studies demonstrated that the gut microbiota can influence systemic immune responses in the respiratory system as well as bronchopulmonary dysplasia (BPD).Purpose: To analyze the composition of the gut microbiota in very low birth weight infants with versus without BPD.Methods: Secondary data from a previous randomized controlled trial were analyzed. Microbiomes were analyzed using QIIME 2 software. Gut microbiota diversity and abundance were compared between groups.Results: Fifty-one neonates were classified into the BPD (n=24) and non-BPD (n=27) groups, between which no differences were noted in the alpha and beta diversities of the gut microbiota. In both groups, Proteobacteria, Gammaproteobacteria, and Klebsiella were the predominant phylum, class, and genus in gut microbiota, respectively. Enterococcus, Acinetobacter, Elizabethkingia, Clostridium sensu stricto 1, Bacteroides, Streptococcus, and Serratia were more abundant, whereas Klebsiella, Faecalibacterium, Escherichia-Shigella, Enterobacter, Bifidobacterium, Veillonella, Staphylococcus, and Enterobacteriaceae were less abundant in the BPD versus non-BPD group. Faecalibacterium, Roseburia, Clostridium, Eubacterium, and Coprococcus were significantly more abundant in the non-BPD versus BPD group.Conclusion: The alpha and beta diversities of the gut microbiota did not differ significantly between the BPD and non-BPD groups. However, in terms of relative abundance, the presence of common respiratory pathogens was notable in the BPD group. Conversely, the non-BPD group had a significantly higher prevalence of anaerobic taxa known for their capacity to produce butyrate, a key component of postbiotics.

Background/Objectives: To identify the risk factors and clinical outcomes of persistent pulmonary hypertension of the newborn (PPHN) in very low birth weight (VLBW) infants in a resource-limited setting. Methods: We conducted a 1:4 matched case–control study in a Thai neonatal unit between 2014 and 2023. Neonates born at a gestational age (GA) < 32 weeks and with a birth weight (BW) < 1500 g were included. Neonates who died in the delivery room or had major congenital anomalies were excluded. Matching was based on GA, BW, year of birth, and endotracheal intubation at birth. Conditional logistic regression analysis was performed. Results: Over the 10-year study period, the incidence of PPHN among VLBW neonates was 4.6% (31/667). After matching, there were 31 cases and 124 controls. In univariable analysis, PPHN was significantly associated with lower 1 min and 5 min Apgar scores; however, no significant association remained in multivariable analysis. PPHN was significantly associated with composite adverse outcomes—including mortality and major morbidities (adjusted odds ratio [aOR] = 7.51, 95% confidence interval [CI]: 2.41–23.40), mortality alone (aOR = 2.88, 95% CI: 1.06–7.63), major morbidities (aOR = 2.99; 95% CI: 1.29–6.95), and severe neurological injury (aOR = 4.44, 95% CI: 1.56–12.59). Daily hospital costs were also higher in PPHN cases, with an average increase of 97.1 USD. Conclusions: In VLBW infants, PPHN was associated with a lower Apgar score and surfactant administration. PPHN was significantly linked to adverse outcomes, particularly mortality, major morbidities, and severe neurological injury.

Background/Objectives: Persistent pulmonary hypertension of the newborn (PPHN) is characterized by increased pulmonary vascular resistance, resulting in severe hypoxemia. This study determined the factors associated with increased risk of mortality and survival rate in infants with PPHN. Methods: This retrospective study was conducted between 2010 and 2023. The risk factors for mortality were assessed by Cox’s proportional hazard models, and the Kaplan–Meier survival curve was used to analyze the survival rates. Results: This study included 233 neonates with PPHN. Gestational age (GA) less than 28 weeks (adjusted hazard ratio [AHR] = 5.46, 95% confidence interval [CI]: 2.25–13.24, p < 0.001), Small for gestational age (SGA) (AHR = 2.93, 95% confidence interval [CI]: 1.24–6.92, p = 0.026), acute kidney injury (AKI) (AHR = 2.48, 95% CI: 1.27–4.84, p = 0.01), pneumothorax (AHR = 3.03, 95% confidence interval [CI]: 1.48–6.21, p = 0.003), vasoactive-inotropic score (VIS) at 24 h of age (AHR = 1.0026, 95% confidence interval [CI]: 1.0004–1.005, p = 0.026), and score for neonatal acute physiology II (SNAP-II) ≥ 43 (AHR = 4.03, 95% CI: 1.66–9.77, p = 0.005) were associated with an increased risk of mortality. The overall survival rate was 82.4%; it rose from 63.8% to 87.1% after inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO) were introduced (p < 0.001). The cumulative survival rates at the end of the 30 days were 62.1% (95% CI: 49.0–78.7) in the Pre-iNO era and 87.5% (95% CI: 82.7–92.6) in the Post-iNO/ECMO era, respectively (p < 0.001). Conclusions: GA less than 28 weeks, SGA, AKI, pneumothorax, high VIS and SNAP-II scores were associated with mortality in infants with PPHN. The improvement in the survival rate was related to the provision of advanced care, including iNO and ECMO therapy.