Gut Microbes and Circulating Cytokines in Preterm Infants with Growth Failure

Circulating extracellular vesicular microRNA signatures in early gestation show an association with subsequent clinical features of pre-eclampsia

In a prospective cohort of subjects who subsequently developed preeclampsia (PE, n = 14) versus remaining healthy (NORM, n = 12), early gestation circulating extracellular vesicles (EVs) containing a panel of microRNA signatures were characterized and their biological networks of targets deciphered. Multiple microRNAs of which some arose from the placenta (19MC and 14MC) demonstrated changes in association with advancing gestation, while others expressed were pathognomonic of the subsequent development of characteristic clinical features of PE which set in as a late-onset subtype. This panel of miRNAs demonstrated a predictability with an area under the curve of 0.96 using leave-one-out cross-validation training in a logistic regression model with elastic-net regularization and precautions against overfitting. In addition, this panel of miRNAs, some of which were previously detected in either placental tissue or as maternal cell-free non-coding transcripts, lent further validation to our EV studies and the observed association with PE. Further, the identified biological networks of targets of these detected miRNAs revealed biological functions related to vascular remodeling, cellular proliferation, growth, VEGF, EGF and the PIP3/Akt signaling pathways, all mediating key cellular functions. We conclude that we have demonstrated a proof-of-principle by detecting a panel of EV packaged miRNAs in the maternal circulation early in gestation with possibilities of biological function in the placenta and other maternal tissues, along with the probability of predicting the subsequent clinical appearance of PE, particularly the late-onset subtype.

Contemporary definitions of infant growth failure and neurodevelopmental and behavioral outcomes in extremely premature infants at two years of age

BACKGROUND

Associations of 2-year neurodevelopmental and behavioral outcomes with growth trajectories of preterm infants are unknown.

METHODS

This secondary analysis of a preterm cohort examined in-hospital and discharge to 2-year changes in anthropometric z-scores. Two-year follow-up included Bayley Scales of Infant Development (BSID-III) and Child Behavior Checklist.

RESULTS

Among 590 infants, adjusted in-hospital growth was not associated with any BSID-III subscale. Occipitofrontal circumference (OFC) growth failure (GF) in-hospital was associated with increased adjusted odds of attention problems (aOR 1.65 [1.03, 2.65]), aggressive behavior (aOR 2.34 [1.12, 4.89]), and attention-deficit-hyperactivity symptoms (aOR 1.86 [1.05, 3.30]). Infants with OFC GF at 2 years had lower adjusted BSID-III language scores (-4.0 [-8.0, -0.1]), increased odds of attention problems (aOR 2.29 [1.11, 4.74]), aggressive behavior (aOR 3.09 [1.00, 9.56]), and externalizing problems (aOR 3.01 [1.07, 8.45]) compared to normal OFC growth cohort.

CONCLUSION

Infants with OFC GF are at risk for neurodevelopmental and behavioral impairment.

CLINICAL TRIAL REGISTRATION

This study is a secondary analysis of pre-existing data from the PENUT Trial Registration: NCT01378273.

Contemporary Definitions of Infant Growth Failure and Neurodevelopmental and Behavioral Outcomes in Extremely Premature Infants at Two Years of Age

Introduction

The association of 2-year neurodevelopmental and behavioral outcomes with in-hospital or post-discharge growth failure (GF) using contemporary definitions for preterm infants is unknown.

Methods

In a secondary analysis of a preterm cohort, changes in anthropometric z-scores were examined between birth and hospital discharge, and from discharge to 2 years. The 2-year evaluation included Bayley Scales of Infant Development (BSID-III) and Child Behavior Checklist (CBCL).

Results

Among 629 infants, accelerated linear growth from birth to discharge was associated with higher BSID-III cognitive scores (+ 3.2 points [IQR 0.02, 6.4]) while in-hospital GF was not associated with any outcomes. Infants with weight GF after discharge had lower BSID-III motor scores (-3.1 points [-5.9, -0.2]). Infants with accelerated weight growth after discharge had increased odds of behavioral problems on the CBCL (aOR 1.9 [1.03, 3.5]).

Discussion

In-hospital and post-hospitalization growth metrics are modestly associated with neurodevelopmental outcomes with length gains apparently most beneficial.