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Liu C, Wang K, Huang G, Huang Z, Guo Y, Xie Z, Wu Z, Guo Z, Guo J. Association of small-for-gestational-age status with mortality and morbidity in very preterm Chinese infants. J Matern Fetal Neonatal Med 2023; 36:2258257. [PMID: 37722705 DOI: 10.1080/14767058.2023.2258257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Very preterm infants born small for gestational age (SGA) are at risk for short- and long-term excess mortality and morbidity resulting from immaturity and deficient intrauterine growth. However, previous findings are inconclusive, and there is a paucity of contemporary data in Chinese population. OBJECTIVES To evaluate the excess risks of mortality and morbidity independently associated with SGA birth in very preterm (before 32 weeks of gestation) Chinese infants. MATERIALS AND METHODS The study population included all very preterm infants admitted to the neonatal intensive care units (NICUs) in our hospital and our medical treatment partner hospitals during a 6-year period. The SGA group consisted of 615 SGA infants, and 1230 appropriate-for-gestation-age (AGA) infants were matched with GA and sex as controls at a ratio of 2:1. The associations between SGA birth and outcomes (in-hospital mortality and morbidity) were evaluated by using multivariate logistic regression analysis after adjustment for potential confounders. The CRIBII score was used to indicate admission illness severity, acting as a covariate in the multivariate analysis. RESULTS The SGA group was associated with increased risks of mortality [odds ratio (OR) 2.12; 95% CI: 1.27-3.54] and BPD [OR 1.95; 95% CI: 1.58-2.41] compared to the AGA group. No significant incidences of respiratory distress syndrome (RDS), severe retinopathy of prematurity (sROP), severe intraventricular hemorrhage (sIVH), and necrotizing enterocolitis (NEC) were observed in the SGA group. Further GA-stratified subgroup analysis showed SGA status exhibited certain patterns of effects on mortality and morbidity in different GA ranges. CONCLUSIONS SGA status is associated with excess risks of neonatal mortality and BPD in very preterm infants, but the increased risks of mortality and morbidity are not homogeneous in different GA ranges. The contemporary data can help inform perinatal care decision-making and family counseling, particularly for very preterm SGA neonates.
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MESH Headings
- Female
- Humans
- Infant
- Infant, Newborn
- Pregnancy
- East Asian People
- Infant, Extremely Premature
- Infant, Newborn, Diseases/mortality
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Infant, Small for Gestational Age
- Infant, Very Low Birth Weight
- Morbidity
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Affiliation(s)
- Chunhua Liu
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Kaiyan Wang
- Medical Informatics Research Center, Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Gaozhan Huang
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Zishan Huang
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Yunchong Guo
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Zhexi Xie
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Zhisheng Wu
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Ziqi Guo
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Jizhong Guo
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
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Correani A, Lanciotti L, Giorgetti C, Palazzi ML, Monachesi C, Antognoli L, Burattini I, Cogo P, Carnielli V. Reduced pulmonary oxygen diffusion at 36 weeks of postmenstrual age in small-for-gestational-age preterm infants of less than 32 weeks without bronchopulmonary dysplasia. Pediatr Pulmonol 2023; 58:3054-3062. [PMID: 37594147 DOI: 10.1002/ppul.26620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/07/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Small-for-gestational-age (SGA) preterm infants are at increased risk of developing bronchopulmonary dysplasia (BPD). There is limited information on pulmonary oxygen diffusion of SGA preterm infants, particularly in those without BPD. OBJECTIVE To compare the pulmonary oxygen diffusion of SGA to that of appropriate-for-gestational-age (AGA) preterm infants without BPD. STUDY DESIGN Preterm infants with a gestational age (GA) between 24.0 and 31.6 weeks were studied. The oxygen saturation (SpO2 ), fraction to inspired oxygen (FiO2 ), and the SpO2 to FiO2 ratio (SFR) were compared between SGA and AGA infants. The association between SGA and SFR at 36 weeks was assessed using a multiple regression analysis. In the subgroup without BPD, SGA were match-paired for GA and gender with AGA infants. RESULTS We analyzed 1189 infants surviving at 36 weeks: 194 (16%) were SGA and 995 (84%) AGA. The incidence of BPD was significantly higher in SGA than AGA infants (32% vs. 13%; p = .000). Out of the 995 infants without BPD, 132 (13%) were SGA and 863 (87%) AGA. SGA was negatively associated with the SFR value at 36 weeks, independently from BPD. SGA infants without BPD had significantly higher (better) SFR at birth, but lower (worse) SpO2 and SFR and from 33 to 36 weeks than their matched AGA counterpart. At 36 weeks, median SpO2 and SFR values were 97.7 versus 98.4 (p = .006) and 465 versus 468 (p = .010) in match-paired SGA and AGA, respectively. CONCLUSION Among preterm infants of less than 32 weeks and without BPD, SGA infants had a reduced pulmonary oxygen diffusion at 36 weeks in comparison with AGA infants.
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Affiliation(s)
- Alessio Correani
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Lucia Lanciotti
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Giorgetti
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Maria Laura Palazzi
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Chiara Monachesi
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Luca Antognoli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Ilaria Burattini
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Paola Cogo
- Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Udine, Italy
| | - Virgilio Carnielli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
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Lanciotti L, Pasqualini M, Correani A, Burattini I, Giorgetti C, Palazzi ML, Cogo P, Carnielli V. Who Needs a Second Dose of Exogenous Surfactant? J Pediatr 2023; 261:113535. [PMID: 37271494 DOI: 10.1016/j.jpeds.2023.113535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To identify prenatal and postnatal risk factors associated with surfactant redosing. STUDY DESIGN Retrospective, single-regional center study including all infants born from 24 + 0 to 31 + 6 weeks of gestation in the Marche Region, Italy, and admitted to a single level III regional NICU from January 1, 2004, to February 28, 2021. Clinical factors associated with surfactant redosing were identified through logistic regression analysis. RESULTS Of 1615 consecutive admissions, 662 infants were treated with exogenous surfactant: 462 (70%) received a single dose and 200 (30%) received more than 1 dose (25.5% two doses and 4.5% three doses). Risk of redosing was higher for infants born to mothers with hypertension in pregnancy (OR 3.95, P < .001), for small for gestational age (SGA) infants (OR 3.93, P < .001) and when the first surfactant dose was 100 mg/kg instead of 200 mg/kg (OR 4.56/4.61, P < .001). Infants with greater GA, delayed first surfactant administration, and milder respiratory distress syndrome had reduced risk of redosing. Infants who required multiple surfactant doses had a higher rate of bronchopulmonary dysplasia and mortality, as well as longer duration of respiratory support than patients that received 1 dose. CONCLUSIONS Hypertension in pregnancy and SGA status were found to be statistically and clinically significant predictors of surfactant redosing. Understanding the pathophysiology of these conditions requires further investigation.
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Affiliation(s)
- Lucia Lanciotti
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy; Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy.
| | - Matteo Pasqualini
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy
| | - Alessio Correani
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy; Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy
| | - Ilaria Burattini
- Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy
| | - Chiara Giorgetti
- Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy
| | - Maria Laura Palazzi
- Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine (DAME), S. Maria Della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Virgilio Carnielli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy; Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy
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Lin CY, Chang HY, Chang JH, Hsu CH, Jim WT, Peng CC, Chen CH. The impact of small-for-gestational-age Status on the outcomes in very-Low-birth-weight (VLBW) premature infants: a prospective cohort study in Taiwan. Front Pediatr 2023; 11:1209765. [PMID: 37520047 PMCID: PMC10376714 DOI: 10.3389/fped.2023.1209765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background The impact of small-for-gestational-age (SGA) on very-low-birth-weight (VLBW) premature infants remains inconclusive. This study aimed to assess the effects of being born SGA status on the short-term and long-term outcomes in VLBW preterm infants. Methods We conducted a population-based, prospective cohort study on VLBW preterm infants born in Taiwan between 2012 and 2017. Sociodemographic, neonatal, growth and neurological data at 2 years of corrected age were collected. A total of 4243 VLBW infants born at 24 through 32 completed weeks' gestation participated in this study, of whom 1,005 had SGA status defined as a birth weight <10th percentile of gestation, and 3,238 did not (the non-SGA group).We compared the risks of short-term outcomes (neonatal mortality and morbidities), long-term outcomes (growth status, including weight, height, and head circumference <10th percentile, and neurodevelopmental impairments at 2 years of age). Subgroup analysis was performed by stratification of gestation age (GA): GA 24-26, 27-29 and 30-32 weeks. Results In the analysis of short-term outcomes, the SGA group had an increased risk of neonatal mortality [adjusted odds ratio (OR) = 2.66, 2.99, and 2.19, respectively] in all GA subgroups in comparison with the non-SGA group (p < 0.05). The SGA group had a significantly increased risk of bronchopulmonary dysplasia in GA 27-29 and 30-32 weeks (adjusted OR = 2.11 and 1.86, respectively). We also found that there was an increased risk of severe retinopathy of prematurity in GA 24-26 and 27-29 weeks in the SGA group compared with the non-SGA group (adjusted OR = 1.68 and 1.59, respectively).In the analysis of long-term outcomes, the SGA group had a significantly increased risk of NDI throughout all GA subgroups (adjusted = 1.94, 1.33, and 1.35, respectively) in comparison with the non-SGA group. The SGA groups also had an increased risk of growth status <10th percentile at 2 years of age (p < 0.05). Conclusions SGA VLBW premature infants had higher risks of neonatal death, growth status <10th percentile, and NDI at 2 years of corrected age compared with the non- SGA premature infants. Prenatal surveillance, postnatal attention, and long- term follow-up are warranted to improve the outcomes of VLBW SGA premature infants.
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Affiliation(s)
- Chia-Ying Lin
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Wai-Tim Jim
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chia-Huei Chen
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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D'Agostin M, Di Sipio Morgia C, Vento G, Nobile S. Long-term implications of fetal growth restriction. World J Clin Cases 2023; 11:2855-2863. [PMID: 37215406 PMCID: PMC10198075 DOI: 10.12998/wjcc.v11.i13.2855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is a complication of pregnancy where the fetus does not achieve its genetic growth potential. FGR is characterized by a pathological retardation of intrauterine growth velocity in the curve of intrauterine growth. However, the FGR definition is still debated, and there is a lack of a uniform definition in the literature. True IUGR, compared to constitutional smallness, is a pathological condition in which the placenta fails to deliver an adequate supply of oxygen and nutrients to the developing fetus. Infants with IUGR, compared to appropriately grown gestational age infants, have a significantly higher risk of mortality and neonatal complications with long-term consequences. Several studies have demonstrated how suboptimal fetal growth leads to long-lasting physiological alterations for the developing fetus as well as for the newborn and adult in the future. The long-term effects of fetal growth retardation may be adaptations to poor oxygen and nutrient supply that are effective in the fetal period but deleterious in the long term through structural or functional alterations. Epidemiologic studies showed that FGR could be a contributing factor for adult chronic diseases including cardiovascular disease, metabolic syndrome, diabetes, respiratory diseases and impaired lung function, and chronic kidney disease. In this review we discussed pathophysiologic mechanisms of FGR-related complications and potential preventive measures for FGR.
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Affiliation(s)
- Martina D'Agostin
- Department of Pediatrics, University of Trieste, Trieste 34100, Italy
| | - Chiara Di Sipio Morgia
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 000168, Italy
| | - Stefano Nobile
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 000168, Italy
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Ceran B, Büyüktiryaki M, Okman E, Kadıoğlu Şimşek G, Kanmaz Kutman HG, Üstünyurt Konuk Z, Canpolat FE. Being Small for Gestational Age Affect Neurodevelopmental Outcomes in Very Preterm Infants. GÜNCEL PEDIATRI 2022. [DOI: 10.4274/jcp.2022.05902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Nitzan I, Roberts CT, Bhatia R, Mimouni FB, Sehgal A. Nucleated Red Blood Cells as Markers of Perinatal Adaptation in Preterm Neonates Receiving Minimally Invasive Surfactant Therapy. Am J Perinatol 2022; 39:1792-1795. [PMID: 33757139 DOI: 10.1055/s-0041-1726317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The study aimed to assess the association of nucleated red blood cells (NRBC), a surrogate of intrauterine hypoxia, and elevated pulmonic vascular resistance (E-PVR) and oxygen requirement after minimally invasive surfactant therapy (MIST). STUDY DESIGN Retrospective study of a cohort of preterm neonates that received MIST in a single unit. RESULTS NRBC were measured in 65 of 75 (87%) neonates administered MIST during the period. In total, 22 of 65 (34%) infants had pre-MIST echocardiography (ECHO).Neonates with elevated NRBC (predefined as >5 × 109/L, n = 16) required higher post-MIST fraction of inspired oxygen (FiO2) than neonates with normal NRBC (<1 × 109/L, n = 17; FiO2 = 0.31 ± 0.10 and 0.24 ± 0.04, respectively, p = 0.02).NRBC correlated positively with % of time in right to left ductal shunt (r = 0.51, p = 0.052) and inversely with right ventricular stroke volume (r = -0.55, p = 0.031) and time to peak velocity to right ventricular ejection time ratio (r = -0.62, p < 0.001). CONCLUSION Elevated NRBC are associated with elevated FiO2 after MIST and elevated E-PVR. Intrauterine hypoxia may impact postnatal circulatory adaptations and oxygen requirement. KEY POINTS · Post-MIST FiO2 requirements are significantly higher in infants with elevated NRBC.. · NRBC correlates positively with elevated PVR in neonates requiring.. · Intrauterine hypoxia may play a role in postnatal circulatory adaptations in neonates with RDS..
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Affiliation(s)
- Itamar Nitzan
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia
| | - Calum T Roberts
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Risha Bhatia
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Francis B Mimouni
- Department of Neonatalogy, Shaare Zedek Medical Center, Jerusalem, Israel.,Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Arvind Sehgal
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
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Severity of small-for-gestational-age and morbidity and mortality among very preterm neonates. J Perinatol 2022; 43:437-444. [PMID: 36302849 DOI: 10.1038/s41372-022-01544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evaluate the association between small for gestational age (SGA) severity and morbidity and mortality in a contemporary, population of very preterm infants. STUDY DESIGN This secondary analysis of a California statewide database evaluated singleton infants born during 2008-2018 at 24-32 weeks' gestation, with a birthweight <15th percentile. We analyzed neonatal outcomes in relation to weight for gestational age (WGA) and symmetry of growth restriction. RESULTS An increase in WGA by one z-score was associated with decreased major morbidity or mortality risk (aRR 0.73, 95% CI 0.68-0.77) and other adverse outcomes. The association was maintained across gestational ages and did not differ by fetal growth restriction diagnosis. Symmetric growth restriction was not associated with neonatal outcomes after standardizing for gestational age at birth. CONCLUSIONS Increasing SGA severity had a significant impact on neonatal outcomes among very preterm infants.
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Effects of being small for gestational age on morbidities of prematurity. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.1096789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Amaç: Gebelik yaşına göre düşük doğum ağırlığı (small for gestational age: SGA) olan prematüre bebeklerin prematüreliğe ek olarak hangi morbiditeler açısından daha riskli olduğu konusundaki kanıtlar yetersizdir. Çalışmamızda gebelik haftası <32 hafta olan SGA prematüre bebeklerin morbidite ve mortalite açısından risklerinin değerlendirilmesi amaçlanmıştır.Yöntemler: Gebelik haftası <32 hafta olup SGA olan bebeklerin morbiditeleri ve mortalite verileri, <32 gebelik haftasında doğan gebelik haftasına uygun doğum ağırlığı ile doğan (appropriate for gestational age: AGA) bebekler ile karşılaştırıldı.Bulgular: Çalışmaya 122 (%24,6) SGA ve 372 (%75,4) AGA bebek olmak üzere toplam 494 prematüre bebek dâhil edildi. Doğumda SGA olan bebeklerde AGA olanlara göre annede preeklampsi, nekrotizan enterokolit (NEK), prematüre retinopatisi (ROP), intraventiküler kanama (İVK) oranı daha yüksekti. Ayrıca SGA olanlarda AGA olanlara göre tam enteral beslenmeye geçiş zamanı, yoğun bakımda yatış süresi anlamlı olarak daha yüksekti (p<0,05).Sonuç: Gebelik haftaları benzer olsa da SGA ve prematüre olan bebeklerde, AGA olan bebeklere göre İVK, ROP ve NEK gibi prematüre morbiditeleri daha yüksekti.
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Hofi L, Flidel-Rimon O, Hershkovich–Shporen C, Zaharoni H, Birk R. Differences in growth patterns and catch up growth of small for gestational age preterm infants fed on fortified mother's own milk versus preterm formula. Br J Nutr 2022; 129:1-24. [PMID: 35748057 PMCID: PMC10197085 DOI: 10.1017/s0007114522000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 11/06/2022]
Abstract
Small for gestational age (SGA) is typically defined as birthweight < 10th percentile for age. Limited data are available regarding the growth of SGA preterm infants in relation to feeding type. We aimed to study SGA preterm infants fed fortified mother's own milk (MOM) or preterm formula (PF) on growth patterns and catch-up growth at discharge and two-years corrected age (CA). Our retrospective cohort study included data from medical records and follow-up questionnaires about SGA preterm infants born at <37 weeks fed on MOM (n=40) and PF (n=40). Weight, length/height and head circumference (HC) were collected at birth, discharge and at two years CA, and Δ z-scores were calculated.The MOM group had significantly larger negative change in weight and length z-scores between birth and discharge, and smaller positive change in HC z-score (-0.47 (±0.41) v. -0.25 (±0.36), P= 0.01; -0.63 (±0.75) v. -0.27 (±0.75), P= 0.03; 0.13 (±0.67) v. 0.41 (±0.55), P= 0.04, respectively). Almost half the MOM fed infants experienced poor length growth by discharge compared to 22% of PF fed infants (P=0.03). By two years CA, both groups had similar positive change in weight and HC z-scores, but MOM fed infants had a slower increase in height z-score (0.64 (±1.30) v. 1.33 (±1.33), P=0.02), and only 40% had achieved catch-up height compared with 68% of the PF group (P=0.02).Our study indicates that fortified MOM fed SGA preterm infants may need extra nutritional support in the first two years of life to achieve height growth potential.
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Affiliation(s)
- Lilach Hofi
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Neonatology, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
- Department of Clinical Nutrition, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
| | - Orna Flidel-Rimon
- Department of Neonatology, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
| | | | - Hilla Zaharoni
- Department of Clinical Nutrition, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
| | - Ruth Birk
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
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Yang T, Shen Q, Wang S, Dong T, Liang L, Xu F, He Y, Li C, Luo F, Liang J, Tang C, Yang J. Risk factors that affect the degree of bronchopulmonary dysplasia in very preterm infants: a 5-year retrospective study. BMC Pediatr 2022; 22:200. [PMID: 35413820 PMCID: PMC9004103 DOI: 10.1186/s12887-022-03273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is one of the most common adverse consequence of premature delivery and the most common chronic lung disease in infants. BPD is associated with long-term lung diseases and neurodevelopmental disorders that can persist into the adulthood. The adverse consequences caused by severe BPD are more serious. However, there were few studies on the risk factors for severe BPD. Methods This is a retrospective study of preterm infants born less than 32-week gestational age (GA) and diagnosed with BPD. Results A total of 250 preterm infants with a diagnosis of BPD and GA < 32 weeks were included (137 boys [54.8%] and 113 girls [45.2%]). The birth weight ranged from 700 g to 2010 g and the mean birth weight was 1318.52 g (255.45 g). The GA ranged from 25 weeks to 31 weeks and 6 days (mean, 30 weeks). The number of cases of mild, moderate and severe BPD were 39 (15.6%), 185 (74.0%) and 26 (10.4%), respectively. There were significant differences in the rate of small for gestational age (SGA), intrauterine asphyxia, pulmonary hemorrhage, neonatal respiratory distress syndrome (NRDS), circulatory failure, pulmonary hypertension, patent ductus arteriosus (PDA), pulmonary surfactant (PS), aminophylline, caffeine, glucocorticoids, tracheal intubation, diuretics, and parenteral nutrition length among the three groups (P < 0.05). The time of parenteral nutrition (aOR = 3.343, 95%CI: 2.198 ~ 5.085) and PDA (aOR =9.441, 95%CI: 1.186 ~ 75.128) were independent risk factors for severe BPD compared with mild BPD. PDA (aOR = 5.202, 95%CI: 1.803 ~ 15.010) and aminophylline (aOR = 6.179, 95%CI: 2.200 ~ 17.353) were independent risk factors for severe BPD, while caffeine (aOR = 0.260, 95%CI: 0.092 ~ 0.736) was the protective factor for severe BPD compared with moderate BPD. The time of parenteral nutrition (aOR = 2.972, 95%CI: 1.989 ~ 4.440) and caffeine (aOR = 4.525, 95%CI: 1.042 ~ 19.649) were independent risk factors for moderate BPD compared with mild BPD. Caffeine (aOR = 3.850, 95%CI: 1.358 ~ 10.916) was the independent risk factor for moderate BPD, while PDA (aOR = 0.192, 95%CI: 0.067 ~ 0.555) and aminophylline (aOR = 0.162, 95%CI: 0.058 ~ 0.455) were protective factors for moderate BPD compared with severe BPD. The time of parenteral nutrition (aOR = 0.337, 95%CI: 0.225 ~ 0.503) and caffeine (aOR = 0.221, 95%CI: 0.051 ~ 0.960) were protective factors for mild BPD compared with moderate BPD. The time of parenteral nutrition (aOR = 0.299, 95%CI: 0.197 ~ 0.455) and PDA (aOR = 0.106, 95%CI: 0.013 ~ 0.843) were protective factors for mild BPD compared with severe BPD. Conclusion The time of parenteral nutrition is the risk factor of moderate and severe BPD. PDA and aminophylline are risk factors for severe BPD. The role of caffeine in the severity of BPD is uncertain, and SGA is not related to the severity of BPD. Severe or moderate BPD can be avoided by shortening duration of parenteral nutrition, early treatment of PDA, reducing use of aminophylline and rational use of caffeine. Trial registration Retrospectively registered.
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Affiliation(s)
- Tingting Yang
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Qianqian Shen
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.,College of Medicine, Dali University, Dali, Yunnan, China
| | - Siyu Wang
- Department of Pediatrics, The First Hospital of Kunming, Kunming, Yunnan, China
| | - Tianfang Dong
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Liang Liang
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Fan Xu
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.,The First Clinical Medical College, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Youfang He
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Chunlei Li
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Fang Luo
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jiahong Liang
- The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.,Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Chunhui Tang
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China. .,The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
| | - Jinghui Yang
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China. .,The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China. .,Yunnan Province Clinical Center for Hematologic Disease, Kunming, Yunnan, China.
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12
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Peles G, Paz-Levy D, Wainstock T, Goldbart A, Kluwgant D, Sheiner E. Pediatric respiratory hospitalizations in small for gestational age neonates born at term. Pediatr Pulmonol 2022; 57:754-760. [PMID: 34931470 DOI: 10.1002/ppul.25797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigates the risk for long-term respiratory hospitalizations of offspring born small for gestational age (SGA) at term. STUDY DESIGN A retrospective population-based cohort analysis was performed to examine the risk of long-term respiratory hospitalizations between SGA compared to appropriate for gestational age (AGA) newborns. The analysis included all term singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations, multiple gestation, cases of perinatal mortality and large for gestational age (LGA) were excluded. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence up to the age of 18 years, and a Cox hazards regression model was used to control for confounders. RESULTS During the study period 216,671 deliveries met the inclusion criteria; of them 4.8% (n = 10,450) were diagnosed as SGA neonates. During the follow-up period, the rate of hospitalization due to respiratory morbidity was significantly higher in the SGA group as compared to the AGA group (5.2% vs. 4.7%, OR = 1.13, 95% confidence interval [CI] = 1.03-1.24, p = 0.011). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the SGA group (log-rank p = 0.026). In the Cox hazards regression model, controlled for relevant clinical confounders, SGA was found to be an independent risk factor for long-term pediatric respiratory morbidity (adjusted hazard ratio [HR] = 1.1, 95% CI = 1.001-1.19, p = 0.049). CONCLUSION Being delivered SGA at term is an independent long-term risk factor for pediatric respiratory hospitalization.
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Affiliation(s)
- Galia Peles
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvora Kluwgant
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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13
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Nobile S, Di Sipio Morgia C, Vento G. Perinatal Origins of Adult Disease and Opportunities for Health Promotion: A Narrative Review. J Pers Med 2022; 12:jpm12020157. [PMID: 35207646 PMCID: PMC8877993 DOI: 10.3390/jpm12020157] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
The “developmental origins of health and disease” (DOHaD) hypothesis refers to the influence of early developmental exposures and fetal growth on the risk of chronic diseases in later periods. During fetal and early postnatal life, cell differentiation and tissue formation are influenced by several factors. The interaction between genes and environment in prenatal and early postnatal periods appears to be critical for the onset of multiple diseases in adulthood. Important factors influencing this interaction include genetic predisposition, regulation of gene expression, and changes in microbiota. Premature birth and intrauterine growth restriction (IUGR) are other important factors considered by the DOHaD hypothesis. Preterm birth is associated with impaired or arrested structural or functional development of key organs/systems, making preterm infants vulnerable to cardiovascular, respiratory, and chronic renal diseases during adulthood. Growth restriction, defined as impaired fetal growth compared to expected biological potential in utero, is an additional negative factor increasing the risk of subsequent diseases. Environmental factors implicated in the developmental programming of diseases include exposure to pollution, stress, drugs, toxic agents, nutrition, and exercise. The DOHaD may explain numerous conditions, including cardiovascular, metabolic, respiratory, neuropsychiatric, and renal diseases. Potential antenatal and postnatal preventive measures, interventions, and future directions are discussed.
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14
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Williamson N, Alcock G, Kandasamy Y. Being Small for Gestational Age does not Change Short-Term Outcomes for Extremely Low Birth Weight Babies at Townsville University Hospital. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0042-1757612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Aim To determine whether being small for gestational age (SGA) is associated with increased mortality and short-term morbidity for extremely low birth weight (ELBW) babies at Townsville University Hospital (TUH).
Methods All babies with a birth weight of <1,000 g born at TUH between January 1, 2010 and January 1, 2021 were included. Data from the neonatal unit's NeoDATA database were used to compare mortality and short-term morbidity outcomes for babies categorized as SGA (birth weight <10th centile) or not. Statistical analyses were used to determine associations between being SGA and survival to discharge, intubation for mechanical ventilation, duration of respiratory support, chronic neonatal lung disease (CNLD), home oxygen, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), sepsis, time to full enteral feeds, and duration of admission.
Results Of 461 ELBW babies, 62 (13.4%) were SGA. The SGA babies were significantly smaller at 714 (580–850) versus 810 (700–885) g (p < 0.001) and of advanced gestational age at 28.6 (26.6–30.2) versus 25.4 (24.4–26.6) weeks (p < 0.001). No significant difference in mortality existed, with 85% of SGA babies and 84% of others surviving. On univariate analysis, being SGA was associated with significant reductions in intubation for mechanical ventilation (p < 0.001), duration of respiratory support (p < 0.001), intraventricular hemorrhage (p = 0.002), NEC (p = 0.037), and admission duration (p = 0.038). After controlling for confounding factors, no outcomes were independently associated with being SGA. Logistic regression found survival was associated with birth weight (p = 0.030), gestational age (p = 0.007), and antenatal corticosteroids (p = 0.008).
Conclusions Being SGA is not an independent predictor of mortality nor adverse short-term morbidity for ELBW babies.
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Affiliation(s)
- Natalee Williamson
- Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
| | - Gary Alcock
- Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
| | - Yoga Kandasamy
- Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
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15
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Abstract
With advancements in neonatal care and nutrition, the postnatal growth of preterm infants has improved; however, it remains an issue. Accurate assessments of growth using a standardized reference are needed to interpret the intrauterine and postnatal growth patterns of preterm infants. Growth in the earlier periods of life can contribute to later outcomes, and the refinement of postnatal growth failure is needed to optimize outcomes. Catchup growth occurs mainly before discharge and until 24 months of age, and very low birth weight infants in Korea achieve retarded growth later in life. Knowing an infant's perinatal history, reducing morbidity rates during admission, and performing regular monitoring after discharge are required. Preterm infants with a lower birth weight or who were small for gestational age are at increased risk of poor neurodevelopmental outcomes. Furthermore, poor postnatal growth is predictive of adverse neurodevelopmental outcomes. Careful monitoring and early intervention will contribute to better development outcomes and national public health improvements.
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Affiliation(s)
- Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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16
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Avorgbedor F, Gondwe KW, Zou B, Conklin JL, Yeo S. A Systematic Review on Outcomes of Preterm Small for Gestational Infants Born to Women With Hypertensive Disorders in Pregnancy. J Perinat Neonatal Nurs 2021; 35:E58-E68. [PMID: 34726657 DOI: 10.1097/jpn.0000000000000603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a lack of knowledge on the intersection between prematurity, small for gestational age, and hypertensive disorders of pregnancy (HDP). Therefore, the aim of this systematic review was to examine the outcomes of preterm infants who were small for gestational age born to women with HDP. Searches were conducted with no date restriction through the final search date of May 13, 2020, in the following databases: PubMed, Web of Science Core Collection, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text (EBSCOhost), and Embase (Elsevier). A total of 6 studies were eligible for this review. The adjusted odds of mortality and necrotizing enterocolitis were significantly lower in the pregnancy-induced hypertension (PIH)/HDP group than in the non-PIH/HDP group. There was no significant difference in the odds of respiratory distress syndrome, bronchopulmonary dysplasia, and intraventricular hemorrhage between PIH/HDP and non-PIH/HDP groups. There was no significant difference between PIH/HDP and non-PIH/HDP groups in cystic periventricular leukomalacia, retinopathy of prematurity, late-onset sepsis, patent ductus arteriosus, length of hospital stays, duration of supplemental oxygen use, duration of mechanical ventilation, and continuous airway pressure. The studies included in this systematic review demonstrated that PIH/HDP is associated with lower infant mortality and necrotizing enterocolitis.
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Affiliation(s)
- Forgive Avorgbedor
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill (Drs Avorgbedor, Zou, and Yeo); School of Nursing, University of Wisconsin Milwaukee, Milwaukee (Dr Gondwe); and Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill (Ms Conklin)
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17
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Marchionni P, Nobile S, Carnielli VP, Scalise L. Uncertainty Estimation of Biomedical Oximeters: Proposal for an Experimental Test-Bench. JOURNAL OF VERIFICATION, VALIDATION AND UNCERTAINTY QUANTIFICATION 2021. [DOI: 10.1115/1.4050721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Paramagnetic oximeters are frequently used in clinical practice to measure and titrate the fraction of inspired oxygen (FiO2) administered to a hypoxic patient. Newborns are prone to several diseases leading to hypoxia but also to oxidative damage, therefore a precise measurement of administered oxygen is of paramount importance. In this study, we evaluated and compared the performance of four commonly used gas analyzers at a Neonatal Unit. A paramagnetic gas analyzer was considered the standard for reference. Gas mixing performed by blenders was also evaluated. We first assessed the stability and composition of O2 and medical air. A settling time study was conducted to estimate a steady-state. Results show how tested blenders underestimated the real measures when FiO2 was <50% and overestimated them when FiO2 ≥50%. In all the tested oximeters the FiO2 was underestimated by 1.18%, but the overall agreement with the gold standard was very good.
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Affiliation(s)
- Paolo Marchionni
- Dipartimento di Scienze Cliniche Specialistiche ed Ondostomatologiche, Università Politecnica delle Marche, Piazza Roma 22, Ancona 60121, Italy; Dipartimento di Ingegneria Industriale e Scienze Matematiche, Università Politecnica delle Marche, Piazza Roma 22, Ancona 60121, Italy
| | - Stefano Nobile
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostin, Gemelli 8, Rome 00168, Italy
| | - Virgilio P. Carnielli
- Dipartimento di Scienze Cliniche Specialistiche ed Ondostomatologiche Università Politecnica delle Marche Piazza Roma, 22, Ancona 60121, Italy
| | - Lorenzo Scalise
- Dipartimento di Ingegneria Industriale e Scienze Matematiche Università Politecnica delle Marche Piazza Roma, 22, Ancona 60121, Italy
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18
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Stylianou-Riga P, Boutsikou T, Kouis P, Kinni P, Krokou M, Ioannou A, Siahanidou T, Iliodromiti Z, Papadouri T, Yiallouros PK, Iacovidou N. Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case-control study. Ital J Pediatr 2021; 47:129. [PMID: 34082803 PMCID: PMC8176707 DOI: 10.1186/s13052-021-01086-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01086-5.
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Affiliation(s)
- Paraskevi Stylianou-Riga
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus. .,Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus. .,Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Marina Krokou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Andriani Ioannou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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19
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Rustogi D, Synnes A, Alshaikh B, Hasan S, Drolet C, Masse E, Murthy P, Shah PS, Yusuf K. Neurodevelopmental outcomes of singleton large for gestational age infants <29 weeks' gestation: a retrospective cohort study. J Perinatol 2021; 41:1313-1321. [PMID: 34035448 DOI: 10.1038/s41372-021-01080-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/05/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes of large and appropriate for gestational age (LGA, AGA) infants <29 weeks' gestation at 18-24 months of corrected age. STUDY DESIGN Retrospective cohort study using the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases. Primary outcome was a composite of death or significant neurodevelopmental impairment (NDI), defined as severe cerebral palsy, Bayley III cognitive, language and motor scores of <70, need for hearing aids or cochlear implant and bilateral visual impairment. Univariate and multivariable logistic analyses were applied for outcomes. RESULTS The study cohort comprised 170 LGA and 1738 AGA infants. There was no difference in significant NDI or individual components of the Bayley III between LGA and AGA groups. LGA was associated with the increased risk of death by follow-up, 44/170 (25.9%) vs. 320/1738 (18.4%) (aOR: 1.60 95% CI: 1.00-2.54). CONCLUSIONS Risk of NDI was similar between LGA and AGA infants.
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Affiliation(s)
- Deepika Rustogi
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Anne Synnes
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Belal Alshaikh
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Shabih Hasan
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Edith Masse
- CHU de Sherbrooke, University of Sherbrooke, Quebec, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
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20
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Huang Y, Zhang L, Sun H, Liu C, Yang Y, Lee SK, Cao Y, Jiang S. Neonatal outcome of small for gestational age infants born at 26-33 weeks' gestation in Chinese neonatal intensive care units. Transl Pediatr 2021; 10:754-764. [PMID: 34012825 PMCID: PMC8107883 DOI: 10.21037/tp-20-339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rate and outcomes of small for gestational age (SGA) infants admitted to Chinese neonatal intensive care units (NICU) has been poorly demonstrated. We aimed to describe the rate and outcomes of SGA preterm infants in Chinese NICU, and to evaluate the association of SGA status with neonatal outcomes in different gestational age (GA) and birth weight percentile groups. METHODS This cohort study included all infants born at 26-33 weeks' gestation and admitted to 25 tertiary Chinese NICUs from April 2015 to May 2018. SGA was defined as a birthweight <10th percentile for GA based on the Chinese neonatal birth weight curve. RESULTS A total of 24,596 infants were included, and 1,867 (7.6%) infants were SGA. SGA infants had significantly higher rates of death or any major morbidity (29.8% vs. 20.5%), mortality (7.0% vs. 4.1%), bronchopulmonary dysplasia (BPD, 17.6% vs. 9.8%), necrotizing enterocolitis (NEC, 4.8% vs. 3.2%) and sepsis (7.3% vs. 4.8%) than non-SGA infants. SGA status was independently associated with increased risk of death or any major morbidity [adjusted odds ratio: 2.37 (2.08-2.71)] as well as increased risks of death, BPD, ROP, death or BPD, death or ROP, NEC and sepsis. The increased risks of adverse outcomes for SGA infants existed across GA groups. The risks of adverse outcomes were highest among infants with a birthweight <3rd percentile. CONCLUSIONS SGA contributes significantly to adverse neonatal outcomes. Specific attentions are warranted when caring for SGA preterm infants.
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Affiliation(s)
- Yihuang Huang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Huiqing Sun
- Department of Neonatology, Henan Children's Hospital, Zhengzhou, China
| | - Cuiqing Liu
- Department of Neonatology, Hebei Children's Hospital, Shijiazhuang, China.,Department of Neonatology, Sanya People's Hospital, Sanya, China
| | - Yi Yang
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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21
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Nakashima T, Inoue H, Sakemi Y, Ochiai M, Yamashita H, Ohga S. Trends in Bronchopulmonary Dysplasia Among Extremely Preterm Infants in Japan, 2003-2016. J Pediatr 2021; 230:119-125.e7. [PMID: 33246013 DOI: 10.1016/j.jpeds.2020.11.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate recent trends in bronchopulmonary dysplasia (BPD) and its risk factors among extremely preterm infants. STUDY DESIGN Demographic and clinical data were reviewed for 19 370 infants born at 22-27 weeks of gestation registered in the affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2016. We investigated the overall survival and prevalence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age and risk factors for developing BPD among the survivors. RESULTS Among 19 370 infants, 2244 (11.6%) died by 36 weeks' postmenstrual age. The mortality rate decreased from 19.0% (99% CI, 15.7%-22.8%) in 2003 to 8.0% (99% CI, 6.2%-10.3%) in 2016. Among 17 126 survivors, BPD developed in 7792 (45.5%) infants, and its proportion significantly increased from 41.4% (99% CI, 36.5%-46.4%) in 2003 to 52.0% (99% CI, 48.2%-55.9%) in 2016. A multivariable analysis of the survivors showed a positive association of BPD with ≥4 weeks' supplemental oxygen or invasive ventilation, birth weight <750 g, small for gestational age, ≥4 weeks' noninvasive positive pressure ventilation, chorioamnionitis, <26 weeks' gestational age, <20 cases per year of center patient volume, or treated patent ductus arteriosus. Although the median duration of invasive ventilation was shortened, the proportions of factors associated adversely with BPD generally showed increasing trends over time. CONCLUSIONS The mortality rate of extremely preterm infants has decreased, but the rate of BPD has increased in survivors between 2003 and 2016. Despite the decreasing duration of invasive ventilation over time, increasing rates of BPD suggest that differences in the patient population or other management strategies influence the development of BPD.
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Affiliation(s)
- Toshinori Nakashima
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan.
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Sakemi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Rocha G, de Lima FF, Machado AP, Guimarães H, Proença E, Carvalho C, Martins LG, Martins T, Freitas A, Dias CP, Silva A, Barroso A, Diogo I, Cassiano G, Ramos H, Abrantes MM, Costa P, Salazar A, Vieira F, Fontes D, Barroso R, Marques T, Santos V, Scortenschi E, Santos C, Vilela F, Quintas C. Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia. J Neonatal Perinatal Med 2020; 12:419-427. [PMID: 31256077 DOI: 10.3233/npm-180129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. METHODS Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant. RESULTS Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01. CONCLUSION The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.
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Affiliation(s)
- G Rocha
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - F Flor de Lima
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Paula Machado
- Department of Obstetrics and Gynaecology, Centro Hospitalar São João, Porto, Portugal
| | - H Guimarães
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - E Proença
- Centro Materno Infantil do Norte, Porto, Portugal
| | - C Carvalho
- Centro Materno Infantil do Norte, Porto, Portugal
| | - L G Martins
- Centro Materno Infantil do Norte, Porto, Portugal
| | - T Martins
- Hospital Pedro Hispâno, Matosinhos, Portugal
| | - A Freitas
- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - C P Dias
- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Silva
- Hospital de Braga, Braga, Portugal
| | | | - I Diogo
- Centro Hospitalar Lisboa Central, Maternidade Dr Alfredo da Costa, Lisboa, Portugal
| | - G Cassiano
- Centro Hospitalar Lisboa Central, Maternidade Dr Alfredo da Costa, Lisboa, Portugal
| | - H Ramos
- Centro Hospitalar Lisboa Central, Maternidade Dr Alfredo da Costa, Lisboa, Portugal
| | - M M Abrantes
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - P Costa
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - A Salazar
- Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal
| | - F Vieira
- Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal
| | - D Fontes
- Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal
| | - R Barroso
- Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal
| | - T Marques
- Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal
| | - V Santos
- Centro Hospitalar do Algarve, Hospital de Faro, Faro, Portugal
| | - E Scortenschi
- Centro Hospitalar do Algarve, Hospital de Faro, Faro, Portugal
| | - C Santos
- Centro Hospitalar do Algarve, Hospital de Faro, Faro, Portugal
| | - F Vilela
- Centro Hospitalar do Algarve, Hospital de Faro, Faro, Portugal
| | - C Quintas
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Hospital de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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23
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Starikov R, Has P, Wu R, Nelson DM, He M. Small-for-gestational age placentas associate with an increased risk of adverse outcomes in pregnancies complicated by either type I or type II pre-gestational diabetes mellitus. J Matern Fetal Neonatal Med 2020; 35:1677-1682. [PMID: 32429723 DOI: 10.1080/14767058.2020.1767572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: One-fifth of pregnancies with pre-gestational diabetes mellitus (pre-DM) yield placentas <10th percentile small for gestational age (SGA), compared to a non-diabetic population. We hypothesized that SGA placentas of women with pre-DM, whether type I (T1DM) or type II (T2DM), exhibit distinct histopathological changes and pregnancy outcomes compared to pre-DM pregnancies with an AGA placenta.Methods: We conducted a retrospective, cohort study of placentas from pregnant women enrolled in the Diabetes in Pregnancy Program at Brown University between 2003 and 2011, by comparing pre-DM patients with SGA placentas to pre-DM patients with AGA placental weights.Results: The SGA placenta groups were associated with an increased risk for adverse clinical outcomes, compared to AGA placentas in pregnancies complicated by either T1DM or T2DM. Compared to their AGA pre-DM counterparts, T1DM, SGA placentas show increased peri-villous fibrin/fibrinoid deposition, thrombosis in fetal blood vessels, and meconium staining. Moreover, the histopathology of SGA placentas from T2DM is characterized by decidual vasculopathy, accelerated villous maturity, and erythroblastosis, compared to T2DM AGA placentas. The contrasting placental pathologies between the two pre-DM SGA phenotypes evolved independent of patient demographics and were unrelated to indicators of the glycemic control present at early gestational ages.Discussion: A sub-population of pre-DM women with either T1DM or T2DM diabetes that have an SGA placenta are at increased risk for adverse clinical outcomes in pregnancy, compared to pre-DM women with AGA placental weights.
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Affiliation(s)
- Roman Starikov
- Women and Infants Hospital of Rhode Island, RI, USA.,Alpert Medical School of Brown University, RI, USA.,Phoenix Perinatal Associates, Phoenix, AZ, USA
| | - Phinnara Has
- Women and Infants Hospital of Rhode Island, RI, USA
| | - Robert Wu
- Penn State College of Medicine, Hershey, PA, USA
| | - D Michael Nelson
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Mai He
- Women and Infants Hospital of Rhode Island, RI, USA.,Alpert Medical School of Brown University, RI, USA.,Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
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24
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Razak A, Faden M. Association of small for gestational age with retinopathy of prematurity: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2020; 105:270-278. [PMID: 31326921 DOI: 10.1136/archdischild-2019-316976] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/03/2022]
Abstract
CONTEXT The association between small for gestational age (SGA) and retinopathy of prematurity (ROP) is unclear. OBJECTIVE A systematic review and meta-analysis was conducted to evaluate the association between ROP and SGA in preterm infants <37 weeks' gestational age (GA) admitted to neonatal intensive care unit. METHODS Medline, PubMed, Web of Science and Cochrane Central databases were searched from inception through 15 January 2019. Studies reporting outcomes based on SGA as the primary exposure variable were included. Data were extracted independently by two coauthors. Modified Newcastle-Ottawa scale was used for risk of bias assessment. RESULTS Database search yielded 536 records (Medline=152, PubMed=171, Web of Science=144 and Cochrane Central=69). Twenty-one studies evaluating 190 946 infants were included. SGA was associated with significantly higher odds of any stage of ROP on unadjusted analysis (unadjusted OR (uOR) 1.55; 95% CI 1.22 to 1.98; 10 studies) but not on adjusted analysis (adjusted OR (aOR) 2.16; 95% CI 0.66 to 7.11; 3 studies). SGA was associated with significantly higher odds of severe ROP (aOR 1.92; 95% CI 1.57 to 2.34; nine studies). SGA was also significantly associated with higher odds of treated ROP (aOR 1.39; 95% CI 1.18 to 1.65; three studies). In subgroup analysis of infants <29 weeks' GA, SGA was significantly associated with increased odds of ROP (uOR 1.64; 95% CI 1.19 to 2.26; two studies), severe ROP (aOR 1.61; 95% CI 1.23 to 2.10; four studies) and treated ROP (aOR 1.37; 95% CI 1.16 to 1.62; two studies). CONCLUSION SGA was associated with increased odds of any stage of ROP, severe ROP and treated ROP in preterm infants. Neonatologists should incorporate SGA into the risk assessment during ROP evaluation and while providing counselling to the families of preterm SGA infants. ROP screening guidelines should look into the frequency of follow-up examination in SGA infants in aim to offer early detection and treatment.
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Affiliation(s)
- Abdul Razak
- Pediatrics, Princess Nourah bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Al Riyadh, Saudi Arabia.,Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Maher Faden
- Pediatrics, Princess Nourah bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Al Riyadh, Saudi Arabia
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25
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Kim YH, Kim KW, Eun HS, Shin JE, Sol IS, Kim SY, Kim YS, Sohn MH, Namgung R. Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia. Pediatr Pulmonol 2020; 55:346-353. [PMID: 31794162 DOI: 10.1002/ppul.24580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine significant indices for assessing the pulmonary function of infants according to bronchopulmonary dysplasia (BPD) severity and to evaluate whether small for gestational age (SGA) could affect pulmonary function in BPD. METHODS We evaluated 117 preterm infants who had undergone tidal breathing flow-volume loop and multiple-breath washout analyses within 7 months after birth. We categorized preterm infants according to BPD severity into mild/moderate BPD (n = 86), severe BPD (n = 21), and without BPD (n = 10) and the presence of SGA or appropriate gestational age (AGA) using the Fenton growth chart. We evaluated nine healthy term infants as controls. RESULTS The tidal breathing ratio (time to peak expiratory flow/expiratory time [tPEF /tE ]) was significantly lower in infants with severe BPD than in those with mild/moderate BPD. Lung clearance index (LCI) was not different based on BPD severity. In the correlation analysis after adjusting for gestational age and sex, tPEF /tE was correlated with the duration of mechanical ventilation (r = -0.347, P < .001) and the duration of oxygen supply (r = -0.248, P = .013) in infants with BPD. The proportion of "lower tPEF /tE ," defined as below the cut-off value, was greater in SGA infants (P = .017), while no significant difference was seen in the percentage of "higher LCI," defined as above the cut-off value between SGA and AGA infants. CONCLUSIONS In infants with BPD, tPEF /tE could be a useful pulmonary index which shows lower values in severe BPD. The finding of SGA in infants with BPD could be associated with poor pulmonary function related to the tPEF /tE values.
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Affiliation(s)
- Yoon Hee Kim
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Neonatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Neonatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Suh Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Neonatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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26
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Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open 2020; 4:e000740. [PMID: 32984553 PMCID: PMC7493091 DOI: 10.1136/bmjpo-2020-000740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age. METHOD We compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study 'Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)'. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant. RESULT The majority of the infants (1194, 89%) were moderate to late preterm (32-36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups. CONCLUSION Neonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.
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Affiliation(s)
- Netsanet Workneh Gidi
- Pediatric and Child Health, Jimma University, Jimma, Oromia, Ethiopia.,Center for International Health, University Hospital, LMU, Munich, Germany
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Assaye K Nigussie
- Newborn & Child Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Elizabeth McClure
- Center for Clinical Research Network Coordination, RTI International, Durham, North Carolina, USA
| | - Amha Mekasha
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
| | - Bogale Worku
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia.,Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU, Munich, Germany
| | | | - Lulu M Muhe
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
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27
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Liu SY, Yang HI, Chen CY, Chou HC, Hsieh WS, Tsou KI, Tsao PN. The gestational effect of antenatal corticosteroids on respiratory distress syndrome in very low birth weight infants: A population-based study. J Formos Med Assoc 2019; 119:1267-1273. [PMID: 31761503 DOI: 10.1016/j.jfma.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/01/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate the efficacy of antenatal corticosteroids for preventing very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) from surfactant use at different gestational ages (GA). METHODS We retrospectively analyzed the VLBW preterm infants registered in the Premature Baby Foundation of Taiwan from 1997 through 2014. Infants at 20-37 weeks' gestation were included, and infants with lethal congenital anomaly, chromosomal anomaly, and congenital infection were excluded. Antenatal corticosteroid courses were classified into two groups (<2 doses or ≧2 doses). The beneficial effect of antenatal corticosteroids on preventing VLBW infants with RDS from surfactant use was evaluated according to gestational ages. RESULTS Total 12,685 VLBW infants were included. For VLBW infants with gestational age 26-33 weeks, antenatal corticosteroid therapy has significantly protective effect (odds ratio 0.43 [95% CI 0.26 to 0.72] - 0.60 [95% CI 0.48 to 0.75], P < 0.05). The effect was not obvious for VLBW infants with gestational age 34 weeks and more (odds ratio 0.32 [95% CI 0.08 to 1.38], P = 0.127). CONCLUSION For VLBW infants with RDS at 34 weeks' gestation and more, the beneficial effect of antenatal corticosteroids on preventing surfactant use was not evident. In conclusion, completion of two doses or more of antenatal corticosteroids is of great importance for VLBW infants with RDS at gestational age between 26 and 33 weeks on preventing surfactant use.
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Affiliation(s)
- Szu-Yu Liu
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Kuo-Inn Tsou
- Department of Pediatrics, Cardinal Tien Hospital and College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; The Research Center of Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
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28
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Lindström L, Ahlsson F, Lundgren M, Bergman E, Lampa E, Wikström AK. Growth patterns during early childhood in children born small for gestational age and moderate preterm. Sci Rep 2019; 9:11578. [PMID: 31399623 PMCID: PMC6688998 DOI: 10.1038/s41598-019-48055-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/23/2019] [Indexed: 02/01/2023] Open
Abstract
Today we lack knowledge if size at birth and gestational age interact regarding postnatal growth pattern in children born at 32 gestational weeks or later. This population-based cohort study comprised 41,669 children born in gestational weeks 32–40 in Uppsala County, Sweden, between 2000 and 2015. We applied a generalized least squares model including anthropometric measurements at 1.5, 3, 4 and 5 years. We calculated estimated mean height, weight and BMI for children born in week 32 + 0, 35 + 0 or 40 + 0 with birthweight 50th percentile (standardized appropriate for gestational age, sAGA) or 3rd percentile (standardized small for gestational age, sSGA). Compared with children born sAGA at gestational week 40 + 0, those born sAGA week 32 + 0 or 35 + 0 had comparable estimated mean height, weight and BMI after 3 years of age. Making the same comparison, those born sSGA week 32 + 0 or 35 + 0 were shorter and lighter with lower estimated mean BMI throughout the whole follow-up period. Our findings suggest that being born SGA and moderate preterm is associated with short stature and low BMI during the first five years of life. The association seemed stronger the shorter gestational age at birth.
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Affiliation(s)
- Linda Lindström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Lundgren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- Uppsala Clinical Research Center, UCR, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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29
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Nobile S, Marchionni P, Gidiucci C, Correani A, Palazzi ML, Spagnoli C, Rondina C, Carnielli VP. Oxygen saturation/FIO2 ratio at 36 weeks' PMA in 1005 preterm infants: Effect of gestational age and early respiratory disease patterns. Pediatr Pulmonol 2019; 54:637-643. [PMID: 30688034 DOI: 10.1002/ppul.24265] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/19/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess oxygen diffusion at 36 weeks' post-menstrual age in preterm infants by means of the non-invasive oxygen saturation/fraction of inspired oxygen ratio (36w-SFR) and to identify factors associated with 36w-SFR - ie, gestational age (GA) and early respiratory disease patterns (ERP). METHODS Retrospective analysis of prospectively collected data. SETTING Neonatal Intensive Care Unit. PATIENTS 1005 preterm infants born below 32 weeks' GA. INTERVENTIONS 36w-SFR was the mean of SFR values over 24 h on the day infants reached 36 weeks' PMA. MAIN OUTCOME MEASURES 36w-SFR. STATISTICS descriptive statistics, univariate, and multivariate analysis to study associations of 36w-SFR, including GA and ERP. RESULTS 36w-SFR was significantly different between infants with and without bronchopulmonary dysplasia (BPD) (371 vs 467, P < 0.001), and according to ERP (LowFIO2 466, pulmonary improvement-PI 460, pulmonary deterioration-PD 405, early persistent pulmonary deterioration-EPPD 344, P < 0.001). Significant differences were found either in BPD and in non-BPD patients according to ERP (P < 0.001). Patients without BPD had significant differences in 36w-SFR according to GA (P < 0.001), while infants with BPD and increasing GA at birth had a non-significant trend for increased 36w-SFR (P = 0.621). Factors associated with 36w-SFR were GA, being small for GA, sepsis, human milk feeding, and ERP. CONCLUSIONS Preterm infants without BPD had a spectrum of oxygen diffusion impairment that was inversely associated with GA at birth. Infants with different patterns of ERP had significant differences in 36w-SFR.
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Affiliation(s)
- Stefano Nobile
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Paolo Marchionni
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Gidiucci
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Alessio Correani
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Maria L Palazzi
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Cristina Spagnoli
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Clementina Rondina
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Virgilio P Carnielli
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
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Reiterer F, Scheuchenegger A, Resch B, Maurer-Fellbaum U, Avian A, Urlesberger B. Bronchopulmonary dysplasia in very preterm infants: Outcome up to preschool age, in a single center of Austria. Pediatr Int 2019; 61:381-387. [PMID: 30793436 PMCID: PMC6850710 DOI: 10.1111/ped.13815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is the most frequent chronic lung disease in infancy and is associated with neonatal comorbidity and impairment in pulmonary and neurodevelopmental (ND) long-term outcome. METHODS This was a retrospective, single-center, cohort study to compare a cohort of very preterm infants (gestational age [GA], 24+0 -28+6 weeks) with BPD (n = 44), with a cohort of GA-matched preterm infants without BPD (n = 44) with regard to neonatal morbidity, incidence of lower respiratory tract infection (LRTI), ND outcome and growth to 2 years' corrected age (CA) and preschool age. RESULTS Bronchopulmonary dysplasia (incidence, 11.3%) was associated with a higher rate of neonatal pneumonia (26% vs 7%, P = 0.001), longer total duration of mechanical ventilation (mean days, 21 vs 13, P < 0.001), and a higher rate of pulmonary hypertension (20.5% vs 0%, P = 0.002) and of severe retinopathy of prematurity (13.6% vs 0%, P = 0.026). Incidence of LRTI was significantly higher in the BPD infants (50% vs 26%, P = 0.025). ND outcome did not differ between the two groups. Growth at neonatal intensive care unit discharge was similar. In the BPD cohort, rate of weight < 10th percentile was higher at 2 years' CA (52% vs 30%, P = 0.041) and rate of head circumference < 10th percentile was higher at preschool age (59% vs 27%, P = 0.028). CONCLUSION Neonatal respiratory morbidity was significantly higher in the BPD cohort, but long-term ND outcome did not differ. Infants with BPD had poorer growth.
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Affiliation(s)
- Friedrich Reiterer
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Anna Scheuchenegger
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Ute Maurer-Fellbaum
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
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31
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Newman KL, Gustafson K, Englund JA, Magaret A, Khatry S, LeClerq SC, Tielsch JM, Katz J, Chu HY. Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal. Open Forum Infect Dis 2019; 6:ofz011. [PMID: 30793004 PMCID: PMC6368846 DOI: 10.1093/ofid/ofz011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022] Open
Abstract
Background Adverse birth outcomes, including low birthweight, small for gestational age (SGA), and preterm birth, contribute to 60%–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. Methods Data were used from 2 community-based, prospective randomized trials of maternal influenza immunization during pregnancy conducted in rural Nepal from 2011 to 2014. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. Diarrhea episodes were defined as at least 3 watery bowel movements per day for 1 or more days with 7 diarrhea-free days between episodes. The Poisson and log-binomial regression were performed to evaluate baseline characteristics and association between diarrhea during pregnancy and adverse birth outcomes. Results A total of 527 of 3693 women in the study (14.3%) experienced diarrhea during pregnancy. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range [IQR], 1–2 episodes) and 2 cumulative days of diarrhea (IQR, 1–3 days). Of women with diarrhea, 85 (16.1%) sought medical care. In crude and adjusted analyses, women with diarrhea during pregnancy were more likely to have SGA infants (42.6% vs 36.8%; adjusted risk ratio = 1.20; 95% confidence interval, 1.06–1.36; P = .005). Birthweight and preterm birth incidence did not substantially differ between women with diarrhea during pregnancy and those without. Conclusions Diarrheal illness during pregnancy was associated with a higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.
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Affiliation(s)
- Kira L Newman
- Department of Medicine, University of Washington, Seattle
| | | | - Janet A Englund
- Department of Medicine, University of Washington, Seattle.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Amalia Magaret
- Department of Medicine, University of Washington, Seattle
| | - Subarna Khatry
- Nepal Neonatal Intervention Project-Sarlahi, Nepal.,Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia
| | - Steven C LeClerq
- Nepal Neonatal Intervention Project-Sarlahi, Nepal.,Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia
| | - James M Tielsch
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle
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32
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Avorgbedor F, Silva S, Merwin E, Blumenthal JA, Holditch-Davis D. Health, Physical Growth, and Neurodevelopmental Outcomes in Preterm Infants of Women With Hypertensive Disorders of Pregnancy. J Obstet Gynecol Neonatal Nurs 2019; 48:69-77. [PMID: 30502314 PMCID: PMC6321773 DOI: 10.1016/j.jogn.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the health, physical growth, and developmental outcomes in preterm infants of women with and without hypertensive disorders of pregnancy (HDP). DESIGN Cross-sectional analysis of health outcomes; physical growth (head circumference, height, and weight) collected at birth and 2 months, corrected for prematurity; and cognitive, language, and motor skills of preterm infants of women with and without HDP. SETTING Four NICUs in the United States. PARTICIPANTS Women (n = 221) and their preterm infants who weighed less than 1,750 g were enrolled in a multicenter, randomized trial of two interventions administered by each infant's mother when the infant was no longer critically ill. METHODS Women and their preterm infants were categorized into groups with (n = 80) and without (control, n = 141) HDP. Data were extracted from infants' medical records, and the women completed questionnaires. RESULTS The infants of women with HDP were more likely to be small for gestational age than the infants of women without HDP (31.7% vs. 10.6%, p < .002). The proportion of infants with greater neurologic risk, patent ductus arteriosus, intraventricular hemorrhage, and days on a ventilator did not differ between the groups. Although mean infant height at 2 months was less in the HDP group than the control group, other growth and neurodevelopmental outcomes did not differ between the groups. CONCLUSION Among preterm infants admitted to NICUs, those born to women with HDP were more likely to be small for gestational age than those born to normotensive women. Additional research is needed to optimize care for infants born to women with HDP.
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MESH Headings
- Cross-Sectional Studies
- Female
- Gestational Age
- Humans
- Hypertension/complications
- Hypertension/diagnosis
- Hypertension, Pregnancy-Induced/diagnosis
- Infant Health/statistics & numerical data
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature/growth & development
- Infant, Premature/physiology
- Infant, Premature/psychology
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Intensive Care Units, Neonatal/statistics & numerical data
- Male
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Outcome/epidemiology
- United States/epidemiology
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Blum M, Weintraub AY, Baumfeld Y, Rotem R, Pariente G. Perinatal Outcomes of Small for Gestational Age Neonates Born With an Isolated Single Umbilical Artery. Front Pediatr 2019; 7:79. [PMID: 30941337 PMCID: PMC6433819 DOI: 10.3389/fped.2019.00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 11/27/2022] Open
Abstract
Objective: To investigate pregnancy outcomes of small for gestational age (SGA) neonates born with isolated single umbilical artery (iSUA) compared to SGA neonates without iSUA. Study Design: This was a population-based retrospective cohort analysis. The study group was defined as a singleton SGA neonate born with iSUA, while an SGA neonate without iSUA comprised the comparison group. We evaluated adverse perinatal outcomes in all SGA neonates born at the Soroka University Medical Center between the years 1998-2013. Multiple gestations, fetuses with known congenital malformations or chromosomal abnormalities and patients with lack of prenatal care were excluded from the study. Multivariate logistic regression models were constructed to identify independent factors associated with adverse perinatal outcomes. Results: Of 12,915 SGA deliveries, 1.2% (162) were complicated with iSUA. Women in the study group were older with a significantly lower gestational age at delivery compared with the comparison group. Rates of women who conceived after infertility treatments were higher in the study group. Additionally, patients in the study group had significantly higher rates of preterm deliveries, placental abruption, cord prolapse, non-reassuring fetal heart rates and cesarean delivery were noted in the study group. These neonates had a significantly lower birth weight (1988.0 ± 697 vs. 2388.3 ± 481 p < 0.001) and higher rates of low APGAR scores at the first and fifth minutes after birth compared with controls. Perinatal mortality was also found to be significantly higher among SGA neonates complicated with iSUA. Preterm delivery as well as perinatal mortality were found independently associated with iSUA among SGA neonates (aOR 4.01, 95% CI 2.88-5.59, aOR 2.24, 95% CI 1.25-4.01, respectively). Conclusion: SGA pregnancies complicated with iSUA are at higher risk for adverse pregnancy and perinatal outcomes as compared to SGA pregnancies without iSUA.
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Affiliation(s)
- Maayan Blum
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Bronchopulmonary dysplasia in neonates born to mothers with preeclampsia: Impact of small for gestational age. PLoS One 2018; 13:e0204498. [PMID: 30248159 PMCID: PMC6152970 DOI: 10.1371/journal.pone.0204498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
Background and objectives Small for gestational age and preeclampsia have both been described as risk factors for bronchopulmonary dysplasia in preterm neonates, but their respective role in the occurrence of bronchopulmonary dysplasia is debated. We evaluated the relation between small for gestational age and bronchopulmonary dysplasia in neonates born to mothers with preeclampsia. We hypothesized that low birth weight is still associated with bronchopulmonary dysplasia in this homogeneous population. Methods Retrospective single-center cohort study including 141 neonates born between 24 and 30 weeks’ gestation to mothers with preeclampsia. The main outcome measure was moderate to severe bronchopulmonary dysplasia at 36 weeks’ postmenstrual age. Neonates born small for gestational age (birthweight < 10th percentile on the AUDIPOG curves) were compared to those with appropriate birthweight for gestational age by bivariable analyses and logistic regression models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results Bronchopulmonary dysplasia rates were 61.5% (32/52) and 27.4% (20/73) for small for gestational age and appropriate birthweight for gestational age neonates (p < .001). On adjustment for gestational age and other confounding factors, the risk of moderate to severe bronchopulmonary dysplasia was greater for small for gestational age than appropriate birthweight for gestational age neonates (adjusted OR = 5.9, 95% CI [2.2–15.4]), as was the composite outcome death or moderate to severe bronchopulmonary dysplasia (adjusted OR = 4.7, 95% CI [1.9–11.3]). Conclusions Small for gestational age was associated with bronchopulmonary dysplasia in very preterm neonates born to mothers with preeclampsia. Registration number CNIL no. 1747084.
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Arigliani M, Spinelli AM, Liguoro I, Cogo P. Nutrition and Lung Growth. Nutrients 2018; 10:E919. [PMID: 30021997 PMCID: PMC6073340 DOI: 10.3390/nu10070919] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/21/2022] Open
Abstract
Experimental evidence from animal models and epidemiology studies has demonstrated that nutrition affects lung development and may have a lifelong impact on respiratory health. Chronic restriction of nutrients and/or oxygen during pregnancy causes structural changes in the airways and parenchyma that may result in abnormal lung function, which is tracked throughout life. Inadequate nutritional management in very premature infants hampers lung growth and may be a contributing factor in the pathogenesis of bronchopulmonary dysplasia. Recent evidence seems to indicate that infant and childhood malnutrition does not determine lung function impairment even in the presence of reduced lung size due to delayed body growth. This review will focus on the effects of malnutrition occurring at critical time periods such as pregnancy, early life, and childhood, on lung growth and long-term lung function.
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Affiliation(s)
- Michele Arigliani
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Alessandro Mauro Spinelli
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Ilaria Liguoro
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Paola Cogo
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
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Yum SK, Kim MS, Kwun Y, Moon CJ, Youn YA, Sung IK. Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants. Pulm Circ 2018; 8:2045894018760166. [PMID: 29480140 PMCID: PMC5843110 DOI: 10.1177/2045894018760166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aimed to evaluate the association between the presence of histologic chorioamnionitis (HC) and development of pulmonary hypertension (PH) during neonatal intensive care unit (NICU) stay. Data of preterm infants born at 32 weeks of gestation or less were reviewed. The development of PH and other respiratory outcomes were compared according to the presence of HC. Potential risk factors associated with the development of PH during NICU stay were used for multivariable logistic regression analysis. A total of 188 infants were enrolled: 72 in the HC group and 116 in the no HC group. The HC group infants were born at a significantly shorter gestational age and lower birthweight, with a greater proportion presenting preterm premature rupture of membrane (pPROM) > 18 h before delivery. More infants in the HC group developed pneumothorax (P = 0.008), and moderate and severe bronchopulmonary dysplasia (BPD; P = 0.001 and P = 0.006, respectively). PH in the HC group was significantly more frequent compared to the no HC group (25.0% versus 8.6%, P = 0.002). Based on a multivariable logistic regression analysis, birthweight (P = 0.009, odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995–0.999), the presence of HC (P = 0.047, OR = 2.799, 95% CI = 1.014–7.731), and duration of invasive mechanical ventilation (MV) > 14 days (P = 0.015, OR = 8.036, 95% CI = 1.051–43.030) were significant factors. The presence of HC and prolonged invasive MV in infants with lower birthweight possibly synergistically act against preterm pulmonary outcomes and leads to the development of PH. Verification of this result and further investigation to establish effective strategies to prevent or ameliorate these adverse outcomes are needed.
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Affiliation(s)
- Sook Kyung Yum
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Sung Kim
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoojin Kwun
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cheong-Jun Moon
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Ah Youn
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Kyung Sung
- Division of Neonatology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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37
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Matsuda N, Taki A, Tsuji A, Nakajima K, Takasawa K, Morioka C, Minosaki Y, Oku K, Kashimada K, Morio T. Perinatal factors affecting growth and development at age 3 years in extremely low birth weight infants born small for gestational age. Clin Pediatr Endocrinol 2018; 27:31-38. [PMID: 29403154 PMCID: PMC5792819 DOI: 10.1297/cpe.27.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022] Open
Abstract
Factors affecting growth and development in extremely low birth weight infants (ELBWIs)
born small for gestational age (SGA) have not been precisely elucidated. We performed a
retrospective analysis of ELBWIs born SGA who were treated in the neonatal intensive care
unit of Kawaguchi Municipal Medical Centre, Japan. A total 244 ELBWIs were born from 2003
to 2010, and 31 were born with weight and height below the 10th percentile for their
gestational age. Among the 31 ELBWIs born SGA, we excluded 9 who died before they reached
3 yr of age or who had severe developmental retardation. A total of 16 patients (weight,
510–998 g; GA, 28w0d–32w5d) who were followed until age 3 yr were eligible for our study.
At age 3 yr, 94% and 88% of ELBWIs were above the −2 standard deviation (SD) for height
and weight, respectively. A history of mechanical ventilation was associated with height.
The average score of the full developmental quotient (DQ) was 85, and 63% (10/16) of
ELBWIs scored more than 85. Lower Apgar score (≤ 7) was a risk factor for lower DQ scores
in motor development and full development. Our study revealed that most ELBWIs born SGA
were more than −2 SD below the mean for height and body weight.
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Affiliation(s)
- Nozomi Matsuda
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Atsuko Taki
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Atsumi Tsuji
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keisuke Nakajima
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Chikako Morioka
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Yoshihiro Minosaki
- Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Kikuko Oku
- Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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