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Cai S, Thompson DK, Anderson PJ, Yang JYM. Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis. CHILDREN-BASEL 2019; 6:children6120131. [PMID: 31805647 PMCID: PMC6956113 DOI: 10.3390/children6120131] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 01/23/2023]
Abstract
Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birthweight), but the long-term functional outcomes are unclear. The objective of this systematic review was to identify observational studies comparing neurodevelopmental outcomes in very preterm infants who had blood culture-proven neonatal sepsis with those without sepsis. Twenty-four studies were identified, of which 19 used prespecified definitions of neurodevelopmental impairment and five reported neurodevelopmental outcomes as continuous variables. Meta-analysis was conducted using 14 studies with defined neurodevelopmental impairment and demonstrated that very preterm infants with neonatal sepsis were at higher risk of impairments, such as cerebral palsy and neurosensory deficits, compared with infants without sepsis (OR 3.18; 95% CI 2.29–4.41). Substantial heterogeneity existed across the studies (I2 = 83.1, 95% CI 73–89). The five studies that reported outcomes as continuous variables showed no significant difference in cognitive performance between sepsis and non-sepsis groups. Neonatal sepsis in very preterm infants is associated with increased risk of neurodevelopmental disability. Due to the paucity of longitudinal follow-up data beyond 36 months, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.
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Affiliation(s)
- Shirley Cai
- Victorian Infant Brain Study, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia; (S.C.); (P.J.A.)
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Melbourne Medicine School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Deanne K. Thompson
- Victorian Infant Brain Study, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia; (S.C.); (P.J.A.)
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
- Correspondence:
| | - Peter J. Anderson
- Victorian Infant Brain Study, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia; (S.C.); (P.J.A.)
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Neuroscience Research, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Neurosurgery, Royal Children’s Hospital, Parkville, VIC 3052, Australia
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Oommen SP, Santhanam S, John H, Roshan R, Swathi TO, Padankatti C, Grace H, Beulah R, Jana AK, Kumar M, Thomas N, Yadav B. Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18-24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study. J Trop Pediatr 2019; 65:552-560. [PMID: 30793756 DOI: 10.1093/tropej/fmz006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors for poor neurodevelopmental outcome in a cohort of very low birth weight (VLBW) infants. SUBJECTS AND METHODS Four hundred and twenty-two infants of a total of 643 VLBW survivors from a teaching hospital in South India were followed up to assess their neurodevelopmental outcomes. RESULTS Among the 422 children who completed the assessment, results of 359 children whose assessments were done between 18 and 24 months were analysed. Thirty-seven children (10.31%) had poor neurodevelopmental outcome, six children [1.67%] had cerebral palsy, one child had visual impairment and another had hearing impairment. Poor post-natal growth was independently associated with poor neurodevelopmental outcomes in the multivariate analysis (p = 0.045). Neonatal complications were not associated with the developmental outcome. CONCLUSION Despite lower rates of neonatal complications compared with Western cohorts, significant proportion of VLBW infants had poor neurodevelopmental outcomes. Poor post-natal growth was an important determinant of the developmental outcome.
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Affiliation(s)
- Samuel P Oommen
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hima John
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reeba Roshan
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - T O Swathi
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Caroline Padankatti
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hannah Grace
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rachel Beulah
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Atanu Kumar Jana
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Bhalala U, Bansal A, Chugh K. Advances in Pediatric Critical Care Research in India. Front Pediatr 2018; 6:150. [PMID: 29892595 PMCID: PMC5985403 DOI: 10.3389/fped.2018.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
Over last 2 decades, there has been a significant progress made in the field of pediatric critical care in India. There has been complementary and parallel growth in the pediatric critical care services in India and the number of pediatric critical care providers who are either formally trained in India or who have returned to India after their formal training abroad. The pediatric critical care community in India has recognized obvious differences in profiles of critical illnesses and patients between Indian subcontinent and the West. Therefore there is a growing interest in generating scientific evidence through local research which would be applicable to critically ill children in Indian subcontinent. This article focuses on advances in pediatric critical care research in India and its future directions.
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Affiliation(s)
- Utpal Bhalala
- Baylor College of Medicine at The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Arun Bansal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Milner KM, Duke T, Steer AC, Kado JH, Koyamaibole L, Kaarira R, Namudu K, Woolfenden S, Miller AE, O'Heir KE, Neal EFG, Roberts G. Neurodevelopmental outcomes for high-risk neonates in a low-resource setting. Arch Dis Child 2017; 102:1063-1069. [PMID: 28847882 DOI: 10.1136/archdischild-2017-312770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 11/03/2022]
Abstract
Worldwide, most neonates who survive prematurity and serious illness reside in low-resource settings where developmental outcome data and follow-up care are limited. This study aimed to assess in Fiji, a low-resource Pacific setting, prevalence and risk factors for moderate to severe neurodevelopmental impairment (NDI) in early childhood among high-risk neonates compared with controls. Retrospective cohort study comparing long-term outcomes for high-risk neonatal intensive care unit patients (n=149) compared with matched term, normal birth weight neonates (n=147) discharged from Colonial War Memorial Hospital between November 2008 and April 2010. NDI was defined as one or more of cerebral palsy, moderate to severe hearing or visual impairment, or global developmental delay using Bayley Scales of Infant and Toddler Development Third Edition (ie, score <70 in ≥1 of cognitive, language or motor domains). At median (IQR) age 36.1 (28.3, 38.0) months, prevalence of moderate to severe NDI % (95% CI, n) in high-risk and control groups was 12 (5 to 17, n=13) and 5 (2 to 12, n=5), respectively, an increased risk ratio (95% CI) of 2.7 (0.8 to 8.9). Median gestational age (weeks (median, IQR)) in the high-risk group was 37.5 (34-40) weeks. Among high-risk neonates, gestational age, birth weight, asphyxia, meningitis and/or respiratory distress were significantly associated with risk of NDI. Prevalence of NDI was high among this predominantly term high-risk neonatal cohort compared with controls. Results, including identified risk factors, inform efforts to strengthen quality of care and models of follow-up for high-risk neonates in this low-resource setting.
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Affiliation(s)
- Kate M Milner
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Trevor Duke
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Andrew C Steer
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Joseph H Kado
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji.,Department of Paediatrics, Fiji National University, Nasinu, Fiji
| | | | - Rakei Kaarira
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Kelera Namudu
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Susan Woolfenden
- Community Child Health, Sydney Children's Hospital, Randwick, Australia.,Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne E Miller
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn E O'Heir
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eleanor F G Neal
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Gehan Roberts
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
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Milner KM, Neal EFG, Roberts G, Steer AC, Duke T. Long-term neurodevelopmental outcome in high-risk newborns in resource-limited settings: a systematic review of the literature. Paediatr Int Child Health 2015; 35:227-42. [PMID: 26138273 DOI: 10.1179/2046905515y.0000000043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Improving outcomes beyond survival for high-risk newborns in resource-limited settings is an emerging challenge. Global estimates demonstrate the scale of this challenge and significant gaps in morbidity outcome data in high mortality contexts. A systematic review was conducted to document the prevalence of neurodevelopmental impairment in high-risk newborns who were followed up into childhood in low- and middle-income countries. METHODS High-risk newborns were defined as low, very or extremely low birthweight, preterm infants or those surviving birth asphyxia or serious infections. Electronic databases were searched and articles screened for eligibility. Included articles were appraised according to STROBE criteria. Narrative review was performed and median prevalence of key neurodevelopmental outcomes was calculated where data quality allowed. RESULTS 6959 articles were identified with sixty included in final review. At follow-up in early childhood, median estimated prevalence (inter-quartile range) of overall neurodevelopmental impairment, cognitive impairment and cerebral palsy were: for survivors of prematurity/very low birthweight 21.4% (11.6-30.8), 16.3% (6.3-29.6) and 11.2% (5.9-16.1), respectively, and for survivors of birth asphyxia 34.6% (25.4-51.5), 11.3% (7.7-11.8) and 22.8% (15.7-31.4), respectively. Only three studies reporting outcomes following newborn serious bacterial infections were identified. There was limited reporting of important outcomes such as vision and hearing impairment. Major challenges with standardised reporting of key exposure and developmental outcome variables and lack of control data were identified. CONCLUSION Understanding the limitations of the available data on neurodevelopmental outcome in newborns in resource-limited settings provides clear direction for research and efforts to improve long-term outcome in high-risk newborns in these settings.
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Abstract
Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries.
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Affiliation(s)
- Bolajoko O Olusanya
- Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London, UK.
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Olusanya BO, Luxon LM, Wirz SL. Benefits and challenges of newborn hearing screening for developing countries. Int J Pediatr Otorhinolaryngol 2004; 68:287-305. [PMID: 15129939 DOI: 10.1016/j.ijporl.2003.10.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The late detection of permanent congenital and early-onset hearing loss (PCEHL) often has severe effects on linguistic, speech, cognitive and educational development in affected children. Since newborn hearing screening (NHS) allows most PCEHL to be detected early enough for optimal intervention, the prospects of its introduction in the developing world are reviewed in this paper. It is observed that a simple generalisation on the feasibility of NHS for the developing countries seems inappropriate in view of the diversities in the health and socio-economic status of these countries and the recent favourable reports of universal newborn hearing screening from the region. NHS empowers parents to make timely choices that will allow their hearing impaired children to be given a good start in life and be fully integrated into the wider community. It also compels attention towards the development of essential hearing healthcare services, besides the specific documented benefits. Existing child-healthcare structures such as the expanded programme on immunisation (EPI), baby friendly hospital initiatives (BFHI) and integrated management of childhood illness (IMCI) provide opportunities for the introduction of some form of NHS in many of these countries where routine or systematic childhood hearing screening does not exist. Limited funding, manpower shortages, inadequate support services, low public awareness and the uncertainty regarding the commitment from healthcare practitioners may present some challenges but these are not insurmountable. Pilot studies are necessary in each country to provide empirical data that will guide healthcare providers who wish to introduce such a programme at any level of healthcare delivery.
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Affiliation(s)
- B O Olusanya
- Academic Unit of Audiological Medicine, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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