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Chung HW, Chen JC, Chen HL, Ko FY, Ho SY. Developing a practical neurodevelopmental prediction model for targeting high-risk very preterm infants during visit after NICU: a retrospective national longitudinal cohort study. BMC Med 2024; 22:68. [PMID: 38360711 PMCID: PMC10870669 DOI: 10.1186/s12916-024-03286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Follow-up visits for very preterm infants (VPI) after hospital discharge is crucial for their neurodevelopmental trajectories, but ensuring their attendance before 12 months corrected age (CA) remains a challenge. Current prediction models focus on future outcomes at discharge, but post-discharge data may enhance predictions of neurodevelopmental trajectories due to brain plasticity. Few studies in this field have utilized machine learning models to achieve this potential benefit with transparency, explainability, and transportability. METHODS We developed four prediction models for cognitive or motor function at 24 months CA separately at each follow-up visits, two for the 6-month and two for the 12-month CA visits, using hospitalized and follow-up data of VPI from the Taiwan Premature Infant Follow-up Network from 2010 to 2017. Regression models were employed at 6 months CA, defined as a decline in The Bayley Scales of Infant Development 3rd edition (BSIDIII) composite score > 1 SD between 6- and 24-month CA. The delay models were developed at 12 months CA, defined as a BSIDIII composite score < 85 at 24 months CA. We used an evolutionary-derived machine learning method (EL-NDI) to develop models and compared them to those built by lasso regression, random forest, and support vector machine. RESULTS One thousand two hundred forty-four VPI were in the developmental set and the two validation cohorts had 763 and 1347 VPI, respectively. EL-NDI used only 4-10 variables, while the others required 29 or more variables to achieve similar performance. For models at 6 months CA, the area under the receiver operating curve (AUC) of EL-NDI were 0.76-0.81(95% CI, 0.73-0.83) for cognitive regress with 4 variables and 0.79-0.83 (95% CI, 0.76-0.86) for motor regress with 4 variables. For models at 12 months CA, the AUC of EL-NDI were 0.75-0.78 (95% CI, 0.72-0.82) for cognitive delay with 10 variables and 0.73-0.82 (95% CI, 0.72-0.85) for motor delay with 4 variables. CONCLUSIONS Our EL-NDI demonstrated good performance using simpler, transparent, explainable models for clinical purpose. Implementing these models for VPI during follow-up visits may facilitate more informed discussions between parents and physicians and identify high-risk infants more effectively for early intervention.
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Affiliation(s)
- Hao Wei Chung
- Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ju-Chieh Chen
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiu-Lin Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Yu Ko
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shinn-Ying Ho
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Center for Intelligent Drug Systems and Smart Bio-Devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Von Borell F, Engel J, Neunhoeffer F, Hoffmann F, Michel J. Current Knowledge Regarding Long-Term Consequences of Pediatric Intensive Care: A Staff Survey in Intensive Care Units in German-Speaking Countries. Front Pediatr 2022; 10:886626. [PMID: 35712630 PMCID: PMC9197504 DOI: 10.3389/fped.2022.886626] [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: 02/28/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Post Intensive Care Syndrome (PICS) describes new impairments of physical, cognitive, social, or mental health after critical illness. In recent years, prevention and therapy concepts have been developed. However, it is unclear whether and to what extent these concepts are known and implemented in hospitals in German-speaking countries. METHODS We conducted an anonymous online survey in German-speaking pediatric intensive care units on the current state of knowledge about the long-term consequences of intensive care treatment as well as about already established prevention and therapy measures. The request to participate in the survey was sent to the heads of the PICUs of 98 hospitals. RESULTS We received 98 responses, 54% of the responses came from nurses, 43% from physicians and 3% from psychologist, all working in intensive care. As a main finding, our survey showed that for only 31% of the respondents PICS has an importance in their daily clinical practice. On average, respondents estimated that about 42% of children receiving intensive care were affected by long-term consequences after intensive care. The existence of a follow-up outpatient clinic was mentioned by 14% of the respondents. Frequent reported barriers to providing follow-up clinics were lack of time and staff. Most frequent mentioned core outcome parameters were normal developmental trajectory (59%) and good quality of life (52%). CONCLUSION Overall, the concept of PICS seems to be underrepresented in German-speaking pediatric intensive care units. It is crucial to expand knowledge on long-term complications after pediatric critical care and to strive for further research through follow-up programs and therewith ultimately improve long-term outcomes.
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Affiliation(s)
- Florian Von Borell
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hanover, Germany
| | - Juliane Engel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
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Long DA, Fink EL. Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice. Transl Pediatr 2021; 10:2858-2874. [PMID: 34765507 PMCID: PMC8578758 DOI: 10.21037/tp-21-61] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Most children are surviving critical illness in highly resourced pediatric intensive care units (PICUs). However, in research studies, many of these children survive with multi-domain health sequelae that has the potential to affect development over many years, termed post-intensive care syndrome-pediatrics (PICS-p). Clinically, there are no recommendations for the assessment and follow-up of children with critical illness as exists for the premature neonatal and congenital heart disease populations. In research studies, primary and secondary outcomes are largely assessed at or prior to hospital discharge, disregarding post-hospital outcomes important to PICU stakeholders. Incorporating longer term outcomes into clinical and research programs, however, can no longer be overlooked. Barriers to outcomes assessments are varied and generalized vs. individualized, but some PICU centers are discovering how to overcome them and are providing this service to families-sometimes specific populations-in need. Research programs and funders are increasingly recognizing the value and need to assess long-term outcomes post-PICU. Finally, we should seek the strong backing of the PICU community and families to insist that long-term outcomes become our new clinical standard of care. PICUs should consider development of a multicenter, multinational collaborative to assess clinical outcomes and optimize care delivery and patient and family outcomes. The aim of this review is to present the potential considerations of implementing long-term clinical follow-up following pediatric critical illness.
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Affiliation(s)
- Debbie A Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Pediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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Social disparities negatively impact neonatal follow-up clinic attendance of premature infants discharged from the neonatal intensive care unit. J Perinatol 2020; 40:790-797. [PMID: 32203182 PMCID: PMC9610791 DOI: 10.1038/s41372-020-0659-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neonatal neurodevelopmental follow-up clinic provides continued surveillance and assessment of high-risk premature infants. We hypothesized that attrition is associated with race and social factors. STUDY DESIGN We performed a retrospective cohort study of neonates born at 26-32 weeks gestation who were admitted to a level IV neonatal intensive care unit. Maternal and neonatal characteristics and follow-up attendance were collected. Statistical analysis was performed with significance set at p value < 0.05. RESULTS In total, 237 neonates met study criteria. There was a 62% loss to follow-up over 2 years. Factors associated with loss to follow-up included older gestational age, African American race, and maternal cigarette smoking. Protective factors included older maternal age, a neonatal diagnosis of bronchopulmonary dysplasia, and longer hospital length of stay. CONCLUSIONS Social disparities negatively impact neonatal follow-up clinic attendance. Efforts to identify and target high-risk populations must be started during initial hospitalization before infants are lost to follow-up.
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Modi N, Ashby D, Battersby C, Brocklehurst P, Chivers Z, Costeloe K, Draper ES, Foster V, Kemp J, Majeed A, Murray J, Petrou S, Rogers K, Santhakumaran S, Saxena S, Statnikov Y, Wong H, Young A. Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background
Clinical data offer the potential to advance patient care. Neonatal specialised care is a high-cost NHS service received by approximately 80,000 newborn infants each year.
Objectives
(1) To develop the use of routinely recorded operational clinical data from electronic patient records (EPRs), secure national coverage, evaluate and improve the quality of clinical data, and develop their use as a national resource to improve neonatal health care and outcomes. To test the hypotheses that (2) clinical and research data are of comparable quality, (3) routine NHS clinical assessment at the age of 2 years reliably identifies children with neurodevelopmental impairment and (4) trial-based economic evaluations of neonatal interventions can be reliably conducted using clinical data. (5) To test methods to link NHS data sets and (6) to evaluate parent views of personal data in research.
Design
Six inter-related workstreams; quarterly extractions of predefined data from neonatal EPRs; and approvals from the National Research Ethics Service, Health Research Authority Confidentiality Advisory Group, Caldicott Guardians and lead neonatal clinicians of participating NHS trusts.
Setting
NHS neonatal units.
Participants
Neonatal clinical teams; parents of babies admitted to NHS neonatal units.
Interventions
In workstream 3, we employed the Bayley-III scales to evaluate neurodevelopmental status and the Quantitative Checklist of Autism in Toddlers (Q-CHAT) to evaluate social communication skills. In workstream 6, we recruited parents with previous experience of a child in neonatal care to assist in the design of a questionnaire directed at the parents of infants admitted to neonatal units.
Data sources
Data were extracted from the EPR of admissions to NHS neonatal units.
Main outcome measures
We created a National Neonatal Research Database (NNRD) containing a defined extract from real-time, point-of-care, clinician-entered EPRs from all NHS neonatal units in England, Wales and Scotland (n = 200), established a UK Neonatal Collaborative of all NHS trusts providing neonatal specialised care, and created a new NHS information standard: the Neonatal Data Set (ISB 1595) (see http://webarchive.nationalarchives.gov.uk/±/http://www.isb.nhs.uk/documents/isb-1595/amd-32–2012/index_html; accessed 25 June 2018).
Results
We found low discordance between clinical (NNRD) and research data for most important infant and maternal characteristics, and higher prevalence of clinical outcomes. Compared with research assessments, NHS clinical assessment at the age of 2 years has lower sensitivity but higher specificity for identifying children with neurodevelopmental impairment. Completeness and quality are higher for clinical than for administrative NHS data; linkage is feasible and substantially enhances data quality and scope. The majority of hospital resource inputs for economic evaluations of neonatal interventions can be extracted reliably from the NNRD. In general, there is strong parent support for sharing routine clinical data for research purposes.
Limitations
We were only able to include data from all English neonatal units from 2012 onwards and conduct only limited cross validation of NNRD data directly against data in paper case notes. We were unable to conduct qualitative analyses of parent perspectives. We were also only able to assess the utility of trial-based economic evaluations of neonatal interventions using a single trial. We suggest that results should be validated against other trials.
Conclusions
We show that it is possible to obtain research-standard data from neonatal EPRs, and achieve complete population coverage, but we highlight the importance of implementing systematic examination of NHS data quality and completeness and testing methods to improve these measures. Currently available EPR data do not enable ascertainment of neurodevelopmental outcomes reliably in very preterm infants. Measures to maintain high quality and completeness of clinical and administrative data are important health service goals. As parent support for sharing clinical data for research is underpinned by strong altruistic motivation, improving wider public understanding of benefits may enhance informed decision-making.
Future work
We aim to implement a new paradigm for newborn health care in which continuous incremental improvement is achieved efficiently and cost-effectively by close integration of evidence generation with clinical care through the use of high-quality EPR data. In future work, we aim to automate completeness and quality checks and make recording processes more ‘user friendly’ and constructed in ways that minimise the likelihood of missing or erroneous entries. The development of criteria that provide assurance that data conform to prespecified completeness and quality criteria would be an important development. The benefits of EPR data might be extended by testing their use in large pragmatic clinical trials. It would also be of value to develop methods to quality assure EPR data including involving parents, and link the NNRD to other health, social care and educational data sets to facilitate the acquisition of lifelong outcomes across multiple domains.
Study registration
This study is registered as PROSPERO CRD42015017439 (workstream 1) and PROSPERO CRD42012002168 (workstream 3).
Funding
The National Institute for Health Research Programme Grants for Applied Research programme (£1,641,471). Unrestricted donations were supplied by Abbott Laboratories (Maidenhead, UK: £35,000), Nutricia Research Foundation (Schiphol, the Netherlands: £15,000), GE Healthcare (Amersham, UK: £1000). A grant to support the use of routinely collected, standardised, electronic clinical data for audit, management and multidisciplinary feedback in neonatal medicine was received from the Department of Health and Social Care (£135,494).
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Affiliation(s)
- Neena Modi
- Department of Medicine, Imperial College London, London, UK
| | - Deborah Ashby
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kate Costeloe
- Centre for Genomics and Child Health, Queen Mary University of London, London, UK
| | | | - Victoria Foster
- Department of Social Sciences, Edge Hill University, Ormskirk, UK
| | - Jacquie Kemp
- National Programme of Care, NHS England, London, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | | | - Stavros Petrou
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Katherine Rogers
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | | | - Hilary Wong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Alys Young
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Mas C, Gérardin P, Chirpaz E, Carbonnier M, Mussard C, Samperiz S, Ramful D. Follow-up at two years of age and early predictors of non-compliance in a cohort of very preterm infants. Early Hum Dev 2017; 108:1-7. [PMID: 28342385 DOI: 10.1016/j.earlhumdev.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/12/2017] [Accepted: 03/03/2017] [Indexed: 11/17/2022]
Abstract
AIM To examine the rates of follow-up at two years of age and perinatal factors associated with non-compliance in an observational population-based cohort of very preterm children enrolled in a routine follow-up program. METHOD Data review of infants born between 2008 and 2012 in the Observatoire de La Grande Prématurité, Reunion Island cohort. All singletons born alive before 33weeks of gestational age and resident on the island at two years of age were included. Patients were considered compliant if they were timely evaluated between 20-28months of age, or non-compliant if they were not evaluated or evaluated after 28months of age. RESULTS Of the 802 survivors (mean gestational age of 30.3±2.0months, mean birthweight of 1364±396g), 468 (58.4%) were examined between 20-28months, 119 (14.8%) after 28months of age, and 215 (26.8%) were never evaluated, respectively. In multivariate analysis, factors associated with non-compliance were higher parity (>2), past history of preterm delivery, maternal diabetes (preexisting or gestational), appropriate for gestational status, and centre of birth. CONCLUSION Sustainable follow-up of vulnerable neonates remains a challenge in clinical practice. Early predictors of non-compliance can be used to define individualized and local follow-up strategies in these infants at high risk for developmental disabilities.
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Affiliation(s)
- Claire Mas
- Neonatal and Pediatric Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, 97405 Saint-Denis Cedex, La Réunion, France.
| | - Patrick Gérardin
- Pôle Femme Mère Enfant, CHU Réunion, Saint Pierre, Reunion, France ; Centre d'Investigation Clinique (INSERM CIC1410) Epidémiologie Clinique, CHU Réunion, Saint Pierre, Reunion, France.
| | - Emmanuel Chirpaz
- Unité de Soutien Méthodologique, Centre Hospitalier Félix Guyon, 97405 Saint Denis Cedex, La Réunion, France.
| | - Magali Carbonnier
- Neonatal Intensive Care Unit, CHU Réunion, 97448 Saint Pierre Cedex, Réunion Island, France.
| | - Corinne Mussard
- Pôle Femme Mère Enfant, CHU Réunion, Saint Pierre, Reunion, France ; Centre d'Investigation Clinique (INSERM CIC1410) Epidémiologie Clinique, CHU Réunion, Saint Pierre, Reunion, France.
| | - Sylvain Samperiz
- Neonatal and Pediatric Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, 97405 Saint-Denis Cedex, La Réunion, France.
| | - Duksha Ramful
- Neonatal and Pediatric Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, 97405 Saint-Denis Cedex, La Réunion, France.
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Professional Nurses' Perceptions of Skills Required for Performing Preterm Infants' Follow-up Assessments. J Perinat Neonatal Nurs 2017; 31:256-262. [PMID: 28198749 DOI: 10.1097/jpn.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Improved perinatal and neonatal care enhances preterm infant survival rates, but the adverse outcomes remain high. Nurses play vitally important roles regarding the follow-up assessments, treatment, and care of preterm infants. This explorative, descriptive study aimed to describe nurses' perceptions of skills required to perform effective preterm infant assessments. Thirteen semistructured interviews were conducted. Identified themes included the role of the professional nurse, the importance of preterm infant assessments, lack of skills and knowledge to conduct quality assessments, formal and continuous development training needs, the absence of assessment tools and physical resources to perform standardized assessments of preterm infants, and the required support and referral systems.
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L Orton J, McGinley JL, Fox LM, Spittle AJ. Challenges of neurodevelopmental follow-up for extremely preterm infants at two years. Early Hum Dev 2015; 91:689-94. [PMID: 26513630 DOI: 10.1016/j.earlhumdev.2015.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/29/2022]
Abstract
AIM This study examined the rates of follow-up for a cohort of extremely preterm (EP -<28weeks gestation) and/or extremely low birthweight (ELBW -<1000g) children at two years with related perinatal and geographical factors. The secondary aim was to determine the rates of developmental delay and disability. METHODS A retrospective review of two year follow-up data for all EP and/or ELBW infants born in a large tertiary neonatal hospital over a two year period was undertaken. Neurodevelopmental outcome was assessed using the Bayley Scales of Infant and Toddler Development Scale - 3rd edition (Bayley-III) and neurosensory disability was assessed by a paediatrician using a standard proforma. Rates of delay (composite score≥1SD below mean) were determined using the Bayley-III test norms and a local cohort normative group. Attrition rates and reasons for loss to follow-up were determined. RESULTS Only 50% (109/219) of eligible children participated in the follow-up. The follow-up rate for children engaged in an ongoing research project was excellent at 98% (58/59), however it was only 32% (51/160) for children following the clinical pathway. The main reason for not attending the follow-up was loss of contact. Factors associated with attendance included a lower gestation, sepsis and living in the metropolitan areas. The rates of delay in this cohort were greater with reference to local cohort normative data compared to Bayley-III test norms with an overall rate of delay of 72% (95%CI, 63% to 81%) compared to 38% (95%CI, 29% to 50%). CONCLUSIONS Follow-up of EP/ELBW infants to two years is an important part of clinical care, however the high rate of attrition in routine clinical follow-up and consequent difficulty in accurately determining rates of delay highlight challenges for centres providing ongoing care.
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Affiliation(s)
- Jane L Orton
- Neonatal Services, Royal Women's Hospital, Locked Bag 300, Parkville 3052, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Carlton, Australia
| | - Lisa M Fox
- Neonatal Services, Royal Women's Hospital, Locked Bag 300, Parkville 3052, Australia
| | - Alicia Jane Spittle
- Neonatal Services, Royal Women's Hospital, Locked Bag 300, Parkville 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, VIC 3052, Australia; Department of Physiotherapy, School of Health Sciences, University of Melbourne, Carlton, Australia
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9
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Kara ÖK, Günel MK, Açıkel C, Yiğit Ş, Arslan M. Is there any difference between high-risk infants with different birth weight and gestational age in neurodevelopmental characters? Turk Arch Pediatr 2015; 50:151-7. [PMID: 26568690 DOI: 10.5152/turkpediatriars.2015.2620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/10/2015] [Indexed: 11/22/2022]
Abstract
AIM This study is aimed to investigate differences between cognitive, language and motor development of high-risk infants related to birth weight and gestational age. MATERIAL AND METHODS One hundred sixty high-risk infants who were born 32 weeks, 1 500 gr and below included in this study. According to corrected age, 58 infants were 1 month, 72 were at 4 months, 82 were at 8 months and 65 were 12 months old. Infants were seperated two groups according to gestational age <30 weeks and 30-32 weeks and birth weight ≤1 000 gr and 1 001-1 500 gr. Infants motor development were assessed with Bayley-III Infant and Toddler Development Motor Scale (Bayley-III) and Neuro Sensory Motor Developmental Scale (NSMDA), cognitif and lanuage development were Bayley-III cognitive and Language scales. Assessments were applied by the same physiotherapist at 1 month, 4 months, 8 months and 12 months old infants in corrected age. Mann-Whitney U Test, 2 x 2 Chi-Square test ve Fisher's exact tests were used to compare group data. Statistical significance was determined p<0.05. RESULTS Cognitive, motor and language developments were in normal ranges in all infants. There were no statistical differences in cognitive, language and motor development between groups (p>0.05). CONCLUSION Results of this study showed that the motor, cognitive and language development were normal in all high risk infants and power gestational age and birth weight did not affect these parametes.
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Affiliation(s)
- Özgün Kaya Kara
- Department of Physiotherapy and Rehabilitation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mintaze Kerem Günel
- Department of Physiotherapy and Rehabilitation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cengizhan Açıkel
- Department of Biostatistics, Gülhane Military Medical Academy, Ankara, Turkey
| | - Şule Yiğit
- Division of Neanatology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Mutluay Arslan
- Department Pediatric Neurology, Gülhane Military Medical Academy, Ankara, Turkey
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Custódio ZADO, Crepaldi MA, Linhares MBM. Redes sociais de apoio no contexto da prematuridade: perspectiva do modelo bioecológico do desenvolvimento humano. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2014. [DOI: 10.1590/0103-166x2014000200010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este artigo apresenta uma revisão crítica da literatura a respeito das redes sociais de apoio no contexto do desenvolvimento de crianças nascidas pré-termo, centrada na abordagem do Modelo Bioecológico do Desenvolvimento Humano, a qual aborda a influência de ambientes externos como contexto para o desenvolvimento. Realizou-se o levantamento bibliográfico nas bases de dados Portal da Capes, MedLine, Lilacs e SciELO, por meio de descritores pré-estabelecidos. Dentre 137 trabalhos, apenas 39 referiam-se à temática proposta, e apenas um relacionou prematuridade e modelo bioecológico. Os resultados apontam a importância do apoio de pessoas significativas e dos programas de acompanhamento de crianças que nascem pré-termo e de suas famílias, o que remete, respectivamente, à rede social pessoal e institucional. Ressalta-se a implementação das políticas de saúde que planejam as ações na saúde perinatal e na área da infância a partir da perspectiva das redes sociais de apoio como estratégia de cuidado.
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Eickmann SH, Malkes NFDA, Lima MDC. Psychomotor development of preterm infants aged 6 to 12 months. SAO PAULO MED J 2012; 130:299-306. [PMID: 23174869 PMCID: PMC10836468 DOI: 10.1590/s1516-31802012000500006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 08/01/2011] [Accepted: 02/24/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The immaturity of preterm infants' organ systems may lead to difficulties in adapting to different environmental stimuli. The aim was to compare the psychomotor development of preterm infants (with corrected age) and term infants aged 6 to 12 months and to investigate associated factors. DESIGN AND SETTING Cross-sectional analytical study conducted at Hospital das Clínicas, Universidade Federal de Pernambuco. METHODS The sample consisted of 135 infants (45 preterm and 90 full-term) aged 6 to 12 months. Neuropsychomotor development was assessed using the Bayley III cognitive, language and motor subscales. Biological, socioeconomic and demographic data were gathered from medical records and through interviews with mothers. RESULTS The mean cognitive, language and motor indices were within the range of normality for the sample as a whole. No significant difference in the development of infants born preterm and full-term was observed, except for expressive communication, in which preterm infants presented a lower index. Motor development was influenced by biological factors, and the poorest performances were observed in male infants; birth weight birth weight < 1500 g; Apgar score at five minutes < 7; weight-, length- and head circumference-for-age < -1 Z-score; and exclusively breastfeeding for < two months. CONCLUSIONS Prematurity did not influence the psychomotor development of infants in this study population. Motor development was the most affected domain in the sample as a whole, especially due to biological factors. Investigations on child neuropsychomotor development should try to identify many determinant factors because of its multifactorial nature.
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Affiliation(s)
- Sophie Helena Eickmann
- Department of Maternal and Child Health, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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Braga PP, Sena RRD. Estratégias para efetivar a continuidade do cuidado pós-alta ao prematuro: revisão integrativa. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012000600023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar as estratégias utilizadas para efetivar a continuidade do cuidado às crianças nascidas prematuras egressas de Unidades de Terapia Intensiva Neonatal. MÉTODOS: Estudo de revisão integrativa com busca nas bases de dados Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scientific Eletronic Library on-line e Web of Science no período de 2001 e 2011. Dos 22 artigos selecionados para leitura, nove foram explorados, considerando o objetivo proposto. RESULTADOS: A necessidade de desenvolvimento de pesquisas sobre a continuidade do cuidado aos egressos de Unidades de Terapia Intensiva Neonatal (UTIN) é evidente nos artigos analisados e confirmado pelo nível de evidência científica dos estudos incluídos nesta revisão. CONCLUSÃO: A intersetorialidade, o conhecimento tecnocientífico dos profissionais para cuidar dos egressos de UTIN, políticas públicas, pesquisas multicêntricas, bem como a construção de vínculo entre profissionais dos serviços de saúde e famílias, são estratégias importantes para a construção da assistência aos prematuros e suas famílias, após a alta hospitalar.
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Charkaluk ML, Truffert P, Marchand-Martin L, Mur S, Kaminski M, Ancel PY, Pierrat V. Very preterm children free of disability or delay at age 2: predictors of schooling at age 8: a population-based longitudinal study. Early Hum Dev 2011; 87:297-302. [PMID: 21316878 DOI: 10.1016/j.earlhumdev.2011.01.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/13/2011] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
AIM To study the predictive value of a developmental assessment at 2 years corrected age (CA) for schooling at age 8 in children born very preterm and free of disability or delay; to identify other factors associated with schooling in this population. METHODS 244 children born before 33 weeks in 1997, part of the population-based EPIPAGE cohort study, free of disability or delay, had their developmental quotient (DQ) evaluated with the Brunet-Lezine scale at 2 years CA. The mental processing composite (MPC) score was evaluated at age 5 with the K-ABC battery. Data on schooling were obtained at age 8 by postal questionnaire. Schooling was considered appropriate if the child was attending age-appropriate grade level in a regular classroom environment without support at school. RESULTS Schooling was appropriate for 172 (70%) children. The predictive value of a DQ≥100 for appropriate schooling was 0.80 [0.75;0.85]. In children with a DQ at age 2<100, schooling varied significantly according to their MPC score at age 5 whereas it didn't in children with a DQ≥100. In multivariate analysis, the rate of appropriate schooling was significantly related to global DQ at age 2 (p<0.01), gestational age≥29 weeks (p<0.05), head circumference at age 2 (p<0.05) and mother's educational level (p<0.05). CONCLUSION A DQ≥100 cannot be solely used for the prediction of appropriate schooling at age 8. Mother's educational level, gestational age and head circumference at age 2 could be taken account. These factors could be used to individualise follow-up.
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Affiliation(s)
- M L Charkaluk
- INSERM, UMR S 953, IFR 69, Research Unit on Perinatal Health and Women's and Children's Health, F-75020, Paris, France; Groupe Hospitalier de l'Institut Catholique Lillois / Faculté Libre de Médecine, F-59000 Lille, France; UPMC Univ Paris 06, UMR S 953, F-75005, Paris, France
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Abstract
In Ontario, publicly funded, regionalized healthcare enables transfer of convalescing infants from level III neonatal intensive care units (NICUs) to regional level II nurseries prior to discharge home. To facilitate a timely transfer and allow time for preparation of families and regional hospital nurseries, NICU staff must recognize infant readiness early. This article describes the implementation process of a 4-part, multidisciplinary, discharge planning instrument that assists staff in early identification of infant readiness for transfer or discharge home. Titled the Discharge Planning Train, this interactive instrument encourages communication and collaboration between all levels of the multidisciplinary staff and with families and decreases confusion at the time of transfer. Barriers to and strategies for successful implementation are included. Evaluation methods and results are presented. The success of the instrument in improving communication and collaboration with the families is well described by the RNs.
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