• Caffeine therapy for treatment of apnea of prematurity has been well established over the past few years. The optimal loading and maintenance dose of caffeine in preterm infants is not well-studied. What is New: • This double blind randomized controlled trial demonstrated that using a higher, than current standard, loading and maintenance doses of caffeine for treatment of apnea in preterm infants is well tolerated and significantly decrease the frequency of apnea.

Chorioamnionitis is a major cause of maternal and neonatal morbidity. The term refers to inflammation of the amniotic fluid, membranes, placenta, and/or decidua and has been strongly associated with premature labor, occurring in 30% of babies born after premature labor with intact membranes and in 75% with premature rupture of membranes (PROM). 1 The incidence of chorioamnionitis varies considerably depending on the gestational age at the time of delivery, with rates as high as 41% in those born at less than 27 weeks' gestation, 15% between 28 to 36 weeks' gestation, and 2% at term gestation. 2 Most cases of chorioamnionitis are a consequence of intra-amniotic infection that has four main sources including ascending infection through the vagina, hematogenous spread through the placenta, retrograde seeding from AbstractChorioamnionitis contributes to neonatal and maternal morbidity and mortality. We aimed to evaluate of the impact of clinical and histological chorioamnionitis on mortality and morbidity of preterm infants. Maternal and neonatal data were collected in a retrospective cohort of preterm infants less than 30 weeks' gestation. Infants were divided into three groups: those born to mothers with clinical chorioamnionitis, histological chorioamnionitis, or no chorioamnionitis. Of 274 identified preterm infants, 33 infants were born to mothers with clinical chorioamnionitis, 95 to mothers with histological chorioamnionitis, and 146 to mothers with no chorioamnionitis. Data were available for 180 (78%) of the 230 survivors at 18 months corrected age. Infants in the study groups were similar in gestational age, birth weight, and sex distribution. Clinical and histological chorioamnionitis were not predictive of infant mortality, cerebral palsy, bronchopulmonary dysplasia, periventricular leukomalacia, or retinopathy of prematurity. Infants in the clinical chorioamnionitis group had significantly lower cognitive (88 AE 10), language (82 AE 12), and motor (89 AE 11) scores compared with infants in the histological chorioamnionitis group (101 AE 13, p < 0.01; 91 AE 13, p < 0.05; and 99 AE 13, p < 0.05, respectively) and to infants in the no chorioamnionitis group (99 AE 13, p < 0.01; 92 AE 15, p < 0.05; and 97 AE 13, p < 0.05, respectively). Clinical chorioamnionitis is associated with developmental delay in preterm infants despite adequate treatment.

Prolonged infusion of meropenem in neonates with GN-LOS is associated with higher clinical improvement, microbiologic eradication, less neonatal mortality, shorter duration of RS and less acute kidney injury compared with the conventional strategy.