AIM To compare the early postnatal pattern of systemic inflammation in growth-restricted infants born before the 28th week of gestation to that of appropriately grown peers. METHODS We measured the concentrations of 25 inflammation-related proteins in blood spots collected from 939 newborns during the first 2 postnatal weeks. We calculated the odds ratios (99% confidence intervals) that concentrations would be in the highest quartile. RESULTS Severely growth-restricted infants (birth weight Z-score < -2) were not at increased risk of systemic inflammation shortly after birth. On postnatal day 14, however, they were significantly more likely than their peers to have a CRP, IL-1β, IL-6, TNF-α, IL-8, MCP-4, ICAM-1, ICAM-3, E-SEL, MMP-9, VEGF-R2, and/or IGFBP-1 concentration in the highest quartile. These increased risks could not be attributed to delivery indication, bacteremia, or duration of ventilation. CONCLUSION Growth-restricted preterm newborns appear to be at increased risk of elevated concentrations of inflammation-associated proteins by postnatal day 14.

Aim Compared to infants born at term, children born very preterm are at increased risk of visual dysfunctions, and neonatal systemic inflammation. Here we explore if these two propensities are related. Methods As part of the ELGAN study, the concentrations of 16 mediators of inflammation were measured in blood obtained on postnatal days 1, 7, 14, 21 and 28 from 1062 children born before the 28th week of gestation. Presence of visual field deficit, strabismus, and/or impaired visual fixation was recorded at age two. The concentrations of each protein were divided into quartiles within gestational week categories. We calculated odds ratios with 99% confidence intervals for having each disorder comparing children with concentration in the top quartile of each protein to children whose concentration was in the lower quartiles on the corresponding day. Analyses were adjusted for gestational age and birth weight Z-score. Results Only one of 90 assessments (16 proteins on 5 different days) was significant for visual field deficit, and one for impaired fixation. No association was found between strabismus and any inflammatory mediator. Conclusion None of the three neuro-ophthalmologic dysfunctions assessed at two years appears to be associated with systemic inflammation measured the first four postnatal weeks.

Objective To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks of gestation). Design The Extremely Low Gestational Age Newborn (ELGAN) Study, a prospective cohort. Setting Ten‐year follow‐up of extremely preterm infants born at 14 US hospitals between 2002 and 2004. Methods Prenatal tobacco smoke exposure was defined as a mother’s report at enrolment of active (i.e. maternal) and passive smoking during pregnancy. Poisson regression with generalized estimating equations was used. Models adjusted for mother’s age, race/ethnicity, education, insurance, pre‐pregnancy body mass index, US region, multiple gestation and infant’s sex; and in sensitivity analysis, gestational age at delivery and clinical subtype of preterm birth, given their classification as intermediate and non‐confounding variables. Main outcomes Neurological impairment at 10 years, epilepsy, cerebral palsy and cognitive impairment. Results Of 1200 ELGAN study survivors, 856 were assessed at 10 years of age with neurological outcomes, of whom 14% (118/856) had active tobacco exposure during pregnancy and 24% (207/852) had passive tobacco exposure. Compared with children who were not exposed prenatally to tobacco, children exposed to active tobacco use during pregnancy had a higher risk of epilepsy (14% versus 5%; adjusted relative risk: 1.68, 95% CI 1.45–1.92). This risk remained after adjustment for gestational age at delivery and clinical subtype of preterm birth. Prenatal tobacco smoke exposure was not associated with other assessed neurological outcomes, including cerebral palsy and multiple measures of cognitive impairment. Conclusions Among children born extremely preterm, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life. Tweetable abstract Among infants born before 28 weeks of gestation, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life.