Clarithromycin treatment in preterm infants: a pilot study for prevention of feeding intolerance

Abstract

Objective: To compare the effectiveness of oral clarithromycin versus placebo treatment in preventing feeding intolerance in very low birth weight (VLBW) infants.

Study Design: A prospective, randomised controlled trial in which two groups of preterm infants (birth weight <1500?g) were randomised to clarithromycin (7.5?mg/kg/dose every 12?h) or placebo treatment. During the period, 38 infants, whose parents accepted participation, were enrolled in the study. Feeding intolerance and time to achieve full enteral feeding were considered as primary outcome measures.

Results: Feeding intolerance was significantly longer in placebo than clarithromycin (p?=?0.031). Time to achieve full feeding after beginning the treatment was equal among the groups.

Conclusion: This is the first randomised controlled study of clarithromycin and placebo treatment that compares the improvement of feeding intolerance in VLBW infants. Our findings indicate a dramatic improvement in feeding intolerance after oral clarithromycin treatment. But according to our results, clarithromycin-treated infants were not able to attain full enteral feeding more quickly than placebo. This may be due to prophylactic usage of clarithromycin. Significant differences might have resulted if only infants who had feeding intolerance were recruited.     

Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study

Objectives: The objective of this study is to determine the association between mode of delivery (vaginal delivery [VD] versus cesarean section [CS]) and the rate of significant intraventricular hemorrhage (sIVH) in preterm infants.

Methods: A multicenter retrospective cohort study, based on data collected from the Vermont Oxford Network database. Infants born between 23 and 31⁺⁶ weeks of gestational age between 2001 and 2014 were identified. Exposure was the mode of birth (VD versus CS). Primary outcome was development of sIVH. Data were analyzed using univariate and multivariate statistical methods.

Results: A total of 1575 infants were eligible. Nine hundred and two infants were born by CS and 673 by VD. Univariable analysis showed that infants born vaginally were more likely to have sIVH (p?p?p?=?.010) and have a longer hospital stay (p?=?.006). After adjusting for available confounders, multivariable analysis persistently showed that infants between 23 and 27 weeks born by CS were less likely to develop sIVH [OR 1.61 (1.01–2.58), p?=?.049].

Conclusions: sIVH is less common in very preterm infants (23–27 weeks of gestation) delivered by CS. However, neurodevelopmental risks associated with survival at this early age, as well as increased maternal morbidities must also be considered.     

Maternal and neonatal outcomes of placenta increta and percreta from a multicenter study in China

Objective: The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.

Materials and methods: We retrospectively analyzed 2219 cases from 20 tertiary care centers in China between January 2011 and December 2015. All cases were diagnosed of placenta increta or placenta percreta, based on either intraoperative findings or histopathological findings.

Results: The incidence of placenta increta and placenta percreta progressively increased from 0.18% in 2011 to 0.78% in 2015. Compared with the placenta increta, placenta percreta was strongly related to serious adverse outcomes: postpartum hemorrhage (65.9% versus 38.6%, p?=?.003), blood transfusion (86.2% versus 46.5%, p?p?p?p?Conclusion: The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes.     

Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors

Purpose: To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors.

Methods: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically.

Results: Among 2419 patients, the rate of PPE was 1.6% (n?=?38) and was associated with lower age (27.0 versus 31.0; p?p?p?=?.0081). There was no difference in PPE for cefazolin 2?g versus 1?g (OR: 1.91; p?=?.17) or 3?g versus 1?g (OR: 3.69; p?=?.29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p?p?=?.001), sexually transmitted infection during the pregnancy (OR: 4.197; p?=?.02) or blood transfusion (OR: 9.50; p?Conclusions: While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.     

The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks

Purpose: To evaluate whether cerclage in twins reduces the rate of spontaneous preterm birth <32 weeks when compared to expectant management.

Methods: This is a retrospective cohort study of twin pregnancies with the following indications for cerclage from two institutions: history of prior preterm birth, ultrasound-identified short cervix ≤2.5?cm, and cervical dilation ≥1.0?cm. The “cerclage” cohort received a cerclage from a single provider at a single institution from 2003–2016. The “no cerclage” group included all patients with similar indications that were expectantly managed from 2010–2015, at a second institution where cerclages are routinely not performed in twin pregnancies. The primary outcome was the rate of spontaneous preterm birth at <32 weeks. Secondary outcomes were the rates of spontaneous and overall (including medically indicated) preterm births at <32 weeks, Results: In all, 135 women were included in two cohorts: cerclage (n?=?96) or no cerclage (n?=?39). The rates of spontaneous preterm birth <32 weeks were 10.4% (n?=?10) with cerclage versus 28.2% (n?=?11) without cerclage (OR 0.23, CI 0.08–0.70, p?=?.017). After adjusting for cerclage indication, clinical history, age, chorionicity, insurance type, race, BMI, in-vitro fertilization, and multifetal reduction, there remained a significant reduction in the cerclage group of spontaneous preterm birth <32 weeks (adjusted odds ratio (aOR) 0.24, CI 0.06–0.90, p?=?.035), spontaneous preterm birth <36 weeks (aOR 0.34, CI 0.04–0.81, p?=?.013) as well as in overall preterm birth <32 weeks (aOR 0.31, CI 0.1–0.86, p?=?.018), and overall preterm birth <36 weeks (aOR 0.37, CI 0.10–0.84, p?=?.030). When stratified by short cervix or cervical dilation in the cerclage versus no cerclage groups, there was a significant decrease in spontaneous preterm birth <32 weeks in the cerclage group with cervical dilation (11.1 versus 41.2%, p?=?.01) but not in the cerclage group with short cervix only, even for cervical length <1.5?cm. Pregnancy latency was 91 days in the cerclage group versus 57 days in the no cerclage group (p?=?.001), with a median gestational age at delivery of 35 versus 32 weeks (p?=?.002). There was no increase in chorioamnionitis in the cerclage group. Furthermore, there was a significant increase in birth weight (median 2278 versus 1665?g, p?p?=?.001).

Conclusions: Cerclage in twin pregnancies significantly decreased the rate of spontaneous preterm birth <32 weeks compared to expectant management. However, when stratified by cerclage indication, this decrease in primary outcome only remained significant in the group with cervical dilation.     

Glycated albumin level during late pregnancy as a predictive factor for neonatal outcomes of women with diabetes

Purpose: To investigate the association between glycated albumin (GA) in diabetic mothers and complications in their children, and to determine GA cutoff values for predicting complications in infants.

Materials and methods: This hospital-based case-control study involved 71 Japanese diabetic mothers and their children. Mean GA values were compared between mothers of infants with and without complications, and relationship with number of complications was analyzed by Pearson’s correlation. Receiver operating characteristic analysis determined GA cutoff values for complications in infants.

Results: GA was significantly higher in mothers of children with neonatal hypoglycemia (15.8?±?3.2 versus 12.6?±?1.2%, p?<.001), respiratory disorders (15.7?±?3.6 versus 12.9?±?1.9%, p?<.001), hypocalcemia (15.9?±?3.7 versus 13.1?±?1.8%, p?<.001), polycythemia (15.7?±?2.3 versus 13.8?±?2.1%, p?=.009), myocardial hypertrophy (16.1?±?3.7 versus 13.1?±?2.3%, p?<.001), and large-for-date status (15.8?±?2.4 versus 13.7?±?3.1%, p?=?.006), showing significant positive correlation with number of complications in infants (r?=?.704, 95%CI: 0.579–0.797, p?Conclusions: GA is useful for predicting pregnancy outcomes in mothers with diabetes and must be maintained at low levels to prevent complications in infants.     

Maternal and neonatal outcomes among scheduled versus unscheduled deliveries in women with prenatally diagnosed,pathologically proven placenta accreta

Objective: To evaluate maternal and neonatal outcomes among scheduled versus unscheduled deliveries in cases of prenatally diagnosed, pathologically proven placenta accreta.

Study design: Retrospective cohort of placenta accreta cases delivered in five University of California hospitals.

Results: Of 151 cases of histopathologically proven placenta accreta, 82% were prenatally diagnosed. Sixty-seven percent of women underwent scheduled deliveries and 33% were unscheduled. There were no differences in demographics between groups except a higher rate of antepartum bleeding in the unscheduled delivery group (81 versus 53%; p?=?.003). Scheduled deliveries were associated with a later gestational age at delivery (34.6 versus 32.6 weeks; p?=?.001), lower blood loss (2.0 versus 2.5?l; p?=?.04), higher birth weight (2488 versus 2010?g; p?p?=?.03) and neonatal length of stay (12 versus 20 d; p?=?.005).

Conclusion: Despite a prenatal diagnosis of placenta accreta, 1/3 of these cases require unscheduled delivery, portending poorer maternal and neonatal outcomes.     

Discharge breastmilk feeding rates in asymptomatic term newborns admitted to the neonatal intensive care unit for maternal chorioamnionitis

Purpose: To compare discharge breastmilk feeding rates among asymptomatic term newborns receiving 48-hour versus >48-hour antibiotics in the neonatal intensive care unit (NICU) and a cohort of well-baby nursery (WBN) newborns.

Materials and methods: This retrospective review included asymptomatic term neonates admitted to the NICU due to maternal chorioamnionitis and a comparison group of WBN neonates between January 2012 and December 2015. Demographic, birth, feeding, and lactation consultant visit data were analyzed in univariate and multivariate models.

Results: Among 272 NICU neonates, 237 (87%) received 48-hour antibiotics versus 35 (13%) who received >48-hour (h) antibiotics; a cohort of 428 WBN neonates was studied for comparison. Exclusive breastmilk feeding was seen in 14% of NICU versus 35% of WBN neonates (p?48?h antibiotics was not associated with altered discharge breastmilk feeding (14 versus 14%; p?=?.89). On multivariate logistic regression analysis among NICU subjects, older maternal age (p?p?=?.02), first-feed breastmilk (p?p?=?.012) were associated with increased discharge breastmilk feeding.

Conclusions: NICU admission for presumed early-onset sepsis due to maternal chorioamnionitis was associated with reduced discharge breastmilk feeding in asymptomatic term neonates, but prolonged antibiotic exposure was not. We speculate that demographic factors, such as maternal age and parity, may aid in focusing lactation consultant efforts to potentially improve NICU exclusive discharge breastmilk feeding rates.     

Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study

Purpose: Placenta previa (PP) is a major cause of obstetric hemorrhage. Clinical diagnosis of complete versus incomplete PP has a significant impact on the peripartum outcome. Our study objective is to examine whether distinction between PP classifications effect anesthetic management.

Methods and materials: This multi-center, retrospective, cohort study was performed in two tertiary university-affiliated medical centers between the years 2005 and 2013. Electronic delivery databases were reviewed for demographic, anesthetic, obstetric hemorrhage, and postoperative outcomes for all cases.

Results: Throughout the study period 452 cases of PP were documented. We found 134 women (29.6%) had a complete PP and 318 (70.4%) had incomplete PP. Our main findings were that women with complete PP intraoperatively had higher incidence of general anesthesia (p?=?.017), higher mean estimated blood loss (p?p?p?p?p?=?.02), a longer median postoperative care unit (PACU) (p?=?.02), ICU (p?=?.002), and overall length of stay in the hospital (p?Conclusions: Complete PP is associated with increased risk of hemorrhage compared with incomplete PP. Therefore distinction between classifications should be factored into anesthetic management protocols.     

The association between obstetrical history and preterm birth in women with uterine anomalies

Objective: To estimate the association between obstetric history and preterm birth in women with uterine anomalies.

Methods: This was a retrospective cohort study of women with uterine anomalies managed by one maternal–fetal medicine practice from 2005 to 2016. Women were separated into three groups based on their most recent pregnancy outcome: preterm birth <37 weeks, nulliparous, and term birth. Delivery outcomes were compared across the three groups, with the primary outcome being preterm birth <37 weeks. A subgroup analysis was performed in women with major uterine anomalies (unicornuate, bicornuate, and didelphys).

Results: A total of 283 women with uterine anomalies were included. Preterm birth <37 weeks was 60.4% in women with prior preterm birth versus 18.2% in nulliparous women, versus 15.8% in women with a prior term birth (p?p?=?.635). Among the 118 women with major uterine anomalies, the likelihood of preterm birth was also highest in the prior preterm birth group (71.4 versus 26.1 versus 25.0%, p?p?=?.906).

Conclusions: In women with uterine abnormalities, a prior preterm birth is significantly associated with recurrent preterm birth. However, a prior term birth does not lower the risk of preterm birth as compared to nulliparous women.     

The association between maternal race and adverse outcomes in twin pregnancies with similar healthcare access

Objective: To compare twin pregnancy outcomes between white and nonwhite women with similar access to health care.

Methods: Retrospective cohort study of all twin pregnancies delivered by a single maternal–fetal medicine practice from 2005–2016. All patients had private health insurance and equal access to physician care. Outcomes were compared between white and nonwhite women using logistic regression to adjust for differences at baseline.

Results: Of the 858 women included, 730 (85.1%) were white and 128 (14.9%) were nonwhite. Univariate analysis demonstrated that nonwhite women had higher rates of preterm birth <32 weeks (12.5 versus 6.7%, p?=?.022), cesarean delivery (78.1% versus 61.4% of all women, p?p?p?=?.029) and gestational diabetes (23.2% versus 7.3%, p?Conclusions: Nonwhite women with twin pregnancies have an increased risk of adverse outcomes that cannot be explained by access to care. Although improving access to care is an important goal for health care systems, our data suggest that this alone will not eliminate all disparities in health care outcomes between women of different races.     

The association of different progesterone preparations with preterm birth prevention

Objective: We aimed to compare the efficacy of commonly available progesterone preparations for preterm birth prevention.

Methods: A retrospective cohort study of all women treated with progesterone to prevent preterm birth and delivered in a single university-affiliated tertiary medical-center. Four progesterone preparations were compared: vaginal Endometrin 100?mg twice daily, vaginal Crinone 8% gel 90?mg daily, vaginal Utrogestan 200?mg daily, and intramuscular 17α-hydroxyprogesterone caproate (17-OHPC) 250?mg weekly. All women were considered at risk for preterm birth according to: prior preterm birth or cervical length below 25?mm measured during the second trimester. Significant maternal morbidity, pregnancy achieved by artificial reproductive technique and cerclage placement were excluded. Primary outcome was the rate of preterm birth prior to 37 weeks of gestation.

Results: Overall, 422 women were allocated to four study groups according to progesterone preparation: Endometrin 175 (41.5%), Crinone 73 (17.3%), Utrogestan 154 (36.5%), and 17-OHPC 20 (4.7%). Rates of preterm birth prior to 37 gestational weeks were lowest on the Endometrin treatment group (12.6 versus 20.5, 17.5, and 35% in the rest, p?=?.05). Multivariate analysis revealed that the progesterone preparation was associated with preterm birth prior to 37 gestational weeks (LR?=?8.3, p?=?.004). The need for maternal red blood cells transfusion was significantly higher in the Endometrin subgroup (4% versus 0 in all others, p?=?.018). This finding remained significant after adjustment to potential confounders (LR 16.44, p?Conclusions: Different progesterone preparations prescribed to women at risk, may possess different efficacy in preventing preterm delivery prior to 37 weeks of gestation.     

Sonographic assessment of the lower uterine segment during active labor in women with or without a uterine scar – a prospective study

Objectives: No study thus far has evaluated the LUS thickness in active labor. In this study, we endeavored to assess the LUS during active labor.

Methods: Using transabdominal sonography in the mid-sagittal position with a full urinary bladder, the thickness of the LUS was measured during active labor phase in women with or without a history of a previous cesarean section.

Results: A total of 28 women with a previous cesarean delivery were compared to 29 women without a history of uterine surgery. The median LUS was significantly thinner in women with a uterine scar both during (4 versus 5?mm, p?=?.001) and between contractions (5 versus 7?mm, p?=?.011). Paired comparison of LUS thickness between and during contractions within each group showed that thinning of LUS during contraction was significant for both the previous CS group (p?p?Conclusions: In this study, we characterized for the first time the LUS during active labor. We found that LUS was significantly thinner in women after a previous CS and that the LUS was significantly thinner during contraction.     

Meconium aspiration syndrome: risk factors and predictors of severity

Purpose: To identify risk factors and predictors of severity associated with meconium aspiration syndrome (MAS) in the patients admitted to the neonatal intensive care unit (NICU).

Materials and methods: Retrospective study including newborns admitted, between 2005 and 2015, with a diagnosis of MAS.

Results: Of the newborns admitted to the NICU, 0.66% were diagnosed with MAS. These had higher prevalence of caesarean delivery (p?p?p?=?.002), Apgar scores at the first minute <7 (p?p?p?=?.001) and 73.3% had pulmonary hypertension (p?=?.027). They required significantly more days of oxygen therapy, mechanical ventilation, nitric oxide, inotropic, and surfactant therapy, as well as longer hospital stay.

Conclusions: Nonreassuring or abnormal CTG and low Apgar score at the first minute were established as risk factors for MAS and need of surfactant therapy as a predictor of severity.     

Does rapid enteral feeding increase intestinal morbidity in very low birth weight infants? A retrospective analysis

Purpose: To investigate the association of a standardized rapid enteral feeding strategy (established in 2011 in our unit) with intestinal morbidity in very low birth weight (VLBW) infants.

Methods: A total of 301 inborn VLBW infants were included in this single-centre retrospective cohort study. We compared the incidence of intestinal morbidity (defined as necrotizing enterocolitis or intestinal perforation) in slowly enterally fed infants in 2008–2010 (10?ml/kg/day increase of milk feeds) to a corresponding cohort of rapidly enterally fed infants in 2011–2013 (20?ml/kg/day increase of milk feeds). Univariate and multivariable logistic and linear regression analyses, respectively, were performed to control for confounding variables.

Results: Both groups were similar regarding baseline demographic and perinatal characteristics. In univariate modeling, intestinal morbidity did not significantly differ between the two groups (p?=?0.25), neither did all-cause mortality nor incidence of late onset sepsis in multivariable modeling. In contrast, length of hospital stay (HS) and duration of parenteral nutrition (PEN) were significantly shorter in the rapid group (HS: ?8.35 days, p?=?0.012 and PEN: ?7.13 days, p?Conclusions: Implementation of a more rapid enteral feeding regime is safe in VLBW infants and may significantly shorten length of HS and PEN in this cohort.     

Relationship between advanced glycation end products and gestational diabetes mellitus

Objective: To investigate the levels of and dynamic changes of advanced glycation end products (AGEs) in maternal plasma during pregnancy and explore the association between these levels and gestational diabetes mellitus (GDM).

Methods: This study recruited 90 GDM women and 90 healthy pregnant controls. The women received prenatal care and were hospitalized for delivery in Peking University First Hospital in China between October 2015 and April 2016. The patients were recruited and provided blood samples during gestational weeks 24–29. The levels of AGEs, TNF-α, hs-CRP, plasma glucose, and FINS and lipid profiles were measured, and HOMA-IR was calculated. New blood samples were collected and AGE was measured again in the two groups at 33–41 weeks of gestation to identify its dynamic changes.

Results: The levels of AGEs were significantly higher in the GDM group than in the NGT group at both 24–29 weeks (473.65?±?105.32 versus 324.36?±?57.86?ng/L; p?p?p?p?=?.003), TNF-α (p?=?.005), and hs-CRP (p?p?=?.001). In the NGT group, there was no significant change in the concentration of AGEs between the two gestational periods (p?=?.388).

Conclusions: Plasma levels of AGEs are associated with GDM. During pregnancy, the changes observed in the levels of AGEs were different between GDM and normal pregnancies.     

Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants?

Objective: Examine the association between placental inflammation and neonatal infections, and 25OH vitamin D (25OH D) levels at birth among very low birth weight infants (VLBWI).

Study design: Serum 25OH D levels were measured in 89 VLBWI (≤1250?g) and 47 mothers on day one, and in 78 infants on day 21. Placentas were examined for maternal and fetal inflammation. Infants were divided into deficient (≤10?ng/ml) and adequate (>10?ng/ml) groups based on 25OH D levels on day 1.

Results: Mean?±?SD maternal levels of 25OH D (21?±?9?ng/ml) correlated with infants’ levels (15?±?8?ng/ml), (p?p?=?.011). Infants’ 25OH D levels rose significantly by day 21 (p?p?>?.05). Logistic regression analyses revealed no association between deficient 25OH D levels and the odds of maternal or fetal inflammation or other infections. Levels of 25OH D did not correlate with severity of placental inflammation.

Conclusions: Deficient levels of 25OH D at birth are not associated with the occurrence of placental inflammation or neonatal infections among VLBWI.     

Adolescence and risk of preterm birth in multifetal gestations

Objective: The objective of this study is to evaluate if adolescence confers additional risk for preterm delivery in multifetal gestations.

Methods: This is a retrospective review of all twin and triplet deliveries from 8/2008 to 12/2012 at two Detroit Hospitals. Outcomes in adolescent mothers aged 19 or younger (n?=?59) were compared with adult controls aged 20–34 (n?=?350).

Results: Mean gestational age at delivery in adolescents was 31.3 (SD: 5.8) weeks versus 34.2 (SD: 4.3) weeks in adults (p?p?=?.02) and early-preterm delivery (aOR, 2.2; 95% CI 1.2–4; p?=?.01). Adjusted rates of preterm and early-preterm delivery were markedly higher in adolescents compared with controls. Being an adolescent was also a significant risk factor for iatrogenic preterm delivery (aOR, 2.4; 95% CI 1.1–5.5; p?=?.04).

Conclusions: Adolescents pregnant with twins or triplets deliver 3 weeks, on average, before adults and are at markedly increased risk of preterm and early-preterm delivery.     

Intervention for promoting breast milk use in neonatal intensive care unit: a pilot study

Abstract

Objective: The health benefits provided by breast milk are significant in preterm infants. Despite recommendations, rates of breastfeeding in preterm infants are lower than in term infants. The aim of this study was to evaluate the efficacy of a multidisciplinary intervention in promoting any breastfeeding in preterm infants at discharge.

Methods: A prospective non-randomized interventional cohort study was conducted. One hundred and twenty-two preterm infants constituted the historical group. A multidisciplinary intervention was performed including staff training and setting up and implementation of a written breastfeeding procedure.

Results: One hundred and ten preterm infants were enrolled in the intervention group. The percentage of infants fed human milk at discharge was 69 and 62 in the intervention group and in the historical group, respectively. The percentage change from any breastfeeding at full enteral feeding attainment to formula feeding at discharge was lower in the intervention group than in the historical group (?9 versus ?23). Belonging to the intervention group and having at least one stress factor during pregnancy were independently associated with any breast milk feeding at discharge.

Conclusions: The multidisciplinary intervention performed appears to be effective in promoting any breastfeeding in preterm infants at discharge.     

High frequency jet ventilation in preterm infants: experience from Western Australia

Objective: To assess if high frequency jet ventilation (HFJV) is associated with reduced odds of death or discharge home on oxygen in preterm infants.

Methods: A case control study (1 February 2010 – 1 June 2014) comparing the primary outcome as “death or discharge home on oxygen” in preterm infants who needed HFJV (Cases) versus those who did not (Controls). Controls were matched to cases (1:1) on gestation, birthweight, gender, place of birth, growth status, antenatal glucocorticoids, and dexamethasone as treatment for severe bronchopulmonary dysplasia (BPD). Logistic regression analysis was used to control for confounders.

Results: Data on all preterm infants who needed HFJV (Cases: n?=?50) and 50 controls during the study period were analysed. Primary outcome was more frequent in cases versus controls, but not significant after adjusting for mean airway pressure and adjuvant therapy (e.g. diuretics) [aOR: 1.46 (0.23–9.14), p?=?.687]. Death before discharge [odds ratios (OR): 6.00 (1.34–55.2), p?=?.013] was more frequent in cases; discharge on home oxygen [OR: 0.88 (0.27–2.76), p?=?1.000] was comparable between groups. Duration of oxygen [adjusted hazard ratios (aHR): 1.23 (0.69–2.17), p?=?.475] and incidence of treatment warranting retinopathy of prematurity [aOR: 0.10 (0.01–1.96), p?=?.127] was not significant between cases versus controls.

Conclusions: HFJV was not associated with reduced odds of death or discharge home on oxygen in preterm infants in our study. Adequately powered randomized trials are required to assess the efficacy and safety of HFJV in preterm infants.