Objective To evaluate vitamin D status in very low birth weight (VLBW) infants and response to vitamin D intake. Study design In this prospective cohort study of VLBW infants, 25-hydroxyvitamin D [25(OH)D] was measured regularly starting at birth. Daily vitamin D intake was estimated from parenteral and enteral sources. Results Of the included 83 infants born between November 2016 and March 2018, 44 (53%) had 25(OH)D < 30 ng/mL at birth but achieved vitamin D sufficiency (VDS) by 3 weeks while receiving 120–400 IU/day. Twenty-three (27.7%) infants had at least one 25(OH)D level >100 ng/mL during the study period. Infants whose intake was > 600 IU/day had higher prevalence of vitamin D excess (VDE). Conclusion In our study, low 25(OH)D was common in VLBW infants at birth. Vitamin D intake of 120–260 IU/day from parenteral and 200–400 IU/day from enteral route was appropriate for VLBW infants to achieve VDS. Doses > 600 IU/day increased risk of VDE.

Objective: To evaluate the effect of the 2015 NRP recommendations of no routine endotracheal suctioning for non-vigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. Design: This was a single-center retrospective cohort study. We recorded data on Non-vigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n=95 (before the new guidelines, Jan 01, 2013-Dec 31, 2015) and prospective period 2, n=91 (after the implementation of new guidelines, Jan 01, 2017- Dec 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. Results: No significant differences in the occurrence of MAS ( 11% vs. 17% ) (Odds ratio of 1.46 (95% CI- 0.59-3.55)) or death (1% vs. 3% ) (Odds Ratio of 2.00 (95% CI- 0.18-21.57)) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37% vs. 61%), with an Odds Ratio of 2.31 (95% CI -1.10-4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12% vs. 28%) with an Odds ratio (OR) of 2.03 (95% CI- 1.02-4.51); p-value of 0.05). Conclusion: Our study did not observe a significant difference in the incidence of MAS or Death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased.

Objective The COVID-19 pandemic is of special concern for pregnant women. A growing body of evidence suggests the virus can have a deleterious impact upon outcomes related to birth and newborn health. There is a paucity of published research demonstrating the factors that influence disease severity among those who are pregnant, while a growing body of evidence demonstrates that vertical transmission occurs. Our study investigated the impact of maternal characteristics upon COVID-19 outcomes, as well as whether disease severity impacted pregnancy outcomes. Methods We conducted a retrospective cohort study of pregnant women with COVID-19 who were admitted to two public hospitals in our state between April-August, 2020. Pregnancy outcomes and clinical, laboratory, and placental data were collected. Results Thirty-four pregnant women tested positive for SARS-CoV-2. Among them, 55% (19/34) were symptomatic. Of those who were symptomatic, 68% (13/19) presented with fever and cough. Those with symptoms had a statistically significant higher pregestational mean body mass index (BMI) compared with asymptomatic women (35.7±7.9 vs 26.7±6.9, P =0.004). Screening of biochemical records demonstrated that symptomatic women had lower potassium levels compared with those who were asymptomatic (median: 3.70 mEq/L vs 4.30 mEq/L, P =0.009). The lowest potassium level (3.0 mEq/L) and one of the highest BMIs (42.4 kg/m 2 ) was observed in the only case of postpartum mortality among the symptomatic women. We did not observe any influence of maternal COVID-19 severity on placental histopathology/infant health or evidence of vertical transmission. Conclusion High pregestational BMI and lower potassium levels were associated with the presence of COVID-19 symptoms among pregnant women.

Term infants born with MSAF and who experienced respiratory distress had significantly lower levels of ACTH and cortisol at birth compared with well term infants born with MSAF or clear amniotic fluid. This study suggests that inadequate response of ACTH and cortisol hormones may play a role in the development of respiratory distress in term infants with MSAF.