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Expanding routine neonatal screening to include a metabolic susceptibility profile could lead to earlier detection of life-threatening complications in premature babies, according to a study by researchers at UC San Francisco. The new method, developed at UCSF, offers valuable and time-sensitive insights into which infants are at greatest risk in their most vulnerable time immediately after birth.

The study, published in Nature Pediatric Research by scientists from the UCSF California Preterm Birth Initiative (PTBI-CA), evaluated the records of 9,639 preterm infants who experienced mortality or at least one complication or mortality.

Using the results of standard neonatal profiles and blood tests, they identified a combination of six neonatal traits and 19 metabolites that together created a susceptibility profile that reliably identified premature babies at significantly increased risk of death and serious illness.

“Our results indicate a number of potential biological pathways that can play key roles in developing negative outcomes in premature infants,” said the study’s lead author, Scott Oltman, MS, Epidemiologist, UCSF PTBI-CA. “If we can better understand these pathways, new treatments or preventive measures may be possible.”

Metabolites are molecules like glucose or thyroid stimulating hormone (TSH) that are naturally produced by our cells when we break down foods or drugs. In a newborn, these molecules can be found in the mother’s bloodstream or made by the infant and can be used to help assess whether the body is functioning normally.

Of particular note are the research team’s findings that black babies are 35 percent more likely to die or experience serious complications than white babies, including serious respiratory and digestive disorders known as respiratory distress syndrome and necrotizing enterocolitis.

“We are particularly excited about the potential of these metabolic models to address critical inequalities in outcomes in black infants,” said senior author Laura Jelliffe-Pawlowski, Ph.D., MS, professor of epidemiology and biostatistics at the UCSF School of Medicine and Director for Discovery and Precision Health at PTBI-CA. “Going forward, we should be able to create personalized care plans for each premature baby to reduce racial and ethnicity disparities in outcomes.”

Advances in science have enabled even the most fragile premature babies to survive in larger numbers and at younger gestational ages. In the United States, approximately 1 in 10 living babies are born prematurely. However, premature birth and associated comorbidities are the leading cause of death in US children under the age of five. Newborns (newborns) account for 46 percent of the mortality in this age group.

Previous models attempting to predict complications after a premature birth relied only on the child’s gestational age, birth weight, and other clinical characteristics. This study expanded the traits to include maternal factors such as race, mother’s age, and education. 19 molecules such as TSH and glycine were also identified which also contributed to the prediction. These metabolites are routinely tested in newborn screenings, but are not scored as a composite. These metabolites play important roles in many biological pathways, including digestion, respiration, and temperature regulation.

“Some of the avenues we have identified could offer advances in intervention and ultimately lead to fewer deaths and a reduction in short- and long-term disability in premature babies,” said Jelliffe-Pawlowski.

This study paves the way for further research on how these models can help premature babies. The next phase of this study will be funded by the National Institutes of Health and will begin fall through 2025. In California and Iowa, 100 premature babies will be enrolled to test how well the newly identified metabolic models are working in the neonatal intensive care unit (NICU). the settings. As part of this work, PTBI-CA researchers will work with the Benioff Center for Microbiome Medicine to examine the microbiomes of babies in the new study and identify additional drivers for both short and long-term outcomes.

Premature babies can catch up with their immune systems, as studies from the University of California in San Francisco show

Quote: Advanced Newborn Screening Could Save the Lives of Premature Babies (2020, October 7th), released October 7th, 2020 at https://medicalxpress.com/news/2020-10-newborn-screening-premature-infants.html was retrieved

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